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Home > News > July > Robust medical screening system in place for enlistees
Robust medical screening system in place for enlistees
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Posted: 04 Jul 2008, 1730 hours (Time is GMT +8 hours)

Report by Ang Yiying
Photos by Aloysius Tan

Pre-enlistees have to go through a series of tests, including an audiometry test.
Pre-enlistees have to go through a series of tests, including an audiometry test.

The numbers are staggering: 25,000 to 27,000 chest X-rays and electro-cardiograms (ECGs), 550 echo-cardiograms, and 300 stress ECGs.

These are the numbers of tests that are carried out every year at the Singapore Armed Forces (SAF) Medical Classification Centre (MCC) for SAF's Full-time National Servicemen as part of the pre-enlistment process.

Colonel (Dr) Benjamin Seet, Chief Army Medical Officer, explained the philosophy behind the rigorous medical screening procedures: "When we look at a pre-enlistee, we would actually have to evaluate him literally from head to toe, to look at the medical conditions that would affect his placement in military training, the types of basic military training or BMT that he goes through, and the vocation that he's placed in the system."

"We try to look at various factors and try to best match and individualise, or rather, to put him into a customised BMT training programme that best meets his medical status," he added.

About 150 to 170 pre-enlistees pass through the doors of the SAF MCC each work day, where they are dispatched to various stations for a series of tests and screenings to assess their Physical Employment Status (PES).

These "head to toe" tests include checking blood and urine samples, dental examinations and dental X-rays, chest X-rays, vision tests, audiometry tests, determination of body mass index and fat percentage, as well as ECGs.

Dr Terrance Chua giving his expert opinion on the SAF medical protocol.
Dr Terrance Chua giving his expert opinion on the SAF medical protocol.
The ECG was introduced in 2000 as part of an ongoing review to enhance the reliability of medical screening at MCC.
The ECG was introduced in 2000 as part of an ongoing review to enhance the reliability of medical screening at MCC.
A standard resting 12-lead ECG will be taken for all pre-enlistees to detect cardiac abnormalities. This test was introduced in 2000 for all pre-enlistees.

Dr Terrance Chua, Deputy Director of the Singapore Heart Centre and Chairman of SAF Cardiac Screening Advisory Panel, said that one of the advantages of the ECG is that it may help pick up cardiac conditions, such as Hypertrophic Cardiomyopathy (HCM, where a part of the heart muscle is thickened), which is one of the causes of sudden deaths in the young, and Wolff-Parkinson-White (WPW) syndrome, a condition which makes one more prone to a very fast heartbeat.

Between 2005 to 2007, the ECGs carried out by SAF MCC successfully detected 71 cases of WPW and eight cases of cardiomyopathy (heart muscle disease).

On recent concerns that more cardiac tests, other than ECG, should be incorporated into the screening process, Dr Chua said: "I think it's natural that there is concern and all of us want to do the utmost to pick up heart diseases and so on. We have to carefully evaluate, though, the value of every test, and that's why this panel of experts was put together, which includes experts from both the public and the private sector with a range of expertise in many areas, such as congenital heart diseases, heart rhythm disorders and so on."

"Our conclusion, looking at the overall SAF approach, was that it was based on very sound evidence," he said.

Dr Chua cited a study of 20,000 US pilots which showed that adding other tests to the ECG did not appear to have additional value in picking up a specific heart condition such as HCM.

He also warned of the complications of testing for a condition which is not common and in which the test has limited accuracy. This may lead to false positive results and further testing, in which people may be exposed to small risks such as radiation.

"At some point, you need to balance the benefit of testing the individual with the small but definite risk of adverse consequences," he said.

Dr Chua pointed out that the SAF's medical screening protocol is based on medical literature and expert advice.

MCC screening standards are also constantly benchmarked against local and international health screening standards for military service and sports participation.

The SAF's cardiac screening protocol, for example, is consistent with the recommendations of the European Society of Cardiology and the International Olympic Committee. It is even higher than the standards recommended by the American Heart Association for competitive athletes.

The SAF's medical screening protocol is also subject to regular reviews every three years by independent panels of top medical specialists in Singapore. The reviews cover 14 medical specialty areas including cardiovascular, respiratory and musculo-skeletal systems.

Reviews have found the SAF protocol stringent and in line with good clinical practice. About 50 medical specialists and senior consultants were involved in the last review.
Last updated on 04 Jul 2008
 
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