operationaL fieLD CoMbat MeDiCine support

Army Medical Services (AMS) plays an important role in the Army’s full spectrum

of operations, including the ield medical support provided to our training soldiers both locally and overseas, medical response to natural disasters in the

region, surgical missions in peace support operations, as well as our medical

preparedness during wartime. The last ive years have seen the remarkable transformation of AMS against the backdrop of the 3rd Generation SAF

transformation.

wHy transforM?The fundamental purpose of our medical transformation is to ensure that our

soldiers will continue to receive the best possible care in the ield. In the last decade, conlicts around the world have led to the development of many new technologies and devices that improve the survivability of casualties. Today, our

combat medics at the front line carry advanced medical equipment so that as irst medical responders, they can arrest haemorrhages effectively with haemostatic

agents and rapidly applied tourniquets, prevent a tension pneumothorax with a

chest seal, and also secure the airway of the casualty. Medical doctrines have

also evolved; a good example is the introduction of damage-control surgery

to improve outcomes in severe trauma patients. We have pushed surgical

capability to the brigade level, so that damage control surgery can be done as

quickly as possible to save lives.

MeDiCaL operationsThe last ive years have also seen the deployment of SAF medical and surgical teams to Afghanistan to assist in international efforts to combat terrorism. We

have broken records of sorts by deploying our irst female medical personnel and our irst NS medical personnel into a combat zone. More importantly, we have gained operational experience from our deployments and have incorporated

some valuable lessons into our training and doctrines. Our medical and

surgical teams have also responded at short notice to natural disasters around

the region. Signiicantly, in the Padang Earthquake of 2009, a surgical team from Tan Tock Seng Hospital was co-deployed with the SAF Surgical Team. Such

professional collaborations with our counterparts in the hospitals reinforce the

importance of this SAF-Civilian nexus.

tHe futureI believe that AMS will continue to transform to meet the needs of the SAF. Our

people are our most valuable asset, and if we continue to invest in nurturing our

next generation of leaders with a common vision and a common mission, we

will continue to achieve success in everything that we seek to do.

73

COL (NS) (DR) CHUA WEI CHONGFormer Chief Army Medical Oficer/Commander, SAF Medical Training Institute

tHe 3rD Generation MeDiCaL transforMation

Keeping in step with the 3rd Generation transformation of the SAF, the Army

Medical Support System has undergone a paradigm shift in the delivery of

medical care to our soldiers. Experiences from our overseas humanitarian

assistance and disaster relief operations and deployment to Afghanistan have

strengthened our strategies for operational improvement and new development.

The 3rd Generation Army Medical Support System encompasses the development

of new medical doctrines, platforms and equipment, and the training of

personnel. The system aims to provide scalable medical support across the

continuum from peacetime to war. The evolution of ield medical doctrines by way of bringing resuscitation and surgical capabilities to the front line, and the

introduction of damage-control surgery, will ensure increased survivability of

our soldiers during combat. The desired end-state is a medical and trauma-care

system that is benchmarked against national and international best practices.

Since its launch in 2009, the 3rd Generation Army Medical Support System

has been validated through the provision of medical care during the ASEAN

Militaries’ Humanitarian Assistance and Disaster Relief Exercise (AHX) 2011

and yearly mass national events such as the National Day Parade and the Army

Half Marathon. Our medical vocationalists are trained in core medical skills and

the provision of clinical care in combat operations so as to keep pace with the

new capabilities of the 3rd Generation Army Medical Support System.

Army Medical Services will continue to stay abreast of the latest developments

in medical care around the world, and will continue to transform to meet the

needs of the SAF. Experiences are continually gained and lessons learnt are

incorporated into our development with one aim: to realise our vision to be a

world-class medical service that instils conidence and trust in our commanders, soldiers and the public.

74

CapabiLities of tHe 3rD Generation arMy MeDiCaL support systeM

In line with the 3rd Generation transformation of the Army Medical

Support System, there have been signiicant changes consisting of both doctrinal and technological breakthroughs at each echelon

of the medical support chain. The 3rd Generation Army Medical

Support System features advanced trauma life support at the front

line, shortened evacuation time, scalable modular and mobile

surgical facilities, and a fully integrated network. Every platform is

crucial to the enhanced survivability of our soldiers.

