UK Government: Military Health Heroes Unveiled

Winners at the second annual Military and Civilian Health Partnership Awards include a Buckinghamshire team who dealt with a pneumonia outbreak on a military base in Afghanistan; a Glasgow team treating troops blinded by injuries on operations; a nurse who ran the emergency ward in Camp Bastion field hospital, and a Birmingham NHS consultant - also a Colonel in the Territorial Army - who has organised life-saving platelet donations from soldiers to injured colleagues in the field in Afghanistan.

Civilians and military personnel from Glasgow, Birmingham, Buckinghamshire, Surrey and County Durham triumphed in eight categories. Hosted by the Scottish Government on behalf of a UK-wide partnership, the awards honoured winners at home and abroad:

* Innovation in Service Development Award - Sealladh, Glasgow - The Neuro Vision Training and Rehabilitation

* Education and Training Award - Scottish Association for Mental Health (SAMH), Glasgow - A Practical Guide to Working with Veterans

* Team of the Year Award: Military and Civilian Health Partnership Award - The University Hospital Birmingham NHS Foundation Trust, Birmingham - Ortho-Plastic Team

* Deployed Healthcare Award - Major Moira Kane - 202 Field Hospital (V) Birmingham, Birmingham

* Healthcare Reservist of the Year - Col Heidi Doughty - Consultant in Transfusion Medicine, NHS Blood and Transplant, Birmingham

* Health Improvement and Promotion Award - COS Health Department, RAF High Wycombe - Management of Community Acquired Pneumonia Outbreak in Kandahar

* Mental Health Award - British Army, Camberley - Trauma Risk Management Training

* Care of Veterans Award - Tees Esk and Wear Valleys NHS Trust, Bishop Auckland - Veterans' Mental Health

The awards were presented at a black-tie reception this evening at Hopetoun House in Edinburgh, attended by Deputy First Minister and Health Secretary Nicola Sturgeon and UK Defence Minister Kevan Jones.

Ms Sturgeon said:

'All our nominees have shown remarkable skill, dedication and commitment. Both civilian and military, their work ranges from life-saving critical care on operations in places like Afghanistan, to life-sustaining long-term physical rehab and mental health care at home.

'Thanks to these doctors, nurses and other healthcare staff, our armed forces and veterans benefit from the outstanding healthcare they deserve.

'Tonight's awards celebrate the partnerships that make this possible. It's an honour to meet these truly remarkable people and I congratulate each and every one of them.'

Defence Minister Kevan Jones said:

'These are incredible people working hard to provide the very best care to our military personnel and veterans, both in the UK and on operations in Afghanistan.

'It is an honour and a privilege to meet them tonight and thank them for all they have done, and for all they continue to do, for their country.'

PLEASE NOTE: WINNERS WILL NOT BE AWARE THEY HAVE WON UNTIL THE AWARDS CEREMONY TAKES PLACE (18:00-20:00, THURSDAY OCTOBER 29) - PLEASE DO NOT APPROACH THEM BEFORE THIS TIME.

Background

The Military and Civilian Health Partnership Awards 2009 are hosted by the Scottish Government - one member of a partnership comprising the Ministry of Defence, the Department of Health, the Welsh Assembly Government and the Department of Health, Social Services and Public Safety for Northern Ireland.

The awards are open to military or civilian members of the Defence Medical Services, NHS or independent sector healthcare professionals who, either on an individual or team basis, have benefited the care of a member(s) of the Armed Forces, including veterans or their families.

More information can be found at www.militarycivilianhealthawards.org

Contact

For more information on the awards, please call Annalena Winslow at the Scottish Government on 0131 244 2797/07917 052 265 or Sara Reed at the MoD on 0131 310 2005/07747 767 963. Please call Sara Reed for pictures.

Pictures from the awards ceremony will be made available from approximately 20:15.

