Army Medical Corps - Wiki

Discussion in 'Indian Army' started by hit&run, Aug 21, 2009.

  1. hit&run

    hit&run Elite Member Elite Member

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    In an enterprise founded on destruction and killing, military doctors have a uniquely constructive mission. They must mend their own comrades’ wounds and if possible, send them back to fight, even if it risks further injury. Doctors rarely carry a weapon and in most instances are exempt from being fired on. That doesn't always protect them from danger, and it surely does not exempt them from the stresses of war. A soldier, if he’s truly lucky, may never witness a casualty; casualties are what wartime military doctors deal with every day.


    Army Medical Corps
    (Sarve Santu Niramyah)
    "may all be disease-free"

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    HISTORY OF ARMY MEDICAL CORPS
    Introduction
    Very little is known of the medical organisations that existed in the various Armies in this country in the ancient times. However, Kautilya’s Arthashastra shows that during battles, physicians with surgical instruments (Sastra, medicines and drugs in their hands besides women with prepared food and beverages) used to stand behind the fighting men. Similarly, from Sushruta Samhita, it is seen that a physician fully equipped with Medicines would live in a camp not remote from the royal pavilion and there the persons wounded by arrows and other war projectiles, or those who had imbibed poison used to be treated. A physician in the King’s service used to adopt certain measures to protect the life of his royal highness from secret poisoning. The physician well versed in technical sciences and with knowledge of other allied branches of study was held in high esteem by the King and others.
    The Army Medical Corps came into existence as a homogeneous corps of officers and men on the pattern of the Royal Army Medical Corps on 03 Apr 1943 by the amalgamation of the Indian Medical Service, the Indian Medical Department and the Indian Hospital Corps. The Corps was formed as a wartime necessity for attracting suitably qualified men for service in a rapidly expanding army.
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    Indian Medical Service

    The history of the Indian Medical Service (IMS) dates back to 1612 when on the formation of the East India Company into a joint stock business, the Company appointed John Woodall as their first Surgeon General. Under him, medical Corps officers (mainly civilians) were recruited more or less on individual contracts. The company expanded activities in various part of the country which necessitated the formation and maintenance of regular bodies of troops in India. As a consequence, they commenced employing Military Surgeons from 1745 onwards. It was not until 1764 that these Surgeons were made into regular establishment of the company’s armies. Thus the Bengal Medical Service was formed in 1764, the Madras Medical Service in 1767 and the Bombay Medical Service in 1779 for the three Presidency Armies of Bengal, Madras and Bombay respectively. Three medical services were in due course combined into one Indian Medical Services (IMS) in Apr 1886 under a Surgeon General to the Govt of India. The designation was later changed into the Director General, Indian Medical Service. In 1913, the appointment was designated as the Director of Medical Services in India.
    Until the First Word War the IMS was pre-dominantly civil in character, but gradually from 1912 onwards those employed in civil duties became less and less in number. Indianisation of this service commenced from 1915 onwards. Sarjoo Coomar Goodeve Chauckerbutty was the first Indian to enter the service as Assistant Surgeon on 24 Jan 1855.
    Until Burma was separated in 1935, the IMS was catering for the civil and military needs of Burma also. During this period, the IMS was assisted by the members of the Indian Medical Department (IMD) and Indian Hospital Corps (IHC).
    The idea of re-organising the medical services into a separate Medical Corps exclusively for the Defence Services was first conceived in 1939 with the out break of World War II and with the formation of Indian Army Medical Corps in 1943, the extinction of the IMS as such was merely a matter of time. On 14 Aug 1947 the service was finally wound up.
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    Indian Medical Department

    The history of the Indian Medical Department (IMD) dates back to 19th century. Initially starting as compounders and dressers in the three Presidency Medical Services they became Sub Surgeons and later on as Indian Medical Assistants in Indian Regiments. In 1868, they were redesignated as Hospital Assistants. In 1900, the Senior Hospital Assistants were granted the rank of Viceroy’s Commissioned Officers and in 1910 the designation was finally changed to Sub Assistant Surgeons of IMD. They were primarily for work with the Indian troops.
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    Indian Hospital Corps

    The Indian Hospital Corps was formed on 01 June 1920 by combining the Army Hospital Corps and Army Bearer Corps and the subordinate personnel of Indian Station Hospitals, comprising persons of categories then considered necessary for hospitals, field ambulances and other medical units.
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    Army Hospital Corps

    In the days of the East India Company there were no regular formations or units charged with the task of looking after the health of troops. In 1881 the British Regimental Hospitals gave way to British Station Hospitals and they needed subordinate persons. So in 1981, the Army Hospital Native Corps was formed of menials of the disbanded British Regimental Hospitals, Compounders, dressers, ward coolies, barbers, shop coolies, cooks, bhistis and sweepers and were designated as, Hospital Attendants. With the abolition of the Presidency Armies by the Government and the evolution of the Army into 10 Divisions, the Army Hospital Native Corps was re-organised into 10 Companies as Army Hospital Corps.

