JSP 950 Part 1 Leaflets

Patients who are brain injured may have undergone Brain Stem Death (BSD). It is important to be able to diagnose BSD and confirm death. This is to avoid further distress to families by giving false expectation of survival and to avoid inappropriate medical transfer of the deceased.

The number of patients who may satisfy the pre-conditions for Brain Stem Testing on operations has historically been small and is expected to remain so. Where preconditions are not met and if any doubt exists, testing should not be carried out. If BST is not undertaken, alternative treatment pathways are to be considered by the clinical team. This may include rearward evacuation where indicated.

This leaflet provides guidance specifically for UK Medical Personnel on deployed operations working in UK Medical Treatment Facilities (MTFs) or UK-led MTFs. In other circumstances such as whenre UK is not the medical lead or where other nations's personnel are being treated by UK Medical Personnel, guidance will need to be sought from the relevant medical commanders, PJHQ and other SMEs on a case by case basis.

JSP 950 Part 1 Lft 2-5-2 (v1.0) May 12 - BRAIN STEM DEATH AND BRAIN STEM TESTING​

Authorised and consented clinical photography has proven utility as an aid to the assessment, diagnosis and treatment of a patient, as a record of clinical conditions for the official medical record and as a tool to support education and research. Outside these legitimate reasons for clinical photography, individuals working within or alongside the Defence Medical Services (DMS), will not or may not record clinical images for their own purposes. Modern mobile telecommunication devices make it possible to transfer these images more easily. Such practices may cause distress to patients, may breach medical confidentially law, thereby exposing the individual and the organisation to legal consequences, and damage the reputation of the wider organisation.

This leaflet provides policy direction to any person taking photographs of patients, in a DMS facility and all personnel taking clinical photographs (medical and dental)​.

JSP 950 Part 1 Lft 2-1-3 (V2.0 Oct 15) DEFENCE MEDICAL SERVICES CLINICAL PHOTOGRAPHIC POLICY

Medical forces on operations are configured to support only the deployed force and medical manpower and materiel is scaled to that end. Current doctrine provides that the medical force can deliver support to non-combatants including children as part of the overall campaign. This medical support is provided in line with the theatre eligibility matrix. Doctrine specifies that any care given must be within existing capability, must not impact on the mission and must not create a dependency among the local population. This doctrine fully recognises the duty under Common Article 3 of the Geneva Conventions requiring that the wounded and sick be collected and cared for but does not fully acknowledge the moral and ethical imperative to render all necessary care to any individuals, including children who might present at military medical facilities whether or not it is within deployed capability. Whilst the proportion of patients under the age of 16 has been low on recent operations (Op TELIC 3%) impact is high with 70% of those requiring transfer to specialist services. During Op HERRICK 16B, 40% of paediatric patients required Intensive Therapy Unit (ITU) admission with hospital stays of up to 26 days. Commanders can be expected to make treat or not treat decisions regarding children on operations, decisions which can have consequences for unit effectiveness on both logistical and emotional levels. For the purposes of this letter children are defined as from birth up to the age of 15 and 364 days.

This tension between doctrine and reality has clinical governance implications and these were highlighted in a review of the Defence Medical Services (DMS) Support to Civilians on Operations3. This paper proposed sets of competencies that will be required of clinicians on operations in order to manage conditions presented by civilian cases. The Permanent Joint Headquarters (PJHQ) Note 345-12 Treatment of Non-Entitled Children on Operations lays out a competency framework for healthcare professionals within the DMS while acknowledging an ethical obligation to treat children, Defence doctrine remains that deployed military medical facilities are configured to support the deployed force.

DMS personnel have regularly been involved at the tactical level in reconciling strategic doctrine and tactical reality and have provided medical care to an exceptional standard to children who have presented at UK military Medical Treatment Facilities (MTF). They have adapted their skills and equipment to overcome the challenges set by treating these different populations and have managed the clinical governance risks. Medical personnel have submitted and continue to submit recommendations on policy, equipment, manning and training enhancements that would improve their confidence and competence and which would do much to reduce governance risks that will have to be managed by medical commanders. DMS personnel regularly express particular concern regarding the management of children in the deployed setting. The Deployed Paediatric Special Interest Group (DEPSIG) exists to guide policy, provide advice to medical commanders and Defence Consultant Advisors (DCA), produce clinical guidance and provide relevant and military specific paediatric medical training.

This policy provides a framework to help clinicians identify their clinical responsibilities, be maximally prepared for, and identify what actions need to be taken to ensure that civilian Paediatric cases are successfully returned either to the local health system or Non-Governmental Organisations (NGO) facilities at the earliest opportunity that their condition allows. It is not the intention of this policy letter to re-establish a Defence paediatric cadre however the training enhancements recommended in this document are to be considered for force generation and seek to advise commanders of the training requirements for forces held at readiness.

JSP 950 Part 1 Lft 2-15-1 (V1.1 Jan 08) TREATMENT OF CHILDREN ON OPERATIONS

Forensic dental examination is used to identify military personnel who have been killed or have died in circumstances where the body has been fragmented, incinerated or is decomposed and cannot be identified by routine identification procedures. It is an essential component of the identification process, being one of the three primary forms of identification along with fingerprints and DNA.

