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A year in the life of an army pharmacist

My first year in the army as a pharmacist provided me with such a varied and interesting career that I have not for one minute regretted the change in career path. My current position as Officer Commanding of a medical distribution centre at RAF Akrotiri in Cyprus has given me the opportunity to refresh my clinical skills due to its proximity to the military hospital. My first year, described below, appears to have been a mere taster of the opportunities yet to come

Having trained at Brighton polytechnic and worked for seven years in National Health Service hospitals as a clinical pharmacist, I felt the time seemed right for a career change. I had wanted to join the armed forces for a number of years and finally the opportunity to do so arose. Previous investigations had revealed that, while the Royal Navy and the Royal Air Force employed military pharmacy technicians, neither appointed commissioned pharmacists. It was a “Be the best” advertisement in The Pharmaceutical Journal which was to provide the final catalyst to becoming a commissioned officer in the Royal Army Medical Corps (RAMC). Six months later I turned up at Keogh barracks for the first phase of military training.

Initial training started at the Defence Medical Services training centre in Aldershot. The “Entry officers” course was designed to prepare army doctors, nurses, veterinary surgeons, dentists, physiotherapists and, of course, pharmacists for military life. On my particular course there were only doctors and nurses in addition to two pharmacists. Initially it centred on military, rather than professional, skills that would be used within the Defence Medical Services.

Opportunities for pharmacists and pharmacy technicians in the army

The Royal Army Medical Corps currently has increasing opportunities for both Regular and Territorial Army pharmacists and pharmacy technicians. Pharmacists have a role in peace, during operational deployments and in war. In peace their principle duties are in the distribution of medical supplies and the provision of pharmaceutical care within Ministry of Defence hospital units and military hospitals. On operations, pharmacists are responsible for the management of medical supplies in general and clinical support. In addition, they will act as the adviser to field medical unit commanders on all pharmaceutical matters, including storage, distribution, security, prescribing and dispensing of medicines.
Pharmacy technicians have a supporting role in all of these activities. The army has not previously recruited trained pharmacy technicians; however, it is hoped that this will be addressed in the near future.

Pharmacists who would like more information about opportunities in the Regular Army can contact Colonel (Retd) Tony Willman, or Captain Tracey Middleton, RAMC, at Officer Recruiting, Regimental Headquarters RAMC, Keogh Barracks, Ash Vale, Aldershot, Hampshire GU12 5RG (tel 01252 340307/9, fax 01252 340224, e-mail ramc.recruiting@army.mod.uk.net). Pharmacy technicians can contact Major Liz Morgan on 020 7807 8764. Pharmacists and pharmacy technicians interested in the Territorial Army can contact Jon Davis on 0800 7311201.

February

As a pharmacy student in Brighton I had, strangely enough, never been taught the nuances of boot-polishing, shoe-bulling, marching drill and beret shaping. These and other skills formed the basis of our first week at Keogh barracks. They ensured that when we moved to the second phase at the Royal Military Academy, Sandhurst (RMAS), we at least had some semblance of a military stance.

The Sandhurst phase was to last only four weeks, in contrast to the regular commissioning course undertaken by non-professional cadets, which lasts a year. This phase aimed to extend the military knowledge of professionally qualified officers (PQOs). Perhaps more importantly, it was intended to teach leadership skills. These are so important in an environment where any officer, irrespective of profession, may be expected to manage personnel, command troops or deal with unexpected military situations.

By this phase the other pharmacist had been deferred to a later course because of a leg injury. The Army Medical Services (AMS) officers joined the other PQOs. These included eight chaplains and four lawyers. The group was divided into two platoons each of about 20 officers. Designated as “4 Platoon” duty student, for the first two days I was expected to produce a list of other platoon members for the directing staff, wake the platoon for reveille at 6am and generally keep them informed of the day’s events. This included details of lectures, venues, necessary uniform requirements, changes to timetables and the like. I was also responsible for the daily hand-over of information to the platoon colour sergeant (CSgt) following reveille. This information chain is a way of instilling communication skills that are so vital in any organisation.

