DiMiMED 2025 – “Blood is human fuel”

“We cannot predict the next crisis. But we can prepare for unpredictability. We cannot stop every attack. But we can build systems that bend, adapt, and recover. We cannot continue relying on doctrines written for yesterday’s wars and disasters because lives are at stake in this one.” With these words, co-chairman Brigadier general (ret.) Dr. Erwin Dhondt, former Director-general Health and Wellbeing of the Belgian Armed Forces, opened the 13th DiMiMED Conference in Koblenz, which took place from September 30 to October 1, 2025, at the Rhein-Mosel-Halle in Koblenz.

Under the motto “Anticipating the Unknown – Preparing for the Future. Strengthening Medical Capacities for Unpredictable Disaster and Combat Challenges” around 200 participants from 24 countries discussed the future of disaster and military medicine.

DiMiMED is the abbreviation for International Conference on Disaster and Military Medicine. It is an international conference that has been dealing with disaster and military medicine for 13 years. The conference brings together civilian and military experts to exchange knowledge and improve medical care in crisis and emergency situations.

“Look at the world around us,” Dhondt said. “In Ukraine, medics and doctors work under relentless missile attacks, performing surgery in basements while hospitals lose power. In Gaza, military and civilian casualties overlap in dense urban warfare, where every medical act is also an ethical decision.”

Prof. Dr. Andre Cap, retired Colonel of the US Army Medical Corps, drew parallels with Afghanistan and Iraq in his keynote presentation: There, the 10-1-2 rule applied – the wounded should be taken to a hospital within ten minutes by comrades, within an hour by medics, and within two hours. “We practically flooded this country with medical evacuation capacities,” Cap explained. “Resources that are not available in Ukraine.” Helicopter missions are not possible due to the drone threat, and instead of ten wounded per day, there are often 1,000 to be treated.

Cap described blood as the crucial “human fuel.” “Like diesel for vehicles, the logistics chain must function right up to the front line.” In Ukraine, blood reserves are now transported directly to the trenches by drone. In addition, combat medics – soldiers with advanced medical training – are crucial in keeping the wounded stable for hours or even days. Ukraine has quickly implemented this concept, while Western armed forces have some catching up to do in this area.

Cap also warned of bureaucratic hurdles: In Ukraine, laws have been amended to allow soldiers on the front lines to perform blood transfusions. In NATO countries, however, legal issues could delay care.

A central block of presentations was devoted to the topic of “Combat Medical Care,” moderated by Lieutenant colonel Dr. Florent Josse from the Bundeswehr Hospital in Ulm. Among other important presentations, Dr. Iryna Rybinkina, an anaesthetist at King’s College Hospital in London (GBR), made a particularly impressive report on her frontline missions in Ukraine.

Many key issues relating to the care of the wounded were discussed. DiMiMED 2025 also addressed future topics such as AI-supported diagnostics, robotics in evacuation, resilience training, cyber and information security in hospitals, psychological support for emergency personnel, and dealing with mass casualty scenarios.

One of the highlights of the conference was the presentation of the new “Handbook of Military Medicine for the Battlefield”, edited by retired Lieutenant general Prof. Dr. Martin Bricknell, retired UK Surgeon General, Dr. Joachim Hoitz, and Aleksandar Smiljanic. It is intended to serve as a practical, compact reference work for European armed forces, similar to the US “Fundamentals of Military Medicine.”

“This year’s DiMiMED was fantastic,” summarized Colonel (ret.) Gerald Kerr, former Surgeon General of the Irish Defence Forces, co-chairman of the DiMiMED conference. “The speakers and presentations were better than ever before. The other dimension – also important for DiMiMED – is the interaction between participants. The facilities here were more than suitable for this.”

DiMiMED 2025 clearly showed that proven concepts from previous conflicts are no longer sufficient. Only through international cooperation, practical training, modern technologies, and bold regulatory reforms can military medicine be made fit for the challenges of future conflicts and crises.