Bundeswehr Joint Medical Service

The Transformation in the Medical

Service in the Light of Missions Abroad

Kurt Bernhard Nakath

The Medical Service of the Bundeswehr has proven well right from the beginning of the changing conditions of German and European security policy and has always performed important tasks in the service for soldiers and humanity. The past times of the Cold War when it was the greatest effort to attend to and care for a large number of personnel to be assumed wounded in action in sufficient treatment facilities in Germany and in friendly foreign countries have given way to the actual challenges of current missions. Today it is essential to meet the requirements for modern armed forces within the scope of the security challenges and to provide medical care for patients on the highest medical quality standard possible right from the place of their illness, injury or wounding in action up to the complete recovery at home.
For the Medical Service there is no sharp dividing line between mission and basic operation, however. We speak of a treatment continuum, which extends from the medical support levels in missions up to the final treatment in Germany . Apart from the medical service commitments in missions, our attention is thus also always focused on ensuring the medical support at home to which our service personnel are legally entitled to and which, as gratuitous medical care and treatment of military personnel, represents a special care and welfare obligation of the government.
As in all military organizational areas the line of development in the Medical Service of the Bundeswehr is determined by a basic process of change, the transformation. Today and in the foreseeable future it is important to face the complexity of the expanded tasks of the armed forces by giving special consideration to asymmetric threat forms. Logically, the Medical Service was further developed in conceptual and structural respects in the past years in order to make allowance for these particular claims. For this purpose, our soldiers need to be trained in such a way that they are able to implement medical support at any place in the world in the shortest possible time in line with the maxim of the Medical Service. Our goal continues to be unchanged in providing our soldiers employed abroad with medical support, which, in the outcome, can be expected to be the same as at home.
In order to be able to make allowance for this high aim the forces and means necessary for that must be led by one authority and economical employment of resources. The buildup of the Central Medical Service of the Bundeswehr as of 2001 as an independent organizational area bearing full responsibility for these tasks is thus the logical approach within the scope of the mission-oriented transformation of the armed forces.
The Joint Medical Forces Command, the four Regional Medical Commands, the Rapid Medical Response Forces Command, and the Bundeswehr Medical Office form with their units, elements and facilities the foundation for the medical support and the sustainability both in the areas of operation and in basic operation. The resultant quality achieved in medical support confirms the correctness of the adopted policy. The chosen structure and organization can cope with the requirements for mobility, flexibility, interoperability, and sustainability of our Medical Service in national and international environment and they are future-oriented.
Aside from the stated demands made on the Medical Service, it is also committed to constant further development of scientific findings, medical skills, and a humanitarian claim in military environment. The management of this challenging and interesting stress field is a special feature of this functional service. Of particular importance is here that the medical personnel in the discharge of its functions are not only subjected to the stipulations of the military service act, but unrestrictedly also to the provisions of the civilian canons of professional etiquette. With this, a civilian defined quality standard becomes the obligatory standard and basis of the professional activity in the military environment.

Medical Service in Operations

Operational Situation since 2006

The operational medical support was enormously advanced in the past years. Medical personnel was trained in a way that it is capable of setting up and providing high-quality medical support within the scope of the given mandates and by request of the troops within a minimum period of time. In parallel to that, the material was also consistently adapted in order to be able to provide military medical treatment on highest standard in both early-entry operations and in prolonged follow-on missions. Of today’s operations it is our mission as integral element of the International Security and Assistance Force (ISAF) in Afghanistan , which makes the most exacting demands on the Medical Service. With the shifting of the main ef­fort of the German contribution to ISAF from the central to the northern region of Afghanistan with main garrison in Mazar-i-Sharif the German medical forces assumed the responsibility from Norway to also provide medical on-site support. To this end, a mission-type hospital with medical specialist modules is operated at Mazar-i-Sharif in static infrastructure as a central treatment facility, which has proved its fitness for the purpose many times already. The rescue centers in the deployment locations of Kunduz and Feyzabad offer primarily the possibility for urgent surgery or surgical exploration after which the patient can, if necessary, be moved to Mazar-i-Sharif for further treatment. It is especially with ISAF where high professional requirements for the employed medical personnel arise due to the increasing endangerment. This goes mainly for the emergency medical care of wounded and injured personnel and for the transport to the receiving treatment facilities. Here, “Mobile Medical Officer’s Teams” manned with medical officers qualified in life-saving medical treatment play a central role. By way of having completed with priority training measures which follow civilian standards and, at the same time, take account of the military peculiarities of missions, the number of medical officers qualified for life-saving treatment who can be included into the Mobile Medical Officer’s Teams was possible to be significantly increased in the past years. Our objective here is to ensure an area­wide and robust modern emergency medical treatment.
As in all missions with military medical participation, treatment of the indigenous population takes place in Afghanistan , too, in coordination with the regional health authorities and within the scope of free capacities. This also contributes considerably to the acceptance of the ISAF force by the population.
In 2007 it was possible to put the deployment hospital with KFOR in Prizren into operation in a newly built fixed infrastructure. With that, the Medical Service of the Bundeswehr provides one of the two main medical facilities of the NATO force in Kosovo. The German contribution to the EU operation EUFOR ALTHEA BIH in Bosnia and Herzegovina was gradually reduced as planned and the former field hospital Rajlovac was handed over to the local civilian authorities. Treatment of German members of the contingent by medical specialists is meanwhile provided by respective health facilities of the country whose quality standard was explored and which are qualified for that task. This example shows that constant endeavors aimed at achieving a close cooperation with the local health system contribute decisively in missions to time-optimally save own resources by leaning on those medical installations of the host country, which offer a respective treatment standard. For EUFOR ALTHEA BIH the possibility for a repatriation of wounded German soldiers by means of strategic air transports remains unchanged, however.
The mission in the Democratic Republic of Congo ( EUFOR RD CONGO ) was completed as planned already before Christmas 2006. It was especially this mission, which has allowed a specific assessment of the experiences gained with regard to the orientation and the buildup of the response forces of the Medical Service. With the operation of two rescue centers in Kinshasa and Libreville as well as with the provision of expert personnel for MEDEVAC aircraft, a Transall C-160 and a CH-53 Medium Transport Helicopter (MTH) in MEDEVAC configuration, Germany has ensured a major part of the medical support for the operation and, to that end, relied on the response forces of the Central Medical Service, the Rapid Medical Response Forces Command. Both the employed material (tent-based and containerized mobile medical facilities) and the medical support concept with a rear support facility in a host country ( Gabon ) and a special responsive facility in the actual country of deployment (Democratic Republic of Congo) have proven well in the special tropical conditions of Central Africa. After evaluation of experiences gained from the EUROFOR RD CONGO Mission, the restructuring of the Rapid Medical Response Forces Command by including elements of the deactivated 12^th Medical Regiment into the Initial Entry Forces (IEF) and robust Follow-on Forces (FOF) with the respective organic mobile capabilities, which was completed last year, was confirmed to be future-oriented.

