The Medical Planning Process-Leveraging Ukrainian Insights to Enhance Small-Unit Medical Planning

Russia's large-scale invasion of Ukraine compelled the North Atlantic Treaty Organization and its allied nations to reassess the readiness of the military medical support system for possible future large-scale combat operations. Based on our previous proposal to reform medical planning, we set forth the Medical Planning Process (MPP) in this article. We position the MPP as an adjunct for commanders at the small unit level to plan, organize and direct missions and tasks to evacuation teams, combat medics and Role 1 personnel, within the context of operational plans from higher echelons.

The MPP was developed by request of Ukrainian medical small unit leaders to assist in planning, preparation and execution of their medical support task. We analyzed Ukrainian experiences in dealing with the challenges of frontline combat casualty care, taking cultural aspects into account. Design requirements were that it avoids a Ukraine-specific solution but supports alignment with NATO and U.S. planning methodologies and Ukraine command transformation, that it is recognizable and reproducible, and informs and augments planning from higher echelon rather than diverging from it. In doing so we identified 3 universal concepts that influence the frontline casualty care chain, namely prioritizing quick casualty evacuation, treatment in place, and safety. These concepts need to be balanced against triage based on clinical need and timeliness of care, and together with clinical timelines form the basis of our proposal.

The structure of the MPP is presented as an adaptation of the widely used Troop Leading Procedures (TLP) at the small-unit level. We outline each step as it relates to the TLP, highlighting the connection to the medical mission. Mission variables are assessed and integrated into the planning process using a newly developed framework called CMPEC3: Casualty Estimation, Materiel, Personnel, Environment and Command, Control & Communications. To avoid having to rely on multiple frameworks, CMPEC3 aims to combine critical medical variables with assessment of available assets (in both the human and technological domain) and analysis of environmental factors and threats. The mission analysis includes stipulating limitations and constraints as well as back-up plans and means of redundancy. The complete analysis is used to construct an evacuation scheme as a map overlay, and a medical mission plan in standard order format.

The MPP aligns with current NATO and U.S. doctrine and supports broader application beyond the current battlefield in Ukraine. Informed decision-making by frontline providers is instrumental in shaping medical support for future conflicts. The MPP supports standardization and coordination, aligning small unit medical planning with broader operations. A clear mission statement and setting timelines reduce risks of fragmentation, and a standardized template like the MPP will reduce planning overhead and support disciplined initiatives. Future directions include detailing the possible application in SOF medical mission planning and exploring how the MPP could support NATO interoperability in Multinational Medical Support.