The Deployed Medical Director: Managing the Challenges of a Complex Trauma System

Abstract

Contemporary combat casualty care has never been more sophisticated or effective, which is matched by an unprecedented level of clinical complexity. The management of this complexity has demanded the evolution of a more direct clinical leadership model in the field hospital: the Deployed Medical Director (DMD). The DMD has a central co-ordinating role in reducing the friction generated by individuals' unfamiliarity in a rapidly developing clinical environment that has diverged from the NHS; in cementing interoperability within a multinational medical treatment facility working at high intensity; and in maintaining and developing the highest clinical standards within the deployed trauma system. This article describes the evolution of the DMD role and illustrates the challenges through a series of vignettes. Particular emphasis is given to the organisational risk that the role carries through necessary ethical choices, the requirement to integrate multi-national cultural differences and the challenge of dealing with interpersonal frictions amongst senior staff.group.bmj.com on August 12, 2015 -Published by

Lessons from the organisation of the UK medical services deployed in support of Operation TELIC (Iraq) and Operation HERRICK (Afghanistan)

“…This role developed into the Deployed Medical Director post as formal appointment for the senior clinician that was separate from a clinical consultant appointment. 31 This post became essential in leading the clinical team through challenging ethical dilemmas in the provision of clinical care and the allocation of clinical resources, particularly in the care of Afghan civilian casualties. 32 33 …”

Innovation Strategies for Defence

“…26 Further institutionalised through military operational support training and hospital macro-simulation exercises, it is only …”

Deployed research

“…This cannot be overemphasised since without the support given by those engaged in the clinical aspects of patient management, studies such as those described in this article would be impossible. Since the studies are being conducted in the challenging and already complex environment that is the responsibility of the Deployed Medical Director (DMD),16 it is essential that the DMD is fully briefed, and is in agreement, before any research is conducted. Because many of these projects span the tenure of several DMDs, it should be the responsibility of the lead for any research project to ensure that this discussion occurs.…”