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    Army Bearer Corps

    It was not until 1901 that the necessity for a proper corps of bearers was accepted by the Government and in this year, Dooly Bearers and Kahars were enlisted in the newly formed Army Bearer Corps, which came under the Medical Department. The Army Hospital Corps persons did the menial service in British Station Hospitals and the Army Bearer Corps provided persons for the carriage of the sick and wounded. In 1903, the Army Bearer Corps was re-organised into 10 Division Companies and the duties of these Companies in war were to carry stretchers and doolies, and in peace for general work in hospital.
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    Station Hospitals

    Indian troops had no station hospital facilities until 1918, and had to depend entirely on their regimental hospitals. In October 1918, Station Hospitals for Indian troops were sanctioned. Ward orderlies and followers came from Army Hospital Corps and bearers were provided by the Army Bearer Corps.
    The IHC initially was divided into 10 Division Companies corresponding to the 10 existing Military Divisions in India and Burma and they were located at Peshwar, Rawalpindi, Lahore, Quetta, Mhow, Poona, Meerut, Lucknow, Secunderabad and Rangoon. The whole corps was re-organised on command basis during the year 1929-32 and thus there were five companies of the IHC in 1932, No 1 Company at Rawalpindi, No 2 Company at Lucknow, No 3 Company at Poona. No 4 Company at Quetta and No 5 Company at Rangoon. On separation of Burma in 1935, No 5 Company of IHC was formed as Burma Hospital Corps and this left four companies of IHC.
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    Indian Army Medical Corps

    World War II was responsible for rapid developments. The idea of having a homogeneous corps by amalgamating IMS, IMD gradually took shape and Indian Army Medical Corps (IAMC) came into being on 03 Apr 1943. On the formation of the IAMC, the IHC HQs at Poona became the Administrative Headquarters of the IAMC in May 1943.
    After Independence of the country, the Corps has made a steady progress. The men enjoy combatant status. The post of Director General Armed Forces Medical Services was created in 1949 as coordinating head of the med services of the Army, Navy and Air Force.
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    Army Medical Corps

    The IAMC was re-designated as Army Medical Corps with effect from 26 Jan 1950.
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    AMC FLAG COLOURS ADOPTED IN 1944 BY IAMC AND RETAINED BY AMC IN 1953.The AMC Flag has the following colours and width of horizontal stripes: -

    Colour Flag 3’ x 2’ Flag 6’ x 4’
    Top Dull Cherry 11" 22"
    Middle Black 2" 4"
    Bottom Old Gold 11" 22"
    [​IMG]


    The flags are required to be made of bunting cloth. The flag is flown in two sizes, flag 3’ x 2’ with flag mast 15' high and flag 6’ x 4’ with mast 20’ (or more). The colours were adopted by the Indian Army Med Corps in 1944, as representative of the three amalgamated components. Later, in 1953, the Army Medical Corps retained the colours for the Corps flag.

    The three Colours are representative and symbolic of : -
    DULL CHERRY: This has historical importance as being the distinguished colour of the Royal Army Medical Corps and Medical Services of many other countries. It is associated with positive health, succor and freedom from diseases.
    BLACK : It was the corps colour of Indian Hospital Corps. It is associated with formless state of creating birth and death.
    OLD GOLD: This is representative of Indian Medical Services which existed in India before 1943. The colour is symbolic of Sun God AESCULAPIUS, the God of Medicine.
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    [​IMG]

    [​IMG]

