Medical Assistant (Royal Navy)

The Medical Assistant provides a broad spectrum of skills in primary care, occupational health, secondary care, pre-hospital trauma life support, medical administration, teaching first aid and disease prevention, providing health briefs, and basic environmental health. These are performed in a variety of roles at sea in a ship or submarine, with Royal Marines Commandos, Fleet Air Arm, shore establishments, Ministry of Defence Hospital Units, UKSF, and other Tri-Service departments. Predominantly they provide day-to-day healthcare for their crewmates as a vital part of the ship's company. On larger ships, they are part of a medical team, while on smaller ships they may be the only medic on board.

Members of the Royal Navy Sick Berth Branch (with patients), formed in 1884.

The Medical Assistant[2] was previously known as Sick Berth Attendant and Sick Berth Steward (19th–20th century) and earlier as loblolly boy (16th–19th century). Medical Assistants are colloquially known as "scablifters" or "doc" in Royal Naval Jackspeak.

The Sick Berth Branch of the Royal Navy originated on 4 May 1833 when an Admiralty order was issued to Commanding Officers to organise a "Sick Berth Attendant" in ships of the 5th rate and upwards a man of good character is to be selected from the complement and rated as Sick Berth attendant, whose duty it will be to attend exclusively on the sick, without being called away by the ordinary duties of the ship, and who is to be paid as an able seaman.[3][4]

Admiralty order 1833 4 May stating the order to form sick berths, rationing for seamen in ill health and for the formation of the Sick Berth Attendant.

They received no formal medical training and it was not until June 1883 that a Committee, known as the Hoskins Committee, after its Chairman, Rear Admiral A. H. Hoskins was formed to enquire into the organization and training of the Sick Berth and Nursing Staff of the Royal Navy Hospitals. The committee, after visiting Naval and Military Hospitals as well as the larger London Hospitals reported their findings to the Admiralty in the autumn of 1884. The Admiralty gave their verdict in an Order in Council dated 17 October 1884.[4] This Order authorised the establishment of a trained Sick Berth Rating Staff with the following Rates:

Sick Berth staff onboard World War I hospital ship

• 1st and 2nd Class Boys
• Sick Berth Attendant
• Sick Berth Steward 2nd Class
• Sick Berth Steward 1st Class
• Chief Sick Berth Steward

The Order also supported the formation of trained female nursing staff in naval hospitals, which in 1902 was to become the Queen Alexandra's Royal Naval Nursing Service.

It was thought that boys from the Greenwich Hospital School, later the Royal Hospital School, would fill the vacancies. This proved not to be the case, so entry was opened to the Royal Marines and civilians.

In 1900, three new posts were created, known as Head Wardmasters, one for each of the three main hospitals.

In 1891 Sick Berth personnel received a new style of uniform. Instead of the blue serge jumper, blue cloth collar and bell bottom trousers, known as ‘Square Rig, they received a single or double breasted jacket and trousers with black buttons, red badges and a peaked cap. This was known as ‘fore and aft’ rig, and issued to ‘all ratings not dressed as seamen. This uniform was also issued to tradesmen known as "Artificers", who were collectively known as "Tiffies". So it was natural that sick berth attendants were also known as "Sick Berth Tiffies".

In 1920, the term Steward was dropped in favour of Petty Officer. Another major change took place in 1965 which affected the Royal Navy as a whole when the "Fore and Aft" rig was abolished in favour of the "Square Rig". Also in 1965 the term Medical Assistant replaced Sick Berth, and so it remains to this day.[4][5]

Royal Navy Commando MA uniform World War II

The Royal Navy Medical Assistant, throughout their history, whether as a Loblollyboy, or Sick Berth Rating, has seen action during war and in peace. From assisting the ships surgeons in amputating limbs to nursing the injured sailors and Marines from wars and battles throughout Britain's history, from the 16th century onwards. Most notably they served with distinction during the Napoleonic Wars at sea,[6] the Crimean War, the Boer and other African wars,[7][8][9] the Chinese Boxer Rebellion,[10][11] and in World War I at sea and on the land as part of the Royal Naval Division. Of note during World War I, the Royal Marines also trained their own medics at Crystal Palace, London to form the R.M. Medical Units.[12] Both Sick Berth Staff of the Navy and the Medical Attendants of the Royal Marines served with distinction at the Battle of Jutland,[13] Flanders,[14] Gallipoli,[15] the Western Front,[16] Battle of Heligoland Bight,[17] Zeebrugge Raid,[5] the Mediterranean Expeditionary Force,[18] Siege of Antwerp,[19] the Battle of Dogger Bank,[20] and the British Campaign in the Baltic (Russia) to name a few.

