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In this edition of Being Specific, in recognition of Anzac Day we focus on the Chapter of Military Medicine.
The relationship between the Australian Defence Force and the RACGP was first established in 2000 and the Chapter has gone from strength to strength. More recently, members of the Chapter of Military Medicine are doing the groundwork on the first post-Fellowship specialty recognition to be offered by RACGP Specific Interests.
While general practice is the core of military medicine, doctors serving in the military also need to maintain skills in areas as diverse as travel, sports, tropical and trauma medicine. I hope you find the information about their work interesting.
On Saturday and Sunday 1–2 June 2019, the Psychological Medicine network in conjunction with the Australian Society for Psychological Medicine will co-host a conference on ‘Trauma informed care in general practice’, in Melbourne. This will include a number of workshops, including Aboriginal and Torres Strait Islander experiences of trauma and self-care for clinicians. You can register for the event through the RACGP Specific Interests events page.
With the federal election only weeks away, I encourage you to speak to your patients, colleagues and community members about the importance of general practice to the health of the community.
While all healthcare is important and must be properly funded, primary healthcare provided by GPs sits at the very heart of community health and no-one should have to make a decision not to see a GP just because they can’t afford it.
Access to general practice for all Australians is vital to ensure a productive healthy population and relieve pressure on hospitals and emergency departments.
Accessibility is the key. One way this can be achieved is by supporting non face-to-face consultations: telehealth is vital for rural and remote patients, but also for people who are housebound, elderly, have disabilities or are carers.
Next, Government must address rising out-of-pocket patient expenses by making sure patient rebates reflect the true cost of providing care. It must recognise and appropriately support the time and skills required for GPs to work through the complex and varied health issues with which our patients present.
Between us, we see over two million patients a week, most of whom understand the importance of strong accessible primary healthcare to the health of Australia – but it doesn’t do any harm to remind them, particularly at election time, that there are real threats to general practice without sufficient government support.
I hope you enjoy the rest of the newsletter.
The Chapter of Military Medicine was established in 2000 following the signing of a charter by the, then RACGP President, Dr Margaret Kilmartin and the, then Surgeon General of the Australian Defence Force (ADF), Major General John Hearn.
In his introduction to the charter Major General Hearn wrote:
'The clinical skills and preventive outreach of all medical practitioners within the Australian Defence Force have as their core, state-of-the-art skills of best-practice general medicine.
'The basic terms of reference for all doctors who serve in uniform within the Australian Defence Force is the maintenance of positive health at the individual level both in peacetime training and during operational service. The individual doctor responsible for the care of service personnel is subject to great demands and carries significant responsibilities.
'Every Regimental Medical Officer, every member of the RAN Medical Branch, every Air Force doctor–officer who cares for the servicemen and women of their battalion, regiment, ship or squadron, is required to be the most skilled of general practitioners. In addition, they need to practise state-of the-art travel medicine, preventive medicine and health, sports medicine, tropical medicine and emergency trauma response – all to discharge their normal professional duties.
'The Military Medicine Chapter will promote such best-practice medicine, in such settings on land, sea and air.'
The Chapter fell under the auspices of the National Faculty of Specific Interests (now RACGP Specific Interests) in 2010.
In recent years, the members of the Chapter have concentrated their efforts in the establishment of a post-Fellowship specialty recognition for RACGP members working in the ADF, the framework of which is currently being piloted.
Dr Ramage is an Australian trained ADF Medical Officer. He has particular interests in military medicine, veteran’s health, military family member’s health, sports and exercise medicine, occupational medicine, musculoskeletal rehabilitation and general practice.
Dr Ramage holds a BAppSc(Hons) in Human Movement Studies from Queensland University of Technology and worked as an exercise physiologist for seven years before starting officer training at Royal Military College, Duntroon. He completed his Bachelor of Medicine, Bachelor of Surgery and a Master of Public Health at the University of Qeensland and is currently completing a Master of Sports Medicine there.
Dr Ramage was elected as Chair of RACGP Specific Interests Chapter of Military Medicine in December 2018. He shares a few words with us:
I was honoured to be elected as the Chair of the Chapter of Military Medicine and would like to thank the previous Chair, Dr Glen Pascoe, for his efforts and achievements while in the role. The Chapter has had some significant achievements since its inception, including the RACGP Standards for Garrison Health Facilities and, more recently, progression of the post-Fellowship specialty in military medicine.
Military Medicine is a complex mix of primary care, population health, occupational medicine, aviation and underwater medicine, emergency medicine and mental health. It is also characterised by exposure to unique challenges of location, resources and personnel management that can sometimes make simple clinical decisions very complicated. For serving Medical Officers, command, leadership, management, clinical governance, health support, aeromedical evacuation and disaster response planning also fall into our remit as GPs. These skills and experiences gained are a direct benefit of military service as a GP and are invaluable skills and experience for military registrars that most civilian registrars will never have the opportunity to acquire.
