Article: J. BACKUS, KAHNERT (GERMANY)

Protected Patient Transport in the German Armed Forces

Synopsis of protected vehicles for the surface transport of wounded personnel

Summary
One of the most urgent tasks in medical service care for supported field units is the provision of qualified on site first aid as
well as qualified transport of wounded personnel by medical squad (Sanitätstrupp = SanTrp) or mobile medical units (Beweg -
liche Arzttrupps = BAT).
The following article provides an overview of the protected, earthbound means for transporting wounded personnel the Central
Medical Service of the German Armed Forces (ZSanDstBw) currently employs as well as an outlook into the future.

Conceptual Basics

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The German Armed Forces (Bw) with their SanDstBw feature a military health care system that is able to persevere and is sufficiently equipped for the requirements of deployment and for current scientific and technological developments. This ensures health care that is able to sufficiently meet the particular needs of the armed forces and that guarantees treatment
for soldiers deployed abroad corresponding to the professional standard in Germany.

The early, immediate and professional introduction of medical competence is
particularly significant in emergency medical care needed for survival and for the
result of the subsequent treatment of the sick, injured and wounded. To save lives
and to avoid additional and unnecessary complications, medical care begins as
close as possible to the site of younding and is continued through suitable followup
care. This is achieved through the entire chain of survival system, which
takes into account the respective theatres of operations.

In particular, it includes:

■ Self- and buddy-care on the ground,
■ Initial medical and lifesaving care (NATO Role 1),
■ Initial emergency surgical care (NATO Role 2),
■ clinical acute care on the ground (NATO Role 3),
■ subsequent in- or outpatient treatment and rehabilitation in Germany (NATO Role 4).

The chain of survival allows for flexible management of wounded personnel
within its specific echelons. Wounded personnel are immediately transported to the
medical facility best suited for their treatment.
The organisation of transporting wounded
personnel represents an integral part of the chain of survival and thus of emergency
medical care. Wounded personnel are transported as carefully and quickly as
possible to the next suitable medical facility based on the state of their emergency
medical stabilisation. In terms of deployment, this is derived from the basic
requirement to make available as quickly as possible qualified medical care at any
time and in any place in the theatre of operations or to sustainably start medical
treatment during secondary transport1 to another medical facility (medical service
treatment continuum).

In the system capability requirement “Transport of wounded personnel in the
armed forces“ dated 20 June 2005, qualified transport of wounded personnel is
therefore understood to be “target-oriented, adequate transport of the wounded, injured
and sick with means of transport in a way that is adjusted to medical and military requirements. Said means of transport are always identified with the protection symbol
of the Red Cross on a white background, with the exception of those means of transport that
are only temporarily medically furnished.“

In the context of care for wounded personnel, the time factor plays an important
role. Qualified wounded personnel transport is conducted based on the emergency
medical and catastrophe standards that apply at home. Furthermore, a distinction
is still made between airborne (AIRMEDEVAC) and earthbound (GROUNDMEDEVAC)
wounded personnel transport. In each case, the goal is to transport
wounded personnel as quickly as possible to a suitable medical facility that is prepared
to admit them without frequently changing the transport vehicle. During
the entire transport, it must be possible to monitor and treat patients in a qualified way.

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Based on experience from exercises and deployments as well as basic professional
considerations, a highly mobile means of transporting wounded personnel on the
ground that meets deployment requirements is required for NATO medical services
in order to guarantee qualitatively adequate medical care. The following
functional requirements are placed on a vehicle intended for the transport of
wounded personnel in order to fulfil the deployment mission:

Capability to appropriately transport patients at any time and in every
deployment scenario in terms of the most care possible, even under extreme
meteorological conditions and in every terrain;

Capability to medically monitor and treat patients according to needs during the entire transport;

For the vehicle, capability to protect wounded personnel, medical personnel
and medical equipment in a way that offers maximum system conformity
and is reasonable given the threat scenario

Wounded personnel must be able to be brought in and passed on with consideration
given to the type and severity of the injury and military situation. It must be possible to trace the route and the patients' health-related state through out the entire transport.

In order to fulfil the requirements of the system capability requirement (SFF)
“Transport of wounded personnel in the armed forces“, in particular considering
the increasingly changing deployment reality, the medical service of the German
armed forces must have suitable, protected medical vehicles that, in particular,
demonstrate the same level of protection, corresponding mobility and as
close to equivalent models as possible as the troops being supported. However, in
addition to deployments made for stabilisation, it is also necessary to be able to
react in a way that is assertive and highly mobile in operations with high combat
intensity against a militarily organised enemy as well as against asymmetrically
combative troops.

The deployment options depicted as well as the various types of troops requiring
medical support call for a certain spectrum of medical transport vehicles. The
objective is to make available missionoptimised means of transporting wounded
personnel by land, air and sea using as often as possible vehicle platforms that
can also be used by the supported troops and that are incorporated in a future networked
operation leadership (NetOpFü) via a command information system/ command and deployment system that fulfils demands so that medical-specific demands can be met in all imaginable deployment scenarios.

