Chairman – Committee of Chiefs of Military Medical Services in NATO
MCIF: General, after having retired from the active service can you give us some impressions of your active life in the Canadian Medical Service.
MG Bernier: When serving as an infantry officer with a regiment and with a Brigade Group headquarters, I became motivated to study medicine partly because of the tremendous importance and impact of health and medical services on personnel, morale, and operations. My subsequent service as a medical officer exposed me to the readiness requirements for conventional and CBRN Cold War operations, as well as the military and strategic evolution necessary to best support humanitarian and unconventional post-Cold War operations in such theatres as the Balkans and Afghanistan. Like most of my COMEDS colleagues, I also saw the clinical, operational, societal, and legal developments that increased the criticality of medical advice and support on readiness, operational success, and public support, whether before, during, or after operations. Throughout that time and to this day, Canada’s modest armed forces and its foreign and defence policies were grounded on collective defence for both North American continental defence and for missions abroad. Coordination and integration with NATO allies has therefore been a major Canadian interest and focus throughout my service, as well as a personal highlight.
In leading the Canadian health services, I was most thankful for our degree of operational readiness and capabilities in Afghanistan, the expansion and refinement of our mental health, rehabilitation, and research programs, the leadership of Royal Canadian Medical Service personnel in several areas of Canadian health care and research, and national recognition of their competence and valour among the Canadian public, medical community, and academia. The most noteworthy operational achievement to which I contributed was the generation and sustainment for almost 4 years of the Role 3 Multi-national Medical Unit in Kandahar, NATO’s first in combat operations. In the heart of Taliban country where much of the heaviest combat and mass casualties occurred, it had to integrate clinicians from several nations into cohesive teams, was one of the world’s busiest trauma centres, faced very difficult environmental conditions and intercontinental lines of communication, and had to keep operating under rocket fire, yet it nevertheless achieved history’s highest war casualty survival rate up to that time. Although Canada was lead nation, its success was the combined achievement of the skill, innovation, and dedication of medical staff from 7 NATO and partner nations working together with the support of NATO’s command and sustainment structures. I was also very gratified by our subsequent work with the Americans in support of the medical NATO training mission in Afghanistan, with the British to fight the Ebola epidemic in Sierra Leone, and several other humanitarian assistance deployments.
MCIF: After your retirement, you could have had an easy life without general responsibility, just for your family. Why did you accept the very interesting but highly responsible position as chairman of COMEDS?
MG Bernier: I wanted to keep serving from a personal perspective because, as the French philosopher Montaigne recognized, there’s no greater joy than working with and serving people who place service to others in their nation’s defence above their own interests. And in helping protect our combatant colleagues and imperiled civilian populations, we in the medical services have a particularly important contribution to make in defending our nations and in preserving peace. Whether serving in Germany during the Cold War, with the US Department of Defense, with various Quadripartite and NATO groups, or with COMEDS, I was always deeply impressed by the competence, unity of purpose, and nobility of my colleagues, their great respect for human rights, dignity, and liberty, and their commitment and devotion to protecting the health and lives of our troops and of all human beings. These qualities were certainly manifested by my predecessor, Lieutenant-General Gérard Nédellec of France, whose example of steady leadership and selfless dedication greatly encouraged me.
Although my function is to coordinate and represent the collective consensus of COMEDS, I and others also considered that the Canadian success at integrating multi-national health service support in a high-casualty combat setting might be relevant to our pursuit of enhanced coordination, standardization and integration of allied medical support. Such efforts support NATO’s Smart Defence concept and Connected Forces Initiative, and remain a collective COMEDS priority given defence budgetary pressures, limited national medical capabilities, and widespread shortages of medical personnel in Europe and North America. Since COMEDS has always been chaired by a continental European, some also considered that a Chairman with a North American perspective might be suitable to succeed General Nédellec.
Finally, it was very appealing to be Chairman with a full-time Dutch COMEDS Liaison Officer (LO) at NATO HQ. Although the Chairman’s nation normally provides the LO in order to optimize his support and their mutual communication, the Netherlands’ Surgeon General, Brigadier-General Johan de Graaf, graciously proposed to provide a superb, highly-qualified, and broadly-experienced senior medical officer, Colonel Gerald Rots. Canadians have a close historical and cultural attachment to the Netherlands, we’ve had great experience working with Dutch personnel in integrated medical units in Bosnia, in Afghanistan, and in many non-operational collaborations, and the arrangement serves as a practical demonstration of effective multi-national integration at NATO’s highest medical strategic level.
