Germany, Federal Republic (Joint Support and Enabling Service)

The Medical Service in the Joint Support and Enabling   Service

The Joint Support and Enabling Service

The most important factor behind the development of the new structured Joint Support and Enabling Service (JSES) was the orientation towards providing a wide range of capabilities for operations. The previous structure with its broad spectrum of capabilities was thus converted into capability coordination commands: 

Logistics Command of the Bundeswehr

Military Police Command of the Bundeswehr

CBRN Defence Command of the Bundeswehr

Territorial Tasks Command of the Bundeswehr

MN Joint Headquarters Ulm

Joint Support and Enabling Command (JSEC) and the

Armed Forces Office 

with their respective subordinated commands and agencies.

Technical and administrative responsibility as well as training authority are brought together. 

The following diagram of the JSES can only provide a rough outline of the tasks and responsibilities of the Service. A detailed illustration would exceed the scope of a compendium such as this. This is why the tasks of the medical elements within the JSES are not specifically outlined.

Fig. 1: Structure of the Joint Support and Enabling Ser-vice

The Medical Service in the Joint Support and Enabling Service

The Medical Service in the JSES provides specialist advice for force commanders, performs military pharmaceutical tasks for the Bundeswehr, and fulfills specific specialist tasks. The JSES further ensures the provision of medical care at Bundeswehr agencies abroad (outside of military operations). 

Senior Medical Officers (SMOs) in capability coordination commands serve as medical advisors to force commanders. In addition, they analyse physical and ergonomic requirement profiles for various specialist tasks and contribute medical expertise to the further development of technology and procedures. These tasks are especially important with respect to future personnel development. 

The Surgeon General of the Joint Support and Enabling Service, the Bundeswehr Logistics Centre, and medical materiel depots perform military pharmaceutical tasks. Military pharmacy elements have in-service, maintenance and supply responsibility for medical materiel in the JSES. They furthermore represent the interests and technical issues of medical materiel management in the further development of logistic systems at the interface to the main logistics process.

A broad range of specific specialist tasks are performed in national and international HQs, authorities, commands and agencies and are carried out by medical advisors, special instructors at schools, veterinarians for working dogs, and toxicologists in the CBRN corps.

Surgeon General of the Joint Support and Enabling Service / Senior Medical Officer of the Joint Support and Enabling Service 

The Subdivision of the Surgeon General of the Joint Support and Enabling Service controls and coordinates health support and medical materiel logistics in the JSES.

The responsibilities of the Surgeon General include:

• assessing medical operational readiness in his area of responsibility,
• providing expert advice to the Chief of Staff of the Joint Support and Enabling Service and the Surgeon General of the Bundeswehr in all medical matters of the JSES,
• assuming in-service and supply responsibility for medical materiel in his area of responsibility,
• exercising functional control over subordinate medical elements and
• providing intermediary or final reports for decision-making processes.

The Chief of the Division of the Surgeon General of the Joint Support and Enabling Service is the technical superior of the Medical Service and in charge of the subdivision of the same name in the Command and Control Directorate of the JSES HQ. He also acts as Senior Medical Officer of the JSES and represents the respective interests in matters of health support and medical materiel logistics. The Surgeon General of the Bundeswehr is his direct technical superior.

The Military Medicine and Military Pharmacy branches provide specialist medical expertise for the mission of the JSES. 

Their tasks include:

• processing, reviewing and co-signing national and international documents, concepts, directives, decrees and service publications containing medical matters,
• ensuring that medical personnel of the JSES receive training and education that is appropriate to their posting,
• monitoring and ensuring medical operational readiness in the JSES,
• analysing and evaluating all guidelines and policy documents with regard to medical relevance,
• implementing requirements of the Surgeon General of the Bundeswehr for the JSES and
• representing the interests of the JSES in medical working groups, committees and study groups (e.g. CIMIC, optimization of assessment systems, organisational health management, evaluation of pre-/post-deployment activities, PTSD, integrated project teams, etc.).

Based upon a service level agreement, the Division of the Surgeon General of the JSES provides all its specialist medical expertise also to the recently established branch of the Cyber and Information Domain Service.

Military Medicine Branch

The Military Medicine Branch evaluates findings in the fields of preventive health protection, ergonomics and man-machine interaction with regard to their military medical relevance and integrates them into the further development of technologies and procedures used in health support. Furthermore, the Military Medicine Branch secures the implementation and further development of the Occupational Health Management in the JSES and the Cyber and Information Domain Service.

Military Pharmacy Branch

The Military Pharmacy Branch has in-service and supply responsibility for medical materiel as well as functional control of medical materiel management in the JSES. The main tasks cover three key areas.

As part of the in-service and supply responsibility with regard to medical materiel, military pharmacy ensures the material readiness of medical facilities in the area of responsibility of the Chief of Staff of the Joint Support and Enabling Service. By also fulfilling this task for the major organisational element Personnel, the JSES emphasizes its role as a service provider for all major organisational elements. The JSES is also the central service provider for all agencies of the Bundeswehr with regard to the provision of medical materiel. Centrally procured medical materiel is managed and kept “ready to use” in medical materiel depots. The maintenance control of Bundeswehr medical materiel also takes place in the JSES, under the responsibility of the Military Pharmacy Branch.

