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  • #16
    Originally posted by ancientmariner View Post
    Exactly. If your hazard is a distant event but could wipe out your population or economy then plan and prepare. World events are not neutral or selective. The irony is that NGO's and Government agencies know that hazards facing us all include Natural disasters and Diseases. We also need to consider manufacturing PPE, using our clothing and chemical/distilling industries, and create a new trade, also for export.
    We currently make 50% of the ventilators used in acute hospitals in the world, that doesn’t mean we can keep the lions share!
    The only way to guarantee that is to enter expensive loss making contracts that is State supports and that (outside of an emergency) isn’t possible

    Originally posted by ancientmariner View Post
    The idea would be to construct rather than also man. The spare hospitals would allow normal sick or convalescents to be transferred and cared for in a non-infectious building (Covid free), leaving Main hospitals continue treating the Covid positives. Manning can be augmented by Civil medical organisations and grounded cabin crews from our airlines etc.

    Originally posted by hptmurphy View Post
    The army don't have the 'trades to run a hospital of this magnitude as the DF have piggy backed on the HSE for all their medical cover for years and with the DF running at under 8000 spread over the country there will never been the staff or the funding to do so.

    This pandemic is being led by Respiratory specialists and Anaesthologists due to the nature of the treatment. There isn't and over flow of these available , so diverting funds to acquire and set up Army Field hospitals is a non runner.

    The DF in a support mode through ambulances, testing and Logs is what is needed . If the DF doctors can be incorporated into the HSE for the duration, all the better.
    Originally posted by Flamingo View Post
    To be fair, no peacetime army needs a large medical footprint, a few orthopaedic surgeons and GP’s could cover 90% of the work, as one is dealing with a workforce that is significantly fitter than the average population, and indeed chosen as such.

    The US and the U.K. (both significantly larger than Ireland in terms of population and Armed Forces) rely on mobilisation of suitably trained professional reservists to staff their medical services in wartime- something that would be counterproductive at the moment.

    This is not to say that having the ability to deploy is unnecessary - I would say the knowledge and ability is vital, even if the actual staff manning it are drawn from civil defence and other sources, rather than being “green”.
    And there in is a major issue

    The military needs the capacity to be able to deploy, establish and man a Fd Hospital. This really has to be Role 2 minimum (really role 2 and 3). The major issue is that it could man it possibly but they need to be people who are dealing with major trauma casualties on a weekly basis, there are a few possible ways of the DF doing that:
    (a) the RDF (who will be pulled from HSE staff and therefore unavailable most of the time and already over worked)
    (b) semi-permanently embed PDF personnel in HSE (what happens HSE when they are required, not available for DF tasks)
    (c) attach (few shifts a week) PDF personnel in HSE (what happens HSE when they are required, lesser degree of exposure to trauma and less availability for DF tasks)
    (d) have it DF only but deploy regularly (extremely regularly) with UN, Irish Aid etc etc

    The DF currently have to send paramedics to HSE to retain sufficient patient contact to retain currency and that isn’t necessarily a bad thing.

    Anything can be a Fd Hospital a tent, a ship, an exhibition hall (cleaners, engineers, etc required) - if it doesn’t have medical personnel and equipment it isn’t a Fd Hospital!

    The DF had one that was based on expanding 20ft containers, it was role 1 due to the manning.




    Look at the Italian army - their medical service is provided by the Order of Malta.
    You sure about that?

    Comment


    • #17
      Originally posted by DeV View Post
      You sure about that?
      Corpo speciale volontario ausiliario dell'Esercito Italiano dell'Associazione dei cavalieri italiani del Sovrano militare Ordine di Malta, Corpo Militare EI-SMOM

      It is a voluntary auxiliary corps that provides medical staff for the Italian Army

      Comment


      • #18
        Originally posted by ancientmariner View Post
        The idea would be to construct rather than also man. The spare hospitals would allow normal sick or convalescents to be transferred and cared for in a non-infectious building (Covid free), leaving Main hospitals continue treating the Covid positives. Manning can be augmented by Civil medical organisations and grounded cabin crews from our airlines etc.
        But again who is to care for them given we don't have enough professionals in front line posts as it is. The 'normal' sick are again of age group in which 90% are over 70 years old and require specialist care whether it be GEMs nursing, Occupational therapy , Physios , Pharmacists and nutritionists, without having any support staff in place to ensure the supports are in place to keep it all running. The health Service as it is has ground to a halt in preparation for the 'surge' Maternity services and oncology are the only things running half normally

        The hospital system and its supports need consolidation and not off on wild goose chases experimenting with non options we know absolutely nothing about.

