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100 years of changing combat, changing health care

At the outset of World War I, military medicine was designed around field hospitals and casualty clearing stations behind the fighting lines, with a link to transportation of wounded away from the front. It was clear to all that patients had to be brought to the hospitals as soon as possible and treatment had to start earlier than upon arrival.

With the invention of the field ambulance to transport wounded away from battlefields in the Napoleonic Wars of the early nineteenth century, a start had been made with frontline medicine. This was improved in WWI by bringing hospital care further forward, experimenting with blood transfusion and further developing a system of patient evacuation.

Today we see a tremendous emphasis on starting treatment early at the scene of wounding and improving the speed of transportation. Battlefield healthcare is bringing prevention, surgical procedures and stabilisation of wounded to the frontline. Timelines for transportation are used to start treatment within 10 minutes and bring each wounded soldier the needed medical attention within an hour.

Since WWI, the perception of life and health has transformed from collective to a much more individual focus. This is also reflected in expectations of deployed forces, where military medicine is no exception.

For example, starting with the Vietnam War, US soldiers who died in combat were no longer buried locally, but brought home. Families now demand the best outcome of care for their military; soldiers need to count on optimal care for morale. Commanders focus more on protection, military health care aims to save life, prevent diseaseand restore abilities.

Military medicine is now no longer a logistic function (of transporting wounded), but has become a societal function, reflecting these improvements. In particular over the last 30 years, health care (including in the military) has become an important player in society, providing a huge number of jobs and playing a key economic role.

It is also a game changer: health care providers from the military, international organisations and non-governmental organisations, are concerned that they can also often be a target for opposing forces. It has become an operational and strategic influential element.

Another major change is that whereas during WWI, health care was a purely national function, today’s military health care is very multinational.

The field-hospitals of ISAF in Afghanistan are often manned by seven different nationalities, and they provide not only care to their own military, but also to all coalition forces, local citizens and - if needed - to the wounded of the opposing force.

That creates a different role, where multinational cooperation, language, standardised procedures, mutual trust, security, etc have driven the way we work today.

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About
the Author

Wynand Korterink is the Medical Advisor of the International Military Staff at the NATO Headquarters and as such works for the NATO Military Committee. He is a military physician with a specialization in Public Health.

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