Despite the issue of better quality boots and the inclusion of NFCI into the standard SHEF and MATT syllabus’ NFCI continues to be a major problem for all Service Personnel who undertake training or operations in cold weather.
Although such changes are of course welcome until they are mirrored throughout the army field by educated and trusting commanders who actively seek out cold casualties and act upon symptoms reported to them, numbers will continue to increase.
In the Institute of Naval Medicine, the MoD has the only specialist Cold Injury Clinic in the world. Their dedicated staff are facing increasing backlogs as demand on their services puts increasing demands on their relatively modest resources.
Until recently, one of their major resources was Dr Howard Oakley. As head of the clinic, Howard has personally diagnosed and advised on the treatment and management of thousands, if tens of thousands of injured Service Personnel over his long career during which he has dedicated himself to the cause.
Not only was Howard at the forefront of diagnosis and management, he was also committed to the prevention of NFCI. He collated statistics and produced quarterly situation reports so that those in managerial positions could make informed decisions on how best the condition could be prevented in the future. He sat on the cold injury working group, helped write JSP539 and tested kit and equipment. In short, no other person on the planet has done more to assist and protect servicemen and women who must train and fight in cold environments.
It is therefore with great sadness that we acknowledge Dr Oakley’s commitments and achievements at the time of his retirement.
The writer is unsure whether or not Howard’s successor has been named. Whoever picks up the mantle will have big shoes to fill. Serving Personnel (Veterans are not permitted to attend the INM CIC for budgetary reasons) can however take some relief and comfort from the knowledge that Dr Oakley will continue to assist the clinic as a part-time locum.
Even Dr Oakley however can do nothing with the hundreds of Soldiers who currently make up the CIC waiting list on part-time hours. Even with efficient administration and co-operation from the Soldier’s unit during the appointment booking process, you should not expect to be seen within the first six months post injury. The numbers who wait more than 12 months are increasing steadily.
Once diagnosed with NFCI a patient should be protected from further cold exposure pending assessment and advice from INM. This will usually mandate a temporary downgrade at the time of referral to INM.
A temporary downgrade must be made permanent after 12 months. Once a permanent downgrade has been awarded, most commanding officers will start to consider discharge under the RECU process in accordance with PAP10. This creates a bizarre situation where PAP10 discharge is a risk to a Soldier whose condition has not yet been diagnosed, let alone any attempts made at treatment or management in the hope that a recovery can be made.
Thankfully the MoD is committed to a sensible approach. Occupational Health teams have been informed that the PAP10 process should not be commenced until after assessment at the Institute of Naval Medicine and an informed decision taken in relation to the severity of the injury and the need for long term restrictions.