COMBAT SERVICE SUPPORT

DEFENCE MEDICAL SERVICES DEPARTMENT (DMSD), ARMY MEDICAL SERVICES

DEFENCE MEDICAL SERVICES (JOINT)
 

ARMY MEDICAL SERVICES (AMS)

Medical support to members of the British Army is provided by the Army Medical Services which consists of the following Corps:

Royal Army Medical Corps
Queen Alexandra’s Royal Army Nursing Corps
Royal Army Dental Corps
Royal Army Veterinary Corps

The Army Medical Services is the army single service element of the Defence Medical Services (DMS). It is certain that without the superb support provided by the Defence Medical Services in both Iraq and Afghanistan, a large number of service personnel who would have been unlikely to have survived their wounds in earlier conflicts are still alive today.

THE ROYAL ARMY MEDICAL CORPS (RAMC)

In peace, the personnel of the RAMC are based at the various medical installations throughout the world or in field force units and they are responsible for the health of the Army.

There are 6 x regular medical regiments and 3 x field hospitals. The reserves provide 13 x field hospitals, 1 x Support Medical Regiment and 1 x Casualty Evacuation Regiment.
In late 2015 our estimate of the regular personnel strength of the RAMC is 2,900 officers and soldiers.

During late 2015 the structure of the regular and reserve units of the RAMC is as follows:

The majority of the reserve units are part of 2 Medical Brigade and many are paired with regular units. (See table below).

On operations, the RAMC is responsible for the care of the sick and wounded, with the subsequent evacuation of the wounded to hospitals in the rear areas. This is achieved by the provision of Close Support Medical Regiments (to treat front line casualties) and General Support Medical Regiments where more major procedures can be carried out some distance behind the front line, before evacuation to a Field Hospital where a full range of medical facilities is available.

Each Brigade in 3 UK Division (the Reaction Force) has a medical regiment which is generally a regular unit (in some cases this may be a hybrid unit) that operates in direct support of the battle groups. These units are either armoured, airmobile or parachute trained. There are generally extra medical squadrons that provide support at the divisional level; once again these squadrons can be either regular or reserve. These squadrons provide medical support for the divisional troops and can act as manoeuvre units for the forward brigades when required.

All medical squadrons have medical sections that consist of a Medical Officer and a number of Combat Medical Technicians (eight). These sub units are located with the battlegroup or units being supported and they provide the necessary first line medical support. In addition, they provide a dressing station where casualties are treated and may be resuscitated or stabilised before transfer to a field hospital. These units have the necessary integral ambulance support both armoured and wheeled, to transfer casualties from the first to second line medical units.

Field hospitals may be regular or reserve and are generally 200 bed facilities with a maximum of eight surgical teams capable of carrying out life saving operations on some of the most difficult surgical cases. Since 1990 regular medical units have been deployed on operations in the Persian Gulf, the Former Yugoslavia, Sierra Leone, Afghanistan and Iraq.

Casualty Evacuation (CASEVAC) is by ambulance, either armoured or wheeled and driven by RLC personnel, or by helicopter when such aircraft are available. A Chinook helicopter is capable of carrying 24 stretcher cases and a Puma can carry six stretcher cases and six sitting cases.



ARMY MEDICAL SERVICES

Medical support to members of the British Army is provided by the Army Medical Services which consists of the following Corps:

Royal Army Medical Corps
Queen Alexandra’s Royal Army Nursing Corps
Royal Army Dental Corps
Royal Army Veterinary Corps

The Army Medical Services is the army single service element of the Defence Medical Services (DMS) . There is more information regarding the Defence Medical Services in the Joint Service Chapter.

It is certain that without the superb support provided by the Defence Medical Services in both Iraq and Afghanistan, a large number of service personnel who would have been unlikely to have survived their wounds in earlier conflicts are still alive today.

The QARANC is an all nursing and totally professionally qualified Corps. Its male and female, officer and other rank personnel, provide the necessary qualified nursing support at all levels and cover a wide variety of nursing specialities. QARANC personnel can be found anywhere in the world where Army Medical Services are required.