Case Studies of Winners are below

Deployed Healthcare

Major Moira Kane, Op Herrick, Afghanistan, 202 Field Hospital (V) Birmingham

Maj Moira Kane is the Nursing Officer in Charge of the Emergency Department of the Role 3 Hospital in Camp Bastion Afghanistan. Her calm approach to what would be described in a atypical large hospital in the UK as a MAJOR INCIDENT, when these are happening on a daily basis is truly remarkable. She manages a large multidisciplinary team directing resources in order to maximise the benefit to the patients in the most appropriate way. The casualties are such that a lesser person faced with multiple cases with such injuries as bilateral traumatic amputations might panic. This lady is rock solid and an inspiration to all.

It is not unusual for this facility to have several severe 'Major Incidents' per week. It is essential that the person controlling this activity is cool calm and collected under this immense pressure. Every one of the consultant specialists agrees that Maj Kane does an amazing job. Without exception every one of her team holds her in the highest regard. It matters not what time we get a Mass Incident, she is always there to ensure the casualties gets the very best of care, 24/7.

The consultant specialists here have all done multiple deployments and all agree that Maj. Kane is exceptional in the way that she deals with the extreme pressures, cares for her patients and most importantly cares for her team who are witnessing trauma the likes of which they are very unlikely to witness anywhere else. Another impressive fact about Maj Kane is that she is a Reservist

There have been many challenges on this Deployment, from the high workload to the difficulties with the high rate of consumption of critical supplies. Maj. Kane has overcome all of these in her area through excellent management and leadership. It is essential that the person running the Emergency Department in this field of Operation is very carefully selected to ensure that they can cope with the pressures of this role.

Care of Veterans

Veterans' Mental Health project

NHS Trust, St Aidan's House, 2A St Aidans Walk, Bishop Aukland, DL14 6SA

For the first time in history, military veterans are receiving appropriate expert prioritised and sensitised mental health treatment thanks to an infrastructure now in place right across the whole of Tees Esk and Wear Valleys NHS. The service is one of a series of pilot partnership projects between the Ministry of Defence and the Department of Health to improve the mental health care of veterans.

Over 100 professionals now form a network of workers trained in military culture and veteran issues and are now better equipped to understand and engage with the veteran and to meet the full spectrum of mental health needs.

The existence of two networks, one consisting of approximately 105 generic mental health workers who have undergone awareness training in veteran issues and military culture; the second network consisting of approximately 50 trauma workers who have expertise in treating Post Traumatic Stress Disorder (PTSD) and who have undergone training in applying these skills to the military context.

Training on military culture and veterans' mental health issues, and working with Military PTSD was collectively provided to over 150 Trust staff across over 60 service delivery teams. Key access points were identified and a media campaign was launched to raise awareness of the service.

Unique to this project, is the overriding philosophy to create a fully 'integrated' and culturally sensitive service that delivers the full mental health service, using existing resources and expertise. In this way it is possible to offer a range of skill mixes to meet various mental health needs including trauma. Furthermore, services can be delivered within the veteran's local context.

This project's approach is arguably more efficient in that it ensures that veterans receive a cultural sensitive service at the key first contact point wherever they enter mental health services, and thereafter through their service journey, by employing the use of mental health workers from mainstream mental health services when required and so increasing the capacity available to them.

Team of the Year

Orthoplastic Team, RCDM, Selly Oak Hospital, Birmingham

The combined Ortho-Plastic Team at the University Hospital Birmingham NHS Foundation Trust, which consists of NHS and MOD personnel, provides an impressively coordinated approach to the management of military patients. The planning for incoming casualties begins well before they arrive at the hospital and often results in casualties being taken straight to the operating theatre on arrival to be dealt with by several consultant-led teams concurrently.

As well as Orthopaedics and Plastic Surgery, the core team includes microbiology, pain management and rehabilitation specialists. From the outset the focus is on delivering a multi-disciplinary, multi-specialty care package to each and every military patient. The weekly military ward round, involving the entire team, clearly addresses the need for battle casualties to have clear, progressive care plans aimed at an end-state, which, for the most complex, is admission to high intensity rehabilitation at the Defence Medical Rehabilitation Centre.

Clinically the most difficult challenge and one which has required the most innovative solutions has been the management of wound contamination. Orthopaedic fixation and soft tissue reconstruction must, in these circumstances, be planned in careful consultation with the microbiologists. Fixation and reconstruction must also take into account the need to begin rehabilitation early in order to achieve the best functional outcome for the patient. The unique needs of the military community, now met through an extensive patient support services team, has allowed the clinicians to focus on developing these innovative solutions.

