Category: All
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2
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2
In a mass casualty situation, is it ethical for a military medical unit to keep beds empty for new military casualties?
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3
The local culture or national legal framework has only weak protections against domestic violence or gender-based violence. How do you respond to a badly injured female who reveals that her husband attacked her?
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A rape victim asks to be given a ‘morning-after pill’ which your clinic has available. However, it is illegal in the country where you are operating. What do you do?
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Under what circumstances would it be appropriate to use local donors to provide blood for patients in a military medical facility in place of the usual standard of care to pre-screen blood donors and use fully screened blood?
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When facing staff shortages, under what conditions may you use local volunteers without any medical training?
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How do you balance time taken for patient care with record keeping? What is the minimum information you should record?
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The command asks you in a routine situation to act in a capacity that your professional body would not recognise you as having the correct qualifications or training to perform.
What should you do?
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Clinical governance is not equal across organisations; how might you respond to an allegation that care in another nation’s medical facility is not clinically acceptable?
Would it/should it affect where you allocate cases?
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10
What should a health care professional do if faced with an order from a commanding officer requiring them to violate the principles of medical ethics?
J
J
J
J
A talented and irreplaceable staff member is accepting bribes in order to prioritise patients for care.
How might this be addressed?
Q
Q
Q
Q
A badly injured enemy combatant claims that his injuries were caused after he had been captured.
How do you respond?
K
K
K
K
Your local military commander asks for off duty medical personnel to contribute to guarding the perimeter of the military compound.
How do you respond?
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A
Special forces capture a combatant who, they believe, has vital information about a future terrorist attack. The combatant refuses a life-saving treatment stating that he would “rather die than live as a prisoner and traitor”.
What can/should you do?
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2
2
2
2
Violent non-state actors may recruit under-18s into their forces.
What are the duties of medical personnel towards 'children' as combatants?
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3
In order for you to get access to the wounded and sick, you have to share information with the host-nation authorities and/or the UN about the identities of the patients in your care.
Do you share the information?
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How do you decide the first person to treat or the allocation of single resources between two casualties with the same triage score?
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A badly injured, unaccompanied female child has been left at your emergency department.
What are the ethical challenges associated with consent for treatment and how might you address these?
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You suspect the host-nation base guards are refusing some people access to healthcare because they are from the 'wrong' area or tribe.
What do you do?
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You have evidence a government is committing atrocities against its own citizens. Should health care personnel allow media access to the patients in order to publicize the alleged crimes?
What else could a health care professional do?
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There is a shortage of beds and you have a stable but ventilated patient who can be moved to a local hospital but you know there are no nurses on night shifts. This could mean a death sentence.
What do you do?
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The divorced parents of a very badly injured soldier in your base hospital refuse to be present together but each insists that only they can speak on behalf of their son.
His brain injuries are such that he is not competent to consent to medical treatment. How do you resolve this?
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Should you allocate extra support to people with disabilities during an emergency evacuation if that means expecting apparently able-bodied people to manage by themselves?
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J
J
The husband of a badly wounded female refuses to permit your male medics to treat her.
What do you do?
Q
Q
Q
Q
A distraught local national father refuses to allow the transfer of his badly injured daughter to another allied medical unit where more appropriate care can be provided.
What do you do?
K
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K
If you were faced with limited resources, how would you balance palliative care priorities with pain relief for incoming trauma patients?
A
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With modern medicine it is possible to save the lives of people with devastating injuries that will profoundly change their lives forever.
Are there limits to how far treatment should be taken? Who decides?
x
2
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2
Faced with an outbreak of a highly infectious disease, you have insufficient PPE for every patient-facing clinician, though you have adequate supplies of equipment used for normal infection control.
To whom do you allocate the higher level of protection? Do you require everyone else to continue working with the lower level equipment?
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Can military medical staff be ordered to deliver care if doing so involves severe risk of injury or death to themselves?
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You are deployed to a conflict area where the enemy are deliberately and consistently violating the laws of armed conflict. You have been tasked to send an ambulance on a very dangerous mission to collect enemy casualties.
Should your own personnel be put in harms’ way to save the life of someone who would not reciprocate?
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You are struggling to justify your country’s involvement in a war you believe to be unwinnable.
How do you cope?
