The answer must be the fundamental shift in thinking about the architecture of medical support, as mentioned earlier. If we establish medical facilities in protected locations – primarily underground, resistant to vertical impacts – we will win the health and lives of medical personnel and the wounded. Container field hospitals are currently only viable as a component of dynamic maneuver operations, especially in enemy territory. However, with limited force mobility, they will become one of the first targets of an attack. Forward medical facilities should therefore be located underground and equipped with operating rooms and intensive care units capable of autonomous operation for at least 72 hours. Only such infrastructure, integrated with an evacuation chain that includes hospitals adapted to receive the wounded, creates an effective chain of survival. This is the essence of modern medical support: organizational flexibility, infrastructure that protects rather than exposes, and wherever possible, support with new technologies that shorten the time to intervention and enhance the capabilities of medics on the battlefield.
Four years of war in Ukraine have passed. Is the Polish army drawing conclusions from this armed conflict? Are we better prepared should such a scenario arise?
Many initiatives are being undertaken, but they are isolated in nature. There are no solutions that would systematically integrate all activities, so that we can objectively state that the military healthcare service is well prepared to both directly support the armed forces and cooperate with the civilian healthcare system. Much remains to be done, but I trust that in the coming months, efforts in this area will accelerate. However, I cannot deny this: we have clearly lost the balance between what a soldier uses to fight and what gives them a chance of survival if wounded. We invest billions in fire systems, yet we still treat medical support as a cost item, not as a strategic prerequisite for the effectiveness of all other defense investments.
I imagine that, based on the Ukrainian experience, the Polish army is implementing new training methods, creating underground hospitals, and organizing exercises for civilian personnel to support the army?
No. You've just listed a number of actions that should be implemented, but which still remain in the realm of proposals. After four years of war in Ukraine, we should have comprehensive solutions for training in tactical medicine and have trained our personnel – at least to the extent necessary to meet the needs of a defensive operation involving hospitals located east of the Vistula River. In parallel, regular exercises should be conducted to coordinate the medical system with other services involved in responding to crises.
What did the Ukrainian conflict demonstrate regarding battlefield medicine? Certainly, medical support rules familiar from NATO asymmetric operations—for example, in Iraq and Afghanistan—were violated.
The war in Ukraine has demonstrated the enormous dynamics and scale of changes in the organization of battlefield medical support. The organization of medical care has undergone a profound transformation since the beginning of the conflict – primarily because the battlefield itself has changed. The widespread use of unmanned systems has resulted in the so-called death zone now extending approximately 20-25 kilometers. As a reminder, at the beginning of the war, Ukrainians assumed that stabilization points, used to provide life-saving medical assistance, must be located within three kilometers of the enemy's line of contact. Currently, they suggest that they should be located outside the 12-20 kilometer zone, as infrastructure located closer would be destroyed. This has redefined the entire logic of organizing medical care on the battlefield – first aid and care at the point of injury, as well as the ability to transport the injured as quickly as possible to an area where they can receive qualified medical care, have become a key challenge.
To what extent can we benefit from Ukrainian experiences?
I have repeatedly emphasized that the Ukrainian experience should be treated as a reference point, not a model for direct replication. Ukraine is a completely different operational space – with a different territorial depth and density of medical infrastructure that can be used in defense operations. In this respect, Poland has clearly more favorable conditions. The same applies to information technology, which in many cases can support medics in activities critical to saving the wounded.
This advantage, however, does not absolve us from considering important nuances, particularly the fact that a system cannot be designed based on fixed and rigid assumptions. Experience from the war in the East demonstrates that the dynamics of change on the battlefield can ruthlessly challenge even seemingly sound assumptions. For example, the issue of investing in third-level mobile hospitals—an infrastructure requiring enormous capital outlays and characterized by high entry and exit barriers—requires in-depth consideration. This isn't about abandoning such projects, but about their proper scaling—proportionate to operational needs and resilience to threats on the modern battlefield. In the realities of modern conflict, ensuring high flexibility and adaptability of medical support, optimal utilization of previously prepared protective infrastructure—including underground hospitals—and the systemic implementation of new technologies is crucial.
What injuries do soldiers fighting in Ukraine most often suffer?
The war in Ukraine has revealed a phenomenon previously analyzed only to a limited extent in NATO medical doctrine: a marked polarization of the medical casualty record. Moderate injuries, previously the dominant category, have virtually disappeared. The modern battlefield generates two extreme groups of casualties: those with minor injuries, and those seriously and very seriously injured, requiring immediate surgical intervention and intensive care. Serious injuries account for 20 to even 40 percent of all medical casualties – without rapid, qualified medical assistance, this number will die within the first hour of injury. The scale of this challenge is critical for medical support planning. Numerous cases of casualties with symptoms of hemorrhagic shock, burns, multiple organ injuries and barotrauma create an unprecedented pattern of medical losses, requiring medical assistance – often highly specialized – provided in close contact with the enemy.
The war in Ukraine has proven false the myth of the "golden hour" when medical aid should reach the wounded. Damian Duda, a battlefield paramedic who provides aid to soldiers in the contact zone, says that sometimes evacuating a wounded person takes not just hours, but days.