Significant trauma in a young population requires a large and dedicated multi-disciplinary and multi-specialty team with a clear focus on functional recovery and the ability to make rehabilitation decisions very early in the pathway. Cross-speciality working provides an environment in which the needs of the patient come first and changes in practice can be implemented quickly.

Mental Health

Trauma Risk Management training (TRiM)

British Army, Camberley

Mental Health is an important issue within the defence forces, one that is constantly being developed to create better support for service personnel. Many soldiers witness traumatic circumstances as part of their operations, which can lead to mental health problems that affect their daily lives and performance.

The Trauma Risk Management (TRiM) training programme has been devised to tackle this and is being delivered to large numbers of deploying troops in order to improve awareness of physiological trauma after critical incidents.

TRiM allows units to take a proactive approach to the management of military personnel involved in traumatic events and improve their psychological management. It is a proactive non-medical system where unit personnel provide risk assessments, accurately assessing how personnel are coping after their experiences. It provides an early opportunity to spot those who might not be coping well, where they can be referred for professional medical help. Early targeted intervention means those in need can be more effectively treated.

In each of the last 3 brigades deploying to theatre, more than 200 personnel have been trained in TRiM. In the last year, more than 2000 Army personnel have been trained by the TRiM Training Cell (TTC) across the world and the initiative is being used widely in Afghanistan.

TRiM training is delivered by a dedicated team consisting of seven experienced Warrant Officers and a late entry Major. All are from various regiments and are actively involved in the organisation and training of Army personnel, both Regular and TA. The team delivers detailed and intensive training to non-medical personnel enabling them to support and work alongside those who are medically qualified to improve the management of soldiers after combat and other traumatic events. Medical personnel are also trained in TriM, which is important as they are a high risk group who are routinely exposed to trauma, particularly on operations.

TRiM also has non-operational applications and can be used after road traffic accidents and other such traumatic events.

By training large numbers of personnel, the Trim Training Cell is providing an important operational capability that may help to reduce the number of psychiatric cases in the long term. Their success is due to the diligence of the team, who with limited time and resources have developed a training scheme which is now regarded as an initiative of excellence, quickly gaining credibility with the chain of command and resulting in an extension of the capability to the Royal Air Force.

By providing a structured framework and improved awareness training, the TRiM programme is actively helping to remove the stigma attached to mental health issues in the Armed forces.

Innovation and Service Development

Sealladh (based in Glasgow): Neuro Vision Training and Rehabilitation Many veterans who have sustained a traumatic brain injury in combat suffer, along with other symptoms, neurological sight loss. Given the often complex needs of such patients, sight loss may be a lower priority and can sometimes be overlooked. This can result in many patients not being aware that their clumsiness or physical difficulties are due to visual dysfunctions and not other brain damage. These visual dysfunctions can take the form of hemianopia (blindness in one half of the visual field), quadranopia (blindness in one quarter of the visual field), or visual neglect (a decreased awareness of part of the visual field).

Neuro Vision Technology is an assessment and training package designed to train someone with neurological vision impairment to maximise the use of their remaining vision and to become as independent as possible. NVT has been used successfully as a vision rehabilitation tool for combat veterans with traumatic brain injury in the USA and in Australia, but there were no plans to develop such a treatment in the UK. Visibility - a west of Scotland charity that works with people affected by blindness, decided to start a pilot programme, which combined intensive NVT training with rehabilitation.

The biggest challenge faced by the visibility team was to convince health professionals in the UK that the NVT programme was going to work. Although it is widely used in other countries, very little is known about it in the UK. To convince these professionals the team gathered evidence and statistics from established NVT centres in the USA and Australia. The team also gathered very convincing evidence from case studies of the first two patients in Glasgow. Once they had demonstrated that the technique really did work, there were much higher levels of interest which, combined with a series of awareness raising talks to health groups throughout the west of Scotland, resulted in an immediate increase in referrals.