One of the first things taught to us was basic weapon skills. Medical personnel are bound by the Geneva Convention, which restricts their use of weapons to defensive situations. The most important aspect of the training was to ensure that we were able to “make safe” any weapon that might be presented to us, for example, if a prisoner was admitted to a field hospital while still in possession of a rifle.

No army training would be complete without the physical education component. My reservations about fitness were dispelled once a structured training programme was established. Even though I was no exercise freak, I found the variety of fitness schedules (almost) enjoyable. The achievement of a fitness level only dreamt about in the past was very satisfying.

Field craft also formed an important component of the RMAS phase. Clothed in combat uniform, wearing camouflage cream and with weapons at the ready, we spent our first exercise patrolling the muddy fields of “Barossa”, a designated training area at the back of the academy. It rained and then it rained some more. The fact that it was the first time that I had spent a birthday under (wet) canvas made it all the more poignant. The closest I came to a birthday cake was the chocolate sponge that happened to make up the ration pack for that day. Many exercises were to follow which would teach us field craft, map reading, night navigation, radio technique, command skills and a variety of other talents.

There were times when it was difficult to relate the skills being taught to the profession of pharmacy. During this phase it was important to remind myself that I would be expected to work in a field hospital or medical provisioning point within an operational environment. Personnel without basic military abilities could rapidly become a hindrance in an already fraught situation.

The RMAS training concluded with the final parade. All the PQOs donned their service dress, formed up in platoons and showed off their newly acquired drill techniques.

March

The AMS officers returned to Keogh barracks where the information learnt at Sandhurst was applied to the provision of medical services. A more “tri-service” approach was adopted that would encompass the navy and air force medical structures in addition to those of the army.

The structure of field medical services revolves around the need to provide immediate basic care at the front line supported by more specialist intensive care further back in the battlefield. A pharmacist is most likely to be employed further back with a field hospital although they could be closer to the battle if located with a medical resupply point or a dressing station.

All medical personnel within the RAMC are taught skills that in civilian life would normally be carried out by doctors, nurses and paramedics. Even the medical support officers within the corps attended the battlefield advanced resuscitation training course which taught us how to intubate, insert chest drains, control a tension pneumothorax, insert venflons and carry out similar emergency procedures. This was in addition to basic battlefield first aid skills, which all military personnel are taught.

Many other management, training and clinical skills were taught prior to moving to the next, more specialist, phase.

April

The “Special to arms” course is designed to provide training specific to the role of a particular professional group within the AMS on operations. My training was aimed at teaching me skills in medical logistics as I was to be posted to the Medical Supplies Agency (MSA). The training took place at the headquarters in Ludgershall, Hampshire.

The MSA is responsible for providing all medicines and medical equipment to all three services in peace and on operations. The HQ provides a central depot through which all orders are processed and dispatched. There are a number of departments that provide support and I was to visit these in turn to learn about distribution procedures.

Week 1 introduced me to the general office area where the requests are processed through a central computer system. The requests are divided into four subsections: pharmaceutical items, surgical equipment, hospital equipment and dental equipment. The purchasing group dealing with pharmaceuticals also deals with dressings and provides drug information.

Week 2 introduced me to another military phenomenon - adventure training. As part of its personnel development commitment, the army encourages individuals to attend adventure training courses. Apart from teaching or developing sporting abilities, these courses encourage teamwork and leadership skills. I was to attend a week’s course in Newquay, where I tried mountain climbing, abseiling and white water canoeing for the first time. This was in addition to hill walking and mountain biking through the Cornish countryside.

I then returned to HQ and spent time learning about other areas, including finance, customer services, stock control and formulary management, storage, distribution and finally mobilisation.

May

It was to the mobilisation (Mob) department that I was to be posted as officer commanding (OC). The OC Mob is responsible for the provision of medicines and medical equipment in direct response to operational and exercise requirements. As OC Mob, I was also second in command of the operational resupply unit, 84 Field Medical Equipment Depot (FMED), which would be deployed on operations.

There is a rolling programme established which allows the department to “build” the equipment needs of individual units. For example, one of my first tasks was to outload all the medical equipment required for use by one of the field hospitals.

