Trendy peer fight has blown aside the parable of protected fight medical items. On the battlefields of Ukraine, scores of medical personnel, shielded in idea by each worldwide legislation and historic norms, now lie useless. To outlive on this atmosphere whereas rescuing others, medics starting from junior enlisted caregivers to senior physicians want tactical expertise beneath fireplace. Skipping this coaching leaves them weak and turns them right into a safety threat — a dropping system in trendy fight.
All through the previous 4 years, Russia has focused Ukrainian help stations, evacuation routes, and trauma groups. These assaults provide a grim triple benefit: killing or wounding medics that function drive multipliers, eliminating wounded troopers who would possibly return to the struggle, and demoralizing troops and the general public. These threats require a new paradigm for frontline fight medical groups that mixes tactical proficiency and medical experience.
This mannequin harkens again to the earliest recorded fight medics described in Homer’s Iliad. These army surgeons served as each battlefield healers and stalwart commanders — a mannequin that meets the calls for of contemporary warfare. But right this moment, the U.S. army well being system isn’t designed to provide combat-savvy medical groups and medical leaders at a scale required for contemporary battle. The tough realities of right this moment’s battlespace demand a elementary redesign of how the U.S. armed forces practice army medical groups, how we choose and promote their leaders, and the way we ship fight casualty care.
Historic Fight Medics Value a Battalion
To avenge the kidnapping of Helen — spouse of Menelaus, King of Sparta — his brother Agamemnon assembled a big Achaean (Greek) coalition. Amongst its leaders had been Machaon and Podalirius — physicians and sons of Asclepius — who sailed thirty ships of males to Troy the place they served as each battlefield surgeons and commanders. Within the following passage from Stanley Lombardo’s translation of the Iliad, Machaon treats King Menelaus, wounded by a Trojan arrow:
Machaon’s coronary heart was pounding as he made his approach
Throughout the crowded sand and thru the troops
Till he got here to the place Menelaus lay wounded,
All the military’s finest gathered round him
In a circle, into which he stepped like a god
And rapidly drew the arrow from the clasped belt.
Because it got here out the barbs had been damaged backward.
Then he undid the metallic belt and, beneath it,
The band with the crushed bronze kilt-piece.
When he noticed the wound the arrow had made
He sucked out the blood and smeared on
Soothing ointments Chiron had given his father.
This compact narrative reveals the essence of a warrior medic: a surgeon on the entrance strains, able to struggle or intervene medically, because the scenario calls for. His presence reassures Menelaus’ males. His decisive motion turns a doubtlessly deadly blow right into a manageable wound.
Later, Machaon himself is wounded by a triple-barbed arrow from the bow of Paris, the Prince of Troy and abductor of Helen. A fellow Greek involves his help and rapidly requires assist:
Nestor, son of Neleus, mount your chariot
And take Machaon again to the ships.
A medic is price a battalion of males
In pulling out arrows and dressing wounds.
It’s onerous to discover a plainer assertion of medical worth as a drive multiplier. Machaon not solely instructions his males within the struggle, however his therapeutic expertise allow many others to struggle once more. Accordingly, the Greeks act rapidly to rescue him by shifting assets to evacuate him to security.
The identical ebook additionally describes “buddy care” rendered beneath fireplace — what right this moment we’d name tactical fight casualty care — by an historic fight lifesaver. Patroclus, finest good friend of Achilles, is not any surgeon, however he is aware of sufficient to avoid wasting a teammate:
Patroclus had him lie down, and with a knife
Minimize from his thigh the barbed arrow.
He washed the wound off with heat water
And patted into it a bitter root
That he had rubbed between his arms,
An anodyne that took away the ache.
The bleeding stopped, and the wound was dry.
Lengthy earlier than the seventy fifth Ranger Regiment, the traditional Greeks distributed lifesaving expertise throughout the formation. These fight lifesavers began the chain of survival and purchased time for definitive assist to reach. This contrasts sharply with the Trojans who fought with restricted medical help.
In sum, the Greeks fought on because of the essential benefit afforded by their medics and different warriors skilled to render fast care. Three millennia later, this precept nonetheless holds true: Pushing life-saving trauma care far ahead to help groups involved boosts confidence and preserves the preventing drive earlier than even the stiffest opposition.
Are Medics and Warriors Intrinsically Incompatible?
From the Iliad, we see battlefield medical experience at its peak — some ten years into the siege of Troy. These surgeons and fight lifesavers handled sufficient fight wounded to maintain their expertise in fight casualty care even whereas they commanded their troops. Centuries later, although, there’s a sharp divide between army medics and warriors. This divide locations each communities in danger. In 1952, Dr. Frank Berry, famed thoracic surgeon and World Warfare II veteran, famous that Machaon, “forsook his major calling and was wounded whereas becoming a member of his fellows in arms to repel a very fierce assault by the Trojans” (emphasis added). This assertion portrays the perceived stress between healer and warrior and raises the query of whether or not these roles are intrinsically incompatible in trendy instances.