So far, 20 veterans aged from 26 to 76 have taken part in this project, and the changes to their lives have been dramatic. The project has demonstrated that intensive training can maximise the use of remaining vision, promote visual memory and spatial reasoning, and improve saccadic and pursuit movements. Ultimately it gives the patient back a degree of independence. The most dramatic recoveries resulting from NVT training are two veterans who have been able return to work.

Project Coordinator, David Logan describes this as the most rewarding part of the job;

'The most rewarding experience is watching those in our care regain confidence and independence throughout all aspects of their lives, especially those able to return to full-time work.'

Fiona Sandford, Chief Executive of Visibility stresses the importance of the NVT project in Scotland:

'If this project did not exist many of our clients would still be undiagnosed and be unaware that their clumsiness and lack of coordination was due to sight loss.'

David Logan said finally:

'We at Visibility are honoured to be nominated for this award. It came as a great surprise and we're delighted that the important work we're carrying has been recognised and appreciated. I would personally like to commend the team's work here at Visibility and say an especially large thank you to our visual rehab practitioner, Laura Campbell who has been central to our success.'

Healthcare Reservist of the Year

Col. Heidi Doughty, NHS Blood & Transplant, Birmingham

Seriously injured soldiers are at risk of bleeding to death due to physical disruption of blood vessels. The problem is due to the low levels of plasma clotting factors and platelets. Platelets are vital for normal clotting and whilst they can be donated in the UK they only last for 5 days in special storage conditions. Delivering platelets to the battlefield from the UK is an enormous logistic challenge - it is almost a 'mission impossible'. The UK is the only nation providing platelets from their blood service and sometimes cannot get the platelets there. A new solution was required - Operational apheresis. This has allowed soldiers to help other soldiers by giving life saving platelets.

Col Doughty had already been closely supporting the Blood Supply Team since 2005 when the military team moved to Birmingham. Col Doughty then volunteered as a TA officer working for the National Blood service to drive forward this Urgent Operational Requirement in Nov 2007 as the medical officer.

Col Doughty is an employee of NHS Blood & Transplant (NHSBT). The organisation has been key to the success of this project. Line managers have granted her unpaid leave and flexible working hours in order to respond at often short notice. The NHSBT has continued to work closely in the provision of advice and highlighting the importance of the work through staff and donor communication. Col Doughty has used the project in the education and recruitment of platelets donors for the NHS. In addition, she has lectured to a wide range of groups highlighting the need for blood and platelet donation to support civilian trauma. Col Doughty has worked closely throughout with the military blood supply team, part of Medical & General Supplies IPT and the Defence Consultant Advisor in Transfusion. The project also supports soldier donors by allowing them to give platelets and return immediately to duties. Donors can give regularly every month unlike whole blood donors who can only give once every few months. Donors have an enormous sense of satisfaction. In addition, she has excellent support from 2 Medical Brigade and her own TA Unit.

The project is a unique example of a small but successful project that has made a real difference in a short space of time with relatively small financial outlay. The UK is the only nation that provides fresh platelets from a home nation. The project has required the purchase of new equipment, new training, concepts of operations and quality systems. Col Doughty been the only member of the team that has stayed with the project throughout and has done this project alongside Command of a Field Hospital, a busy NHS consultant job and despite ill health. The project has worked because of a few committed individuals who have gone that extra mile.

Operational apheresis has been a complex project that has required working with a number of agencies who have sometimes had to take a leap of faith. The greatest challenge is that of training. Apheresis is now taught as a pre-operational course to nurses and biomedical scientists who have often never seen the process and may have never heard of it. The techniques require the nursing staff to place a relatively large needle safely within a vein. It has been an enormous ask to persuade TA and regular nurses to have the confidence that they can perform this technique safely on their colleagues and to be able to do it with a very seriously ill patient waiting for the product. Dr Doughty developed a training programme working with together with the NBS, the commercial company and others. The programme now permits live apheresis to be included in pre-deployment validation exercises.

The operational apheresis programme has demonstrated how TA personnel can bring unique skills to the Defence Medical Services. The programme has also demonstrated the increasingly flexible and integral role that TA healthcare reservists provide which goes beyond the traditional 27 days a year and deployment.

