Germany (Air Force), Federal Republic of
Prof Dr med Rafael Schick
Brigadier General MC
The medical services of the Bundeswehr were centralized into the Bundeswehr Joint Medical Service in 2002. The responsibility for the medical support of the vast majority of the military was transferred to this major organisational element. However, because of the specialised needs of military aviation, an Aeromedical Service was retained within the aeronautical units maintained by the Air Force, Army and Navy of the Bundeswehr, and a centralised aeromedical institution under the lead of the Surgeon General of the Air Force was established to provide specific support in the entire field of Aerospace Medicine.
German Air Force Center for Aerospace Medicine (GAFCAM)
By fusion of the former office of the Surgeon General German Air Force and the Air Force Institute of Aviation Medicine, a new institution was established in October 2013: the German Air Force Center for Aerospace Medicine. This center discharges responsibilities for the “Aerospace Medicine” sector on behalf of the Bundeswehr, and it administers the Aviation Medical Service of all flying units.
While the Surgeon General of the Air Force is the highest ranking flight surgeon of the Bundeswehr, the senior flight surgeons of the Army and the Navy are assigned to GAFCAM, and the head of one of the divisions of GAFCAM is the senior flight surgeon of the Air Force.
The duties of the Aviation Medical Services include not only the medical examination, evaluation and support of military flight personnel, but also the evaluation of pilots on behalf of civilian aviation authorities. The Center for Aerospace Medicine provides a broad spectrum of services, such as the selection of candidates for flying duties by means of computer and simulator-based testing of aptitude and trainability, the provision of national and international training courses in aerospace physiology and aviation medicine, as well as the testing of aircraft, aircraft equipment, flight clothing and safety systems with regard to their suitability for use by the flying crews. Further tasks include the forensic investigation of aircraft accidents, including toxicological and DNA analysis, the processing of all aspects of flight physiology, and intervention in crisis situations. As a science-based service provider, the GAFCAM has to assure the quality of its services by conducting its own scientific research. All tasks relating to scientific aspects, research, testing and development in the Center for Aerospace Medicine of the German Air Force are united in a single department at one location.
Following the restructuring, the Surgeon General of the German Air Force is now in command of the GAFCAM (ZentrLuRMedLw), which comprises the personnel and facilities of the units of the former Institute of Aviation Medicine based in Fürstenfeldbruck, Manching and Bückeburg together with those of the previous Office of the Surgeon General of the German Air Force and the majority of those of the previous advisory services within the command units based at Cologne-Wahn. The Flight Physiology Training Centre with its large-scale equipment typical for aerospace physiology, such as human centrifuge, high altitude simulation chamber and disorientation trainer, remains in Königsbrück, close to Dresden in Saxony.
The center also incorporates the flight surgeon-related departments Evaluation Center and Skills Center (that were previously responsible for evaluation and aptitude testing) with the Aeromedical Center, and is additionally responsible for deployment support, healthcare, logistics, administration and training. In the areas of international and national joint projects, research orientation and quality management, the Surgeon General of the German Air Force has the support of a Scientific Coordinator. The formation of the GAFCAM has thus achieved the concentration of specialised assignments, the facilitation of processes and the removal of command structures that were among the main objectives of the restructuring of the Bundeswehr.
The GAFCAM shares a lot of common ground with the civilian Institute of Aerospace Medicine of the German Aerospace Centre (DLR) with regard to the basic, adjacent and neighbouring disciplines of aerospace medicine. Close cooperation with the DLR´s institute is thus planned for the future to provide for the efficient and targeted development of available civilian and military aerospace medical capacities. The joint projects will include the implementation and supervision of specific research projects, the mutual use of largescale equipment as a cost-saving measure, and the exchange of personnel for training purposes and to promote young researchers.
The aeromedical services of the German Air Force
The aeromedical services of the German Air Force In its target active operational form, the German Air Force maintains 140 multi-role Eurofighters, 85 Tornado aircraft, 16 MALE (medium altitude, long endurance) UAVs and nine HALE (high altitude, long endurance) UAVs. The Eurofighter wings are stationed at the airfields in Laage, Nörvenich and Neuburg a.d. Donau. Air Group Richthofen at Wittmund is attached to Tactical Wing 31 Boelcke at Noervenich. In order to provide optimum coverage of German airspace, particularly over coastal and border areas, QRA (Quick reaction alert) units are also permanently based at Neuburg a.d. Donau and Wittmund.The wings have been renamed as ‘tactical air force wings’ (TaktLwG) to reflect their multi-role capability, as opposed to the former “fighter” and “fighter bomber” wings. The training of Eurofighter crews has been relocated to Holloman Air Force Base in the USA. The reconnaissance units of the Luftwaffe, including its TORNADO aircraft and HALE/MALE UAVs, are concentrated at the Kropp/Jagel airfields in the newly designated Tactical Reconnaissance Wing 51 Immelmann. The Air Force Reconnaissance Training Center is also located here. Fighter Bomber Wing 33 stationed in Buechel retains its previous assignment. The military airfield in Lechfeld is used as an alternative aerodrome as required, with restricted opening times.
