A Baptism of Fire

When Nordic Battlegroup was launched in autumn 2007 an intense debate broke out in the media concerning the Armed Force's capacity to take care of severely injured soldiers. In time for the launch of the next NBG, in 2011, the Armed Forces will be equipped with an entirely new, ready and tested, health care organisation. Development is led by the Armed Forces Centre for Medicine at the Gothenburg garrison.

The Armed Forces’ medical vision is to strive to meet the standards of medical care offered by the Swedish civilian health service. Photo: Försvarsmedicincentrum

The term "golden hour" refers to the first critical sixty minutes following an injury. This period can be decisive for whether a trauma patient survives, is handicapped for life or dies.
The Armed Forces’ medical vision is to strive to meet the standards of medical care offered by the Swedish civilian health service, but in reality that means doing as good a job as possible under the prevailing circumstances.
The new organisation, Sjukvårdssystem 11 (“Health care 11”), is due to be in place in time for the launch of the next Nordic Battlegroup in 2011.

"… like a nervous system"
Development of the new organisation is led by the Armed Forces Centre for Medicine in Gothenburg. It is a delicate task with a range of interested parties involved, such as the logistics regiment in Skövde, military units, naval flotillas, the F 7 Skaraborg Air Wing, the Helicopter Wing, FMV (Försvaretsmaterielverk, the Swedish Defence Materiel Administration), and many others.
"You can say that we act as a nervous system; with responsibility for the whole chain of events – from injury in the field to the injured soldier’s journey home", says Magnus Blimark, the man in charge of development at the Armed Forces Centre for Medicine.
The “Health care 11” programme of organisational change is based on NATO’s division of health care capacity into different levels, running from primary health care groups and medical dressing stations to army surgical units and  field hospital companies. It is important that, at each link of the chain, medical evacuation capacity is at hand, by air, sea and land; meaning by helicopter, plane or speed boat

Directing resources
As the system is modular it can be adapted to varying types of mission and unit.
New for the Armed Forces is the construction of a central station for receiving alarms, PECC or Patient Evacuation Coordination Cell, which is to act as a communications centre for the different health care levels, directing medical evacuation resources and health care groups within an area of mission operations.
Central to the new health care organisation is the recognition of the importance of an holistic perspective – from injury to tactical medical evacuation.

Three main elements
The structure of Sjukvårdssystem 11 is characterised by three main elements: materiel development, recruitment and education. All of which are central to the twelve different projects run by the Armed Forces Centre for Medicine.
These projects involve everything from the individual soldier’s equipment and training, dressing stations’ medical capacities and dental care resources to tactical Medevac (emergency evacuation of personnel in need of treatment), preventive health care and psychiatry.  
Materiel procurement can present a bottleneck. Since the Defence Materiel Administration (FMV) is bound by laws on public tendering, completing the procurement process early enough to be able to test materials and equipment may be difficult.

Shortened rotation
"But the most inflexible limit to operations is set by the need to recruit qualified personnel. We need time to put in place a programme of education and training, with courses for surgical teams and those who are to take part in medical evacuations".
"The new organisation is supposed to be ready in time for 2011. That’s an incredibly short period of time, says, head of Armed Forces' medicine", Leif Härdig.
Surgeons are the most difficult to recruit. We are going to do two things to speed up recruitment and lend some continuity to the organisation: shorten periods of service to six weeks instead of six months and offer attractive specialist courses in trauma medicine.
Each doctor is offered an individual plan for a period, for example, five years. The first year includes a foundation in soldiery followed by a course in trauma medicine in Sweden or abroad.
In the second year the doctor is scheduled for a six week period of international service. Further trauma courses are planned for the third year and in the fourth it’s time again for another six week period in the field. And so on and so forth.

To South Africa?
Magnus Blimark, whose day job is surgeon at the Sahlgrenska University Hospital, has an ambition to offer medical personnel the opportunity to work for several six week periods at Accident and Emergency clinics in South Africa.
"South Africa offers plenty of scope for acquiring trauma experience: knife wounds and firearms injuries are as common as a broken arm or a twisted ankle in Sweden. The availability of County Council trauma courses is limited and in this way participating medics get a chance to develop their skills", Magnus Blimark says.
The aim is to build up a pool of medical personnel that also acts as a contact network, with courses and lectures, fostering a sense of collective identity.
The around 800 Swedish military personnel already serving abroad are, of course, in receipt of support from the Armed Forces Centre for Medicine, but before the launch of the new health care organisation such support is often a sort of fire fighting, reacting to problems as they arise. Magnus Blimark has, for instance, doubts regarding the medical evacuation capacity of the current mission in Chad.

Information for decision-making
Both Magnus Blimark and Leif Härdig emphasise the importance of paying due attention to health care needs in the preliminary analysis made before a decision to begin a military operation. While admitting that improvements have been made, both make an appeal for better co-operation on medical matters in the military and for health care to be recognised as a key issue for the Armed Forces in its decisions. 
Magnus Blimark and Leif Härdig believe that a certain slowness in decision-making, and a failure to utilise medical expertise when preparing military analysis, can, in part, be traced back to the fact that the Gothenburg based Armed Forces Centre for Medicine, charged with the task of building up a new health care organisation, relative obscurity after barely three years in existence. And, in addition, that the Armed Forces are still working its way out of the old "defence against invasion" way of doing things.

Medical response
"We are working now on turning things round. Among other activities, by putting together a handbook on military medicine. I am convinced that the Armed Forces Centre for Medicine is the organisation that will give Sweden a genuine medical emergency response capacity, in the civil sphere as well as in the military", Leif Härdig concludes.

Susanne Högdahl