Putting medical boots on the ground

Tuesday, September 19th, 2023

The conflict in Ukraine presents an opportunity for the US to prepare for future potential conflicts with near-peer adversaries (NPAs), including medical care:

Injury in NPA conflict

  • Current US military body armor will likely be insufficient against NPA arsenals with ballistic components that can hit laterally, above, or below standard issue armor plates from multiple angles due to the larger number of accurately impacting munitions.
  • Concussive injury and TBI will be far more prevalent when facing NPA arsenals that can accurately deliver large volumes of more devastating fire.
  • NPA arsenals will be capable of causing significant multisystem trauma to far greater numbers of US personnel.

Providing care for injured in NPA conflict

  • Medical facilities are not safe areas to provide care, even if they are hundreds of kilometers from the line of ground fighting.
  • The resources needed to adequately provide lifesaving care will be far greater than what the US has allocated for in the past.
  • Air, ground, and sea–based medical evacuation will be practically impossible due to very long range and accurate fire capabilities of NPA arsenals; forward surgical teams should be established in hardened structures, possibly underground, capable of withstanding direct attack by NPA munitions.

Preparation and training of US medical teams for NPA conflict

  • Forward medical/surgical capabilities by US personnel will need to be able to handle more casualties simultaneously.
  • Prolonged field care should be a routine part of the medical training curriculum, because evacuation may be delayed or impossible in an NPA conflict.
  • In a future NPA conflict, communications may be limited or nonexistent due to jamming by the NPA or for operational security reasons, preventing advanced notice of casualty arrivals, a scenario that should be practiced regularly (no-notice casualty loads with extensive high-fidelity, situation-based training).

System-level preparation of the US military medical system and structure for future NPA conflict

  • Given electronic jamming by NPA adversaries, robust and redundant command and control of medical assets should be able to be delegated further into the field.
  • Cadres of qualified and capable surgeons need to be developed so that they are ready, able, and willing to deploy to forward locations in a future NPA conflict.
  • Surgeons with expertise in damage control surgery and resuscitation are limited, but this gap may be filled through specialty training, either in person by groups like GSMSG or remotely through programs like the M-Course provided by the ACS.
  • NPAs may ignore international laws against attacking medical resources, medical evacuation platforms, and infrastructure.
  • A database like the US Joint Trauma Registry needs to be implemented for process improvement in the war against Russia, but the US could implement its already established data collection protocol in a future NPA conflict.


  1. Gavin Longmuir says:

    One would hope that the situation in the Ukraine would give the US Ruling Clique pause for thought. Maybe it would be better to focus on resolving future disputes through negotiation rather than through bluster & weapons.

    Anyway, our Rulers future conflict that matters is the one they are trying to gin up with China. That will mainly involve US naval assets near China being sunk and US air assets near China being shot out of the skies. That is the kind of thing which happens if a junta goes half-way round the world to attack someone else’s home territory. The logistics mean that the US Army will have no significant role.

  2. Jim says:

    The number-one thing that the United State could do to prepare for future conflicts with more technologically advanced and economically productive rivals, such as Russia or China, is the decriminalization of marriage for Americans, but to do that would be to permit the Founding Fathers’ progeny to benefit from Federal rule, a completely unacceptable proposition, so unacceptable that evidently not even the prospect of 5TFR Anglo-Germanic teenbodies for the natsec meatgrinder may serve as sufficient inducement.

    For Our Democracy, everything; for Our Posterity, the law.

  3. Bob Sykes says:

    Epstein et al. do not understand the nature of the Ukraine/Russia war. This is not Somalia or Afghanistan, it is Passchendaele and the Somme. It is a massed artillery war. They have no idea what the field surgeons would experience.

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