Dr Jo Laird / Surgeon Lieutenant / HMS Somerset
Military medicine can be a fantastic way to combine practising cutting edge medicine, unique personal and professional challenges, with plentiful opportunities for travel and adventure. Dr Jo Laird gives us an insight into life on land, in the air and at sea as a Royal Navy doctor.
Flying over Cornish beaches, I found myself in a Search and Rescue helicopter co-ordinating an ongoing resuscitation. Unable to hear any air entry into the lungs over the sounds of the rotor blades my stethoscope became redundant and there was potential for the electrical equipment to become temperamental. Communication between the team became a struggle. The two paramedics now on board were more used to life on four wheels than practicing medicine high in the sky. Their helmets, hastily put on while the patient was being transferred into the helicopter, were missing the radios that allowed the search and rescue team to discuss the patient’s deteriorating condition. The dim light tested our knowledge of the layout of our medical kits. Only a few minutes later, although it seemed longer on account of the ongoing CPR, we touched down on the hospital’s heli-pad and handed over to the gathered Emergency Department team.
Applying to be a Royal Navy Doctor
I applied for a sponsored cadetship with the Royal Navy (RN) in the third year of my medical degree. This was after I had spent two weeks’ work experience onboard an aircraft carrier, HMS ILLUSTRIOUS, sailing across the Atlantic to New York. Always looking for adventure and a keen sportswoman, the RN seemed to provide exactly what I was searching for in a prospective employer.
Foundation Year and Initial Officer Training
For medical students who are sponsored by the RN, Foundation Year training posts are undertaken in six different Ministry of Defence Hospital Units (MDHUs) where they work in NHS hospitals wearing military uniform. I completed my Foundation training at MDHU Derriford in Plymouth before starting Initial Officer Training at Britannia Royal Naval College, Dartmouth. This consists of 15 weeks of training and covers weapon handling, leadership, the Law of Armed Conflict and a lot of physical conditioning to prepare for the arduous assessment on Dartmoor.
New Entry Medical Officer Course and Streaming
After passing out from the Naval College as a Surgeon Lieutenant there is a three month New Entry Medical Officer (NEMO) course at the Institute of Naval Medicine in Portsmouth which covers the administration and common medical issues that arise when deployed at sea. The NEMO training includes courses such as BATLS (Battlefield Advanced Trauma Life Support), the Standard Underwater Medicine Course and a course on nuclear and chemical warfare casualties. After completing the NEMO course the next three years are spent as a General Duties Medical Officer (GDMO) after being streamed into the surface fleet, submarines or Royal Marines. Medical Officers (MOs) that have been streamed into submarines undergo further specialist training and this year will see the first female MO start this course. MOs selected for Royal Marine training undergo the All Arms Commando Course at Lympstone. I was streamed into the surface fleet and I’ve been fortunate to spend my GDMO time travelling all over the world to places such as the Mediterranean, the Gulf and the Caribbean.
Deploying on a Warship
Deploying abroad on a warship provides extra challenges for a MO as you are the only doctor on board and can be responsible for the health of over 200 personnel including specialist teams such as Royal Marines or divers. GDMO time offers a unique environment to practice clinical medicine alongside the challenges of practicing without direct supervision. Practising medicine without direct supervision means that GDMOs rely more on email and satellite telephone in order to obtain advice from senior doctors. Remote medicine necessitates “out of the box” thinking and requires resourcefulness, such as using a bag full of rubbish to elevate a patient’s legs during a vasovagal episode. I have found that medicine in the RN has a larger focus on occupational health aspects than in the NHS. This is because the medical team aim to keep the whole ship healthy so the ship can complete its operational tasking. An engineer with a bad back may not be able to fix machinery in the cramped engine spaces or a sailor with a migraine may not be able to focus on their radar display screen to protect the ship. As well as RN personnel there are civilian contractors on board who may have long-term health conditions and co-morbidities. Another significant role of the medical team is as tutors to the whole of the ship in first aid, including more advanced training for the specific first-aid teams.
Medical Planning and CASEVAC
On call 24/7 while at sea, you never know when you’ll hear the words “casualty, casualty, casualty” come over the main broadcast tannoy. On hearing those words the first aid teams and the medical team spring into action. Command teams take up positions and await information about whether the casualty needs to be evacuated to hospital and if so, how urgently. Getting this information quickly is important so that if there is a helicopter on board the ship it can be made ready to fly and the seating configuration changed to fit a stretcher in. Things that you’ve never considered prior to joining the RN take on a new level of importance, so that when the aircrew ask if there are any altitude restrictions you know what the answer is for your patient with a chest drain or whether the Automated External Defibrillator can be used in the helicopter. Learning how NATO communicate requirements for CASEVAC (Casualty Evacuation) is imperative and means that you can work as part of a multi-national taskforce.
Expeditions and Adventurous Training
The RN provides numerous opportunities to get involved with expeditions and adventurous training, especially as a medical professional. In 2012 I spent three weeks in South America on ‘Exercise Bolivian Venture’, a Defence Medical Services research expedition looking into altitude acclimatization in the Cordillera Real mountain range. Adventurous training is designed to push people beyond their comfort zone in order to reinforce the qualities that the RN finds desirable in their recruits: courage, commitment, discipline, respect for others, integrity and loyalty.
As for me, specialty applications are on the horizon, but my short-term focus is on the final part of my current six-month deployment in the Gulf. Who knows what the future will hold but I’m sure it’ll prove to be an exciting challenge.
The Royal Navy requires specialists in various areas with a focus on areas such as General Practice, Emergency Medicine, Anaesthetics and Surgery. Specialty training occurs in NHS hospitals, usually where the MDHUs are based and in Royal Navy Medical Centres on RN bases.
For more information about medical roles within the Royal Navy, visit their website.