Land Warfare: Military medicine in NZ| ADM October 2012
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.”