At the end of the great war the Royal Marine Medical Units were disbanded along with a reduction of the Sick Berth Branch. During World War II the Sick Berth Branch once again served with distinction from the Atlantic to the Pacific, in Commando raids at St Nazaire and the D-Day landings at Normandy, the far East, and with the British Pacific Fleet at Okinawa.[5]

Post-war they served with further recognition and distinction in Op Musketeer (Suez Crisis), Korea, Aden, Malaya, Malaysia/Borneo Operation Claret, Op Banner N. Ireland, Op Corporate Falkland Islands, Gulf War 1, Bosnia, Kosovo, Op Herrick Afghanistan, Op Telic Iraq, various humanitarian and other peacetime Operations, both at sea and with the Royal Marine Commandos.[5]

Commando Forward Surgical Group 2 Az Zubayr Port Iraq 2003

So far recorded the Sick Berth/Medical Assistant branch rating has earned:

• Albert Medal x 4
• Conspicuous Gallantry Medal x 4
• George Medal x 3
• Distinguished Service Medal (2 with x2 Bars) x 87
• Distinguished Conduct Medal x 2
• Military Cross x 3
• Military Medal (4 with Bar) x 106
• Queen's Gallantry Medal x 1
• British Empire Medal x 181
• Member of the Royal Victorian Order x 1
• Royal Victorian Medal x 5
• Order of St John Serving Brother x 11
• Venerable Order of Saint John (Serving Sister) x 1
• Royal Humane Society Medal x 2
• Member of the Order of the British Empire Medal x 15
• Meritorious Service Medal x 93
• Queen's Commendation for Brave Conduct x 3
• Mention in Despatches x 336
• Royal Red Cross 2nd Class x 7
• Queens Commendation for Valuable Service x 3
• (Foreign awards listed are only those of which the reigning monarch of the time provided permission to wear, and therefore noted in the London Gazette. Many hundreds of foreign decorations have been awarded to the medical branch which have not been noted in the London Gazette)
• Cross of St George 4th Class (Russia) x 1
• Croix de Guerre (French) (1 with palm) x 4
• Croix de Guerre (Belgium) x 2
• Croix de Virtute Militara 2nd Class (Romania) x 1
• Krzyz Walecznych (Polish Cross of Valour) x 1
• Romanian Distinguished Conduct Medal 2nd class x 1
• Medal of the Order of Orange-Nassau Gold with crossed swords (Netherlands) x 1
• Gold Medal for Zealous service (Serbia) x 1
• Medal of the Order of Orange-Nassau Silver (Netherlands) x 1
• Silver Medal of Military Valor (Italy) x 1
• Bronze Medal of Military Valor (Italy) x 2
• Médaille militaire (French) x 6
• Decoration Militaire (Belgium) x 1
• Medal D'Honneur des Epidemies (Bronze) (French) x 1
• Medal of Military Merit (Greece) x 1

An ongoing project is underway to find all honours and awards that have been recorded in the London Gazette for the Sick Berth/Medical Assistant ratings. Many more are being discovered.

Basic training (10 weeks) is conducted at HMS Raleigh shore establishment in Torpoint, Cornwall. Medical training[21] (39 weeks) is conducted at the Defence Medical Academy at Whittington Barracks in Lichfield.

The first 13 weeks is called Common Core and is also completed with the medics from the British Army and RAF. This training includes:

• Anatomy and physiology
• Disorders and their treatments
• Basic pharmacology and dispensing
• Basic environmental health
• Preventative medicine
• Wounds and dressings
• Medical administration
• Geneva Convention
• First-Aid
• Military Acute Care Course, involving pre-hospital trauma and life support.

An exam is taken on each week, those unable on the pass on their second attempt of each exam are 'back classed'.

Once complete a clinical placement of 6 weeks is conducted in a Ministry of Defence Hospital Unit (MDHU) on various wards. Trainees then return to DMSTG Whittington barracks to complete 6 weeks of Single Service (SS) training. SS training involves learning all aspects of Royal Navy medical administration, medical care in the CBRN environment and the care of those suffering from CBRN causes. Included in this is a week spent on board the training ship, HMS Bristol to practice casualty extraction, treatment, casualty simulation, organising of First-Aid exercises and the management of First-Aid Parties during peace and action stations.

The final set of clinical placements covers a period of 12 weeks. The first 6 weeks are conducted at a Medical Centre at a shore establishment to put into practice clinical primary care and administrative skills. The next 6 weeks are spent once again at a MDHU, this time culminating in shifts at Emergency Rooms and Medical and Surgical Acute Care wards.

On return from the final phase of clinical placements the trainees return to DMSTG for 2 weeks which involves final exams on everything learned and if successful, graduation. The final phase, called 'Part IV training' is then concluded by a consolidation period of 'on the job' supervised training (12 weeks) on board a ship or shore establishment sick bay.

The insignia of the Medical Assistant badge is the Red Cross of Geneva on a white background with gold circling. A Royal Crown above the insignia denotes that the rating is qualified at the senior rate level (PO).

The branch structure of the Medical Assistant follows the same as structures of the other branches of the Royal Navy.

• Medical Assistant 2 (under training) (MA 2)
• Medical Assistant (MA)
• Leading Medical Assistant (LMA)
• Petty Officer Medical Assistant (POMA)
• Chief Petty Officer Medical Assistant (CPOMA)
• Warrant Officer Medical Assistant (WOMA)

Those who are at PO level who are qualified, recommended and selected, can go on to become Medical Services Officers (MSO). They undertake their initial training at Britannia Royal Naval College (BRNC) Dartmouth. The MSO are commissioned officers who provide policy, guidance and other managerial, administrative and staff skills to the Medical Branches of the Royal Navy and Tri-service environment. The highest level they can reach is that of Captain, although there has been one instance of a Commodore. The MSOs were also previously called ward masters.

• Combat Medical Technician
• Hospital corpsman
• Kate Nesbitt
• Medical assistant
• Royal Navy Medical Service

• Medical Assistant (General Service), RN Careers
• Virtual Naval Hospital – a digital library of military medicine and humanitarian medicine
• Medical Assistant Liam O'Grady MC
• Combat Medics Falklands conflict