The NATO Medical Support Capstone Concept (NMSCC), NATO’s first ever strategic Medical concept, was approved by the Military Committee on 8 December 2022. The NMSCC was written by the Medical Branches in ACT and ACO and is very much a Bi-Strategic Command document. It is predicated on both ACT’s NATO Warfighting Capstone Concept and ACO’s Deterrence and Defence of the Euro-Atlantic area, both of which are derived from NATO’s Military Strategy. Underpinned by this strategic alignment, the NATO Medical Support Capstone Concept provides the basis for defining, understanding and integrating operational employment and capability development in the medical arena. It informs NATO’s mid- and long-term medical planning and the development of Alliance medical capabilities through to 2040 in support of NATO’s combatant commanders engaged in Alliance missions across the spectrum of conflict. These medical capabilities will be essential for NATO Nations to sustain, across their Armed Forces, the will to fight that is an essential element of the moral component of fighting power. It is widely acknowledged that a failure to provide adequate medical support can have a corrosive effect on the collective morale of Armed Forces.
The creation of the NMSCC comes at a point in history when events are reminding us that there is a spectrum of conflict. For many years, NATO Nations have been focused on the point on the spectrum of conflict represented by operations in Iraq and Afghanistan. Those operations and the long period for which they endured caused aspects of the force structure and the way the force operated to be seen as ubiquitous. In the medical sphere, six key aspects emerged. These were: relatively small numbers of casualties that did not ever come close to overfacing the available medical facilities; dedicated MEDEVAC helicopters with highly skilled medical staff on board; the uncontested reach of MEDEVAC helicopters in a situation of enduring air supremacy; a plurality of very high quality and well-stocked trauma treatment facilities which were able to push up the rate of ‘unexpected survivors’ from the comparatively small casualty cohort; readily available strategic aeromedical evacuation assets; and, most crucially, a mindset that saw missions terminated once a casualty had been taken and that casualty becoming ‘the mission’. The abiding image of medical support became a number of people carrying a single casualty on a stretcher towards a helicopter in sandy or dusty terrain.
Today, operations in Afghanistan have been terminated, the Chinese government is openly stating its intent to reunify with Taiwan and Russia has invaded Ukraine. This series of events reminded everyone that there is a spectrum of conflict. The next conflict – the next conflict that may require NATO Nations to deploy forces – has the potential to fall elsewhere on that spectrum. Future operations may not feature air superiority, far less air supremacy. They may not feature dedicated MEDEVAC helicopters, readily-available supplies of medical materiel or below-capacity medical facilities. And, most significantly, future operations may not feature low casualty numbers, nor may they allow missions to be aborted simply because casualties have been taken, and there may well be large numbers of civilian casualties that will drive Civil-Military co-operation in the medical arena. To add to the complexity, the COVID-19 pandemic provided a stark and forceful reminder to military commanders that there are other medical conditions which might affect both their forces and the civilian population, and which military clinicians would be required to treat, beside ballistic and blast trauma injuries. The NMSCC provides a pivot to enable a switch from a focus on one area of the spectrum of conflict to looking broadly across that spectrum and being prepared for the operations of the future and the treatment of the casualties, military and civilian, that may result.
The ACT Medical Advisor and Head of Medical Branch in HQ SACT, Colonel Steven Tracey, commented, “As General Rupert Smith once said to aspiring commanders: The result of your plan will be casualties. The enemies’, if it’s a good plan. Yours’, if it isn’t. We now need to be prepared for those casualties to include civilians, possibly in large numbers, and maintain the flexibility to treat always according to clinical priority, in line with international humanitarian law.”