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Primed for action

What's it like to be a physio in the military? Matthew Limb talks to physios being deployed in Iraq

Some physios find themselves treating prisoners of war. Others local civilians. On operations, they must be prepared to provide medical care to soldiers from the UK, allied or host nations. And that care spans the spectrum from musculoskeletal input to critical care physiotherapy.

To be a physio in the British armed forces being ready for deployment to war-torn countries. The British army is the lead provider of physiotherapy for the armed forces, so physios can be posted to army, navy and RAF establishments around the world.

Typically, there are postings to Ministry of Defence hospital units, in rehabilitation centres, army training regiments and primary care rehab facilities. The army employs around 98 physios as commissioned officers.

Before operational deployment, physios undergo specific clinical training. 'The training challenge,' says Major Pete Le Feuvre, 'is to ensure physios who deploy have the necessary skills to treat a broad range of clinical presentations involving burns, respiratory conditions, orthopaedic trauma, head injuries as well as soft tissue musculoskeletal injuries.'

The pre-deployment clinical training is in three stages. First, there is a week-long operational physiotherapy critical care course. Largely class-based, it incorporates scenario training within a simulated field hospital intensive care unit.  It also introduces physios to specific operational elements such as procedures for medical evacuation.

Phase two involves a two-week clinical attachment to an NHS critical care unit, Designed around individuals' training needs, attachments usually give physios exposure to burns, trauma and head injuries. They are currently run from Selly Oak Hospital, Royal London and Broomfield hospital, Chelmsford.

The third phase is included as part of HOSPEX - a 48 to 72 hour scenario-based exercise that seeks to test the medical and organisational capability of a field hospital. Clinicians are observed working together as they face routine and mass casualty incidents.

'The priority is that we remain fit for purpose and operationally ready,' says Major Le Feuvre. He adds that this is especially important given current operational commitments. 'We must ensure we remain clinically current in the skills required in an operational setting. We must also maintain and prove our physical fitness and military skills, such as weapons handling, and chemical, nuclear and biological awareness.'

 The experience and skills which physiotherapists gain in the forces offers the possibility of opportunities within the NHS, private practice, the university sector and health management, he says. FL


For details of careers in the army, contact officer recruiting at the Royal Army Medical Corps tel: 01276 412744

Officer and clinician

Lieutenant Mark Jenkins was studying for a physiotherapy masters at King's College, London when he contacted the army regarding career options.

'I had always been interested in the services, but also physiotherapy, so when I found out you could do both I jumped at the chance,' he said. He now works at Headley Court, the Defence Medical Rehabilitation Centre in Surrey.

Speaking to Frontline before his deployment in Iraq, he said: 'I'm sure I'll be pushed well out of the comfort zone at times but as an army officer that's part of your job and part of the risk you accept when you join.'

He adds: 'I'll get plenty of musculoskeletal experience, as well as exposure to acute polytrauma and burns that you just can't get as a physiotherapist anywhere else.'

He believes the wider physiotherapy community sometimes misunderstands the role of army physios. 'Not the therapy role,' he observes, 'but the requirement to be an officer as well as a clinician.

'We have a commitment to continue our military training and ethos which includes field craft/adventure training, military qualification courses, fitness training, military sports events and secondary duties, such as mess duties. This training is mandatory and not a luxury.'

Service life offers excellent remuneration and well-funded continuing professional development, he says. But there are sacrifices too, such as time away from the family, and having to change postings every two years, sometimes at short notice.

'The army always takes into account your preferred job and location but at the end of the day your personal preference comes a close second to the needs of the service.'

Learning Arabic

Lieutenant Dale Walker is based at Headley Court, the Defence Medical Rehabilitation Centre in Surrey.

'DMRC is tri-service so you could be treating an RAF pilot, navy driver and an army tank driver all in the same morning. What other job could give you this variety?' he says.

'I enjoy working with this elite patient group that are well motivated, and are rehabilitating to a much higher fitness level than the general population.'

Lt Walker joined the Territorial Army at 19, 'to earn extra cash' while studying for a first degree in exercise physiology. He became a personal trainer, qualified as an army physical training instructor and then joined the Royal Marines Reserve.

After suffering a back injury during commando training, he underwent intensive physiotherapy that, 'sparked an old interest' in a career helping others. He graduated from St George's, University of London and took up a junior physio post at the Queen Elizabeth the Queen Mother hospital, Margate.

To prepare for his deployment to Iraq, Lt Walker received training in intensive care unit/respiratory skills and in physiotherapy for burns patients. 'I have been learning Arabic in anticipation of treating members of the Iraqi army and police,' he told Frontline.

He admits being an army physiotherapist is not for everyone. 'There is more to the job than just the clinical side of things, you have to be an officer, a soldier and also a physiotherapist.'

Danger is part of the job

In 2003, Captain Helen Buchanan spent seven months in Bosnia working with multinational troops. 'Iraq will be a very different experience from Bosnia. Clinically we will be dealing with acute polytrauma, burns and critical care patients. We may find ourselves treating locals with chronic conditions on top of acute trauma, children, elderly as well as soldiers. We will also be kept busy treating soldiers with the usual musculoskeletal complaints, both chronic and acute.'

Capt Buchanan told Frontline she was looking forward  to what she expects will be an extreme environment. 'I think coming to terms with the constant potential mortar threat will be the most challenging part. Until you see the trauma of war, you don't really appreciate how good life here is.'

Capt Buchanan worked in the NHS for a year as a junior physio prior to joining the army in 2002. Now on an intermediate regular commission, she is signed up until 2018.

 She joined Oxford University Air Squadron and later Oxford University Royal Naval unit. 'This gave me a good understanding of service life and enabled me to participate in adventurous activities including flying, sailing, mountaineering and skiing.'

Currently based in Germany, she is officer in charge of the primary casualty receiving facility and runs an outpatient department.

'My family will of course be concerned about the risks with my deployment. You have to accept that when you join the army deploying to dangerous environments is part of it.'


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Matthew Limb

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21 November 2007

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