    Armed Forces Medical College, Pune

    TRAINING INSTITUTIONS

    Medical, Dental, Nursing and Para-medical personnel of Armed Forces Medical Services are trained in own institutions of repute.
    In Dec 1941 in IHC-VCOs and NCOs school was established with No 3 Indian Hospital Corps Battalion in Pune which later evolved into the Army Med Training Centre (AMTC) in Jan 1942. The AMTC was the forerunner of the present Armed Forces Medical College at Pune, which was raised on 01 May 1948. The college started its under-graduate wing on 04 Aug 1962.
    The Armed Forces Medical College, Pune is a premier medical institution responsible for training under-graduate and postgraduate doctors. The selection of under-graduate students is done on basis of an open All India Entrance Examination. In addition, a number of military hospitals have also been recognised for imparting postgraduate training and are affiliated to various universities. The training of Nursing Officers is conducted at College of Nursing, Pune for BSc Nursing and various Nursing Schools for Diploma in Nursing. The training of para medical staff is conducted at Army Medical Corps Centre and School Lucknow, Armed Forces Medical College, Pune and various Military Hospitals. In addition Officers’ Training School, Lucknow, imparts training to Medical Officers, Nursing Officers and Non-Technical Officers in Military Science, Military Medicine, general administration and so on.
    A continuous and systematic upgradation of training is conducted for the para medical staff to ensure career prospects and rehabilitation in civil after retirement. The other ranks are given adequate opportunities to be selected as officers through Army Cadet College, Indian Military Academy. The JCOs and other ranks are also given opportunities to be commissioned in the AMC (Non-Technical) cadre through the Service Selection Board.
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    AMC Centre and School, Lucknow

    It has originated from No.2 Company of Indian Hospital Corps (IHC). In May 1941, the until was enlarged and reorganised as No.2 Indian Hosp Corps Battalion. In 1942, the battalion was re-designated as No.2 Training and Depot Centre when the training facilities of the unit were enlarged and in Feb 1947, it was re-designated as Indian Army Medical Corps Centre (North). The designation of Army Medical Corps Centre (North) was given in 1950. No.3 Company of IHC was enlarged and reorganised into No 3 Battalion of IHC which was subsequently re-designated as Indian Army Medical Corps Centre (South) in 1947 and later on Army Medical Corps Centre (South).
    Army Medical Corps Centre, Lucknow was formed as a result of amalgamation of AMC Centre (North) with AMC Centre (South) in 1957. Due to the large scale invasion of the Indian Territory by the Chinese during Sep 1962 and the decision of the Govt of India to increase the strength of the Armed Forces, the necessity arose for an Additional Centre for AMC. Consequently Army Medical Corps Centre (South) was established at Hyderabad in Dec 1962. The Centre at Lucknow was re-designated as Army Medical Corps Centre (North).
    Both the centers at Lucknow and Hyderabad have been reorganised in Jan 1963 in that the Training Battalions have been split into Military Training and Technical Training Battalions. In 1967 AMC Centre (South) was merged with AMC Centre (North) to form the AMC Centre, Lucknow. With the increase in scope of training of Officers of the Corps, both tech and non tech, the officer training wing of the AMC Centre was reorganised as Officers Training School and became a category ‘A’ establishment on 09 Aug 1969. Consequently the AMC Centre was re-designated as AMC Centre and School.
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    LIST OF GOVT APPROVED CIVIL HOSPITAL FOR SPECIALISED TREATMENT
    SERVICE PERSONNEL AND THEIR FAMILIES


    Advanced Cardiovascular Treatment
    • PGI, Chandigarh
    • KEM Hospital, Mumbai
    • Bombay Hospital & Medical Research Centre, Mumbai.
    • Jaslok Hospital, Mumbai
    • CMC Vellore (Tamil Nadu)
    • Southern Railway Hospital, Perambur (Tamil Nadu)
    • AIIMS, New Delhi.
    • GB Pant Hospital, New Delhi.
    • Apollo Hospital, Chennai.
    • Batra Hospital, New Delhi.
    • National Heart Instt, New Delhi.
    • Ruby Hall Clinic, Pune.
    • Escorts Heart Instt, New Delhi.
    • Madras Medical Mission, Chennai.
    • Apollo Hospital, Hyderabad.
    • BM Birla Heart Research Centre, Calcutta.
    • Medwin Hospital, Hyderabad.
    • Wockhardt Hospital, Bangalore.
    • Indraprastha Apollo Hospital, New Delhi.
    • Manipal Heart Foundation, Bangalore.

    Kidney Transplantation
    • PGI, Chandigarh
    • AIIMS, New Delhi
    • Christian Medical College, Vellore (Tamil Nadu).
    • Jaslok Hospital, Mumbai.
    • Apollo Hospital, Chennai.
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    cont........
     
