Reply by Minister for Defence Dr Ng Eng Hen to Parliamentary Question on IPPT and Cardiac Events

Dr Lim Wee Kiak: To ask the Minister for Defence (a) what is the incidence rate of cardiac events during and after Individual Physical Proficiency Tests (IPPT) over the past five years; (b) whether there are any plans to review the IPPT criteria; and (c) what additional medical screening procedures are in place to minimise such cardiac events.

Minister: The Individual Physical Proficiency Tests (IPPT) remains an efficient and effective tool for testing the fitness of large groups of servicemen. Appropriate standards are set for different categories of servicemen according to gender, age and medical status. These standards are comparable to those used by armed forces in other countries such as the United States and United Kingdom.

About 116,000 SAF personnel take the IPPT annually. Over the past five years, from 2007 to 2012, two cases of sudden cardiac deaths occurred during or soon after IPPT. This works out to an incidence rate of 0.35 cardiac fatalities per 100,000 persons, or 3.5 per million, and this is comparable or equivalent to the age comparable population rate. This is a low rate but despite this low occurrence rate, the SAF takes a serious view of any cardiac death or for that matter, any training-related injury or fatality.

Comprehensive medical screening is conducted for all National Servicemen during their entire NS period or over the career for regulars. The screening guidelines for heart related conditions are developed by a panel comprising leading senior cardiologists from the public sector and senior SAF doctors. These guidelines are regularly reviewed taking into account the latest medical evidence and clinical best practices - the most recent, in May 2011. These guidelines are in line with, and in some instances, exceed existing national and international standards.

All pre-enlistees undergo a medical review by the SAF Medical Officer to detect electrical or structural heart abnormalities which includes routinely, a chest X-ray and resting electrocardiogram or "ECG". Where abnormalities have been detected, they are referred for further evaluation, which may include treadmill ECG and heart ultrasound, or referral to a cardiologist.

SAF servicemen also undergo medical screening before any major training activities, such as overseas exercises to determine if they are fit for that activity. Should a serviceman develop symptoms or become unwell, he is to consult a Medical Officer at any time, irrespective of whether he is due for a scheduled medical review.

All servicemen, Regulars and NSmen aged 35 years and above, undergo health screening annually before they are allowed to take the IPPT. This health screening comprises a medical examination by a medical officer, a resting ECG and blood tests for cholesterol and sugar levels. When required, servicemen would be referred for further tests including treadmill ECG, an ultrasound and other specialised investigations, such as CT calcium scoring and nuclear medicine cardiac scans. They can only take part in IPPT if they have successfully completed the health screening process.

The SAF reviews its health screening and training processes on a regular basis to ensure that we adhere to the highest standards of safety.