Cent Eur J Public Health 2020, 28(4):325-330 | DOI: 10.21101/cejph.a6045

NATO and evidence-based military and disaster medicine: case for Vigorous Warrior Live Exercise Series

John M. Quinn1, Vladimír Bencko1, Alexander V. Bongartz2, Preslava Stoeva3, Adrijana Atanasoska Arsov4, Stefano De Porzi5, Milos Bohonek6,12, Ronald Ti7, Jack Taylor5, John Mitchell8, Veronika Reinhard9, Petr Majovsky10, Jozef Kuca5, Petr Kral5, Laszlo Fazekas5, Zoltan Bubenik10,11
1 Prague Centre for Global Health, Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
2 Emergency Medical Faculty, Prague Institute of Postgraduate Medical Education, Prague, Czech Republic
3 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
4 Medical Military Centre Skopje, Army of the Republic of North Macedonia, Skopje, Republic of North Macedonia
5 Interoperability Branch, NATO Centre of Excellence for Military Medicine, Budapest, Hungary
6 Department of Haematology and Blood Transfusion, Military University Hospital, Prague, Czech Republic
7 Specialist Technical Advisor, Poland Office, Department of Defence, Canberra, Australia
8 Secretary of Defence, Operational Medicine Readiness Policy and Oversight, Pentagon, Washington, D.C., USA
9 Estonian Military Academy, Tartu University Hospital, Tartu, Estonia
10 Ministry of Defence of the Czech Republic, Prague, Czech Republic
11 Committee of Chiefs of Military Medical Services in NATO, Brussels, Belgium
12 Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic

The North Atlantic Treaty Organization (NATO) is the premier and only security alliance uniting 30 countries and growing with many partner states in the provision of collective security and against threats posed by conflict and natural disasters. Security of countries and communities is increasingly threatened by a broad spectrum of unconventional types of war and disease threats - from hybrid and asymmetric to multi-domain and peer-to-peer/near-peer conflict. The NATO Centre of Excellence for Military Medicine (MILMED COE) is the centre of gravity for medical best practices and promotion of medical doctrine across the NATO alliance. Disaster medicine is multidisciplinary and in NATO, multinational, requiring best practices that are driven by data and evidence to prevent death on the battlefield and prepare for future conflicts. "Vigorous Warrior" is a live military and disaster medicine exercise series using both civilian and military actors across all sectors of health focused on health security and identifying lessons learned to ready the alliance for future threats. In this brief report, we make the case that the Vigorous Warrior exercise exposes gaps, highlights challenges and generates an evidence base to make NATO military medicine systems more robust, more efficient and in provision of best medical practices. We specifically argue that clinical data capture must be duplicated and continuous across the alliance to ensure evidence-based medicine stays current in NATO military medical doctrine.

Keywords: military medicine, disaster medicine, NATO

Received: December 10, 2019; Revised: September 15, 2020; Accepted: September 15, 2020; Published: December 18, 2020  Show citation

