Zentraler Sanitätsdienst / medical services in a military

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According to the Bundeswehr itself, the central medical service of the Bundeswehr counts 19,860 personnel out of a total of 183,116 (31st July 2022). This does not include soon-to-be officers who are studying at universities, those are counted separately. The personnel share is thus 10.8%. The Heer has a 34.3% share only! This is insane. The constitutional mission of the Bundeswehr is defence, not being a self-licking ice cone.

This large share is not all due to the greater ease of recruiting (particularly for officers, as they can easily transition into high-paying civilian jobs after their volunteer term). The Bundeswehr does traditionally maintain an oversized medical branch, and it did protect itself well against the otherwise widespread outsourcing to civilian contractors.

Overpriced, overweight, oversized MEDEVAC - a nightmare

 

(c) Wolpat

I will propose an entirely different way of doing business that would provide better care* AND reduce costs. But first, let me make a statement appraising the extremely important role of army medical services:

The confidence of the fighting men in getting good and timely medical treatment is an extremely valuable boost to morale. The effect of seeing a comrade in pain with a leg bone shattered by a bullet turns into sheer horror if you think that he'll either bleed to death, get his arm amputated or die in agony due to wound infections. Small unit leaders can get the minds of his comrades back on track to pursue a mission if the wounded man's pain gets treated (so he stops screaming), his bleeding stopped and blood loss compensated with intravenous liquid (better things than saline solution are available) supply. He needs to be moved away for medical treatment properly, and well-informed troops will understand that the survival rate can be near-100% if wounded men arrive at a surgical hospital within an hour, as even the really bad cases have a good chance of survival if they arrive there alive.

The army needs to take care of its soldiers and doing so does indeed help accomplishing missions. I don't doubt that at all, it's just that the bloated peacetime medical service is largely unnecessary and partially even detrimental to this.

 

So here's how I would do it (or rather, this is a first order proposal for a long-term transition):

(First, a precondition; the German military is for deterrence & defence, not for military adventure bullshit on distant continents. Any deployment outside of geographic Europe and NATO-included territories should be banned (save for tiny 2-men military observer missions).)

 

Every soldier has to join an ordinary Gesetzliche Krankenversicherung (regulated health insurance, the most common kind of health insurance in Germany) and the Bundeswehr pays 100% (rather than the normal 50% employer co-pay) for the basic health insurance (no co-pay for any extras, but 100% reimbursement for dental treatments after service-related dental injuries and for certain jobs also 100% co-pay for eye surgery for improved vision). Illnesses and injuries in peacetime would thus overwhelmingly be dealt with by civilian medical care capacities.

The peacetime medical personnel gets reduced to

• One medical doctor per battalion-sized garrison, ideally with a civilian government-employed medical doctor (Amtsarzt) as helping out as backup. This medical doctor (actually no doctor degree required) gives medical courses at the garrison, confirms when a soldier is really too sick for work and is part of the battalion HQ.
  
• One combat medic with a combat medic backpack (and additional stuff stored in motor vehicles) per almost every** platoon meant for employment on the battlefield (not a member of the medical branch)
  
• Soon-to-be reservists on basic training
  
• Reservists on two-week refresher exercise
• A tiny, tiny overhead at whole Bundeswehr level administration for medical topics, mostly busy trying to introduce improvements (methods, tools, consumables, vehicles) and getting necessary procurement initiated.
  

(No medical doctors would be needed for the navy, for I would disband the useless service.)

The mobilised/wartime medical support would look like this:

Every non-officer in the Bundeswehr completes a full First Aid course (with a theoretical and practical test that needs to be passed!) every 2nd year, army personnel additionally receives combat injury-specific courses during the other years (also biannually, also with mandatory pass test). All personnel has a personal injury kit (mostly stored in upper leg pouches due to the low weight) and at least one canteen with (ideally sterilised) water (essential for treating white phosphorous wounds, for example).

Combat medics at platoon level stop external bleeding, replace blood loss (avoid volume shock), treat injury pain, provide quick assembly stretchers and arrange for casualty evacuation together with the assistant platoon leader. These combat medics would still be armed with a self-defence subcarbine with 100 m iron sights and carry maybe 2x20 rounds for it. Some platoon combat medics would receive secondary training as a signaller, to watch radio traffic for the platoon leader when the primary signaller is not available. Infantry combat medics would additionally carry non-munitions supplies such as batteries and not have an active combat role (other than keeping an eye on radio traffic and the back).

Battalion battlegroups have a bandaging station with a medical doctor and a few medics. They provide extra blood loss compensation, improve the blood loss stop and take care of burn wounds to limit the risk of infections. These bandaging stations/vehicles are the transfer point between casualty evacuation (CASEVAC***, transport by ordinary vehicle) to medical evacuation (MEDEVAC, using a dedicated vehicle with a medic taking care of the wounded during transportation - usually 4x4 vehicles).  They need to be highly mobile and should generally match the mobility of the battlegroup (so at least two 4x4 vehicles of less than 8 tons gross weight with 1.2 m maximum fording depth ability, better a 20 ft ISO container on a 8x8 universal container/pallet transport vehicle with protected cab). I would prefer complete camouflage over Red Cross markings for these vehicles, as the Russian military doesn't respect the Red Cross anyway.

