[Orthopedics and trauma surgery in national and collective defence : Resilient emergency and palliative care in crises and armed conflict situations].

BACKGROUND: The current European political security environment is very tense due to the return of conventional and hybrid warfare. National and collective defence have again become key political tasks. In this context, the resilience of the healthcare system, understood as critical infrastructures contributing to social cohesion, institutional trust and democratic stability, have moved to center stage. Orthopedics and trauma surgery (O&U) are central to injury care, while palliative medicine represents an essential component of humane and functional healthcare provision in crises and armed conflict scenarios.

OBJECTIVE: This article describes the structural, organizational and competency requirements of O&U in the context of national and collective defence. The article outlines the preparedness for war-related and disaster-related injuries, the development of mission-relevant generalist competencies, the establishment of resilient hospital structures and the explicit integration of palliative care and ethical concepts into crises and armed conflict scenarios.

MATERIAL AND METHODS: Narrative review based on military medical and clinical experiences, relevant national and international emergency and disaster medicine guidelines, palliative care literature and health scientific and health policy documents on resilience of healthcare systems.

RESULTS: Key requirements for O&U facilities are: (1) a shared understanding of the political security situation and the realistic nature of defence scenarios, (2) mission-relevant generalist profiles (emergency surgeon in crisis and disaster situations) with broad damage-control surgery skills, (3) robust clinical structures with clear standard operating procedures (SOP), defined triage and leadership pathways and material as well as personnel redundancies, (4) systematic promotion of psychological resilience and ethical ability to act of the team and (5) the broad integration of core principles of palliative care to ensure symptom control and dignified dying despite resource constraints.

CONCLUSION: Preparing O&U for national and collective defence is not only a special military medical task but also a discipline-specific and total societal responsibility. Emergency surgery , complex reconstructions and palliative care must be regarded as complementary pillars of a resilient healthcare system. Resilient trauma surgery and palliative care structures contribute doubly by maintaining treatment capacity in times of armed conflict and stabilizing public trust and social cohesion.