75

tHe 3rD Generation CoMbat MeDiC

Every 3rd Generation combat medic is highly trained and

equipped with cutting-edge medical technology to augment

his or her ability to operate on enhanced platforms and

provide the best possible care to wounded soldiers at the

front line. Not only do SAF medics receive internationally

accredited training, their new equipment have also improved

their life-saving capabilities.

The featured 3rd Generation equipment include a drop-leg

pouch, pocket Automated External Deibrillator (AED), one-way-valve chest seal, arterial tourniquet and a chemical-

compound-based haemostatic dressing. In addition,

the electronic ield medical record system allows for the digitisation of ield medical records and the seamless integration of medical information to the wider network of the

Army.

tHe 3rD Generation battaLion CasuaLty stationThe primary role of the 3rd Generation Battalion Casualty

Station (BCS) is to provide emergency resuscitation and

the stabilisation of combat casualties. The 3rd Generation

BCS has brought the capabilities of the accident-and-

emergency department resuscitation bay to the front line.

With the military ive-tonner as its vehicular platform, the 3rd Generation heavy-mode BCS is itted with power supply, electrical lighting as well as communication and

navigation equipment. It is more mobile and can be readily

deployed during the combat phase.

A new level of capability is also achieved via the

procurement of new ruggerised miniature transport

ventilators and patient monitors that allow for automated,

monitored ventilatory support en route to the next echelon

of the medical chain.

SAF medics are now trained to deploy and operate the

3rd Generation BCS in ield exercises, increasing ease of deployment and allowing the treatment of a wide range of

injuries.

CoMbat support HospitaL The modular and scalable Combat Support Hospital (CSH)

provides a multi-disciplinary range of ield medical services including emergency care, surgical and dental care, psychiatry

care, radiology, intensive care, laboratory, general ward, as

well as outpatient treatment. The CSH has a dedicated blood

bank, rendering it operationally ready to deliver life-saving

blood to casualties in the operating theatre.

Leveraging on the advances in telemedicine, ield medical teams can now remotely discuss complex clinical cases in

real time with medical specialists at the CSH. Similarly, digital

X-ray images using new lightweight portable digital X-ray

machines can be transmitted for interpretation by specialists.

The CSH medical personnel are medical specialists in the

ields of orthopaedics, general surgery, ear, nose and throat (ENT), eye and neurosurgery, among others. There is also a

dental team that is equipped to handle a spectrum of dental

conditions, ranging from basic dental services to complex

oral maxillofacial surgery.

76

The SAF Medical Corps signed a Memorandum of Understanding (MoU) with Tan Tock Seng Hospital (TTSH),

joining forces in the ield of traumatology for training and research. Spearheaded by former Chief Army Medical Oficer, COL (NS) (Dr) Chua Wei Chong, the MoU was inked on 18 October 2007 by then-Chief of Medical Corps, Rear-Admiral (Dr) John Wong, and then-Chairman of the TTSH Medical Board, Professor

Philip Choo.

Trauma care is key to the Medical Corps’ operational readiness, and TTSH, which deals with the largest

number of trauma cases in Singapore, became the natural hospital of choice for the collaboration.

TTSH conducts a Deinitive Surgical Trauma Care (DSTC) course that attracts world-renowned experts and surgeons in the ield of traumatology. The NSmen selected to participate were mainly doctors from the combat support hospitals as their operational roles require them to handle complex trauma patients.

Other than DSTC, many other collaborations have been established. Regular medical oficers are attached to TTSH’s General Surgery and Orthopaedics departments for their specialist training. Medics and military

medical experts are also attached to the Emergency Department for tailored training prior to their deployment

for missions. Research collaborations between the SAF, the Defence Medical and Environmental Research

Institute and TTSH were also established.

MobiLe surGiCaL teaM anD MeDiCaL CoMpanyThe Mobile Surgical Team (MST) is a highly versatile unit that

is able to deliver forward-deployed damage-control surgery.

It comprises operating theatre units and high dependency

units which are designed to function round the clock. The

MST is capable of delivering up to 20 surgeries in 48

hours. Field anaesthesia capabilities allow for the general

anaesthetisation of the casualty on the battleield.

