The medic of the future - CDE themed call launch 16 July 2013

© Crown copyright 2013 Dstl
23 July 2013

The Medic of the Future
Centre for Defence Enterprise

© Crown Copyright MOD 2011
The aim of CDE

Prove the value of novel, high-risk,
high-potential-benefit research

To enable development of cost-
effective military capability advantage

23 July 2013
Five key operating principles
underpin the CDE model

23 July 2013
Accessible opportunity

Minimising participation costs

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Effective proposals

Challenge, pace & exploitation

01235 438445
cde@dstl.gov.uk
www.science.mod.uk/enterprise

Surgeon General
Defence Medical Services
Air Marshal Paul Evans
Surgeon General

Surgeon General
Defence Medical Services Mission
Our Mission. Provide health policy & advice, healthcare
and medical operational capability in order to maximise
the fighting power of the Armed Forces

Surgeon General
AIM
To PROMOTE, PROTECT & RESTORE
the health of the Defence population
in order to maximise fitness for role
Aim of the Defence Medical Services
HealthcareAdvice
Operational Capability
THE STRATEGY FOR THE DMS

Surgeon General
Role of Surgeon General
End to end process owner of healthcare pathway for
Service personnel
Head of Service
CEO of Defence Medical Services

Surgeon General
Scope
Main Effort
• Operations: Afghanistan & return to contingency
Primary Care
Rehabilitation & Mental Health
Secondary Care
Education & Training
Research
Current Issues/Discussion Points

Surgeon General
The Operational Patient Care
Pathway

Surgeon General
The Operational Patient Care Pathway
 Point of Wounding }
 Buddy-Buddy Care } Pre-hosp
 Role 1 Effect – Medic + Doc }
 Evacuation – Damage Control Resuscitation } Care
 Role 2/3
• Damage Control Resuscitation
• Damage Control Surgery
• Hold
 Evacuation
• Tactical
• Strategic

Surgeon General
The Operational Patient Care Pathway
Role 4
• Royal Centre for Defence Medicine – Birmingham
– Clinical Care
– Support to the Patient Group
• Defence Medical Rehabilitation Centre Headley Court
 Return to Duty / Medical Discharge

Surgeon General
Operating Theatre History
Number of trips to theatre 27
Specialities involved 6 inc: Orthopaedics, Plastic Surgeons,
Vascular, Urology, General Surgeons,
Intensivists.
Total amount of time spent in surgery 75 hours & 15 mins
Theatre trip time length Shortest: 1hr 15 mins
Longest: 6hrs
Procedures included Femoral nail, closure of abdo,
consistent debridement & washout of all
wounds, reconstructive soft tissue flap,
split skin grafting, colostomy, insertion
of iliosacral screws, changing of
dressings, inc application of TNP &
other necessary procedures

Surgeon General
The Operational Patient Care Pathway -
Issues
Golden Hour
Bastion Vs Tent
Time to Evacuation

Surgeon General
The formation of Defence Primary Healthcare means that SG will now
deliver end-to-end clinical care in the firm base and the permanent
bases overseas
•More efficient use of personnel & resources;
•Quicker implementation of healthcare policy & Defence
change;
•Better governance and performance management;
•Better links with the NHS to manage access to secondary
care;
•More attractive employer for clinicians and administrative
staff.
Defence Primary Healthcare - Implications
Key Benefits

Surgeon General
Primary Care
1 Apr 13 – Defence Primary Healthcare Care
SG now directly accountable for tri-Service primary
care delivery with budget
DMS legislated to provide primary care
Occupational Primary Care Service
• Return to duty philosophy

Surgeon General
Defence Medical Rehabilitation
Programme
 Tiered approach – Multidisciplinary occupational approach
 Tier 1 – Primary Care Rehabilitative Facility (PCRF)
 Tier 2 – Regional Rehabilitation Unit (RRU)
• 16 in UK
• Function:
– Medical Injury Assessment Clinic (MIAC)
– Group Treatment capability
 Tier 3 – Defence Medical Rehabilitation Centre (DMRC)
• Complex Trauma
• Musculoskeletal
• Neuro