The hospital unit was planning a large exercise and, having taken control of their equipment, would then hold and maintain it at their base in York.
This outload was, in itself, no mean task. Up to this point, I had relied on the vast experience of the senior non-commissioned officer (SNCO) who worked alongside me in the Mob department. He was not, unfortunately, available on the vital day to advise me how best to load the eight long vehicles that arrived courtesy of a Ghurka transport regiment - again, not a skill taught at Brighton. I rapidly had to learn the number of standard sized NATO pallets that could fit inside a freight container. The equipment included X-ray machines, dental couches, pathology laboratory analysers and syringe drivers.

As the pharmacist within the department, it was also my responsibility to ensure that all storage and supply legislation was adhered to in the building of kits and modules. Pharmaceuticals stored within kits ready for outloading would need to be regularly rotated or included in an earmarking system to prevent wastage from time-expiry. The kits, however, had to be in a state of readiness to supply quickly. The Royal Fleet Auxiliary ship RFA Argus was called at short notice to support humanitarian rescue efforts following the volcanic activity in Monserrat and steps had to be taken to ensure all pharmaceuticals were obtained and supplied under appropriate conditions. This was carried out with support from the MSA sub-depot in Portsmouth.

June

June began with an exercise. I was called upon to be a “medical watchkeeper” - a role about which I knew nothing. I turned up at Warminster armed with my combat uniform, helmet and sleeping bag only to discover that I had taken my Sandhurst training a little too seriously in this instance. We were doing the kind of exercise that includes accommodation in huts (no tents), access to electricity sources (my room-mate had brought a radio) and chocolate pudding cooked by trained chefs! What luxury!

As a watchkeeper I was expected to man the medical telephone within the general HQ and co-ordinate the requests for medical support. My first call was from a field ambulance reporting that it had seven casualties who required to be evacuated to the field hospital.

I soon learnt that my friends in this instance were in the team responsible for controlling the movement of people and equipment by air and that they could arrange the appropriate helicopter support if I could give them a few more details. Were the casualties all on stretchers, or could they sit up? Were there any seriously ill patients? Oh, and some minor details. What was the grid reference and which field hospital did I want them to go to? A few frantic radio/telephone messages later I was confident that “my” casualties (as they had become) were en route to a safe location beyond the fighting.

The next call was from the 23 Parachute Field Ambulance (23 PFA) section asking for a replacement for all their pharmaceuticals and dressings that had been destroyed when the kit had dropped on to a landmine. Once the kit was assembled through 84 FMED, I arranged transport which would use routes designated by the Geneva Convention. The exercise provided a valuable insight into the way the military services combine to support each other during wartime.

The remainder of the month was spent co-ordinating supplies to support the summer RAF airshows and the Royal Tournament. It was also during this month that I was told that I would be required to spend six months in Croatia supporting the Bosnian operations. Plans were made for me to undergo the necessary military training for the tour.

July

This month reflected further the airshow season. Equipment loaned to one show was returned, reused if possible and then prepared for the next show.

Given my impending tour to the Balkans, much time was spent organising the necessary equipment required, sorting out personal administration such as bank payments for the time I would be away and visiting friends and relatives.

August

The most notable event this month was the United Nations Training and Advisory Team course which I had to attend before being deployed. For administration purposes I was affiliated to 24 Armoured Field Ambulance (24 Armd Fd Amb). We arrived at the training centre where I was accommodated with two doctors and two nurses from Iceland. The dormitory was also shared with some Bosnian interpreters who had had to leave the Balkans when the troubles first flared up.

On the first day of training I was to meet these Bosnians again when we were taught how to use local interpreters, when necessary, to carry out the peace-keeping mission. We were given lectures on a variety of subjects, including the history and politics behind the conflict and which insects and reptiles to avoid. Of particular concern was the lecture given by transport personnel on the vagaries of driving in the region. The dangerous road and weather conditions combined with the “unique” driving skills of the local population make road traffic accidents the most common cause of serious injury and death among troops.

