The latest trend in the U.S. military is “near-peer conflict.” After nearly two decades of mainly counter-terrorism and counter-insurgency operations, the Pentagon is changing gears. It is taking a step back in time to a more Cold War setting in preparing for conflict against potential adversaries like Russia and China. 

We can argue that open warfare with the Russians and/or Chinese, while entirely possible, is still very unlikely. As we’re seeing unfold in many places, large states are employing proxy forces as the U.S. has traditionally done since WWII. So the belief here is that while large state conflicts may erupt for short periods of time, the next conflict will be more of what we’re seeing now: wars by proxy. 

Yet, there still exist sub-state actors, like al-Qaeda, ISIS, al-Shabaab, etc. The threat from the combination of those types of forces makes for a very volatile mix. It will make it difficult for the U.S. to balance where our resources are employed in order to deal with these multiple threats simultaneously.

However, with the military gearing up for “near-peer” conflicts, we were curious as to how much the realm of combat medicine will change — and yes, everything about combat medicine will be very different in the near-peer combat realm.

We were introduced to and spoke with retired Colonel Dan Irizarry who served 26 years on active duty. Dr. Irizarry’s career spanned the full spectrum of military medicine from direct combat medical support in multiple areas of operation at the tactical level with the 82nd Airborne Division and 3rd Special Forces Group, to operational command of garrison healthcare facilities and strategic SOCOM leadership as the first command surgeon for NATO Special Operations Headquarters (NSHQ) in Mons, Belgium. Dr. Irizarry is also the Senior Medical Advisor for TraumaFX that provides some of the most realistic medical simulators for troops in training.

As the NSHQ Command Surgeon, Dr. Irizarry built and led a team that envisioned and implemented the NATO SOF Medicine Development Initiative (NSMDI). The initiative is designed to improve SOF medical support through the establishment of the SOF Allied Centre for Medical Education (ACME). 

We spoke about the strides the U.S. military has made in combat medicine, especially during the wars in Iraq and Afghanistan. We also spoke about how many of those advancements may very well take a step backward in near-peer combat and why training, not just for the medical personnel but for the average soldiers is paramount moving forward. 

The realm of military medicine vastly improved during the wars in Iraq and later Afghanistan. In both WWI and WWII, the wounded-to-killed ratio for troops was 4:1. Today, that number has more than doubled; it currently stands at 10:1. That significant decrease has to do with a couple of factors: better training of medical personnel, the reintroduction of the tourniquet to combat troops, and the incredible strides in getting wounded troops to life-saving medical care within 60 minutes, often referred to as “the golden hour.”