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How should the Defence Medical Services prepare for an Article 5 NATO collective defence operation with the prospect of high volumes of combat casualties?
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  • Published on: 11 January 2024
    NATO Collective Defense and Expectant Casualties
    • Thornton L. Ray, Medical Service Corps United States Air Force Reserve
    • Other Contributors:
      • Daniel J. Hurst, Professor

    During a recent NATO conference in Helsinki, to which one of us (TLR) was invited, the topic of how best to continue providing care to expectant casualties in an austere environment was discussed among participants, though no definitive conclusion was reached. This aligns with Mark Robert Riley’s recent perspective on the preparedness of the Defence Medical Services for a potential Article 5 NATO collective defense operation, especially concerning the possibility of encountering a high influx of combat-related casualties (1).

    In US Department of Defense doctrine, “expectant” is reserved for “casualties who are so critically injured that only complicated and prolonged treatment can improve life expectancy. This category is to be used only if resources are limited” (2). As Riley states, if the Russo-Ukrainian war is a model, NATO would experience 45,000 casualties in the first six months. The number of expectant casualties would likely increase because of a larger denominator, lethality of weapons used, and the number of wounded straining medical resources, requiring medical professionals to make triage decisions, oftentime in the field at point of injury. NATO forces currently lack substantial doctrine regarding the management of expectant casualties, primarily due to the exceptional performance of medical evacuation systems in swiftly transporting individuals from the point of injury to definitive care over the past two decades. As Riley mentioned, that will not be...

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    Conflict of Interest:
    Both TLR and DJH are United States Air Force Reserve officers. The viewpoints expressed here are their own.