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© Crown copyright 2013 Dstl
23 July 2013
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The Medic of the Future
Centre for Defence Enterprise
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Rapid technological change
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© Crown Copyright MOD 2011
The aim of CDE
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© Crown Copyright MOD 2011
Prove the value of novel, high-risk, high-potential-benefit research
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© Crown Copyright MOD 2011
To enable development of cost-effective military capability advantage
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23 July 2013
Five key operating principles underpin the CDE model
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Engaging innovators
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23 July 2013
Accessible opportunity
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Sustaining incentives
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Minimising participation costs
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Compliance
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Intellectual property
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Two routes to funding
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Online bid submission
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Themed calls
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CDE themed call programme
Secure communications Call close 22 Aug 2013
Innovation in drug development processes
Call close 29 Aug 2013
The medic of the future Call close 5 Sept 2013
Novel solutions for emulating ship signatures
Call launch 23 Jul 2013
Strengthening biological security Call launch 17 Sept 2013
Register and further details at www.science.mod.uk under ‘Events and Calls’
All calls close at 17:00 hrs
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Defence Open Call
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Seeking the exceptional
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4568 proposals received
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17% proposals funded
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£41.5M contracts awarded
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Exemplar project
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Fuel efficiency
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‘Micro generators’
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© Crown Copyright MOD 2011
Effective proposals
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Challenge, pace & exploitation
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The future of CDE
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The Medic of the Future
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Network and question
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Surgeon General
Defence Medical Services
Air Marshal Paul Evans
Surgeon General
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Surgeon General
Defence Medical Services Mission
Our Mission. Provide health policy & advice, healthcare
and medical operational capability in order to maximise
the fighting power of the Armed Forces
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Surgeon General
AIM
To PROMOTE, PROTECT & RESTORE
the health of the Defence population in order to maximise fitness for role
Aim of the Defence Medical Services
HealthcareAdvice
Operational Capability
THE STRATEGY FOR THE DMS
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Surgeon General
Role of Surgeon General
End to end process owner of healthcare pathway for
Service personnel
Head of Service
CEO of Defence Medical Services
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Surgeon General
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Surgeon General
Scope
Main Effort
• Operations: Afghanistan & return to contingency
Primary Care
Rehabilitation & Mental Health
Secondary Care
Education & Training
Research
Current Issues/Discussion Points
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Surgeon General
The Operational Patient Care
Pathway
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Surgeon General
The Operational Patient Care Pathway
Point of Wounding }
Buddy-Buddy Care } Pre-hosp
Role 1 Effect – Medic + Doc }
Evacuation – Damage Control Resuscitation } Care
Role 2/3 • Damage Control Resuscitation
• Damage Control Surgery
• Hold
Evacuation • Tactical
• Strategic
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Surgeon General
The Operational Patient Care Pathway
Role 4
• Royal Centre for Defence Medicine – Birmingham
– Clinical Care
– Support to the Patient Group
• Defence Medical Rehabilitation Centre Headley Court
Return to Duty / Medical Discharge
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Surgeon General
Operating Theatre History
Number of trips to theatre 27
Specialities involved 6 inc: Orthopaedics, Plastic Surgeons,
Vascular, Urology, General Surgeons,
Intensivists.
Total amount of time spent in surgery 75 hours & 15 mins
Theatre trip time length Shortest: 1hr 15 mins
Longest: 6hrs
Procedures included Femoral nail, closure of abdo,
consistent debridement & washout of all
wounds, reconstructive soft tissue flap,
split skin grafting, colostomy, insertion
of iliosacral screws, changing of
dressings, inc application of TNP &
other necessary procedures
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Surgeon General
The Operational Patient Care Pathway -
Issues
Golden Hour
Bastion Vs Tent
Time to Evacuation
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Surgeon General
The formation of Defence Primary Healthcare means that SG will now
deliver end-to-end clinical care in the firm base and the permanent
bases overseas
•More efficient use of personnel & resources;
•Quicker implementation of healthcare policy & Defence
change;
•Better governance and performance management;
•Better links with the NHS to manage access to secondary
care;
•More attractive employer for clinicians and administrative
staff.