ACS AIP APA ASA Harvard Chicago IEEE ISO690 MLA NLM Turabian Vancouver
Quinn JM, Bencko V, Bongartz AV, Stoeva P, Atanasoska Arsov A, De Porzi S, et al.. NATO and evidence-based military and disaster medicine: case for Vigorous Warrior Live Exercise Series. Cent Eur J Public Health. 2020;28(4):325-330. doi: 10.21101/cejph.a6045. PubMed PMID: 33338371.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Fazekas L, McCown ME, Taylor JB, Ferland KA. NATO military medical exercise Vigorous Warrior 2017. J Spec Oper Med. Spring 2019;19(1):27-30. Go to original source...
    2. Allied Joint Medical Doctrine for Military Health Care (MHC). NATO standard: AJMedP-8(A)(1) [Internet]. Brussels: NATO; 2018 [cited 2020 Mar 28]. Available from: https://www.coemed.org/files/stanags/02_AJMEDP/AJMedP-8_EDA_V1_E_2598.pdf.
    3. Gubás F. Medical support of military operations led by organizations of international crisis management. Sci Mil J. 2015;10(1):25-9.
    4. Růžička M, Humlíček V, Witt P. Medical support in asymmetric operations. Mil Med Sci Lett. 2012;81(3):90-5. Go to original source...
    5. Ciottone GR, Biddinger PD, Darling RG, Fares S, Keim ME, Molloy MS, et al., editors. Ciottone's disaster medicine. Philadelphia: Elsevier; 2015.
    6. Quinn J, Bencko V, Osvald V, Majovsky P, Kral P, Bubenik Z, et al. Conference report: Future Forces Forum Prague, World Medical Congress (CEBIRAM) 2018. Mil Med Sci Lett. 2019;88(1):37-40.
    7. Balázs R, Kopcsó I. Evidence based military medicine - The NATO Trauma Registry Initiative. AARMS. 2014;13(1):17-29. Go to original source...
    8. Bedubourg G, Wiik H, Queyriaux B, Lausund P, Meynard J. Collection and sharing of medical information and medical intelligence (M2I) in NATO: a transversal survey. J R Army Med Corps. 2018;164(4):271-6. Go to original source... Go to PubMed...
    9. Vitiello A. Evidence based medicine: how to practice and teach EBM, Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB, 2nd ed, Churchill Livingstone (2000), ISBN: 0443 062 40 4. J Osteopath Med. 2001;4(1):40-1. Go to original source...
    10. Straus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based medicine: how to practice and teach EBM. Philadelphia: Elsevier; 2019.
    11. Feldbaum H, Lee K. Public health and security. In: Ingram A, editor. Health, foreign policy & security: towards a conceptual framework for research and policy. UK Global Health Programme Working Paper No. 2. London: The Nuffield Trust; 2004. p. 19-28.
    12. Aldis W. Health security as a public health concept: a critical analysis. Health Policy Plan. 2008;23(6):369-75. Go to original source... Go to PubMed...
    13. Rushton S. Global health security: security for whom? Security from what? Political Studies. 2011;59(4):779-96. Go to original source...
    14. Rushton S, Youde J, editors. Routledge handbook of global health security. London: Routledge; 2015. Go to original source...
    15. Weir L. Inventing global health security, 1994-2005. In: Rushton S, Youde J, editors. Routledge handbook of global health security. London: Routledge; 2015. p. 18-31.
    16. Eckmanns T, Füller H, Roberts SL. Digital epidemiology and global health security; an interdisciplinary conversation. Life Sci Soc Policy. 2019;15:2. doi: 10.1186/s40504-019-0091-8. Go to original source... Go to PubMed...
    17. Russell R, Reid A, Borgers G, Wassink H, Grove A, Niebuhr DW, et al. A NATO guide for assessing deployability for military personnel with chronic medical conditions: medical fitness for expeditionary missions, Task Group 174, Human Factors, and Medicine Panel. Mil Med. 2014;179(12):1404-11. Go to original source... Go to PubMed...
    18. Allied Joint Publication. NATO standard: AJP-01(E)(1) [Internet]. Brussels: NATO; 2017 [cited 2020 Mar 28]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/905877/20200728-doctrine_nato_allied_joint_doctrine_ajp_01.pdf.
    19. Mann-Salinas E. Evaluation of Role 2 (R2) medical resources in the Afghanistan combat theater: past, present and future [Internet]. Tacoma: The Geneva Foundation; 2016 [cited 2020 Mar 28]. Available from: https://apps.dtic.mil/sti/pdfs/AD1033398.pdf.
