Parenteral medications at Role 1: do doctors in the British Army require improved training and experience?

Role 1 doctors in the British Army work predominantly in primary healthcare, but also provide prehospital emergency care and administer potent parenteral medications in the field. Role 1 doctors have theoretical training in the use of these medications on short courses but then have little refresher training and use them infrequently in their routine practice, introducing the risk of skill fade. This may lead to higher rates of medication errors in an environment where the consequences may be significant. This article explores the current training of Role 1 doctors, the threat of skill fade and how the safety of drug administration can be improved. This includes recommendations for the development of training competencies, bespoke courses and clinical placements, e-learning and the use of new technology. Application of these recommendations has the potential to improve patient safety and the confidence of doctors in the use of parenteral analgesia.

Banning smoking at Army Foundation College, Harrogate: a military phase I training establishment's experience of introducing a smoking ban.

In September 2019, Harrogate Army Foundation College (AFC) introduced what is believed to be the British Army's first smoking ban. AFC, the British Army's only training college for junior soldiers (JS) aged 16-18 years, had identified the possibility of JS adopting a smoking habit during training and introduced positive steps to mitigate this risk. The smoking ban for JS was part of a phased approach, with a complete ban being implemented in January 2020, which extended to all personnel on camp. A historically strong smoking culture in the military meant introducing a ban had inherent challenges, but the potential benefits from doing so made it worth considering. The introduction of the ban coincided with an intake of around 1070 new JS. Intakes are a busy period for the medical centre, with each JS requiring an Initial Medical Assessment. The added requirement to provide smoking cessation therapy at this time resulted in an increased workload. Medical challenges during this period included staffing numbers, dispensary stock levels for nicotine replacement therapy and disruption to routine clinics. However, experience gained from the September 2019 intake resulted in modifications that allowed the next intake in March 2020 to be optimised. Success when introducing a smoking ban in a military establishment is dependent on early planning and clear communication between the chain of command and the medical centre. As the military moves towards a larger scale smoking ban, lessons from AFC's experience may help guide other military establishments with the implementation process.

Epidemiological study of emergency ambulance activation in the British Eastern Sovereign Base Area of Cyprus, September 2013 to August 2016.

OBJECTIVES: To record the activation and use of the Eastern Sovereign Base Area (ESBA) emergency ambulance service of British Forces Cyprus between 1 September 2013 and 31 August 2016. To reflect on these findings in light of data from 1995 to 1998 to identify current treads and areas of development. METHOD: Retrospective epidemiological study of all activations of the ESBA emergency ambulance service within the study period. RESULTS: 812 patients were treated over 3 years, an 80% increase in workload, of which 41% were entitled personnel. Forty-two per cent of activations were for medical complaints compared with 41% for trauma. The number of deaths remained static (n=15). Road traffic incidents (RTI) remain the top activation by type, but accounting for a smaller proportion of workload. RTI mortality has declined by 50%. CONCLUSION: The ESBA emergency ambulance service responded to double the activations, when compared with 18 years ago, with a significant shift to medical cases over trauma. This ESBA emergency ambulance provides a varied and vital service for the local community that also benefits Defence Medical Services personnel interested in the Pre-Hospital Emergency Medicine environment in order to maintain clinical skills and currency for the benefit of future deployments, both humanitarian and kinetic in nature.

Unusual case of suspected recurrent scarlet fever in a UK serviceman.

The UK prevalence of scarlet fever, a Group A streptococcal infection, is increasing. We present an unusual case of suspected recurrent scarlet fever in a member of the UK Armed Forces. Treatments, occupational implication and public health measures to mitigate the risk of disease spread.