ADF Health 2009 - Volume 10 Number 1TrainingDeployed Surgeons Obstetric and Gynaecologic Skills (DSOGS) Course
The CGOG & the CMOG recognise that the primary purpose of the deployed surgical unit is surgical military support. However the overwhelming majority of recent ADF deployments have had a humanitarian assistance (HA) component and indeed it would seem that humanitarian aid by the Joint Health Command (JHC) is becoming an instrument of Australian foreign policy 2. The culmination of such HA support was seen in the Tsunami Assist operation after the Boxing Day, 2004 tsunami in Sumatra. The major purpose for JHC staff deployment on that occasion was HA. Approximately 3,700 medical procedures were performed at the ANZAC Field Hospital including 275 surgical operations and 19 obstetric confinements 3. It was described as the ‘largest humanitarian assistance mission that the ADF has ever undertaken’ 4. A subsequent deployment, Operation Pakistan Assist, which followed a devastating earthquake near Muzaffarabad on the Pakistan side of the Kashmir Line of Control,was also primarily focussed on humanitarian assistance: 9500 medical treatments and over 4000 immunisations were given and there were 5 obstetric confinements 5. An ADF Skills Course on Emergency Obstetrics (DSOGS)Commencing in 2005 the CGOG and CMOG have conducted four day long courses in emergency obstetrics and gynaecology for ADF surgeons and support health personnel. These have been termed Deployed Surgeons Obstetrics and Gynaecology Skills (DSOGS) courses. The courses rely on participants absorbing an extensive package of prior reading which is now provided electronically several weeks before the planned date. During the course a team of anaesthetists, gynaecologists, and ultrasonologists deliver practical modules including vaginal examinations, instrumental delivery, perineal repair, manual removal of the placenta, control of massive postpartum haemorrhage using balloon tamponade, films on caesarean section and caesarean hysterectomy. In addition an important component of the course is the live ultrasound scanning of women in advanced pregnancy. A key teaching aid is the lifelike pelvic models produced by Model-medTM which allow realistic experience of vaginal examinations, instrumental deliveries as well as manual removal of the placenta. The last two of these courses have been conducted at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in Melbourne, the others being at the Medical Simulation Centre at Royal North Shore Hospital in Sydney and at 1 Health Service Battalion at Holsworthy in Sydney. Participants are provided with CD copies of the film on Caesarean Section for future reference. The typical program commences with brief lectures on the place of obstetrics on deployment and basic ultrasound physics .Groups of 4 or 5 candidates then rotate through skills stations at 45 minute intervals. There are skill stations on vaginal assessments in labour, instrumental delivery-especially vacuum extraction-pudendal block and perineal repair, manual removal of the placenta, balloon tamponade for management of massive postpartum haemorrhage, caesarean section and caesarean hysterectomy (video). Outcomes of DSOGS So far a total of 45 health personnel have completed the full day course and a further 20 have attended the short course held at 1HSB, Holsworthy as part of the Military Module of the Definitive Surgical Trauma Course in 2007. Participants from all 3 Services have attended: 24 (53%) from Army, 13 from Navy (28%) and 8 (17%) from Airforce. The response of participants has been very positive especially in relation to the experience afforded in practical skills in vaginal examination, instrumental vaginal deliveries and other manoeuvres and the video teaching on caesarean section. No formal ADF recognition by Health Training Accreditation Group (HTAG) has yet occurred. This prevents full funding of participants for travel and accommodation. It also forces the organisers to rely on the goodwill of civilian tutors and organisations to provide services and facilities free of charge. The next DSOGS course will be in Adelaide on 10-11 April 2010.Live operating sessions on Caesarean Section are planned. Please email CAPT O’Connor if you are a medical officer and are interested in attending. celticdr@bigpond.net.au Footnotes
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Introduction The ADF Consultative Group in Obstetrics and Gynaecology (CGOG) and the Chapter of Military Obstetrics and Gynaecology of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (CMOG) have been concerned for at least 10 years about the lack of training and experience in obstetrics and gynaecology for deployed specialist general and orthopaedic surgeons. Such skills may be required for two main patient groups: 
