Land Warfare: Military medicine in NZ| ADM October 2012

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If there is anyone qualified to comment on the New Zealand Army’s health services it is surely Lieutenant Colonel Chris Mitchell, Chief Staff Officer Health.

Based at Headquarters Joint Forces New Zealand (HQ JFNZ), at Trentham, near Wellington, LTCOL Mitchell is responsible for the health support to all deployed New Zealand Defence Force (NZDF) elements overseas, both on operations and exercises and has served in the Royal New Zealand Army Medical Corps (RNZAMC) for almost 25 years. The RNZAMC celebrated its centenary in 2008.

ADM
asked LTCOL Mitchell about the challenges currently facing the Corps.

“The biggest challenge to the RNZAMC and Defence Health Services is meeting the triple demands placed on it by the high operational tempo while simultaneously having to meet training support requirements and generate health capability.

There are shortfalls across the health team in most, if not all, health professions.

” It is not surprising there are significant shortages in the ‘health team’ for not only is the RNZAMC below strength, but its numbers are falling.

“Current manning within the RNZAMC is approximately 230 across all ranks, which is about 65 per cent of established posts and is trending down due to retention issues within the NZDF,” said LTCOL Mitchell.

The NZ Army is generally funded to 75 per cent of established posts.

“This is being addressed through a number of recruiting initiatives and changes to employment policy designed to attract those health and allied health professionals we need to generate the health outputs and capabilities required to support NZ Army and NZDF operations.”

LTCOL Mitchell told ADM that NZDF medics are trained at the Defence Health School at Burnham in the South Island with a two and a half year training syllabus. This process enables the use of medics from any of the three armed services to provide health support to deployed forces.

Over the last five years, due to developments in NZ’s health system legislation, there have been major changes to the training and the competencies required of both the RNZAMC and NZDF medics to meet the health needs of deployed Kiwi personnel.

“This has resulted in the NZDF Health Services medics becoming more aligned to a paramedic based scope of practice, to meet the health needs of deployed service personnel and of the local population. This also ensures that NZDF medics will, in the future, be recognised as health professionals under the national health legislation.

“Moreover, over the last 10 years we have experienced a higher operational tempo which has placed a significant strain on such a finite resource as medics. The changes in training have led us to develop a transition model to enable those staff who were trained on the old scheme to meet the competencies and qualifications of the new medic scope of practice. Of course we have had to continue to support operations whilst transitioning to the new model. Inevitably there are never enough resources to do the job, so all members of the NZDF health services have been going from one role to the next and covering multiple jobs with little or no respite.”

Nature of operations


This turbulence is, of course, just another challenge on top of the existing complex nature of operations and the austere environment in which the RNZAMC and NZDF Health Services operate.

What, asked ADM, is a deployed RNZAMC medic required to do?

“Provide primary health care, health protection, support in remote locations, understand the tactical situation, train others and provide advice to the supported commander, 24/7,” LTCOL Mitchell explained. “The NZ Army medic is expected to support the health needs of deployed service personnel in an environment that has a number of asymmetric health threats and operations from humanitarian aid and disaster relief to combat.

” Given the push to get more civilians involved in tasks that are not uniform specific ADM asked about civilian paramedic involvement.

“No civilian paramedics are deployed on operations or exercises unless they are a member of the Army Reserve,” LTCOL Mitchel confirmed. “However we do have a Civilian Volunteer Health-specialist Scheme (CVHS) that enables us to call on those civilian health professionals volunteers who have joined the scheme to deploy on HADR activities, such as Tropic Twilight exercises and Samoan tsunami relief.”

On Tropic Twilight 2012, for example, the CVHS contribution to the deployed NZDF Health Team to Samoa included anaesthetists, doctors, nurses, a radiographer and surgeons.

Needs and wants


How do you cope on a deployment such as Tropic Twilight, asked ADM, with yearning to do more for the local population?

“This is an ongoing challenge and it’s a constant battle to manage the expectations of the local population. We rely on liaison with the local health system and a robust media plan that clearly specifies what we are there to do.

“Specific guidance is also given to the deployed health team on what their tasks are, but flexibility is also afforded for them to go beyond that, as long as it is requested by the local government health agencies and provided it will not result in any elements of the deployed health team remaining in-country beyond specified exercise dates.

“The key factor is communication prior to and during deployment between the local population, the local government health agencies and the deployed NZDF health team.”

The basic medical kits carried by RNZAMC medics and by individual NZDF personnel are tailor made for each mission, building on past experience and best practice from around the world.

“The contents are the result of evidence based best practice from research and development over the last decade by both NZ, coalition partners and civilian research agencies, based on wound profiling and illness patterns.

“For example, the introduction, in 2004, of the US Army’s Institute of Surgical Research combat application tourniquet (CAT) to control arm or leg blood flow post injury.

“All NZDF deployed land based troops carry an individual first aid kit, which includes a CAT, emergency bandage and wound packing for the management of haemorrhage control, based on the NZDF Tactical Combat Casualty Care Program. An individual medical kit is issued for treatment of minor ailments.

“Each NZDF patrol includes a number of trained Combat Life Savers; they carry a more advanced set of combat casualty care kit that enables them to provide pain relief, establish an airway for an unconscious casualty and to manage a tension pneumothorax (collapsed lung),” LTCOL Mitchell said.

“More emphasis on the treatment of injuries at the point of wounding reduces the number of preventable deaths and enhances casualty survivability. Other life saving measures include early damage control resuscitation and having a resuscitation team on the aeromedical evacuation aircraft.”

 

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