Combat Casualty Care in the 21st Century: Advances, Challenges, and Evidence-Based Strategies for Armed Forces Medical Services

AbstractBackground Combat casualty care remains central to military medicine and has historically shaped the evolution of modern trauma systems. In recent decades, advances in haemorrhage control, damage control resuscitation, balanced transfusion strategies, portable diagnostics, aeromedical evacuation, and telemedicine have resulted in substantial reductions in preventable battlefield mortality. Despite these developments, combat medical care continues to be challenged by austere environments, logistical constraints, variability in training, and the long-term psychological impact of combat injuries. There is a continuing need to consolidate current evidence and contextualize best practices for Armed Forces Medical Services. Methods A narrative review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Peer-reviewed articles, systematic reviews, and military medical guidelines published between January 2015 and November 2025 were reviewed. Literature was synthesized thematically to examine advances, challenges, evidence-based strategies, and emerging directions in combat casualty care. Results Key advances include widespread adoption of tourniquets and haemostatic agents for haemorrhage control, implementation of damage control resuscitation and whole blood transfusion, increasing use of point-of-care diagnostics such as ultrasound, and improvements in prehospital and aeromedical evacuation systems. Standardized frameworks, particularly Tactical Combat Casualty Care and Joint Trauma System guidelines, have improved consistency of care and survival outcomes. Persistent challenges include limited resources in forward areas, evacuation delays, training variability, and the burden of psychological trauma, including post-traumatic stress disorder. Emerging technologies such as artificial intelligence-assisted decision support, wearable biosensors, and digital health platforms show potential to further enhance battlefield medical care. Conclusion Combat casualty care continues to evolve through evidence-based practice, operational experience, and technological innovation. For the Indian Armed Forces, contextual adoption of established global guidelines, strengthening of simulation-based training, and careful integration of emerging technologies can further enhance battlefield readiness and long-term rehabilitation outcomes.