Understanding Role 1 Military Medical Support: A Systematic Review With a German Perspective

North Atlantic Treaty Organization (NATO) military medical support is currently gaining attention and relies on "the continuum of care" to return soldiers to duty. Role 1 as first contact medical care forms the basic capability of the role-based military medical support. Interestingly enough, no systematic review could be identified that elaborates on Role 1. This systematic review aims to fill that gap by describing Role 1 in its entire capability. As an overarching objective, this is intended to establish a "common understanding" that supports future interoperability and research.

Systematic research was conducted between April and October 2024. The databases Medline and Google Scholar were searched. Data were included when published between 2004 and October 2024. Additionally, 2 German military medical journals, "Wehrmedizin und Wehrpharmazie" and "Wehrmedizinische Monatsschrift," were included in the scope of research to incorporate the German perspective on the topic within the structural conception of the review. North Atlantic Treaty Organization, Allied Joint Publication (NATO AJP 4.10) was referenced as a doctrinal document. Data inclusion was conducted following the flow diagram of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses". The analysis of the included data was based on a NATO defined scheme for capability analysis: Doctrine, Organisation, Training, Materiel, Leadership, Personnel, Facilities, Interoperability (DOTMLPF-I).

Role 1 is defined as initial capability within the medical support for combat operations. Its main objectives are to enable the soldier to directly return to duty or stabilize him for further evacuation to a higher Role of care. Role 1 is identified to encompass 3 different organisational structures: (1) Role 1 directly accompanying troops on their mission, (2) Role 1 being situated in rearward areas within theater, (3) Role 1 as a medical evacuation (MEDEVAC) component providing en route care. Role 1 depends on "the mission, the force and the risks the force will face" in all aspects of DOTMLPF-I. Records did reveal several inconsistencies concerning the description of Role 1. Dominating differences were identified in the definition of the start and end points for Role 1, and the provision of selected capability aspects (primary health care [PHC; including general medicine], surgical care, administration of blood products, and telemedicine support).

As the first role of military health care, Role 1 inherits frontmost medical personnel. Role 1 must be adapted to the mission, the force, and the risk the force will face addressing all capability aspects of DOTMLPF-I. Agreeing on a uniformed definition of Role 1 on a (inter-)national level would improve interoperability and it is recommended to refer to a superior guideline document (e.g., NATO AJP 4.10). Additionally, the value of Role 1 PHC provision shall be emphasized. It is suggested that future research and development should increasingly reflect current war scenarios including major joint operations plus (MJO+) against (near-)peer adversaries. As a result, improvement at Role 1 level of care is considered to contribute considerably toward maximizing return-to-duty-rates and reducing the need for critical resources (e.g., MEDEVAC and medical logistics).