Future combat likely will involve massive “carnage” like the Army has not dealt with in the past 16 years of war, where the U.S. military spent untold resources on minimizing casualties suffered at the hands of a relatively unsophisticated enemy, according to Lt. Gen. Sean MacFarland, deputy chief of Training and Doctrine Command (TRADOC).
In a “decisive-action fight,” the mission is prioritized over minimizing casualties because defeating the enemy is the way to accomplish that goal, he said.
“On land, war will always remain bloody and personal,” he said. “The Army’s unique medical culture stems from that reality. It’s a direct result of the need to provide medical care as far forward as possible and return soldiers to battle whenever possible and as quickly as possible.”
“That’s not going to change,” he added.
What will be new to most soldiers fighting in a future war against a near-peer nation is “carnage” on a level that has not been seen at least since Vietnam and possibly not since the Korean War, MacFarland said. He illustrated that harsh reality with a slide depicting a Ukrainian armor battalion that was “wiped out in just minutes” by a Russian artillery barrage of thermobaric weapons.
“The United States Army hasn’t experienced that kind of catastrophic attack since the Korean conflict,” MacFarland said.
“From the point of entry all the way back to home station, our soldiers have to be prepared to help each other and themselves for the physical and emotional impact of massive casualties.”
To avoid being wiped out by indirect fire and precision munitions, the Army stresses dispersal of forces in multi-domain battle. Units deployed to combat zones in recent conflicts have operated largely from static forward operating bases. Wounded troops often were evacuated to established medical facilities within the all-important “Golden Hour” in which medics are most likely to preserve life and limb.
“Our medical facilities, just because they have red crosses on a white background … is not going to protect them,” McFarland said July 24 during the Association of the U.S. Army’s annual Medical Symposium in San Antonio, Texas. “They are going to be within range of numerous enemy effects, not just lethal effects, but non-lethal as well.”
Adherence to that Golden Hour and the assurance of available medical care are not guaranteed in a war zone where enemy missiles threaten medevac aircraft, MacFarland said. The Army will be forced to provide extended and complex medical care to soldiers the field.
“Contested domains will cause delayed evacuation and will require future forces to have the ability to treat and hold casualties for longer periods of time,” he said. “We require advanced medical care at the point of entry by providing advanced trauma and resuscitation skills.”
The Army is employing Medical Simulation and Training Centers where combat medical personnel, are exposed to catastrophic wound care using dummy wounded soldiers. Plans are in the works to expand MSTC rotations to “even greater portions of the operating and generating forces,” MacFarland said. The tactical combat casualty care-exportable, or TC3X, provides a similar experience to deployed forces.
A Holistic Aviation Assessment Task Force is currently studying the aircraft fleet requirements for medevac missions in future wars. Meanwhile, the Army is reorganizing its combat support hospitals to make them more mobile and modular so they can grow or shrink according to the scale of a particular battle.
“Are these changes enough? Are there other innovations that we can use to mitigate these challenges? I don’t know,” MacFarland said. “As we look to the future, we need to ensure that massive casualties don’t take us by surprise and cause us to break faith with our soldiers.”