Defence Medical Services telemedicine now: a successful pilot of video consultations and instant messaging support to firm base training.

INTRODUCTION: Telemedicine was pioneered in the Defence Medical Services (DMS) in 1998, since then the capabilities within the DMS have not advanced in step with advances in technology. We present our findings of a pilot of remote video consultation via Skype for MODNET during an arduous course held in the UK. METHOD: Combat medical technician sick parades were live streamed via Skype to a Defence Primary Healthcare Medical Centre and medical officer (MO) support was delivered remotely. This process was augmented by the use of Pando for still images of wounds and infection sites in order to enhance decision making and situational awareness. RESULTS: Over a 3-week period, 34 consultations carried out during sick parade required the input from a remote MO, of those 34% required a prescription from an MO. None of the presentations required a face-to-face consultation, and all patients received MO-led care remotely. CONCLUSION: We have successfully demonstrated that video telemedicine consultations are safe, while simultaneously improving patient care, augmenting the distribution of medical assets and reducing costs.

Secure app-based secondary healthcare clinical decision support to deployed forces in the UK Defence Medical Services.

BACKGROUND: Modern instant messaging systems facilitate reach-back medical support for Defence Medical Services (DMS) by connecting deployed clinicians to remote specialists. The mobile app Pando (Forward Clinical, UK) has been used for this purpose by the DMS via the 'Ask Advice' function. We aimed to investigate the usage statistics for this technology in its first 1000 days to better understand its role in the DMS. METHODS: An observational study was undertaken using metadata extracted from the prospective database within the application server for clinical queries between June 2019 and February 2022. These data included details regarding number and name of specialties, timings, active users per day and the number of conversations. RESULTS: There were 29 specialties, with 298 specialist users and 553 requests for advice. The highest volume of requests were for trauma and orthopaedics (n=116; 21.0%), ear, nose and throat (n=67; 12.1%) and dermatology (n=50; 9.0%). There was a median of 164 (IQR 82-257) users logged in per day (range 2-697). The number of requests during each day correlated with the number of users on that day (r=0.221 (95% CI 0.159 to 0.281); p<0.001). There were more daily users on weekdays than weekends (215 (IQR 123-277) vs 88 (IQR 58-121), respectively; p<0.001). For the top 10 specialties, the median first response time was 9 (IQR 3-42) min and the median time to resolution was 105 (IQR 21-1086) min. CONCLUSION: In the first 1000 days of secure app-based reach-back by the DMS there have been over 500 conversations, responded to within minutes by multiple specialists. This represents a maturing reach-back capability that may enhance the force multiplying effect of defence healthcare while minimising the deployed 'medical footprint'. Further discussions should address how this technology can be used to provide appropriately responsive clinical advice within DMS consultant job-planned time.

The History of the Post-Graduate Medical and Nursing Officers (PGMNO) course in the British Army.

Military medicine has been evolving for over 5000 years of recorded civilisation and conflict. The Army Medical Services performed poorly during the Crimean War and the British Army introduced a professional training course for medical officers in 1860. The Army Medical School and the predecessor of today's Post-Graduate Medical and Nursing Officers (PGMNO) course have had to adapt to changes in British foreign policy and military requirements. The Army Medical School instigated a rigorous scientific medical training which led to major advances in the study of tropical diseases and trauma medicine. These advances were quickly included in the training of future cohorts. Although the Army Medical School has now closed, the PGMNO course thrives at its new location at the Defence Medical Academy, Whittington. Modern general duties medical officers (GDMOs) must be able to provide medical care in a range of austere environments, including humanitarian relief and conflict zones. New clinicians complete their basic military training before completing the PGMNO course and the Diploma in the Medical Care of Catastrophes. This programme ensures that GDMOs and military nurse practitioners gain a wide knowledge of the latest military and humanitarian medicine. The current era will require clinicians who are competent generalists, who can perform in small teams in dispersed locations. This article summarises the development of the British Army's PGMNO course and the evolution of its syllabus as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

Fellowship in Immediate Medical Care examination: applicability to the Defence Medical Services.

The Fellowship in Immediate Medical Care (FIMC) is the highest level of formal qualification available for pre-hospital practitioners, aiming to test the knowledge, technical and non-technical skills of those providing specialist Pre-Hospital Emergency Care (PHEC). The FIMC is a multiprofessional examination with the potential to support continuous quality improvement of the PHEC that the Defence Medical Services (DMS) can offer to our patients now and in the future. The aim of this article is to inform the readership about the evolution of the FIMC examination and its applicability to military clinicians (and their civilian counterparts). A secondary aim is to inform those who are preparing for the examination.

Procedural sedation at role 1: applicability to military clinicians and minimum monitoring criteria.

Procedural sedation is defined as producing a state of reduced consciousness, where the patient is still able to respond to verbal or physical stimulus and to continuously maintain a patent airway and adequate ventilation. This can be done to facilitate treatment that would not be otherwise possible. Recent evidence, guidelines and new equipment introductions have improved the safety of procedural sedation at UK role 1 medical treatment facilities (MTFs). A role 1 MTF is defined by the North Atlantic Treaty Organization as a medical facility focusing on the provision of primary healthcare, specialised first aid, triage, resuscitation and stabilisation, and is usually staffed by a general practitioner or a general duties medical officer. This paper aims to update role 1 clinicians on the current evidence base and guidance regarding monitoring of patients during procedural sedation.

Packers, pushers and stuffers--managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review.

Body packing, pushing and stuffing are methods by which illicit drugs may be carried within the human body. Patients involved in these practices may present UK emergency departments with complex medical, legal and ethical considerations. This review article examines not only the evidence behind the clinical management of these patients, but also the legal powers afforded to the authorities to authorise the use of intimate searches and diagnostic imaging for forensic purposes. Serious complications from concealed drug packets are now rare, and most asymptomatic patients may be safely discharged from hospital after assessment. Emergency surgery is indicated for body packers with cocaine poisoning and for some cases of heroin poisoning. Urgent surgery is indicated for obstruction, perforation, the passage of packet fragments and failure of conservative treatment. Guidance is given for doctors who are faced with requests from the authorities to perform intimate searches and diagnostic imaging for forensic purposes.

Heat illness--recent developments.

This paper reviews the literature concerning exertional heat illness in soldiers. It focuses on developments since Bricknell's two part paper "Heat Illness--A Review of Military Experience" published in this journal in 1996. Recent advances in the understanding of risk factors, pathophysiology and treatment are discussed with a view to reducing the already low incidence of heat illness within the Armed Forces.