Defence Primary Healthcare - Implications
Key Benefits
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Surgeon General
Primary Care
1 Apr 13 – Defence Primary Healthcare Care
SG now directly accountable for tri-Service primary
care delivery with budget
DMS legislated to provide primary care
Occupational Primary Care Service
• Return to duty philosophy
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Surgeon General
Defence Medical Rehabilitation
Programme Tiered approach – Multidisciplinary occupational approach
Tier 1 – Primary Care Rehabilitative Facility (PCRF)
Tier 2 – Regional Rehabilitation Unit (RRU)
• 16 in UK
• Function:
– Medical Injury Assessment Clinic (MIAC)
– Group Treatment capability
Tier 3 – Defence Medical Rehabilitation Centre (DMRC)
• Complex Trauma
• Musculoskeletal
• Neuro
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Surgeon General
The Future – Defence National Rehabilitation Centre
A decision on a Defence National Rehabilitation Centre to
meet future UK rehabilitation needs is likely this year
•With a Defence element at its core, it would replace Headley Court
•A campaign to raise £300M is being led by the Duke of Westminster
•The Duke has already acquired a site – Stanford Hall in the Midlands
•An announcement is likely once £200M has been raised (possibly later in 2013)
•If confirmed, the intention would be to open the Defence element in 2017
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Surgeon General
Defence Mental Health
Occupational Community based service
Departments of Community Mental Health (DCMHs)
• Multidisciplinary – Psychiatrists, Clinical Psychologists, Mental Health nurses & social workers
• 13 in UK
Minimal requirement for in-patient capability
• NHS contracted service with South Staffs consortium
• NB – Lower admission threshold
Academic Centre for Defence Mental Health - Kings
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Surgeon General
Secondary Care
NHS Provision under our entitled access to
secondary care
• Vast majority for provided under NHS routine access
driven by clinical need
• Majority of elective care is outpatient or day case
• Contract for rapid access to Imaging & Operative
orthopaedic care
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Surgeon General
Strategic Challenges – Secondary Care Commissioning
We need to resolve uncertainty about funding to meet the secondary
care needs of Service personnel under new NHS arrangements.
•Funding for military patients will be held
centrally by NHS England, not regionally.
•Will funding requirement be calculated
accurately?
•Discussions held up by delays to
establishing posts within NHS England.
•There is uncertainty about who will fund
occupational referrals.
•Our position: Any funding shortage
should be a NHS risk not a Defence
one.
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Surgeon General
Education & Training
Doctors:
• Medical Cadets
• Specialist training
• GPVT
• Direct Entrants
Nurses
• Direct Entrants
• In-house Nurse Training – Birmingham City University
AHPs
• Some In-house some recruited post training
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Surgeon General
Education & Training
Defence Medic
• Current Training Programme
– Common Core 20 weeks
– Individual Services
Army/RAF – 7 weeks
RN – 19 weeks
– Professional Status
– Keogh Barracks Aldershot
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Surgeon General
The Future – Creating a Regional Centre of Excellence
DMS Whittington will be at the hub of a regionally-based
centre of professional excellence for the 21st Century
•£138m construction including HQ, training and accommodation
•Future home for over 1,000 military and 400 civilian staff
•Phase 2 Construction will be
completed by Feb 2014
•Currently on-time/on-budget/to user-
defined requirement
•Feedback is good across the board
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Surgeon General
Research
Created Medical Director post in 2009
Mission:
To support deployed DMS personnel through academia,
research, clinical policy, personnel management, and
equipment capability developments, which ensure the
highest standards of governance, whilst continually
promoting innovative, world leading, quality and safe
patient care.
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Surgeon General
JMC Medical Directorate
Title ‘Medical Director’ aligns to NHS titles
Job is outward looking to civilian NHS and academic
practice
Combines professional leadership with academic
research
Development of Clinical Policy and provision of
clinical advice to Theatre/PJHQ in real time
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Surgeon General
Defence Medical Academia
8 Defence Profs with senior lecturers and lecturers
• Emergency Medicine
• Surgery
• Orthopaedics
• Medicine
• Anaesthetics & Critical Care
• General Practice (GP)
• Mental Health
• Nursing
Royal College recognition
All are deployable and most have deployed in last 18 months
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Surgeon General
DMS Academia & Research
Research is focussed through SG’s Research Plan
Multiple Internal, National and International
Collaborative Partners (Dstl, Russell Group Universities, NIHR,
TRBL Blast Centre, US, NATO
Research and audit is part of medical revalidation
Clearance of all clinical papers
End users are often the researchers – unique to
Defence
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Surgeon General
Issues
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Surgeon General
QUALITY AND ASSURANCE
Care Quality Commission
• Very positive review of both Primary and secondary care
including operational environment
Inspector General
• Accountable to SG
Defence Internal Audit
Joint Force Command / SoS /HCDC
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Surgeon General
Revalidation
No different from civilian requirement
NB – full clinical practice
• Operations
Role of Medical Manager
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Surgeon General
Clinical Skills post Afghanistan
Is a ‘dip’ in performance inevitable following draw-down in
Afghanistan and if so, how deep will it be?
