Already in the exercise VOLCANEX 08 a multinational crew concept was requested. Due to national requirements of certified training and lack of lead time a realisation was not feasible. Therefore in 2009 an academic curriculum was developed, which made the assignment of foreign soldiers in a German AirMedEvac C-160 possible. From 3rd to 10th of November 2009 the NATO exercise VOLCANEX 09 took place in Villafranca/Italy. The German Air Force participated with a C-160 Transall in MedEvac configuration to display the StratAirMedEvac part. The medical crew, consisting of a flight surgeon and five flight nurses, was provided by the Royal Dutch Air Force. In preparation for the exercise the designated Dutch staff had been sent to the Air Transport Wing 61 in Penzing/Germany from 31.08. to 03.09.2009 for instruction in the German AirMedEvac system. The Dutch crew who went through this education were prepared for their job aboard the airplane and were certificated by GAF national directives as German crews are. In preparation for and during the exercise synergies, differences and possibilities of improvement were successfully identified. For standardization of multinational operations it is necessary to develop international training requirements. These should include documented proficiency in handling of the medical equipment and instruction in the aircraft type (especially rescue and safety instruction). Therefore the medical equipment used in AirMedEvac, the educational guidelines and the provided aircraft of each nation have to be checked and listed. After a comparison of these lists, overlappings and divergencies between the national system and the multinational requirements could be identified and these gaps could be closed where applicable. Last not least regular or periodic refresher practice for foreign crews in the different national systems will have to be provided.