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As the Queen Alexandra’s Royal Army Nursing Corps celebrates its 70th Anniversary, army nursing continues to advance patient care delivery to new levels. Advanced level nursing practice has moved from the relatively ‘calm’ confines of the NHS to the austere desert of Oman. This article will provide a personal account of the first deployment of a military nurse practitioner since it was formally introduced in 2012 to frontline medicine, leading an armoured prehospital treatment team.

IntroductionChanges of environment brought about by deployments are often attributed to an increase in smoking of service personnel. Electronic cigarettes are recognised as being a viable aid to quitting smoking but are currently banned from sale in Oman and were therefore banned during exercise SAIF SAREEA 3 (SS3). This paper sought to establish whether smoking increased on this exercise and for what reasons. Also, if deployed smoking cessation services are likely to be used, if available.MethodsQuestionnaires were distributed to deployed troops at various locations in theatre for data collection.ResultsSmoking prevalence increased by 5.2% (29) in the deployed population by the end of the exercise. The largest increase was seen in those smoking 20 cigarettes a day or more, rising by 269.8% (73) with a mean increase of 9 cigarettes per day. During the exercise the number of personnel using electronic cigarettes decreased and individuals’ rate of electronic cigarette use also decreased. Those who smoked less during the exercise did mainly through choice (56.8%). 50% (280) of all individuals who increased smoking habits during the exercise did so out of boredom.ConclusionsDuring exercise SS3 the number of individuals who smoked and the quantity they smoked increased. The ban on electronic cigarettes in Oman and while on exercise potentially had an effect on the increased smoking habits. There is an argument to include smoking cessation material in medical modules to prevent ex-smokers from restarting, continue to aid those quitting and potentially lessen severity of increasing smoking habits while deployed.

IntroductionEx SAIF SAREEA 3 was a joint British-Omani military exercise involving approximately 5500 British personnel deployed to Oman over a 6-month period. Role 1 medical care was provided by medical treatment facilities (MTFs) deployed with medical equipment as per the UK 300 medical module.MethodRetrospective analysis was undertaken of prospectively collected equipment usage data from two Role 1 MTFs in Duqm (MTF 1) and Muaskar Al Murtafa (MTF 2) camps over a period of 6–8 weeks. Data were analysed alongside routinely collected epidemiological data (EPINATO) during the deployment. Equipment used in addition to the module was also recorded.ResultsMTF 1 used 50 out of the 179 different items from the module over the 8-week period. MTF 2 used 45 out of the 179 different items from their module over the 6-week period. The most commonly used items across the sites were non-sterile examination gloves, plastic aprons, tympanic thermometer probe covers, disinfectant wipes and self-adhesive plasters. Extramodular items (blunt fill needle, water pump sprayer, Jelonet gauze and stool specimen pot) accounted for 5% of all equipment used in MTF 1.ConclusionThe study showed that the 300 module accommodates 95% of Role 1 patients’ needs but highlights the requirement for dedicated equipment for the treatment of heat casualties if deemed likely and blunt fill/filter needles for the administration of parenteral medication. Commanders must perform a thorough medical estimate and risk assessment prior to deployment to ensure that the 300 medical module is likely to provide the necessary equipment and supplement the module if required.

Exercise SAIF SAREEA 3 (SS3) is a triservice combined joint training military Exercise between the UK and the Omani Armed forces. SS3 represented a rare opportunity to exercise a complete role 1 medical reception station (MRS) in a tented platform for a prolonged period providing ‘real life support’, as opposed to an exercise without casualties. This article is a discursive paper making recommendations for amendments to the established structure for the MRS within static high-temperature deployments. Considering the facility blueprint, recognising and implementing improvements to patient flow and increasing infection prevention control measures resulted in limiting the spread of disease outbreak. During the deployment there were considerable challenges delivering care in extreme heat above 50°C these included the use of environmental control units, white liners and refrigerator units which allowed care to be delivered throughout the day, and for the appropriate care of both casualties and medication. Finally, the article covers improved patient service with a paper-based triage system supporting innovative ideas to deliver care.

