Deploying physios adds to capability
Physio facts by Capt Ross Railton, 2HSB

My recent return from deployment to the UN Military Hospital in Dili, East Timor, provided me with the opportunity to compare physiotherapy support to this operation with other operations namely, Op Tamar (Rwanda) and Op Belisi (Bougainville).

Op Tamar was a one-rotation, one-year operation whereas Ops Belisi and Tanager/Citadel (East Timor) have been operating for several years.

The provision of medical support (including physiotherapy) to the operations used a variety of patient accommodation structures.

Op Tamar used an established Rwandan hospital rather than tentage or Brunswick shelters. This “hospital” was in an extremely poor state and required intensive cleaning before patients could be seen. Op Tanager/Citadel refurbished the previous museum for the ward. Op Belisi personnel provided medical support under canvas and the “big shed” at Loloho.

Types of patients supported by the ADF on the various operations can be divided into several categories:

• Australian/UN Military personnel
• Other/UN Military personnel
• UN civilians
• Indigenous civilians.

All three ops allowed for the treatment of local civilians, though the main emphasis was on the provision of medical treatment to UN or Australian personnel.

Landmines laid in Rwanda caused indiscriminate damage to UN and local personnel. Lower limbs, in particular, were often involved in blast injuries. Below knee amputations and blast injuries to the face and hands were common, especially with women and young children working in the fields.

Landmines were not used to any great extent in East Timor or Bougainville, so the injuries here tended to be as a result of motor vehicle accidents, machete lacerations, falls from trees, small arms fire, assault, obstetric complications or sport.

Physiotherapy support was provided to Intensive Care Unit (ICU), ward patients and outpatients. In my experience, most ICU patients treated have been from other UN contingents or local civilians. Their injuries have been primarily head injuries, internal injuries and fractures sustained from landmines, assault or motor vehicle accidents. Treatment consisted mainly of chest function maintenance and joint mobilisation to prevent stiffening and contracture.

Ward patients seen by the physiotherapist include post surgical patients, respiratory conditions, back pain and fractures.

Treatment consisted of techniques to maintain good lung function for patients not able to get out of bed due to their injuries; joint strength and range of motion exercises; joint mobilisation; passive movement for unconscious patients; soft-tissue massage; pain relief using ice, hot packs, heat creams and TENS machine; posture advice; crutch education and strapping/bandaging unstable joints.

Outpatient injuries did not differ much between operations. No matter where you go there will always be people who sustain back, knee, shoulder and ankle injuries through accident, poor work/exercise/training behaviours or re-aggravation of previous injuries. Many significant injuries were caused by lifting heavy weights, too much running, faulty exercise prescription and continuing to exercise with minor injuries.

The nature of the support has been dependant upon the time of intervention into the crisis, types of weapons used, geography, level of support to the civilian community, work methods, vehicle use and recreational behaviours. I believe the support provided by the five physiotherapists who deployed on these operations has made a significant contribution to maintaining the good health of service members and civilians in country.

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