Surgeon General
The Future – Defence National Rehabilitation Centre
A decision on a Defence National Rehabilitation Centre to
meet future UK rehabilitation needs is likely this year
•With a Defence element at its core, it
would replace Headley Court
•A campaign to raise £300M is being
led by the Duke of Westminster
•The Duke has already acquired a site –
Stanford Hall in the Midlands
•An announcement is likely once £200M
has been raised (possibly later in 2013)
•If confirmed, the intention would be to
open the Defence element in 2017

Surgeon General
Defence Mental Health
Occupational Community based service
Departments of Community Mental Health (DCMHs)
• Multidisciplinary – Psychiatrists, Clinical Psychologists,
Mental Health nurses & social workers
• 13 in UK
Minimal requirement for in-patient capability
• NHS contracted service with South Staffs consortium
• NB – Lower admission threshold
Academic Centre for Defence Mental Health - Kings

Surgeon General
Secondary Care
NHS Provision under our entitled access to
secondary care
• Vast majority for provided under NHS routine access
driven by clinical need
• Majority of elective care is outpatient or day case
• Contract for rapid access to Imaging & Operative
orthopaedic care

Surgeon General
Strategic Challenges – Secondary Care Commissioning
We need to resolve uncertainty about funding to meet the secondary
care needs of Service personnel under new NHS arrangements.
•Funding for military patients will be held
centrally by NHS England, not regionally.
•Will funding requirement be calculated
accurately?
•Discussions held up by delays to
establishing posts within NHS England.
•There is uncertainty about who will fund
occupational referrals.
•Our position: Any funding shortage
should be a NHS risk not a Defence
one.

Surgeon General
Education & Training
Doctors:
• Medical Cadets
• Specialist training
• GPVT
• Direct Entrants
Nurses
• Direct Entrants
• In-house Nurse Training – Birmingham City University
AHPs
• Some In-house some recruited post training

Surgeon General
Education & Training
Defence Medic
• Current Training Programme
– Common Core 20 weeks
– Individual Services
Army/RAF – 7 weeks
RN – 19 weeks
– Professional Status
– Keogh Barracks Aldershot

Surgeon General
The Future – Creating a Regional Centre of Excellence
DMS Whittington will be at the hub of a regionally-based
centre of professional excellence for the 21st Century
•£138m construction including HQ,
training and accommodation
•Future home for over 1,000 military
and 400 civilian staff
•Phase 2 Construction will be
completed by Feb 2014
•Currently on-time/on-budget/to user-
defined requirement
•Feedback is good across the board

Surgeon General
Research
Created Medical Director post in 2009
Mission:
To support deployed DMS personnel through academia,
research, clinical policy, personnel management, and
equipment capability developments, which ensure the
highest standards of governance, whilst continually
promoting innovative, world leading, quality and safe
patient care.

Surgeon General
JMC Medical Directorate
Title ‘Medical Director’ aligns to NHS titles
Job is outward looking to civilian NHS and academic
practice
Combines professional leadership with academic
research
Development of Clinical Policy and provision of
clinical advice to Theatre/PJHQ in real time

Surgeon General
Defence Medical Academia
8 Defence Profs with senior lecturers and lecturers
• Emergency Medicine
• Surgery
• Orthopaedics
• Medicine
• Anaesthetics & Critical Care
• General Practice (GP)
• Mental Health
• Nursing
Royal College recognition
All are deployable and most have deployed in last 18
months

Surgeon General
DMS Academia & Research
Research is focussed through SG’s Research Plan
Multiple Internal, National and International
Collaborative Partners (Dstl, Russell Group Universities, NIHR,
TRBL Blast Centre, US, NATO
Research and audit is part of medical revalidation
Clearance of all clinical papers
End users are often the researchers – unique to
Defence