IntroductionModule 501 provides core medications which are fundamental to the capability of a prehospital treatment team (PHTT). The quantities of each medication in the module inventory undergo regular review, but these do not correspond to a population at risk (PAR) figure or deployment length for which they intend to be used. This article proposes how the quantities of Module 501 drugs can be scaled for a given deployment, in this example using statistics taken from static PHTTs on Exercise Saif Sareea 3 (SS3).MethodsThe statistics were gathered using a custom-built search of electronic records from the Deployed Defence Medical Information Capability Programme in addition to written record-keeping, which were aligned to the weekly PAR at each PHTT location throughout their full operational capability periods. A quotient was then derived for each module item using a formula.ResultsAmong the 10 most commonly prescribed drugs were four analgesics and three antimicrobials. 42 of the 110 studied drugs were not prescribed during SS3.DiscussionThe data from SS3 reflect the typical scope of disease encountered in the deployed land setting. Employing these data, the use of a formula to estimate the drug quantities needed to sustain a Strike Armoured Infantry Brigade over a 28-day period is demonstrated.RecommendationsFurther study of Module 501 across varied deployment environments would be valuable in evolving this approach to medicinal scaling if proven effective for the warm desert climate. It could then be applied to other modules to further inform future Strike medical planning.LimitationsSeveral considerations when drawing deductions from the data are mentioned, including the inaccuracy of predictor variables taken from the EpiNATO-2 reports.ConclusionThe proposed formula provides an evidence-based framework for scaling drug quantities for a deployment planning. This may improve patient safety and confer logistical, storage and fiscal benefits.

IntroductionEpidemiological data captured from military exercises and operations can highlight treatment requirements specific to operating in certain environmental conditions. Such data is invaluable to enable accurate planning for future exercises. Epidemiological data were collected during Exercise SAIF SAREEA 3 (SS3) to provide an insight into medical provision requirements for low-tempo military operations in hot, desert climates.MethodEpidemiological data was collected from all consultations conducted during the exercise within the LAND Medical Reception Station, 24 August–14 November 2018, using Epi-NATO surveillance systems.ResultsOf the 1414 total consultations recorded, 759 were first presentations and 665 were follow-up consultations, with 35 referrals made to hospitals. 1348 days of limited duties were given and 258 working days were lost. The most common coding reported for consultations were ‘non-battle non-sport related injuries’, ‘sport related injuries’and ‘dermatological'.DiscussionThe data highlight the most common cause of injuries and the role of assets such as dental, sexual and mental health services for future deployments. A number of explanations are considered in relation to the patterns identified and the effect on future planning for working in hot climates. Furthermore, Exercise SS3 had reduced numbers of personnel requiring deployed Role 2 or host nation hospital services, which again raises further considerations for future deployments.

Health and risk management of personnel in hot climates remains a Commander’s responsibility, with Joint Service Publication 539 Heat Illness and Cold Injury: Prevention and Management (JSP 539) being the guiding document for the UK military. This policy can be challenging to interpret occasionally, needing medical professionals to provide ongoing advice to commanders. This is to achieve a shared understanding of scientific concepts and risks to allow a more informed decision-making by commanders. This then leads to the appropriate mitigation of risks to as low as reasonably practical. Exercise SAIF SAREEA 3 saw commanders and medical cooperation at all levels with a practical and pragmatic application of the principles articulated in joint policy. The elements which saw enhanced cooperation included pathophysiology, work rates and work:rest ratios, rest and sleep periods, uniform, acclimatisation, and hydration and electrolyte balance. This approach was exhibited throughout the planning, deployment and execution of Exercise SAIF SAREEA 3, which saw extremely low levels of heat injury throughout the exercise when compared with SAIF SAREEA 2 and related exercises. This personal view aims to describe the command and medical interaction on SAIF SAREEA 3 which the authors feel contributed to those successes against climatic effects.