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The Role Played by Royal Navy Medical Assistants on Operation Herrick 9 Can We Do More to Prepare Them for Future Operations In

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The Role Played by Royal Navy Medical Assistants on Operation Herrick 9 Can We Do More to Prepare Them for Future Operations In J Royal Naval Medical Service 2010, 96.1 17-22 General The Role played by Royal Navy Medical Assistants on Operation Herrick 9. Can we do more to prepare them for future operations in Afghanistan? D Ablett, L J Herbert, T Brogden Introduction sciences, medical administration and pharmacy. The first ever, independent review of the Defence Their next stage of training lasts 19 weeks and Medical Services by the independent healthcare is mainly hospital-based. It is during this time watchdog for England, The Health Care that MAs are first exposed to a real clinical Commission(1) was published in March 2009. environment. Their practical work on the wards This review was commissioned by the then is reinforced with classroom teaching. The final Surgeon General Lieutenant General Louis stage of training consists of 3 months spent on Lillywhite and in it, the trauma and rehabilitation a ship or at a shore-based RN Medical Centre services for military personnel hurt in battle consolidating learning and achieving key were described as “exemplary”. competencies. Following completion of initial The review praised the care provided to training, MAs are posted to various locations at casualties of war, highlighting the ability to sea, at home and abroad. quickly reach and treat casualties, innovations in MAs were pooled from throughout the Royal the treatment of major injuries, the training of Navy for OpH9. Some were from the Medical staff, design of field hospitals, clinical audits to Squadron of Commando Logistic Regiment feed back important lessons and rehabilitation (CLR) and had spent several months involved in for injured personnel. The review took place pre-deployment training. The majority, however, during Operation Herrick 9. were augmentees who were drafted in to the Royal Navy Medical Assistants (MAs) played Medical Squadron, from other units, shortly a vital role in the delivery of medical care to 3 before deployment. Commando Brigade Royal Marines on the Certain pre-deployment training targets were Herrick 9 Operation in Afghanistan (OpH9) from set. These included attendance on the October 2008 to April 2009. Battlefield Advanced Trauma Life Support 3 Commando Brigade is expected to deploy (BATLS) course, attendance at the 2 week to Helmand Province, Afghanistan on Operation Mission Rehearsal Exercise (one day of which Herrick 14 (OpH14) in 2011 and medical support was focused on medical training and used the should once again be provided by the Royal ‘Amputees in Action’ for role-play casualty Naval Medical Services. scenarios) and attendance on HOSPEX (a The training of MAs is longer than that of hospital exercise, the first few days of which their peers in the Army and RAF. MAs initially focused on pre-hospital care). undergo 8 weeks of basic training at HMS On OpH9 all MAs were rotated through Raleigh(2). Twenty weeks are then spent at the different posts of varying intensity. The vast Defence Medical Services Training Centre, majority, however, worked at Forward Keogh Barracks, studying basic medical Operating Bases (FOBs), Forward Aid Posts at 17 18 J Royal Naval Medical Service 2010, Vol 96.1 Patrol Bases (PBs) and on Combat Logistic The questionnaire aimed firstly to identify Patrols (vehicle borne patrols). MAs based at the MAs seniority, gender, background, FOBs and PBs regularly deployed on foot previous military experience and whether patrols with front-line troops. The role of the they were augmentees or not. It also asked MA on any patrol is to provide care under fire about their previous medical training and and initial life-saving treatment to casualties. experience, specifically with regards to When not on patrol, the role of the MA is to paediatrics and trauma as well as establishing provide primary and emergency medical care whether they had attended a recent BATLS to ISAF (International Security Assistance course. Questions were also directed Force) troops, local nationals of all ages and towards establishing the roles that MAs ANSF (Afghan National Security Forces) played on OpH9, the locations in which they personnel. worked, their exposure to treating trauma, paediatrics and primary care and their level of Aim supervision by medical officers. The number The aim of this study was to examine the roles and type of medical procedures that they that MAs had performed on OpH9 and to performed were also quantified. Two free-text correlate this with their pre deployment answers encouraged suggestions for possible experience and training. improvements to pre-deployment training and We hoped to identify areas in which pre any further comments. deployment training could be strengthened in order to ensure that an even higher level of Results care could be provided on OpH14. Of the 120 Royal Navy Medical Assistant’s who deployed on OpH9, 