Congratulations once again on a fantastic piece of work. I certainly enjoyed reading it.
My contribution to the debate as it were is from my background in military medicine. Whilst by no means an expert, I've sufficient immersion from both my reserve service and my first BSc research to chip in my personal two pence, as it were. By no means to I wish to undermine Allanea, only to add to their excellent piece of work.
Role
Medical services in the military, like all services, do a vast number of things, from the obvious to the sublime:
- Emergency care - The standard role, one might think - save lives. Whilst the focus is on trauma, this extends to medical emergencies as well.
- Primary care - Preventative medicine in practice, as it were - preventing illness, preventing illness from causing loss of man hours, preventing illness from becoming severe, referring as necessary. This extends to dental care, which normally comes under a structure of its own.
- Mental Health - Speaks for itself. Highly neglected in many armed forces, which may come onto at a later date.
- Rehabilitation - Ensuring the injured are returned to as close to full function as possible - either for return to combat, or for return to civilian life.
- Veterinary Care - Providing care to working animals.
- Environmental Health - Preventative medicine outside of illness. This includes water purity, food cleanliness, location of latrines, insect extermination.
- Education - Educating all other branches in medical roles - for prevention of disease, and death. And for morale.
- Selection - More prevention (See a theme?), but of people already ill from getting into the service and causing issues to themselves and others.
- Media Operations - Hearts and minds and all those lovely words that get neglected in the NS conventional war paradigm, but are critical in the current model of war amongst the people. And the best way to win that is by providing healthcare; the best way to lose it by denying help.
- Care of the Dead - Another neglected area in NS; mainly because it's kept out of public sight, or not appreciated fully.
Impact
It's best to think of the impact medical services have in the three key areas use to describe military force:
> Physical
- At the end of the day, all weapons and artillery are force multipliers. That number being multiplied being number of men. If you lose men to illness, you may have lost the battle before it even started; both from ineffective fighting, and from men not being there.
- From the total/absolute war viewpoints, better medical care = better recycling of manpower = bonus.
- I mention this because Allanea mentioned it: pharmacological enhancement. This really is a double-edged sword, that needs using with far too much caution in this day and age to make it truly viable. But this is NS, eh?
> Moral
- This is the true sticking point these days: soldiers need to be encouraged to fight. And medical care is critical - if a soldier knows what medical resources are available, and that it's likely he will get world class care, and the best shot at surviving whatever's thrown at him, he'll be more willing to throw himself into the fray.
- War is an extension of politics. If people see lots of body bags and not that much medical support, you'll eventually lose the fight at home. You'll also see far more people attempting to avoid the draft, or voluntary service, if they know there's little medical care and lots of death and disfiguring injury.
- Further to that, the veteran body after a draft is likely to be a large, politically powerful movement. Again, messing with healthcare will cost political points.
> Intellectual
- Good medical systems in armed forces will often lead to benefits being passed back to civil society - both from doctors being dual-skilled in military/civilian service, and from innovations and techniques forced forward by necessity. The list is endless.
- Good medical support when factoring into military planning opens more options to a commander, who is now able to strategically risk more if he knows that risk is mitigated by good medical services.
Purpose
It is at this point I start to digress from Allanea. The core role of military healthcare has been preventative, as the biggest scourge of armies has in the past been pestilience. The development of military medical personnel into returning men to service only truly came about (in Europe at least) from the First World War; prior to that, the limits of medical and surgical knowledge meant there was very little prospect of returning those who were truly injured to service, instead acting as convalescence centres for nature to take its course. Indeed that concept of reverse triage (treat people who can be returned to service first) has rarely been practiced in western forces.
In the modern day, that idea of recycling personnel sits as a secondary objective - often, in this day and age, it is about combat effectiveness, through preventing illness and the complications of illness; and about providing moral incentive for people to join and people to fight.
