[New security threats in Europe: how prepared is German surgery for victims of war and violence?]

The Russian invasion of Ukraine has confronted Germany with the realities of military conflict, including the medical care of seriously injured soldiers and civilians brought in through humanitarian efforts. This raises concerns about the preparedness of the German healthcare system for such scenarios, particularly in terms of personnel and structural resources for the treatment of penetrating injuries, which are typical for the military context.

An online survey was distributed via email to members of the German Society for General and Visceral Surgery (DGAV). Respondents were asked about structural prerequisites in emergency care capabilities at their institutions and personal experiences managing penetrating trunk injuries (n = 411; 94.6% from civilian hospitals).

Despite increasing specialization 34% of visceral surgeons reported performing emergency thoracotomy themselves. Access to a thoracic surgeon is available in only 50% of the hospitals and to a cardiac surgeon in 26%. The majority of respondents felt inadequately prepared to manage penetrating injuries, especially those resembling military trauma patterns (e.g., shrapnel, blast injuries) as opposed to civilian gunshot wounds.

Given these findings and the evolving geopolitical and security landscape, basic military surgical knowledge must be more broadly disseminated and systematically integrated into national emergency preparedness and disaster response frameworks in order to strengthen the capability for treatment in exceptional situations.