The MST is supported by the Medical Company (MedCoy),

whose intensive care unit and general ward unit deliver care

for post-surgical patients, while its medical platoons are

deployed to perform tasks in remote areas, supporting the

forward forces.

Operational Field Combat Medicine Support

77

CoLLaborations to enHanCe CoMbat CasuaLty Care at tHe frontLine

our peopLe: tHe 3rD Generation saf MeDiC

SAF medics play an integral role in the SAF Medical Corps, serving as irst responders in medical emergencies. Regardless of the various operational

requirements and mandates of their appointments, all SAF medics work towards

one primary objective: to save lives.

Evolving from the 1st and 2nd Generation medics to the present 3rd Generation,

there have been signiicant changes for SAF medics on two major fronts: enhancements in medical equipment and an improved training programme.

The state-of-the-art medical technology and tools have enabled the medics to

handle a broad range of cases in the shortest possible time. On top of that, a

more robust training programme has ensured that the medics are proicient in their skills and knowledge in order to respond to medical emergencies whenever

they are called upon.

Here, some 3rd Generation medics share their thoughts on their journeys and

experiences in the SAF.

MeDiCs: Life savers

Proud to be a Medic in the SAF3SG Lim Chong Sian, a combat medic and an

assistant instructor at the SAF Medical Training

Institute (SMTI), said that as a son of Singapore,

he feels a sense of pride and responsibility to

serve the nation as a medic in the SAF.

The full-time national serviceman added: “My

vocational attachments to a public hospital and

on board an ambulance exposed me to real

injuries and gave me the opportunity to do my

part to help the casualties feel better.” He is now

part of a team of instructors tasked with training

new generations of medics by imparting skills

and knowledge to his younger counterparts.

The Difference MakerME1 Mohd Zulhilmi Bin Lukmanuddin, a diploma in nursing graduate from

Nanyang Polytechnic and the Battalion Senior Medic of 1st Singapore Infantry

Regiment (1SIR), was part of an SAF Medical Team deployed to Afghanistan

to render medical relief to war victims in that country. He is glad that he has

been able to make a difference to the lives of those he helped in the course

of his work. “I get immense job satisfaction when I touch people’s lives. For

example, I attended to a child injured by an Improvised Explosive Device during

my deployment to Afghanistan and nursed him back to health. The sight of

the child smiling and laughing on crutches allowed me to experience the real

impact we had made on the lives of the people there.”

The 25-year-old Army regular added: “SAF medics are trained and equipped

to perform in the most challenging environments and are prepared for any

contingency. However, the challenge remains in keeping up to date with the

responsibilities and requirements of each new posting and the capabilities of

the fast-evolving medical ield.”78

An Aspiring War Fighter Becomes a Medic – And is Proud of ItFull-time national serviceman and combat

medic 3SG Leow Wei Shan said that he was

fortunate to be trained as a combat medic as

he would be able to apply the skills learnt

during medic training throughout his life.

learnt that I would be training to be a medic

Then I realised the important role that medics

play in the SAF. I saw a range of medical

conditions, injuries, casualties and life-and-

death situations. These encounters instilled in

me a sense of pride in the medic vocation,”

said 3SG Leow, a training coordinator at SMTI.

A Gift to Save LivesAs a course senior instructor, ME1 Tan Ting Ting has been a mentor to numerous

batches of medic trainees undergoing the Emergency Medical Technician (EMT)

course in SMTI. She has witnessed on many occasions the growth of trainees

her time with the SAF Medical Corps.

“When parents come up to thank me for taking care of their sons at the medics’

Passing Out Parade, I get a lot of satisfaction. It is hard work, but it is all

worthwhile,” she said.

Aside from her SMTI work, ME1 Tan was also a member of the SAF Medical Team

deployed to Cilodong, Indonesia, as part of the ASEAN Militaries’ Humanitarian

Assistance and Disaster Relief Exercise (AHX) 2011. There, she provided medical

aid to the underprivileged who had little or no access to quality medical care. “I

felt an immense sense of satisfaction when the Indonesian patients appreciated

our efforts. It is truly a gift to save lives,” she recalled, her eyes gleaming with

pride. “My training prepared me well and I take pride in what I do.”

LOOKING AHEADME1 Mohd Zulhilmi, of 1SIR, hopes that the SAF Medical Corps will empower

military medical experts (MMEs) like himself to perform some of the clinical

doctors’ heavy workload.

