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  1. #26
    Commander in Chief hptmurphy's Avatar
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    Although soldiers in CMU are soldiers first in the main their day to day is as clinicians,
    Clinicians refers to doctors... how many do the army have?

    I
    ’m not talking about put Capt Y into the Mater to help on shift (being no more than a MFR at best) I’m proposing a formal recognised scheme whereby Capt (Dr) Y as part of his studies (as a fully trained medical doctor) has to do say a 4 shifts a month in an A&E (this is partially happening as part of the Mil Medicine/GP training but I mean that it should be ongoing) or where DF ambulances (fully trained paramedics) provide an extra ambulance to the HSE (happens already). Liken it to instead of the infantryman’s weekly duty being on guard, the CMU soldiers duties include in a hospital/ambulance.
    the problem being that if you include the them as part of the staffing level, who relieves them in the vent of leave or sick leave, as the DF doesn't have the kind of numbers needed to provide cover. If you commit to something , you need to commit to it fully and can't drop out because someone calls in sick. The HSE / NAS can't back fill for their own , never mind for positions created to upskill people.

    Doctors in training will have done their various rotations during their NCHD years.

    Doing nothing is not a viable option. Elements of PDF are already helping
    I have no doubt if a certain cohort of people go down in the hospitals that the DF could be the next line of defence and with rapid induction programmes could be quite efficient, its to get that training and placement done now is the issue, St. Lukes Hospital Kilkenny should have contacted the DF and put a plan in place to look after catering, portering should it be required but for now they are recruiting people from the general population instead. One hospital lost its entire compliment of porters for two weeks recently, your not going to pull in a body of that number off the street and expect them to carry out their duties... definitely the DF have a role to play in hospitals that has gone unidentified.
    Last edited by hptmurphy; 1st April 2020 at 08:26.
    Covid 19 is not over ....it's still very real..Hand Hygiene, Social Distancing and Masks.. keep safe

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  3. #27
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    Quote Originally Posted by hptmurphy View Post
    Clinicians refers to doctors... how many do the army have?





    I have no doubt if a certain cohort of people go down in the hospitals that the DF could be the next line of defence and with rapid induction programmes could be quite efficient, its to get that training and placement done now is the issue, St. Lukes Hospital Kilkenny should have contacted the DF and put a plan in place to look after catering, portering should it be required but for now they are recruiting people from the general population instead. One hospital lost its entire compliment of porters for two weeks recently, your not going to pull in a body of that number off the street and expect them to carry out their duties... definitely the DF have a role to play in hospitals that has gone unidentified.
    In the early 2000's there was a big push by FF in Govt. to save money at all costs, as usual they expected DOD to come up trumps so we started an avalanche of shutting down barracks and Hospitals. Everything that happened over the next two decades saw the PDF neutered as a complete in-house Service. Even today Medical Services within PDF, for day to day, sick parades, injuries, medicals, are under pressure, and quite adversarial as decisions can effect careers and Service.
    When the pandemic is over Military Medicine must be restored to make the PDF independent and self supporting at home and abroad. We cannot have a competition for treatment between PDF and civilian populations. When my Dad was in the 1923 Army++ and got married we were born, and subsequently taken care of in the Families Hospital in the Curragh. As kids we got stitched, inoculated, dental care, and medically assessed once a year. The Generals need to be Go PDF.

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  5. #28
    Commander in Chief hptmurphy's Avatar
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    In the early 2000's there was a big push by FF in Govt. to save money at all costs, as usual they expected DOD to come up trumps so we started an avalanche of shutting down barracks and Hospitals. Everything that happened over the next two decades saw the PDF neutered as a complete in-house Service. Even today Medical Services within PDF, for day to day, sick parades, injuries, medicals, are under pressure, and quite adversarial as decisions can effect careers and Service.
    The facilities used wouldn't qualify for HIQA licensing , so up grades or new builds would probably be huge out of an already underfunded DF
    Covid 19 is not over ....it's still very real..Hand Hygiene, Social Distancing and Masks.. keep safe

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  7. #29
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    Quote Originally Posted by hptmurphy View Post
    The facilities used wouldn't qualify for HIQA licensing , so up grades or new builds would probably be huge out of an already underfunded DF
    There you go , it's just money. In any combat capable Armed Force it is a sine qua non that varying degrees of medical management is required. Just get it done or refer it to EU for non-compliance.

