Specific Topic(s):

Expanding your workforce under crisis situations

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ – In armed conflict or other emergencies, health-care personnel are required to render immediate attention and requisite care to the best of their ability.

Geneva Conventions:

Rule 25 Medical personnel exclusively assigned to medical duties must be respected and protected in all circumstances. They lose their protection if they commit, outside their humanitarian function, acts harmful to the enemy. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule25

Practice Relating to Rule 31. Humanitarian Relief Personnel

https://ihl-databases.icrc.org/customary-ihl/eng/docs/v2_rul_rule31 - personnel undertaking humanitarian relief are entitled to protection under GC.

Discussion:

Review of the question: it may be necessary to augment foreign medical teams with local staff for both non-clinical and clinical support functions. What are the issues around this?

Interpretation of the principles/policy from the references: Medical personnel are expected to provide healthcare to their patients to the best of their ability, which also places obligations on their employing organisation to provide training and experience for their role. This also allows local personnel to volunteer to support humanitarian response and local personnel to be employed (i.e. paid and under ‘contract’) in this role. Individuals are expected to work to the best of their ability – but what is the responsibility of the organisation/leadership?

Framework for answering the scenario/question:

• Who might legitimately be employed within a medical unit? This could include international medical staff, local medical staff, local support workers, volunteers, medical personnel of the opposing forces to care for prisoners of war….

• What are obligations for an employing organisation in defining their ‘employees, including volunteers’ and the implications for protection under the Geneva Convention?

• What are the responsibilities of the medical unit to ensure its employees are trained for role, including certification of competence, credentialing, local training etc.

Further issues for consideration:

• How is ‘best of their ability’ defined from a medical negligence perspective? The paper in further reading discusses the evolution in UK in the legal interpretation of the ‘standard of practice’. How does this apply in the application of ‘medical negligence’ in a military or emergency situation?

Lee A. ‘Bolam’ to ‘Montgomery’ is result of evolutionary change of medical practice towards ‘patient-centred care’. Postgraduate Medical Journal. 2017;93:46-50. http://dx.doi.org/10.1136/postgradmedj-2016-134236