During early 2015 the QARANC personnel total was approximately 800 all ranks.

The RADC is a professional corps that in mid 2004 consisted of 395 officers and soldiers. The Corps fulfils the essential role of maintaining the dental health of the Army in peace and war, both at home and overseas. Qualified dentists and oral surgeons, hygienists, technicians and support ancillaries work in a wide variety of military units from static and mobile dental clinics to field medical units, military hospitals and dental laboratories.

The RADC personnel total is believed to be approximately 300.

THE ROYAL ARMY VETERINARY CORPS (RAVC)

The RAVC look after the many animals that the Army has on strength. Veterinary tasks in today's army are mainly directed towards the army's 550 guard or search dogs and its 460 horses for ceremonial duties. Personnel totals believed to be in the region of 320.

DEFENCE MEDICAL SERVICES (DMS) JOINT

The Defence Medical Services include the whole of the medical, dental, nursing, health professional, paramedical, veterinary and support personnel (about 7,000 uniformed personnel) including civilian staff, employed by the three Armed Services. These elements are responsible for providing healthcare to service personnel serving in the UK, overseas and on operations. In addition and where appropriate, the families of service personnel and entitled civilians (possibly about 260,000 people). DMS also provides some aspects of healthcare to other countries’ personnel overseas, in both permanent military bases and in areas of conflict and war zones.

The range of services provided by the Defence Medical Services includes:

• Primary healthcare

• Dental care

• Hospital care

• Rehabilitation

• Occupational medicine

• Community mental healthcare

• Specialist medical care

Defence Medical Services also provide healthcare in a range of facilities, including medical and dental centres, regional rehabilitation units and in field hospitals.

The Deputy Chief of Defence Staff - Health (DCDS(H) is accountable for the overall outputs of the Defence Medical Services.

The Surgeon General is the professional head of the Defence Medical Services and
responsible for the healthcare and medical operational capability. His responsibilities include defining the standard and quality of healthcare needed in both operational and non-operational environments and assuring its delivery. He is also responsible for setting the strategy and the associated (non-clinical) policies for the Defence Medical Services.

These two senior officers oversee the work of three separate organisations:

Notes:
(1) The Defence Medical Services Department (DMSD) is the headquarters for the Defence Medical Services providing strategic direction to ensure delivery of defence medical outputs. The DMSD operates through the following four directorates: Medical Operations; Medical Policy; Healthcare; Finance and Secretariat.

(2) Joint Medical Command (JMC) – This is a joint service agency providing secondary care personnel to meet requirements for operational deployments. It also supports the front line units by educating and training medical personnel through the Defence Medical and Training Agency (DEMTA). DMETA runs about 2,000 clinical courses (providing about 300,000 training days) to all three services. JMC has responsibility for the following:

• MDHUs (Ministry of Defence Hospital Units)

• RCDM (The Royal Centre for Defence Medicine)

• DMRC (The Defence Medical Rehabilitation Centre at Headley Court

• DMSTC (The Defence Medical Services Training Centre in Aldershot

• The Defence Medical Postgraduate Deanery

The JMC provides a single headquarters responsible for healthcare delivery.

(3) Defence Dental Services (DDS) – this is a joint service organisation employing both Armed Forces and civilian personnel that provides dental services in the UK at service establishments and to personnel on operations overseas. The DDS came under the ‘umbrella’ of the JMC from mid 2009.

SINGLE SERVICE MEDICAL CARE

The three armed services are responsible for delivering primary healthcare to their respective services and for providing the required medical support on operations.

Royal Naval Medical Service (RNMS)
Army Medical Services (AMS)
Royal Air Forces Medical Services (RAF MS)

Late 2014 regular and reserve personnel figures are as follows:

DMS Regular personnel 7,990
DMS Reserve personnel 2,910

Defence Nursing Staff

On operations, nursing staff and medical officers from all three services deliver primary and emergency care at the front line and secondary and critical care in field hospitals. Aeromed evacuation of casualties is supported by defence nurses who deliver intensive care nursing during patient transfers both in theatre and on return to the UK working within the Critical Care Air Support Teams.