In addition, the Military Pharmacy Branch represents the interests of the JSES to the main process manager for logistics in matters related to the management and maintenance of medical materiel. 

This branch also acts as Authorized Representative of the Chief of Staff of the Joint Support and Enabling Service for military medical projects in the Integrated Planning Process and establishes medical materiel investment and running cost requirements for the financial requirements analysis and medium-term financial planning.

The Senior Medical Officer (SMO) of the Armed Forces Office

The Senior Medical Officer of the Armed Forces Office could be considered the unit physician with the largest area of responsibility in a geographical sense. He is responsible for the medical care of all German soldiers stationed abroad outside of military operations. This includes all medical advice, especially with regard to travel medicine, the implementation of vaccination programs, the supply of pharmaceutical products, and medical assessments. Of course, he also provides advice and support if family members, for example of a military adviser in Central Africa, experience medical problems.

The Senior Medical Officer is under the administrative control of the Chief of Staff of the Armed Forces Office and under the technical control of the Surgeon General of the Joint Support Service. He organizes and leads the medical service of his command area. He advises the Commander of the Armed Forces Office, heads of agencies in his command area in Germany and abroad, German military attachés, heads of Bundeswehr agencies abroad as well as heads of the German Military Advisory Groups in Africa and Asia on all matters related to the medical service. 

He has technical control over the following medical areas:

• unit physician at Supreme Headquarters Allied Powers in Europe (SHAPE) in Mons, Belgium;
• unit physician of the German element of the Joint Forces Headquarters in Brunssum, Netherlands;
• medical sergeants of German elements of NATO staffs in Fontainebleau, France; Naples, Italy; Innsworth GBR, Lisbon, Portugal; JFC HQ Brunssum, Netherlands and Izmir, Turkey, as well as at the German Armed Forces Command, United States and Canada in Reston, USA
• Commander, Bundeswehr School of Dog Handling, Ulmen.
  
  

SMO / CJMed Division of the Multinational Joint Headquarters

In 2013, the Response Forces Operations Command in Ulm was transformed into the Multinational Joint Headquarters (MN JHQ) Ulm. 

This new command is a multinational joint headquarters at the operational level. Its capability to lead both EU and NATO operations is unique. It leads from the theatre of operations and must therefore be quickly deployable to any place in the world. 

The headquarters comprises approximately 400 German and multinational soldiers and civilian personnel and is able to lead multinational joint operations of NATO and the EU up to an overall strength of 50,000 soldiers. It is particularly qualified to work closely together with civilian partners, such as the European External Action Service, host countries, international organisations such as the Red Cross and relief organisations (comprehensive approach).

The MN JHQ Ulm staff therefore includes elements such as Intelligence and Knowledge Development, Strategic Communications, and an Operational Competence Centre. In addition, the MN JHQ Ulm provides key personnel for a German-led EU headquarters at the military-strategic level. 

The Combined Joint Medical (CJMed) Division plans and coordinates multinational medical care for each operation. Personnel of this division are closely involved in the operational planning process in all relevant bodies. 

Medical support also includes force health protection, medical logistics, and medical intelligence. A key task is implementing the comprehensive approach, in other words in-theatre medical civil-military co-operation with governmental, international and non-governmental organisations.

A patient evacuation coordination centre (PECC) staffed mainly by CJMed personnel coordinates patient evacuation at the operational level. 

In addition, CJMed contributes to further medical development and medical operations analysis at the multinational and national level. The CJMed Division is also extensively involved in the planning, execution and follow-up analysis of multinational pre-deployment and certification exercises.

The Chief of CJMed Division is the SMO of the command area during routine operations. At the same time, he is the medical director of each overall operation and acts as a multinational technical superior to all medical forces participating in the operation and as a medical advisor to the force commander.

Bundeswehr School of Dog Handling

The Bundeswehr School of Dog Handling in Ulmen is headed by a veterinarian and provides the Joint Support and Enabling Service with a very special capability from the wide range of Medical Service capabilities. Starting from their recruitment until the end of their service, working dogs of the Bundeswehr receive veterinary care in Ulmen to ensure their fitness for their main tasks of protection and guard duty, searching for missing persons, detecting drugs and explosives, and mine detection. This includes a reach back procedure for the treatment of illnesses and injuries the animals may suffer on operations.

The recruitment of the dogs is realized by buying young adult dogs on the European market but the main number of the working dogs is provided by the own military breeding of Belgian Shepherds and in smaller numbers German Shepherds. Following its selection and training, a working dog is handed over to its handler, who will work with this dog until it reaches approximately 8 years of age. With the help of modern technology, the training of dogs and their capabilities are continuously optimised and developed. Time and again dogs have been found to be clearly superior to other sensors.

The school's veterinary clinic is equipped with modern medical technology. This means that even major surgical procedures can be performed there. Since 2011, a documentation system for veterinary data is available at the clinic.