Echoing his sentiments, Formation Sergeant Major of HQ AMS, ME3 Zainal

Abidin, said: “The image, identity and visibility of MMEs could be enhanced, so

that those outside the Medical Corps can have a better idea of who we are and

the important work that we do.”

Operational Field Combat Medicine Support

79

MiLitary sports MeDiCine in tHe safHow It StartedThe foundation for military sports medicine in the SAF was laid in the early 1980s with the

establishment of the Physical Performance Laboratory, which functioned as a centre for exercise

stress testing. In 1988, it was renamed Soldier Performance Centre (SPC) and focused on

providing physiotherapy consultation and musculoskeletal (MSK) injury management and

prevention initiatives. Today, SPC is well on its way to becoming the leading centre of excellence

for the enhancement of soldier performance and the management of MSK conditions in the SAF.

The Role of Military Sports MedicineThe value of military sports medicine in the SAF is apparent given the physically demanding

nature of realistic training and the inevitability of injuries. Over the years, SPC’s programmes and

initiatives have contributed signiicantly to training safety, MSK injury management, performance maximisation and even obesity management.

Acknowledging the importance of equipping our medical personnel with skills and knowledge

in sports and exercise medicine, the SAF sent two regular medical oficers, MAJ (Dr) Alexander Gorny and MAJ (Dr) Noreffendy Bin Ali, to the United Kingdom in 2009 to further their education

in this emergent ield.

With the increasing number and competency of sports medicine professionals, coupled with the

advancement in technology that has enhanced the diagnosis and treatment of MSK conditions,

the great majority of injured personnel are now able to achieve functional recovery.

In April 2012, 3SG Ngoh Jun Dat, a training coordination specialist with the SAF Military Police

Command, sustained a lower back injury whilst handling heavy stores. He was referred to the

Military Medicine Institute (MMI) Physiotherapy Centre where SPC physiotherapist Marc Chionh

Woei Seng administered a combination of pain relief and functional conditioning techniques to

set 3SG Ngoh on the road to recovery.

Impressed by the service and treatment rendered, the 22-year-old full-time national serviceman

who has since made a full recovery, said: “The Physiotherapy Centre is an excellent place to

recuperate. I appreciate that the SAF has such a world-class facility for servicemen to seek

treatment.”

Strategic Partnerships in Education and ResearchRecognising the value of educating SAF medical oficers (MOs) in the emerging ield of sports medicine, SPC established collaborations with Changi General Hospital’s (CGH) Changi Sports

Medicine Centre (CSMC) on several initiatives. Today, Dr Benedict Tan, Singapore’s pioneering

senior sports physician and Head of CSMC, together with his team of doctors, conduct sports

medicine workshops for SAF MOs during the Medical Oficer Cadet Course (MOCC). SPC has also sought professional input from the CSMC team in the development of the SAF MSK Injury

Management Pathways that guide MOs on the treatment of soldiers who suffer from common

MSK injuries seen in the SAF. These pathways have since been implemented at all medical

centres and have empowered MOs on the ground with the conidence and competence to better manage MSK conditions.

On 29 Nov 2011, a Memorandum of Understanding was signed between SAF Medical

Corps and CGH. This marked the start of a partnership in the areas of enhanced clinical

services, professional exchange, education and research with the country’s leading centre

of excellence in sports medicine.

SPC also invests signiicantly in research initiatives. Some examples include the SAF Training Injury Study, a prospective cohort study conducted in collaboration with Republic

Polytechnic that examines MSK risk factors among soldiers and correlates them with

biomechanical and physical parameters, as well as the Military Training-Related Injuries

Study conducted in collaboration with the Defence Science Organisation that investigates

the effects of a multi-interventional injury prevention programme on MSK injuries.

Human Factors EngineeringSPC has also been heavily involved in Human Factors Engineering (HFE) issues for the

reinement of speciications and designs in the Army’s capability development efforts. Ms Grace Heng, Head Physiotherapist of SPC and the only ergonomics physiotherapist in the

SAF, was engaged as the ergonomics consultant for several projects. She contributed to

the designs of the Terrex Infantry Carrier Vehicle (ICV), our Leopard Tanks, the Advanced

Combat Man System (ACMS) as well as the new SAF running shoes. As part of the

developing committee for the Terrex ICV, she provided input on the seat design and interior

layout so as to provide a conducive environment for soldiers and optimise their operational

performance. The Terrex ICV won the Defence Technology Prize 2010 and Ms Heng was awarded a Certiicate of Commendation from Chief of Army for her invaluable contributions.

