INTRODUCTION I am shortly leaving the Army after becoming wounded and losing a leg on Operations. i thought this post would be helpful, educational and hopefully dispel a few myths and untruths that are out there in the treatment of our wounded. After i recovered from my injury I took up the post of a Military Liaison Officer (MLO) at the Royal Centre for Defence Medicine (RCDM) for a period of 4 years. Certainly not a normal job for an Infanteer however post-injury faced with a choice of working in a relatively boring job back in Battalion or attempting to give something back looking after the wounded i jumped at the chance. The way we look after our wounded has changed and consistently revolves, i am very proud to have been a part of it and i will miss being inspired by the inspirational every day. RCDM For those of you that are not aware, The Royal Centre for Defence Medicine, located in Birmingham is a partnership with the NHS. Originally based at Selly Oak hospital and has now moved to the new Queen Elizabeth hospital a few miles away. RCDM is a Tri-Service fully functioning Unit with an OF-5 Commanding Officer with all the usual CoC personalities contained with-in their own building inside the new hospital. RCDM has undergone dramatic change from the early days, When the causalities were coming in thick and fast from Herrick and Telic RCDM received an uplift in almost every department from drivers to nurses. People and processes were put in place very quickly to achieve the right balance of care, This has now been formalised and the manning establishment enhanced. I’m not sure of exact numbers but i would suggest there are at least 600+ Military Nurses, Doctors etc working at RCDM and fully integrated into the trust. Everyone who is in the Military wears their respective single Service Uniform. The Partnership with the NHS The partnership with the NHS really does work, with the NHS pulling out all the stops. The NHS nurses alongside the Military Nurses take great pride in looking after our wounded blokes. All the stories that appeared in the media a few years ago were completely false, i know because i was there. Beds have always been available and there has never been one case where a Soldier who has been aero medically evacuated back to the UK after being injured in battle has had to wait for a bed. With regard to civvies being on the ward, yes there is where there is space and spare capacity, and the NHS ensure the ‘right mix’ of civvies are allocated beds on the same ward as the wounded soldiers. It works well, there are never any drama’s, both the Soldier’s and Civvies get along great and the civvies enjoy a much higher standard of care than they would get in any other ward in any other hospital in the UK. The staffing levels on the ‘Military Ward’ are far superior to most other Trauma Wards. With Nurse to patient ratio far exceeding what would be the norm. When i deliver presentations one of the most asked questions is: Military Hospitals are now gone is RCDM delivering what they could? My answer is: Yes and more! A SP who sustains a severe injuries can require up to 14 different medical specialities, the injuries are more complex in their nature and SP are now surviving injuries that in the days of Military hospitals they would of died. If you take the Falklands War as an example - some of those with real complex injuries, ie - Neuro, were transferred to the NHS for specialist treatment as the Military did not possess the skills needed. Also, The Military medical personal are clinically better at what they do through working with the NHS. There exposure to Trauma and other injuries are allot more frequent therefore when deployed they are as good as they can be, and the survival rate is testament to that. Composition of RCDM and their functions, Services and Resources available to injured Soldier’s and their families. Apart from the obvious medical personal, RCDM is made up of smaller sub Units. The resources available to a SP and their families are very comprehensive, whilst everyone has a job role, more often than not, you will find people who’s boundaries cross and will go above and beyond on a daily basis to ensure that an injured SP and there families are looked after - and rightly so. Every department is Operationally focused and most are available 24hrs a day. Military Mental Health - Available 24/7. Every SP is screened once admitted to the hospital, any treatment action is conducted whilst they are an in-patient with follow up treatment after discharge. Defence Medical Welfare Service - Available 24/7 and normally in work at 0300hrs in the morning. These guys visit every SP admitted to hospital, they are trained councillors and provide the 1st line welfare, ie - a listening ear, sort out any clothes/toiletries they may need (they have a huge storeroom). They will also refer SP to 2nd line welfare if required. They also meet the families, manage and provide them with accommodation if entitled and ensure the families who are having difficulties coming to terms with the SP’s injuries are fully supported. Military Liaison Officer’s - Available 24/7 and normally in work 24/7. All the MLO’s (normally 4) are from Tri-Service fighting Unit’s which brings a degree of Militarism to RCDM. First and foremost we are heavily involved with VO’s - Visiting Officer’s and EO’s - Escorting Officer’s in assisting them in their plan in transporting the family of