•Unless maintained, skills will have to be
relearned on the next campaign.
•Will we retain our most able people if we
return to a ‘peace-time’ routine?
•Our Position. To maintain hard-won
skills, we need to provide:
•quality clinical placements,
•exposure to simulation,
•rewarding research opportunities
•‘real-life’ opportunities
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Surgeon General
Changes in NHS
Efficiency pressures in NHS.
DH committed to development of new, mutually beneficial arrangements.
Includes DAs on Partnership Board
Placements for Secondary Healthcare Personnel
Level 1/Major Trauma Centres
Current MDHU Arrangements (placements & commissioning) no longer fit for purpose
Review has DH support.
DMG Scotland
Partnerships & Collaboration
Generate symbiotic relationships
Changes in NHS England
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Surgeon General
Conclusion
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Surgeon General
VISION
To be recognised by those
we serve as a World Leader in military
healthcare and health advice
THE STRATEGY FOR THE DMS
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Surgeon General
THE STRATEGY FOR THE DMS
VALUES
Excellence, by striving for continuous improvement and
the highest quality in all that we do
Commitment to patients, and evidence-based practice
Integrity, by adhering to the highest professional and
ethical standards, maintaining the trust and confidence
of all with whom we engage
Teamwork and leadership, which are key to success
Respect, by treating those with whom we serve and
work with dignity and respect
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MOD Medical Sciences Research Programme
Overview
Surgeon Commodore Alasdair Walker, Joint Medical Command
Neal Smith, Dstl Programme Delivery Directorate
16 July 2013
© Crown copyright 2013 Dstl
23 July 2013
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Defence S&T Medical Sciences Programme
23 July 2013
© Dstl
Casualty Care
To investigate techniques and interventions that address complex injuries from current and emerging battlefield threats in conventional (non-CBRN) warfare.
Force Effectiveness and Rehabilitation
Focused on improving numbers of those fit to deploy, improving the quality of life of survivors from military conflict, minimising residual disability and providing aftercare support to wounded veterans.
Medical Systems
Research, develop and evaluate systems that will maintain and/or enhance the effectiveness of deployed forces in extreme and austere environments and produce medical treatments, interventions and rehabilitative support to injured personnel.
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Defence S&T Medical Sciences Programme
23 July 2013
© Dstl
Casualty Care • Resuscitation
• Haemorrhage Control
• Battlefield Pain Management
• Blast Injury Characterisation
• Extremity Trauma
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Defence S&T Medical Sciences Programme
23 July 2013
© Dstl
Force Effectiveness and Rehabilitation
NIHR Programme (Joint MoD/Department of Health)
• Acute response to injury • Microbiology • Regenerative/Reconstruction Medicine King’s Centre for Military Health Research
• Long term investigation into possible health effects of operational deployment among UK Armed Forces personnel (initiated 2003)
Health & Well-Being
• Potential chronic health effects • Help seeking behaviours and stigma reduction • Nutrition • Noise Induced Hearing Loss & Vibration
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Defence S&T Medical Sciences Programme
23 July 2013
© Dstl
Medical Systems
Centre for Defence Enterprise
2012: The Extremes of Defence Medical Capability
• Small Rugged Blood Fridge • Spiral peripheral nerve interface • Knitted prosthetic sleeves • Integrated patient monitor • One arm drive wheelchair
Today… 2013: The Medic of the Future: Training and Support
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CDE Medical Call 2013
The Medic of the Future: Training and Support
16 July 2013
UNCLASSIFIED
FOR PUBLIC RELEASE © Crown copyright 2013 Dstl
23 July 2013
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The Medic of the Future: Training and Support
• Context
• Technology Challenges:
– 1: Exploring the potential of simulated training and high-
fidelity models
– 2: Identifying novel systems that will help those injured in
battle
• Exploitation
UNCLASSIFIED
FOR PUBLIC RELEASE © Crown copyright 2013 Dstl
23 July 2013
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The Medic of the Future: Training and Support
• Context
– The human component is central to delivering military
capability
– Provision of sufficient, capable and appropriately trained
personnel is critical to operational success
– There is a need to sustain capability by protection, treatment
and rehabilitation
– Provision of high quality support, care and treatment at all
points along the continuum of care is essential
© Crown copyright 2013 Dstl
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE
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The Medic of the Future: Training and Support
Technology Challenge 1
• Exploring the development of high fidelity models with
enhanced haptic feedback to replace existing live
simulation methods especially in advanced clinical
practice and surgery
– Simulated Environments
– Mannequins
– Synthetic tissue
– Trauma scenario simulation
– Virtual coaching
© Crown copyright 2013 Dstl
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE
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The Medic of the Future: Training and Support
Technology Challenge 1
• We want systems which:
– Novel and innovative systems
– Consider cost to MOD of introduction
– Provide realistic scenarios, but avoid live models
– Consider standards and measures of competency
– Provide constructive feedback to trainees and trainers
– Demonstration of proof-of-concept for further investigation.
