ENHANCING SAF'S EMERGENCY MEDICAL SUPPORT SYSTEM WITH MOBILEMET

What happens when a soldier collapses in camp or during training?

The Singapore Armed Forces Medical Corps' (SAFMC's) three-tier emergency medical support system, adopted from international resuscitation protocols, kicks in immediately.

The soldier's buddy or any military personnel nearby immediately calls the medical centre and performs Cardio-Pulmonary Resuscitation or CPR on the casualty, while waiting for the medics to arrive. This first tier is termed Buddy Aid.

After assessing the soldier's condition, the medics provide Basic Life Support by applying the Automated External Defibrillator (AED) to determine if the soldier has a shock-able heart rhythm and if so, administer AED shocks on-site. Air is also introduced into the casualty's lungs and CPR continues. This is the second step.

In the third step, the casualty is sent to the medical centre's Emergency Resuscitation Bay (ERB), where the SAF Medical Officer (MO) and his team apply advanced resuscitation techniques to stabilise the casualty's condition before evacuation by the SAF's Taurus ambulance to the nearest hospital for further treatment.

To ensure that these processes are robust and up to date, the SAFMC introduced the Mobile Medical Evaluation Team (MobileMET) last October, to assess the competencies of the emergency medical response team.

The MobileMET comprises four assessors from the Military Medicine Institute (MMI) who conduct the annual audit on the SAF's emergency medical support system from October to March.

Explained Lieutenant-Colonel Ng Yih Yng, MMI's Deputy Commander (Primary Healthcare Service) and a consultant in emergency medicine at the Singapore General Hospital: "When you're distributed over 32 different locations, you want to ensure standardisation across 32 places. Different lessons are learnt from each medical centre. It's all about feeding back to the system so that the next group of medics and doctors who come in are better trained."

He added: "This is also a moving target. You want a high performance system. When you know that the medical centres have reached a certain level of proficiency and standard... there's always an opportunity to see how they can raise their standards over time."

Simulating an emergency situation and using a mannequin, the assessment by the MobileMET begins at a common area like a gym or swimming pool. They evaluate how the emergency medical response team - which includes an MO, a senior medic and three other medics - perform, based on a checklist of emergency care steps in areas such as evacuation procedures, resuscitation skills and drug administration.

The evaluation process is recorded, and the MMI assessors review the footage with the emergency medical response team to identify learning areas. This information is also shared with medical personnel in the SAF's 32 island-wide medical centres.

Trainers from the training institutes are also invited to observe the assessment to understand better how the knowledge taught in schools is applied in reality.

Commenting on the MobileMET, Clinical Associate Professor Eillyne Seow, Tan Tock Seng Hospital's Divisional Chairman of Ambulatory and Diagnostic Medicine and chair of the SAF Emergency Medicine Specialist Advisory Board, said: "When you have a huge system, you need to build it - from single building blocks of skills training, to making sure that the individuals know how to put the whole thing together and work as a team... and the different teams know how to link together."

"What I'm happy about the present SAF system is that the links have been recognised and put in place. This audit is good because it tests systems. A lot of times, a bad system can trip up even the best of clinicians. So for the SAF to want to audit itself is admirable," added Dr Seow.

Other enhancements to the SAF emergency medical support system in recent years include training all recruits in CPR and AED as part of their Basic Military Training, the SAFMC's 2010 collaboration with the Justice Institute of British Columbia, the upgrade of the SAF's Taurus ambulances, and training MOs in Emergency Airway Management. The course, which started last year, trains SAF MOs more extensively in resuscitation capabilities than their equivalent civilian counterparts.