Host of COMEDS 2015

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Interview with the Surgeon General of the German Military Medical Service Lieutenant General MC Dr Ingo Patschke

MCIF: General, you have been heading the Bundeswehr Medical Service since 2011. Could you tell us some of the highlights you have experienced as Surgeon General so far?

Patschke: Looking back on my time in service as Surgeon General of the Bundeswehr so far, I can say that it has been heavily influenced by the reorientation of the Bundeswehr and thus, of course, of the Medical Service. Recent years have brought about fundamental changes not only, but in particular, in the structures of the Medical Service, which had a bearing on the work of all its members. I am proud of and grateful for the constructive and professional way our military and civilian personnel, partly regardless of personal hardship, have actively participated in this process and have always and everywhere ensured optimal medical care for our comrades. During this most radical restructuring process in the history of the Bundeswehr, the Medical Service has not only been able to stand its ground but even to improve its efficiency.

Connecting our Medical Service with national and international partners has also been of particular importance to me over the past few years. As to my personal highlights, the deepening of cooperation between the medical services of Germany and China is definitely worth mentioning. As an encouraging next step, expert talks to investigate further fields of cooperation will start in the course of this year between representatives of both our medical services – something we could hardly imagine just a few years ago.

Against the backdrop of the major challenges of our time that also face our defense alliance, I am particularly pleased that the medical services within NATO and those of our partner countries are noticeably growing closer. Germany will play a prominent role here. We are well aware of our responsibility as a strong medical service in the Alliance and are prepared to act as a driving force to press ahead with future cooperation based on partnership. Traditionally, we have been fostering very close bilateral relations with our partners in France and in the Netherlands for many years now. Our close relations with the United States of America have also been intensified significantly. A visible sign of this development is the recent establishment of the position of a German liaison officer in the rank of colonel, Medical Corps, at the Pentagon.

In addition to these positive developments in the field of international cooperation and partnership, improving cooperation between the Bundeswehr Joint Medical Service and the medical services of the other major military organizational elements of the Bundeswehr was of particular concern to me early on in my term of office. We are making very good progress here, too. As a visible expression of our shared identity, I had the collar insignia removed which at the beginning of my term of office was still an identifying feature at the uniform of Joint Medical Service personnel.

We have also succeeded in enhancing networking with national partners outside the Bundeswehr in recent years. We were able to enhance specialist cooperation with the professional organizations through participation in a number of bodies (as for instance in the development of post-graduate training regulations) and symbolic cooperation through regular ­participation in the meetings of the medical umbrella organizations at the German Medical Association.

And last but not least, another highlight is certainly approaching soon. I take great pleasure in organizing the COMEDS spring meeting in Berlin this June, and it is a special honor for Germany and our Medical Service to welcome the NATO members and the numerous partner countries.

MCIF: The Bundeswehr Medical Service has been cooperating with international partners for many years now. At NATO’s 2014 summit in WALES, the Heads of State and Government endorsed the Framework Nations Concept in their final declaration. What implications does this have for international co­operation of the Bundeswehr Medical Service?

Patschke: This will have quite significant implications. The Framework Nations Concept is indeed exciting. It offers many different opportunities for our Bundeswehr Medical Service, but also for the further development of the medical capabilities of NATO as a whole. International cooperation at bilateral or multilateral level has been normal practice in the Medical Service for many years now and continues to be so. In this context, we are involved in combined exercises, in scientific exchange activities and, not least, very successfully in the operation of medical treatment facilities together with international partners on operations abroad. The Bundeswehr has a broad portfolio of medical capabilities that is accepted across all political lines of thought. However, not all NATO partners have comparable resources. Many smaller partners, in particular, are hardly able or willing to afford a complete system of military medical components. This is where the main idea of the Framework Nations Concept will take effect. A group of nations – the so-called framework grouping – will form a platform that is aimed at maintaining, extending or improving certain capabilities. Nations with a broad spectrum of capabilities will offer the opportunity to other nations to voluntarily make their own contribution to the further development of these capabilities. At the NATO Summit in Wales in September 2014, ten nations under German leadership have, through a joint letter, committed to working together in specific areas of capability development. The field of medical capabilities, among others, was identified as an urgent and worthwhile priority area. We therefore initiated the Medical Support cluster right at the outset of this process, the outcome of which may be combined institutions, combined doctrines and procedures, preferably identical or at least compatible equipment or combined training in preparation for future operational scenarios. These thoughts are followed with great interest at the military-strategic command level. The deliberations concerning the establishment of a multinational helicopter unit designed to remedy the persistent forward air medical evacuation capability deficit in Europe, for instance, go back to an initiative by the German Chief of Defense. Within such a project, persistent capability deficits in Europe could be remedied, with the burden being shared on the many shoulders of multinational partners. Such a project can only be implemented together – and possibly only together. In November, we gave the go-ahead for the Medical Support cluster in MUNICH – the response of our partners was exceptionally positive. Altogether, eleven projects were described and will now be refined.

