How large-scale combat battles bring new medical ethics challenges

A decade filled with conflicts applying modern, digital techniques of warfare which highly differ from the classical martial tactics has not only led to a change in how combat forces organize themselves but also the medical members. The War on the Rocks defense publication has examined the new challenges medical teams are facing behind the frontlines and how this affects how battles are being fought out. Caliber.Az reprints this article.

"As the US military prepares for an era of large-scale combat operations, the 'golden hour' as medics know it is dead. So long as near-peer adversaries can create anti-access/area denial zones that threaten ground and rotary wing medevac units, they will not be able to get servicemembers to Role 2 surgical care within an hour after the injury.

The result will be more casualties. With initial estimates from warfighter exercises suggesting casualty rates as high as 55 percent in future conflicts, the current military medical system, regardless of service, will quickly become overwhelmed. The Center for Army Lessons Learned reached the same conclusion based on the experience of a brigade rotation at the National Training Center. During the last 20 years of conflict, the statistical category “died of wounds,” which measures those who were killed after reaching a medical treatment facility, has rarely even been discussed due to high survival rates. In Ukraine, however, this category has returned.

Large-scale combat operations will bring new ethical dilemmas to combat casualty care. The real potential exists for medical logistical needs to outpace the availability. Contested air environments will deny freedom of movement, and dedicated medevac units will need to say no to requests for evacuation. Finally, the pure volume of casualties will require difficult decisions be to made. There will be a shift from years past when we treated all casualties to deciding who is treated and who does not receive limited resources.

Squad Multi Equipment Transport casualty evacuation platform employed by the Army and Marine Corps. Those same clogged roads will also present a robust targeting opportunity for a near-peer adversary.

Another example of potential difficult decisions arising from medical logistic shortfalls comes from the 1991 Gulf War. A General Accounting Office report on the topic discusses shortfalls in medical supplies that occurred during the conflict. All 10 hospitals reviewed for the study experienced medical supply shortfalls. This included oxygen, morphine, antibiotics, plasma, reagents necessary for laboratory tests, flu vaccines, and antibiotics. Pharmaceuticals and reagents are notoriously expensive and frequently expire before use in field units. Additionally, they can lose efficacy if not kept in environmentally controlled conditions.

While some might relegate the lessons of Desert Shield to a bygone era, medical logistics remains a significant issue today. Even civilians often wind up short of medical logistics. When adversarial forces seize family medicines, ambulances, supplies, and facilities, the civilian populace is left with few options. In the early years of the wars in Iraq and Afghanistan, locals seeking medical aid at front gates was a common occurrence. Failure to provide medical resources that are perceived to be plentiful but that are in actuality limited can help fuel insurgency. Even Ukraine, which is currently the beneficiary of a worldwide effort led by the World Health Organization, has seen shortages of medical supplies.

In order to bring higher numbers of casualties home, would a medical draft, in conjunction with the activation of the National Disaster Medical System, be necessary?

Large-scale combat operations will require a significant paradigm shift from past conflicts. Commanders should anticipate higher casualty rates and prepare accordingly. What will not change, however, is the medical maxim of doing the greatest good with limited supplies, so that others may live".