Quadriga 2025: Role2Sea

Medical support is an essential element of all maritime operations, regardless of their intensity. It ensures the operational readiness and capability of national and multinational forces. In this context, the categorisation of medical support into what is referred to as “Roles” and the maintenance of the medical evacuation chain are crucial factors. NATONorth Atlantic Treaty Organization standards exist for both. These structures facilitate a common understanding and the implementation of consistent standards in a multinational context. The roles are defined as follows:

The naval surgical hospital meets the requirements of a Role 2 treatment facility. Also referred to as “Integrated Mobile Naval Surgical Hospital” (German: Integriertes Marineeinsatzrettungszentrum, or i-MERZintegriertes Marine Einsatzrettungszentrum), it is a permanently installed component of combat support ship (CSS) “Frankfurt am Main”. The i-MERZintegriertes Marine Einsatzrettungszentrum includes two operating theatres, a hospital ward with 45 beds, an X-ray room, laboratory capacities, and a dental unit equipped with a dental laboratory. Around 45 military personnel serve in the i-MERZintegriertes Marine Einsatzrettungszentrum. They undergo comprehensive training to prepare for emergencies.

Testing the medical evacuation chain

For this purpose, the German Navy will conduct Exercise Role2Sea 2025 as part of the Quadriga 2025 exercise series. Sea-based Role 2 support in the i-MERZintegriertes Marine Einsatzrettungszentrum will be tested under realistic conditions in the Western Baltic exercise area. The first part of the exercise will focus on the medical evacuation chain (Roles 1 and 2). After that, “casualties” will be brought ashore for further medical treatment (Roles 2, 3 and 4), involving airlift operations.

The exercise will cover a wide range of potential emergency situations. This will include initial treatment on board, primary surgery, and organising the transfer of seriously injured casualties to specialised land-based facilities. The focus will be on close cooperation between the ship's crew, the specialist medical personnel on board and civilian rescue forces. The use of state-of-the-art medical equipment, standardised procedures and regular training ensure that patients receive the best possible care in emergencies. In this way, Exercise Role2Sea is making a significant contribution to preparing the German Navy for all maritime contingencies and to ensuring smooth cooperation with civil structures.

Scope and focus of the exercise

The exercise comprises various high-intensity segments covering different aspects. This will include compiling a comprehensive picture of the medical situation as well as setting up and operating internal and external information and communication structures. The manpower and materiel needs will be tested along with organisational processes and procedures, such as the timely activation of the i-MERZintegriertes Marine Einsatzrettungszentrum staff and the reception of casualties arriving on board by boat or helicopter. The core elements of the scenario will cover the management of casualties within the various functional areas, helicopterborne evacuation of patients after medical treatment, and the conduct of Tactical Aeromedical Evacuation - i.e. the transfer to civilian health facilities by Navy, Army or Federal Police helicopters.

One of the exercise objectives will be to validate civil-military cooperation capabilities. This includes the handover of casualties from CSS “Frankfurt am Main” to civilian rescue services in Rostock, Germany. On August 25, 2025, the “Frankfurt am Main” will berth at the Rostock Naval Arsenal. The Rostock fire brigade will then take over, load casualties onto ambulances and transport them to the Rostock University Hospital and the “Klinikum Südstadt” hospital. There, another triageTriage is a procedure for the rapid assessment and thus prioritization of wounded patients. Its goal is to determine the order of treatment based on urgency. will be performed, and patients will receive further medical care.

Finally, patient outcome, i.e. the quality and quantity of medical care, will be analysed as well. Flight and naval operations will round off the exercise spectrum to make sure that all processes run like clockwork.

Shift operations and long-term medical care

During the core phase of the exercise from 22 to 26 August, an accident will be simulated on mine countermeasures (MCM) drone controller “Pegnitz” and Tender Werra. 30 “casualties” will be transferred to CSS “Frankfurt am Main” for medical treatment, some of them requiring surgery. During the exercise, the i-MERZintegriertes Marine Einsatzrettungszentrum medical staff will have to ensure constant medical care for casualties and reprioritise their treatment as needed. For example, if a casualty requires Role 3 or Role 4 medical support, the patient will be immediately disembarked to receive treatment in a civilian hospital. Assistance will also be provided by the Search and Rescue Coordination Centre in Nordholz, Lower Saxony.