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  3. hit&run

    hit&run Elite Member Elite Member

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    MEDICAL FACILITIES TO EX-SERVICEMEN

    Ex-servicemen (ESM) were entitled to medical treatment for the first time in 1961 vide GOI letter No16307/DGAFMS/DG-3A1417-S/D(AG) dated 14 Oct 66. Specific conditions are prescribed for entitlement to treatment through Armed Forces Medical Services (AFMS) and are reproduced in para 296(0) of regulations for Medical Service of the Armed Forces 1983 (RMSAF-1983) as amended. The salient conditions are summarized below.
    Retired defence personnel granted status of ESM as per notification issued by Dept of personnel and training from time to time for the purpose of recruitment in Central Civil Services and posts, their families and families of deceased service personnel drawing pension of some kind are entitled to medical facilities through AFMS.
    The term ESM means a person who has served in any whether as a combatant or non combatant in the regular Army, Navy and Air Force of the Indian Union and,
    who retired from services after earning his/her pension, or
    Who has been released from such service on medical ground attributable to military service or circumstance beyond his control and awarded medical or other disability pension, or
    Who has been released from such service after completing the specific period of engagements, Otherwise than at his own request or by way of dismissal or discharge on account of misconduct or inefficiency, and has been given a gratuity and include personnel of TA of the following categories namely :
    Pension holders for continuous embodied service.
    (a) Pension with disability attributable to military service.
    (b) Gallantry award winners
    ESM and their families are entitled to free OPD treatment in the nearest Armed Forces Hospital including supply of medicines necessary for their treatment. In patient treatment is subject to Availability of beds.
    The treatment will be limited to the facilities available locally.
    ESM are not entitled to transfer/referral from one service hospital to another.
    The disease should not be incurable.
    No conveyance will be provided for journeys from residence to the hospital and back.
    No special nursing would be admissible.
    ESM when re-employed in Govt/Semi Govt Depts. or other public or private sector undertaking which provide medical facilities to their employees, are not entitled to medical facilities through AFMS.
    Treatment through AFMS will not cover treatment of Pulmonary Tuberculosis, Leprosy, Mental disorders, malignant disease or any other disease for which treatment is not ordinarily available from local service hospital.
    In addition to para 296(0) of RMSAF 1983, a separate provision exists under para 296(f) under which ESM drawing disability pension from Defence Services Estimates for disability accepted as attributable to, or aggravated by service with Indian Armed Forces are also entitlement to medical treatment through AFMS is as follows :
    "Family comprises wife/her dependent husband, unmarried children, including step children or adopted children dependent on him/her".
    ESM drawing grant of Fixed Medical Allowance @ Rs. 100/- per month for meeting expenditure on day to day medical expenses that do not require hospitalization, are not entitled to OPD treatment. Such ESM and their dependants are entitled to inpatient treatment as governed by existing regulations.
    Medical Treatment Entitlement Certificate for Ex-servicemen.
    A medical Treatment Entitlement Certificate will be produced by the ex-servicemen pensioners when reporting to the service hospitals for treatment.
    The certificate is in two parts- Part-I & Part -II. Initially part-I & Part-II of the certificate will be issued by the designated authority as given below. Part-II of the certificate will be validated by Station HQ once every 3 years after the initial issue.
    initial issue of certificate. The initial issue of Certificate (both part-I &II) will be by the following authorities before discharge from service.
    (i) Officers DG MP (MP5), AG's branch MPRS (0) Med Dte (In case of Med/ Dental/MNS Officers)
    (ii) JCOs/OR Officer In charge Records

    Note: For thos4e personnel and widows who were not issued with the medical entitlement treatment certificate before retirement/release from service, the certificate will be issued by Stn HQs/Zila Sainik Boards after verification of the particulars based on the discharge documents.