Ms Heng feels that the experience gleaned from being involved in the design and

development process has motivated her to continue working on the areas of maintaining

and regenerating soldier combat itness and power. “These experiences have also given me conidence as I continue to push the boundaries of soldier performance maximisation, and this is what keeps me going after 12 years in the SAF,” she added.

The SPC TeamSPC currently has three sections - Sports Medicine, Performance Maximisation and

Occupational Health - that comprise doctors, physiotherapists, physiotherapy assistants,

an exercise scientist, occupational health professionals and staff oficers. Although the team is situated in different camps all over the island, there is excellent team camaraderie

and solidarity between the members.

As physiotherapist Marc Chionh, who is based at the MMI Physiotherapy Centre, noted:

“Despite the physical distance, the entire team is united and cohesive. I must say that

credit goes to Head SPC, who places great emphasis on team solidarity. Regular cohesion

activities and outings have allowed the team to gel and remain bonded, and this has

translated to excellent teamwork within SPC.”

Looking AheadSPC has made great strides in advancing the ield of military sports medicine in recent years. As it continues to look forward to more new initiatives and projects on the horizon, it will continually strive to champion the practice and furtherance of military sports medicine,

both in the SAF and in Singapore, for years to come.

81

Operational Field Combat Medicine Support

asean MiLitaries’ HuManitarian assistanCe anD Disaster reLief exerCise 2011

Under the overarching framework of the 8th ASEAN Chiefs of Defence Forces Informal Meeting

(ACDFIM-8) held in March 2011, the ASEAN Humanitarian Assistance and Disaster Relief

Exercise (AHX) was conceived to enhance practical military cooperation in the ield of humanitarian assistance and disaster relief operations.

The irst AHX was co-hosted by Indonesia and Singapore, and consisted of a table-top exercise (TTX) in Singapore and a socio-civic component in Cilodong, Indonesia. A 27-strong SAF

medical team led by LTC (NS) (Dr) Aymeric Lim, together with hosts from Tentera Nasional

Indonesia (TNI), participated in the socio-civic mission of this exercise from 11 to 15 July

2011. The SAF team comprised NSmen from the 2nd Combat Support Hospital (2CSH) as

well as active servicemen from Headquarters Army Medical Services (HQ AMS).

The SAF medical team was divided into primary healthcare and surgical teams. The primary

healthcare team, augmented with counterparts from TNI, saw a staggering 850 patients over

three days. The surgical team performed twelve surgeries, one cleft lip repair, one tendon

release, one lipoma excision and nine circumcisions.

82

Enhancing Practical Military Cooperation and Training ValuePractical military cooperation was evident throughout the

exercise as integration between the TNI and SAF was seen at

all levels. The SAF medical team operated out of tents set up

by the TNI and the primary healthcare team comprised medical

personnel from both armed forces.

Underscoring the key objective of the exercise, CPT (NS) (Dr)

Tan Wah Tze, anaesthesiologist in 2CSH, remarked: “We paved the way for closer cooperation among the militaries of ASEAN

which will ultimately beneit the people of affected countries in any future disaster.” The interaction among personnel from both

the TNI and SAF also served to strengthen the long-standing

close cooperation and partnership between both militaries.

This exercise also lent an opportunity for HQ AMS to validate

recently procured critical medical equipment. It was the irst time the new anaesthesia machine was successfully used on

a live patient in a ield environment. The work low of a ield surgical deployment was also exercised where proper patient

triage, pre-operative preparation, operative treatment and post-

anaesthesia care were performed. Live exercises such as AHX

hence served to enhance training value and instil conidence in servicemen with regard to their equipment and training.

Making a DifferenceIn addition to the strategic and operational achievements,

participants of AHX felt that the greatest reward was simply

being given the opportunity to help and provide much-needed

medical and surgical treatment to the residents of Cilodong.

