Civilian-Military Collaboration before and during COVID-19 Pandemic—A Systematic Review and a Pilot Survey among Practitioners

Abstract

Due to the similarity in skills and assets, Civilian-Military collaboration has emerged as one of the most reliable partnerships during the disaster and public health emergency management to address all necessary elements of surge capacity, i.e., staff, stuff, structure (space), and systems. This study aimed to evaluate this collaboration before and during the coronavirus 2019 pandemic. The outcomes of the systematic review revealed several published reports on successful civilian-military collaboration and proposed a need for further improvement. One hundred sixty-six individuals from 19 countries responded to nine questions, included in an online survey with the possibility to leave comments if necessary. The questionnaire referred to elements such as command and control, safety, communication, assessment, triage, treatment, and transport, as the crucial components of emergency management. The comprehensive examination of the survey results together with registered comments revealed a possible improvement in collaboration particularly on the strategic levels, i.e., meetings at the command-and-control level, safety, communication, and networking issues. While logistic collaboration seemed to be unchanged, the practical parts of the collaboration, i.e., clinical and non-clinical operational partnership (Triage and Treatment), mutual education, training, and operational understanding of each organization remained unchanged. In conclusion, although the current pandemic may have facilitated a more intense collaboration between civilian and military healthcare organizations, it lacks practical partnership and operative engagement, representing two crucial elements necessary for harmony and compatibility of both systems. Such collaboration may require a political will and perhaps a mutual civilian-military authority.

Differences in Ethical Viewpoints among Civilian–Military Populations: A Survey among Practitioners in Two European Countries, Based on a Systematic Literature Review

“…In such a situation, the diversity in ethical viewpoints among healthcare providers may cause a considerably vaster issue [30,37,55,[68][69][70]. Since CMC remains an alternative for subsequent management of crises, a consistent and successful civilian-military collaboration can only be achieved if there is compatibility between organizations in both medical and nonmedical aspects [13,31,71,72]. One crucial element of such compatibility remains the ethical and moral standings of the staff.…”

Organizational Changes Needed in Disasters and Public Health Emergencies: A Qualitative Study among Managers at a Major Hospital

“…The highest managerial level needs to know all important elements of disaster management, surge capacity, and how they need to collaborate, locally, regionally, and nationally. Finally, higher managerial levels need to recognize the need for education, training, and exercises for key persons in the management system to gain the necessary knowledge to prepare colleagues to manage unexpected incidents and to develop the required instruments for communication, coordination, cooperation, and collaboration (Khorram-Manesh et al 2016a;Goniewicz et al 2021;Khorram-Manesh et al 2022). Thus, developing an organization with the right staff on the right spot and with the necessary mandate to make vital but necessary decisions is imperative.…”

“…Since civilian-military collaboration is desired and one of the most suitable partnerships between two healthcare organizations in Sweden and elsewhere, the armed forces could perhaps share their knowledge and experience or offer opportunities for joint analysis of civilian incidents. Such collaboration could also ease the formation of the future Total Defense Healthcare System Khorram-Manesh 2020b;Khorram-Manesh et al 2022).…”

Global key concepts of civil-military cooperation for disaster management in the COVID-19 pandemic—A qualitative phenomenological scoping review

“…As COVID-19 crisis management occurred in general in a peace time setting, direct civilian-military information exchange and even direct military assistance to the population—within the constitutional framework under civilian leadership—would not pose any issue to civilian organizations including NGOs or other humanitarian actors. In any case, a close dialogue between military and civilian or humanitarian actors is considered essential and key elements of humanitarian civil-military interaction includes information sharing, task division and joint planning as well as practical partnership and operative engagement ( 71 , 74 ).…”