    Life saving medical treatment/medical attention will be provided to pensioners/widows and their entitled family members in the event of life threatening emergencies even if appropriate certificates not produced at the first instance. However the required certificate will have to be produced on the next working day to establish the bonafides and avoid being discharged from the service hospital.
    The maximum benefits admissible under AGI MBS would remain Rs 2 lakh each to a member and spouse i.e. total 4 lakh ________________________________________
    TREATMENT OF EX-SERVICEMEN AND FAMILIES OF NEPAL ORIGIN

    The AMC also provides treatment to the serving personnel and ex-servicemen and their families settled in Nepal through the Medical Welfare teams. Every year the army sends 13 teams consisting of Medical specialists. Eye specialists and Dental Officers in addition to other para medical staff. The medicines are provided free of cost. The Eye teams also perform eye operations including cataract surgery and provide free spectacles to the patients.
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    MODERNISATION AND THE FUTURE

    The rapid technical changes in the past two decades and the commitments of the Corps to provide a cradle-to-grave service have necessitated diversification in the fields hitherto unexplored in many military medical services e.g. coronary artery surgery, renal transplantation, malignant diseases treatment etc. The time is now for the corps to take over commitment in the geriatric field also. The Army Medical Corps along with its affiliated sister services in the Navy and Air Force are the major facility with the Govt to affect its welfare activity for serving and retired defence personnel.
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    INTEGRATION WITH NATIONAL HEALTH PROGRAMME

    The Armed Forces Medical Services are intimately integrated with the National Health Programmes and provide efficient preventive and curative coverage to all its members. The AIDS control programme is being taken up in a big way to meet the challenge of the day. The existing specialised treatment facilities for Heart, Lungs and Kidney diseases and Cancer treatment facilities available at limited places and extended through reputed civil Institutions are now being planned to be extended to major military stations in the country, with a view to make them available within easy reach of troops and their families.
    The handicapped children of the Armed Forces personnel, who need special care are cared for in the various centres opened under the guidance and patronage of the President, Army Wives Welfare Association. The existing facilities in Military Hospitals are utilised to provide succour, relief and rehabilitation to this vulnerable population to make them self-reliant and bring them into the main stream of life.
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    Provision of a Trauma Resuscitation and Anaesthesia Service in an Advance Field Military Hospital in Northern India

    An Insight by Army Anaesthesiologist & General Surgeon

    Trauma is a leading cause of death and debility in India. Anaesthesiologists are commonly involved in providing acute management of such patients. A trauma anaesthesiologist as a resuscitation specialist, as a part of mobile resuscitation team, or as a member of a critical care transportation team will ensure the optimal clinical state of the patient on his arrival at
    the trauma centre. While provision of anaesthesia and critical care for such victims is always a challenge, the requirements dictated by a patient’s medical condition do not vary with location. However, difficult environments restrict the ability to provide high quality care. All trauma patients require an organized pre hospital response and definitive care followed by rehabilitation to achieve the best outcome. In an ideal world, intensive care management of the seriously injured patient would start in the pre hospital setting and continue until no longer necessary or considered to be futile.
    The development of military anaesthesia dates back to the discovery of anaesthesia itself. Morton administered ether to the wounded close to the field of battle in 1864 during the American Civil War.5 Each war and conflict has required anaesthesiologists to adapt to new challenges in different environments. Whether the terrain is a snowbound area along the line of control (LOC) or counter insurgency operations (CIOPS) in jungles, all present unique problems. A complex military conflict has continued in Northern India since 1989, causing numerous military and civilian casualties.
    The cross-border terrorism turned into war in mid-1999. Liberal use of small arms as well as artillery shelling and air raids followed. During military operations in Kargil, more than 400 Indian soldiers died and about 600 suffered serious injuries.
    Though the conflict officially ended in July 1999, hostile exchanges have continued, with morbidity and mortality of troops. In addition, this sector is faced with harsh climate, difficult terrain, and inadequate logistic support. In this environment, field resuscitation and anaesthesia aim at minimizing delay and preserving life and limb. This can be accomplished only with meticulous planning and rehearsed protocols. This article provides an insight into the working of a forward military trauma care centre located in the conflict area of northern India.

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    Trauma Care Set Up of the Armed Forces Medical Services

    In contrast to civilian counterpart organizations, the Indian Armed Forces Medical Services has a well-evolved system of trauma care, which features:

    • Level III facilities: Forward Surgical Centre (FSC), field hospital, or static border hospital
    • Level II facilities: Base hospitals or zonal hospitals with multidisciplinary surgical care
    • Level I facilities: Command hospitals/Army hospital with tertiary rehabilitative surgical care

    The most remote surgical service in the Indian army is a FSC with a single anaesthesiologist, a surgeon, and ancillary staff, including operating room assistants and radiology and laboratory technicians.
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    Key Problems Encountered

    The importance of teamwork is critical in the management of trauma victims with limited resources. Resuscitation, analgesia, and anaesthesia may need to be practiced simultaneously, requiring coordination between anaesthesiologists, surgeons, operating room assistants (ORA), and other ancillary staff. Anaesthesiologists working in a FSC dealing with battle casualties assume the responsibility of guiding all members of the team. Individuals must clearly understand the important role that each plays. Adaptability is the key to achieving optimal results.

