Incidence of Cardiac Events During and After Individual Physical Proficiency Test (IPPT)

Dr Lim Wee Kiak asked the Minister for Defence (a) what is the incidence rate of cardiac events during and after Individual Physical Proficiency Tests (IPPTs) 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.

The Minister for Defence (Dr Ng Eng Hen): Mr Speaker, Sir, the Individual Physical Proficiency Test (IPPTs) 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 0.345 cardiac fatalities per 100,000 persons, or 3.5 per million. This is comparable or equivalent to the age comparable population rate. This is 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 his 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.

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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, stress heart 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.

Dr Lim Wee Kiak: Mr Speaker, Sir, let me thank the Minister for his answer. In fact, I just completed my in-camp training today, and just did my IPPT this morning. I can attest to what the Minister has just mentioned, that the medical personnel in the SAF take this very seriously to ensure that all servicemen are checked. My question to the Minister is: when was the last time the IPPT was reviewed? And the Minister mentioned that the IPPT criteria were benchmarked to standards in the UK and US. But in the UK and US, they have professional military men, while in Singapore, IPPT is taken by all NSmen, many of whom in their real jobs are not doing professional military training everyday. They take it once a year or so during their in-camp training. I am not sure whether we should be benchmarking to the same criteria as in the US and UK. So, the question is whether such criteria are due for review.

Dr Ng Eng Hen: Mr Speaker, Sir, I am delighted that Dr Lim Wee Kiak is here and alive [ Laughter ]. Dr Lim asked a question about IPPT, but there are two considerations. One is whether it is an adequate test for their fitness; and two, the safety of it. They are different aspects. In terms of safety, I have outlined quite in detail the medical screening and I would not touch upon it. But in terms of fitness of large groups, we do not use the UK and US as benchmarks for our tests. This was evolved on our own and we still find it relevant as a test for strength, flexibility and speed.

My point was that our IPPT standards are comparable to the UK and the US. It has been reviewed a number of times over the years and, as I said, we need the test because so many NSmen take it a year – over 100,000 SAF personnel. We need a test which is efficient and effective. We looked at other models, and each time we reviewed it, we could change a few items but, at the end of the day, people are used to it. It is still an adequate test. So I suspect that we will keep reviewing it and, if we find a model or some stations that better suit our needs, we will change. But at this point of time, for the IPPT, all of us have done it and are familiar with it, and if you do your IPPT well, most of people will agree you are a fit person.

Mr Pritam Singh: Mr Speaker, Sir, I would like to thank the Minister for the answers to the question. The question covered the incidence rate for cardiac events during and after IPPT. Could I enquire whether there were any fatalities or unfortunate incidents with regard to non-cardiac events during and after IPPT?

Dr Ng Eng Hen: Sir, I answered specifically to Dr Lim Wee Kiak's question on cardiac events, so I do not have the data. I would be happy to supply the data if Mr Pritam Singh files a question but I suspect the rate, even though it is so low, is related to cardiac events.

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Mr Nicholas Fang (Nominated Member): Thank you, Minister, for the very clear explanation as to the procedures. I have a question not on the IPPT but perhaps on the screening process. The Minister mentioned that resting-state ECG is conducted first and, if abnormalities arise, then a treadmill or an active-state ECG is conducted. In comparison to some tests done by the Sports Council for athletes, for example, the test immediately proceeds to an active-state ECG. The resting-state ECG typically does not show up abnormalities which usually come up when strain or physical stress is imposed. Would the Ministry of Defence consider the screening process to involve straightaway a treadmill ECG instead of just starting with a resting-state ECG?

Dr Ng Eng Hen: Mr Speaker, Sir, MINDEF is open to any suggestions that we feel can protect the safety of our NSmen. But we are careful to listen to the advice and recommendations by experts. Even though I am medically trained and I have a practising medical certificate, I defer to the guidelines. As I said, we have a panel comprising leading senior cardiologists from the public sector and senior SAF doctors, and they regularly review the latest medical evidence and clinical best practices. As I said, the most recent review was in May 2011. This is on-going. I would say that our current guidelines are in line with and, in some instances, exceed national and international standards. So if this expert panel says that we should add this, we will do so but we are guided by the expert panel.