Medical Force Protection - What have we learnt from HERRICK? Colonel David A Ross QHP MSc MBBS MRCGP FRCPCH FFPHM FFTM RCPS(Glasg.) Parkes Professor of Preventive Medicine Army Medical Directorate [email protected] 27 June 2014 Med FP - Budapest Abstract Medical Force Protection (Med FP) measures are important in mitigating morbidity and mortality in deployed forces. Historically Disease Non Battle Injury (DNBI) accounts for significantly more morbidity than traumatic injury. However how successful have we been in implementing such measures in Afghanistan? The author who conceived and undertook 3 Med FP Audits in Afghanistan will describe the UK findings and contextualise these in comparison to previous UK experience. The presentation will conclude with some key recommendations that must be implemented for future campaigns to ensure that the Med FP lessons of Afghanistan are not forgotten and therefore negate the need to “reinvent the wheel.” 27 June 2014 Med FP - Budapest Crimean War 1854-1856 27 June 2014 Med FP - Budapest Causes of Morbidity 1800s… 27 June 2014 Med FP - Budapest Health Threats 1982 • Malaria • NFCI • Musculoskeletal • NIHL 27 June 2014 Med FP - Budapest Medical Force Protection The conservation of the fighting potential of a force so that it is healthy, fully combat capable, and can be applied at the decisive time and place. It consists of the actions taken to counter the debilitating effects of environment, disease, and selected weapons systems through preventive measures for personnel, systems and operational formations. AJP- 4.10(A) 27 June 2014 Med FP - Budapest Medical Audit 27 June 2014 Med FP - Budapest HERRICK Med FP Audit 2009 • Visits – In/Out of theatre – Units/Elements • Interviews – Practitioners – Commanders & Staff • Observation 27 June 2014 Med FP - Budapest Locations Visited in Theatre • Main Operating Bases • Forward Operating Bases • Patrol Bases 27 June 2014 Med FP - Budapest Audit – Headline • Compliance with policy –Intent –Evolution –Constraints • Extent and applicability of policy 27 June 2014 Med FP - Budapest Observations • Key themes – Information – C2 – Infrastructure – Human factors – Training – Health protection 27 June 2014 Med FP - Budapest 27 June 2014 Med FP - Budapest Human Factors • Degradation – Seasonal effect • Ergonomics – Weight – OSPREY, ECM, Ammunition – Distribution • Food • Noise exposure • Psychological 27 June 2014 Med FP - Budapest 27 June 2014 Med FP - Budapest Information • Quality – WIA – EpiNATO oCategorisation oDisposal • Guidance • Flow • Exploitation 27 June 2014 Med FP - Budapest DNBI Epidemiology Attendance rate – 75/1000/week Impact – 24.4 working days lost/1000 personnel/week Admissions 2/1000/week Aeromedical Evacuation – 0.7/1000/week NOT SIGNIFICANTLY DIFFERENT FROM OTHER CAMPAIGNS BUT………….. 27 June 2014 Med FP - Budapest Impact of Specific Conditions - WDL Total 24.4/1000/week Enteric Disease 11.2/1000/week Musculoskeletal Conditions 6.3/1000/week Others 1.8/1000/week 27 June 2014 Med FP - Budapest “The Good, The Bad & The Ugly” The Good – EH, Rehabilitation, Dental Surveillance The Bad – Outbreaks, CDC Management, Training, DNBI & Data, Vector Control The Ugly – Noise Induced Hearing Loss 27 June 2014 Med FP - Budapest 27 June 2014 Med FP - Budapest Health Threats Now… Disease Climatic Mental health 27 June 2014 Med FP - Budapest 27 June 2014 Med FP - Budapest The Continuum of Care - Medical Force Protection PreRecruitment Recruit Predeployment Train Operational Deployments Force Generation Pathway NHS Care & Health Protection Postdeployment Discharge Discharge Pathway Force Health Protection Understand health of population: - Smoking - Fitness - Obesity - Alcohol - Sexual Health - Suicide rate - Dental health - Immunisation schedules - Post-code Collect health data: - PUD - Smoking - Fitness - Obesity - Alcohol - Sexual Health - Suicide rate - Dental health - Immunisation schedules - Post-code - Employability Activities in Red only affect the soldier 27 June 2014 Data Health Promotion Health Protection Quality Health Services Epidemiology Health Information Employability Mitigation of health hazards of the workplace Medical Intelligence Health Promotion Health Protection Quality Health Services Epidemiology Health Information Employability Mitigation of health hazards of the workplace Medical Preparation of the Force Med FP Audits Pre deployment briefings Medical Intelligence Health Protection Morbidity Surveillance Medical Planning Recording Environmental Exposure CBW Monitoring Employability Deployability Mitigation of health hazards of the workplace Med FP audits Health Surveillance Health Research Identifying cohorts Employability Deployability Mitigation of health hazards of the workplace Dependents Health Pathway Information Med FP - Budapest Analysis Intelligence Analysis of Medical Discharges PostDischarge NHS Care & Health Protectio n Health surveillance of veterans Post discharge health surveillance JRAMC puts high quality research into practice, improving medical care for soldiers, wherever they serve, as well as those beyond the military • Over 100 years old, reporting on major innovations in military medical care • It’s not just UK research. Publishes articles from all ranks, services and corps, wherever they serve, as well as submissions from beyond the military • It’s not just for the military. Many articles are relevant to wider medical practice, including trauma management, musculoskeletal medicine, rehabilitation and emergency medicine • Acts as an Institutional Memory for the practice of military medicine in its broadest sense VISIT: ramcjournal.com for Editor’s Choice articles, military campaigns, our online archive and much more Next Time • Look at past campaigns and USE the lessons • Continually remind Senior Commanders that DNBI is more likely than trauma to have an impact on operational tempo • Surveillance, Surveillance……..!! • Audit, Audit Audit…..!!! 27 June 2014 Med FP - Budapest A helmet is usually thought to be very heavy, but when one is attacking a castle or something similar, and arrows, bullets, large rocks, great pieces of wood and the like are coming down, it will not seem the least bit so. Yamamoto Tsunetomo (d 1719) 27 June 2014 Med FP - Budapest
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