Operational Medicine Medical Education and Training

Medical Support of Women in Military Settings

Pre-deployment Planning

Planning for the medical support of women in operational environments is important for a successful operation. Four planning areas are particularly important:

  • Supplementation of AMALs (standard equipment and supplies) and Sick Call Blocks to support female personnel

  • Establish Command policy on deployment and medical evacuation of pregnant personnel

  • Pre-deployment screening of deploying women

  • Pre-deployment briefing of all personnel on women's health issues and host nation customs

Medical Support of Women in Military Settings

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AMAL and Sick Call Block Supplementation

Knowing your available equipment and supplies is the first step. Perform a line-item review of AMAL contents by category to insure your familiarity with it. Frequently needed additional items include:

  • Small size surgical gloves worn by female medical personnel and small males.

  • Equipment required for pelvic exams. The need to provide for pelvic exams depends on your proximity to higher echelon operational and fixed MTF's (Medical Treatment Facilities). If a better equipped US Military facility nearby is able to provide this service, you may not need to establish this capability. Maintaining pelvic exam capability requires considerable logistical planning and funding. Do not assume that every higher echelon facility has this capability - check before you deploy.

  • Speculums - small and medium. Disposable types are good because the ability to clean and repackage speculums in the field is limited. However, metal instruments may be the only type available and have the advantage of being reusable.

  • Light source - You will need some type of light source that can be directed as needed. Goose neck or fiberoptic lights are nice but not always available. Automotive type caged "shop lights" provide excellent operational lighting, can be hung anywhere, and are inexpensive.

  • Drapes - Some type of draping for exams should be provided, disposable or fabric. Disposable drapes are rarely available. Bed linens (sheets and blankets) are not included in AMALs. You'll need to obtain these from unit supply. Note: you'll need some means to wash non-disposable linens.

  • Microscope - ideally needed to perform wet-preps of vaginal discharge, but this is optional as general clinical guidelines can be used for brief field operations.

Consumable supplies - normal saline, KOH, microscope slides, coverslips, lens paper, large and small cotton tip applicators, K-Y Jelly, and stool guiaic kit.

Equipment for early OB care. This capability should be taken into an operational setting only when large numbers (100+) of deployed women are to be supported in a highly isolated setting or when civilian humanitarian operations require.

  • An OB "Wheel" is very helpful.

  • Tape measure. It is helpful for measuring fundal heights and for assessing any structure that might be enlarging over time, such as masses, cysts, hematomas, etc.

  • Fetal Doppler. There is no good substitute for a fetal Doppler. The DeLee stethoscopes are effective after 20 weeks of pregnancy, but require some practice to be proficient. A Doppler is much easier. Remember to bring ultrasonic conductive gel. If you don't have any, any water-soluble lubricant such as K-Y jelly, will serve reasonably well as a sonic conductor. Even water is better than nothing.

Bedpan. This not only serves the obvious function but provides excellent buttocks elevation for pelvic exams and precipitous deliveries.

For routine obstetrical care, it is useful to have some forms, including a prenatal risk assessment form and a standard pregnancy form. Bring a precipitous delivery package...just in case!

  • Prenatal vitamins.

  • Iron tablets.

Continue to the PowerPoint Lecture...

From:

Operational Obstetrics & Gynecology
2nd Edition
NAVMEDPUB 6300-2C

Bureau of Medicine and Surgery
Department of the Navy

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