The school also ensures that four-legged pensioners and veterans receive lifelong care. If they cannot stay with their handlers' families or be placed with someone else, they remain in Ulmen, spending their sunset years with a pack and housed in modern kennels.

Bundeswehr Logistics Command

The Bundeswehr Logistics Command in Erfurt and the Bundeswehr Logistics Centre, which has direct authority over fixed logistic installations, follow the capability-oriented approach of the JSES. This means that joint technical and administrative control of medical materiel depots lies directly with the Bundeswehr Logistics Centre. The group for the technical supervision of military pharmacy in the Bundeswehr Logistics Centre and its military and civilian personnel are the central point of contact and control agency for ensuring the provision of medical materiel by the JSES. Medical materiel is provided by the medical materiel depots in Epe and Krugau, which also have the status of Bundeswehr pharmacies.

In addition to materiel requirements and stock management for centrally procured medical materiel, the central maintenance control point for medical materiel is also part of the Bundeswehr Logistics Centre. It is responsible for planning, controlling and coordinating the maintenance of medical equipment throughout the Bundeswehr. It also acts as an interface between different units and military and civilian maintenance facilities across all major organisational elements. 

As a unique ability, the medical materiel depot in Krugau has a center of excellence for the inspection and maintenance of modular medical units containers. This has reduced the pressure on supply facilities for medical materiel of the Bundeswehr Medical Service.

Bundeswehr CBRN Defence Command and Bundeswehr Military Police Command

The Bundeswehr CBRN Defense Command and the Bundeswehr Military Police Command do not have an on-site SMO. Their medical tasks are administrated by the Military Medicine Branch within the JSES HQ.

Bundeswehr Territorial Command

The Senior Medical Officer (SMO) of The Bundeswehr Territorial Command (BwTerrCOM) advises the commander in all medical matters. The BwTerrCOM is the German OpsCommand for inner German operations. Territorial tasks mainly include: 

• Host Nation Support, 
• Mediator between civilian and military authorities following the civilian administration structure and according to the levels of cooperation, 
• inter-agency assistance/disaster relief at home and functional leading element of military training areas. 
• Responsibiliy for the territorial reserve e.g.Regional Security and Support Companies to support regional home defense capability.
  
  

Joint Support and Enabling Command

The Joint Support and Enabling Command (JSEC), being under SACEUR`s operational command, is the NATO Command and Control (C2) entity on operational level for the Rear Area and supports Host Nations (HNs) in planning, execution & coordination of Security, Force Protection and Area Damage Control. JSEC furthermore enables Training and Integration (RSOM-I) of NATO Follow-on-Forces. Last, JSEC conducts security operations and Force protection operations in support and on request of the HNs.

At 1 April 2019 JSEC was build up in ULM as a new entity and part of the NATO Force Structure. Next milestones are Initial Operating Capability (IOC) scheduled for 1 October 2019 and the Full Operating Capability (FOC) scheduled for 1 October 2021.

JSEC Medical Service

JSEC Medical Service (MedServ) is NATOs operational-level responsible entity in coordinating medical-related matters in the Rear Area (RA). MedServ identifies requirements for the whole range of upcoming tasks from Baseline Activities and Current Operations (BACO) up to Maximum Level of Effort (MLE) within the own Area of Responsibility (AoR). 

The tasks are, to plan, direct, co-ordinate and assess the joint medical support for transiting and assigned forces, assigned operations and contingencies including command, control, communication and information (C3I) structures for an integrated system of treatment, medical evacuation and medical supplies, force health protection and reporting. 

Furthermore, JSEC MedServ contributes in all medical and medical-related matters to the development of joint medical plans, situational awareness, procedures, policies and doctrine. A core basis for this is the establishment of a recognized medical picture already in BACO and maintained and expanded in Crisis and MLE. 

Essential in the RA is a functional network and active relationship with all relevant entities in the AoR including the Host Nation (HN) to establish and provide comprehensive and high-level Medical Support. In a coordinating function, JSEC MedServ de-conflicts and harmonizes national and alliance medical support plans from a Rear Area perspective and supports bi- or multinational medical support solutions and arrangements. 

MedServ is able to cover the three sectors medical planning, medical operations and medical Logistics / Force Health Protection. Staffed with national and multi-national members, the Peacetime Manning Requirements include additionally dual-hatted posts from Multinational Joint Headquarters ULM (CJMed).

Summary

Medical tasks are only one part of the support activities carried out by the JSES for the Bundeswehr. The Medical Service in the Joint Support and Enabling Service supports units of the JSES by providing advice on all medical issues and by contributing expertise to further development. The Medical Service also provides the Bundeswehr with special medical, pharmaceutical and veterinary capabilities that only exist within the JSES. The Medical Service in the JSES has been optimised in the new structure in order to fulfil its functions. It will continue to be developed based on lessons learned. 

Col (MC) Dr. Grohmann
Kommando Streitkraeftebasis
Generalarzt SKB
Postfach 13 28
53003 Bonn

status: 12 January 2023)