Czech Republic

Cooperation and coordination are key to success – the multifocal role of the Czech Armed Forces Military Medical Service // Interview with Brigadier General Zoltan Bubenik, Czech Surgeon General (EMMS 2021)

Basic Task of the Military Medical Service

To guarantee the soldiers and officers of the Czech Armed Forces an outstanding medical support in operations and to ensure both the physical and mental welfare. The medical care is based on prevention and treatment procedures, however, if military personnel get injured, they should receive the standard care.

Structure

The Surgeon General is double-hatted as the CHOD Medical Advisor
and the Director of the Military Medicine Division, integrated into the structure of
the General Staff. The Military Medicine Division of the Ministry of Defence (MoD MMD) of the Czech Republic is responsible for concepts, policy and inspection activities, capability development and for specialist and methodological management in the domain of military medicine. The MoD MMD runs the planning of assets and funds in the military medical domain. It provides the performance of functions of the service authority, which is responsible for military occupational specialties in the specialist purview of the Director of the MoD Military Medical Division. It performs the government functions and the government medical inspection in the area of public health protection and support, government functions and government veterinary inspection in the area of veterinary care, government functions in the area of pharmaceuticals management and in the field of peaceful use of nuclear energy and ionising radiation in the Ministry of Defence. 

The MoD MMD provides specialist and methodological guidance to the military canine service, and biological protection of military airfields and flight operations
in the Ministry of Defence. It supervises the performance of hygienic,
counter-epidemiological and veterinary in operations of the Czech Armed Forces
 in the domestic territory, on operations abroad and in the provision of the Host Nation Support in the territory of the Czech Republic. 

The Military Medical Agency has three departments directly dealing with medical service command and control: Medical Services Department, Pharmacy and Medical Materiel and Veterinary Service Department and Operational Psychology Department. The Military Medical Agency is responsible for medical command and control, health care quality, medical development and cooperation with other authorities regarding force health protection, medical supply activities, medical assistance and crisis management. Field hospitals are part of the Military Medical Agency. Currently, there is a significant strengthening of the capabilities and capacities of these hospitals, including an increase in the capacity of MEDEVAC elements. Within this framework, the construction of a Medical Battalion is underway, as a key organizational structure for the deployable military medical units.

The Primary Health Care within the Czech Armed Forces is mostly covered by Regional Medical Treatment Centres (7) and Battalion or Based Aid Stations (17). Regional Medical Treatment Centres provide the Initial Care for the military personnel and other related beneficiaries and ensure the primary contact members of the armed forces with the medical service. The Role 1 medical unit - battalion aid stations as an integral part of the military units, perform tasks mainly within the area of medical training, medical support for military training, exercises and force deployments.

MILITARY MEDICAL SERVICE STRUCTURE

Military Hospitals

There are three military hospitals in the structure of Ministry of Defence of the Czech Republic. Although the primary target group of patients are the members of the Czech Armed Forces, the military hospitals provide medical care for the civilian population in the given region. Therefore, almost 90% of patients in military hospitals are civilians. The hospitals have two sources of funding: reimbursement from the health insurance companies as well as funding from the Ministry of Defence. Military hospitals assess the health status of soldiers in active duty and applicants (recruits) to join the Czech Armed Forces. They play a key role in providing medical training to military medical personnel.

The Military University Hospital Prague is a training, educational and professional medical facility of the Czech Armed Forces, which provides comprehensive health care at the level of university hospital. The number of treated patients, as outpatients, and hospitalized is gradually increasing (around 1,1 million outpatients and 25 thousand hospitalized patients yearly).

The Military University Hospital Prague provides a nearly complete range of medical services except for paediatrics, obstetrics, cardiac surgery, and treatment of burns. It focuses mainly on acute surgical conditions and internal profile, the care of polytrauma, including brain and spinal cord injuries. 

The Military University Hospital Prague is continuously developing modern, especially minimally invasive, medical procedures in various fields. 

The hospital has currently 10 clinics, 20 specialized departments and 674 beds. The hospital has been also involved in the care of war veterans. The quality and safety of care in the Military University Hospital is in accordance with international principles and the hospital has been accredited by a Czech auditing body.

The Military Hospital in Brno consists of following wards: Department of Internal Medicine with ICU and Oncological short-stay ward, Surgical and Orthopaedic department with ICU, Neurological department with ICU, Psychiatric department, Ophthalmology department, and ENT department include a total of 212 beds for acute care patients. Clinics radiology, Clinical Laboratories, Psychology, Rehabilitation and physiotherapy, Dermatology, Stomatology, Anaesthesiology and resuscitation, Pharmacy and Medical Technology, Medical assessment board and Department of Occupational Diseases belong to the outpatient clinics. The hospital is well equipped with modern technology and reflects contemporary trends in medicine.