Where human remains have been incinerated, dental tissues may be the only means of identification possible. Defence's forensic dental identification capability, the Dental Identification Team (DIT), is provided by Defence Primary Healthcare (Dental). The DIT forms part of the deployable capabilities offered by the Defence Medical Services (DMS) and is available for activation 365 days a year.

The aim of this policy is to articulate the roles, responsibilities and interactions of the military forensic DIT capability across Defence and other Government Departments.

JSP 950 Part 1 Lft 2-23-2 (V1.0) Dec 16 FORENSIC DENTAL IDENTIFICATION OF DECEASED PERSONNEL​

The term Traumatic Brain Injury (TBI) describes the diruption of brain function resulting from either a penetrating or non-penetrating injury and covers a spectrum through mild, moderate and severe. Whilst moderate and severe cases typically present with obvious clinical injury, the signs and symptoms associated with mTBI can be less distinct.

This policy gives guidance to medical personnel and commanders on the diagnosis and management of UK Military Personnel presenting with concussion/mTBI in the deployed setting.

Please note that this policy is currently under review and will be updated on CGOs and JSP950 on completion.

JSP 950 Part 1 Lft 2-4-3 v1.1 (May 11) THE MANAGEMENT OF CONCUSSION / MILD TRAUMATIC BRAIN INJURY ON DEPLOYED OPERATIONS

Personnel on operations may be exposed to blast, which may damage the ear (Blast Induced Trauma to the Ear - BITE). Exposure to Short-term High Intensity Noise (SHIN) as may be expereinced in a firefight, may also cause damage. this policy provides guidance on the management of those exposed to SHIN or suffering BITE on operations.

JSP 950 Part 1 Lft 2-7-2 v1.0 (May 13) EXPOSURE TO SHORT-TERM HIGH INTENSITY NOISE AND BLAST
INDUCED TRAUMA TO THE EAR ON OPERATIONS

The purpose of analysing surgically removed munition fragmentation is to ascertain their composition through laboratory analysis and determine if fragments remaining is a casualty might be toxic to the individual. This policy gives specific direction and superseded the previous policy released as SGPL10-09.

JSP 950 Part 1 Lft 3-3-1 v1.1 (Jul 11) THE IDENTIFICATION, DOCUMENTATION AND RETENTION OF MUNITION FRAGMENTS SURGICALLY REMOVED FROM UK PERSONNEL

All Defence Medical Services (DMS) patients are recorded on the National Health Applications and Infrastructure Services (NHAIS) SYSTEM. All DMS patients are linked to the NHAIS system via DMICP (GP links). This enables medical alerts to be raised for eligible patients. This policy leaflet gives direction on responsibilities for medical alerts for eligible DMS patients whilst on operations.

JSP950 PART 1 LFT 8-2-3 - Medical Alerts for Deployed Service Personnel

The aim of this policy is to outline the Defence Medical Services arrangements for Infection Prevention and Control and detail responsibilities and governance processes.

JSP 950 Part 1 Lft 2-10-2 (V1.0 Apr 16) DEFENCE MEDICAL SERVICES (DMS) INFECTION PREVENTION AND CONTROL (IPC) POLICY

Micro-organisms will always be present in the clinical environment. ALL staff have a responsibility to be aware of methods to reduce or prevent the transmission of potentially infective agents. The choice of decontamination method depends on a number of factors, which include the type of material to be treated, the likely organisms involved, the time available for decontamination and the risks to staff and patients.

Decontamination of equipment and the environment are key Infection Prevention and Control (IPC) measures and the Defence Medical Services (DMS) must aspire to the highest standards while accepting that there are significant environmental and logistical factors that may prevent those standards being achieved in more rudimentary treatment facilities.

Medical devices decontamination involves the decontamination of re-usable medical devices used in the diagnosis, monitoring and treatment of patients. The whole process includes a full chain of evenets starting with the initial procurement of equipment through to their cleaning, disinfection, sterilisation, transportation, storage and final disposal.

DMS Strives for excellence in surgical instrument decontamination but accepts that there may have to be some compromise in the interests of logistical and environmental constraints along with the need for ruggedness and portability of equipment. Single use surgical instruments are currently relatively poor in quality and the quantity required, even for a short deployment would create a significant logistical burden. When a medical devices decontamination capability (MDDC) is generated, it must be deployable and sustainable in all operational envirobments. MDDC should be at least comparable to but ideally comparable with that used by our allies as this will enhance inter-operability.

This policy sets the standards for the DMS to develop and deploy an MDDC that will deliver a safe decontamination of re-usable medical equipment such that it protects patient and staff from the risk of infection on deployed operations and in the firm base.

JSP 950 Part 1 Lft 2-10-3 (v1.3) Jan 17 DEFENCE MEDICAL SERVICES MEDICAL DEVICES DECONTAMINATION POLICY (MDDP)​

Adventure travel to the world's highest mountain ranges is becoming increasingly popular. Military personnel may take part in such activities either privately or as part of officially organised Service Adventurous Trainin. On occasions there may be an operational requirement to deploy personnel to high altitude at short notice.