    The main challenge in this harsh environment is completing essential tasks in a timely manner. Of particular concern for
    resuscitation and anaesthesia are the following:

    • Loss of the “Golden Hour” due to location and difficulties in evacuation
    • Hostile weather conditions and inadequate warming equipment
    • Non-availability of blood products and radiology facilities
    • Compromise in sterility and asepsis
    • Lack of conventional anaesthesia and surgical equipment
    • Lack of facilities for equipment repair
    • Lack of manpower and difficulties with staff turnover

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    cont......
     
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  4. hit&run

    hit&run Elite Member Elite Member

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    Evacuation:

    Evacuation of the injured is a difficult task. Northern India is at high altitude, with extreme cold and high wind velocity. Soldiers are assessed for fitness and undergo very strict acclimatization before deployment. Posts are provided with high altitude pulmonary oedema (HAPO) bags and special equipment to counter cold injuries. Besides the altitude and cold, the steep gradient and loose rocky surface make the region prone to avalanche. In addition to the threat of shelling and mortar attack, much of the area is heavily mined.
    Selected soldiers are trained by medical units on a regular basis to provide battlefield first aid. These soldiers are called battlefield-nursing assistants (BFNA). The BFNAs provide first aid and cardiopulmonary resuscitation and help with evacuation of casualties to the FSC, where the medical officer nearest the site of action provides care.
    Before evacuation, rapid dressing of wounds and splinting of fractures site are usually done. Because of the terrain, rapid evacuation of the casualties is often not possible. A road opening party (ROP) checks every inch of vehicle routes each morning before movement of vehicles is allowed. Soldiers are then placed every 10 to 15 metres along the route to ensure security. Ambulances and helicopters are used for evacuations. The mode of evacuation depends largely on the time of occurrence, number of casualties, and access to the site.
    Ambulances are generally used, but in the afternoons helicopters are available until 1600 hours. Later in the day, victims can be transported only by road accompanied by a Quick Reaction Force (QRF), which consists of a minimum of 50 heavily armed men, who move on mine-prone roads at risk of ambush. In winter, when forward bases are cut off by snow, helicopters are also unable to land. It may take up to 16 hours to bring a patient to the nearest road head or helipad. Six-member stretcher-bearer squads carry the injured. Soldiers in their 16- piece winter gear move through waist-deep snow to reach a point from which patients can be evacuated. This is a challenging job on a steep climb, even with scoop stretchers incorporating local modifications with bamboo and blankets.

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    Golden Hour:

    Speed is vital in all cases; however, the goal of reaching the FSC within the Golden Hour is rarely achieved. Despite the enormous difficulties outlined above, the majority of the wounded do receive medical attention within the first 60 minutes. Ambulances are equipped with resuscitation equipment to provide care, which during evacuation shortens delays
    and improves patient condition on arrival. With these resources, we managed 574 casualties over a 2-year period
    (November 1999 to August 2001) (discussed below).

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    Initial Management

    The trauma centre organization recognizes that trauma care requires highly trained resuscitation and anaesthesia personnel to achieve optimal outcomes.
    In our advance field surgical hospital, where a single anaesthesiologist is available, the job of the anaesthesiologist starts with pre-hospital care. A team of three ORAs and the nurses serve as assistants. The anaesthesiologist secures the airway; ensures adequate ventilation; gives appropriate fluid management, sedation, and anaesthesia; and looks after the
    safe transport of patients.

    Obtaining a history and physical examination is difficult within the time constraints. Communication with other soldiers, stretcher bearers, and surgeon helps to gather information. A general trauma survey is conducted to identify or exclude all injuries. The mechanism of injury determines the pattern of associated injuries, and this knowledge focuses treatment priorities.
    For example, effects of blunt trauma often evolve with time and require re-evaluation, whereas penetrating thoracic trauma resulting from shrapnel, missiles, or bullets requires immediate intervention. Penetrating injures in the neck region can seriously jeopardize the airway, so early intubation is essential and the best protection against aspiration.

    http://www.youtube.com/watch?v=tKz2zadEX_0[/URL]

