Military medical support

Committee of the Chiefs of Military Medical Services in NATO

The Committee of the Chiefs of Military Medical Services in NATO (COMEDS) was established in 1993 when the need for the coordination of medical support in peacekeeping, disaster relief and humanitarian operations became vital for NATO.

COMEDS coordinates and provides common vision for military health care through formal setting and endorsement of policy, doctrine and standards. It regularly brings together the Chiefs of Military Medical Services from NATO and partner countries, including from specific partnership agreements that NATO has with its partner countries, such as the Mediterranean Dialogue, the Istanbul Cooperation Initiative and partners across the globe.

COMEDS draws upon subject matter experts (provided by individual states) within its structure to sustain work in COMEDS Working Groups and Panels. These Working Groups and Panels cover tasks in different areas of medical support. The seven Working Groups functioning under the auspices of the COMEDS Steering Group are: the Military Healthcare Working Group; the Force Health Protection Working Group; the Military Medical Structures Operations and Procedures Working Group; the Medical Standardization Working Group; the Military Medical Training Working Group; the Health Information Systems and Technology Working Group; and the Chemical, Biological, Radiological and Nuclear (CBRN) Medical Working Group. The COMEDS Futures Advisory Board is directly subordinate to the COMEDS Plenary.

Medical support provides essential combat service support, making it one of the key planning domains for operations, alongside armaments, logistics, air traffic management and other areas of specialisation. COMEDS, in cooperation with the NATO Command Structure Medical Advisors, contributes to NATO’s defence planning process. It steers the development of new concepts for medical support for operations, focusing on multinational health care, modularity of medical treatment facilities and partnerships.

COVID-19: medical support in practice

With the outbreak of the COVID-19 pandemic in December 2019, the military medical community helped to deal with the consequences of the evolving health crisis situation. The military medical community plays a key enabling and support role. More specifically, it helped to improve coordination, standardization and interoperability in the medical field, and the exchange of information between NATO member and partner countries.

In effect, this pandemic highlighted the need for timely, relevant and consolidated medical advice for decision-makers, and clearly showed the impact of this medical advice to engage in effective actions. It also highlighted the need for overarching policy and readiness plans agreed by all member countries, and stressed the importance of resilience. Societies need to be resilient and supported by resilient health systems to rapidly detect, assess, report and respond to new outbreaks.

Although most NATO countries have robust health systems, they often lack sufficient capacity to treat surge numbers of patients. Civil-military coordination and cooperation proved its value, showing the fundamental role of close cooperation between the national civil and military authorities. There are national pandemic response plans, but not always the capacity and resources to follow up so, in almost all countries, the military was asked to support the fight against the pandemic. While military medical personnel and units assisted civilian efforts in testing, patient tracking and treatment, the armed forces provided logistic support and other services, as required.

In cooperation with the Medical Advisors of the NATO Command Structure, COMEDS took a proactive approach by addressing the following issues:

• National plans to prevent, detect and respond to a biological outbreak,
• What role in these plans the military medical services play,
• What issues countries find necessary to coordinate at COMEDS level.

By understanding the capacity (civilian and military) of NATO members and partners to respond to the pandemic and see how the crisis was being addressed in each country, medical planners in operational headquarters adapted contingency and outbreak response plans. More broadly, by enhancing coordination and information-sharing, the military medical community harmonised the tasks that national military medical services and COMEDS played in support of civilian efforts to fight the pandemic.

Supporting the efforts of the medical community, the NATO Centre of Excellence for Military Medicine (MilMed COE) and the Multinational Medical Coordination Centre/European Medical Command (MMCC/EMC) take part in military medical training, simulation, the lessons learned process and interoperability development. They assist in collecting and analysing data provided by member and partner countries, analyse epidemiological reports from NATO operations and open source medical information, and make and share assessments.

The military medical community has developed recommendations regarding preparations for and management of follow-on waves of the COVID-19 pandemic. Similarly to many other areas of society, within the COMEDS community, virtual meetings have become the norm among Allied and partner experts for communication and information-sharing. Telehealth has evolved from being a crisis management tool to a "game changer" in education, mental health, clinical consultations and COMEDS business continuity.

Civil-military cooperation

COMEDS representatives led the delivery of clinical patient care within military and civilian hospitals, co-authored national COVID-19 clinical guidelines and led Military Assistance to Civilian Authority (MACA) responses, including critical care patient transfers and mobile testing centres.

Civil-military cooperation remains a significant part of the national response in many countries, and reservists play a key role as the ’ambassadors and interpreters’ between military and civilian organisations. Establishing and maintaining a good relationship between the respective military and civilian leaderships is critical for effective decision-making and cooperation.

COMEDS Working Groups and Panels support civilian authorities directly via military medical experts. Multinational entities like the MilMed COE and the MMCC/EMC provide states with expert analysis and additional coordination capacity. COMEDS, in cooperation with the NATO Science and Technology Organization (STO) and the Resilience Committee, has long been in the lead for initiating research programmes with medical relevance, therefore helping states implement medical research and apply the outcome of innovation.

Always looking ahead

The COMEDS Futures Advisory Board (CFAB), in collaboration with STO and Allied Command Transformation (ACT) for medical capability–building, support preparations for future military medical challenges. Future events, crises or conflicts that NATO may face over the next years are of direct concern to the military medical community. Emerging and disruptive technologies (EDTs) are defined as technologies or scientific discoveries whose effects on the Alliance’s defence, security and enterprise functions are not entirely clear and are expected to have a major effect on NATO in the period 2020-2040. Development of EDTs provides NATO with an opportunity to rethink its approach to operations, including in order to maintain its technological edge in military medical support.

COMEDS remains committed to serving NATO and individual states in meeting these future challenges of a volatile, uncertain and complex nature. COMEDS, as a key coordination body, will continue to provide support in identifying and developing new tools, ways and solutions to equip the Alliance with agile, responsive, effective, innovative and optimised medical support.