The Military Hospital in Olomouc is the oldest military hospital in the territory of the Czech Republic (established in 1748). The Military Hospital in Olomouc offers an identical range of medical services as the Military Hospital in Brno. It has currently 273 beds. The hospital is equipped with Light Speed VCT, which is one of the latest innovations in CT technology. It has other top equipment for laparoscopy, arthroscopy, endoscopy, EEG, EMG etc. Since 2006, the hospital has become involved in the regional emergency medical system.

Military Institutes

The Institute of the Aviation Medicine Prague (the IAM) is a diagnostic, therapeutic, advisory and training facility with a nationwide competence for both civilian and military personnel, with the possibility of providing a whole range of highly specific services exploitable by other patients and even healthy persons. 

The IAM performs both initial and regular medical examinations of flight personnel, air traffic control personnel and the people involved in rescue operations (e.g. divers, fight – fighters, rescuers, paramedics and police officers) and therapeutical and advisory activities relating to the military and aviation personnel, paratroopers, divers and air traffic controllers. The above-mentioned services are primarily aimed at making a speedy diagnosis, after-treatment, assessment of an examinee´s ability to execute his/her job and giving recommendations on preventive as well as therapeutic measures. Skilled staff provide these services, mainly to outpatients, but also by means of a short-term hospitalization with frequently used methods requiring sophisticated equipment that is not in use in other clinical branches (hypobaric chambers, simulators etc.).

BNP

GYRO IPT II

TL-39F Flight Simulator

The Military Health Institute in Prague is a specialized medical facility responsible for anti-epidemic and hygienic support within the Czech military, laboratory and expertise activities (both in the Czech territory and in Czech military foreign deployments), radiation protection, biological protection, vaccination of troops of the Czech Armed Forces and operation of the Serum Bank. The Institute includes the Preventive Care Department in Ceske Budejovice and the Biological Defence Department in Techonin.

The Department at Technion is a specialized medical institution of the Czech Armed Forces ensuring complete biological defence primarily in favor of the Czech troops. There are the following primary objectives:

• Isolation of bacilli carriers of dangerous diseases and prevention of spreading of contagious diseases to the rest of the population;
• Identification of the sort of contamination, determination of diagnosis, suggestion and taking necessary measures - especially in issues of prevention;
• Treatment of affected persons;
• Biological defence research.

The Biological Defence Department includes the Specialized Infection Hospital for persons affected with dangerous or exotic infections under biosafety level 3 & 4 conditions equipped with laboratories for diagnostics of selected biological agents. It also offers isolation-quarantine capabilities for the examination of the troops returning from military missions abroad. 

The Department serves as a training and education facility both for military and civilian specialists from the Czech Republic and within the NATO (Centre of Excellence).

The Department is part of the Integrated Rescue System of the Czech Republic, and, at the same time, it is involved in the NATO biological defence system.

The Biological Defence Department in Techonin:

The Biological Defence Department in Techonin

Number of the Medical Service Personnel

Qualified physicians:	288
Qualified dentists:	11
Pharmacists:	30
Veterinary surgeons:	29
Assisting/nursing personnel:	533
Medics / drivers:	181

Training

Basic training for all members of the Czech Armed Forces is provided by the Training Command - Military Academy in Vyskov. Specialized education and training of military physicians and nurses are covered by the Faculty of Military Health Sciences in Hradec Kralove and by Military Hospitals.

 

The Faculty of Military Health Sciences (FMHS) of the University of Defence represents a centre of medical education and research of the Czech Army with long-term history in the Czech Republic. At present, the Faculty is the only institution, which provides a military medical education at the university level. The Faculty provides an education in one accredited Bachelor´s study program (Military Paramedic), three Master´s study programs (Militay General Medicine, Military Dentistry, Military Pharmacy) and eight doctoral study programs. However, the main role is not only to educate and train all medical, pharmaceutical and nursing specialist, but also to provide a general support to the Military Medical Service.

The specificity of this educational model lies in a close cooperation with other scientific and educational workplaces. Thus the Faculty enjoys close collegial relationships with the Medical and Pharmaceutical Faculties of Charles University, Faculty of Health Studies of University Pardubice, the Faculty Hospital Hradec Kralove and the Military Medical Agency. 

At present, the Faculty covers the needs of troops concerning medical professional training in all specializations, medical science and research. The Faculty has educated a lot of specialist  who have been awarded key positions both at national and international levels. 

The Active Reserves 

The Active Reserves Unit was founded in 2017 and it was primarily designated for strengthening the Biological Defence Department in Techonin. Currently, there are also members of the Medical Battlion and Medical Material Center. 

MEDEVAC capabilities

Patient transport (ground medical evacuation) can be provided by protected transport vehicles of the Military Medical Service. That are eight-wheeled Pandur II armoured personnel carriers and, the medical version of Iveco LMV (Light Multirole Vehicle). Medical version replaces older Soviet-era OT-64 SKOT. All the types of vehicles have the same capacity - four casualties. 