Travel to high altitude is associated with a number of unique medical problems, the most common of which is Acute Mountain Sickness (AMS). Anyone can get AMS; there is no variation in incidence based on age, gender, fitness or previous altitude exposure. This policy leaflet provides guidance to Service Medical Personnel on the prevention and management of AMS. It supersedes SGPL31/01 and should be read in conjunction with 2005DIN06-010 "Guidance for the Conduct of Adventurous Training Expeditions at
Altitude".

JSP 950 Part 1 Lft 2-9-1 (V1.1 Nov 11) THE PREVENTION AND TREATMENT OF ACUTE MOUNTAIN SICKNESS​​

The aim of this leaflet is to provide policy and direction to all Ministry of Defence personnel who procure, store, prescribe, supply, administer or dispose of medicines. It provides policy on the safe and secure use of all medicines, ensuring compliance with legislation and best practice, allowing each Command or unit to develop appropriate medicines management SOPs.

JSP 950 Part 1 Lft 9-2-1 (V1.0 Dec 15) MANAGEMENT OF MEDICINES POLICY​​

This leaflet outlines the role of the MOD's Controlled Drug Accountable Officer (CPAO) and associated roles and responsibilities for all personnel involved in the management and use of controlled drugs. For the purposes of this leaflet, the term controlled drug encompasses those drugs classed within the MOD as accountable drugs unless specifically stated otherwise. This policy is in accordance with UK legislation but will
detail where military variation exists.

JSP 950 Part 1 Lft 9-2-2 (V2.0 Jan 15) THE SUPERVISION OF THE MANAGEMENT AND USE OF CONTROLLED DRUGS

Service personnel undertaking operational deployment may experience events which may adversely affect their mental health, the chief cause of which is involvement in heavy combat particularly involving the death of colleagues and friends. As a result there is a requirement to provide deployment-related mental health and wellbeing briefings as part of the deployment process. The objective of such briefings is to provide sufficient
information about deployment related mental ill-health to allow individuals, peers and family members to take sensible steps to avoid mental ill-health (PREVENT), to recognise early signs of mental ill-health (DETECT) and to facilitate help-seeking from the right source at the right time (TREAT).

JSP 950 Part 1 Lft 2-7-1 (v1.1 Jul 10) MENTAL HEALTH AND WELLBEING BRIEFING BEFORE DURING AND AFTER DEPLOYMENT​​

Dr Andrew Murrison's report 'Fighting Fit - A Mental Health Plan for Servicemen and Veterans' was published in August 2010. The report recognised the importance of stigma and of making interventions acceptable to a population accustomed to viewing itself as mentally and physically robust and commented that there was scope for improving the focus of periodic, discharge and invaliding medical examinations on service related ill health, particularly mental health. One of the 4 principle recommendations made was:

"...that a mental health systems enquiry is built into routine service medical examinations, discharge medicals and the medical medical examinations conducted prior to invaliding from the Service on the grounds of physical or mental incapacity."

This recommendation was accepted by the MOD recognising the benefits of a structured approach to assessing mental fitness

JSP 950 Part 1 Lft 2-7-5 v1.0 (Apr 13) STRUCTURED MENTAL HEALTH ASSESSMENT​

In broad terms G&A refers to the values and behaviours, structures and processes that need to be in place to enable an organisation to deliver its outputs. In terms of healthcare, adopting a positive culture of G&A allows the DMS to ensure that essential standards of quality and safety are met. Furthermore, G&A should be based on a framework that drives continuous quality improvement, engaging all those who deliver and/or manage healthcare, or act in a supporting capacity to a healthcare delivery organisation. To that end, all healthcare professionals who are employed across the DMS are responsible for G&A in accordance with their regulatory bodies, and policy and standards laid down by SG, for example within JSP 950. Additionally and in recognition
of external influences, our arrangements should take account of the Key Lines of Enquiry as laid down by the Care Quality Commission (CQC).

The DMSR will collect, collate and analyse the evidence required to provide an assessment of assurance on all aspects of healthcare and medical operational capability. This assessment of assurance, alongside a summary of supporting evidence, is presented to the DMS board and is the means by which all providers of healthcare
and medical operational capability are held to account.

JSP950 Part 1 Lft 5-1-4 Defence Medical Services Regulator - Governance and Assurance in the DMS May 2018​​

The duty of candour was enshrined in legislation in November 2014 and applies to all health service bodies including the Defence Medical Services (DMS). Promoting a culture of openness and truthfulness is a prerequisite to improving patient safety and delivering high quality healthcare. The duty of candour is the statutory requirement of the 'being open' process and applies where there is a notifiable safety incident. A notifiable safety incident is defined as any incident, intended or unintended, which leads to death, severe harm or prolonged psychological harm.

The aim of this leaflet is to provide policy direction on the application of the Duty of Candour across the DMS.

JSP 950 Part 1 Lft 5-1-6 (v1.0) Jun 16 DUTY OF CANDOUR (BEING OPEN) IN THE DEFENCE MEDICAL SERVICES​​​