It is important to note that the role of the GP in military medicine extends beyond that of uniformed GPs and registrars. Civilian GPs working in Garrison Health and Recruiting facilities provide valuable services that help to ensure the maintenance of entry standards and the conservation of the human element of combat power for the ADF.
Special acknowledgement also needs to be made of the GPs who provide healthcare to the families of serving ADF members, reservists and veterans. While not directly involved in the ADF, understanding the unique stressors, support services and benefits available to ADF families, Reservists and Veterans is important for these GPs to feel confident that they are facilitating the best care possible. The Chapter has an important role in communicating the considerations and entitlements when working with these special populations.
I would also like to extend thanks to those GPs who are providing supervision, education and training to ADF Registrars. The demands of military service on Registrars often see them deployed or sent on military training activities at short notice. This can be disruptive to practices and training. Civilian GP supervisors and practices are critical in the training of ADF Medical Officers and, by extension, the health capability of the ADF. I am extremely grateful to the practice managers, owners and GP supervisors who continue to support ADF Registrars in their training and development.
Finally, I hope to continue to expand the understanding of military medicine within the RACGP, ADF and wider medical community. This will require active participation from as many members of the Chapter as possible. I encourage you to become actively involved in the Chapter by participating in meetings, conducting and publishing research, contributing articles to AJGP, presenting at conferences and participating in working groups and Chapter meetings to progress the understanding of the breadth and depth of military medicine.
This article reviews the contributions that Royal Navy physicians have made to medicine over the centuries.1 They have detailed some of the better known, as well as some almost forgotten, but still remarkable, achievements. Royal Naval ships' companies that are isolated by hundreds of miles of sea with contacts to the outside world tightly regulated, provided perfect environments to study the epidemiology of disease.
In 1747, James Lind organised one of the earliest clinical trials, demonstrating that scurvy (pictured left) could be treated by lemon juice. A century later, Alexander Bryson proved the value of careful epidemiological data collection and observation of infectious diseases encountered on the West Africa station. In the twentieth century, Royal Navy physicians were at the cutting edge of vaccine research and antibiotic production. Nuclear submarines placed naval physicians at the forefront of nuclear medicine and environmental safety.
1. Houlberg K, Wickenden J, Freshwater D. Five centuries of medical contributions from the Royal Navy. Clin Med (Lond). 2019;19(1):22-25. doi:10.7861/clinmedicine.19-1-22.
This analysis of all US military casualties, from October 2001 to December 2017, found that survival among the most critically injured casualties increased three-fold during the course of the conflicts. 2
Three key interventions – tourniquets, blood transfusions, and prehospital transport within 60 minutes – were associated with 44% of mortality reduction. Across 16 years of conflict, military trauma system advancements, namely, improvements in methods to control bleeding, replace blood, and reduce time to treatment, may be associated with increased survival of battle casualties.
2. Howard JT, Kotwal RS, Turner CA, et al. Use of combat casualty care data to assess the US military trauma system during the Afghanistan and Iraq conflicts, 2001–2017. JAMA Surg 2019. doi:10.1001/jamasurg.2019.0151.
The purpose of this historical article is to demonstrate the scale of gonorrhoea and syphilis infections in the Australian Army's overseas campaigns during the twentieth century.3
It refers to the Australian Army’s major overseas deployments; from the Boer War at the beginning of the century to the war in Vietnam, which ended in 1975. It investigates the measures taken by the staff of the Army Medical Service to prevent the sexually transmitted diseases (STDs) and to treat those who contracted STDs.
3. Howie-Willis, I. The Australian Army’s two ‘traditional’ diseases: gonorrhea and syphilis — A military-medical history during the twentieth century. J Mil Veterans Health 2019;27(1):11–22.
This paper describes a collaborative effort between line-unit leaders, medical personnel and installation services to synchronise suicide risk identification and communication between these disparate entities.4
It describes the process of implementing a suicide risk assessment and management policy at one installation in the Pacific Northwest. This policy was subsequently adopted as the standard of care for the US Army.
4. Hoyt T, Repke DM. Development and implementation of US Army guidelines for managing soldiers at risk of suicide. Mil Med 2019;184(Supplement_1):426–431. doi:10.1093/milmed/usy284.
While trauma may have a severe, negative impact on an individual’s life, trajectories that promote recovery and growth are possible. This conference will explore research and clinical advancements in the field of traumatic stress studies that continue to transform the understanding of treatment and recovery for those affected by trauma and its aftermath.
Research into the science of post-traumatic growth further demonstrates that trauma can bring a deeper response to personal transformation.
