„All for One – More Than Just a Motto“

Post-Conference Report: Combat Medical Care Conference 2025

Florent Josse^a,b, Daniela Lenard^a, Martin Kulla^a

^a Department of Anesthesia, Intensive Care, Emergency Medicine, and Pain Therapy, Bundeswehr Hospital Ulm

^b Tactical Medicine Working Group of the German Society for Military Medicine and Military Pharmacy, Bonn

„All for One – More Than Just a Motto“

The Combat Medical Care Conference (CMC) 2025, held on July 2nd and 3rd in Blaubeuren near Ulm, effectively demonstrated the outcomes when expertise, camaraderie, and the willingness to collaborate converge. With over 1,400 participants from more than 45 nations, CMC 2025 was not only the largest but also the most significant international symposium on tactical casualty care amidst military and police operations. Medics, emergency medical personnel, nurses, and physicians gathered under this year‘s motto:

„All for One.“

However, this well-known motto encapsulates far more than literary romance¹. It symbolizes a deep-rooted understanding of solidarity, mutual support, and a clear goal: Providing the best possible care for our wounded in deployments, emergencies, and combat situations.

Given the security-political landscape, global military conflicts, and the necessity of preparing for national and alliance defense (LV/BV), it remains clear: The initial care of the sick and wounded determines life or death.

„The fate of the wounded rests in the hands of those who apply the first dressing,“ said U.S. military surgeon Dr. Nicholas Senn in 1889 (University of Chicago 2016).General Senn‘s assertion was not only a guiding principle but also the benchmark for numerous lectures, workshops, and discussions at this year‘s CMC Conference. The importance of initial care by comrades – applying the principle of self-aid and buddy care – as well as by emergency medically trained personnel, was vividly illustrated through realistic scenarios, mission reports, and training formats. The treatment outcome for the sick and wounded largely depends on the quality of the first measures, long before professional medical help is available.

Fig. 1: Drums & Pipes for the dignified opening of the conference (Image: B. Hossfeld)

Key Focus Areas of the CMC Conference 2025

Under the scientific leadership of the Department of Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy (AINS) of the Bundeswehr Hospital Ulm, alongside numerous national and international professional partners, a broad international program and over 30 workshops were realized. The focus was on the recent shifts in warfare, notably the transition from the GWOT (Global War on Terror) model to the LSCO (Large Scale Combat Operations) model and its impact on medical services. Additionally, medical approaches in the Israeli-Palestinian conflict were compared with those in the Russian-Ukrainian war. These scenarios provide NATO with valuable insights for casualty care in modern military operations. Furthermore, new weapon systems and their medical implications were comprehensively discussed. All presentations emphasized the importance of flexibility in strategic orientation, as no future conflict can be resolved with current tactical and strategic planning. Simultaneously, and this is not to be understood as a contradiction, every form of planning, preparation, and training contributes to conflict prevention.

Fig. 2: Participating international professional partners at the CMC Conference 2025

The Israeli Model

This model focuses on reducing echelons of care in favor of highly specialized medical interventions in the immediate operational area. This allows for rapid treatment near the combat zone – especially for mobile deployments and urban operations (e.g., Gaza) – with quick evacuation averaging 66 minutes. The geography of this country permits extremely short transport distances and evacuation times.

• Core principles: Maximum adaptability, readiness to change, potentially deliberate abandonment of established standards („know-how sometimes less“), and comprehensive data collection.
• Outcome: Despite an increase in the Injury Severity Score (ISS), the Case Fatality Rate (CFR) was reduced from 15 % to 6.9 %.

The Ukrainian Model

A well-documented multi-tier model with stabilization stations 5–10 km from the front line has been established. Simple surgical procedures, resuscitation, and basic care by available medical personnel are conducted there. Due to limited mobility and constant threats from drones and artillery, many medical facilities must be constructed up to 6–7 meters underground.

The necessity for optimal training of non-medical personnel was particularly emphasized, as they often have to act independently. Other challenges include the high prevalence of chronic illnesses (due to the high average age of soldiers) and the growing importance of dental care at the brigade level.

