The German Air Force has a tarmac Airbus A400M at the Berlin Brandenburg Airport. The plane has come out of a deployment mission in Lithuania, where the 45th Battletank Brigade of Germany is deployed to assist in the protection of NATO’s eastern flank in case the Russians attack NATO.

The medics transport a badly wounded soldier to the emergency teams, on a stretcher, using the open rear ramp, and hand him down to emergency crews of the St John Ambulance and Maltese aid service. There, he is enrolled and admitted to a hospital in Germany to be treated.

For now, it’s only a drill.

To train the so-called rescue chain of the injured army soldiers, as part of the 2026 Quadriga exercises of the German military, the Bundeswehr is practising the so-called Medic Quadriga exercise alongside the emergency services of the civilian community, the complete path along which the injured army soldiers arrive and will receive treatment in Germany.

It is the “most complex” and the “largest” medical exercise that the Bundeswehr has conducted since the beginning of the full-scale invasion of Ukraine by Russia in 2022.

‘Joint strategic stress test’

The drill will enhance the operational preparedness and response ability of the Bundeswehr, as well as intensifying its collaboration with civilian partners in the healthcare sector, such as St John Ambulance and aid agency Malteser International.

This was also the initial time that the entire military medical evacuation chain had been put to the test, treatment of the wounded on the operational theatre in Lithuania, up to their care in the German hospitals. Military rescue chain is a coordinated plan that aims at ensuring that casualties are given quick and continuous care, both at the injury point and up to the hospital level.

Approximately 1,250 individuals participated in the exercise, comprising approximately 1,000 military staff and 250 civilian organisation staff.

Federal Office of Civil Protection and Disaster Assistance (BBK), the German Red Cross, Johanniter, the German Life Saving Association (DLRG), ADAC Air Rescue and the Berlin Senate were the participants. The aeroplane is the MedEvac Airbus, which is basically a flying intensive care unit run by the German army and which was to have ferried the exercise casualties in Lithuania to Berlin last week.

Yet, the flight had been cancelled at the last moment because of the current situation in the Middle East in terms of security. The plane is on operational standby.

Although the flight was cancelled, several exercise casualties were to be transported to a centre close to the Berlin Airport, where they were registered, assessed medically, and, according to the extent of the injuries, treated last Friday.

Surgeon General Dr Ralf Hoffmann was explaining that in a real emergency, not planes but trains would also be involved in evacuations.

He said he hoped that by 2028 at the latest, there would be trains available that could be used to transport the wounded.

An example that he gave is the war in Ukraine, where 90 per cent of transfers of patients are performed by rail, which indicates that trains are one of the most critical vehicles in the crisis zones.

The airport during the Medic Quadriga exercise, however, acted as the main link in the rescue chain. It starts with checking to see whether it was a case of chemical or biological agents. In case of need, the injured are to be decontaminated prior to their primary medical check-up.

This is then followed by a preliminary check-up and medical check-up, after which the patients are transferred to emergency teams. They then organise further transportation to the nearby civilian or military hospitals. An ambulance or a helicopter finally takes the wounded to the hospitals in Berlin and Brandenburg.

One must only trust what he has practised

Hoffmann also added that it was significant that we could handle and attend to high numbers of the injured during an emergency.

They would have to move up to 1,000 casualties per day out of the Baltic states to Germany in case of an assault on the eastern flank of NATO.

It would take into consideration the number of hospital stays; “our calculations reveal that we would need approximately 15,000 acute care beds in the system. I think that may be managed when we get ready for it in time,” he said.

The Defence Minister of Germany, Boris Pistorius, who attended the exercise last Friday, justified this effort with a credo which is the following: “You can only trust what you have practised. And nothing you train and practice in peacetime, you master in times of strain and defence.”

The defence minister argues that the exercise is a combined strategic stress test, and this underscores the fact that Germany is a logistical centre in case of a crisis due to its central location.

NATO’s logistics hub

Germany will be NATO’s central logistics hub in case of war. This is provided through the so-called Operational Plan Germany (OPLAN DEU). The plan showed that a maximum number of 800,000 troops would be able to pass through German territory to the eastern side of NATO in case of an emergency.

The Wall Street Journal says that OPLAN DEU is a classified document of approximately 1200 pages. It was printed about two and a half years ago at the Julius Leber Barracks in Berlin, and is now being put to full speed.

The plan is intended to make sure that a quick take on the political decisions in an emergency or a war, among other things, can be undertaken in accordance with the constitutional procedures and in close coordination so as to come up with a quick response. 

But the Wall Street Journal mentions that there may be significant problems during the implementation process, among them being backward infrastructure like old, battered bridges, ports that may collapse because of structural flaws, the absence of military capabilities and lack of coordination with the authorities.

Rescue chain in action

The US-Israeli military operation targeting the Iranian nation has already lasted more than a week, and in addition to the US military bases in the Middle East, Germany is also involved: Ramstein Air Base is among the most significant military bases of the US in Europe, including the medical evacuation of injured soldiers.

It demonstrates the way in which a military rescue chain would work during a real emergency. Similar to an eventual crisis in the eastern flank of NATO, the process starts at the operational level, where the medics and field hospitals initially give treatment.

Injured soldiers are then transported out on strategic transport aircraft, typically Boeing C-17 Globemaster III aeroplanes, as part of the so-called Aeromedical Evacuation System (when they are seriously injured).

Most of these flights are initially based at Ramstein Air Base. Patients are then moved to the Landstuhl Regional Medical Centre, which is the largest US military hospital outside the United States.