Cover: Medical Support to Light Footprint Operations

Medical Support to Light Footprint Operations

Why smaller operations require a different approach to medical support

Published Jun 9, 2017

by Susanne Sondergaard, Marta Kepe, James Sladden, Adam C. Resnick, Darryl Metcalf, Ann C. Sims-Columbia, Anthony Marinos

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Research Questions

  1. What are the current practices of medical support provision and the existing support capabilities in Europe?
  2. What are the issues associated with European medical skills and training?
  3. Are there current and potential future technology and resources that could be harnessed to provide medical support to LFO?
  4. Could overarching doctrinal standards, especially those favouring multinational cooperation, define medical support to LFOs?
  5. How could multinational cooperation lead to updated standards in the field of medical support to CSDP missions?

Light Footprint Operations (LFO) is a concept not currently found in EU doctrine, despite a number of recent EU military missions being characterised as: involving a limited number of personnel deployed with no host nation support; seeking to leave small infrastructure footprint; being relatively short. Whilst so far all EU missions without host nation support have deployed medical support for more traditionally defined medical capabilities (Role 1 and Role 2 medical treatment facilities (MTFs)), these capabilities are designed to support larger military formations in both permissive and hostile operating environments.

This study was carried out in support to the European Defence Agency's work to achieve more efficient medical support to LFO carried out as part of the EU Common Security and Defence Policy (CSDP). A selection of methodologies was employed, including concept development, case study analysis, literature reviews, interviews, expert workshop, survey on European medical support capabilities and attitudes towards multinational cooperation and harmonisation, scenario development, medical technology scan and feasibility assessments. The study proposes a definition for LFO and concludes with a set of recommendations on current doctrine, harmonisation and standardisation, modularisation of Roles, multinational cooperation in technology development and deployment and engagement with civilian medical community.

Key Findings

No definition of light footprint operations has been proposed

  • Given that there is no definition of a light footprint operation in EU doctrine despite a number of EU missions having its characteristics, the study proposed a new definition that has been developed to be consistent with existing related EU policies and doctrines.

Current medical support practices to operations are varied

  • Case studies showed that while there are standard operating procedures, agreement and doctrinal requirements of medical capabilities in place, each national medical treatment facility or element works to its own national clinical standard.

European medical support capabilities differ depending on country priorities

  • Findings from the survey on the medical capabilities of the European Defence Agency's participating member states showed that the more complex or advanced the medical capabilities were the more likely the gaps at European level.

European countries are interested in standardisation and harmonisation among their militaries and with civilian sector

  • While different cultures and expectations exist within Europe with regards to medical support, overall the development of common standards was seen positively.

New technologies can improve resilience of soldiers and enhance medical support for LFOs

  • While technology may assist in improving medical support in LFOs, further development and monitoring is required to ensure that they are fit-for-purpose and that possible concerns are answered.

Medical support options have been developed and their feasibility assessed

  • Medical support feasibility assessment was carried out for four different LFO scenarios and options for the lowest possible capacity that can be generated for LFOS were developed.


  • Introduce changes to current EU doctrine on medical support.
  • Improve harmonisation and standardisation for greater interoperability between forces medical support.
  • Reconsider the concept of roles and options for potential modularisation
  • Consider opportunities for multinational cooperation in the development and deployment of new technologies.
  • Seek to develop and nurture engagement and cross learning between the military and civilian medical community.

Research conducted by

The research described in this report was prepared for the European Defence Agency and conducted by RAND Europe.

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