“I believe we made an impact and a difference to the lives of

the Indonesians. Those who underwent surgery deinitely felt grateful for the successful operations and knew that they were

in the safe hands of the SAF medical team,” remarked LTA (NS)

Muhammad Fazli, Manpower Oficer of 2CSH.

Overall, the inaugural AHX was a success on many levels.

It enhanced practical military cooperation in response to

humanitarian assistance and disaster relief scenarios and

served as a useful platform for operational learning and

personal development.

AHX’11 is testament that good

co-operation and trust can be fostered with

bilateral humanitarian missions such as this

one.”

Looking at the patients’ smiling faces

encouraged me immensely, and I felt that

the small challenges we faced were worth

all our efforts in Cilodong. This exercise has

also taught our team to rectify shortcomings

in the planning and execution processes

and better prepare us for times of disaster.”

Caring for the less fortunate in a

neighbouring country was a life-changing

experience that made us feel proud. The

fond memories of our time spent together

as a team, as well as the interactions we

had with the locals and the little children

who liked to crowd around our team’s tent,

will remain irmly etched in our minds.”

The AHX made me realise how

fortunate we are in Singapore to have a

developed healthcare system compared with

what the villagers we met have access to.

Also, it reminded me that it is important to

always be operationally ready, so that when

the need arises, we are always ready to

help and to serve.”

ME4 Daniel ChooOT Nursing Oficer, Medical Team, AHX’11.

ME1 Tan Ting TingDocumentation I/C, Medical Team, AHX’11.

2WO Lim Teck HwaiRegimental Sergeant Major and Medical Planner, Medical Team, AHX’11.

LTC (NS) (Dr) Aymeric LimCommanding Oficer of 2CSH and Chairman of the Medical Board of the National University Hospital.

Operational Field Combat Medicine Support

MeDiCaL support for

nationaL Day paraDe 2012In its 45-year history, the SAF Medical Corps has helmed the medical support planning

for several civilian events, the signature one being the annual celebrations of our nation’s

independence, the National Day Parade (NDP). NDP12, organised by HQ Guards, was

held at The Float @ Marina Bay on 9 August and was a culmination of two months of

combined rehearsals. NDP12 was an especially signiicant occasion as it not only marked the nation’s 47 years of independence; it also commemorated 45 years of

National Service.

To provide medical support for such a large event, several Army units were mobilised to

run the three Medical Posts and staff the Quick Response Forces (QRF). These included

the Battalion Casualty Station (BCS) teams from the Army units of the 7th Singapore

Infantry Brigade (7SIB), 1st Guards Battalion (1GDS), 3rd Guards Battalion (3GDS),

2nd Singapore Infantry Regiment (2SIR), 6th Singapore Infantry Regiment (6SIR) and

42nd Singapore Armoured Regiment (42SAR).

84

LTC (Dr) Dale Lim, Chairman of the NDP12 Medical Committee, said: “The members of the

Medical Committee demonstrated commitment and dedication in ensuring the safety and well-

being of all NDP participants and spectators alike. The smiles on the faces of those who had

received good medical care made the extra hours of working behind the scenes all worthwhile.”

Medical Simulation Training and Force PreparationPart of the build-up to NDP12 saw the Medical Post personnel undergoing a series of refresher

involved. The medical teams then went through sessions of simulation training at the SAF Medical

covering different types of casualties and various scenarios, including care for women and

children. This year, Headquarters Army Medical Services (HQ AMS) also conducted the inaugural

Burns Management Workshop to better prepare its medical teams to treat any injuries sustained

from burns and pyrotechnics.

3rd Generation Battalion Casualty Station NDP12 saw the continued use of the 3rd Generation Battalion Casualty Station (BCS), which

would be activated to augment the deployment of Singapore Civil Defence Force (SCDF) and

MOH forces in the event of contingencies such as a mass-casualty scenario. The versatility of

the 3rd Generation BCS and its sturdy vehicular structure allow the medical teams to deploy

to perform clinical and administrative tasks within the vehicular platform, forming an integrated

easier, especially amid the initial confusion of a mass-casualty situation.

The 3rd Generation BCS is also easy to manoeuvre and, when co-sited with the vehicles from

the SCDF, performs the important life-saving task by seamlessly weaving into the national mass-

casualty response plan.