65 returned Methods completed questionnaires. The results for MAs were presented with an anonymity- this survey have been quantified using protected questionnaire as part of their leaving percentages of MAs based on those who routine from Camp Bastion in early April 2009 completed questionnaires. at the end of OpH9. Graph 1 Bar chart illustrating the percentage of Medical Assistants Who had attended the BATLS course Within certain time interVals prior to deploYing on Op H9. The Role played by Royal Navy Medical Assistants on Operation Herrick 9 19 Graph 2 Bar Chart illustrating the percentage of Medical Assistants Who performed high- risk roles during OpH9. Personal Details hours of paediatric training during this time. The vast majority of MAs (76%) were of the most junior rate of Medical Assistant (rate Roles of MAs on Op Herrick 9 equivalent to private), 12% were Leading Medical Assistants on Op H9 performed a Medical Assistants (rate equivalent to corporal) wide variety of medical duties. These ranged and 12% were Petty Officer Medical from administrative roles at Camp Bastion to Assistants (rate equivalent to sergeant). The foot patrols in highly kinetic areas of operation. male: female ratio was 1.2: 1.0. The high-risk roles where MAs were more likely to treat casualties included the following: Background EXperience foot patrols, Combat Logistic Patrols (vehicle 95% of the MAs came from general service borne patrols) and Forward Operating Base backgrounds (i.e. had worked within Fleet), medical support. The percentage of MAs who 3% were submariners and 2% were performed these high-risk duties is illustrated commando-trained. 66% were augmented below in Graph 2. to Medical Squadron prior to deployment. 17% had served on a previous land operation PreVious Clinical EXperience and 55% had been on a land exercise 46% of MAs on OpH9 had never been involved before. Details of the number of medical in the treatment of a real-life trauma casualty assistants to have fulfilled the target of and only 21% of them had done so within the completing the Battlefield Advanced Trauma 10 months prior to deployment on OpH9. and Life Support (BATLS) course are Graph 3 illustrates these findings in more illustrated in Graph 1. detail. Further to this, 20% of all MAs questioned had not observed real-life medical Paediatric Training trauma management. 89% of MAs had received less than 2 hours of paediatric training during their basic training. Adult Trauma management on Op Herrick 9 86% of MAs had received less than 2 hours During OpH9, 88% of MAs were directly within the year preceding their deployment on involved in the delivery of trauma care at the OpH9 and only 3% had received more than 5 point of injury or at Role 1, with 38% of them 20 J Royal Naval Medical Service 2010, Vol 96.1 Graph 3 Bar chart shoWing the percentage of Medical Assistant’s Who had treated real life trauma casualties Within certain time frames (months) prior to deploYment on OpH9 Airway % Breathing % Circulation % Procedure Medics Procedure Medics Procedure Medics Chin Lift/ 57 Ashermann’s™ 32 IV Cannulation 75 Jaw Thrust Chest Seal Oral Pharyngeal 38 Needle 11 EASY I.O. TM* 15 Airway Decompression Nasal Pharyngeal 35 Chest Drain 4.6 F.A.S.T TM* 12 Airway Endotracheal 3 Tube Insertion Tracheostomy 4.6 Table 1 The Percentage of Medical Assistants Who used particular clinical procedures during real life trauma management on OpH9. * Intra-osseous Cannulation DeVices treating more than 10 trauma casualties during trauma, with 9% managing more than 10 cases. their 6-month operational tour. Table 1 shows which trauma care procedures were most PrimarY Health Care on Op Herrick 9 commonly used during OpH9. All MAs were involved in primary care during OpH9 with 65% delivered primary health care Paediatric Trauma management on Op Herrick in a setting that did not have a medical officer 9 present. 55% were involved in delivering During OpH9, 62% of MAs were directly paediatric primary health care with 20% involved in the management of paediatric treating more than 6 cases. The Role played by Royal Navy Medical Assistants on Operation Herrick 9 21 Graph 4 Recommendations made bY MAs for improVement in Pre-deploYment Training for future Land Operations. Recommendations for improVement by 83%, but 17% had never attended a BATLS MAs were asked to identify areas in pre- course and, of those that had, 26% had deployment training for future land operations attended a course more than 6-months prior to that they thought required improvement, based the deployment. Augmentees had sometimes on what they had experienced on OpH9. found it difficult to get time off from their units Graph 5 illustrates the most common to attend a BATLS course, as they could not be recommendations made. released due to the deleterious impact that their absence would have on medical service Discussion provision to their unit. The vast majority of the MAs questioned had a The authors feel that whilst the BATLS background in General Service and had not course offers an excellent introduction to the worked with 3 Commando Brigade before.
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