We should not rely on helicopters for MEDEVAC, but (mostly civilian) helicopters could be commandeered for the purpose (with a new crudely-applied paintjob) - maybe their employment is not too risky, after all. No gold-plated nightmares like NH90 would even only be maintained in service, neither for MEDEVAC nor for CASEVAC.

An (the) army corps maintains two pairs of leap-frogging (moving alternatingly) mobile surgical hospitals. These would not be container & tent villages, but rather prefer to make use of civilian buildings with man-movable equipment (same as headquarters above battalion). Tents would be backups that should be avoided. Such a mobile surgical hospital would be the place for surgical treatment (including for eye and burn injuries), largely drawing on civilian emergency room experience of their personnel. Much attention would be on maximising the survival rates of highest priority patients, so these surgical hospitals have to be within range for the golden hour for battlefield injuries of almost all combat troops (not forward scouts). The primary job of these mobile surgical hospitals would be to make the patients ready for transportation by civilian medical transport vehicles to civilian hospitals. It would take care of all patients until they can be transported. This explains why we'd need leap-frogging hospitals; whether the army corps advances or withdraws or simply moves laterally to a different region; one hospital of the pair would stay behind with those patients that cannot be moved except in most dire emergencies. The exact required quantity of hospitals is driven by the operations area of the Corps (all combat formations within one hour radius of a mobile surgery hospital) and this leapfrogging (x2).

The MEDEVAC vehicles and their crews (for movement of wounded to the mobile surgical hospitals) would form each one MEDEVAC Company per mobile surgical hospital, consisting almost entirely of reservist drivers and reservist medics.

Battalion-level garrison medical doctors exist as in peacetime (though typically being reservists in wartime) unless the garrison is largely empty (it might be in use for refresher training for reserves in wartime).

And that's it. The use of civilian medical care in peacetime improves the care and reduces costs, while the wartime strength of the medical service would largely depend on reservists, especially regarding medical doctors.

The key challenge would be to recruit the medical doctors and medics who would normally work in the civilian world, but be available as reservists. This is so far being done by giving people contracts for 17 years including the time when they study medical jobs at civilian universities.

We'd need to apply a different motivation than providing medical training while paying them on the job for many years. I basically propose to pay only as much as necessary; they get subsidies for their years at a civilian university and become reserve officers (medical doctors for surgery/emergency care and for eye emergency care) and reserve non-commissioned officers (medics) with little basic military training and a two-week refresher course once every 2nd year (ideally with much of the 2nd week overlapping with a non-computer exercise at corps or at last battalion battlegroup level). The pay would be good, the intrusions into their life kept minimal and they would be shielded from the usual red tape bollocks as much as feasible.

Now keep in mind; this was partially tailored to an army that's based in its own country, preparing for being deployed to a rather populous (not desert-ish, devoid of hospitals) developed world region for alliance defence. This approach would work just as well for Republic of Korea (save for the navy) or Taiwan (save for their stupid forward fortress islands and their navy) and any European country if it abstains from stupid military adventures such as the stupid occupation wars of the past two decades or the war of aggression against Iraq in 2003.

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You may have noticed that what I described is not extremely different from what's being done or meant to be done, but I

• skipped insane waste of budget by relying more on civilian medical personnel,
• opposed the container+tent village nonsense for field hospitals,
• opposed MEDEVAC (dedicated vehicles) within the manoeuvre forces on the battlefield****
  
• and opposed gold-plated helicopters due to their high costs and survivability concerns.

S O

defence_and_freedom@gmx.de

*: Disclosure: I received spectacularly bad dental "service" in the Bundeswehr in the 90's myself, and this poor treatment was directly caused by persisting systemic nonsense. The dental assistants were inexperienced and thus incompetent and did not find the correct tools for the dentist.

**: Not for tank platoons, for example. Platoons of mostly vehicle crews (also some logistics small units) could simply have some extra supplies such as IV solution and extra bandages stored in their vehicles and a member or two with extra training. It would be difficult to find a good place for a medic in such platoons.

***: By the way; vehicles suitable for CASEVAC (this includes APCs and if existing IFVs, both of which should have folding seats to enable transportation of stretchers and small pallets) should have equipment to mark themselves as in CASEVAC action, so for example military police knows to prioritise them in traffic. This could range from detachable blue lights to a red cross flag attached to the vehicle front.

****: I am in favour of having tracked protected carriers with a crew of two but no dedicated cargo or passengers, held at infantry battalion level. These kind of (H)APCs would move infantry, supplies, prisoners of war (evacuation only) and civilians (evacuation only) through dangerous areas of the battlefield, preferably with concealment (by smoke and terrain features), rarely support by neutralising or suppressive fires (usually only for infantry assault to objective). They would have thin folding seats on the sides of a separated transport compartment to offer maximum cargo and stretcher capacity with folded seats. These universal battlefield transports would be preferred for casualty evacuation and could easily store a couple litres of medical supplies. The infantry would normally ride in vehicles that have the very same (limited offroad, 1.2 m fording, 1000 km road range, 80 kph road march) mobility and protection (presumably mostly against 99% fragments of 152mm HE@50 m, maybe PKM ball bullets @100 m threat) as the vehicles of the battalion battlegroup support.

 

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