ACOTS2019 will launch a dedicated clinical training stream that will provide clinicians and practitioners working with those affected by traumatic stress a unique training opportunity to refresh their skills in core evidence-based, trauma-focused treatments, and be exposed to some of the latest treatment innovations in the field.
ACOTS2019 conference is a collaboration between the Australasian Society for Traumatic Stress Studies (ASTSS) and Phoenix Australia – Centre for Posttraumatic Mental Health.
The conference will be held on Thursday and Friday 13–14 September in Sydney, NSW at ICC Sydney, Darling Harbour with pre-conference workshops on Tuesday 12 September 2019.
Registration is now open.
The 2019 Australian Military Medicine Association (AMMA) Conference will be held in Adelaide on Friday to Sunday 4–6 October 2019.
The AMMA Scientific Committee are seeking standard (20-minute) and short (five-minute) oral presentations, and poster presentations.
Topics sought include, but are not restricted to:
• aero medical evacuation
• veteran's health (including PTSD and rehabilitation)
• operational health support
Abstracts of no longer than 600 words must be submitted by Friday 31 May 2019 through the AMMA submission portal.
shareGP is the RACGP's online space for members to share collaborative content including blogs, papers or research, search and connect with peers;
All members of the RACGP with an interest in military medicine are welcome to join. Once you have requested to join, an administrator will approve your membership within 48 hours.
You will need your RACGP password to log in. If you are unsure of your password, it can be reset on the RACGP login page.
The 2019 combined RACGP and Australian Society for Psychological Medicine conference will examine the difficult area of treating patients affected by trauma in general practice.
The workshops in the program include:
This conference has been accredited as a Focussed Psychological Strategies (FPS) CPD activity and for 40 Category 1 Quality Improvement and Continuing Professional Development (QI&CPD) points for the 2017–19 triennium.
Saturday and Sunday 1–2 June 2019
Victoria Hotel, 215 Little Collins Street, Melbourne
RACGP / ASPM members (early bird): $450
Non-members (early bird): $550
RACGP / ASPM members: $550
Register through the RACGP Specific Interests events page.
7.00–8.30 pm AEST, Thursday 20 June 2019
A child’s psychological recovery from experiences of trauma, loss and other adverse experiences is often dependent on their network of supportive and nurturing relationships.
This webinar examines frameworks that GPs use to remain curious about the circumstances of children affected by trauma, while establishing support networks that assist in recovery.
It is the final in the RACGP Specific Interests / Emerging Minds – National Workforce Centre for Child Mental Health series of on mental health issues for infants and children.
The webinars are accredited for three Category 2 QI&CPD points for the 2017–19 triennium. Complimentary for RACGP members.
Register through the RACGP Specific Interests events page.
6.30–8.30 pm AEST, Tuesday 9 July 2019
The second networking event for Victorian members will be held at RACGP House in Melbourne.
Places are limited, to express your interest in attending contact RACGP Specific Interests events.
This year, RACGP Foundation is proud to offer 16 research grants and awards to GPs and registrars. With the support of our funding partners, RACGP Foundation is able to provide these vital research grants each year. The research conducted by the recipients of RACGP Foundation grants contribute to advancing medical achievements within the general practice community.
You could play a vital role in shaping the health of Australia.
Online applications are now open and will close on Monday 6 May 2019.
RACGP Foundation is where general practice research begins.
Developed and delivered by members of the RACGP Expert Committee – Practice Technology and Management (REC—PTM) and eHealth experts, the RACGP eHealth webinar series will present monthly webinars throughout 2019 on eHealth topics pertinent to general practice.
All webinars are accredited for two Category 2 QI&CPD points for the 2017–19 triennium and are free of charge for all participants.
Webinar recordings are made available via the RACGP website at the conclusion of each month’s sessions.
National Palliative Care Week is an initiative of Palliative Care Australia supported by the Department of Health to raise awareness and understanding of palliative care in the Australian community.
The theme for National Palliative Care Week 2019 is ‘What matters most?’
The theme addresses the need for Australians to plan ahead for their end-of-life care and discuss it with their families, friends and health professionals.
For further information on events and palliative care resources, visit the National Palliative Care Week website.
The National Health and Medical Research Council (NHMRC) Symposium on Research Translation provides a platform for NHMRC’s community of researchers and others with an interest in the creation and use of research evidence, to share information and experiences, and to be challenged by new ideas or approaches.
The theme for the 2019 symposium is 'Research Translation in the digital age: Harnessing the power of data and analytical technologies’. It wil reflect on the effective optimisation of the use of health and medical research data to inform heathcare policy and practice.
It will also examine the social, ethical and legal issues in the context of health data.
Abstracts for 10-minute oral and poster presentations are now open.
Abstracts should be submitted through the NHMRC abstract portal by Friday 14 June 2018.
The symposium will be held on Tuesday and Wednesday 19–20 November 2019 in Melbourne.
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