THOUGHTS ON THE DEVELOPMENT OF THE FIELD HOSPITAL

Discussion in 'Professionally Qualified, RAMC and QARANC' started by Comments1978, Jun 30, 2008.

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  1. The AMS has recently looked at the three regular Field Hospitals with the aim of standardising exactly what each one holds and the facilities it will provide. The aim I am told, although I have seen nothing in writing, is to be able to set up a facility which will treat casualties for a period of 30 days. During this 30 days a second ‘tier two’ facility will be constructed and the medical unit will move into that. This is a good idea in theory, however, it is my opinion that the way that this has been gone about is completely wrong and as such the Field Hospitals, and consequentially the AMS will not be best placed to support the Field Army in the future.

    The restructuring and standardisation of the Field Hospital is long over due, and as part of the Improved Medical Support to the Brigade (IMSB) study it was decided that the Field Hospitals should have two roles. Firstly they should have small manoeuvrable hospitals which are able to be tactically placed within the Bde area, ensuring that medical timelines are met within the moving battle space. Part of the study suggested that 2, 50 bed facilities would be able to ‘pepper pot’ forwards (or backwards) ensuring that one is always open and able to provide care in a suitable location. Secondly there should be a larger field hospital within the rear area manned by the Territorial Army, this larger hospital could equally well be met using Strategic Air or Sea Assets and transporting personnel back to the UK and will not be considered futher here.

    As part of the restructuring of the Field Hospitals, 2 Med Bde initially felt that they should provide direction to the 3 Regular Field Hospitals. This was protested and consequentially the Field Hospitals were allowed to combine their knowledge and decide on what they felt was the best lay out of a Field Hospital as part of the IMSB study. The result was a Hospital of increased size, loosely based on the current tier two facilities in Iraq and Afghanistan. The design has been recently trialled requiring a lift of approximately 50 ISO containers and a flat area of approximately 100 x 150m for construction. The trial also showed that it took approximately 3½ days to construct and equip the hospital. This is certainly not something that is designed to be in keeping with the manoeuvreist approach that drives the other Arms and Services and should also drive the AMS.

    The fact that the design of the Field Hospital has been driven by the Regular Field Hospitals and not AMD or even 2 Med Bde has led to a narrow, almost isolationist approach to the problems faced. There has been no ‘buy in’ by any of the following:

    Engineers. At this scale a vital requirement to prepare the land, provide water and electricity to the Hospital. They are also required to install a system to remove the waste water.

    Logistics. At its current size the hospital is not planned to move once placed. However, moving 50 ISO containers to the right place at the right time raises serious concerns. Is this really achievable considering the amount of lift that may be available during a fast moving battle? Although Medical assets are important, they need to be weighed up against the requirement to move Ammunition, food and water to the front line.

    Manoeuvre Brigades. The Manoeuvre Bdes must be able to support their Field Hospitals, they must also see the Hospital as an Asset that they can deploy and not a hindrance to their Scheme of Manoeuvre.

    In order to ensure that the Field Hospital is the best that we are able to provide for “a War”, rather than “the War” we must ensure that the proposed solution fits with as many Principles (most suitable here are the Principles of Logistics) as possible. I will now consider each of the principles in turn (less Foresight):

    Economy. Approximately 90-95% of the capability that can be provided by the IMSB Field Hospital could be provided by a much smaller facility (approximately 25% the size). This would provide sufficient medical capability for the first 30 days of an operation. Any specialist equipment such as a CT Scanner would need to be procured specifically for the operation and is extremely difficult to support in a Manoueverist environment. Physio, Welfare, CPN and GU Med do not necessarily need dedicated areas in the first 30 days of an operation as they will be mostly employed elsewhere if required at all. These facilities should however be included in the tier two build. The reduced size ensures that there is less construction required allowing the Hospital to be ready to receive casualties in a matter of hours rather than days. A smaller facility would also have less requirements for power and water. It is also my opinion that the facility should be planned to operate without the need for plumbing, at least for the first 30 days. Such a facility would also be less of a burden on the logistic chain allowing more efficient placement, there is also the potential that a facility can be dismantled within a reasonable period of time. This would allow the facility to be ‘recycled’ in a moving battle, reducing the waste of deploying an entirely new Field Hospital.