Requirements for Future Medical Support Systems

A resilient and agile medical architecture is required, capable of flexibly transitioning between clinic-centered and tiered systems based on the conflict situation. New weapon systems (e.g., thermobaric weapons, energy weapons, drones) present additional medical challenges and demand innovative, mission-oriented solutions. Depending on the conflict field, the electronic signature of the medical facility becomes a target.

PTSD and Moral Injury as Operational Challenges

A central theme was the psychological burden on personnel in asymmetric and conventional combat scenarios. Contributions on PTSD and moral injury highlighted that moral injuries – such as experienced or observed acts of violence, failure to assist, or betrayal – can have profound psychological effects. An interdisciplinary therapy program developed in Germany showed promising results in treating shame-based coping patterns.

Parallel to this, the team from the French D-STRESS project introduced an innovative screening procedure for early detection of subclinical PTSD, based on physiological responses in virtual combat simulations. Finally, U.S. researchers presented the successful combination of stellate ganglion block and intensive exposure therapy as an effective treatment approach for deployment-related PTSD.

The insights from the CMC Conference 2025 underscore the need to comprehensively assess and integratively treat psychological operational consequences as a fixed component of modern operational medicine.

Realistic Training – To Stand in Deployment

A central concern of the CMC Conference in 2025 was the practice-oriented training and continuing education: More than 30 workshops, numerous expert lectures, and hands-on training enabled participants to stay current, deepen their skills, and train for emergencies.

The principle applies: In deployment, one does not rise to the level of expectation but falls to the level of training. The CMC Conference adheres to this principle – with realistic scenarios, interdisciplinary exchange, and modern simulation.

Fig. 3: Responsible for the scientific program and spirit of the CMC Conference since 2014 are Lieutenant Colonel (MC) Dr. Florent Josse and Lieutenant Colonel (MC) Daniela Lenard from Ulm. (Image: B. Hossfeld)

Interoperability and Networks – Stronger Together

The CMC Conference‘s focus remains on providing a platform and stage for close cooperation between military and civilian actors, special and conventional forces, as well as various nations and organizations. The personal encounter at the CMC Conference fosters interoperability – a crucial factor for casualty-oriented care in multinational operational contexts. Especially in the context of LV/BV scenarios or large-scale disaster situations, the ability to effectively cooperate across borders is indispensable.

Conclusion

All for One – All for One Goal:

The Lives of Our Wounded

The CMC Conference has established itself as a leading platform for military medical exchange and tactical medicine in Europe. The high scientific standard combined with practical orientation makes the event particularly attractive for a broad professional audience – from NSCOM (NATO Special Combat Operation Medic), NSOMT (NATO Special Operation Medical Technician), nursing staff, planners, and senior leadership to physicians, whether from the military, national security services, or civilian emergency services. The accompanying industrial exhibition provided a comprehensive overview of current solutions for military medicine – from advanced simulation to innovative care concepts.

Fig. 4: Colonel (MC) Prof. Dr. Björn Hossfeld, Bundeswehr Hospital Ulm (DEU), and Colonel Dr. Jennifer Gurney, Joint Trauma System (US), are co-chairing a session. (Image: A. Knöfel)

The CMC Conference 2025 was more than just a congress; it was a clear commitment to camaraderie, a sense of duty, and medical action under extreme conditions. In times of global uncertainties and increasing operational demands, the primary goal remains: Saving lives – under the most challenging circumstances. This requires more than ever: a strong network, well-founded knowledge, and continuous training.

Fig. 5: Filled main hall of the CMC Conference 2025 with over 1,400 participants from 45 nations. (Image: B. Hossfeld)

The SOF CMC Conference from November 7 to 18, 2026, will take place in Paris as a satellite conference dedicated to Special Operations Forces (SOF). Under the professional leadership of the Department of AINS of the Bundeswehr Hospital Ulm, the regular large CMC Conference will be held on July 7 and 8, 2027, in Blaubeuren/Ulm.

For the Organizers

Lieutenant Colonel (MC) Dr. Florent Josse
Department of Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy (AINS)
Bundeswehr Hospital Ulm
Oberer Eselsberg 40, 89081 Ulm
E-Mail: florentjosse@me.com