UK — Navy medics in major exercise at sea

150 Roy­al Navy per­son­nel have been tak­ing part in a major med­ical exer­cise off the UK’s south west coast on board Roy­al Fleet Aux­il­iary (RFA) ves­sel Argus.

RFA Argus’s bridge at action sta­tions dur­ing Exer­cise Med­ical Endeav­our 2012 [Pic­ture: Lead­ing Air­man (Pho­tog­ra­ph­er) Rob Gillies, Crown Copyright/MOD 2012] Source: Min­istry of Defence, UK Click to enlarge

Wear­ing white anti-flash over­alls and face masks, as if at war, the hos­pi­tal unit and crew of the ship rehearsed tak­ing on board and treat­ing casu­al­ties of bombs and ene­my fire. 

Exer­cise Med­ical Endeav­our 2012 sees Argus oper­at­ing in her main role as the Roy­al Navy’s pri­ma­ry casu­al­ty-receiv­ing ship. The train­ing involves a series of exer­cis­es on board Argus where casu­al­ties air­lift­ed to the ship are tak­en to a hos­pi­tal like that in Camp Bas­tion, Afghanistan, which has sim­i­lar­i­ties to an acute dis­trict gen­er­al hospital. 

Using skills honed in Iraq and espe­cial­ly Afghanistan the exer­cise also sees the doc­tors and nurs­es and stretch­er-bear­ers from the Band of Her Majesty’s Roy­al Marines Scot­land put on a war-foot­ing for 24-hour days while air and war­ship attacks are sim­u­lat­ed and bat­tle-wound­ed casu­al­ties tak­en on board from ashore and with­in the ship. 

The exer­cise graph­i­cal­ly demon­strates to pri­mar­i­ly naval per­son­nel, but also air­men and sol­diers, that giv­ing top-lev­el med­ical care to severe­ly ill patients with burns, smoke inhala­tion, head injuries and blast and firearm injuries at sea is a far cry from work­ing in Plymouth’s Defence Hos­pi­tal Unit at the Der­ri­ford NHS Hos­pi­tal, let alone the bat­tle­field hos­pi­tal at Camp Bastion. 

At action sta­tions in between mis­sile and tor­pe­do attack alerts, herald­ing more casu­al­ties, the head of the Roy­al Naval Med­ical Ser­vice, Sur­geon Com­modore Andrew Hugh­es, said: 

“It is vital we do this train­ing togeth­er, even if it is only once a year. It is espe­cial­ly dif­fi­cult to get every­one togeth­er with per­son­nel from across the Ser­vice serv­ing in Afghanistan. But it is essen­tial if we are to remain at the top of our game clinically.” 

He explained that the chal­lenges of run­ning a float­ing hos­pi­tal based on con­sul­tant-led care are numer­ous and range from the basics of learn­ing your way round a ship, deal­ing with sea-sick­ness, and train­ing in deal­ing with bat­tle-dam­age, to evac­u­at­ing a ship’s hos­pi­tal on a sink­ing ship and deal­ing with pan­ick­ing casu­al­ties in pain on a shift­ing ward, or con­duct­ing life-sav­ing surgery in a mov­ing oper­at­ing theatre. 

Sur­geon Cap­tain David Lunn, oper­a­tional clin­i­cal direc­tor on board, said: 

“The chal­lenge is to main­tain the high­est clin­i­cal stan­dards wher­ev­er we are sent in the world at sea in the face of fires and floods. It is also hard to focus minds on look­ing after them­selves, on force pro­tec­tion, because they are so used to putting patients first in the nor­mal hos­pi­tal envi­ron­ment, but at sea that is an impor­tant element. 

“Here on board such mul­ti-task­ing is essen­tial and naval per­son­nel are used to it if they have been to sea regularly.” 