Airbus A-319 CJ

For STRATEVAC medically adjusted Airbus A-319 CJ or CASA C-295 is used. The specialized equipment, the Patient Transport Unit (PTU), can be quickly installed for the transport of intensive care patients. The aircraft interior can be adjusted to accommodate up to six lying patients (two PTUs for seriously injured and four beds for slightly or moderately wounded).

AIR TACEVAC can be performed
by FW assets (CASA C - 295).

Field Deployments

Treatment chain for wounded soldiers commences at the self-aid or body-aid and continues with the enhanced first aid delivered by a combat lifesaver at the point of injury. Role 1 MTF encompasses the provision of the first emergency medical care. 

The Medical Service of the Czech Armed Forces has currently the capability to deploy MTFs up to Role 2E – (field hospital). The Military Medical Service has two field hospitals available. Each field hospital is composed of several tents and containers, containing emergency, surgery with two operation rooms, ICU, ward, dentistry, laboratory, X-Ray, ultrasound, CT, pharmacy and sterilization. As mentioned above, the construction of additional medical field elements is currently underway to strengthen the capacity of the deployable units.

The Military Medical Service personnel have been participating in all major foreign activities. The fact that the Czech military medical personnel are being included in the NATO, UN or EU-led missions reflects their considerable credibility. 

Field hospitals personnel were involved e.g. in the missions in Albania, Turkey, Afghanistan or Iraq, medical teams were deployed in several peacekeeping operations. 

Experience of active deployment with medical services of other nations:

Period	Operation	Area	Unit	Personnel
1994 - 1998	UNCRO	Croatia	FST	40
1999	AFOR	Albania	FH	89
1999	Humanitarian	Turkey	MT	35
1999 - 2001	WEU MAPE	Albania	MT	8
2002 - 2003	Enduring Freedom	Kuwait	D	40
2002 - 2003	ISAF	Afghanistan	FH	260
2003	ISAF	Afghanistan	FST	11
2003	Iraqi Freedom	Iraq	FH	310
2004 - 2005	Iraqi Freedom	Iraq	FST	60
2005 - 2006	Winter Race	Pakistan	MT	30
2007 - 2008	ISAF	Afghanistan	FH	500
2011 - 2017	Resolute Support	Afghanistan	FST	240
2013 - 2022	EUTM	Mali	MVT	38
2015 - 2020	EUNAVFOR MED Sophia	Mediterranean Sea	I	10
2016 - 2017	Inherent Resolve	Iraq	FST	15
2020	Resolute Support	Afghanistan	FST	50
2021	Resolute Support	Afghanistan	PCHT	2x16
2018-2022 (1)  (2 rotace za rok – 6 měsíců)	ÚU AČR eFP Litva	Litva	I	19
2018-2022 (1) (2 rotace za rok – 6 měsíců)	ÚU AČR eFP Lotyšsko	Lotyšsko	I	18
2021-2022 (1)	ÚU AČR Mali	Mali	MVT	5
2022 (03-07)	ÚU AČR enhanced Air Policing Litva	Litva	I	1
2021-2022  (4 rotace po 4 měsících)	ÚU AČR Takuba	Mali	I	8
2021-2022 (1)	EUNAVFOR MED IRINI	HQ Roma	I	15

Caption: 
FH – Field Hospital, FST – Field Surgical Team, MT – Medical Team, MVT – Medical and Vet Team, D – Detachment, I - Individuals

Civil-Military Cooperation

Military Hospitals are fully integrated into the civilian healthcare system.

Air Rescue Service and Emergency Medicine Department Pilsen-Line has become an integral part of the state-sponsored emergency medical services and acts as an important part of the Integrated Rescue System of the Czech Republic. Currently, The Czech Armed Forces have been fully covering the Air Rescue Service in the regions of South Bohemia, Karlovy Vary and Plzen. 

The Institute of Aviation Medicine in Prague serves the military and civilian flight personnel and air traffic control service.

The Biological Defence Centre in Techonin serves as a training and education facility both for military and civilian specialists from the Czech Republic and within NATO (CBRN Centre of Excellence). 

The department is also a part of the Integrated Rescue System of the Czech Republic, and at the same time, it is involved in the NATO biological defence system.

Other Special Aspects

Military Medical Science Letters is a national professional journal of military doctors, pharmacists and veterinary doctors with a long tradition. It is the oldest military journal in the Czech Republic whose first issue was published in April 1925. 

The journal is mainly aimed at military pharmacists, veterinary doctors and researchers, members of the integrated rescue system units and the others from the professional public. 

The journal informs of research work results in conditions of military health care.
 It presents preventive, diagnostic and therapeutic activities and it is a significant resource of experience from the practice of the Czech Armed Forces Medical Service, not only in peacetime but also wartime services mainly in foreign missions. 

Contributions from all medical branches such as pharmacy, veterinary medicine, works in the field of nursing, and other works focused on military health care are possible to be published here. 

Military Medical Science Letters meets the criteria set by the Research and Development Council of the Czech Republic Government and it is included in the List of the Reviewed Non- Impact Factor Journals published in the Czech Republic. 

 

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 (status: 17 May 2024)

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