Shot-up ambulances and a race against time under “enemy pressure”: Bundeswehr medical experts advocate far-reaching conclusions from a systematic analysis of the course of the war in Ukraine so far. More armored and larger rescue vehicles, including hospital trains, would have to be procured, the conditions for first aid on the battlefield would have to be improved and cooperation with civilian health services in Germany would have to be expanded. This becomes clear in a study available to the German Press Agency. It also states that “the required needs must now be implemented urgently and without further delay”.
For the investigation, the Bundeswehr Medical Service Command systematically evaluated images and information from Ukraine and held discussions with Ukrainian medical personnel. The injury patterns are determined by the effects of explosions, shrapnel, burns and chemical wounds. “The individual gunshot wound is not the problem,” says Colonel Doctor Kai Schmidt, who is based in the Falckenstein barracks in Koblenz. As an expert in the management of operations and the situation center, he evaluated the available information.
What German medics learn from the war in Ukraine
The study found that the red cross as a symbol of the medical service received little or no attention from the Russian armed forces and was documented in numerous ways. And: “Clearly, medical facilities and vehicles were even deliberately attacked in order to cause lasting material, personnel and moral damage. There is also no distinction between military and civilian forces.” Therefore, vehicles and facilities must be protected against attacks and highly mobile.
One in ten wounded people is seriously injured. Two thirds of the soldiers killed in an attack died in the first ten minutes, and another third died mostly within the first hour. This illustrates how important immediate first aid is on the battlefield, where life-threatening bleeding must be stopped within a few minutes with a so-called tourniquet – a binding strap. Doctors have encountered cases in which all four extremities had to be tied off and eight of these straps had to be applied at the same time.
“At almost a fifth, the number of casualties in the Ukraine conflict is significantly higher than that calculated by NATO, which was also used as the basis for German planning rationales,” it states. NATO’s failure rates are based on the assumption that roughly equivalent opponents will meet. The focus is on Russia.
Defense Minister Boris Pistorius (SPD) says that the Bundeswehr must quickly become capable of national and alliance defense. He proclaimed “warworthiness as a maxim for action”.
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What the Bundeswehr is still missing – and why hospital trains are so important
NATO countries have calculated how many injured people need to be treated when a division of around 20,000 soldiers fights in high-intensity combat against an equivalent opponent. Germany has promised NATO such a large, combat-ready formation for the year as “Division 2025”. When deployed on the front line, several hundred wounded per day can be expected, and possibly up to 1,000 soldiers who have to be cared for – and also brought back home.
Germany’s considerations so far have been based on being able to transport two thirds of patients by road and one third by air. Trains don’t matter. In Ukraine, however, almost two thirds of the wounded are brought to safe treatment by rail and a third by road. The air route is the absolute and dangerous exception because Ukraine has no air superiority.
It can already be seen today that in the Bundeswehr there is a lack of large-capacity transport for high patient volumes and that significantly more transport capacity is needed to cope with the expected number of patients. For example, medical buses are required. And: “As a result, rail-based transfer with hospital trains is of particular importance on larger routes.”
“The civil clinics in Germany must also be able to do war surgery”
The medical experts also recommend expanding cooperation with civil organizations and maintaining sufficient reserves in terms of materials and personnel. “The further you move from crisis to war, the more civilian capabilities will matter. The civilian clinics in Germany must also be able to do war surgery,” says Colonel Schmidt.
More than 900 injured Ukrainian soldiers have now been brought to Germany for treatment. They were distributed throughout the country and mostly to civilian hospitals, whose doctors are now treating the most serious war injuries, often for the first time.
Germany plays a special role in NATO’s concepts as a military hub. In an emergency, you will also have to help yourself. It says: “Contrary to the current situation in Ukraine, where many third nations offer help and take in patients and refugees, in the event of crisis and war, Germany will largely be on its own primarily in terms of medicine and medical services; just like probably every other nation in Europe.”