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Your team has been working under intense conditions for days; you are all sleep-deprived and are making errors that put patients at risk. There is no back-fill support available.
As team leader, what is your duty of care to protect your team and yourself?
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Pre-deployment you had concerns about a colleague struggling with his mental health after multiple tours of duty. His performance is erratic. One day he seems fine the next he is making preventable errors.
His surgical skills are desperately needed. What can you do?
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Inevitably, the delivery of health care in conflict means not everything goes the way you would like or had planned, even when you have tried to do everything right.
How do you manage a sense of failure e.g. a patient death or a missed diagnosis?
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You are in a convoy that drives past the aftermath of a roadside bomb. Several local nationals are in need of emergency care. The commander orders you not to stop because the road is dangerous and there is a risk of being attacked.
Is the commander right?
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Can medications be used pending regulatory approval or ‘off label’ for non-licensed indications to save the lives of military personnel?
J
J
J
J
Is it acceptable to allow firearms into a medical facility?
If so, who may carry them?
Q
Q
Q
Q
A local patrol commander tells the attached medical personnel to remove their Red Cross arm bands because this disrupts camouflage.
Is this acceptable?
K
K
K
K
The commander of a logistic convoy wishes to put food and water into the ambulance of the convoy.
Should this be permitted?
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When faced with an infectious disease outbreak, should military medical personnel be willing to accept greater risks than civilian medical workers?
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You will lead a medical unit and have a one week pre-deployment training period together in the country capital before setting up the unit.
How might you communicate to the team members before you meet them, and what ground rules would you wish to establish?
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You will lead a medical unit. 3 countries have agreed to provide medical personnel.
What cultural barriers might challenge the creation of successful team dynamics and how might you address these.
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You will lead a medical unit. There may be differences between members of the team. What characteristics are 'protected' under discrimination law?
How might you respond to an allegation of direct discrimination by one of your team members?
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You will lead a medical unit. There is a risk that poor communication across the team could result in patient harm.
How might you set up a system to review adverse clinical events that could sensitively identify weakness in teamwork?
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Your new unit has had its first Mass Casualty event. The following day, a senior male intensive care nurse takes you to one side and tells you that he refuses to work with the female orthopaedic surgeon as she is rude and incompetent.
What do you do?
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Four months into your tour as leader of a medical unit, your deputy comes into your office to tell you that senior members of your team are concerned about your mood and behaviour towards them.
What do you do?
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You will lead a medical unit. 3 countries have agreed to provide medical personnel.
How might you assess the credentialing and competence of each member of staff so as to ensure that they are suitably qualified for their role?
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You are conducting a daily round of ward patients and notice several new entries for a drug that is not in the hospital formulary.
The ward nurse explains that a new doctor has brought the drug as he wants to conduct a drug trial. What do you do?
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A Mass Casualty incident has just been called and the senior emergency department nurse cannot be found. After 30 mins, you are told that he is in his bed and refusing to come out.
What do you do as the team leader?
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J
J
Four months into your deployment, you are told that a fourth country will be sending a medical team to work in your unit to treat their casualties because of complaints about medical care.
What do you do?
Q
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Q
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You are the leader of a multinational medical unit. One country’s leader insists they will wear national uniform and refuses to allow her personnel to wear the set of surgical scrubs that all personnel wear when on duty in a clinical role.
What do you do?
K
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You will lead a medical unit. The leader of one contingent insists that his country has agreed to provide 'one shift' in a three-shift system and will not allow rostering at department level.
What do you do?
A
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You and your team have had a very successful tour. 2 of the 3 national contingent leaders want to organise a farewell party and to allow alcohol to be consumed, acknowledging the other contingent is forbidden to drink alcohol.
What do you do?
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Основные принципы Женевских конвенций
Касается следующего: ведение вооруженного конфликта, защиту тех, кто не учавствует в вооруженном конфликте (медицинские подразделения и транспорт), защиту тех, кто не может брать уч
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1
The Four Principles of Medical Ethics
Beneficence, Justice, Autonomy and Non-malificence
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A friend is a battalion commander. He is also a patient in your clinic. His wife asks for your help because he is drinking heavily, is abusive, and seems to be spending money recklessly. What do you do?