This perceived incompatibility has two major origins: one principled and one other sensible. First, on precept, the U.S. army treats medics as a protected class somewhat than operational belongings. This designation harkens again to the primary Geneva Conference of 1864. Like civilians and journalists in a fight zone, medical personnel — as long as they aren’t working in a combatant position — are thought-about non-combatants by worldwide legislation. But, scores of examples within the many years since — together with unintentional collateral harm and deliberate strikes — exhibit the hazards of relying solely on authorized and normative safety throughout battle.
To mitigate this threat, the U.S. army providers have settled on a compromise. Navy surgeons, nurses, and different help personnel obtain coaching in fight fundamentals centered on self-protection and safety of 1’s sufferers. Sometimes led by different medical personnel, these predeployment programs usually lack the realism and seriousness that characterize most operational coaching. When cloistered properly behind the entrance strains of their medical bubble, fight medical groups can get by with these elementary expertise. But when the necessity arises to relocate the medical facility or to look after casualties outdoors the wire, these fight neophytes symbolize a safety legal responsibility somewhat than an asset.
What’s extra, right this moment’s large-scale army workouts sometimes neglect any medical parts or permit medics to decide out of those drills. It is a mistake. Medical groups must learn to operate in an operational atmosphere, guarantee their gear works, and make sure hypothetical plans operate as anticipated, particularly in contested environments. Likewise, operational commanders profit from interfacing with their medical groups earlier than actual bullets begin to fly. Familiarity breeds belief, and belief breeds confidence.
On the identical time, medics ought to proceed to adhere to worldwide legislation. Masquerading as a healer whereas actively collaborating in offensive assaults constitutes the crime of perfidy. Weapons like handguns and even an M-4 or M-16 are allowed and needs to be used expertly in self-defense and to defend one’s sufferers. Offensive weapons like hand grenades, nevertheless, ought to stay off limits.
Wish to Lead? Give Up Affected person Care
The sensible origins of the warrior-medic divide stem from the explosion in medical data over the previous century, the lengthy medical coaching pipeline, and elevated medical specialization. Surgical coaching right this moment requires properly over a decade: 4 years of premedical research, 4 years of medical college, and 5 to seven years of surgical residency. Analysis and specialty coaching tack on extra time to this already prolonged course of. Then, to observe clinically, board certification and steady skilled training require close to fixed maintenance.
This rigorous medical coaching leaves little time for army operational research in our present system. What’s extra, no trendy medical observe encompasses the corpus of battlefield drugs — from illness prevention to trauma surgical procedure. Dr. Edward Churchill, Allied Chief Surgical Advisor within the Mediterranean and North African theater of World Warfare II, noticed: “Navy surgical procedure is a subspecialty of surgical procedure, however a discontinuous one.” It’s as if your complete area should be reinvented each time the U.S. goes to battle. Eighty years later, the super-specialization throughout all of drugs has made this discontinuity even worse.
Recreating a system of fight casualty care at the start of every battle prices lives. This recognition has motivated the event of a devoted army coaching pipeline in “expeditionary surgical procedure.” This novel method ensures that the U.S. army all the time has no less than just a few fight casualty care consultants. It emphasizes experience in trauma and burns, emergency circumstances, and mass casualty occasions. Giant medical facilities throughout america — together with Brooke Military Medical Middle and plenty of civilian trauma facilities — constantly handle sufficient sufferers with these circumstances to supply deployment-relevant coaching. As soon as battle breaks out and the demand for fight medical groups surges, these consultants can supervise or practice others with adjoining or adaptable expertise.
Even after buying these expertise, nevertheless, those that aspire to steer as warrior medics face another stumbling block: Trendy senior medical leaders usually don’t handle sufferers. The standard army medical profession development begins with constructing a medical observe utilizing the talents developed throughout coaching whereas serving in native management roles. Nonetheless, as soon as physicians attain the O-6 (colonel/Navy captain) stage — and nurses even earlier — they sometimes should select both medical observe or management development. Confronted with this determination, most take the third choice of separation or retirement.
Framing senior army medical management and medical expertise as a binary alternative deprives the U.S. army well being system of many extremely expert clinicians with excellent management expertise. In civilian drugs, the most effective senior leaders usually keep a medical observe. This higher informs their strategic decision-making, and for working surgeons, permits them to maintain their medical relevance.
Trendy Fight Medics Modeled After the Historic Greeks
Within the face of an ongoing battle with Iran and a peer menace in China, how can america finest restructure its present method to arrange for contemporary fight? Briefly, I imagine it wants to coach and advance true warrior medics within the mould of Machaon.