The BCS teams spent many Saturday mornings training on the various aspects of the 3rd

Generation BCS, such as the full deployment of three 3rd Generation BCS vehicles along with

simulated casualties and ambulance runs.

MUV Support AmbulancesNDP12 was also supported by 16 Multi-Role Utility Vehicle (MUV) Support Ambulances from HQ

AMS. The ambulances, each of which is able to accommodate up to eight casualties and three

crew members, are equipped to support Advanced Cardiac and Trauma Life Support en route

to the nearest restructured hospital. The well-equipped ambulances were critical in allowing the

Mobile QRF from 2SIR to attend to any casualties swiftly within the Area of Operations. A total

of 26 evacuations were made using the MUV Support Ambulances during NDP12, including

one spectator who suffered from an acute asthma attack at the Esplanade Park after the NDP

Preview. She was picked up by the Mobile QRF and treated en route to the nearby KK Women’s

and Children’s Hospital, where she recovered well and was discharged soon after.

“The new ambulances allow ventilatory support to be administered more expeditiously than

ever before, and this may just make the difference between life and death in an emergency

situation. The increased capacity of the new ambulances also allows more room for the medic

to manoeuvre and treat casualties,” said ME3 Timothy Rajah, Deputy Secretary of the NDP12

Medical Committee and concurrently a BCS trainer at the SAF Medical Training Institute.

Working Hand-in-hand with National AgenciesThe Medical Committee worked closely with several key agencies and external organisations

such as the Ministry of Health, Singapore Civil Defence Force, Singapore Red Cross Society,

St. John Ambulance Singapore, the Community Emergency Response Team from People’s

to all participants and spectators of NDP12. This was achieved by deploying 450 medical

.yrotsih PDN ni lennosrep lacidem fo rebmun tsegral eht deyolped taht tneve eht 21PDN gnikam

CPT (Dr) Oh Han Boon, Secretary of the NDP12 Medical Committee and concurrently the Brigade

and backgrounds to work together for the same cause was challenging. All our efforts were

worthwhile at the end of the day when we saw the patients leaving our Medical Posts well and

happy.”

85

tHe evoLution of peaCetiMe MeDiCaL support for tHe arMy HaLf MaratHon

The SAF Medical Corps prides itself on the provision of professional and timely

medical care in peacetime medical support. The annual Sheares Bridge Run/Army Half Marathon (SBR/AHM) is one of the signature events of the Army, for which robust medical support is required owing to rising participation rates.

The Medical Support Plan developed by Headquarters Army Medical Services

(HQ AMS) has been continually reined year after year to provide close and comprehensive medical support to the participants. Several key

lessons shaped the foundations of the excellent medical support in

SBR/AHM 2012.

We trace the transformation journey of the medical support

in SBR/AHM over the years and how the incorporation of new platforms have helped resolve some previous

challenges.

Medical Shelter SystemPrior to 2008, the medical support for SBR/AHM consisted mainly of a solitary Medical Post at the

endpoint of the race, usually at the Padang. The medical

equipment available were based on the medical stores

of our 2nd Generation Battalion Casualty Stations

(BCS), which were basic but adequate.

In 2008, MAJ Anthony Loo was tasked with developing the

deployment concept for the main Medical Post at the Padang and enhancing

our medical capabilities in the ield. The new Medical Shelter System (MSS) provided the fundamental platform that subsequent Medical Post deployments

were built upon.

However, several obstacles faced the medical team that year. “One challenge

was that the MSS and Container Body Cooling Units (CBCU) were so new that

no one other than then-Head Training Branch (now Head Medical Logistics),

LTC Chua Thiam Beng, and I had experience in their ield deployment,” said MAJ Loo.

Other challenges included deploying the Medical Post in the wee hours of

the morning because the crane utilised to lift the sizeable CBCUs occupied three lanes of the four-lane St Andrew’s Road; and there was a need to cause

minimal disruptions to F1 contractors erecting crash barriers at the same

site for the inaugural Singapore Grand Prix. With determination and quick

thinking, the team resolved the dificulties faced, and several important lessons gleaned from 2008 helped to pave the way for the systematic

adoption in the years ahead.