    Simplicity. The larger and more complicate the facility and the more equipment that is deployed the more there is to go wrong. Such a facility requires a larger logistical footprint for just day to day support. The smaller and consequentially simpler that we can make the facility the better.

    Cooperation. A study should be made into the other NATO countries to ensure that we are moving in the same direction. We should aim to provide a similar range of facilities (to NHS standards where possible). Then with an Joint Allied Deployment, Operational Commanders at the highest level would understand what they were deploying with. The Other Arms and Services should also be spoken to ensure that we are providing the facility that they expect from us and are able to support.

    Flexibility. A smaller facility can be potentially supplied and maintained at a lower cost (in both monetary and manpower terms), as such there would be potential for a greater number of Field hospitals to be in place which can be deployed to support a wide range of situations. This would also bring into play the Economies of scale and could potentially provide a saving in the long run.

    WHAT SHOULD HAPPEN NEXT

    In my opinion the current work towards the IMSB should be stopped immediately before more time and effort is ‘wasted’ on something that may not be the best solution to the current problem of Medical Support. A high level meeting then needs to take place at AMD, who should be the lead on the matter. The meeting should decide on the Effects that IMSB wishes to have on the Battlefield. Following this, all Defence Consultant Advisors (DCAs) should be tasked to work on how best they can achieve these Effects. They should produce two pieces of work, the first being the minimum level of resources required to achieve each Effect (representing the initial entry Hospital), and the second being the resources required to meet the gold standard (representing the Tier two build after 30 days).

    Once these pieces of work have been completed a conference should be convened with at least the following attendees:
    2 Med Bde
    DCAs
    Each Regular Fd Hosp
    Representatives from the Med Regts (to ensure interoperability)
    REME (MDSS Representation)
    RLC
    Manoeuvre Bdes
    Royal Engs (STRE)

    Over the conference, a Field Hospital should be considered which fits best within the Principles of Logistics, both for the initial entry hospital and subsequent tier two build. This can then be refined over a period of trials. Instigated now, the whole project may take between 12 and 18 months. However, it will only be by going through this process that we ensure that the AMS is moving forwards and developing its doctrine in the best possible way.
     
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  2. I think hospitals are a good idea.
     
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  3. Comments 1978 - perhaps you don't need an opinion.........your own seems to be quite developed??
     
  4. Really good article and totally bang on. Summerise's the thoughts of a lot of those that are involved.
     
  5. You are very informed, too much info for this forum perhaps. Perhaps you would be better served to present a paper for secure circulation rather than give all this statistical data on current / future capability to those who perhaps should not be reading it.

    Mod do somthing?
     
  6. An excellent post with perhaps a little too much info as has been said however, cast your mind back 15 years to the Field Ambulance. The smaller hospital smacks of this kind of deployment which, after all, has been tried and tested over many years and campaigns and it works !

    Move with the times but in my opinion, it wont be too long before the wheel is re-invented and we find ourselves doing exactly what was scrapped 15 years ago. Financially viable, logistically tried and tested and above all trusted by front line troops
     
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  7. Do you not think you might need some input from ISS or Royal Signals as i assume you will want some form of CIS for DMCIP and stuff of that ilk. What will your Information Exchange Rate (IER) (Bandwidth requirements etc be?)

    Just a thought
     
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  8. Far too much info in your post Fella; where was the trial and which unit hosted it?

    L
     
  9. msr

    msr LE

    Too much info and you ask for more?

    msr
     
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  10. Check your PM's.

    Thought exactly the same when I read the first post. I've seen very little to indicate what modern ICS will bring to the battlefield or what it requires e.g. installation techs to cable up a hospital, IS Eng/tech to run the computer system, hmm... RSigs takeover, what do the RLC now do?? For the DMS/AMS I'd expect of lot of information being provided that changes the way they work.
     
  11. Excellent post

    The "Fd Hospital" that the Irish purchased in what the UN calls a Level 1 (possibly level 2 can't quite remember) Medical facility (battalion level) and it is the equivalent of around 10-15 ISO containers.

