Treating non-battle casualties in the littoral

While trauma care will always be a key part of military medics’ skill sets, Army’s 2 Health Battalion – part of 2 Health Brigade – has been looking ahead to a different set of challenges that could prove just as important.

CAPTION: Medics from 2nd Health Battalion deliver treatment to a simulated casualty on a river bank under the supervision of instructors on Exercise Viper Guardian. Story by Captain Chris Wade. Photo by Private Lani Pickering.

During Exercise Viper Guardian, 2 Health Bn troops from a range of medical backgrounds, regular and reserve, were tested in an environment challenging and unfamiliar to most – namely, the winding, densely vegetated waterways of Coochin Creek in south-east Queensland.

According to Lieutenant Colonel James Savage, the battalion’s senior medical officer, the thinking behind the exercise was to give the best possible preparation for future operations.

“This is very applicable to what we’re training for – large-scale combat operations,” Lieutenant Colonel Savage said.

“We know our army is focusing on training in the littorals, so, we need to practise in that kind of environment.

“We tend to focus on the trauma, which is important.

“Statistically, however, we know that DNBI [disease and non-battle injuries] will be the main threat in these places.

“It’s not something we tend to focus on during our training though, so I don’t think we’re particularly good at it.

“We’re looking at diseases that historically the Australian Army has faced in the Pacific – malaria, dengue, scrub typhus.

“We’ve also broadened that exposure to include other rarer diseases that you may see, such as rabies.

“We’ve looked at the skin conditions that you might find in the jungle, and we’ve included components of the marine environment as well – stings, bites and coral cuts – and how we would manage those.”

Alongside this catalogue of misfortunes are the practical dangers associated with waterborne operations.

While the Zodiac RHIBs used for the exercise are sturdy, stable and manoeuvrable, risks include capsize or man overboard situations are always a possibility.

For Major James Smith, a reservist working as a public health physician at the Royal Brisbane and Women’s Hospital in his civilian life, the demands on soldiers make them vulnerable to natural hazards.

“Soldiers are a unique occupational group in that their environmental exposures differ from the vast majority of other jobs out there,” Major Smith said. 

“They may, for example, be sleeping rough, exposed for prolonged periods to things like long grass, which can hold mites and potentially spread infection.

“If you went camping in your family tent, you’re almost certainly not going to get scrub typhus.

“But, if you’re on a military exercise and you’re spending significant amounts of time crawling through long grass and sleeping under a hoochie, then you’re much more likely to get exposed to the mites that carry that particular disease.”

Corporal Lauren Sankey, a health technician in Alpha Coy (surgical), said the real value of the training was its tactical realism.

“I think it’s been really beneficial for us because it’s realistic training that reflects what we’re likely to do in conflicts in the near future,” Corporal Sankey said. 

“Up to 90 per cent of the patients have been DNBI cases, rather than trauma, so for us it’s been the best of both worlds to be able to combine these two things.

“They may be low acuity [severity] patients, but they’re new conditions that we haven’t really looked at before in a tactical setting, especially infectious diseases, and, we haven’t worked in a littoral environment before, so being able to treat these conditions is just good reps, really.”

Lieutenant Colonel Savage said building a solid understanding of tropical medicine would pay generous dividends when it counted.

“We may not become experts in it, but certainly making our medics and our clinicians aware of the conditions out there and what options we have to treat them – as well as what we’re lacking and what we need further experience and training in – is extremely valuable,” Lieutenant Colonel Savage said.

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