Where Do Surgeons Belong on the Modern Battlefield?

The views expressed in this article are solely those of the authors and do not reflect the official policy or position of the UK Defence Medical Services or UK Government, U.S. Army, U.S. Navy, U.S. Air Force, Department of Defense, or U.S. Government. Since Taoist alchemists discovered what they called “fire medicine” (“huoyao” 火藥) 1,500 years ago,1 the refinement of the explosive properties of gunpowder has led to the development of weapons with increasing destructive capability. In parallel, advancements in medical care for casualties have progressed, although often in “fits and starts.” Despite such advancements, human biology has not changed over millennia of warfighting, and early deaths from combat continue to be most likely due to brain injury and massive hemorrhage, many of which will still be un-survivable even with optimal postinjury care. Furthermore, all aspects of warfare are constrained by limitations of resources, and the medical treatment of combat casualties is no exception. Finding the optimal geospatial location and timelines for surgical facilities must be done within the larger operational framework if it is to be credible, achievable, and sustainable.