The second day concentrated on teaching us about landmines, and how to recognise and avoid them and arrange for their clearance. As I crawled across the ground prodding for dummy mines and trip wires I recalled my time in hospital pharmacy and realised what a career change I had made.

In the afternoon, we carried out a confidence course. The obstacles were designed to reflect a destroyed village and had us clambering over rubble, climbing up through windows, dropping through holes, crawling through pitch black drainage systems and jumping from heights. Later that day we were taught how to set up a helicopter landing site and how to direct a helicopter to land on it in case there was ever an air evacuation requirement.

The following day I collected my pistol and headed towards the ranges to refresh my weaponry skills. They certainly needed refreshing.

The final day was based around command scenarios where all the skills learnt were combined in role-playing situations. On one, I was expected to co-ordinate the rescue of military personnel from a vehicle involved in an explosion. In the scene, we had come across the accident in a local village and had to remove both local and military personnel from the danger area. Through speaking to local interpreters we realised that the area was not mined and the explosion had resulted from a gas leak. The press were briefed as medical personnel treated the injured and the helicopter was requested to take them to the field hospital.

The remainder of the month was spent preparing for Bosnia. Personal effects were packed in a box for transport to Split. The mobilisation department continued to prepare kits and modules and to deal with unexpected operations.

September - Bosnia

I joined 24 Armd Fd Amb at its unit in Catterick in order to fly out with it. We boarded a Hercules aircraft at RAF Leeming and landed at Split airport, in Croatia, five hours later. The weather was hot, sunny and a far cry from the footage we had seen on the videos. I was to remain in Split for the duration of my tour as it was the main airhead where medical supplies were brought in. The rest of the unit was transported to the various medical facilities throughout the theatre. These included a field hospital at Sipovo as well as at more remote sites in Gornjii Vakuf, Glamoc and the Vitterog mountain site. My roommate, a “movements” officer, welcomed me to Split and introduced me to some of the quirks of being on an operational tour.

The following day I took over the medical provisioning point (MPP) and met the five other members of staff who would be working alongside me. The two drivers had been there for some time but the remainder of us had all flown out on the same flight. Fortunately, once again, I had an SNCO with a wealth of military experience.

The unit provided medicines and equipment for use by British troops in Bosnia and Croatia. The MPP consisted of an office area with a computerised stock control system, two large refrigerated shipping containers and a small warehouse. Attached to the section was a Royal Electrical and Mechanical Engineers (REME) technician who was responsible for repair and maintenance of electromedical equipment, such as defibrillators and monitors.

Fortunately, there were no major incidents during the first month. This gave me time to adjust to the requirements within the theatre. I learnt a great deal about logistic support to the forces and took great delight in being able to read my reports while listening to the Adriatic sea lap against the wall by my office.

October

Once established in Split, I took the opportunity to familiarise myself with Bosnia. I travelled throughout the British controlled sector, passing deserted villages, minefields, destroyed mosques and churches, waving and smiling children, mountains, mass grave sites, lakes, memorial crosses, Tito’s HQ, and rebuilt bridges. My visits took me to the medical sections where I advised on storage conditions of medicines, inspected Controlled Drugs registers, gave talks on prescribing and dispensing and arranged for the destruction of time-expired medicines. I met artillery and cavalry units, field hospital personnel, engineers, mechanics and even a Malaysian contingent. I found that the learning curve was as steep as it had been in Sandhurst.

Within my own unit in Split we were faced with reorganising the warehouse, given that the long sought after shelving had finally arrived. Air-conditioning units were supplied so that the cramped drug storage facilities could be expanded. A system was established whereby the supplies arriving into the warehouse were received, stored and prepared for distribution in time for the next aircraft to arrive with more stores. A transport run by the MPP drivers took place twice a week with additional deliveries being made as the need arose.