Military medicine is certainly different from civilian medicine - every practitioner is forced to be a generalist out of necessity for starters. This comes from the focus on disease prevention and treating small niggles, the opposite extreme of dismemberment, and lack of a western modern hospital on the frontline. This is compounded by a demographic of healthy, fit, young men and women. Malingering is somewhat a minor thing of note, and played up far too much to the cost of ignoring or belittling true problems (often with mental health); civilian A+E departments and primary carers see their fair share of malingerers across the land, and often dismiss them rather than tackling the issue of mental illness (often untreated in these individuals) straight on. My experience may in part be down to the voluntary nature of service in the UK; though I suspect cases in other countries with conscription are likely overplayed as good conversation pieces or propaganda against anti-draft activists.
Roles
The statement you make on the individual being responsible for healthcare hits the spot perfectly. I follow with a descriptor of the UK system.
At the pre-medical services level, you are correct in noting the medical support available within a combat/combat support unit's own personnel. In the UK, the 'team medic' concept of certain soldiers trained to a level where they can administer support to injured in their section/fireteam, and assist a more qualified medic, is prolific. The individual soldier is trained to medically assist themselves or their buddies with their individual aid kits, and issued a handy flowchart as an aide-memoire for medical assistance. This comes within a relatively new concept of the 'Platinum 10 minutes' - that most trauma deaths that aren't immediate can be prevented by treatment received in the first ten minutes after injury.
This links in nicely with the battalion's level of aid - each individual combat unit will have its own unit aid post, incorporating its organic medical support (Doctors, Nurse, Combat Medical Technicians) which then provides preventative care to the unit, and in combat the first line of medical aid.
Outside structures get involved in a tiered system, based on a NATO standard:
> Role 1 - Field GP/A+E provided by a squadron level formation. Supports battalion formations and higher, often leapfrogging with a tactical move (ie one role 1 facility will move forward whilst the other stays fixed, ensuring support keeps up with the frontline). Also provide the casualty transport/evacuation facility, and a basic field service for mental health, physiotherapy, etc. Can move within an hour.
> Role 2 - Field Hospital - A larger version of the above, but with the capability of having casualties bedded down: pneumonia patients for example, who may only need three days rest away from their unit before being returned on light duties. Most versions are ''Enhanced'' with an attached surgical team, and will have attached specialists in environmental health and such-like. Operated by a medical regiment (battalion level formation). Can move within a day, shorter if a light role.
> Role 3 - Large Field Hospital - Supposedly a general hospital in the field, providing general services including X-Ray/CT, multiple operating theatres, and numerous specialists. In theory mobile, in practice not. Operated by multiple medical units - in theory a field hospital, in practice multiple in order to gain the spread of professionals.
> Role 4 - Specialist/Convalescent - Facilities operated back in the home country, often civilian, focused on rehabilitation, or specialist care not available overseas. In recent years in the UK, this has involved those stabilised at Bastion Field Hospital and undergoing further definitive treatment, and those who contracted Ebola whilst serving in Sierra Leone.
The larger the role number, the larger the formation. The navy use a similar linear scale, and refer to it as 'Echelon' rather than 'Role'. Of course there's numerous in betweens, jump arounds, and the like. But it's a nice framework to start with.
General Comments
I will note the rest of the points made in Allanea's above post are all relevant, and all true considerations. Health is physical, mental and spiritual. Healthcare when tasked with prevention spreads its tendrils into every aspect of the military. The more you look, the more you'll find it.
Medical care is something most NS wars that aim for realism neglect, much like logistical challenges. The impact of medical care, or lack of it, extends both to the simple nature of statistics that NS'ers like when gaming (losses to disease, to exhaustion and exposure), and to the more complex niceties of politics, domestic affairs, long term impacts on society, and the motivation of the average soldier. For character RP'ers, it's an area fraught with extremes of emotion, drama, morality, and insight into the human condition, and an area that is so often not paid justice - not in the sense of how accurate procedures are, or what facts are right or not, but in how the average soldier and medic experiences such a thing.
Generally it's an area that always warrants research - I can guarantee you'll be fascinated by what you find.
PS - TG if any questions, I'll always try my best to answer, or find someone who knows answers.
. For my part, the medical reference:
