Why don't we get the army in? I was asked this by non-NHS colleagues as COVID-19 impacted for a second time. Many are unaware that most serving clinical staff were already part of the response because their roles, when they are not deployed overseas, are working clinically within the NHS.
NHS England (2017) states that the NHS is generally expected to manage emergency responses within its own capabilities. However, where capacity has been exceeded or the NHS does not have the specific capability to deliver, the military may be required to augment responses. Military support in an emergency is provided on an assistance basis, known as Military Aid to the Civil Authorities (MACA).
Typically, the armed forces can be brought in to deal with a range of situations, such as flooding, bomb disposal and mountain rescue; also included in the list are public health epidemics. My Trust was privileged to be supported by a regional MACA request to assist us during our recent COVID-19 response.
A military team was deployed in January 2021, comprising both non-patient-facing personnel and combat medical technicians (CMTs), a role that usually provides battlefield first aid as well as health education to the military. The CMT team were attached to critical care and emergency care areas.
We quickly assembled a team to support their arrival, rapidly working up an induction programme, which included role cards to ensure that NHS staff and Ministry of Defence (MoD) staff had a clear scope of practice. We also arranged a Mess area. Feedback was extremely positive and came through early into the deployment. As one critical care nurse said:
‘Today I worked with two CMTs. I would like to express my gratitude and thanks. I am extremely impressed by them, their resilience, their capacity to adapt and learn so quickly and being proactive. I was a bit concerned before the start of my shift because of the challenges and wondered if I would have time to teach, but I did and I think they should be an inspiration for us all. They are a real asset to critical care, and I would like them and their leads to know how they really made my day! This is something that hasn't been so easy to achieve these days.’
It would be fair to say that any changes from ‘business as usual’ challenges teams. Non-patient-facing military personnel identified quickly that teams were opening numerous packs of the same items because there was a lack of clear organisational structure for stock. This was compounded by utilising too many areas, causing further confusion and inefficiency. Solutions were explored and facilitated, such as new storage racks, making bespoke overflow areas, and sharing communication with local teams. This led to building mechanisms for staff so they had confidence in the consumables being available in the right place and time against demand. The teams redesigned areas and introduced bar coding to help procurement teams with stock and delivery. Nothing was too big or too small to support, and the result released direct care time.
The military staff deployed to our safe staffing team were supported with a Microsoft Forms survey to gather feedback from deployed members of staff, and this was linked to a QR code to aid facilitation. This helped further analysis of redeployed staff and focused on ongoing care needs. In addition, they monitored a group email to manage deployed members and keep contact with their own team. Furthermore, they inputted staff hours on to a database to ensure that those employed by the various medical schemes and incentives were paid correctly. Finally, they set up an email address to support new MoD staff within the Trust (covering COVID-19 testing/blood tests/mask-fitting arrangements and so on).
The discharge planning team were embedded into a complex environment to manage arrangements, enhancing the safe placement of patients into the next phase of their onward care pathway. Their role required an increased level of induction, encompassing training using the Trust electronic patient management systems, as well as working alongside NHS colleagues who, due to the pandemic, are working remotely.
The CMTs provided much needed support to a high standard. The NHS is built on multidisciplinary teamwork and their delivery has been invaluable and has shown flexibility and discipline. The team were outstanding in their approach to teamwork, care and compassion. As a team who do not routinely undertake placements in secondary care, this is now an area that is being formally explored in partnership because the benefits to all were truly realised during this time. One of the CMTs commented in feedback on their time in the emergency department (ED):
‘ED assessment: epistaxis level 2 escalation treatment using tranexamic acid on swabs—a potential easy skillset to be added for deployed medics. Not something I'd ever come across before. Very simple effective treatment. Skill development piece.’
Our Trust teams remain thankful and grateful to the military teams. Their professionalism and enthusiasm were exceptional. All teams delivered in line with our Trust values and ethos. This joint venture can only be described as a success by all parties.