MCIF: Are there any special considerations for this appointment, any particular goals you want to pursue?
MG Bernier: With the support of various NATO elements, COMEDS LO Colonel Edouard Halbert, and COMEDS members, Lieutenant-General Nédellec placed us on the right track to suitably advise the Military Committee, further enhance medical interoperability, and address the strategic issues relevant to NATO’s evolving challenges as articulated by the Heads of State in Wales. He and Colonel Halbert also made great progress in addressing some of my own interests for NATO, such as greater COMEDS accountability to the Military Committee, more structured COMEDS oversight of the efforts of its sub-groups, and greater alignment between COMEDS research interests and the work of the NATO Science and Technology Organization’s (STO) Human Factors and Medicine (HFM) Panel. My main effort will therefore be to help progress and expand all of these efforts as quickly as possible, with particular attention to the challenge of generating appropriate medical capabilities to support all NATO operational interests.
I hope, however, to also focus on two related areas to the extent supported by my colleagues. The first is broader communication within and outside the NATO structure of COMEDS’ work, the strategic and operational importance of appropriate medical capabilities, and the measures necessary to achieve them that are beyond the control of medical authorities. As we all know from our respective national experiences, military readiness, operational success, and public support can be affected by the degree to which the senior military leadership understands the relevance of health matters.
My second focus will be on more optimal and balanced engagement with STO’s HFM Panel and the Military Medicine Centre of Excellence (COE). Since it’s so critical that NATO maintains the leading edge in medical capabilities, I’ll strive to help optimize their generation of relevant new knowledge in a manner to best support COMEDS and NATO medical advisers in fulfilling our respective responsibilities to the Military Committee and the Strategic Commands. A more refined exploitation of their organizational and analytical capabilities offers the potential to better analyze the implications of new knowledge and technologies to future NATO medical support, as well as to more rapidly and broadly communicate knowledge and standardization across the Alliance.
MCIF: Most NATO-countries have experienced painful cuts to their military budget. This could mean that, in future,international cooperation will become more and more important. Are you going to support such cooperation – and if yes, in which way?
MG Bernier: COMEDS has always supported and facilitated multi-national cooperation through the continuous efforts of its Working Groups and Panels and its extensive development of up-to-date Standardization Agreements and medical publications, with over 4500 pages of common doctrine. As publicly highlighted by NATO’s former Secretary General and NATO Heads of State, however, we nevertheless faces challenges in generating sufficient medical capabilities to support the ambitious number and scale of operations that NATO aims to be able to conduct simultaneously.
NATO’s Framework Nation Concept and Connected Forces Initiative aim to partly address this concern through the pre-organized and exercised integration of national sub-elements together under the leadership of a “framework “ nation to form more complete deployable capabilities. COMEDS has been supporting this through the development of standardization guidelines for multi-national medical units, greater coordination of all medical standardization efforts among its sub-groups, the definition of functional modules that can be integrated together to form complete Medical Treatment Facilities at various levels, support for multi-national medical exercises to help validate standardization practices and identify gaps, and other efforts. The integration of multi-national medical elements to form complete capabilities has been practiced in NATO operations for years, but the pre-identification, commitment, and exercising of such elements should enhance NATO readiness and the speed of deployment.
Limited national military medical resources have also highlighted the importance of medical reservists and of closer cooperation with health-related international organizations, non-governmental organizations, and commercial enterprises to achieve the best possible health service support to NATO forces and operations. Closer cooperation with our national civilian health systems is particularly important for some nations not only because of limited national defence and health budgets, but also because of a common civil-military challenge of limited numbers of health professionals.
Very importantly, resource constraints have highlighted the contributions and importance of COMEDS members from NATO’s partner nations. They bring tremendous additional knowledge, experience, perspectives, and research capacity to COMEDS, several have deployed highly-skilled medical capabilities to support NATO-led operations, and many have very effectively assumed leadership roles in addressing elements of COMEDS work.
Finally, budget and personnel constraints highlight the need for ongoing cooperative research and development of knowledge and technologies to help compensate for limited resources and to support timely adaptation to new military, medical, technological, and political developments. Areas of focus include tele-health and robotic applications, more mobile and robust medical technologies that require less maintenance and personnel support, better personal protection measures and equipment, advances in casualty stabilization for earlier evacuation, use of UAVs for evacuation, automated physiological sensors and diagnostics, medical simulation for training, enhancements to physical and mental resilience, and many others.