Health Improvement and Promotion

RAF High Wycombe: Controlling a pneumonia outbreak whilst on operations in Kandahar

Catching pneumonia is a serious problem at the best of times, but when a particularly contagious strain broke out at Kandahar Air Field where 2,700 serving personnel were based during Operation HERRICK 9, the consequences could have been catastrophic. An outbreak could reach epidemic proportions amongst the personnel at the base putting operations seriously at risk.

During daily patient reviews at Kandahar Airfield, medical staff began to notice that there was a dramatic rise in respiratory infections, with over 204 people reporting symptoms including high fever, fatigue, coughs and chest pains within a three week period. It was recognised that a respiratory infection was present at the base and risked spreading rapidly if left unchecked.

Not only did it risk spreading through the base, but also to other bases as the aircraft loadmasters are regularly in contact with personnel from all areas of the military. There was also a real possibility that aircraft could have been grounded due to lack of able bodied personnel - at one stage three Harrier pilots were out of action due to the illness, one more and Harrier close air support to the task force in Afghanistan would have completely stopped.

A rapid response that incorporated clinical awareness, excellent team skills and hard work made containment of the infection possible. The quick identification of the presence of the infection meant action was taken promptly by medical staff at the base.

An information campaign on the infection was started immediately within the base and shared across the whole spectrum of military health care. People were quickly mobilised to setup Quarantine blocks and rooms to hold infected personnel, making sure they were isolated until they were treated and cleared of the infection. To assist with the effort, a specialist Public Health team was deployed to the base. All medical personnel involved worked tirelessly to contain the significant outbreak.

Use of public health containment principles combined with the professionalism and diligence of medical staff meant that operations were not halted in Helmand or Kandahar provinces due to the outbreak. The spread of the infection to forward operating bases was prevented and troops affected in Camp Bastion were recognised and treated early in the process, all down to the information sharing and invaluable work of the team at Kandahar Air Field.

This sterling effort has also raised awareness across the defence forces of the serious impact that disease outbreaks can have operations, putting force health protection back at the front of the commander's agenda. As a direct result of the experience of dealing with this outbreak, permanent joint headquarters have setup a public health notification system that rapidly engages public health experts, in collaboration with the Health Prevention Agency in order to provide timely interventions in future.

Education and Training

Life Force: A Practical Guide for Working with Scotland's Veterans

(based in Glasgow)

Veterans with mental health problems often find it difficult to engage with community agencies, for several reasons, including stigma that is attached to military personnel, having lived within military regimes and then difficulties and negative experiences associated with the transition to civilian life. Community agencies often work with veterans, who tend to have a higher incidence level of mental health problems, but they have no specialist advice on the issues faced by veterans or the difficulties they may have experienced.

The Scottish Association for Mental Health (SAMH) developed the 'Life-Force' guide to help mental health and community professionals engage more effectively with veterans who suffer mental health problems. The guide provides a practical understanding of how best to identify and work with veterans and their families as well as signposting information to make sure the appropriate support is identified and utilised.

The initial structure of the guide was drawn from unique accounts of Veteran's experiences, which were then analysed and backed up by a review of relevant literature from the past 10 years. This gave value to veteran's real and often traumatic experiences. Many other organisations were also consulted and involved throughout the process of writing, including the Medical Assessment Programme and Citizen's Advice Bureau, who helped add validity to the guide.

The biggest challenge faced by the team putting the guide together was gaining the trust of the veterans. The SAMH anticipated that because the charity had no specialist military knowledge, Veterans might approach with suspicion. To help this, Malcolm Luing (former Military Social Worker) was recruited; his wealth of knowledge and contacts facilitated positive communication with individual Veterans and agencies.

From an early stage the project team had to recognise that there are unique differences which many Veterans have encountered, which sets them apart from the rest of our communities. Examples such as experiences of war and violence, the reliance on comradeship in times of difficulty and a military regime which controls day to day life, all affect coping mechanisms and susceptibility to mental health problems.

According to Charlie McMillan, Director of Research Influence and Change for the SAMH:

'This helped to develop, at the very least, an awareness and understanding of how this affects Veterans in our society and facilitated relationship building in progressing the project.'

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