        People mention shortages of PPE, I'd be more concerned about the shortage of Portable bottled oxygen in 'CD' size becuase of the amount of cylinders removed from hospitals by people for their own use leaving an acute shortage of this size in the country....the cylinders are out there... can we have them back please to have them refilled?

        The amount of high value PPE that walked out the doors of hospitals because staff wanted to protect them selves at home!... I know of a hospital where 200 'duck bill' type FFP3 masks were issued on Friday, non left on monday and no patient of the type requiring this type of mask presented....

        First aiders, community responders are just that, not equipped by any means to deal with people who will be / are very sick. To expect them to do other than their title suggest is unfair and they are needed in those roles as well.

        If the surge happens , when the current support staff are wiped out , its the people to clean wards , wash and feed patients, porters, chefs,supplies people we are going to need .

        We saw it in SIPTUs strike last year, you can have all the nurses and doctors you like, without the support staff , hospitals cannot function.

        Back to field hospitals, you can't do it in days, it takes years to get it right, we haven't the luxury of that time....and the DF are a limited force, 125,000 people working in the HSE......with large portions of them now redeployed to simply supporting hospitals.. the DF is less than 8000 people all ranks, without any real hospital experience behind them bar Paramedics.

        Reality please.
        Covid 19 is not over ....it's still very real..Hand Hygiene, Social Distancing and Masks.. keep safe

        Comment


        • #19
          There’s much more to a field hospital than a building with a few beds, Dr’s and nurses. The whole logistics of equipment, supplies, feeding patients and staff, water, sanitation, admission, laboratories, power, auxiliary staff, waste disposal (both ordinary and hazardous), mortuary services, (the list can go on) is not something that can be designed in five minutes on the back of a fag packet.

          In a way, having the people to man it is the easy bit.

          The army/civil defence would be ideally placed to plan and provide all the services needed to set up the facility.
          Last edited by Flamingo; 31 March 2020, 21:30.
          'He died who loved to live,' they'll say,
          'Unselfishly so we might have today!'
          Like hell! He fought because he had to fight;
          He died that's all. It was his unlucky night.
          http://www.salamanderoasis.org/poems...nnis/luck.html

          Comment


          • #20
            Originally posted by ancientmariner View Post
            The idea would be to construct rather than also man. The spare hospitals would allow normal sick or convalescents to be transferred and cared for in a non-infectious building (Covid free), leaving Main hospitals continue treating the Covid positives. Manning can be augmented by Civil medical organisations and grounded cabin crews from our airlines etc.
            The current plan in most places seems to be to use the field hospitals for the Covid-19 cases, keeping the ordinary hospitals clean. This would make sense, keep the dirty cases together and provide the facilities they need there, while having the specialist facilities needed by the “ordinary” patients still available.
            'He died who loved to live,' they'll say,
            'Unselfishly so we might have today!'
            Like hell! He fought because he had to fight;
            He died that's all. It was his unlucky night.
            http://www.salamanderoasis.org/poems...nnis/luck.html

            Comment


            • #21
              Just a couple of things

              (
              a) the RDF (who will be pulled from HSE staff and therefore unavailable most of the time and already over worked)
              In emergency such as this , they wouldn't be released for RDF service

              semi-permanently embed PDF personnel in HSE
              No benefit as the training regime and requalification within a hospital setting would be rendered null and void unless they were permanently based in a hospital setting, even in the most basic roles. use it or lose it scenario. To work simply as a porter would take a week of very simple qualifications, hand hygiene, standard precautions, working with gases, patient handling, TMVA, fire training, Sharps, Spinal Lifting, Waste Management etc. And thats if the resources are available to train them as the HSE have enough difficulty getting access to training the selves.

              Soldiers train to be soldiers and a few specialize in some hospital functions, The HSE is not a training facility for the Army but a live environment where the people are there for the long haul and live in a ever changing environment. Some would thrive in it, but if thats what they want, why did they become soldiers.
              Covid 19 is not over ....it's still very real..Hand Hygiene, Social Distancing and Masks.. keep safe

              Comment


              • #22
                Originally posted by EUFighter View Post
                Corpo speciale volontario ausiliario dell'Esercito Italiano dell'Associazione dei cavalieri italiani del Sovrano militare Ordine di Malta, Corpo Militare EI-SMOM

                It is a voluntary auxiliary corps that provides medical staff for the Italian Army


                Military Corps Edit


                Logotype of the Military Corps of the Sovereign Military Order of Malta

                Military Corps of the Sovereign Military Order of Malta, ACISMOM, in parade during Festa della Repubblica in Rome (2007)
                The Order states that it was the hospitaller role that enabled the Order to survive the end of the crusading era; nonetheless, it retains its military title and traditions.

