For US medics in Afghanistan and Iraq, air superiority more often than not allowed for relatively quick evacuation of injured soldiers in need of advanced surgical care. In contrast, medics in Ukraine commonly are forced to provide prolonged care to patients at or near the frontlines. 4-12 hours, or more, may pass before conditions are safe enough for ground evacuation of patients. Air evacuation is generally impossible due to high risks from Russian air defense platforms, and to a lesser extent, Russian aircraft. Additionally, due to heavy use of artillery, patients often come in clusters. Attrition amongst experienced frontline medics has the potential to burden inexperienced replacement medics with multiple severely injured patients at once, who are in need of prolonged patient management under very austere circumstances.
Similar conditions might well prevail during a hypothetical ground war involving the US and either China, or a similarly strong alliance of powers. Under such conditions, ability to provide advanced prolonged care techniques in the field would be an important tool to improve patient outcomes.
US military working groups have made great progress on developing evidence-based prolonged field care guidelines, mostly based on experience in Iraq and Afghanistan over the past two decades. These guidelines are also applicable to traumatic injuries in many non-combat austere medical situations, such as maritime and wilderness environments. Tactical Casualty Combat Care - Prolonged Casualty Care Guidelines are published by the US Military Joint Trauma System here. In-depth podcasts on various prolonged field care topics can be found here, on the Prolonged Field Care Collective website, or on Spotify, and Youtube.
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