When not deployed on operations, defence nurses work within Ministry of Defence Hospital Units within NHS Trusts across the UK to maintain their clinical skills and care for the general public. In particular, Defence Nurses working at the Royal Centre for Defence Medicine in Birmingham and at the Defence Medical Rehabilitation Centre at Headley Court contribute directly to the health care provision of military personnel.

Nursing staff for the three services (with approximate personnel figures) are found from the following organisations:

Queen Alexandra's Royal Naval Nursing Service (QARNNS) - 300
Queen Alexandra's Royal Army Nursing Corps (QARANC) - 800
Princess Mary's Royal Air Force Nursing Service (PMRAFNS) - 430

Hospital Care

In the UK hospital care is provided at Ministry of Defence Hospital Units (MDHU). The Defence Medical Services Department (DMSD) has contracts with the NHS for provision of care in MDHUs, which are run as military units embedded within selected NHS hospitals. There are MDHUs at Derriford (Plymouth), Frimley Park (Aldershot), Northallerton (near Catterick), Peterborough and Portsmouth.

In addition, the Defence Medical Services runs a number of other units which include the Royal Centre for Defence Medicine (Birmingham), Defence Services Medical Rehabilitation Centre (Headley Court) and the Duchess of Kent’s Psychiatric Unit (Catterick). There are also about 245 DMS medical and dental primary care facilities mostly located in the UK. Outside of the UK primary healthcare, and some secondary healthcare, is provided on board Royal Navy ships and in overseas bases and theatres of military operations.

The Military Ward at the Queen Elizabeth Hospital in Birmingham started taking patients in 2010 and service personnel are cared for in single rooms or four-bedded bays that have additional features for the exclusive use of military patients. The ward has more staff than a normal NHS ward, a quiet room for relatives as well as a communal space for military patients to gather. A dedicated physiotherapy area has also been provided close to the ward for service patients.

On operations overseas locations Field Hospitals provide medical support that includes primary surgery, an intensive care unit, medium and low dependency nursing care beds and diagnostic support, as well as emergency medical care. These Field Hospital may be staffed by medical personnel from all three services.
Service personnel serving in Germany who require hospital care are treated in one of the five German Provider Hospitals. As the withdrawal from Germany gathers pace these services will be reduced.

Royal Centre for Defence Medicine (RCDM)

The RCDM in Birmingham provides a centre for military personnel requiring specialised care, and incorporates a facility for the treatment of service personnel who have been evacuated from an overseas deployment area after becoming ill or wounded/injured. RCDM also acts as a centre for the training of Defence Medical Service personnel.

In operation since 2001 the RCDM operates on a contract between the DMSD and the University Hospitals Birmingham (UHB) NHS Trust.

The RCDM is a Joint Service establishment with medical personnel from all three of the armed services wearing their respective Naval, Army, or Air Force uniforms.

Midlands Medical Accommodation Project

From 2010 Whittington Barracks in Lichfield became the home of military medicine. The Midlands Medical Accommodation project (MMA) will ensure that the area becomes the central focus for military medical expertise and assets. About 2,000 military and civilian staff are believed to be working at the barracks following completion of the MMA project in 2015.

The first phase - MMA Increment 1 - delivered a modern headquarters office building for the DMS at Whittington Barracks that incorporates both the Surgeon General’s strategic Headquarters and those of the Joint Medical Command, both of which are fully operational.

The second phase – MMA Increment 2 – saw the DMS elements relocated from Keogh Barracks near Aldershot to a new modern training centre at Whittington Barracks. The new complex includes training facilities, a learning centre; lecture theatre, messes for Officers, Warrant Officers and Senior Non Commissioned Officers, living accommodation for permanent staff and a new Junior Ranks’ dining and leisure facility.

About £200 million was invested in MMA1 and 2.