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3
You have just performed a pregnancy test for a female recruit. The test is positive. In tears, she tells you that the father is a training instructor and requests a secret termination of pregnancy. There are strict rules prohibiting sexual relationships
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You overhear a social conversation between two senior officers in your unit discussing the anti-malarials for a forthcoming deployment. One says he will use a new drug that he has found on the internet that has ‘no side-effects’, rather than the drug pres
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You have received an x-ray report that identifies a serious pelvic stress fracture in a young recruit. You had been treating them for over 6 months with painkillers and physiotherapy, and only arranged the x-ray after her insistence. What do you do?
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A soldier complains that a senior female doctor includes a genital examination as part of the annual routine medical review for male soldiers. When challenged, she states that this is good medical practice for screening. What do you think?
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You receive 4 separate requests for medical reports for lawyers on your patients who are claiming that they have suffered non-freezing cold injury during a recent field deployment. There is no record in their notes about this condition. What do you do?
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You have been invited out for a date by one of the personnel in your unit whom you are attracted to. You have recently prescribed contraception to this person. What do you do?
9
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You receive a complaint that a patient heard some other personnel talking about her private medical information. Reviewing her health record as see that a junior nurse was the last recorded viewer. What do you do?
10
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You are told to start a vaccination programme against a biological weapon, though there are known side effects. You don’t agree with the use of this vaccine as you have had very severe side-effects, what do you do?
J
J
J
J
You are reviewing the electronic health record of a young soldier whom you think is being bullied. You notice that one of your colleagues has seen him and seems to have deleted some notes. What do you do?
Q
Q
Q
Q
You see 4 soldiers with symptoms of a sexually transmitted disease from the same sub-unit. You refer them for immediate clinical assessment. A medic comes in to tell you that their platoon officer has not allowed them to attend the clinic. What do you do?
K
K
K
K
You have conducted a routine medical on your Commanding Officer and found a significant heart murmur. He does not wish you to refer him to a military cardiologist and wishes to go private. What do you do?
A
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A
Your partner complains that you are working too hard and this affects your relationship with them and your children. You requested support from your superiors. They say that no one can help and that your duties are the same as everyone else. What do you d
x
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You are the SNCO in charge of a small medical unit. One of your medics is brought in by a friend disorientated and smelling of alcohol. He is on duty in 4 hours. What do you do?
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You are the SNCO in charge of a small medical unit. A female soldier does not want to attend the facility as she is worried she will face disciplinary action for getting sunburnt? What should you do for her to receive the right care and treatment?
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4
You are an Advanced Practitioner. A soldier presents with lower back pain. Following an assessment, you take him off guard duty but he informs you that if he doesn’t do guard duty it will impact on his promotion prospects. What should you do?
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You are on an operational tour and are a junior NCO. You witness a verbal altercation between the SNO with the DMD both Colonels. Patients and staff can hear this altercation. What should you do?
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You are a sergeant at a field hospital. An anaesthetist uses a rapid infuser with the incorrect bore size for a deteriorating patient. They shout saying you are incompetent. You make an offensive comment and walk away. What are the ethical issues?
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A patient has reported to you as the SNCO that a female medic has made an inappropriate sexual remark to a male nurse in front of them. What actions should you do? What are the ethical issues?
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A sergeant who is a patient has behaved inappropriately using offensive language towards a junior soldier admitted for a mental health crisis. A soldier visiting witnesses this and reports it to you. What should you do as a Corporal? What are the ethic
10
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A female nurse of the same rank heard a male nurse say about a 43-year-old female Warrant Officer admitted for abdominal pain, ‘I wonder why at 43 years old she is not married. Do you think she is a lesbian?’ What should the female nurse do? What are the
J
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J
A Sgt is in charge of the medical unit. A doctor at the rank of Lt Col who is renowned for being abrasive has prescribed a soldier penicillin despite being allergic to it. This is the second time the doctor has done this. What should the Sgt do?
Q
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Q
Q
A corporal who qualified two years ago has noted that, on a few occasions when administering medication, the captain who is a qualified nurse did not check the patient’s drug card and their identity. What should the corporal do?
K
K
K
K
A soldier on an operational tour has a positive pregnancy test. She is unsure how many weeks she is and begs you not to say anything to anyone. She refuses to give her consent for her pregnancy to be disclosed. What should you do?
