Monday, 23 April 2012

SAF explains its emergency medical protocol

WE THANK Dr Ng Shin Yi ('NSF's death: Doctor queries medical protocol in field, SAF centres'; Thursday).

The Singapore Armed Forces (SAF) emergency medical support system (EMSS) is built upon the 'chain of survival' process adopted by the American Heart Association.

The system's chain comprises five key components: Early Access (to medical attention), Buddy Aid (including cardiopulmonary resuscitation), Basic Life Support and Early Defibrillation, Advanced Resuscitation, and Evacuation for Continuing Care.

Every link in this chain is designed to provide the best possible medical care for our soldiers in training and operations.

All SAF medical centres have an Emergency Resuscitation Facility (ERF) to handle medical emergencies.

These are modelled after emergency resuscitation bays in the emergency departments of hospitals.

SAF medical officers stationed at the ERF are trained and accredited in advanced clinical resuscitation protocols, including Advanced Cardiac Life Support, Advanced Trauma Life Support and Emergency Airway Management.

Medical evacuation is an important component of EMSS.

The principle is to evacuate an injured serviceman to an emergency medical facility with the appropriate level of care within the shortest possible time.

This can either be the nearest ERF within an SAF medical centre or a restructured hospital's emergency department.

All SAF medical personnel are trained to decide on the most appropriate facility to evacuate an injured serviceman to in an emergency.

Dr Ng also asked about the training of our front-line medical personnel. SAF medics undergo systematic training on paramedic protocols for medical emergencies that they are likely to encounter.

This training is developed in conjunction with the Justice Institute of British Columbia, a leading educator for training pre-hospital care paramedics.

In addition, SAF medical personnel regularly conduct team-based training in managing medical emergencies.

Last year, the SAF introduced mobile medical evaluation teams to assess the medical response standards of the entire EMSS.

This stress-testing and evaluation allow the SAF to continually improve its EMSS capability and proficiency.

The SAF's EMSS is endorsed by the SAF Emergency Medicine Specialist Advisory Board, which comprises senior emergency medicine and trauma surgery specialists from Singapore's restructured hospitals.

This clinical governance framework ensures that the SAF's evacuation policy, training, medical equipping and protocols are continually benchmarked against best clinical practice guidelines.

The Ministry of Defence assures the public that while the training remains tough and realistic, the SAF also maintains high safety standards to ensure that the safety of our soldiers is not compromised.
Colonel (Dr) Kang Wee Lee
Chief of Medical Corps
Singapore Armed Forces
ST Forum, 21 Apr 2012

NSF's death: Doctor queries medical protocol in field, SAF centres
LIKE most of the other national servicemen who collapsed during training, the latest victim was attended to by an onsite medic before evacuation to a Singapore Armed Forces (SAF) medical centre ('NSF dies after collapsing during training exercise'; yesterday).

As I understand from the protocol, such servicemen will be treated by an SAF medical officer before being evacuated to a hospital, with resuscitation en route. Some of these servicemen, unfortunately, do not survive.

Can the SAF shed light on the standards of its medical officers, who often take up duty at its centres after having graduated from medical school only one to two years earlier, and are expected to perform life-saving resuscitation?

Are SAF medical officers expected to run a full adult cardiac life support code, that is, undertake a set of clinical interventions competently and urgently to stall or arrest life-threatening situations?

It is difficult for a junior medical officer supported only by medics to execute this medical code.

In a hospital, the code team often consists of experienced doctors and nurses.

Does the SAF Medical Corps audit the codes run by its servicemen? Are its medical officers regularly certified?

When a civilian collapses in public, he is tended to by Singapore Civil Defence Force (SCDF) paramedics, who practise a basic life support code called Basic Cardiac Life Support and Defibrillation, before being taken directly to a hospital.

As time and advanced medical support are of the essence, the SAF may want to harmonise its protocol with the SCDF's, and consider direct evacuation to a hospital when a soldier collapses in the field.
Dr Ng Shin Yi
ST Forum, 19 Apr 2012

Former NS doctor's take on training and evacuations
HAVING served as a full-time national service medical officer, I was involved in resuscitation cases and have full admiration for my medical orderlies ('NSF's death: Doctor queries medical protocol in field, SAF centres' by Dr Ng Shin Yi; Thursday). In many cases, the resuscitations were successful.

For instance, one medic applied mouth-to-mouth resuscitation on a serviceman who was fished out of the waters off Sembawang. He applied it at the beach and on the jeep until they reached the medical centre 500m away. After that, we worked on the serviceman until he regained consciousness. If we had done what Dr Ng suggested, that is, take the casualty directly to a hospital about 12km away, he would have faced certain death.

Our medical officers are trained to provide early resuscitative care, be they in the Singapore Armed Forces (SAF) or the Singapore Civil Defence Force.

Early resuscitative care is the best chance for survival. An unsuccessful resuscitation does not mean that the doctors are inexperienced or incompetent. If the problem is training, it should be addressed at medical school and during the doctor's housemanship; and experience is subjective.

In any military exercise, there may be casualties. If we evacuate every casualty to a hospital, it will require an aero-evacuation team. An ambulance reportedly takes about 30 minutes to reach a hospital during peak hours after a casualty is reported. So it will be better for a medical officer to initiate treatment at the location and en route.

The SAF has the best interests of its servicemen at heart. I have two sons who completed national service safely. I suggest that the SAF Medical Corps look into the training of young medical officers instead of reviewing protocol.
Dr Chong Jin Long
ST Forum, 21 Apr 2012

Worried parent calls for independent review, preventive measures
AS A parent, I am concerned and distressed by the news of the death of a third national serviceman in less than four months ('NSF dies after collapsing during training exercise'; Wednesday).

The latest tragedy calls for a thorough review of the standard operating procedure for training and rendering of medical aid, especially as all the three men who died were young, fit and in the prime of life.

While the Ministry of Defence (Mindef) may have undertaken a thorough investigation after each fatality, it seems that it has been unable to identify or rectify the root cause.

Perhaps it is time for an independent board of inquiry to be set up to investigate such deaths and review the preventive measures taken, especially as the public has never been given a thorough report of such investigations.

Every Singaporean male has been told to fulfil his responsibility as a soldier for national security.

As a parent, I recognise the importance and the need to place such a high emphasis on maintaining a credible defence force. So we entrust our sons to Mindef with the implicit assurance from its commanders that their safety and care will not be compromised in any way.

The onus is now on Mindef to give an open account of what actually happened and what appropriate measures are being taken to prevent a recurrence.

As the Government has emphasised repeatedly, our most precious resource is our people. One death in camp or training during national service is one death too many.

For a parent, the loss is painfully irredeemable, and not about one statistic among many.
Helen Kang (Ms)
ST Forum, 21 Apr 2012

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