Surgeon General
QUALITY AND ASSURANCE
Care Quality Commission
• Very positive review of both Primary and secondary care
including operational environment
Inspector General
• Accountable to SG
Defence Internal Audit
Joint Force Command / SoS /HCDC

Surgeon General
Revalidation
No different from civilian requirement
NB – full clinical practice
• Operations
Role of Medical Manager

Surgeon General
Clinical Skills post Afghanistan
Is a ‘dip’ in performance inevitable following draw-down in
Afghanistan and if so, how deep will it be?
•Unless maintained, skills will have to be
relearned on the next campaign.
•Will we retain our most able people if we
return to a ‘peace-time’ routine?
•Our Position. To maintain hard-won
skills, we need to provide:
•quality clinical placements,
•exposure to simulation,
•rewarding research opportunities
•‘real-life’ opportunities

Surgeon General
 Changes in NHS
 Efficiency pressures in NHS.
 DH committed to development of new, mutually beneficial
arrangements.
 Includes DAs on Partnership Board
 Placements for Secondary Healthcare Personnel
 Level 1/Major Trauma Centres
 Current MDHU Arrangements (placements & commissioning) no
longer fit for purpose
 Review has DH support.
 DMG Scotland
 Partnerships & Collaboration
 Generate symbiotic relationships
Changes in NHS England

Surgeon General
VISION
To be recognised by those
we serve as a World
Leader in military
healthcare and health
advice

Surgeon General
VALUES
Excellence, by striving for continuous improvement and
the highest quality in all that we do
Commitment to patients, and evidence-based practice
Integrity, by adhering to the highest professional and
ethical standards, maintaining the trust and confidence
of all with whom we engage
Teamwork and leadership, which are key to success
Respect, by treating those with whom we serve and
work with dignity and respect

MOD Medical Sciences Research Programme
Overview
Surgeon Commodore Alasdair Walker, Joint Medical Command
Neal Smith, Dstl Programme Delivery Directorate
16 July 2013
23 July 2013

Defence S&T Medical Sciences Programme
23 July 2013
© Dstl
Casualty Care
To investigate techniques and interventions that address complex
injuries from current and emerging battlefield threats in
conventional (non-CBRN) warfare.
Force Effectiveness and Rehabilitation
Focused on improving numbers of those fit to deploy, improving the
quality of life of survivors from military conflict, minimising residual
disability and providing aftercare support to wounded veterans.
Medical Systems
Research, develop and evaluate systems that will maintain and/or
enhance the effectiveness of deployed forces in extreme and austere
environments and produce medical treatments, interventions and
rehabilitative support to injured personnel.

23 July 2013
© Dstl
Casualty Care
• Resuscitation
• Haemorrhage Control
• Battlefield Pain Management
• Blast Injury Characterisation
• Extremity Trauma

23 July 2013
© Dstl
Force Effectiveness and Rehabilitation
NIHR Programme (Joint MoD/Department of Health)
• Acute response to injury
• Microbiology
• Regenerative/Reconstruction Medicine
King’s Centre for Military Health Research
• Long term investigation into possible health effects of
operational deployment among UK Armed Forces personnel
(initiated 2003)
Health & Well-Being
• Potential chronic health effects
• Help seeking behaviours and stigma reduction
• Nutrition
• Noise Induced Hearing Loss & Vibration

23 July 2013
© Dstl
Medical Systems
2012: The Extremes of Defence Medical Capability
• Small Rugged Blood Fridge
• Spiral peripheral nerve interface
• Knitted prosthetic sleeves
• Integrated patient monitor
• One arm drive wheelchair
Today…
2013: The Medic of the Future: Training and Support

CDE Medical Call 2013
The Medic of the Future: Training and Support
16 July 2013
UNCLASSIFIED
FOR PUBLIC RELEASE
23 July 2013