    From what you are saying the new British Army Fd Hosp is at brigade level?!

    ===========================
    UN (probably equates to NATO) Levels are:

    Level One:
    Bn level (at least 20 ambulatory patients per day)
    Entry medical exams, minor surgery under local anaesthesia
    Emergency Resusication & Triage
    5 patient ward for up to 2 days
    Vaccinations
    Basic lab facilities
    Provide 2 Forward Medical Teams (ambulance with MO)
    Preventive medicine
    It has supplies for up to 60 days.
    2 x MOs, 6 x EMT/Nurse, 3 x support staff

    Level 2:
    Bde- level (up to 40 ambulatory patients per day)
    Entry medical exams
    Limb & life saving surgery (3-4 major procedures under general anesthesia per day)
    Emergency Resusication & Triage
    Hospitalize up to 20 patients for up to 7 days (ICU for 2 patients)
    Basic x-rays (up to 10 per day)
    Dental (up to 10 cases per day)
    Vaccinations
    Lab tests (20 per day)
    Provide 2 Forward Medical Teams (ambulance with MO)
    It has supplies for up to 60 days (plus able to resupply level 1)
    Staff: 2 x surgeon, anaesthist, intern, GP, Dentist, Hygiene Offr, Head Nurse, 2 x ICU Nurse, O/T Assistant, 10 x EMT/Nurse, Radiographer, Lab Tech, Dental Asst, 2 x Driver, 8 x support staff

    Level 3 (rarely deployed by UN usually uses existing hospital):
    Bde+ level (up to 60 ambulatory patients per day)
    Specialist medical consultancy
    Major general/orthopedic surgery (10 per day under general anesthesia)
    Advanced life support & Triage
    Stabilise for long-haul air evacuation to Level 4
    Hospitalise up to 50 patients for up to 30 days (4 ICU beds)
    Basic x-rays (up to 20 per day) including ultrasound & CT
    Dental (10-20 cases per day) including limited oral surgery
    Vaccinations
    Lab tests (40 per day)
    Provide at least 2 Forward Medical Teams (ambulance with MO)
    It has supplies for up to 60 days (plus able to resupply level 1)
    Staff: 16 x MOs (surgeons, anaesthists, interns, GPs, orthopedics, dermatogist, psychiatrist), dental surgeon, pharmacist & assistant, Dentist, Hygiene Offr, 50 x Nurse/EMTs (ICU, O/T Assistant, EMT, Nurse), 2 x Radiographer, 2 x Lab Tech, Dental Asst, 14 x support staff

    Level 4 would be the equivalent to a fully equipped NHS hospital
     
  12. Ventress

    Ventress LE Moderator

    The problems highlighted in the first post were being confronted in 1988 when 22 Field Hospital in Thornhill Bks.
    The size that the Hospital was required to become made it unman able and unmovable. The Clinical Governance of today means you must have equipment and a standard of treatment that must be provided. But with which comes a huge Logistic tail.
    The Engineers should have a permanent presence in the Hospital not just a pop in and sort out attitude. (I mean a full RE troop not just the usual Plumber, Carpenter etc) Also as stated the RLC seem to go white when the ISO’s needed moving.
    Setting up time will always be extended, but when we exercised with a 25 bed facility that blistered onto a Dressing Station, the idea seemed to work quite well until the 25 beds suddenly ended the Dressing Station’s mobility. In GW1, our DS had the 25 beds and theatre towards the end of the deployment and it worked fine. But don’t ask it to move in 5 hours.
    Having seen what was a 1985 Fd Hosp and the beast they became in 2004, you are always playing off speed and maneuverability against service supplied.
     
  13. Sorry to repeat myself. The biggest change within the DMS is IT, any review needs to consider this. It changes the way decisions are made, i.e. a solder gets injured and is sent to the RAP and that information is available at PJHQ within seconds. Its not RLC/RE assisted 'tortoise' environment anymore
     
  14. I was somewhat confused when I saw the proposed footprint for the IMSB 50 bed and realised it was actually bigger than the old 200 bed. How does that work?
     
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  15. Comments1978

    If you introduced yourself properly, I believe you would put a lot of people's minds at ease and get the feedback you seek..

    ..or not..