MCIF: How will the development of the military situation at the Treaty’s eastern flank and the already negotiated NATO-measures like the Readiness-Action-Plan affect the medical services in NATO?
MG Bernier: COMEDS members must consider the southern flank and other potential threats in addition to the eastern flank with respect to medical implications. The ongoing maintenance of capability-based planning and expeditionary medical support capabilities will therefore remain necessary in addition to a renewed focus on medically supporting defensive operations in the east.
Medical support to the established NATO Response Force (NRF) has long been defined and exercised. In developing the necessary enhancements to medically support the Readiness Action Plan and Very High Readiness Joint Task Force (VJTF), Allied Command Operations and individual COMEDS members must consider factors that have been less prominent in post-Cold War NATO operations, such as medical preventive measures, treatment and evacuation under CBRN conditions or in the absence of local air superiority, potentially larger numbers of casualties including refugees and other civilians, the security and capacity of domestic civilian medical systems, mobility and capacity of field medical units, and many others related to defensive operations against conventional forces in Europe. In addition to the multi-national interoperability and integration measures I noted earlier, medical support considerations will be an element of NATO’s six new multinational command and control Force Integration Units on the territory of the eastern allies to facilitate rapid deployment of forces, as they are in the planning process of Headquarters Multinational Corps Northeast in Szczecin, Poland, the hub for regional cooperation. Resurgent Russian aggression has highlighted the importance of multinational medical exercises, a subject of current COMEDS attention to ensure that their frequency and content is optimal and that there is appropriate medical content in broader NATO exercises.
MCIF: In your opinion, how should the provision of medical support for the military forces for this region be planned? Are there any multinational concepts?
MG Bernier: This is the prerogative of the NATO command structure considering the collective strategic advice of COMEDS. There will be no major change from the medical support concept and planning for the previous multinational NRF structure, although COMEDS and the NATO command structure will continue to refine the multi-national force generation approach that was, incidentally, pioneered by the medical services during operations in Bosnia. Germany, the Netherlands and Norway have already established an interim VJTF, the full expanded NRF will be ready in 2016, and several allies have offered to serve as lead nations.
MCIF: Everyone talks about hybrid warfare. What implication does this have for medical services? Do we have to adapt our concepts to these developments?
MG Bernier: Students of history recognize that there is nothing fundamentally new to this asymmetric and multi-pronged approach to warfare that would have major implications for the mission and capabilities of NATO medical services. It can, however, influence many functions in certain operational scenarios such as casualty estimation, determination of population at risk, the scale and composition of deployed medical support, the dispersion and command and control of medical elements, protection of electronic health information, public health and force health protection measures, civil-military health system and health surveillance cooperation, medical training and support as a diplomatic tool, medical training and supplies, etc. These potential factors, the adaptive flexibility of a hybrid approach, and its application to remain below NATO’s conventional response threshold therefore call for a review of the suitability of existing NATO medical guidance. NATO’s medical community is evaluating this question in depth through coordinated analyses of lessons learned and future medical support involving COMEDS working groups, Allied Command Transformation, the Military Medicine Centre of Excellence, and others. Some of the potential implications may be readily addressed by the lessons learned process and specific initiatives such as the modular approach to multi-national medical units, but other changes may be indicated by the results of the analysis.
MCIF: Lessons learned from the EBOLA-crisis show that military medical services would have to render short-term support in civil pandemic situations as well. Are there any multinational developments in this regard?
MG Bernier: For many reasons, the response to such crises should be led by civilian public health authorities. In many nations, however, the armed forces and their medical services are the only national capability under government orders with the logistical support, transport, equipment, training, and expertise necessary to rapidly and effectively deploy in such crises. This reality led to the deployment of military medical personnel of several NATO nations to fight the Ebola epidemic. Some of these were multi-national deployments of personnel from COMEDS members, such as the British operation in support of Sierra Leone that integrated British, Canadian, and Irish military medical staff. Although NATO did not organize or generate medical capabilities in response to this crisis, the lessons learned are relevant to NATO interests. They are being reviewed by relevant NATO medical elements in the context of our existing publications on military assistance, civil-military interfaces, and medical support in disaster relief and humanitarian emergencies, as well as medical publications related to protection against biological threats. There are no plans at this time, however, to establish a NATO multinational medical response capability dedicated to non-military threats.
MCIF: General, let me thank you for granting us this interview, and, in particular, for your concise and open remarks.
Let me wish you all the possible success for your demanding appointment.