A
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A
An experienced soldier has an infected leg that requires surgical intervention and antibiotics. The soldier is refusing all treatment. The Adjutant has rung the ward asking when he will be discharged and fit for duty. What are the ethical issues?
x
2
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2
2
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?
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2
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?
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3
You have written performance reports on your subordinates. Your superior officer seems to be showing favoritism in their reports on a specific group of your people. What do you do?
4
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You receive formal notification of a complaint of bullying against you. You have recently written an adverse performance report about the complainant. What are your ethical duties?
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5
In addition to your staff role, you are also senior clinician. A friend asks for your support in an investigation of a clinical incident. On reviewing the documents, you believe that your friend was negligent. Do you agree to support them?
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You receive a formal complaint about the quality of medical care in a coalition hospital on a military mission that your country has responsibility for leading. How do you respond?
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The number of tasks for medical support is believed to be affecting the ability of clinical personnel to maintain their professional skills. Can you stop the deployment of medical personnel?
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You have provided advice on the medical support requirements for a difficult military operation. You have been told to halve the medical forces so that more combat units can be deployed. How do you respond?
9
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You receive a letter from a drug company complaining that the research project that they were sponsoring in a military hospital is being badly managed. There is no record of this project receiving approval. What do you do?
10
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10
A consultant has refused to deploy for a military mission. You suspect this is because of their private practice. You receive a report that they have just been medically downgraded below the deployment standard. Can he/she be ordered to deploy?
J
J
J
J
You are asked to write a rebuttal for an adverse news report on the provision of mental health services to veterans. You know that your request for more funding for this service was rejected. Is it ethical to write a media release?
Q
Q
Q
Q
Military commanders want to use a new drug that protects against travellers' diarrhoea. There is disagreement between the adviser in medicine and the adviser in microbiology as to whether the drug is effective. Can the drug be introduced?
K
K
K
K
The medical services are asked for their judgement on the military effectiveness of a new weapon that uses sound to incapacitate the enemy. Is this ethical?
A
A
A
A
A medical equipment company invites your leadership team to an important overseas medical conference that cannot be funded from your budget. You have just approved a major contract with them to supply equipment to military medical units. Do you accept?
x
2
2
2
2
A national newspaper reports allegations that civilian patients seem to be taking priority for care over military patients in your military hospital. What do you do?
3
3
3
3
A military patient insists on being discharged so they can go to a private civilian hospital for their medical care. Do you agree?
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4
One of your nurses reports that a group of patients have uploaded unpleasant images of their wounds onto social media. What do you do?
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The wife of the Commanding Officer of a number of patients in your hospital wants to visit them. What do you need to check before you might allow this?
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A badly injured patient has returned to the ward after their third admission to ITU. They are requesting not to be resuscitated in the future but the junior staff object. Should they be allowed to sign the document?
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7
At a routine meeting, one of your consultants proudly announces the publication of a research paper reporting outcomes of patients treated in your unit. This project had not been submitted to the unit Research Ethics Committee. What do you do?
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A military charity requests that publicity material is handed to relatives of patients. It contains photographs of patients that could only have been taken in your hospital, and you have no knowledge that they were taken. What do you do?
9
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A junior nurse has publicly disagreed with the treatment plan proposed by a senior consultant in a multidisciplinary review meeting because she believes that the patient does not want this. The consultant has ordered her to leave the room. What do you do?
10
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10
You receive 3 soldiers with life-threatening heat stroke and two others with moderate symptoms. The history of the conduct of this military event training suggests that basic prevention rules were not followed. Do you tell their relatives?
J
J
J
J
An immobile bilateral amputee in long-term rehabilitation wants to invite a person he has met on a dating site to visit him in the military hospital. A member of staff thinks that this is a prostitute. Can the visit go ahead?
Q
Q
Q
Q
A young soldier with a severe head injury has met the criteria of ‘brain death’ and the clinical team seek to turn off mechanical ventilation. One of the divorced parents refuses this decision. Can the ventilator be switched off?
K
K
K
K
The partner of an unconscious patient with a poor prognosis wants to arrange for ovarian egg harvesting. There is no pre-existing consent. Can this go ahead?
A
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A
A senior nurse complains to you that there have been too many visits from senior military officers to your hospital which is disrupting patient care. What do you do?