Guidelines for and types of protected, earthbound means of transporting wounded personnel

The ability to use protected, earthbound wounded personnel transport is significant
to all troops deployed in terms of the ability to survive. At the heart of the matter,
the following guidelines apply, as described above: Medical troops must
have the same level of mobility and protection as the troops receiving medical
care!

The three guidelines derived from this “lightly, medium level, and heavily protected medical vehicles“ and the resulting additional available vehicle variations are essentially distinguished with regard to the number of VUK to be transported and their operative deployment capabilities.

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Light protected medical vehicle Vehicles that can be deployed with CH
53 are required for the medical support of operations with airborne troops. All
requirements regarding protection, mobility and medical functionality are therefore
limited to the maximum vehicle load capacity and the transport dimensions/
hold dimensions of the available aircraft. The current airborne medical units
(LBAT) are comprised of an emergency medical vehicle and a wounded personnel
transport vehicle, each based on the WOLF vehicle with long wheelbase and
modular shatter protection (MSS). They have reached the limit of technical capacity
and sustainability and also connect two crews as a vehicle combination. The
intended armament project “protected air/land medical vehicle“ should fulfil all
requirements as a “one-vehicle-solution“. The current solution recommendations for
a suitable medical vehicle still exceed the permissible air load mass. Therefore, the
innovative potential of the defence industry is required in order to present a vehicle
that fulfils all requirements.

However, even deployment under the primarily very confined and at times Alpine
street and terrain conditions as is the case in the theatres of operation of the
German operational contingent in North Afghanistan, for example requires small
and highly mobile protected vehicles. The LBAT-WÖLFE deployed up to now are agile,
but they are not a long-term, reliable solution due to protection-related considerations.
Thus, the EAGLE IV, which was already introduced in the armed forces, was
equipped as a medical variation and has been deployed as EAGLE IV BAT in the AFG
theatre of operations since March 2011.

Medical requirements for the lgSanKfz
■ Medical equipment for the transport of one supine VUK (“intensive care“)
■ Crew: 3-man crew concept
■ Clearance over the stretcher of approx. 60 cm or – to the extent this is not possible
– ergonomic optimisation for realisable possibilities
■ Universal retrofit kit “wounded personnel transport“


Mobility and protection
■ in accordance with the requirements for mobility and relocating capabilities as
well as the protection level of the vehicles of the troops in need of support

Medium level protected medical vehicle
Due to the cross-section-formed task assignment, the medium level protected
medical vehicle (mgSanKfz) will also form part of the main scope of protected
wounded personnel transport vehicle for the central medical service of the German
armed forces. It is used to complete a qualified primary transport of the injured,
wounded and sick at all levels of severities from the location of the injury/wound or
wounded nest to a medical facility with care level 1 or 2 (role 1 or 2) under constant
survival medical monitoring and guarantee of vital functions with protection.

In this context, the medical equipment of a medium level protected medical vehicle
must offer the ability to provide quick initial medical treatment on site and therapy
and/or prophylaxis for life-threatening complications that arise in the context
of rescue or transport.

Because of the lacking reserves of the current YAK vehicle type in the BAT version
from the LKW armaments project vehicle, medium level, protected, the original
demands will be met with this vehicle type as a representative of the “medium
level medical vehicle“ line.

In the context of the new medium level protected medical vehicle project, a suitable
vehicle can now be identified that closes the gap between the lightly protected
medical vehicle and the heavily protected medical vehicle in terms of
mobility and medical functionality requirements. Because of the required
transport capacities, two supine VUK must be able to be properly admitted into the
vehicle.

Medical requirements for the medium level medical vehicle
■ Medical equipment for the transport of two supine VUKs (one of which is in “intensive care“)
■ Up to 4-man crew concept
■ The medical personnel must be able to provide the VUK with medical care in an ergonomically comparable way (working height)
■ Clearance over the stretchers should be approx. 60 cm or – if this is not possible – ergonomically optimised
■ Universal retrofit kit “wounded personnel transport“ 

Mobility and protection
■ in accordance with the requirements for mobility and protection level of the vehicles of the troops in need of support
■ permissible overall weight within the limits of lightly and heavily protected medical vehicles

Weapon station
■ Ability to adapt a remote controlled light weapon station (FLW) for the use
of an MG for self-defense 

Heavily protected medical vehicle 
Even armoured combat troops must be able to support themselves on a wounded transport vehicle for medical support in any deployment scenario; said vehicle must be able to follow them with comparable protection in every terrain and without limitations. Thus, the successor of the KrKwPz M 113, the heavily protected medical vehicle (sgSanKfz), was developed
based on the GTK BOXER. Its purpose is to provide medical support to armoured
combat troops and those troops that used the GTK BOXER as a base platform to support
themselves.

