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Medical staff with front line units in Iraq
Fully equipped onboard operating theatre
Medical supplies in Iraq

The Primary Purpose of the Medical Director General (Naval) is to:

'Conserve manpower by ensuring that the Royal Navy has a medical capability for war which meets the standards set by the Surgeon General and is adequate to maintain the operational effectiveness, availability, endurance and health of Naval personnel in peace, crisis, major crisis and war.' This purpose has remained constant over many years in the face of rationalisation and reorganisation of the Navy as a whole and the Medical Services in particular. In addition, medical science has advanced at an unprecedented rate and the expectations of patients have, quite rightly, increased accordingly.

Operational Medical Support

Naval Medical personnel are deployed in all arms of the Royal Navy: Surface and Submarine Flotillas, Fleet Air Arm and Royal Marines. In addition to their medical training personnel receive special to arms training to prepare them for the military role in which they are to deploy. Operational Support is delivered in three stages of increasing capability known in the Navy as Echelons of medical care.

Echelon 1 (E1) Medical Support

Within ships and Submarines E1 medical support equates to primary care and is provided by Medical Assistants who deliver day-to-day clinical treatment and preventive medicine, often in isolation from a Medical Officer. They may also train non-medical personnel from within the ship's company to form first aid parties who can assist in recovering injured personnel and rendering emergency first aid in preparation for evacuation. Medical Officers are permanently carried on capital ships and larger submarines, and augment other ships when operationally indicated.

Medical Assistants deployed with Royal Marines assist the Commando Unit Medical Officers in the provision of routine medical support. During operations they may act as the Company Medical Assistant, providing treatment at the point of wounding, or man Regimental Aid Posts - a central facility treating and holding casualties until they can be moved away from the front line. Medical Assistants working in this role have the opportunity to undergo Commando Training and earn the right to wear the coveted green beret.

Dental care in peacetime is achieved by deploying Dental Officers to RM units, aircraft carriers and some amphibious ships, with temporary mobile teams deployed to other ships as requested in order to maintain oral health at high levels. In conflict, such care would be enhanced with the deployment of additional mobile teams, each of which would provide support for a small group of ships.

Echelon 2 (E2) Medical Support

An emergency surgical capability (secondary care) is maintained in aircraft carriers. A dormant E2 facility exists in HMS Ocean, and the Auxiliary Oiler Refueller ships of the RFA Flotilla. Coupled with organic helicopter support these platforms provide a substantial medical asset to the Carrier Group. The aircraft carrier's medical assets are staffed and fully equipped, requiring only augmentation with a surgeon and anaesthetist to reach full operational capability. The dormant facilities require augmentation with a complete surgical team.

When operations dictate, additional surgical elements may supplement the clinical capabilities of the Medical Squadron of the Commando Logistic Regiment to form Commando Forward Surgical Groups. These groups are lightly equipped and mobile, enabling surgical support to be provided to Commando units close to the forward edge of the battle area.

Echelon 3 (E3) Medical Support

Echelon 3 support comprises the substantial surgical facilities in the Primary Casualty Reception Ship (PCRS) on RFA ARGUS which, although not permanently manned, is fully stored, and can be staffed at short notice. With 4 fully equipped operating theatres, 4 orthopaedic and general surgical teams and a specialist head and neck team, the PCRS is able to undertake a comprehensive range of surgical procedures. The staff of PCRS also includes accident and emergency specialists, physicians, anaesthetists, intensivists and GPs, supported by Intensive and High Dependency nursing facilities and the full range of technical support including pathology, digital radiology and CT scanning. Over 250 highly trained specialist medical personnel are augmented by RM Band casualty handlers and RAF Aeromedical Evacuation Teams to form a coherent medical unit, comparable in standards to any district hospital found in the UK.

Current capability

The Royal Naval Medical Service can fully meet the deployed requirements for medical care to all Naval personnel around the world. In addition to the capabilities described above, Naval medical staff are regularly deployed to the Gulf, the Balkans, Cyprus, Gibraltar, Diego Garcia and the Falkland Islands. There are small permanent clinics in Lisbon and Naples. As defence medical care is taking on a more 'joint' approach to provision, in future the PCRS is likely to be staffed predominantly by RN personnel but with some support from the Royal Naval Reserve and specialists from the Army and Royal Air Force Medical Services.

The Medical and Dental Agencies

The Defence Secondary Care Agency (DSCA), Defence Dental Agency (DDA) and the Medical Supplies Agency (MSA) formed in 1995. The 2001 Medical Quinquennial Review recommended that the DDA would remain. DSCA however, has been disestablished with the responsibility for commissioning secondary care transferred to the Surgeon General's Department and the MSA has now been transferred to the Defence Logistics Organisation. Secondary care provision has also undergone substantial change with the closure of all UK based Service Hospitals and the formation of Ministry of Defence Hospital Units within NHS Trust Hospitals.