Combat medicine lessons from the Russo-Ukrainian conflict: A shifting paradigm

The Russo-Ukraine war has been the first large-scale combat operation between two near-peer adversaries after World War II. It has seen the no holds barred and lethal use of all the new weapon systems developed in the last eight decades. The result has been an increase in casualties to the tune of nearly 10 to 15 times of those seen in the global war on terror in the US operations in the Gulf wars and in Afghanistan. The casualties have been much more severe with multi-system involvement and more lethal, owing to the munitions used. Lack of air superiority has necessitating Prolonged Field Care as far forward as possible with casualty evacuation (CASEVAC) only when available. Other aspects such as training of medical personnel in mass casualty scenarios where triaging would have to be done in a way to benefit the maximum numbers. The provisioning of blood and products as far forwards with the use of "walking blood banks" would have to be synergied, and capacities to deal with cognitive casualties and rehabilitation in the post-war period would have to be vastly enhanced. Novel ideas such as the use of logistic drones for medical and blood-supply delivery and even for CASEVAC may also be viable, depending on the combat situation.