ACORNS - POLICY - TWO

All of the scenarios in the policy suit should be considered from the perspective of a health professional in a staff appointment as the lead officer for medical policy within a Ministry of Defence (rank equivalent of OF4/Commander/Lieutenant Colonel/Wing Commander).

Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: You have been tasked to organise the deployment of a field hospital to deploy overseas to add capacity to local services to manage the outbreak of a highly lethal infectious disease. Can they be ordered to go?
• List the Issues that arise from the scenario.
• Identify Critical Information required and Assumptions to be made:

This scenario covers the ethics and law regarding risk of military operations and the legally of an order to deploy. It complements the scenarios in HEARTS ACE, HEARTS TWO and HEARTS THREE. This topic is placed within the Policy suit to create discussion on the duties of medical planners in the allocation to tasks to military medical units. Therefore it also complements the scenarios at POLICY EIGHT and POLICY SEVEN.

Step 2 – ANALYSE

Patient: this is set in the context of a humanitarian mission. There is clearly an urgent health need which could be mitigated by international military health services. - Justice

Clinical: you need to consider if a military medical contingent is competent to manage such cases within the clinical setting. Do they need additional education and training to protect themselves and to provide the right clinical treatment?

Legal: military personnel can be ordered to deploy if the deployment is legal, i.e. has the right authorities and approvals. However, the ‘employer’ also has to take the appropriate mitigations to protect the health of their employees – system of work, protective equipment, training and education – from the risk of infection with the disease.

Societal/Military: there may be political, diplomatic or humanitarian pressure to deploy military medical units as part of this response. However, it is important to establish any risks or second order consequences of the armed forces deploying to civilian health crisis – including over securitising a non-military problem. Are there better alternatives, and is it reasonable to expose national military health professionals to the risks of this disease?

Step 3 – FUSE

• Summarise conclusions
• Insert citations to key reference sources for your analysis
• Determine the exact Decision(s) to be made

This scenario covers the legal and ethics dimensions of high risk military deployments.   

Step 4 – DECIDE

• What is your Decision?
• Why (can you justify it)?
• Residual uncertainly, need for review?

Military health professionals are obliged to comply with a legal military order to deploy to a high risk environment. As a senior medical planner, you will need to consider if this risk is justified by the ‘military necessity’ benefit of such a risk both for the individuals and the organisation. Is the mission justified? You also need to consider how to mitigate risks, the assurance arrangements for any mitigations, and whether a direct order or a call for volunteers is appropriate. Consider how you might explain the consequences to a family member of a killed or very sick member military health professional who deployed under your orders.  

Contributor – Air Vice Marshal (Rtd) Alastair Reid CB FFOM, Surgeon General UK Defence Medical Services 2019-2021.