FREC Level 4 ( Bexhill )

As the next step for those who have completed the QA Level 3 Certificate in First Response Emergency Care (RQF), this qualification provides Learners with a wider scope of practice in Prehospital care emergencies, allowing for greater employment opportunities. It also forms part of a progressive suite of Prehospital care qualifications that lead to the QA Level 6 Diploma in Paramedic Practice (RQF).

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3rd-8th October


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Homeostasis/physiological variables including

  • Blood glucose levels
  • Blood and tissue oxygen and carbon dioxide levels
  • Blood pressure
  • Core temperature
  • Water and electrolyte concentrations
  • Ph level of body fluids

Normal physiological values including

  • Breathing rate
  • Capillary refill
  • Heart rate
  • Blood pressure
  • Temperature
  • Blood glucose level
  • Oxygen saturations

Negative and positive feedback mechanisms
History taking

  • Presenting complaint/History of presenting complaint
  • Past medical history
  • Drug/medication history
  • Overall impressions
  • SOCRATES pain scoring
  • Wong-Baker FACES pain rating scale
  • FLACC scale
  • Glasgow Coma Scale
  • FAST test
  • Physiological measurements
  • Sphygmomanometer
  • Thermometer
  • Pen torch
  • Blood glucose meter
  • Peak flow meter
  • Pulse oximeter
  • Peak expiratory flow rate
  • Capnography
  • Heart and cardiovascular emergencies
  • Atheromatous plaque
  • Pathological changes associated with heart disease

Structure/Function of the heart

  • Location
  • Pericardium
  • Myocardium
  • Endocardium
  • Blood supply
  • Cardiac conduction system
  • Sinoatrial node
  • Atrioventricular node
  • Autonomic nervous system
  • Stages of the cardiac cycle.

Coronary artery disease

  • Heart failure
  • Arhythmias
  • Blood vessel pathological changes:Atheromatous plaques
  • Causes of atheroma
  • Effects of atheroma
  • Predisposing factor in atherosclerosis
  • Arterioscelerosis
  • Thrombosis
  • Infarction
  • Haemorrhage
  • Aneurysm


  • Electrical changes of the heart (P
  • Q
  • R
  • S
  • T waves)
  • Difference between 3 and 12 lead ECG trace
  • Cardiac output
  • Stroke volume
  • 3-lead ECG
  • Normal sinus rhythm
  • Ventricular fibrillation
  • Ventricular tachycardia
  • Asystole
  • Pulseless electrical activity
  • Bradycardia
  • Tachycardia
  • First degree atrioventricular heart block
  • Second degree atrioventricular heart block type 1 (Wenckebach)
  • Second degree atrioventricular heart block type 2 (Mobitz)
  • Third degree atrioventricular heart block (complete)
  • ECG paper components
  • Small squares
  • Large squares
  • Calibration
  • Paper speed
  • 12-lead ECG including
  • Premature ventricular contractions (PVC)
  • Accessory pathways
  • ST elevation/depression
  • R on T
  • SVT’s including supraventricular tachycardia
  • atrial fibrillation and atrial flutter

Invasive skills assists including

  • Canulation and bag fluids preparation
  • Intra muscular injection (IM)
  • Subcutaneous injection (sub-cut)
  • Supraglottic airways including
  • I-Gels
  • Laryngeal Mask Airways (LMA’s)
  • Intraosseous access bone drilling/puncturing
  • Endotracheal (ETT) tube intubation
  • Magill forceps

Other topics

  • Sexual assault
  • Major incidents
  • Other emergency services
  • Terrorist incidents
  • Thoracic trauma.

There is a mixture of

Pre-course reading: This consists of 20 hours around patient assessment strategy, ‘normal’ physiological parameters for children and adults, oxygen/entonox administration guidelines, anatomy physiology (respiratory, cardiovascular, nervous and digestive systems), spotting the sick child and sepsis.

There is a choice of 2 essential textbooks;

  • Generic Core Material
  • or Ambulance Care Essentials.

Both of these are available to buy from our awarding body website.

Other useful textbooks are:

  • Anatomy and Physiology in Health and Illness, 13th edition by Ross and Wilson
  • UK Ambulance Services Clinical Practice Guidelines (current edition) by JRCALC, AACE and University of Warwick

Classroom based instructor lead training; our FREC level 4 instructors have hands on experience of delivering prehospital patient care through working for local ambulance services or as military medics. The classroom learning is facilitated by the instructor through powerpoint presentation, scenario-based learning, open discussions and formative and summative assessment.
self-study or CPD: this is a mandatory aspect of the course where learners are expected to complete 3 separate workbooks and study for the end of course invigilated exams.

A total of 180 hours of learning is required, this is comprised of 20 hours of pre-course learning, 5 days of classroom based, instructor lead learning and 81 hours of self-study.

The course will run over a period of 6 weeks.

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