Many of the med­ical per­son­nel embarked on RFA Argus for the exer­cise have only just returned from Afghanistan as Roy­al Naval Med­ical Ser­vice per­son­nel have been pro­vid­ing all the med­ical sup­port on Oper­a­tion HERRICK 14. Their abil­i­ty to adapt and work in a vari­ety of dif­fer­ent envi­ron­ments only serves to demon­strate their ver­sa­til­i­ty and con­tin­ued util­i­ty to Defence. 

The med­ical com­plex with­in Argus is a ful­ly-equipped 100-bed hos­pi­tal facil­i­ty, includ­ing a four-bay oper­at­ing the­atre, togeth­er with a 10-bed inten­sive care unit, 20-bed high depen­den­cy unit, two 35-bed gen­er­al wards and the full range of clin­i­cal sup­port ser­vices, includ­ing imag­ing, pathol­o­gy, phar­ma­cy and physiotherapy. 

In the inten­sive care ward, head­ing her team is Chief Pet­ty Offi­cer Nico­la Left­ley from Der­ri­ford Hos­pi­tal. She said her time in Afghanistan had giv­en her expe­ri­ence of trau­ma care in a com­bat hos­pi­tal which was now being put to use at sea. She said the major dif­fer­ences were hav­ing to ensure the small­est items were not left to fall to the floor on a rock­ing ship in rough weath­er and hav­ing to deal with a flood that was unlike­ly in a land hos­pi­tal, all adding to mul­ti-task­ing duties and stress while treat­ing severe­ly ill casualties. 

Com­man­der Stu­art Dick­son heads the inten­sive care unit. He said the hospital’s abil­i­ty to con­duct emer­gency surgery while under attack was lim­it­ed and oper­a­tions might have to be delayed until it was deemed safe to per­form them. He said the military/NHS part­ner­ship ben­e­fit­ed both organisations: 

“This mod­el of con­sul­tant-led care has been proven in Iraq and Afghanistan and is ben­e­fit­ing NHS trau­ma care where we also work. We have con­sul­tants always at hand instead of going through junior doc­tors. We know what sort of injuries to expect in bat­tle sit­u­a­tions and are sav­ing lives that would have been lost a few years ago.” 

A wide vari­ety of exper­tise is embarked, includ­ing con­sul­tants, nurs­es and allied health pro­fes­sion­als cov­er­ing the full spec­trum of clin­i­cal capa­bil­i­ty: emer­gency med­i­cine, gen­er­al surgery, trau­ma and orthopaedics, burns and plas­tics, anaes­thet­ics, gen­er­al med­i­cine, psy­chi­a­try, radi­ol­o­gy, pathol­o­gy, gen­er­al prac­tice, den­tal, and inten­sive care. And there are also oper­at­ing the­atre prac­ti­tion­ers, phys­io­ther­a­pists and pharmacists. 

Com­man­der Neil Wagstaff, com­mand­ing offi­cer of the med­ical unit with­in the ship, said: 

“The pri­ma­ry casu­al­ty-receiv­ing facil­i­ty deliv­ers deployed hos­pi­tal care to mem­bers of the UK Armed Forces, from the sea. The pri­ma­ry casu­al­ty-receiv­ing facil­i­ty aims to deliv­er out­comes of treat­ment which equate to best prac­tice and evi­dence-based med­i­cine, offer­ing the high­est lev­el of care to deployed Ser­vice personnel. 

“The prin­ci­pal objec­tive of Exer­cise Med­ical Endeav­our 2012 is to ensure that the casu­al­ty-receiv­ing facil­i­ty can deliv­er first-rate health­care to those deployed on future operations.” 

The Com­mand­ing Offi­cer of RFA Argus, Cap­tain Ian John­son, said: 

“This is an excel­lent oppor­tu­ni­ty for the ship to exer­cise its pri­ma­ry role. We are proud to be the Roy­al Navy’s pri­ma­ry casu­al­ty-receiv­ing ship and this exer­cise will rein­force the enhanced capa­bil­i­ty of this unique facility.” 

Press release
Min­istry of Defence, UK 

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