Every three years, all army medical services territorial army (AMS TA) units carry out a fast-paced, 48-hour military medical exercise in the field training centre at Towthorpe Lines, in Strensall, Yorkshire. The latest exercise took place on September 18. Zoë Gross was there to see what happened and the role pharmacy plays in the AMS
Left to right: Major Craig McCarthy (pharmacist), Major Rosie Goldsmith (nurse), Lieutenant Colonel Andrew Cope (A&E consultant) and Corporal Hugh Paton (pharmacy technician) attending to a casualty on a ward |
Over 200 TA members, half of whom were recruited from civilian medical professionals, went to 306 Field Hospital, Towthorpe Lines, to take part in exercise "Petit Mash." The exercise formed part of a 15-day annual camp at Towthorpe Lines and tested the medical capabilities of the AMS in a high intensity war situation. It was designed to assess the medical response to civil disasters or combat.
Health care professionals in the TA are not required to fight, but to provide medical care for soldiers who are injured. They receive annual training, including learning how to adapt their medical skills to the military environment. Towthorpe Lines is a specialist unit and recruits nationally.
In the space of just over 24 hours a fully functional hospital, equipped with facilities such as an operating theatre, casualty department, wards and pharmacy stores, was built in a vast warehouse-like field trainer complex. By mid-day on September 18, around 120 simulated casualties had been treated in the field hospital. A team of two pharmacists and two pharmacy technicians worked in 12 hour shifts throughout the exercise.
The field hospital was set up just like any other hospital. But what made it unique was that its physical conditions could be manipulated to represent any real-life situation and therefore really tested the skills of the officers working inside it. The scenario could be that of North West Germany, in which case the temperature could be brought down to below zero. Climate conditions could also be set to the opposite extreme, such as those in the Gulf countries. Utilities such as electricity could be switched off in order to simulate power cuts, in which case the AMS would have to bring in generators to deal with the situation.
Two hundred army cadets from the North and West Yorkshire and Cleveland army cadet forces played the part of casualties during the exercise. To make the operation realistic, special make-up was used to simulate injuries, ranging from fractures and missing limbs to burns and soft tissue wounds.
In terms of communication, a recent advance for field hospitals has been a link via the internet to other units and headquarters. This has allowed doctors to consult using telemedicine.
Casualties arriving at the field hospital by ambulance, helicopters and Land Rovers were quickly moved to the reception area of the hospital, which was manned by doctors and nurses (with accident and emergency qualifications), combat medical technicians and military clerks. Like any A&E department, casualties were sorted to enable the seriously injured to be treated first, a process known as triage. Casualties requiring urgent resuscitation or emergency life-saving surgical intervention were taken directly to the resuscitation department, which was run by anaesthetists and trauma trained nurses. Although essentially functioning in the same way, the operating theatre in the field hospital looked very different to one in a civilian hospital because all the equipment is designed to be portable. The McVicar operating table could be dismantled so that it could easily be dropped by parachute if required. Operating lights, anaesthetic equipment and autoclaves were also all designed to be easily portable. Four surgeons (two general and two orthopaedic) made up the operating team. |
A casualty receiving treatment for a simulated leg injury |
After surgery, casualties were moved to either the intensive care unit or a ward. In intensive care each casualty was closely monitored by trained intensive care nurses supported by anaesthetists. Unconscious casualties and those with chest or limb injures were attended to by a physiotherapist to help minimise muscle wastage and other conditions occurring from poor positioning on beds.
The Towthorpe field hospital had three wards and could hold up to 200 beds.
The pharmacists and pharmacy technicians were active on the wards, working both as part of the medical team and ensuring adequate supplies of drugs were to hand at all times.
The pharmacy team was also responsible for getting medical equipment to areas such as the pathology laboratory and the X-ray department. The X-ray department was equipped with a mobile X-ray machine. In the near future CT scanning and ultrasound equipment will be available.
Less seriously injured casualties were taken directly from the reception area to the wards, or treatment or evacuation departments. In the treatment area, minor ailments were dealt with, wounds were cleaned and stitched and broken bones were X-rayed and set, much like in any busy A&E department. Medication, ranging from over-the-counter products to prescription only medicines, was set out on a table. Stocks were continuously checked and replenished by the pharmacy team.
Casualties left the evacuation area either to return to duty in their own unit or to be moved to another hospital.
Pharmacists and their role in the TA
Twenty pharmacists currently work in the territorial army's medical services. The pharmaceutical services are integrated with the rest of the AMS and the main role of the pharmacist within a field hospital is to anticipate pharmaceutical needs and assist other medical staff on the use of appropriate treatment regimens.
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