Medical Service at Home

Bundeswehr Station Hospitals and Regional Medical Treatment Facilities

The Medical Service at home is the basis and indispensable prerequisite for the medical support in missions abroad. Transformation and further development are processes which have their starting point here and which determine the quality of the medical support abroad to a great extent. The Bundeswehr hospitals are here essential guarantors for a professionally high-quality treatment within the scope of gratuitous medical care of military personnel at home and for the provision of medical personnel for the deployment.
Our present four Bundeswehr hospitals and the Westerstede cooperation model have essentially the task to provide general and advanced training as well as to maintain and develop the competence of the medical professional staff on the level of academic teaching hospitals. The shaping of this key task was determined by the fact that an Army in Operations requires qualified professional personnel to treat specific injuries and illnesses/diseases. This personnel (medical officers, nurses and other assistance personnel) are provided in large numbers by the Bundeswehr hospitals in which high standard health care is offered. In order to be able to fulfill the respective training task and to achieve the quality prescribed by the professional association of doctors, the treatment of also civilian patients is indispensable. For that purpose, all Bundeswehr hospitals are networked with the civilian health care system and integrated into the regional medical care plans. An example for the close integration of the Bundeswehr hospitals in the civilian health care market is the respective regional rescue system. Medical and nonmedical rescue personnel of our hospitals have been successfully participating in air and road rescue activities together with fire brigades, police, and civilian rescue organizations for years already. The immediate care and treatment of patients in the rescue system guarantees the acquisition of decisive qualifications of our medical personnel for emergency medical tasks in the missions.
Within the scope of civilian reorganizations the specialization spectrum of the Bundeswehr hospitals was also re-orientated with a clear shifting of the main focus to the mission-relevant specialist fields of surgery and anesthesia. In surgery, sections for thorax, vascular and visceral surgery were established. The specialist fields of trauma and orthopedic surgery will be combined. The specialist fields of neurology and psychiatry will be operated independently and separately according to changed stipulations by the professional body of doctors (General Medical Council). Other important steps in the further development of our hospitals are the projection of the quality and operations management as well as the intermediate care units as a medical support level between the normal and intensive care treatment. Supplementary to the inpatient performance spectrum there will be day hospitals established in the Bundeswehr hospitals for partially inpatient and outpatient treatment, respectively.
The performance spectrum of the Bundeswehr hospitals will be complemented by regional medical treatment facilities. They will ensure an area-wide outpatient medical support and form a pool system with the units/elements in the respective region. In addition to the medical support and treatment, which is normally provided on medical specialist level, the regional medical treatment facilities support the troops in a training and exercise pool. Here it is by no means exclusively about the performance of medical services within the meaning of a “medical accompaniment at the training area”. On the contrary, by an enhanced integration of medical personnel in exercise projects of the troops we want to achieve those procedures are known and mastered by both sides. Only this will guarantee a harmonious acting in missions. At the same time this is an indispensable prerequisite to ensure that military and medical parametric conditions and limits in the operational and tactical mission planning are indeed taken into account.

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