MEDICALLY ASSESSING THE ROYAL FLEET AUXILIARY SEAFARER 3/28/2017 MEDICALLY ASSESSING THE ROYAL FLEET AUXILIARY SEAFARER GRAEME NICHOLSON Cons OM Navy Command HQ SHARON KITWOOD Occupational Health Nurse RFA Sharon intro

3/28/2017 This presentation expresses the views of the speakers and not necessarily the policy or views of the MoD And we must say this

3/28/2017 Sharon structure and who the 2 ‘idiots’ in bold are

Who are we? 16 ships (11 post SDSR) 2,300 personnel 3/28/2017 Who are we? 16 ships (11 post SDSR) From 10,000 to 41,000 tonnes 2,300 personnel Medical Technicians on all ships RN MOs when deployed or on long passages RFA ARGUS (dormant hospital) – RN MO plus RN Medical Assistant Sharon on who we are Stress that post SDSR there will still be a very large requirement for RFA to support a potentially even more widely dispersed RN Medical Technicians allow us to cover for emergency medicine, Occ health and the military aspects of the role - damage control, fire-fighting and casualty handling Background of the medical technicians – mix of military and civilian personnel

Personnel MOD civilians 2300 unionised employees 3/28/2017 Personnel MOD civilians 2300 unionised employees Deck, supply, engineers, communicators, force protection Average age 42 (officers) 39 (ratings) 107 females (4.6%) Average length service 10 years Home base worldwide Sharon on numbers Still have comms personnel due to the requirements of military signal traffic They need to have their eyesight standards assessed on the same basis as engineers (discussion with Dr Carter for the summer MCA newsletter in 2009) Force protection teams go onto ships deployed into certain areas e.g. Gulf and Somali basin to provide close in weapons support for self defence. Mostly drawn from RNR Personnel with mixed civilian and service backgrounds Some of our seafarers live in Thailand, Australia, America, You can be assured that when something catastrophic happens, the individual will reside thousands of miles away.

3/28/2017 What do we do? Keep the RN at sea by supplying fuel, spares, food, equipment e.t.c Vert-rep and helicopter operations Counter-piracy operations Disaster relief Boarding operations (drug-busting) Support Mine-counter measures vessels & submarines Land Royal Marines to a hostile beach Self-defence and damage control Graeme on what and how

3/28/2017 Graeme

3/28/2017 Graeme

3/28/2017 Graeme

Why are we different? Deploy to conflict areas and disaster zones 3/28/2017 Why are we different? Deploy to conflict areas and disaster zones Fire-fighting roles and training Damage control and CBRN Aviation operations Must be able to operate like the RN as well as with the RN Graeme

3/28/2017 Fitness for Sea Fitness standards based on holding an in-date, unrestricted ENG1 medical certificate Restricted certificates can be tolerated for limited periods. May use any appropriate AD. In house ADs post illness / injury and for problematic cases Primary care from civilian GPs Emergency and urgent care as well as OH from RFA and RN Sharon Can you discuss how limited ENGs cause personnel difficulties Also where our in house Ads are and when / why we would use them instead of a seafarer returning to their previous AD. Raise GPs and medication supply problems and see if we can get any good ideas from the floor on how others resolve this problem

3/28/2017 Fitness for Sea If landed then can be medically evacuated back to UK via RAF system Med Techs produce letters for GP Plans to produce end of tour GP note RFA OH Nurse follows up those landed or reporting illness with GP / Specialist Sharon

Working Patterns 4 months at sea, 2 months leave 3/28/2017 Working Patterns 4 months at sea, 2 months leave Then either back to sea or courses Shift patterns at sea are different for different ranks and trades Sharon Can you stress that we effectively lose medical control of the seafarers for the 2 months away and that they may have health problems, operations e.t.c. without our knowledge and often without teling us. Can you give some examples of courses and of the shift patterns at sea, indicating that there are some evolutions that may need off shift personnel stood to.

3/28/2017 Graeme

Joining OH Screen Every time seafarer joins a ship. 3/28/2017 Joining OH Screen Every time seafarer joins a ship. Height, weight, bp, urinalysis, ENG1, PMH, medications', allergies and lifestyle. If considered unfit after medical advice, landed from the ship Total medical discharges in 2009 – 132 Aero-medivac 32 Own way passage 90 Graeme

3/28/2017 Joining OH Screen Failures at OH screen reported to RFA OHN and Navy Command Medical HQ Problems with ENG1 also reported Discrepancies between ENG1 and seafarer’s medical state reported to MCA. Graeme

Common Problems Reported 3/28/2017 Common Problems Reported Untreated hypertension Urinalysis – blood, protein and sugar Unresolved illnesses / injuries Obesity (and unfitness) Inadequate medication supplies Graeme

Fitness Testing The RN fitness test: 3/28/2017 Fitness Testing The RN fitness test: Timed 1½ mile run (age & gender related pass times) Shuttle run (Multi-stage fitness test) 1 mile walk with time, weight and heart rate changes fed into a VO2 max calculation Consideration given to whether RFA should introduce these test. Graeme to lead into Sharon

Healthy Living Campaign 3/28/2017 Healthy Living Campaign Introduction on 1 Jan 11. Menus marked with fat, sugar and calorie content Encouragement to exercise and lose weight (ship-board gyms and PT) Sharon – background to Campaign the details of plan Ship-board provision of exercise equipment

Healthy Living Campaign 3/28/2017 Healthy Living Campaign BMI and waist circumference at OH screen. Cardiac risk calculated against NICE guidance Those at v high risk considered for landing by CO (until lose weight) Sharon continued Can you say something about the support we might be able to offer for personnel who are landed?

3/28/2017 Any questions?