  8. #30
    Moderator DeV's Avatar
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    I suppose I should have said healthcare professionals rather than clinicians.

    The roster wouldn’t probably be a roster as such, an agreement that the HSE would accept a doctor, nurse, paramedic etc on a particular shift (in advance and on an as available basis), not replacing a HSE staff member, ie as an extra pair of hands or in addition. Heaven forbid patients would get seen quicker or staff would have some pressure taken off them. It would obviously have to be more formal than someone just turning up.

    Without that forget the DF being able to provide any sort of quality healthcare in the field to DF (or partner nations with UN, EU, etc) or any type of emergency/surge cover to the HSE. That isn’t to say that the DF doesn’t have trained capable people but without sufficient patient contact they won’t have the level of experience to cover those eventualities (eg major trauma accident on an ex at home) or will lose registration due to lack of sufficient patients. Which would mean that if a field hospital is required by the DF in say Mali and the State has to provide it .... it will be the HSE providing it!

    Militaries multiple sizes of the DF have to do it, to a degree the DF currently do it...it is the only way for an military medical corps to be viable ... to work with the civilian health services on a day to day basis (or add a few zeros to the strength of the PDF and make sure they have lots of complicated accidents and injuries).

  9. #31
    Lord Chief Bottlewasher trellheim's Avatar
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    The facilities used wouldn't qualify for HIQA licensing , so up grades or new builds would probably be huge out of an already underfunded DF
    Are the DF subject to HIQA ?
    "Are they trying to shoot down the other drone? "

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  10. #32
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    Quote Originally Posted by trellheim View Post
    Are the DF subject to HIQA ?
    Let's say it's a "grey" area. However the Brits handed over a busy capable hospital in 1922 at the Curragh and it was staffed by 37 members of the ANS who provided a 365 day 24/7 service to the Curragh Based Army and it's families. The hospital also looked after IRA prisoners. As the pols lost interest in the soul and ethos of the PDF it all withered on the vine. The last time I checked the ANS staff in the Curragh was down to 5 with nearly 16 decades of service between them. It just means our PDF is not combat capable except embedded in someone else's formation. Duty of care is a problem.
    I did a check on HIQA's inspections up to January 2020 and in 360 inspections there were no Mil Hospitals inspected.

  11. #33
    Commander in Chief hptmurphy's Avatar
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    Quote Originally Posted by trellheim View Post
    Are the DF subject to HIQA ?
    All medical facilities are subject to HIQA ...worse than the Health and Saftey

    That isn’t to say that the DF doesn’t have trained capable people but without sufficient patient contact they won’t have the level of experience to cover those eventualities (eg major trauma accident on an ex at home) or will lose registration due to lack of sufficient patients.
    I'd be interested to see what the numbers are around trained registered health professionals is within the DF, I do know Paramedic qualified pers are imbedded within the NAS as part of their training.

    Specialist such as Anaesthetics do need to carry out a certain amount of certain types of procedures to remai current as do surgeons , but medical physicians don't. hence the lack of surgeons in the DF.

    Support functions in hospitals after a short period of induction could be carried out by members of the DF and I'm constantly surprised that this hasn't take place or at least liaison should it be required, but then again I'm not sitting at the top table, but to fit in with my function there would need to be some consultation.
    Last edited by hptmurphy; 2nd April 2020 at 09:06.
    Covid 19 is not over ....it's still very real..Hand Hygiene, Social Distancing and Masks.. keep safe

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  13. #34
    Chief Casey Ryback
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    Quote Originally Posted by hptmurphy View Post
    All medical facilities are subject to HIQA ...worse than the Health and Saftey
    Indeed they are , I've crossed paths with them a few times .
    Don't spit in my Bouillabaisse .

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  15. #35
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    Quote Originally Posted by Laners View Post
    Indeed they are , I've crossed paths with them a few times .
    I've checked HIQA inspection reports up to January 2020 and they do not log a MH visit. I noticed they visited Royal Victoria in Belfast. Maybe visits to our facilities were exploratory and under the counter.
    Last edited by ancientmariner; 2nd April 2020 at 09:58.

