Report: J. Hoitz

German Military Hospital in Hamburg: Regionally potent, internationally cross-linked

German Armed Forces run five military hospitals. One is located the North of Germany in Hamburg, the beautiful and well-known german harbour city.

History

The German Armed Forces Hospital in Hamburg was founded in 1958. It was established in buildings that were used by a british military hospital after WW II. Initially responsible only for military service members, in 1969 the hospital was opened for civilian patients also. In 1973, the emergency helicopter service for the Hamburg region was established by the German Armed Forces and located at the military hospital. Since those days, the military hospital has developed to a modern hospital well embedded in the military medical service as well as in the health care system in the Hamburg region.

Characteristics and faculties

Our mission comprises the medical care for the military service members in northern Germany and for civilian patients in the Hamburg region. According to our mission, the hospital is established as a general hospital with stress on acute care of patients in need of acute medicine, offering health care in surgical as well as in conservative specialties. However, treatment of patients is not the only major mission for the hospital. The training of medical officers after graduating from university until board certified specialists and subspecialists is another major mission for our hospital. Medical officers, nurses and technicians must be trained to perform their profession also in the missions abroad, where ever the German Armed Forces will be sent by the parliament, on the same level of quality in health care that is standard in our home country. 

Photo2 Arrival of an severely injured patient in the shock room Specialties regarding surgical faculties as well as emergency medicine are very important for military medical services abroad.. Consequently our hospital offers a broad spectrum of surgical disciplines. In the department of general and visceral surgery are performed from minor operations to extensive visceral operations with great experience in modern surgical techniques. This is a great range of therapeutic opportunities for the patients as well as a great range of training possibilities for surgeons extending from graduation from university to readiness to be deployed to fieldhospitals in military missions. The same is true for our department of orthopedy and trauma surgery. Our hospital has been certified as Regional Trauma Center within the Hamburg Trauma Network in 2010. Beyond that, the department of urology offers the complete spectrum of surgical and conservative treatment in the urogenital tract, a very important specialty with a view to the devastating blast injuries by IED in this body parts in dismounted soldiers.

Additionally to these surgical disciplines there are two other important disciplines cooperating to treat head and neck diseases and injuries. The department of Maxillo-Facial-Surgery is well known in the Hamburg region due to the wide range of surgical and therapeutic alternatives. From the point of view of military missions and the experience of the devastating effect of e.g. blast weapons in combat casualties, the numerous surgical operations of facial injuries in our hospital are as well important as the high sophisticated surgical reconstructions of facial defacements including the techniques of reconstruction of the mandibula and implantation of a set of teeth. The department of Ear – Nose – Throat (ENT) offers the whole spectrum of operations in this specialty, from minor operations up to laryngectomies and other major operations. As a specialty in the Hamburg area, a “Comprehensive Hearing Center” was established, offering different techniques to patients with hearing loss including the high sophisticated surgical technique of cochlea implant. The ENT doctors also operate on injuries at the skull base in cooperation with neurosurgeons, another very important specialty housed in our hospital. The ophthalmology clinic amends these specialties to the focus of head and neck injuries within the Hamburg region. These training opportunities are very important for training of medical officers for high level treatment of those injuries in german medical facilities in missions in Afghanistan and elsewhere. 

Photo3 In the operating theatre However, another major focus of our hospital is represented by emergency medicine. According to the german physician based preclinical emergency medical system, there is located a major emergency rescue centre in our hospital. The emergency medicine rescue helicopter, flown by border police and manned by medical personnel of our hospital consisting of emergency physician and emergency medical technician, performs over 2000 rescue missions per year. In addition, two emergency physician manned cars, ambulance and fast emergency physician car, operate in the emergency rescue center. As a further specialty, the emergency rescue center operates a highly sophisticated equipped special ambulance for interhospital transfers of severely ill patients from one intensive care unit to another hospital, including long distance transfers – e.g. for heart transplants in the German Heart Center in Berlin – over several hundred kilometres. The total of over 8500 rescue missions per year allows for excellent training of many medical officers in preparation of deployment as role 1 emergency physicians in military missions. 

