In a recent corps-level wargame, U.S. Army forces sustained 21,000 casualties in seven days. That’s nearly half the soldiers in a full-strength corps.

“It will take everyone to clear the battlefield as quickly as we can when we’re talking about the scale of 21,000 casualties in corps warfighting,” said Maj. Gen. Michael Talley, head of the Army’s Medical Center of Excellence. “That’s reality. How do you keep going? How do you sustain momentum?”

Talley laid out these challenges the military medical community faces, and what can be done, during a recent Maneuver Warfighter Conference panel at Fort Moore, Georgia.

The two-star noted the successes of medical treatment and casualty care in the demanding but comparatively low-casualty conflicts of the last two decades, during which medics would sustain a soldier until the wounded could be transported to higher levels of care.

But those successes have a time limit, and military medical leaders have been warning that the “golden hour” — the critical first hour of treatment following a major injury or wound — may stretch to hours or even days, depending on a unit’s level of isolation during large-scale combat.

“They may have to stay on the ‘X’ a lot longer, with perhaps less capability but have significantly less know-how,” Talley said.

But now, experienced medics in the security force assistance brigades will spearhead a pilot program starting this fall to upgrade medical training, equipment and skills that Talley expects will set the standard for all 68W (the medic MOS), which has the second highest number of soldiers of any MOS in the Army.

That will mean more training for Guard and Reserve counterparts, he said, because more than two-thirds of those medics are not on active duty.

Right now, medics leave their schools with basic emergency medical technician qualifications. Once completed, the pilot aims to have all standard training put every medic at the paramedic-qualified level.

The training goes beyond CPR and tying tourniquets. Talley said observations from the war in Ukraine, where soldiers have fought for more than 17 months straight, show disease, not battle injuries, are consuming much of the force and resources.

As the U.S. Army shifts from using the brigade as the unit of action to focusing on the division as that unit, Talley said Army leaders are considering inserting a Role 3 unit into the division. (Role 3 is a category of medical support.) Those units include specialist surgical and medical capabilities, diagnostic resources, dentistry, food inspection, and other elements, according to the Defense Department.

But while the service improves medical kit, it must also provide the knowledge to use it, Talley explained.

“We can build all the kit we want, condense it, ruggedize it. But if those medics don’t understand physiology, don’t understand if I put a ventilator on you it’s going to have an effect on your kidneys, we’re not going to be able to sustain life the way we have, certainly not going to be as successful as we have in the last 20 years of combat,” Talley said.

But changing the curriculum at the school will likely be the easy part, he added. “What’s most important is how do you sustain that skill set?”

The key to that involves medics drilling those skills at home station in the medical simulation training centers. But Talley did acknowledge they’re not of uniform quality across the Army.

He encouraged commanders to ensure their medics are trained and their medical officers are involved in all training and planning. Even the lowest level soldier can contribute.

“It starts with the [individual first aid kit], knowing how to use everything inside,” Talley said.

The major general pointed to training and practices that are standard in the 75th Ranger Regiment, where universal blood donors are identified in each unit and every soldier has combat lifesaver and additional medical training.

The center is currently revamping each of its 190 medical training courses to include large-scale combat scenarios.

Talley pointed to recent studies by the Army, noting 17 gaps for formations as they transition from a focus on counterinsurgency and counterterrorism to large-scale combat operations.

“Not one of them has anything to do with casualty evacuation,” Talley said. “I think that’s about to change.”

Todd South has written about crime, courts, government and the military for multiple publications since 2004 and was named a 2014 Pulitzer finalist for a co-written project on witness intimidation. Todd is a Marine veteran of the Iraq War.

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