When we look back to the period of the “Old” and “Cold” war, all political and military leaders knew with which factors they would be confronted in case of conflicts that would lead to battlefields.
- Huge opponents along a static border with a known enemy and a known environment where eventually possible battles would take place
- That allowed ample time for preparation
In most of the NATO countries, medical support for the numerous army divisions had to be organised for known health risk and known supply and evacuation routes, using pre-known scenarios. Medical support had to be build up using also reserves, consisting of large medical operational structures such as numerous medical companies and field hospitals.
Until little more than a decade ago, military medical support, from role 1 to role 4 was a pure national responsibility and focussed basically on NATO Article V mass casualty planning. Multinational medical assets were not in the phrasebook of the average medical staff officer.
One of the results was that in most nations medical was considered as a sub-function of logistics, emphasizing more on quantities than on technical quality and the influences on "Force Protection".
Since the end of the cold war, the economical, social, political, strategic and health environment has profoundly changed. After the fall of the Iron Curtain, most of the NATO Armed Forces were faced with major challenges. On the one hand falling defence budgets and on the other hand rising costs of both equipment and personnel, especially when the draft systems was turned into professional armed forces.
Globalization has brought an unprecedented interdependence of human activity, increased mutual contacts and mobility of people, goods and ideas so that lingering crises somewhere in the world indirectly can affect supply lines of energy, stock markets, global economy and finally jobs in other parts of the world. Increasing international competition for shrinking natural resources such as water and oil will boost instability in major parts of the globe.
Moreover, it has become crucial to win the media war. Media coverage now has a dramatic effect on public opinion, the morale of troops and the political sustainability within large coalitions.
The period of the cold war was first followed by a hot period of NATO led operations, starting in the early nineties in the Balkans.
The characteristics of the Peace Support Operations were already quite different of those we had known in the past. Since the nine-eleven terrorist attacks on the US, the Defence Against Terrorism approach changed profoundly the Alliance posture. NATO was no longer only focussed on the state-centered threat but had to adjust to non states menaces, called asymmetric threats, by organisations like “Al-Quaeda”.
Huge progression has been achieved in the medical world since the sixties and the seventies. Medicine becomes more and more sophisticated but also more and more expensive. Military Medicine has to keep track, especially as public opinion and politicians expect highest standards of care and do not tolerate large numbers of casualties in these deployments we face today, taking place while homelands are in deep peace. So individual care under civilian treatment protocols with the best possible outcome demands tremendous efforts from the military medical support systems.
This leads to a whole new quality of deep multinational integration, as not every troop contributer can bring in his own support.
Remote locations multiply the health risks compared to the old, well known scenarios of homeland defence. Preventive medicine has gained a much greater impact on operational planning and conduct, as medical preparations and force protection issues are to be taken into account.
And again – only an integrated approach on all those issues can lead to success. And this development has brought a great necessity for cooperation among nations on the medical field - -and just that is where COMEDS, the Committee of Chiefs of Medical Services – comes into play.
Cold war: Mass casualty situations, logistic/supply focussed matter of pure quantity à indeed logistic issue.
Today: Med spt evolved to complex area about high-quality treatment of fewer patients in dramatically changed environment
(Peacetime standards, public opinion – no acceptance for avoidable risks, remote challenging environments with numerous health hazards, not middle of Europe…)
Still overlap with Logistics: Deployment issues, movement of units, med supply, transportation like Strategic Aeromedevac
Majority of elements in med spt no relation lo Log at all !
Medical intelligence of op theatres, Force protection like preparation of pers to be deployed / vaccinations, Preventive medicine measures during ops, Health surveillance as monitoring against Bio-attacks, Med CIMIC as part of disaster relief or stabilization ops, delivering Hum Ass…coop civilian actors…
Complex treatment issues in multinational coop with all legal restrictions of peacetime medicine,
Planning activity of staff elements combining elements for med assessments, situation awareness supported by Med CIS Com and Information Systems
All that has relations to all the different staff areas, but to the least of all to logistics.
Before the creation of COMEDS existed EUROMED, founded in November 1968, which was the forum for the Chiefs of Medical Services of the EUROGROUP.
The highest medical authorities of the US, CA and FR also recognized the value of such a forum. The delegates of these Nations, actively participated as observers in the work of EUROMED, together with the medical representatives of the Major NATO Commanders. So, even before its transfer to NATO, EUROMED had already become an unofficial authority on military medical matters in NATO. It was meant as a forum to promote mutual understanding, co-ordination of operational principles and procedures and exchange of medical information between the member medical services.
Although initially EUROGROUP Ministers had agreed in Dec 92 to the transfer of all EUROGROUP activities to the Western European Union, it was subsequently decided on 22 May 93 to make EUROMED available to NATO as the most appropriate umbrella organization.
- Advising the MC on military medical matters affecting NATO;
- Acting as the coordinating body for the MC regarding all military medical policies, doctrines, concepts, procedures, techniques, programmes and initiatives within NATO.
- To propose the NATO Military Medical program of Work to the COMEDS Plenary for validation;
- To direct the Military Medical Working Groups (Main WGs and Expert panels) on the basis of the endorsed NATO Military Medical program of Work and the Military Committee policies for military operational standardization in the medical field;
- To work with the NATO institutions, Allied Command Transformation (ACT) and Allied Command Operations (ACO) on the same basis as mentioned for the WGs and Panels;
- To implement the results of the NATO Military Medical Program of Work in standardization matters and medical policy development;
- To review the work of the RTO/HFM panel and make proposals to the Plenary for future research;
- To convene at the initiative of the COMEDS chairman to address urgent situational matters to be submitted to the COMEDS under silence procedure;
Based on the higher level guidance and priorities, COMEDS agreed on a ‘Vision and Objectives’ stating the major themes and the primary objectives to address in the future years.
This was refined to the next level of detail, the level 2 requirements brought in by the MMSG and endorsed by COMEDS in November 05.
And the further refinement of these requirements to detailed action within the working groups resulted in the level 3 requirements, meaning the ‘Program of Work’, that will be revised and updated in a yearly cycle.
Every project has to be deliberately linked to the respective Level 2 objective.
So with these V&O, we are able to monitor closely the progress of working groups and panels, and assure that all proceedings are in line with the overall goals in a rather simple continuous controlling process.
Combining each theme in a matrix with all connected objectives gives the forum for development of more detailed requirements (Level2) – see next slide.
That policy – sooner or later – has to be transposed into NATO doctrine, as done with support of the NSA (NATO Standardization Agency) by the Standardization Boards. Since 2005, a separate MC Medical Standardisation Board is in place for medical doctrine.
What makes this Board unique is the way it is related and performs its work: The Medical Board is co-chaired by the COMEDS and MCJoint Board chairmans, as COMEDS is a MC Delegated Tasking Authority for doctrine as well. When the board receives note to develop a doctrinal document, it tasks the same medical Working Groups and expert panels already working on the policy side (in a kind of matrix organisation).
This is unique as usually a body as the Air Board has for the remaining medical purposes a specific and exclusive Working Group as well as an expert panel. This is still the case a few areas of very specific content like aeromedical or underwater maritime medical input to air and naval doctrine. Those structure for the time being remain in the old single service board structure.
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