                On 26 March 1876, the Association of the Italian Knights of the Sovereign Military Order of Malta (Associazione dei cavalieri italiani del sovrano militare ordine di Malta, ACISMOM) reformed the Order's military to a modern military unit of the era. This unit provided medical support to the Italian Army and on 9 April 1909 the military corps officially became a special auxiliary volunteer corps of the Italian Army under the name Corpo Militare dell'Esercito dell'ACISMOM (Army Military Corps of the ACISMOM), wearing Italian uniforms.[82] Since then the Military Corps have operated with the Italian Army both in wartime and peacetime in medical or paramedical military functions, and in ceremonial functions for the Order, such as standing guard around the coffins of high officers of the Order before and during funeral rites.[83]

                I believe that it is a unique case in the world that a unit of the army of one country is supervised by a body of another sovereign country. Just think that whenever our staff (medical officers mainly) is engaged in a military mission abroad, there is the flag of the Order flying below the Italian flag.

                —?Fausto Solaro del Borgo, President of the Italian Association of the Sovereign Military Order of Malta, stated in a speech given in London in November 2007.[82]
                Air force Edit

                Roundel of the air force of the Sovereign Military Order of Malta

                SMOM Savoia-Marchetti SM.82 at the Italian Air Force Museum
                In 1947, after the post-World War II peace treaty forbade Italy to own or operate bomber aircraft and only operate a limited number of transport aircraft, the Italian Air Force opted to transfer some of its Savoia-Marchetti SM.82 aircraft to the Sovereign Military Order of Malta, pending the definition of their exact status (the SM.82 were properly long range transport aircraft that could be adapted for bombing missions). These aircraft were operated by Italian Air Force personnel temporarily flying for the Order, carried the Order's roundels on the fuselage and Italian ones on the wings, and were used mainly for standard Italian Air Force training and transport missions but also for some humanitarian tasks proper of the Order of Malta (like the transport of sick pilgrims to the Lourdes sanctuary). In the early '50s, when the strictures of the peace treaty had been much relaxed by the Allied authorities, the aircraft returned under full control of the Italian Air Force. One of the aircraft transferred to the Order of Malta, still with the Order's fuselage roundels, is preserved in the Italian Air Force Museum.[84]

                Logistics Edit
                The Military Corps has become known in mainland Europe for its operation of hospital trains,[85] a service which was carried out intensively during both World Wars. The Military Corps still operates a modern 28-car hospital train with 192 hospital beds, serviced by a medical staff of 38 medics and paramedics provided by the Order and a technical staff provided by the Italian Army's Railway Engineer Regiment.[8
                I have seen a photo of my father in the early 50’s being loaded onto an OOM ex-Italian bomber for a pilgrimage to Lourdes - he was bed bound with a nasty form of TB in his bones.
                Last edited by Flamingo; 31 March 2020, 21:40.
                'He died who loved to live,' they'll say,
                'Unselfishly so we might have today!'
                Like hell! He fought because he had to fight;
                He died that's all. It was his unlucky night.
                http://www.salamanderoasis.org/poems...nnis/luck.html

                Comment


                • #23
                  Military Medical Facilities

                  Doing nothing is not a viable option. Elements of PDF are already helping. In our extinct hospitals orderlies were often pirated from well patients to help the Army nurses. I remember we "lost" a seaman in Cork MH and the Matron pleaded to leave him as he was great with the patients. In any ARMY there should be an implementation Plan on the shelf for a Field Hospital ( 200) and there is no excuse for not being able to produce ,at a number of locations, a Troop Hospital (50) for Military or civil use. The Nightingale units in the UK are going to use Airline Cabin crew staffs to assist. If we just capitulate we are losing the battle. A willing volunteer is another pair of hands and can always follow orders. In Stores we should have the construction elements and plans for such hospitals to be erected in buildings, stadia, or tentage.

                  Comment


                  • #24
                    Originally posted by EUFighter View Post
                    Corpo speciale volontario ausiliario dell'Esercito Italiano dell'Associazione dei cavalieri italiani del Sovrano militare Ordine di Malta, Corpo Militare EI-SMOM

                    It is a voluntary auxiliary corps that provides medical staff for the Italian Army
                    Like the Irish Red Cross being under DoD?

