2010 Paulatim Magazine - RAAMC Association

What is military health and what’s in it for me?
“Medical Operational Capability must be delivered by
personnel who are sufficiently integrated into the
moral, physical and conceptual components of
fighting power in order to be able to conduct their
mission successfully”.
are irreversible. These effects are far more critical than in many
other logistic functions.
• Ethical Issues. A moral dilemma can occur whilst a military health
professional is deployed. This dilemma occurs where application of
oaths, clinical obligations of registration are conflict with military
service creating friction e.g. care of civilians.
PAULATIM
You may of heard our non-health brethren say “what is this black
magic, military health is just like RAEME equipment chain, isn’t it?”
The reality is military health is unique and many articles within this
magazine highlight the key differentiators, some emotively.
fundamental difference is that we cannot remove the human from
health delivery. I would like to discuss what is different about military
health, what challenges face the ADF and what you must do to make a
difference.
Military Health development for each of us is a work in progress, and
yet is a basic skill area; I believe that any military health professional
has key components to improve unit outcomes and satisfaction.
I classify these as Military (all corps requirements), Military Health
(key components) and Specialist (principal specialist skill-set).
These skills may appear in conflict but through diligence enable a
balanced approach to employing skills on the work place. One example
of this conflict is the provision of clinical support to civilian casualties
whilst in uniform. These skills over time contribute to the required
competency for any military health professional to deploy at various
levels. What makes us unique, and truly different should be what we
take to our workplaces, they include but are not limited to:
• Legal Status. The Geneva Conventions, and Defence acts confer a
number of rights and duties on Australia. These duties and rights
apply to each of us by virtue of acts of parliament and are
therefore enshrined in Australian law. Any lack of compliance can
therefore be punishable by law. These are designed to provide
freedom of health delivery on a battlefield. There is a requirement
to provide care to all casualties, irrespective of origin.
• Clinical Prioritisation. Another principal of the Geneva Conventions
is that priority is based solely on clinical need rather than the
operational importance of individuals or their origin. Casualties are
sorted into their priority groups using a system known as triage.
• Casualty Deterioration. Unlike damaged equipment, casualties
cannot be left for periods of time without deteriorating.
• Standards of Care. The standard of medical care provided has a
permanent effect on the medical outcome of casualties. Delayed or
poor quality care cannot be reversed after the event; many effects
• Continuity. Continuity includes both clinical and information
continuity:
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• Time.
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Clinical Continuity. Once health has been compromised medical
care must be delivered continuously and progressively to
ensure optimum results. Some casualties will need rapid
evacuation to other health facilities. Continuous links should be
maintained to allow casualties to be transferred. This is unlike
the other logistic functions where continuous links may be
unachievable for all or part of an operation or campaign.
Information Continuity. Clinical continuity is underpinned by
information continuity. This has two aspects, access to
individual clinical data via patient records and direct
communications between attending clinicians. Agreed protocols
reduce the requirement of the latter.
Medical planning is based on time rather than distance per se.
Time taken to reach expert treatment will influence survival
rate, complication rate, rate of recovery and in the longer term
the ultimate quality of life of the casualty.
Within the logistic chain, prioritisation of additional transport
can speed up the delivery of supplies by increasing the lift
available. Faster evacuation means or intermediate medical
staging facilities are required if the clinical timelines are to be
met and continuity of care delivered.
The clinical timelines for land-based operations dictate that the
medical operational timeline is that of the current battle
requiring constant regulation of casualties. This differs from
logistic support/supply planning which aims to resource battles
in advance, or recovering equipment from previous battle and
is focused on the next battle.
• Space. Although the terms ‘forwards’ and ‘rearwards’ are less
clearly defined in a non-linear battle-space, they retain some utility
when discussing the relationship of units and facilities to
operational activity. In terms of space, the medical effort is
‘forward’ because that is where most casualties are generated.
By contrast the main logistic support/supply effort is ‘rearwards’
because that is from where stock is held, controlled and dispatched.
PA U L AT I M – M A GAZINE O F T HE R OYA L A U S T R A L I A N A R M Y M E DICAL C O R P S – 2 0 1 0 8 7