Internal Medicine is a very important department, not only for the elderly civilian patients, but also for military service members suffering from acute and chronical diseases. The department houses specialists for cardiology, pulmonary, gastroenterology, oncology and hematology, and infectious diseases. There is a close cooperation to the department of neurology. This department offers high sophisticated neurophysiological diagnostic possibilities. The medical officers are very experienced in chronic neurologic diseases as multiple sclerosis. The department of dermatology is one of only three dermatological departments within the Hamburg metropol region offering the patients an inhouse treatment.  Photo11 As instructor in Workshop of Respiratory Tract Management at XVIII Asian Pacific Military Medical Conference (APMMC) Singapore 2008 Consequently the treat a lot of patients with severe dermatological problems, that cannot be managed on a outpatient basis. In close cooperation with the section of tropical diseases, the department of dermatology has also specialized in tropical dermal diseases. As a unique feature, the specialty of tropical medicine is another focus of our hospital. The department for tropical medicine is since 2006 affiliated to the Bernhard-Nocht-Institute for Tropical Medicine (BNI) and the attached Bernhard-Nocht-Klinik of the University-Hospital Hamburg Eppendorf. By this collaboration it is possible for the German Armed Forces to keep experts in the field of tropical medicine and rare infectious diseases constantly active. In addition to specialist in tropical medicine also many members of the department of anaesthesiology, internal medicine and emergency medicine are trained in barrier nursing. This allows for the unique feature of performing interhospital transfer of rare infectious patients under the condition of barrier nursing as well as sustainable treatment of these patients in intensive care units in the University Hospital Hamburg Eppendorf, enabled only by the additional allocation of trained military medical personnel. 

There is the experience to every nation deploying service members in missions that some of those service members returning form missions develop the symptoms of Post Traumatic Stress Disorder (PTSD). The department of Psychiatry has spezified for years in the treatment of PTSD and is currently one of the treatment centers of the German Military Medical Service. 

International Activities

Photo4 Emergency Rescue Helicopter outside There are a lot of international activities. A few years after being established, in our military hospital were treated Portuguese service members who suffered traumatic amputations in the colonial liberation wars in Angola and Mozambique. Starting in May 1963, over 5000 Portuguese patients have been treated with the climax in the 1970s, when there where dozens of those patients in our hospital at the same time. This assistance is going on until today. The Association of Portuguese disabled veterans ADFA (Associaçao dos Deficientes das Forças Armadas) cares of over 160.000 veterans in Portugal and works together with our hospital closely. Orthopedic surgeons of our hospital care for those patients in improving the prosthetic treatment. Every year, medical officers of the department of orthopedy and trauma surgery travel to Lisbon to see veterans with artificial limbs in cooperation with ADFA and the Portuguese Armed Forces. If necessary, they identify patients who should be treated in Hamburg. Next year the 50th anniversary of this international cooperation will be celebrated. In preparation of this event, a delegation of Portugues Veterans recently visited our military hospital. 

Photo4 Emergency Rescue Helicopter inside In the last years, there developed partnerships with military hospitals of other NATO nations. One partnership is related to the Polish military hospital in Scecin, Poland with several mutual visits of medical personnel since 2008. In 2011 the partnership with the French Hopital d`instruction des armées in Marseille, H.I.A. Alphonse Laveran was inaugurated. This partnership is very interesting because of the focus on tropical medicine in both military hospitals. 

After the Congo-mission had revealed a significant lack of microbiological capabilities in the field the department initiated a project for the rapid PCR-based diagnosis of infections caused by protozoa and  bacteria like Salmonella typhi. 2007 this was in established in Ghana in cooperation with the Kumasi Centre for Collaborative Research. Also a partnership was initiated with the Presbyterian Hospital in Agogo, Ghana. This provides the opportunity to send younger doctors and nurses regularly to West-Africa to gain expertise in tropical   medicine and to directly exchange experiences with African doctors.