  16. #36
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    Given the two brigade structure, does the ORBAT (even on paper) not include two Field Ambulances (or equivelant) to cover casualty evacuation? Or is it purely Regimental Aid Posts (or equivelant)?
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  17. #37
    Moderator DeV's Avatar
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    Quote Originally Posted by Flamingo View Post
    Given the two brigade structure, does the ORBAT (even on paper) not include two Field Ambulances (or equivelant) to cover casualty evacuation? Or is it purely Regimental Aid Posts (or equivelant)?
    Not in public domain

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  19. #38
    Moderator DeV's Avatar
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    Quote Originally Posted by hptmurphy View Post
    I'd be interested to see what the numbers are around trained registered health professionals is within the DF, I do know Paramedic qualified pers are imbedded within the NAS as part of their training.

    Specialist such as Anaesthetics do need to carry out a certain amount of certain types of procedures to remai current as do surgeons , but medical physicians don't. hence the lack of surgeons in the DF.

    Support functions in hospitals after a short period of induction could be carried out by members of the DF and I'm constantly surprised that this hasn't take place or at least liaison should it be required, but then again I'm not sitting at the top table, but to fit in with my function there would need to be some consultation.
    Not sure of numbers but not huge

    EMTs (not sure about Paramedics & APs) have to have min 12 patient contacts annually

    It doesn’t make medical sense or VFM to have specialists that aren’t used or are used rarely..... i know id prefer to be treated by someone who had treated someone with the same issues more frequently and was more experienced in it.

    The typical MO is basically a GP with some additional training and a lot of that will have never/rarely used .... which is a good thing ... until it is needed.

    A start is definitely the Traineeships in Mil Medicine
    https://www.military.ie/en/careers/s...-medicine.html

    From military.ie for direct entry MO’s:
    In addition it is desirable but not essential that candidates be entered on one of the following Specialist Register of the Medical Council of Ireland.

    Emergency Medicine
    Anaesthetist
    General Practice Medicine
    Occupational Medicine
    Psychiatric specialties
    Public Health Medicine

    You don’t want an Major accident/incident that happens at home/overseas to be the first time a MO has seen a major trauma in 10 years.

    Again I’m not proposing that DF personnel replace HSE personnel.

    One good way for MO’s would be for them to be on call for ICRR with the Merit3 project

  20. #39
    Commander in Chief hptmurphy's Avatar
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    You don’t want an Major accident/incident that happens at home/overseas to be the first time a MO has seen a major trauma in 10 years.
    EDs are not only for ED qualified persons.

    All ED units have Surgical and Medical persons attched to assist in fast tracking people to the correct service.

    Too many people watching the likes of 'ER' . Our system is absolutely the opposite of what you see on TV shows where all triage is carried out by nurses here, Doctors is about third in line unless its a major injury.

    he typical MO is basically a GP with some additional training and a lot of that will have never/rarely used .... which is a good thing ... until it is needed.
    and then he has no place in hospital medicine as Hospital medicine has define boundaries
    Covid 19 is not over ....it's still very real..Hand Hygiene, Social Distancing and Masks.. keep safe

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  22. #40
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    Quote Originally Posted by hptmurphy View Post
    EDs are not only for ED qualified persons.

    All ED units have Surgical and Medical persons attched to assist in fast tracking people to the correct service.

    Too many people watching the likes of 'ER' . Our system is absolutely the opposite of what you see on TV shows where all triage is carried out by nurses here, Doctors is about third in line unless its a major injury.



    and then he has no place in hospital medicine as Hospital medicine has define boundaries
    We know that in a backs to the wall scenario 200 military personnel built an expandable 4000 bed field hospital in the ExCel Centre in London , in 9 Days. It requires 16,000 staff which is being dredged up from St. Johns Ambulance, retired medical staffs, Military medical personnel, and other willing volunteers. It opens it's doors today. We must show willing. We got SBA's badged in the 60's and 70's by attaching them to busy A&E's in Major Hospitals. To keep the ship afloat we must take our turn at the pumps. When this is over, proper Military functions and potential essential supports must be reestablished.

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  24. #41
    Moderator DeV's Avatar
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    Quote Originally Posted by ancientmariner View Post
    We know that in a backs to the wall scenario 200 military personnel built an expandable 4000 bed field hospital in the ExCel Centre in London , in 9 Days. It requires 16,000 staff which is being dredged up from St. Johns Ambulance, retired medical staffs, Military medical personnel, and other willing volunteers. It opens it's doors today. We must show willing. We got SBA's badged in the 60's and 70's by attaching them to busy A&E's in Major Hospitals. To keep the ship afloat we must take our turn at the pumps. When this is over, proper Military functions and potential essential supports must be reestablished.
    This discussion isn’t necessarily COVID19 related (although now everything is)

    They took over a well maintained building which will not be available in every scenario and fitted it out... that is a very big difference (not taking away from what they have done) from a green field scenario.

