Page 116 - JSOM Winter 2025

PTSD and Moral Injury as Operational Challenges The accompanying industry exhibition showcased cutting-
edge innovations, from advanced simulation to novel treat-
Another major focus was the psychological burden of person- ment concepts.
nel in both asymmetric and conventional conflicts. Presen-
tations on PTSD and moral injury highlighted the profound CMC 2025 was and is more than a conference—it is and is an
consequences of witnessed or enacted violence, failure to pro- ongoing commitment to camaraderie, responsibility, and the
vide aid, or experiences of betrayal. practice of medicine under extreme conditions. In a world of
• A German interdisciplinary therapy program demon- uncertainty and growing operational demands, the mission re-
strated promising results in addressing shame-based coping mains unchanged: saving lives under the most difficult circum-
patterns. stances. This requires, more than ever, strong networks, sound
• France’s D-STRESS project presented an innovative screen- expertise, and continuous training.
ing tool for subclinical PTSD, based on physiological re-
sponses in virtual combat simulations. Outlook
• U.S. researchers reported success with combining stellate The Paris SOF CMC Conference, dedicated to Special Opera-
ganglion block and intensive exposure therapy for deploy- tions Forces, will take place 19 and 20 November 2026. In 2027,
ment-related PTSD.
the regular large-scale CMC Conference will again be hosted
These insights underscore the need to recognize and treat psy- in Blaubeuren/Ulm on 8 and 9 July under the scientific direc-
chological consequences as an integral part of modern opera- tion of the Department of AINS at Bundeswehr Hospital Ulm.
tional medicine.
The Science Behind Improvised Medicine:
Realistic Training – Preparing for Deployment A Hands-On Experience-Based Approach
Aebhric O’Kelly, FFRRHHEd, FRSM, FAWM, Dean Emeritus,
A cornerstone of CMC 2025 was hands-on education; more College of Remote and Offshore Medicine Foundation
than 30 workshops, specialist lectures, and training modules
allowed participants to refresh skills, deepen expertise, and re- Current conflicts have demonstrated that resources and re-
hearse high-stakes scenarios. supply on the battlefield can be delayed due to the increased
use of UAVs and the rapid movement of troops. According to
The conference emphasized, in deployment, you do not rise Haque et al., hospital services in the Russia-Ukraine War have
to expectations—you fall back to the level of training. And it been challenged to provide resupply of medical equipment.
embodied this principle through realistic simulation, interdis- The evolving character of modern warfare has exposed critical
ciplinary exchange, and practical exercises. gaps in conventional medical supply chains. In such environ-
ments, the ability to improvise safe, scientifically proven, and
effective clinical interventions is a necessity. This presentation
and workshop examined the structured application of impro-
vised medicine in combat and austere settings, with a focus
on equipping medics to deliver lifesaving interventions when
standard equipment is unavailable. Drawing on lessons from
Ukraine, Gaza, and historical guerrilla medical systems, we ad-
vocate for the deliberate teaching of improvisation as a cogni-
tive and procedural skill set central to modern battlefield care.
A growing body of literature supports the validity of impro-
vised medical techniques in resource-deprived environments.
Studies have described the successful use of pressure dressings
fashioned from elastic wraps, negative pressure wound ther-
apy using Tegaderm and syringe systems, and the creation of
airway adjuncts from various options. Loftus et al. published
Interoperability and Networks – Stronger Together studies showing that trousers can be cut to bind the pelvis
effectively.
CMC continues to provide a platform for collaboration be-
tween military and civilian actors, special and conventional The hands-on workshop challenged participants to create ef-
forces, and international partners. Interpersonal encounters at fective tourniquets using bed sheets, mylar emergency blankets
CMC strengthen interoperability—an essential requirement and cut-up clothing. Emphasis is placed on clinical safety, re-
for multinational casualty care, whether in large-scale defense producibility, and adaptation to dynamic environments. Par-
operations or disaster response. ticipant feedback showed increased confidence, ingenuity, and
reduced equipment dependency, supporting the argument that
Conclusion: All for One – All for Saving Lives improvisation is a teachable, scalable competency with direct
The CMC has established itself as Europe’s leading platform battlefield applicability.
for military medical exchange and tactical medicine. Its com- Improvised medicine will continue to be regarded as the min-
bination of high academic standards and practical relevance imum option. The better and best options should be inte-
attracts a wide professional audience—from NATO Special grated into medical planning. More research is warranted for
Operations Medics and medical technicians to nurses, plan- this option, but it can be incorporated into doctrinal training
ners, senior leaders, and physicians from both military and pathways, supported by experimental validation and after-
civilian sectors. action reporting from current conflicts. As future battlefields

114 | JSOM Volume 25, Edition 4 / Winter 2025