    20. Frantzen H. NATO and Peace Support Operations, 1991-1999: policies and doctrines. London: Frank Cass; 2005. Go to original source...
    21. Borden Institute. Emergency war surgery. Fourth United States revision. Washington, DC: Borden Institute; 2013.
    22. Zielinski M. Military trauma. In: Papadakos PJ, Gestring ML, editors. Encyclopedia of trauma care. Heidelberg: Springer; 2015. p. 413-4. Go to original source...
    23. NATO. Collective defence - Article 5 [Internet]. NATO [updated 2019 Nov 25; cited 2020 Mar 28]. Available from: https://www.nato.int/cps/en/natohq/topics_110496.htm.
    24. Shea J. NATO's Warsaw Summit: re-establishing deterrence, projecting stability. In: Kammel A, Zyla B, editors. Peacebuilding at home: NATO and its 'new' Member States after Crimea. Baden-Baden: Nomos Verlagsgesellschaft; 2018. p. 209-22. Go to original source...
    25. Shalamanov V. Cyber defense in NATO's perspective: counter-terrorism context in SEE. In: Minchev Z, Bogdanoski M, editors. Countering terrorist activities in cyberspace. Amsterdam: IOS Press; 2018. p. 12-24.
    26. U.S. Army Peacekeeping and Stability Operations Institute; Marr S. Stability in multi-domain battle. Carlisle: PKSOI; 2018.
    27. Multi-Domain Battle: evolution of combined arms for the 21st century, 2025-2040 [Internet]. U.S. Army Training and Doctrine Command; 2017 [cited 2020 Mar 28]. Available from: https://www.tradoc.army.mil/Portals/14/Documents/MDB_Evolutionfor21st%20(1).pdf.
    28. Perkins W, Olivieri A. On multi-domain operations: is NATO today sufficiently 'Joint' to begin discussions regarding multi-domain command and control? JAPCC. 2018;(26):16-23.
    29. Allen MA, Fordham BO. From Melos to Baghdad: explaining resistance to militarized challenges from more powerful states. Int Stud Q. 2011;55(4):1025-45. Go to original source...
    30. Arreguín-Toft I. How the weak win wars: a theory of asymmetric conflict. Cambridge Studies in International Relations, 99. New York: Cambridge University Press; 2005. Go to original source...
    31. Wither JK. Making sense of hybrid warfare. Connections. 2016;15(2):73-87. Go to original source...
    32. Johnson R. Hybrid war and its countermeasures: a critique of the literature. Small Wars Insurgencies. 2018;29(1):141-63. Go to original source...
    33. Nemeth WJ. Future war and Chechnya: a case for hybrid warfare. Monterey: Naval Postgraduate School; 2002.
    34. Andresson J, Tardy T. Hybrid: what's in a name? [Internet]. Paris: EUISS; 2015 [cited 2020 Mar 28]. Available from: https://www.iss.europa.eu/content/hybrid-what's-name.
    35. Chivvis CS. Understanding russian "hybrid warfare": and what can be done about it. Santa Monica: RAND Corporation; 2017 Go to original source...
    36. Van Puyvelde D. Hybrid war - does it even exist? [Internet]. NATO Review; 2015 [cited 2020 Mar 28]. Available from: https://www.nato.int/docu/review/articles/2015/05/07/hybrid-war-does-it-even-exist/index.html.
    37. Woolley T, Badloe J, Bohonek M, Taylor AL, Erik Heier H, Doughty H. NATO Blood Panel perspectives on changes to military prehospital resuscitation policies: current and future practice. Transfusion. 2016;56 Suppl 2:S217-23. Go to original source... Go to PubMed...
    38. Rappold JF, Spinella PC. Editors' preface to the THOR 2018 supplement. J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S1-S2. Go to original source... Go to PubMed...
    39. Yazer MH, Cap AP, Spinella PC. Raising the standards on whole blood. J Trauma Acute Care Surg. 2018 Jun;84(6S Suppl 1):S14-S17. Go to original source... Go to PubMed...
    40. Heier HE, Badloe J, Bohonek M, Cap A, Doughty H, Korsak J, et al. Use of tranexamic acid in bleeding combat casualties. Mil Med. 2015;180(8):844-6. Go to original source... Go to PubMed...
    41. Joint Trauma System. Clinical Practice Guidelines (CPGs) [Internet]. JTS [updated 2020 Mar 11; cited 2020 Mar 28]. Available from: https://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs.

    Return to the content