    Securing the airway can be very difficult if a fibreoptic brochoscope and laryngeal mask airway are not available. Intubation can be facilitated with the use of improvised devices such as a spoon or torchlight. In difficult cases, awake intubation after superior laryngeal nerve block and transtracheal injection of local anaesthetic is our preferred method. Surgical airway is reserved for patients who cannot be intubated orally or nasally. Cricothyrotomy is the preferred technique. The anaesthesiologist needs to be comfortable with both needle cricothyroidotomy and cricothyroidotomy with insertion of a tracheostomy tube.
    Great debate continues on the subject of how much and which fluid should be used in multi trauma patients. At our centre, all staff follows a fluid administration protocol that involves insertion of two 14G intravenous (IV) cannulae in the upper extremity if possible and may involve venous cut down. Warmed IV colloids and crystalloids are administered to all
    casualties to avoid precipitating or worsening hypothermia. Warm water baths are used in the absence of heat-exchanger devices. An inflated blood pressure cuff around the IV fluid bags facilitates rapid administration. Following assessment of blood loss, the anaesthesiologist monitors the patient’s response to therapy to guide further fluid and blood administration.
    A list of blood donors is kept in the hospital at all times; therefore, fresh whole blood is readily available for transfusion.

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    Definitive Treatment

    Life- and limb-saving surgery with cardiovascular and respiratory stabilisation are the primary concerns. Variousadaptations have been made to meet these goals.

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    Operating Facility.

    The main operating theatre is inside an underground bunker. The bunker contains a preoperative resuscitation room; an instrument room with an autoclave; a postoperative room; and a storeroom, which is also used as a difficult terrain of far North India. The cold climate, high wind velocity, and high wind chill factor may lower the temperature of operation theatre to as low as –25oC (Fig. 3). Hypothermia correlates with a very poor outcome. Therefore, warming the theatre is a major priority and is accomplished with blower-type heat convectors, which rely on a generator. Casualties are also kept warm by being covered with blankets. Irrigation of body cavities is performed with warmed saline solution. We managed a total of 574 casualties between November 1999 and August 2001. This included all battle casualties and accidents as well as weather-related injuries, mountain sickness, and HAPO.
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    Anaesthesia Equipment:

    Military anaesthesia requires small, lightweight, versatile, and easily transportable anaesthesia machines for use in a frontline field surgical unit. A portable Boyles machine with a backup cylinder supply system is available in our hospital.
    It is a rugged and robust machine that has withstood the test of time despite problems with a lack of safety features, gas leaks, and the inability to use a closed circuit. A Goldman vaporiser, which is a variable bypass, flow over without wick, out of circuit, non thermo compensated vapouriser, is used for the administration of halothane. An Epstein-Macintosh-Oxford (EMO) vaporiser is also available but is seldom used. While total intravenous anaesthesia (TIVA) has a role in difficult environments, we are unable to use this technique because infusion pumps and suitable IV anaesthetic agents are not available. However, ketamine has been used increasingly, with satisfactory results. Dissociative anaesthesia was used in 40% of cases, general anaesthesia induced by halothane in 30%, and regional local anaesthetic techniques in 30%. Over a period of 22 months, 141 cases of isolated extremity trauma were managed with regional local anaesthetic techniques with good results. Despite numerous advantages of regional techniques over general anaesthesia, they are probably still underutilised. Patients requiring postoperative ventilation are moved to an acute surgical ward for further management.

    The East Radcliffe, the Drager Evita, and the Compaq ventilators are available and sufficiently robust and versatile for use in our difficult environment. There are limitations to the monitoring devices available.

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    Conclusion

    Trauma care continues to be an important part of medical practice. With improved resuscitation and definitive care, military experience has seen a reduction in mortality and morbidity of soldiers. Despite enormous difficulties, in the recent conflict in India, Army doctors working in advance surgical units have saved innumerable lives. The presence of
    expert care at a forward post is a major moral boost for troops, who recognize that prompt optimal care gives the best chance of recovery. There are numerous challenges for anaesthesiologists involved in trauma care in an advance field surgical unit. Improving the available level of care with the limited resources and minimization of morbidity and mortality
    continue to be our goals.
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    Recent Updates and news