NATO must gear itself up for the increasing challenges that it faces east and south of the Alliance’s territory. The Readiness Action Plan and the establishment of the Very High Readiness Joint Task Force as the spearhead of the Alliance are the first visible responses to a rapidly changing environment. Again, this entails requirements for the medical capability spectrum of NATO as a whole and thus for the Bundeswehr Medical Service. What applies to the Framework Nations Concept also applies in this context – the German Medical Service wants to be a key enabler and contribute, in cooperation with our partners, to maintaining and improving sustainability and the spectrum of medical support. Our objective is to reliably provide every patient with access to high-quality medical support that is based on the latest scientific and technological developments, be it in a national or multinational environment.

Let me point out some current projects that exemplify the development of international cooperation in the Bundeswehr Medical Service.

I had the opportunity very recently to sign a Letter of Intent with my Dutch counterpart, Brigadier General Johan de Graaf, Surgeon General of the Royal Netherlands Army, regarding the intensification of cooperation between the medical services of both our countries. This Letter of Intent focuses on the enhancement of cooperation in the fields of education, training and exercises as well as in the combined operation of mobile surgical hospitals.

Another deep and traditional bond exists between the German and the French medical services. Currently, we are seeking to deepen cooperation through mutual utilization of research facilities in the fields of CBRN medical defense and aerospace medicine as well as through personnel exchange and combined in-hospital training.

I am particularly pleased with current developments regarding cooperation with our partner, the United States. We have in common that both our countries are among the few nations that provide the full range of medical support. I would like to emphasize again what I have mentioned before – I consider it a strong indication of our mutual willingness to cooperate that we have succeeded in establishing the position of a German liaison officer at the Pentagon’s Office of the Assistant Secretary of Defense for Health Affairs. This will bring our partnership to a new level.

MCIF: Germany has assumed the role of a Framework Nation in the Medical Support cluster. Let us talk about the field of training. Which are the specific plans pursued by the Bundeswehr Medical Service with regard to simulation support in basic and advanced training?

Patschke: Let me give you an example. The use of modern training technology is a significant subject for the future of the Medical Service. Especially our young medical personnel have grown up in a digitalized and challenging world. They have no reservations against modern technology but believe it to increase the attractiveness of an employer. We have seen highly positive developments in the field of modern training technology in the Medical Service, which is why, at the next Framework Nations Concept meeting in PRAGUE, we will offer cooperation in this field to our partners.

The development of simulation technology for live training sessions has progressed so far that it is increasingly finding its way into the civilian and military sectors. We must not and will not take a back seat here, because the benefits are obvious – the repeatability of specific medical measures during training with no danger to oneself or others creates confidence. The employment of simulation systems saves resources and can increase training effectiveness while maintaining the required fidelity – both in a purely clinical environment and when training military medical skills, such as those required in Tactical Combat Casualty Care.

Substantial progress has been made in the development of concepts which, of course, will entail significant cost when implemented. We consider the introduction of simulation systems in hospitals and medical units to be indispensable, however. By simulating realistic combat and weather conditions, we want to prepare our personnel in the best possible way for all imaginable mission scenarios. As part of the reorientation of the Bundeswehr, training and simulation centers will be established in the medical regiments and Bundeswehr hospitals. Conceptual preparations will soon be completed.

MCIF:The Committee of the Chiefs of Military Medical Services in NATO (COMEDS) is the highest specialist authority of the medical services of the NATO member states and will certainly play a significant role in coordinating multinational cooperation. Given the prominent role Germany as a Framework Nation plays in this field, it is certainly no coincidence that the COMEDS meeting will be hosted in Berlin in June this year. What will be the focus of this meeting? What impetus do you hope for?

Patschke: It is a great honor for us to host a COMEDS meeting in Germany again after so many years. Germany is aware of its role as one of the leading nations in medical service matters. We would thus like to be a good host and will use the opportunity to give our international partners an overview of our capabilities and present our Medical Service in static and dynamic components during the supporting programme.

As for the main focus of the meeting, the heads of NATO medical services will discuss and develop their common vision of a future NATO Medical Service. Current security developments that in my opinion are considerably influenced even by natural occurrences such as the recent Ebola virus epidemic in West Africa clearly show that health will be a trending topic in the coming decades. Demographic change, limited resources and simultaneously increasing healthcare costs are additional parameters. In this regard, COMEDS will have to sharpen its own profile as an advisor for military and political decision makers. I expect valuable input from the meeting in this respect.

But Germany is only one of many partners in this committee. We are prepared to do our part and we consider ourselves an advocate of the smaller nations. Aside from the COMEDS plenary, however, the continuous work performed by the COMEDS working groups is also very important. The work done there is essential to enable NATO partners to maintain the operational capability and readiness of medical services both in a multinational environment and in transnational coalitions in a coordinated, successful and patient-centered manner at any time.