an injured SP to Birmingham, making sure they have all their bases covered and linking them in with other important agencies, ie- DMWS and to arrive at the correct time. We work closly with all sub units and providers ensuring a close liasion between them all, we sign post and provide the SP deployed and Rear Op’s CoC with a link into the hospital and their injured SP. We visit every SP who is admitted into the hospital every day and ensure the SP are helping themsleves, ie, they are still required to shave if clinically able too, keep a tidy bed space - whilst to some this may seem 'over the top’ it is in-fact beneficial to their recovery. The SP is still in the Armed Forces regardless of injury and it’s therefore important they are treated as such. We escort high profile visitors and celebratory to see the injured and each of us have a debit card from the RCDM Patient Welfare Fund Welcome to the RCDM Royal Centre for Defence Medicine Patient Welfare Fund in Selly Oak Birmingham to use for the good and benefit of the SP and their family, - Pizza or Chinese takeaway on a Saturday night, an electric razor for someone with injured hands, if some of the SP are clinically able we will take them out for a beer and some scoff or attend a football match - the list is endless and we will do pretty much anything as long as it’s sensible. When a SP is initially admitted if they are conscious the duty MLO will give them a mobile phone with credit and a troop aid bag to keep. Troop Aid Kings Court Business Centre 17 School Road Hall Green Birmingham B28 8JG as well as a regimental bag from their parent Unit - Regimental T-Shirts, short’s and even Regimental dressing gowns! Concurrently one of the other MLO’s will be waiting to meet the family of a SP, The MLO will conduct the meet and greet and then hand the family over to DMWS, from here DMWS will escort the family to the ward. We also attend and arrange meeting’s, do abit of project managing, pre-deployment briefs and anything else that would benefit the SP and their family. You defiantly earn your monthly pay-packet! AWS/Royal Marines Welfare - Available 24/7. Provide the 2nd line welfare support to the SP and their families. Often heavily involved in delicate and long running cases. RAF Aeromed Cell - Available 24/7. These work their arse’s off and are always in work at silly times. Working very closely with the Military Liaison Officer's and Defence Medical Welfare Service, These guys organise the reception of Aero medical evacuation of the SP to RCDM. Meeting the aircraft on arrival and ensuring the required transport is provided to the hospital (Blue light, Police escorts etc). They also get the SP accepted into the hospital under a named consultant and with the MLO’s assist in getting the SP out the back of the ambulance onto the relevant ward. Discharge Co-ordinators- Available 24/7. These are qualified Military Nurses who manage a SP discharge , sort out clinical referrals and onward admissions, ie DMRC Headly Court, speak to the SP Unit’s medical centre and arrange medical cover if required. Occupational Therapist - MOD paid Civilian who works her arse off. Liaises with all the Unit’s in preparation for the SP discharge, assist the UWO in ensuring the MQ, SLA is adapted if required. Military Physiotherapist's - Most SP if clinically able conduct Physio at least once a day. They have the use of a purpose built facility and work on the principle of the more they do at RCDM the better it will be for the SP at DMRC Headly Court. Remedial Instructor - A PTI who has done a long and complicated course on advance things to do with the body and how it recovers. Basically someone who ‘gently’ beasts the injured SP in fitness whilst they recover. Padre - Available 24/7. Visits SP and their families every day. Conducts remembrance services, Liaising with the SP Unit Padre and Organises trips out for some families of a spirtural nature. Also offers support and advice to everyone. Top Bloke. Military Drivers - Available 24/7. These Guys have immediate access to a wide varity of Vehicles- Minibuses, People Carrier’s, cars. They run shuttles between the accommodation and to the hospital for visiting times. They also transport families into Birmingham City Centre or most other places in the local vicinity, they assist the MLO’s in many tasks and are worth their weight in gold. Duty Critical Care Nurse - A senior Military nurse available 24/7. He/She provides a service to the families of SP admitted to the Critical Care Unit. He/She explains all the clinical terminology and the subsequent meaning. He/She also prepares the SP and their families for a move to a more open ward when appropriate. Alexandra Wing - Open 24/7. Soon to be replaced by a new build. Manned by either a Nurse or Medic this is a facility that provides accommodation for soldier’s who don’t require addmission to hospital but do need to be seen by a Doctor. Also it proves accomadtion for families which is closely located to DWMS for intiment support. Generally, it has a kitchen with free food, tea and coffee etc, 2 living rooms with Sky etc. It also stores all the kit a SP has when they are aero medically evacuated to Birmingham ie- Body Armour, Helmet etc. The Alexandra Wing provides the R/V point for a VO/EO and their respective family when they first arrive to see thier injured SP. Fairford Flats - Open 24/7. A block of flats that are leased by the MOD for the use