    Please update in Thread.
    Rapid progress of Army Medical Corps lauded

    LUCKNOW: 11 October 2002, General Officer Commanding-in-Chief, Central Command, Lt-Gen DS Chauhan on Thursday lauded the Army Medical Corps for keeping pace with rapid advances made by science and technology both in diagnostic and therapeutic procedures, despite many constraints. He said that some of the hospitals of the Army Medical Corps (AMC) could be compared with corporate hospitals in terms of efficiency, size and services. He was speaking after inaugurating the three-day 46th AMC annual conference at the AMC Centre and School in Cantonment.
    General Chauhan said that besides leading luminaries of AMC, participation of representatives from peripheral formations and medical units in the conference would help in getting the necessary feedback and inputs which would aid in solving various problems faced by formations and units providing healthcare to the clientele.
    They would also be able to provide inputs on problems faced in actually implementing various policies and programmes laid down by army headquarters, he added. He expressed confidence that the deliberations during the conference would be meaningful and fruitful and would leave a lasting and constructive impact on medical services.
    Welcoming participants, Lt-Gen BN Shahi, DGMS (Army), said the conference was going to deliberate upon issues that were of concern not only for AMC, but also to every member of the armed forces, both serving and retired, and their families. Maj-Gen RT Awasthi, officiating Commandant of AMC Centre and School, delivered the vote of thanks.
    Earlier, Lt-Gen RK Jetley, DGAFMS and senior colonel commandant of AMC, was presented a guard of honour at the AMC stadium. Capt P Murugesan commanded the smartly turned up contingent.
    A large number of top officials of the armed forces medical services, including Surgeon Vice-Admiral SP Malhotra, DGMS (Navy), Air Marshal SK Dham, DGMS (Air Force), and Lt-Gen JL Sharma, director-general dental services are also participating in the conference, which will deliberate upon policies regarding the Army Medical Corps. Lt-Gen A Natrajan, Adjutant-General, army headquarters is also attending the conference.

    13/4/2005
    India and the United States Wednesday signed a Memorandum of Understanding (MoU) on training and academic cooperation in military medicine that will open up new frontiers in research and education for armed forces of both the countries.
    The agreement, signed between Indian Armed Forces Medical Services (AFMS) and the Uniformed Services University of Health Sciences of USA (USUHS) here, will allow both the countries to share military medical experience, professional knowledge and facilities.
    The collaboration conceptualises training and research work in areas like "Biologicial warfare, management of emerging infectious diseases including AIDS, using state-of-the-art techniques, wound healing and tissue repair, and clinicial trial setups," Director General of Armed Forces Medical Services Lt Gen. Bhardwaj said.
    He said the primary objective is to enhance the preparedness of military personnel, faculty and students of military medical colleges in India and the US and to establish long-term academic and personal relationship between the two countries.
    Bolstered by both the countries' shared values and interests, Deputy Chief of US Mission in India Robert O Blake said "the US and India are making great progress in transforming our relations into a comprehensive partnership".
    "The collaboration between USUHS and AFMC is an important component of our overall collaboration in health. The benefits from our collaboration inevitably flow back to the citizens of both countries and, indeed, to the global community," he said.

    To follow...
    ________________________________________
    References:

    http://www.itaccs.com/traumacare/archive/summer_02/provision.pdf

    ARMY MEDICAL CORPS

    Article: India, US sign MoU on cooperation in military medicine. | AccessMyLibrary - Promoting library advocacy

    To be continued.................
     
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  5. A.V.

    A.V. New Member

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    [h=3]Military abbreviations applicable to the Medical Corps[/h]Within the military, Medical officers could occupy a number of roles that were dependent on experience, rank and location. Within military documentation numerous abbreviations were used to identify these roles of which the following are some of the most common:
    • ADMS = Assistant Director Medical Services
    • DADMS = Deputy Assistant Director of Medical Services
    • DDGMS = Deputy Director General Medical Services
    • DDMS = Deputy Director Medical Services
    • DG = Director General (Medical Services)
    • DGAMS = Director General Army Medical Services
    • DGMS = Director General Medical Services
    • DMS = Director Medical Services
    • EMO = Embarkation Medical Officer
    • GDMO = General Duties Medical Officer (a junior army doctor attached to a field unit before commencing higher specialist training)
    • MCD = Military Clinical Director (a senior army Consultant)
    • MO = Medical Officer
    • OMO = Orderly Medical Officer
    • PMO = Principal Medical Officer
    • RMO = Regimental Medical Officer (normally an army General Practitioner with additional training in Pre-Hospital Emergency Care and Occupational Medicine)
    • SMO = Senior Medical Officer (normally a senior army General Practitioner)
     
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