2010 saw the procurement and utilisation of Rapid Deployable Tents (RDT) which were lighter

and easier to deploy. Their deployment was swiftly managed by a competent crew of military

medical experts (MMEs). The usage of RDTs enabled the compartmentalisation of our main

Medical Post into ‘light’, ‘intermediate’ and ‘severe’ resuscitation areas, modelled after the

hospital’s emergency department. This has enabled our front-line medical support to be more

eficient and responsive in treating casualties.

Container Body Cooling UnitsHQ AMS has been at the forefront of heat injury management over the past decade. With our recent

collaboration with the Ministry of Health in developing the Clinical Practice Guidelines for Heat

Injuries, HQ AMS is widely regarded as a subject matter expert on heat injuries. The recognition

of the need to manage heat injuries effectively in the ield prompted the commissioning of the CBCU in 2008.

The utilisation of the new platform in SBR/AHM 2008, however, saw several logistical challenges, including the transport and transfer of the CBCUs within relatively constrained spaces. ME2 Ng

Chun Hsiung, a BCU Operator in 2008, is now a Senior Medic at Khatib Medical Centre. He

recalled: “We faced the challenge of transporting the equipment to the deployment ground. For

example, when the Singapore Recreation Club withdrew its permission to allow SAF vehicles

onto the Padang, citing damages to the turf, we had to think on our feet to solve the problem. In

the end, we loaded the stores onto the vehicles manually and rented a 200-tonne crane to move

the CBCU and 100kVA generators.” These were crucial learning points for the medical team that

year. Building upon these lessons, the medical support planning teams in subsequent years

modiied their plans to ameliorate these issues.

The CBCU eventually turned out to be a useful addition to our existing armamentarium. In

particular, SBR/AHM 2010 saw 12 cases of heat injuries that were successfully treated with the CBCU. The CBCU has become the mainstay of our medical deployment every year.

Advancements in the 3rd Generation SAF Medical Support SBR/AHM 2010 also saw the expansion of our medical support to render medical help to casualties sustained along the running routes. That year, the SAF Medical Corps incorporated

the 3rd Generation BCS as Medical Posts deployed along the running route which augmented

our ability to treat severe casualties. This was most evident during SBR/AHM 2011. A Medical

Post along Fort Canning Road treated a severe casualty and swiftly evacuated him to a nearby

restructured hospital. The patient eventually recovered and was discharged.

Information exchange and knowledge management also feature heavily in SBR/AHM. For example, wireless casualty reporting systems and an Integrated Transport Management System

(ITMS) that monitors ambulance movement were some of the new capabilities introduced in

SBR/AHM 2011. With the introduction of wireless technology in the ield, the seamless transfer of casualty information greatly facilitated the coordination of evacuation operations and medical

resources in the system. This is of signiicant importance as we seek to transit into a knowledge-focused, network-centric SAF.

Increasingly, mobile medical elements have been employed to augment our evacuation assets.

The recently concluded SBR/AHM 2012 drew more than 70,000 participants, and covered extended portions such as areas along iconic landmarks like the Marina Bay Sands Shopping

Mall that were not accessible to vehicular trafic, and the newly minted Gardens by the Bay (South). This proved a challenge for the medical support but the use of buggy carts in the

affected areas proved to be extremely useful in the evacuation process. In addition, our new

Multi-Role Utility Vehicle (MUV) Support Ambulances were also deployed, further enhancing our

evacuation capabilities.

Army Medical Services – Operational and ProfessionalOur medical support planning has evolved with the gradual equipping of more functional and

task-speciic platforms, as we strive to achieve our objectives of providing world-class medical care for our soldiers. Interoperability of platforms is crucial, as we seek to operationalise our

3rd Generation Army Medical Support System. The MSS, CBCU, 3rd Generation BCS and MUV

Support Ambulance continue to be the cornerstones of our Medical Support System, and the SBR/AHM provides an annual opportunity for us to showcase our professional medical expertise and

enhance our credibility. As aptly summarised by ME3 Timothy, who was involved in the set-up of

the Medical Posts in many events: “When we started providing medical cover for SBR/AHM, we deployed a simple BCS in a modular tentage. Today, we have moved to high-technology tents

and medical equipment, and deployed the Medical Post on a much larger scale. This shows

that we have learnt from our past experiences and we put the well-being of the patient as an

utmost priority.”

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