Due to a cooperation with the Bernhard-Nocht-Institute the department is also involved into a couple of follow-up studies taking place in Madagascar – one topic is the diagnosis of typhoid fever and the partially PCR – based diagnosis of parasites and protozoa causing diarrhoea in children and adults which is another relevant topic also in field missions. We have participated in the foundation of a microbiology lab and in the training of local staff and technical assistants. When analysing stool samples an amazingly high percentage was found positive for schistosomes which provided the ground for a mass treatment campaign in schools in 2012. Another project is the screening of pregnant women for HIV and other sexually transmitted diseases. Together with the virologists of the BNI we are planning to get involved into a Lassavirus-project in Nigeria due to the fact that teaching and training of barrier nursing methods is a mainstay of the activities of our department. The presence of viral haemorrhagic fevers in Afghanistan and in the Kosovo (also in Libya and Mali) makes it necessary to be prepared. The entomologist Lt. Col. Krueger is involved into two international projects. One is studying the sandfly-vectors of cutaneous leishmaniosis in Northern Cameroon and the second one in cooperation with the University of Pristine deals with the epidemiology of Crimean-Congo-Virus in the Kosovo and is supported by the local state government.

Photo5 Intensive Care Interhospital Transfer Ambulance outside As mentioned above, training in emergency medicine is one major focus in our hospital. Accordingly we work together closely with the NATO Centre of Excellence for Military Medicine (MILMED COE) in Budapest. In our simulation center, we conduct together an international course, NATO Emergency Medical Pre-Deployment Team Training (see MCI 03/12). In this international training military medical service members of several nations work together in handling emergency patients in preparation of international cooperation in the missions abroad . 

The head of the Department of Psychiatry is working in the NATO Military Mental Health Expert Panel (MMHEP) as the representative of Germany. This group is the advisory board for the COMEDS of the NATO partners. Here he yields the great experience of our Department of Psychiatry. 

Photo5 Intensive Care Interhospital Transfer Ambulance inside There has been established a governmental program of international military training assistance led by the German Ministry of Defence. Within this program also physicians, nurses and technicians from non-NATO countries also can be trained in their specialty. After nine months of German language Courses they are sent to the German military hospitals. Those international students planned for our hospitals are contacted during the period of language course. The head of the department concerned where they will work according to their specialty develops curricula tailored to the special needs of these students. In addition to the professional training, the students get an impression of Hamburg, with personal visits to the German Armed Forces Command and Staff College and a University of Armed Forces that are located, and of also Germany. For this reason the guests have the opportunity to visit the governmental district in the German Capital, Berlin, and other military medical facilities, e.g. Military Medical Academy in Munich. The advantage of this international training program for our house staff with students from several countries like Mongolia, Azerbaijan, Armenia, Georgia, Thailand, Mali, Jemen etc.  consists of the exchange of information on the structure, training programs and circumstances in the home countries of our guests. The medical officer responsible for this program in our hospital has repeated contacts to former students of our hospital and has initiated an “Alumni” network for ongoing exchange of experiences among the former students. 

Members of our hospital have also participated in international conferences and workshops, presenting the German experience in military medicine. These conferences are not restricted to Europe but can also be elsewhere e.g. USA, South-Africa, Asia etc. and comprise every medical specialty.  

Photo6 Patient transfer under condition of barrier nursing However, we also send German military officers into international trainings. Recently there has been sent the second resident of the department of ENT in row to the French Hopital d`instruction des armées (HIA) Percy, France. There the ENT-residents have the opportunity within one year to be trained in this specialty abroad and learn about the French way of treating ENT patients. They are very welcome and completely integrated in the faculty of the department of Otorhinolaryngology in H.I.A. Percy. Additionally, this is a very appreciated opportunity to extend their knowledge in French language being very important for international cooperation between Germany and France. 



Conclusion

Since its foundation, the German Armed Forces Military Medical Hospital in Hamburg has developed from a facility dedicated to the treatment of military patients only to a modern hospital within the Hamburg region well accepted by civilian patients also. There have been established and extended unique features like “Comprehensive Hearing Center”, tropical medicine and others within the Hamburg region hospitals and the other military hospitals offering high sophisticated treatment to our patients. It grew up to one the major training centre for military medical officers in emergency medicine and as a well accepted training site for young military medical officers in every specialty. The international activities have greatly expanded from the beginning in 1963 and have led to an extensive international network. Even in the future, the German Armed Forces Hospital will be part of an internationally growing military medical community, firmly anchored in modern medicine facilities in the Hamburg region and training military medical personnel in their professions in preparation for deployment to missions anywhere Germany is joining in. 

Date: 09/13/2018

Source: Medical Corps International Forum 4/2012