Countries that fail to grasp the philosophy that medical tactical planning is an absolute necessity, and that do not approach it with due seriousness, will never be able to save themselves from experiencing far greater suffering in potential contemporary war dynamics than they can anticipate. One does not need extraordinary talent to foresee this; it is a truth easily accessible to anyone capable of thought. Simply “being concerned” is reason enough to understand it.
Consider the scenario of a very simple math problem that everyone can easily recall. Two vehicles are mentioned, and the question asks which approach would allow them to cover the distance between them in the shortest possible time. The correct answer is the option stating that “both vehicles move simultaneously toward each other from opposite ends.”
The logic behind this answer forms the core mechanism of military medical services concepts over the past 50 years. Efforts are made to create options where the wounded can be rapidly brought to the medical personnel and centers that will provide life-saving interventions—or conversely, where the medical personnel and centers are quickly mobilized toward the wounded. It is now a well-established fact that early intervention after injury is life-saving. The sooner a bleeding vessel can be controlled, the higher the chance of the patient’s survival.
Modern trials of tasks defined along the main axis of the Echelon Shuttle Evacuation System essentially focus on minimizing this time as much as possible. The goal is to get the physician or team who will intervene with the patient to the wounded as quickly as possible. The intention is to bring the wounded and the team or equipment to intervene together as soon as possible. New options are developed concerning the time and space between injury and definitive treatment.
This concept is always valid not only in wars but also in terrorist attacks, contemporary wilderness environments, and injuries in harsh conditions. Securing the wounded, providing life-saving interventions, and delivering them to a Role-2 Surgical Unit where surgery can be performed will vary depending on conditions, geography, and the unique dynamics of the process. Tactical planning skills are vital at this stage. One single plan will not be suitable for all conditions and environments. Flexible and adaptable tactical medical plans must be made with the understanding that each environment and condition can give rise to completely different processes.
Mobile surgical units have also arisen from this need and mindset. They originated from the thought: “How can I perform this task more efficiently with fewer personnel? How can I carry it out with lighter equipment?”
The training of these teams is planned. Today, in medical units deployed on the frontlines or in low-intensity conflict areas, while 9–10 surgeons from all surgical disciplines might typically be assigned, a team of three trauma surgery-trained surgeons and one anesthesiologist can carry out the shift in an extremely efficient and economical manner.
Unnecessary workload and personnel inefficiency are avoided. The same task can be performed at a much higher quality with fewer competent and effective personnel.
Mobilized teams and equipment should be structured as mobile surgical units positioned solely to perform damage-control resuscitation and surgery. They should be able to adapt quickly to any environment suitable for them and perform surgeries.
However, simply creating such teams is clearly not sufficient. Wounded individuals must be rapidly brought to them, and the necessary medical logistics must be continuously maintained.
This is precisely the primary mission of military medical services.
For example, in the United States, the “Austere Resuscitative Surgical Care” team, established in 2019, released a clinical practice guideline in the same year. This guideline focuses on enhancing the capabilities of mobile surgical teams, achieving effective results with limited resources, and emphasizing the question: “How can we address small gaps in the system?” These teams are far more agile and maneuverable than elements operating within the traditional Role-2 framework. They can operate closer to the injury site.
Field medical care centers are the locations where initial interventions are performed to allow the transfer of injuries to more advanced centers. To provide the expected services, these centers must receive training.
Without training, no progress is possible. This process requires both the individual and their team to acquire the skills needed to operate in synchronization. Complex and intricate injuries can only be treated most effectively in this way. Guidelines should be developed that ensure the wounded can survive safely with the most advanced technologies, and these should be enforced as absolute obligations for all.
From simple injuries to highly complex cases, life-saving surgeries must be performed as quickly as possible. Detailed training must be provided on resuscitative procedures and the subsequent care process. How to intervene with a wounded person, how to transport them, or if they cannot be moved, how to maintain field medical care must be well understood.
These practices must not vary from person to person and must be taught as a doctrine to every duty officer. Practices reached through one or more workshops should be compiled into a comprehensive guidebook, and representatives of all disciplines within that responsibility area must follow the rules. The guide is expected to be taught to all personnel. Every soldier deployed in an operational area, whose injury is possible, has the right to expect the highest level of medical care.
Providing this right is the absolute responsibility of us, the decision-makers in military medical services.
It is the expectation of our time that both planners and executors on the battlefield fully understand the philosophy of medical tactical planning. Operations without medical operational planning will carry severe legal and moral responsibility. In modern warfare, outdated or “pretend” plans cannot excuse negligence.
Flexible, expandable, and adaptable tactical medical plans must always be modifiable to suit conditions. Only then can the highest survival rates be achieved in potential injuries.
An operation should have as many roles as necessary. Roles should not be limited to the familiar Role 1–4 but must be as numerous as needed.
The power of the philosophy of medical tactics will determine the high efficiency of an army’s medical services. Planning should be done like playing chess—and results must be achieved.
Each operational area requires unique tactical medical planning. Societies that minimize human losses are, in reality, the most advanced societies. Not a single life should be tolerated to be lost.
Those we lose are not mere objects; each is a human with loved ones. They are all potential heroes capable of saving our future. They are the ones who go first.