• Context
• Technology Challenges:
– 1: Exploring the potential of simulated training and high-
fidelity models
– 2: Identifying novel systems that will help those injured in
battle
• Exploitation
UNCLASSIFIED
FOR PUBLIC RELEASE
23 July 2013

• Context
– The human component is central to delivering military
capability
– Provision of sufficient, capable and appropriately trained
personnel is critical to operational success
– There is a need to sustain capability by protection, treatment
and rehabilitation
– Provision of high quality support, care and treatment at all
points along the continuum of care is essential
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE

Technology Challenge 1
• Exploring the development of high fidelity models with
enhanced haptic feedback to replace existing live
simulation methods especially in advanced clinical
practice and surgery
– Simulated Environments
– Mannequins
– Synthetic tissue
– Trauma scenario simulation
– Virtual coaching
FOR PUBLIC RELEASE

• We want systems which:
– Novel and innovative systems
– Consider cost to MOD of introduction
– Provide realistic scenarios, but avoid live models
– Consider standards and measures of competency
– Provide constructive feedback to trainees and trainers
– Demonstration of proof-of-concept for further investigation.
FOR PUBLIC RELEASE

• What we don’t want
– Management or provision of training services.
– Consultancy on training and education.
– Existing ‘off the shelf’ products.
FOR PUBLIC RELEASE

• Identifying novel systems that will help those injured in
battle
• Opportunities to maintain force effectiveness
– Equipment enhancements
– Easing burden for the battlefield medic
– Enhanced protection for patients
• Military Patient Transport
– Reducing contamination and infection
– Enhancing safety and protection
FOR PUBLIC RELEASE

• What we want
– Proposals that demonstrate the benefits of tailoring
conventional medical systems to bespoke defence challenges
– Demonstration of proof-of-concept for further investigation
• What we don’t want
– Systems which result in an unrealistic burden on other
components of capability
FOR PUBLIC RELEASE

Exploitation
• Research integration
– Medical Sciences Programme
– Training & Education Programme
• Procurement
– Refine, trial or purchase
• Policy
– Refinement and implement
– Development of doctrine
FOR PUBLIC RELEASE

Summary
• Technology Challenges
– 1: Exploring the potential of simulated training and high-fidelity models
– 2: Identifying novel systems that will help those injured in battle
• What we want
– Systems which consider full cost of introduction
– Realistic models that assist training
– Systems which ease the burden of the battlefield medic
– Enhancements for patient and medic safety
– Demonstration of proof-of-concept for further investigation
FOR PUBLIC RELEASE

Submitting a Successful Proposal

Read available
information
Start with –
Quick Start
Guide
plus other CDE manuals –
Account Manual, User
Manual, Technology
Application Manual
Know what is available

Value from technology
Innovative
concept
Future
capability
Proof of
concept Incremental development

MOD Performance Assessment Framework
Five criteria:
Operational relevance
Likelihood of exploitation
Builds critical S&T capability
Scientific quality/innovation
Science, innovation and technology risk

Contribution to future benefit

Based on a claim of future benefit
Contribution to realisation of future benefit
Logical programme of work
Evidential outcomes
Demonstration of progress towards goal
Health check

This call closes:
17:00 hrs on
Thursday 5September 2013
Deadline

www.science.mod.uk
Events and Calls > Current calls for proposals
> The Medic of the Future
Webinar:23 July 2013 14:30-15:30
Register online
Further information

cde@dstl.gov.uk
www.science.mod.uk/enterprise
Call process queries

© Crown copyright 2013 Dstl23 July 2013
1. Exploring the potential of simulated training
and high-fidelity models
2. Identifying novel systems that will help those
injured in battle
Technology Challenges

HD&MSDomain@dstl.gov.uk
Call technical queries

The medic of the future - CDE themed call launch 16 July 2013

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