CAMO24 – Casualty Move Exercise series enters its final stage

Exercise focus and exercise objectives 
After 2020, 2022 and 2023, the Camo Exercise series is taking its last decisive step, a step on a more or less untrodden field which is the interaction between the military and the civilian side. After three iterations during which the development of CAMO went through the tactical, high tactical and operational levels of NATOArticle 5 Collective Defence Operations, always focusing on the military medical support, a so far unexplored and highest possible level was finally reached to be targeted on: the national and multinational civilian-military cooperation regarding medical evacuation and the handover of patients from NATO back to the national healthcare systems. In addition, it will apply and test the recently released NATO Patient Flow Management Guideline for Article 5 Operations. It also contributes to the development of procedures aiming on the interaction between the military and the civilian environment with regard to the further distribution of patients from Rearward Medical Evacuation Hubs to nations.It also opens a huge window of opportunity not only for MMCC-E,which also owns a CIV-MIL Branch in its structure, but also for NATO, EU and participating nations to develop a common understanding of processes and harmonise their concepts which are required to receive and treat a high number of patients at the same time. Having all this in mind, this exercise will be a huge step for the participating institutions, entities and nations in terms of common medical support to collective defence with a strong civ-mil interface.

Focus CAMO20 -CAMO24 (source: MMCC-E)

CAMO exercise overview 2020 to 2024
Being a multinational institution, the MMCC-E was created on the spirit of mutual cooperation and coordinative interaction. Therefore, it always had to rely on the support of its participating NATO and EU nations when it comes to achieving its goals and making big events like exercises happen.
After Vigorous Warrior 2022-CASUALTY MOVE 2022 (VW/ CAMO22), hosted by Hungary and CAMO23, hosted by Estonia, the next CAMO exercise will take place in ENKÖPING (Sweden) in September 2024 as Swedish Armed Forces offered to host the fourth iteration called Casualty Move 2024 (CAMO24). Brigadier General Dr Stefan Kowitz (MD), Director of the MMCC-E, already expressed his gratitude to the Swedish Armed Forces on behalf of the MMCC-E, EU and NATO for hosting CAMO24. He stated that after having received a very positive feedback from EU and NATO medical community, Sweden as a participant in and the host of CAMO24, will greatly contribute to the operational planning for the defence of NATOs Northern flank, enhancing its own and neighbouring nations’ military and civilian medical capabilities.
It is also a strong sign towards NATO’s opponents showing that the new NATO-member state SWE has already established a very intensive cooperation on all levels. Thus, CAMO24 can be seen as but one of many consecutive steps on the way to fully integrate SWE to the alliance in the near future. It also shows that SWE and all participating NATO nations strongly support this process by closely working together and making this exercise a successful one.
A first visit to ENKÖPING Garrisons Training Facility conducted in November 2023 by an MMCC-E delegation showed that the infrastructure offered by the Swedish Armed Forces can easily host a complex exercise like CAMO24. It also proved that the commitment of SWE personnel assigned to supporting the exercise is outstanding and stands for an inseparable cooperation between SWEDEN and NATO in the future.
The desired focus of CAMO24 rests on close civ-mil interaction. The Exercise and Wargaming Branch of the MMCC-E are the developers behind the concept of CAMO24. They are convinced that the content of the exercise will allow the participating nations to strengthen the resilience for handling international crises or even war scenarios in northern Europe.
Nevertheless, concept-wise CAMO24 differs a lot from previous, more wargame-oriented CAMO Exercises: its setting is more discussion-based which allows more space for finding best solutions by discussing more detailed options instead of rigidly sticking to a given rule-book. It is also a highly strategic and political level that characterises the next iteration.
For the development of the exercise CAMO24 the MMCC-E already has conducted several conferences and scripting workshops and will continue to do so, inviting experts from high-level NATO and EU civilian and military institutions to discuss and to define the content and the parameters for the gameplay.
The Initial Planning Conference (IPC), organised and hosted by the MMCC-E in Koblenz (Germany) in December 2023, clearly demonstrated that there is a huge interest of all participating Nations, NATO and EU Entities and Institutions in structuring and harmonising the existing concepts and national approaches. The EU will be represented by the European Commission`s European Civil Protection and Humantarian Aid Operations department which will play an important role as an advisor and supporter in CAMO 24. 