The main objective of future air transport involves the amalgamation of strategic and operative air transport capacities. The target structure requires the German Air Force to operate 40 multi-role A400 M Airbus air transporters and up to 64 medium-lift CH-53 transport helicopters. Because of its central location in Germany and the current framework situation, the A400 Ms are stationed in Wunstorf. The CH-53 helicopters are combined in a helicopter squadron based at Laupheim and Schönewalde (Holzdorf airfield). Special flight services for the federal government and parliament are provided from Berlin-Brandenburg International Airport and Cologne Airport by a wing-sized unit (Flugbereitschaft BMVg).
The aeromedical care of personnel who require a pilot license is provided by the flight surgeons within the units of the individual military formations and the flight surgeons of the Bundeswehr Joint Medical Service. Flight surgeons support flight operations, provide flight safety services and flight physiology training, and are responsible for the aeromedical health of flight crews. They advise their wing commanders and all their superior Air Force officers on matters relating to aviation medicine and general healthcare, and with their specialist medical skills they contribute to the success of training, exercises and missions of airborne military formations. The Aviation Medical Service of the Bundeswehr ensures that the health of flight crews is such that they retain their operational capabilities. Extensive aeromedical support, regular examinations and evaluations of the aptitude, suitability and ability of personnel with regard to their assignments help reduce health-related risk factors among flight crews to a minimum.
The aeromedical support provided also includes preventive inoculation, advice on travel medicine, help in the preparation for and follow-up of missions, rehabilitation measures, the promotion of a healthy lifestyle, and encouragement to participate in sporting activities.
The aim of all aeromedical measures is to establish and maintain the best possible level of operational capacity, flight safety, morale and health among aircrews. They improve individual resistance to stress and optimise performance capacity, enhancing the ability of air crews to act appropriately in threshold situations and thus providing for sustainable efficiency and – in particular – safety during flight operations. Aviation medicine, as practised by flight surgeons in operational flight units, combines aspects of clinical aeromedicine, flight physiology, flight psychology, physiotherapy, sports, nutritional and occupational medicine with direct experience of flight operations to form an integrated sub-process of health provision within the overall healthcare requirement.
Flight surgeons in the field / AIRMEDEVAC
Appropriate and continuous aeromedical support is also an essential factor in successfully maintaining military flight operations at a deployed operating base. Special requirements thus apply with regard to the training, motivation and proficiency of flight surgeons stationed in the field. A deployed flight surgeon must also be capable of acting as Aeromedical Evacuation Coordinating Officer (AECO), providing the aeromedical expertise required by the casualty evacuation chain.
A flight surgeon must have the abilities required to discharge the duties of Medical Director (MD) in all STRAT- and TACAIRMEDEVAC missions and, like the civilian senior emergency physician, to coordinate the civilian emergency medical services during airborne evacuation. A Medical Crew Chief (MCC) is at hand to assist the flight surgeon. The flight crew also includes the Medical Device Technician, whose job it is to ensure that onboard medical equipment and material are both functional and safe. The direct medical treatment and monitoring of wounded, injured and sick personnel being transported by aircraft is provided by the specialists of the Bundeswehr Joint Medical Service.
In order to ensure the best possible medical results for the patients in accordance with the fundamental guideline of the Bundeswehr Joint Medical Service, a particular focus is placed on AIRMEDEVAC as a significant component of the evacuation chain. For this purpose, the German Air Force has a tried and tested system in place, which consists of various kinds of aircraft with different medical equipment, an airborne and aeromedical transport command system, and established standard operating procedures. To provide for strategic patient air evacuation worldwide, the German Air Force maintains an A310 MRTT Airbus with full medical configuration and the corresponding personnel in rapid response status at all times.
The introduction of the A400 M Airbus with its enhanced capacity and operational potential represents a significant extension of the spectrum of aircraft that can be used in STRAT- and TACAIRMEDEVAC missions.