    But they don’t have the trained personnel to man it. It is supposed to be an ICU facility. That (according to NHS) requires a ICU nurse:patient ratio of max 1:2 24/7. If we assume 1:2 and 12 hour shifts. They will need 4000 ICU nurses to man it (and that is 7 day working weeks for the foreseeable). There will be some in the regular military, if there are any in the reserves changes are they are NHS and therefore already tasked.

  25. #42
    Moderator DeV's Avatar
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    Quote Originally Posted by hptmurphy View Post
    EDs are not only for ED qualified persons.

    All ED units have Surgical and Medical persons attched to assist in fast tracking people to the correct service.

    Too many people watching the likes of 'ER' . Our system is absolutely the opposite of what you see on TV shows where all triage is carried out by nurses here, Doctors is about third in line unless its a major injury.



    and then he has no place in hospital medicine as Hospital medicine has define boundaries
    All trainee GPs spend the first 2 years of their 4 year specialist training in rotations in the hospital environment (including A&E).

    The MO is fairly unique as they need to be able to give GP type services, pre-hospital care and potentially some field hospital care.

    Currently (non military) Irish GPs provide pre hospital care via ICRR

  26. #43
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    Quote Originally Posted by DeV View Post
    All trainee GPs spend the first 2 years of their 4 year specialist training in rotations in the hospital environment (including A&E).

    The MO is fairly unique as they need to be able to give GP type services, pre-hospital care and potentially some field hospital care.

    Currently (non military) Irish GPs provide pre hospital care via ICRR
    Forgive my ignorance here but what is ICRR?

  27. #44
    Commander in Chief hptmurphy's Avatar
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    All trainee GPs spend the first 2 years of their 4 year specialist training in rotations in the hospital environment (including A&E)
    the GP scheme is just that the GP scheme they don't specialise and have very limited experience of the specialities in the hospital as their own chosen path is a speciality unto itself.


    This discussion isn’t necessarily COVID19 related (although now everything is)


    And based on that on that 'I'm bowing out and self isolating from IMO until the current crises is over just as I am from all social media as I need a break from anything Covid related . Bad enough I work in a place where every second word is related to it.. and then have it a home with three HCW under the one roof and my oldest daughter also a HCW. i need a break from it all

    So guys take it easy and look after yourselves and we'll talk in the future.
    Covid 19 is not over ....it's still very real..Hand Hygiene, Social Distancing and Masks.. keep safe

  28. #45
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    Mind your headspace Murph.
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  29. #46
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    Keep the Faith Brother and stay safe.
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  31. #47
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    Gotta be truthful and say the banter here, and the funnies I'm getting on Facebook Messenger are keeping me from going bonkers....
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  33. #48
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    Quote Originally Posted by hptmurphy View Post





    I have no doubt if a certain cohort of people go down in the hospitals that the DF could be the next line of defence and with rapid induction programmes could be quite efficient, its to get that training and placement done now is the issue, St. Lukes Hospital Kilkenny should have contacted the DF and put a plan in place to look after catering, portering should it be required but for now they are recruiting people from the general population instead. One hospital lost its entire compliment of porters for two weeks recently, your not going to pull in a body of that number off the street and expect them to carry out their duties... definitely the DF have a role to play in hospitals that has gone unidentified.

    That seems to be the problem. We had our first death from COVID19 in February yet what agencies were brought on line then to prepare for the worsening situation. For all intents and purposes this is a HSE run situation concerning HSE only. As far as I am aware very little meaning full use of outside state agencies used to aid or replace HSE staff. Maybe I am wrong but on the surface that seems to be the picture.

  34. #49
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    Quote Originally Posted by apc View Post
    That seems to be the problem. We had our first death from COVID19 in February yet what agencies were brought on line then to prepare for the worsening situation. For all intents and purposes this is a HSE run situation concerning HSE only. As far as I am aware very little meaning full use of outside state agencies used to aid or replace HSE staff. Maybe I am wrong but on the surface that seems to be the picture.
    When you say we, who do you mean? Ireland had its first instance of Covid19 on 29 feb, first death was 2 weeks later.
    German 1: Private Schnutz, I have bad news for you.
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    Apologies on getting the dates wrong

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