                    Originally posted by Flamingo View Post
                    There’s much more to a field hospital than a building with a few beds, Dr’s and nurses. The whole logistics of equipment, supplies, feeding patients and staff, water, sanitation, admission, laboratories, power, auxiliary staff, waste disposal (both ordinary and hazardous), mortuary services, (the list can go on) is not something that can be designed in five minutes on the back of a fag packet.

                    In a way, having the people to man it is the easy bit.

                    The army/civil defence would be ideally placed to plan and provide all the services needed to set up the facility.
                    We could have a team of 1000 people to set it up but no use if no clinicians.

                    Originally posted by Flamingo View Post
                    The current plan in most places seems to be to use the field hospitals for the Covid-19 cases, keeping the ordinary hospitals clean. This would make sense, keep the dirty cases together and provide the facilities they need there, while having the specialist facilities needed by the “ordinary” patients still available.
                    It looks like they are the overflow as the initial cases will have made that “clean” hospital “dirty”

                    Originally posted by hptmurphy View Post
                    Just a couple of things

                    (

                    In emergency such as this , they wouldn't be released for RDF service



                    No benefit as the training regime and requalification within a hospital setting would be rendered null and void unless they were permanently based in a hospital setting, even in the most basic roles. use it or lose it scenario. To work simply as a porter would take a week of very simple qualifications, hand hygiene, standard precautions, working with gases, patient handling, TMVA, fire training, Sharps, Spinal Lifting, Waste Management etc. And thats if the resources are available to train them as the HSE have enough difficulty getting access to training the selves.

                    Soldiers train to be soldiers and a few specialize in some hospital functions, The HSE is not a training facility for the Army but a live environment where the people are there for the long haul and live in a ever changing environment. Some would thrive in it, but if thats what they want, why did they become soldiers.
                    I’m not talking about the current situation I mean in general.

                    Although soldiers in CMU are soldiers first in the main their day to day is as clinicians, which means that they are trained in that kind of thing already.

                    Hospitals & ambulances are very much training environments. Student doctors, NCHDs, supernumeraries on ambulances, paramedics on rotations, etc etc

                    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.

                    Comment


                    • #25
                      Originally posted by hptmurphy View Post
                      But again who is to care for them given we don't have enough professionals in front line posts as it is. The 'normal' sick are again of age group in which 90% are over 70 years old and require specialist care whether it be GEMs nursing, Occupational therapy , Physios , Pharmacists and nutritionists, without having any support staff in place to ensure the supports are in place to keep it all running. The health Service as it is has ground to a halt in preparation for the 'surge' Maternity services and oncology are the only things running half normally

                      The hospital system and its supports need consolidation and not off on wild goose chases experimenting with non options we know absolutely nothing about.

                      People mention shortages of PPE, I'd be more concerned about the shortage of Portable bottled oxygen in 'CD' size becuase of the amount of cylinders removed from hospitals by people for their own use leaving an acute shortage of this size in the country....the cylinders are out there... can we have them back please to have them refilled?

                      The amount of high value PPE that walked out the doors of hospitals because staff wanted to protect them selves at home!... I know of a hospital where 200 'duck bill' type FFP3 masks were issued on Friday, non left on monday and no patient of the type requiring this type of mask presented....

                      First aiders, community responders are just that, not equipped by any means to deal with people who will be / are very sick. To expect them to do other than their title suggest is unfair and they are needed in those roles as well.

                      If the surge happens , when the current support staff are wiped out , its the people to clean wards , wash and feed patients, porters, chefs,supplies people we are going to need .

                      We saw it in SIPTUs strike last year, you can have all the nurses and doctors you like, without the support staff , hospitals cannot function.

                      Back to field hospitals, you can't do it in days, it takes years to get it right, we haven't the luxury of that time....and the DF are a limited force, 125,000 people working in the HSE......with large portions of them now redeployed to simply supporting hospitals.. the DF is less than 8000 people all ranks, without any real hospital experience behind them bar Paramedics.

                      Reality please.
                      Shit load of PPE went missing from a health center in Tallaght two weeks ago including FFP2 duckbills

                      Comment


                      • #26
                        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; 1 April 2020, 09:26.
                        Covid 19 is not over ....it's still very real..Hand Hygiene, Social Distancing and Masks.. keep safe

                        Comment


                        • #27
                          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.

                          Comment


                          • #28
                            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

                            Comment


                            • #29
                              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.

                              Comment


                              • #30
                                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).

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