of long term patients families. Regularly re-ferbished and most with Sky TV. Managed by DMWS. SSAFA Norton House - Open 24/7. Very nice, rather large house. Superbly kitted out. Provides accommodation for families. Managed by DMWS in conjuctioin with SSAFA. Unit Welfare Officers - 99% of the UWO’s i have dealt with have been spot on, re-active and will pull out all the stops. Normally they are the first to hear of injuries before we give them the formalised comfirmed version. The days of improving your handicap on rear party are long gone! The UWO is absolutely cruitial to the success of the treatment of an injured SP and forms a vital link, Many UWO’s i have seen after a 6 month tour look like they have aged by 10 years! We always encourage the UWO to visit their injured SP and gives them the chance to deal with any Unit issues. Outside Agencies and Support - Blesma, St Dunstans and a few others who can offer something to an injured SP in common with their injuries are allowed onto the ward and are normally referred by DMWS. Unfortunately, we don’t allow Regimental Assosiations or Vetrans groups. As you can see from above the ammount of people involved with a SP care are immence, so a limit does have to be inposed otherwise a SP never gets any rest! Unfortunaterly, not everone that is evactuatied back to RCDM injured wins their fight. When this does happen, or we know that it is going to happen a seperate team is formed comprising of revevant people i have listed above to help support the family through this. Whilst we do everything we can, ususally we find it’s the appointed VO and the UWO who carry the burden but ensure the family are rightly looked after - anything they require or need - they get! Sometime’s when a SP is KIA one of his best Oppo’s may be injured and be a patient at RCDM. In a few case’s, the SP who was KIA saved the life of the injuried SP. We break the news to the Injured SP after the family have been informed but just before the name is realised to the media with authority from JCCC. Being the bearer of bad news is never good, even more so when it’s to a SP who is beadly injured and is in hospital but it’s better being told properly than just finding out through chinese whispers or the media. Day to Day life on the ward The ward is absolutely manic at times! there are so many people involved in a SP care that sometimes you have to queue to see an injured SP. That aside, the ward is split into 3 x 4 man bays each with their own toliet and shower and numerous single rooms with en suit. In each bed space is a pull down TV. It requires a payment card to use it, The SP are given these cards free of charge. You can also browse the Internet on them too. At the end of the ward is a dedicated day/rest room with comfty sofa’s, Sky TV, IPads, Xbox, Tea and Coffee, cold drinks and as much sweets/chocolate/cake and fruit you could ever eat. Normally one of the MLO’s will be organsing a trip out for the SP that are clinically fit to attend and of course it’s all free, for those that can’t attend we will at the very least get them a takeaway to their beds. We encourage those that can mobilise, be it on crutches or using a wheelchair to get out and about if it’s ok with their nurse, using the Military drivers to transport them. All SP are entilited to double rations, and the food is generally good and their is always plenty of it. Some injured SP do struggle coming to terms with their injuries - thats perfectly natural in the circumstances, we do all we can to help them, including getting simular serving injured SP from DMRC Headly Court who are now walking on Prosethic legs to show what can be achieved. No two days are the same, On a Tuesday the Military ward round takes place and gives the injured SP the oppitunity to ask any Service related questions with regard to their injury, clinical updates, poss discharge date’s etc. Every morning, a Military paitent team meeting takes place with almost all the above listed personailtys where each and every injured SP is discussed, their clinical progress, morale, welfare and family issues and then any highlighted problems are solved. Not all Soldier’s who are admitted to the hospital go to a Trauma ward. They go where it’s clinically best for them. To us, that makes no difference and we will visit them and they will recieve exactly the same service. Some day’s we host VVIP and celebrity visit’s. They always over run because they spend so much time talking to the injured, they genuinely do cheer the injured up and more often than not they go away truely speechless and overwhelmed by the courage shown. Secruity is taken very seriously, the ward itself is secure with controlled access and a host of other arrnagements in place. 　 I hope i have provided a useful insight into how we look after out wounded and their families. I know some Arser's on here have been also been a patient, i hope there view's mirror mine. All the information i have written is publically available, i have deliebrately left out some speciffics for obvious reasons. If you ever get the chance to become an MLO grab it - it will be one of the most challeging but rewarding jobs you could ever do. If anyone has any questions please feel free to ask and i will do my best to asnwer. 　 Edited to add: I thought i would 'test' the water with my initial post, as the response has been good i have more to add therefore will write a 2nd post on this subject.