© Crown copyright 2013 Dstl
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE
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The Medic of the Future: Training and Support
Technology Challenge 1
• What we don’t want
– Management or provision of training services.
– Consultancy on training and education.
– Existing ‘off the shelf’ products.
© Crown copyright 2013 Dstl
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE
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The Medic of the Future: Training and Support
Technology Challenge 2
• Identifying novel systems that will help those injured in
battle
• Opportunities to maintain force effectiveness
– Equipment enhancements
– Easing burden for the battlefield medic
– Enhanced protection for patients
• Military Patient Transport
– Reducing contamination and infection
– Enhancing safety and protection
© Crown copyright 2013 Dstl
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE
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The Medic of the Future: Training and Support
Technology Challenge 2
• What we want
– Novel and innovative systems
– Proposals that demonstrate the benefits of tailoring
conventional medical systems to bespoke defence challenges
– Demonstration of proof-of-concept for further investigation
• What we don’t want
– Systems which result in an unrealistic burden on other
components of capability
© Crown copyright 2013 Dstl
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE
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The Medic of the Future: Training and Support
Exploitation
• Research integration
– Medical Sciences Programme
– Training & Education Programme
• Procurement
– Refine, trial or purchase
• Policy
– Refinement and implement
– Development of doctrine
© Crown copyright 2013 Dstl
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE
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The Medic of the Future: Training and Support
Summary
• Technology Challenges
– 1: Exploring the potential of simulated training and high-fidelity models
– 2: Identifying novel systems that will help those injured in battle
• What we want
– Novel and innovative systems
– Systems which consider full cost of introduction
– Realistic models that assist training
– Systems which ease the burden of the battlefield medic
– Enhancements for patient and medic safety
– Demonstration of proof-of-concept for further investigation
© Crown copyright 2013 Dstl
23 July 2013 UNCLASSIFIED
FOR PUBLIC RELEASE
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Centre for Defence Enterprise Submitting a Successful Proposal
Centre for Defence Enterprise
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Maximising your chances
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Know what is available
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Know what is available
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Know what is available
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Read available information
Start with –
Quick Start Guide
plus other CDE manuals – Account Manual, User Manual, Technology Application Manual
Know what is available
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Know what is available
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Developing a CDE proposal
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Value from technology
Innovative concept
Future capability
Proof of concept Incremental development
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The essentials
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Description
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mins
Assessment
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Not an exam
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MOD Performance Assessment Framework
Five criteria:
Operational relevance
Likelihood of exploitation
Builds critical S&T capability
Scientific quality/innovation
Science, innovation and technology risk
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Commercial tab
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Government-furnished X
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Health and safety
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Ethics
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Unclassified
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Proposal health check
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Claim of future benefit
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Contribution to future benefit
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Logical programme of work
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Generation of evidence
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Demonstration of progress
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Based on a claim of future benefit
Contribution to realisation of future benefit
Logical programme of work
Evidential outcomes
Demonstration of progress towards goal
Health check
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Early birds
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This call closes:
17:00 hrs on
Thursday 5 September 2013
Deadline
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www.science.mod.uk
Events and Calls > Current calls for proposals > The Medic of the Future
Webinar:23 July 2013 14:30-15:30
Register online
Further information
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The Medic of the Future
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© Crown copyright 2013 Dstl 23 July 2013
1. Exploring the potential of simulated training
and high-fidelity models
2. Identifying novel systems that will help those
injured in battle
Technology Challenges
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© Crown copyright 2013 Dstl
23 July 2013