An analytical article in the journal Military Medicine calls for a comprehensive reform of NATO military medicine based on Ukraine’s wartime experience. One of the co-authors is Dr. Denys Surkov.
Medical Director of the Tactical Medicine School,
184th Training Center
An analytical article published in the journal Military Medicine calls for comprehensive reform of NATO military medicine based on Ukraine’s war experience. Dr. Denys Surkov co-authored the piece with both Ukrainian and international colleagues.
The core message is critical: the current NATO model of battlefield medicine does not match the realities of full-scale, high-intensity war—especially at the tactical level, which determines whether wounded soldiers live or die.
What NATO’s Model Is Based On
NATO medical standards are rooted in experiences from low-intensity conflicts like Afghanistan, Iraq, and Kosovo. These campaigns had:
- Complete air superiority
- Stable rear zones
- Secure logistics routes
- Evacuation to surgery within the “golden hour” (60 minutes)
This model worked—until a new kind of war began.
How Russia’s Full-Scale Invasion Changed Everything
- Frontlines are constantly shifting
- Rear zones are under missile and drone attack
- Helicopters are targets, not safe evacuation tools
- Evacuation routes are unpredictable and dangerous
As a result, frontline medics operate in isolation without support or intelligence. Evacuation takes 6–24+ hours, and field hospitals and transport vehicles are under threat. Medical staff often perform clinical, logistical, and command roles simultaneously.
The Golden Hour Is Obsolete
Instead of aiming for 60-minute evacuation, Ukraine applies Prolonged Field Care—stabilizing the wounded in the field for hours or even days until safe transport becomes possible.
Why the Tactical Level Is Central
Unlike traditional command models, the Ukrainian experience shows that the tactical level is the core of battlefield decision-making. Medics here face the toughest conditions, make split-second decisions, and ensure survival when centralized support can’t react fast enough.
Key Reform Proposals
- Replace “golden hour” doctrine with Prolonged Field Care
- Make the tactical level central in medical operations
- Update NATO STANAG standards for modern combat
- Fully integrate medics into combat planning
- Design new training for independent medical action and logistics
What Ukraine Is Doing
Ukraine has already launched a training program for tactical-level commanders to address these challenges. The course includes:
- Integration of medical planning into missions
- Case-based scenario analysis
- Decision-making under isolation, time pressure, and low resources
It’s not about theory — it's about surviving when Plan A fails and no backup exists.
Infographic: © Olya Ostapchuk
