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: 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?
• 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 the mitigation of health risks from a military deployment by providing adequate arrangements for medical support. This scenario is similar to Card NINE but is more at the strategic/operational level versus the operational/tactical level. Most countries employ their military health professionals in garrison healthcare or civilian healthcare to maintain their professional skills when not deployed on military operations or training. Fortunately, most military missions or field training do not cause large numbers of casualties. This means that the clinical skills of military healthcare workers can decay through lack of clinical work when they are deployed.

Step 2 – ANALYSE

Patient: there is an institutional duty to military patients to ensure that the care that they receive is appropriate and complies with established medical practice.  

Clinical: there is a personal professional duty on medical planners to ensure that military clinical personnel are able to maintain their clinical skills. Each clinical professional will have to ensure that they maintain the skills they need to care for military patients on operations by undertaking sufficient clinical duties/case-mix.

Legal: healthcare practitioners are obliged to practice within their clinical competence. There is increasing regulatory oversight of case-mix and training as part of professional appraisal and revalidation. This means that periods of low clinical activity have to be compensated by re-training/re-skilling.  

Societal/Military: an increase in military activities increases the requirement for supporting services. It is unlikely that commanders will accept the risk of deployments without medical support; but may not fully understand the opportunity costs associated with deploying healthcare personnel to duties with low levels of clinical activity.

Step 3 – FUSE

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

This scenario replicates a key challenge faced by medical planners at the strategic/operational level. It determines the ‘dwell time’ between missions for health professionals so that they can maintain their clinical skills, take holiday, and do all the other welfare activities they can’t do when deployed. You will have to undertake some detailed staffwork to determine the facts about the issue in the scenario.   

Step 4 – DECIDE

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

Your professional duty is to provide the best technical advice. After analysis, if the belief is found to be true you will need to work out how to explain the issue to senior military commanders. In the end, you will be asking them to reduce the volume of military activity to ensure that the medical support plan is competent. You will have to consider all other solutions including the use of alternative personnel (allies, partners, contractors), alternative providers of medical capability, the reduction of medical support, alongside the reduction in military activity. Whilst the military commanders might insist that medical personnel continue to be deployed in this way; you will need to decide how to measure the consequence of such a decision (e.g. treatment errors, resignations etc).   

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