Challenges in exercise planning & preparation
Whilst the focal point of the overall idea and concept of CAMO24 is in place and continuously refined, MMCC-E is discussing the processes with the participating nations which are divided into three groups: frontline nations, nations, who are part of the rear area of the Joint Area of Operation (JOA) and nations, who are not part of the JOA. All these nations have functions and significant tasks for the patient flow management. The number of nations attending CAMO 24 is limited to around ten, having always in mind that playing with ten different national civilian-military systems will be challenging enough not only for the participants but also for the Exercise Organisation (EXORG) and Exercise Control (EXCON) team from MMCC-E.
One of the challenges for the MMCC-E in the planning process is to bring together the right experienced personnel for this exercise, i.e. (wargame) facilitators who will guide and steer the Training Audience (TA) through the gameplay to let them achieve the Training Objectives (TOs), Exercise Objectives (EOs) and the overall Exercise Aim (EA). They must show a high level of expertise as CAMO24 is focused on an operational and strategic level but also partially touches political decision levels. This challenge also applies to exercise control personnel who must perfectly know which answers they need to give when being addressed with a question by Training Audience, e.g. inquiries regarding the exercise development, driven by the Simulation Cell (SIMCELL).
Another challenge that the CIVMIL branch of MMCC-E is working on during the preparation of CAMO24 is to acquire the knowledge about how the civilian sides of the participating nations plan and prepare civil protection for a crisis and war environment.The CIVMIL branch of MMCC-E is responsible for training and advising the training audience, especially the wargame facilitators, and providing them with all understanding about each respective national CIVMIL system in order to guarantee that realistic measures will be taken by the training audience to handle the given issue.

Evaluation process
To assure a reliable collection of findings for the Exercise Evaluation and Lessons Learned/Lessons Identified (LL/LI) process, the MMCC-E planning team invited an experienced Evaluation team, composed of experts from NATO and EU. They accompany and monitor the processes of the exercise including the development of the entire exercise, the proper handling of events with their exercise control measures and the responses given by the training audience. The main reason to engage such an exercise evaluation team is to find out and to confirm if both the Exercise Objectives and the overall Exercise Aim were achieved.

CAMO 24 Exercise Control Organisation (source: MMCC-E)

Exercise value
Taking all those challenges into account during the preparation and planning phase it must be clear right from the beginning how participating nations in first line, but also NATO and EU institutions and MMCC-E will profit from this exercise.After the conduct of CAMO24, participating nations, institutions and entities will be able to identify, refine and already work on gaps or general room for improving existing systems. By analysing them carefully, they will be able to improve the CIVMIL medical interaction. But first of all and as all systems differ from nation to nation, nations will learn from each other as approaches in crisis and war situations are never the same. Another important finding is: CIVMIL interaction is a complex topic. Instruments and methods have to be identified and implemented how to facilitate the process of growing together.
The scenario for CAMO 24 that will be applied mirrors the threat of Russian aggression against NATO and Europe, thus facilitating the decision-making process of the participants and giving them a realistic geo-political conflict situation they will potentially be thrown in. The patient numbers played with in this exercise will not overwhelm the Training Audience but will certainly create a feeling of what they can expect in a scenario in the case of a real conflict on NATOs eastern flank.

CAMO24 Exercise Structure (source: MMCC-E)

Author:
Lieutenant (DEU N) Thomas Makowski (DEU) 
MMCC-E, Wargaming/Exercises Branch 
Andernacher Strasse 10056070 Koblenz
Email: MMCCPAO@bundeswehr.org

Date: 10/18/2024

Source: European Military Medical Services 2024