Medical requirements for the sgSanKfz
■ Medical equipment for the transport of three supine VUKs (one of which is in “intensive care“)
■ Crew: Up to 4-man crew concept
■ The medical personnel must be able to provide the VUK with medical care in an ergonomically comparable way (standing height)
■ Clearance over the stretchers should be approx. 60 cm or – if this is not possible – ergonomically optimised
■ Universal retrofit kit “wounded personnel transport“ 

Mobility and protection
■ in accordance with the requirements for mobility and protection level of the vehicles of the troops in need of support


Weapon station
■ Ability to adapt a remote controlled light weapon station (FLW) for the use of an MG for self-defense

Medical functionality

In terms of the medical vehicles in use up to now, the medical functionality as an
medical squad or mobile medical unit vehicle was determined in particular
through the medical equipment used in the vehicles. Thus, the vehicles were
deployable for either purpose. As a result, the ability to rededicate in terms of function
was not specified.

To increase flexibility in practice, this distinction should be avoided in future,
and the vehicles should be equipped with a so-called universal retrofit kit "wounded
personnel transport", as depicted in Image 3. Said retrofit kit depicts the
functionalities for a mobile medical unit. The difference between the two
funcitons is thus no longer primarily based on materials; but rather on staffing
(both include paramedics, the mobile medical unit always includes a medical officer).

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Additional vehicle variations

TPz FUCHS San

Since KFOR began to be deployed in 1999, readily available army TPz have
been refitted as wounded transport vehicles due to the recognized capability gap
for protected wounded transport for deployments abroad.

The ZSanDstBw has TPs FUCHS San in various armament states deployed both
with the German operational contingents KFOR and ISAF as well as at home for
deployment preparation training. Currently, all vehicles being used in
Afghanistan with modular protective equipment and IDE/mine protection in
the version are being refitted as BAT. The TPz FUCHS has proven itself in the
field in terms of its protective effect and medical functionality, and will continue
to be used until a sufficient number of sgSanKfz and mgSanKfz have been provided
for medical support.

Nevertheless, it remains to be determined whether or not the vehicle's dimensions and weight limit its tactical mobility when deployed in urbane areas and as a patrol escort on confined routes and mule tracks. Furthermore, qualified wounded transport can only be guaranteed
for one wounded person.

Protected wounded transport container (GVTC)
In order to constantly maintain the admittance capacities in the primary care facilities during operations with increased threat scenario and high combat intensity, wounded individuals who have already been stabilised must be able to be transported with protection to other medical care facilities (secondary transport). For this, a container-based system is planned
that has main protection, ballistics protection and protection against dangers from the side through booby-traps. The GVTC should also be able to transport four supine and six sitting individuals that have been lightly wounded or six supine individuals with light or minor injuries. The MULTI FSA is intended for use as a carrier vehicle.

BV 206 S
As described above, wounded transport vehicles must have a capability profile analogue to  the vehicles used by the troops in need of medical support in terms of protection and  mobility. The vehicle equipment of the units from the central medical service of the
German armed forces must therefore be primarily oriented toward their mobile large equipment in order to ensure the medical support of the army's mountain troops.
Previously, the vehicle type BV 206 S in its variations as SanTrp and BAT were
used. This vehicle has high mobility due to its continuous tracks; however, with
regard to its performance capabilities and its growth potential in terms of the
intended medical functionality, it has reached its limits. Therefore, a new, suitable
successor vehicle must now be identified that fulfils the requirements for mobility and medical functionality.

Summary

for deployed troops rightly leads to the expectation that in the case of sickness, injury or wounding a treatment result can be achieved that corresponds to the current professional standard in Germany. This maxime is an expression of our conception of humanity and has an important and positive effect on the motivation and deployment preparedness of the
troops. Qualified and protected patient transport is an essential component in terms of fulfilling this maxime, in particular in theatres of operation.

Based on the three conceptually derived basic types "lightly, medium level and heavily protected medical vehicles", it is possible to sufficiently take into account the requirements for the medical service in the context of highly complex medical care missions, in particular in theatres of operation. The troops supported by the medical service have to andcan be provided with adequate means of patient transport based on the deployment scenario.

The additional vehicle variations  available sensibly complete the medical deployment portfolio with regard to deployment-relevant protected means of transporting the sick, the injured and the wounded.

References with the author.

OFA Dr. Backus / OTL Kahnert
1) Primary transport = Transport from the
place of the incident to a medical service treatment
facility
Secondary transport = Transport from a
treatment facility to another treatment facility
Released wounded personnel transport =
Transport of wounded personnel that have
received primary care and are able to be transferred
and whose state is not acutely lifethreatening
from a medical facility to a continued
treatment medical facility, the goal
being to relieve the strain on the primary
treatment facility.

Date: 09/12/2011

Source: MCIF 3/11