November

The colder weather associated with Bosnia began to set in. Split was still warm and sunny but just over the border, beyond Kamensko, the roads began to get more dangerous. Plans were made to deliver goods by alternative means if the weather deteriorated further. Restrictions were placed on drivers, who were not allowed to travel after sunset. Cold weather kit was issued. On occasions the people in Split had an insight into the temperatures in Bosnia as the cold Borra winds travelled down across the mountains towards Croatia, bringing with them icy cold air and rain.
I was introduced to members of the Support Helicopter Force (SHF) while trying to arrange for an emergency supply of oxygen to reach Sipovo. The Navy Sea King element of the SHF is responsible for responding to emergency incidents such as landmine explosions, road traffic accidents, etc. Together with the RAF Chinook helicopters, they became an invaluable transport source for medical supplies when emergencies arose.

December

It was during December that we had to coordinate the return of morphine Autojets that were due to expire. These are individual spring-loaded injections of 10mg morphine, designed to be used by military personnel in the event of an accident. Over 800 individual syringes were returned to the MPP. The expired medicines had to be checked and counted carefully before secure transport arrangements were made to return them for destruction in the UK.

During this month I returned to the UK on the two-week leave that personnel on six-month tours are granted. I returned two days before Christmas to find that all was calm in the medical world. A year earlier I had stayed in Oxford to provide on-call cover for the Radcliffe infirmary wishing I could have been with my family. I could never have imagined then that the following Christmas I would be in a foreign country, working seven days a week in combat dress, supporting a peace-keeping operation. Interesting times.

New Year’s Eve was another poignant time. We took the opportunity to see the New Year in twice. The first was local time and a large party had been organised for all personnel in Divulje barracks in Split. We left this in time to see in the UK new year at the quieter location of the Adriatic sea.

January

The calm of the previous two months was shattered during the first week of January when a Czech helicopter crashed in the British sector. There were about 18 personnel on board, some of whom had serious spinal injuries. A Sea King helicopter transferred medical personnel from the field hospital to the site and then casualties back to the hospital. The MPP was contacted to provide further supplies of oxygen; these were flown to the hospital by an RAF Chinook squadron. Fortunately, there were no fatalities, and the more seriously injured patients were transferred as soon as they were stable enough to be moved.

It was also this month that I experienced my first helicopter journey. There were spare seats on a flight to Dubrovnik and having been offered the opportunity to go I boarded the helicopter that afternoon. We were able to spend only a few hours in Dubrovnik but it was enough to see the remarkable efforts that had been made to restore the city to its former state. There was, unfortunately, no time to visit the apothecary’s shop established there during early medieval times.

A few days later the senior medical officer contacted me. He requested some fexofenadine for a patient presenting with hay fever. I informed him that it was not an item we stocked and suggested alternatives. I was told that the patient was unable to take any other form of antihistamine as he was aircrew and subject to strict limits on the types of medication he could take. The pilot concerned had to be restricted to ground duties until such time as stocks of the drug could be supplied. The grounding of even one member of a crew has a serious knock-on effect on the SHF. This led to further discussions. I was able to find out the types and classes of medication that aircrew could and could not take and worked with the doctors to ensure relevant supplies were stocked in future.

Further Controlled Drug checks had to be carried out. This time I took the opportunity to see Bosnia from the air and travelled mostly on the established helicopter “bus run”. A trip to Brac island proved particularly interesting as I was used for winching practice from the helicopter!

February

February was a very busy month as the unit began preparing for handover to new personnel. Parades were held in Sipovo to present medals to those personnel having served in the Bosnia operation for the first time. My second birthday in the army was spent in Split. Two days later I visited Sarajevo to advise the medical officer at the European Community Monitoring Mission on dispensary and storage facilities within their organisation.
We were taken on a battlefield tour of Sarajevo. The scars of war will remain for a long time. Buildings were still booby-trapped and could not be repaired. Hotels and bakeries, featured in the news at the time of the main conflict, still displayed bullet and shell marks. Red roses were painted in the craters made by shells landing in the streets of the city; none was more poignant than those near the market where a terrible massacre had taken place. The tour provided a sombre reminder of the reason why so many British troops are dedicated to the peace-keeping mission in the Balkans. It was a fitting end to an exceptional tour and indeed to my first 12 months in the army.

 

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Citation: The Pharmaceutical Journal URI: 20000187

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