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Alongside COMEDS, UK Surgeon General, Maj General Tim Hodgetts CBE KHS OStJ, brought together representatives from the Defence Medical Services of 10 Nations and the UK. All were warmly welcomed by Brig Gen Victor Bados, DCOS of Support Division within the ARRC/

The day was very well received by all participants and as can be seen led to some very fruitful discussion themes.

The participants represented many of the key NATO organisations, along with national representatives and several different areas of the UK defence medical services. The broad audience allowed for very detailed discussion on some of the key issues that all parties face in the delivery of medical support in an interoperable, integrated and interchangeable fashion.

Some of the key themes that developed through the day included the need to ensure joint planning at the highest levels throughout NATO, to ensure that there is clear understanding of military and civilian medical capabilities and how these may be used in a time of crisis potentially providing mutual support. Discussion was also had around the need to influence current thinking on casualty management to ensure that at the political, societal and senior military level there is an understanding of the nature of the care that would be provided at a time of significant casualty sustainment, and that this may well look quite different from that seen during recent campaigns.

Other areas that were covered included the importance of the logistical chain to support the delivery of care and how currently this would be very difficult to deliver in a multinational environment across many areas of health care delivery, due to the lack of commonality in equipment, pharmaceuticals, policy, training and regulation. Other areas for potential development include novel approaches to patient flow along the evacuation chain, development of decision making tools to support senior medical commanders in delivering equitable care across a JOA when faced with resource constraints and also the need to consider civilian healthcare systems undertaking training in the delivery of care to injuries that are more aligned to warfighting which they may not be routinely exposed to.

The topics discussed can now be developed into areas for further innovation and experimentation through both NATO force structures and the multiple working groups that feed into the COMEDS. This is hopefully a significant steppingstone to ensuring that NATO are able to provide the best possible health service support to those that may be required to undertake warfighting at scale.