On the operational stage, grooming tactically expert medics with trauma experience has just lately gained recognition. Austere resuscitative and surgical care groups meet the best requirements of far-forward trauma care whereas additionally reaching a excessive stage of tactical proficiency. These medics embed with operational items and endure intensive health, weapons, and team-based coaching. On the medical aspect, they be taught to transfuse blood, staunch hemorrhage, and carry out life-saving surgical procedure near the ahead fringe of battle.
Sadly, the variety of casualties austere resuscitative and surgical care groups can handle is small — one to 2 emergent surgical sufferers at a time. Thus, this mannequin affords beautiful care however in restricted portions. Constructing a strong survival chain upfront of a large-scale battle with a peer enemy would require experience at scale from level of harm by means of restoration. Latest efforts to implement pre-hospital tactical fight casualty care coaching utilizing a four-tiered mannequin throughout all providers inside 5 years reveals the extent of dedication required for fulfillment. Declaring fight casualty care as mission essential felt like an incredible win. Nonetheless, inadequate assets and inconsistent enforcement led to disappointing preliminary outcomes. These traits have just lately reversed, suggesting a renewed dedication to maximizing battlefield survival. Extending this identical scaling method to full trauma groups would require a strong coaching funding from each civilian and army drugs, beginning with medical and nursing faculties and lengthening by means of specialty coaching.
Wiggle room for including military-specific medical and tactical coaching already exists. Take, for instance, the Well being Professions Scholarship Program, the U.S. army’s scholarship for finding out at a civilian medical college. Through the required however largely unstructured 180 days of army service, studying tactical fight casualty care and expeditionary surgical procedure would symbolize a much better use of valuable time than studying to learn electrocardiograms in a army hospital. The previous is exclusive to a army profession whereas the latter might be realized anyplace.
On the management stage, current efforts to modernize the army well being system led to the creation of the Protection Well being Company. The Protection Well being Company serves as a fight help company tasked with working all army hospitals and well being clinics whereas additionally supporting medical readiness. However every service retains command and management over its personnel. This division of labor holds the promise of improved effectivity for the well being system. In observe, although, army medical readiness has suffered: Solely 10 p.c of the final surgeons on energetic responsibility qualify as fight prepared — a bellwether of the entire system. Fixing this egregious hole requires pressing consideration at a number of ranges.
First, the Protection Well being Company’s mission wants clarification, and its construction requires additional refinement. The in-garrison and forward-deployed missions are largely divergent, making it not possible for the Protection Well being Company to serve each. Going ahead, the Protection Well being Company ought to focus solely on the in-garrison noncombat mission whereas studying from the opposite federal healthcare system — the Veterans Well being Administration — and from wonderful civilian healthcare programs. These programs profit from constant civilian executive-level management centered on a singular mission of delivering efficient and environment friendly care in america. Appointing a senior civilian healthcare administrator to direct all home army medical healthcare for servicemembers, their households, and beneficiaries — and holding that chief accountable for efficiency — would permit the Protection Well being Company to excel at this singular mission.
Second, the armed providers ought to personal the fight casualty care mission beneath a joint unified medical command. This is able to elevate forward-deployed care — the one mission that solely the army well being system can carry out — to its rightful place of primacy. Holding the commander of a joint unified medical command accountable for each medical and tactical readiness amongst all fight medics would serve operational items properly in trendy conflicts. For medical foreign money, the commander of the joint unified medical command ought to embed these warrior medics in choose Protection Well being Company services or civilian trauma facilities that supply massive volumes of combat-relevant medical coaching. The commander also needs to coordinate operational coaching and enormous scale workouts with line commanders to make sure its groups are actually fight prepared. Lastly, establishing a clinician-commander management observe — one wherein senior leaders keep their affected person care expertise — inside this joint unified medical command would guarantee our nation maintains a pipeline of actually distinctive warrior medics.
For many years, the armed providers have resisted a unified medical command. Scandalously insufficient readiness suggests the historic service-centric method has failed. On this mild, can the armed providers lastly be coaxed into a brand new paradigm? The admonition of Odysseus in rallying the troops rings true: “We Achaeans can’t all be kings right here. Too many kings can smash a military — mob rule! Let there be one commander, one grasp solely.” The brutal realities of the battle in Ukraine and the prospect of an imminent peer battle with China lend urgency to those reforms. Now greater than ever, the U.S. army wants operationally savvy, clinically wonderful warrior medics and medical leaders — like those that fought on the plains of historic Troy.
Jeremy W. Cannon, M.D.-S.M., is a trauma surgeon and professor of surgical procedure on the College of Pennsylvania. He served a number of fight excursions through the “International Warfare on Terror” and retired from the U.S. Air Power Reserve in 2023. He just lately coedited Edward D. Churchill’s Surgeon to Troopers, 2024 Version with Trendy Commentary. From 2024 to 2025, he was a veteran fellow within the Bochnowski Household Veteran Fellowship Program on the Hoover Establishment, Stanford College.
Picture: Sgt. Caitlinn Belcher by way of Wikimedia Commons
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