Photo credit: www.businessinsider.com

Challenges in Battlefield Medical Care: The Fight for the “Golden Hour”

The U.S. military has raised alarms about the potential absence of lifesaving “golden hour” care in future conflicts, a concern starkly illustrated by the ongoing experiences of soldiers in Ukraine. The delay in receiving medical treatment can extend to hours or days, resulting in severe, lasting injuries, amputations, and fatalities.

Years ago, U.S. generals warned that the high intensity of future warfare could significantly disrupt the evacuation and medical care processes for injured servicemen. This prediction is proving true in the current Ukrainian conflict where rapid access to medical care within the “golden hour”—the critical first hour after sustaining severe injuries—often cannot be achieved. This timeframe is essential, as timely intervention can significantly improve survival odds.

“Until there’s a real concrete answer for drones, it’s going to continue to be pretty hectic when it comes to that type of care,” said a medic known by the call sign Tango, who serves with a foreign volunteer unit in Ukraine. Tango reflected on his experience with Chosen Company during a tumultuous encounter in the village of Pervomaiske, where severe Russian artillery fire struck his team, complicating immediate medical efforts. Despite suffering his own injuries, Tango provided first aid to fellow soldiers, but the wait for comprehensive care stretched dangerously long—resulting in the loss of two men.

The presence of numerous drones and relentless artillery strikes significantly hampers evacuation efforts in Ukraine, leading to a troubling rise in both casualty numbers and the severity of survivors’ injuries.

The Struggles of Emergency Evacuation

During a session with Congress in 2019, General Mark Milley, who was then the Army chief of staff and later became chairman of the Joint Chiefs of Staff, conveyed a somber outlook regarding the military’s ability to conduct evacuations within the golden hour in future conflicts, stating, “Probably not.” His sentiment reflects a broader concern among military leadership about the evolving nature of battlefield care, as Maj. Gen. Anthony McQueen indicated a shift from the concept of a “golden hour” to a more flexible ‘golden window of opportunity.’ This highlights the ongoing challenges faced by medical personnel on the front lines.

Wounded Ukrainian soldiers frequently risk being stranded near the front lines for extended periods, often only able to be evacuated during brief lulls in combat or during the dim light of dawn and dusk. A U.S. Army veteran, known as Jackie, commented, “Here in Ukraine, we have a golden three days,” emphasizing the need for timely evacuations within a longer, yet critically insufficient, timeframe.

A Ukrainian combat medic echoed these sentiments, stating, “The struggle to quickly evacuate is a big problem,” a situation exacerbated by the increased use of drones over the past two years. Current estimates suggest that approximately one million individuals have either been killed or injured in the ongoing Ukraine conflict, with many casualties attributed to drone attacks and artillery shelling.

These cheap drones complicate evacuation efforts by serving as both eyes in the sky for artillery units and deadly weapons dropping munitions. The second medic highlighted that Russian forces intentionally target evacuation vehicles and medical personnel, as incapacitating medics translates into a larger impact on troop survival. The medic noted, “If you kill a medic, it means that you killed thousands of soldiers,” emphasizing the critical role medics play in sustaining troop effectiveness.

“For medics, staying discreet is vital,” Tango noted, adding that wearing identifying patches could lead to being targeted by drones. “You never wear a medic patch on the front line. That’s a guaranteed drone strike.”

While drones significantly impact evacuation processes, they are not the sole source of injury. A 2023 medical study indicated that approximately 70% of injuries sustained by Ukrainian soldiers were a result of shelling or rocket fire. Delays in obtaining necessary medical attention can lead to dire consequences; prolonged application of a tourniquet, for example, can inflict irreversible nerve damage. Jackie recounted a friend’s experience following a shrapnel injury that resulted in an infection after four days without evacuation, ultimately necessitating amputation of his leg.

Innovative Adaptations: The Concept of “Magic Hour”

In a creative analogy to the film “Reign of Fire,” medics in Ukraine are finding that the early morning and late evening hours, described as “magic hour,” provide brief opportunities for evacuations. Tango explained that during these times, enemies transition from regular drones to thermal or night vision, creating an opening for medics to move injured soldiers more safely.

These transitional periods can be essential for mediating between risks, allowing for evacuation to medical collection points—often well-concealed locations—where wounded individuals can be stabilized for further transport to field hospitals once safe passage is available.

Implications for Future Conflicts

The extensive use of drones in Ukraine has redefined battlefield medical dynamics, presenting unique challenges to both Ukrainian and Russian forces. The inability of either side to establish air superiority due to advanced anti-air technologies means that the rapid aerial evacuation tactics employed by the U.S. in Iraq and Afghanistan are no longer viable.

Reflecting on his past deployment in Iraq, Tango noted, “I knew even if I got really messed up, there is a pretty good chance I’m going to survive.” He contrasted this with the current situation in Ukraine, stating, “It’s a gamble every time you step off on a mission.”

In potential large-scale confrontations involving the U.S. against rivals like China or Russia, similar challenges could arise. Col. Matthew Fandre, a U.S. Army medical officer, highlighted in 2020 that in such scenarios, the golden hour would shift from an expectation to merely an objective, returning to patterns reminiscent of World War II operations.

George Barros, an analyst at the Institute for the Study of War, emphasized the need for significant learning to prepare for modern state-to-state confrontations. However, there are also valuable lessons that Ukraine can glean from U.S. military experiences, particularly in prolonged battlefield care.

Despite the difficulties faced, soldiers like Tango are adapting by closely studying and implementing advanced medical strategies under fire, although scaling this knowledge to broader military operations presents challenges. The exploration of using drones for logistical support in contested areas is also on the horizon, albeit in its preliminary phases.

As the conflict endures, frontline medical personnel will continue to race against time, navigating the dangers of war while striving to deliver lifesaving medical care.

Source
www.businessinsider.com