Absolutely – and operational data clearly confirms this. The concept of the "golden hour" – a fundamental NATO doctrinal assumption, developed almost to perfection in asymmetric conflicts in Iraq and Afghanistan, where the coalition enjoyed air supremacy and the survival rate of the wounded reached a record 98 percent – proved to be a mirage in Ukraine. Ukrainians report that evacuations take not 24 or 48 hours, but sometimes even two weeks. In conditions where 40 percent of the medical infrastructure is destroyed in the first months of the war, evacuation lines are systematically attacked, and MEDEVAC helicopters are unable to operate, the mortality rate among the wounded is dramatically high.
In the Ukrainian reality, soldiers initially have to supply themselves, and after some time, a drone delivers medical supplies, medicines, and food, sometimes for days. Are we even prepared for such a scenario of support for soldiers in this contact zone? Of course, I realize that the war in Poland will likely not look like the one in Ukraine, where we are witnessing classic trench warfare.
The scenario you describe—a soldier in the contact zone for days, relying solely on self-help and supply delivery via drones—is precisely the operational scenario we are analyzing and preparing for. At the Military Institute of Medicine (WIM-BIP), we have been developing solutions for years, including unmanned systems for transporting medicines and medical supplies, autonomous platforms for evacuating casualties, and extensive communication and data exchange systems. The goal of this work is to provide soldiers and medics in close contact with the enemy with rapid support—both material and diagnostic and decision-making. It should be emphasized, however, that Ukrainian, as well as Finnish and Estonian, experiences dictate great caution in developing airborne platforms for evacuating the wounded. Practice is shifting decisively toward autonomous ground platforms. This doesn't rule out air transport, but its role will focus primarily on delivering medical supplies—blood, medicines, and dressings—rather than transporting people. This is why proper preparation of the soldier himself remains crucial – training in self-help and mutual aid, equipping him with individual medical kits capable of sustaining life during an extended period of isolation, and ultimately integration with an unmanned supply system delivering medical supplies in multi-day cycles.
All of the solutions mentioned are within our reach – we've been researching and developing them for years. However, the key is that they can finally be implemented within a new military healthcare system, tailored to the needs of a modern army.
Do we have such platforms for evacuation?
Over the past five years, WIM-PIB, together with the Military University of Technology and industrial partners AMZ KUTNO, TELDAT, and Pelixar SA, has implemented research and development projects that comprise a comprehensive program for the digital transformation of battlefield medical support. Key projects include MEWAMED, a remote medical reconnaissance and evacuation system using unmanned aerial vehicles; MILGEOMED, which integrates geolocation and medical data in a unified operational environment; and SWD-EwMED, a medical evacuation decision support system based on soldier vital signs monitoring and enhanced situational awareness.
Such solutions are emerging in Ukraine, but mostly the evacuation of the wounded is carried out using civilian vehicles, which are minimally equipped to transport the wounded. Are we ready to use telemedicine to treat them in situations where there is no electricity, internet, or adequate medical supplies?
This touches on a fundamental issue. A key element of good healthcare organization is having efficient IT networks and databases – a system that allows access to medical data of both soldiers and residents of the region. Implementing such solutions – and we have specific proposals in this area – allows, among other things, for immediate identification of a wounded person's blood type and initiation of transfusion preparation procedures at the intended treatment site, targeted referral of the injured person to a facility with capacities commensurate with the type and severity of injuries, and, on a systemic level, optimal distribution of the wounded between hospitals, eliminating the risk of overloading some facilities while underutilizing the capacities of others.
However, you raise a much more important question: what happens when the entire digital superstructure ceases to function? The Ukrainian experience is merciless: the systematic destruction of energy infrastructure, cyberattacks crippling hospital systems, and the collapse of supply chains have exposed the vulnerability of systems dependent on advanced technologies. The evacuation by civilian vehicles you mention is a natural consequence of this degradation.
Therefore, we adopt a principle: use technology when it works, but maintain full functionality when it fails. This means a hospital infrastructure capable of operating autonomously without power for at least 72 hours, redundant connectivity, and parallel documentation in paper format. Furthermore, every electronic device must have a mechanical equivalent. Equally essential is the reactivation of basic skills: diagnosis based on physical examination instead of imaging, the use of traditional surgical instruments, and hemostasis through vessel ligation instead of electrocautery.
Implementing these seemingly simple solutions reveals a paradox: preparing to function without technology requires more training than operating the most advanced systems. Survival will therefore depend on the ability to work at the level of mid-20th-century medicine – using 21st-century knowledge.
Why is it important?
It is in this context that drones play a key role. They help us determine the injured person's condition and the type of injury. For example, if significant blood loss is detected, we read the soldier's ID, which contains information about their blood type, and immediately transmit the data to the nearest blood donation center and hospital, where time-consuming procedures for transfusion can begin. Similarly, when burns are identified, the information is automatically transferred to the nearest center specializing in their treatment, initiating the necessary protocols for admission. This is crucial because, in this category of injuries, response time directly determines survival. Ukrainians lack such capabilities because they lack the appropriate infrastructure behind the scenes, and therefore claim that the technologies have failed.
The Americans are taking the opposite approach – they rule out the possibility of infrastructure damage that would disable the entire system, and they are basing all medical care and subsequent stages of evacuation on this digital infrastructure and real-time data flow. Therefore, we urgently need to decide in which direction we intend to develop our system. I advocate a middle ground. In the first weeks of a conflict, we will likely have a functioning digital infrastructure, and wherever mass casualties occur, we should absolutely use it for triage and managing the flow of wounded. However, over time – if we don't implement technology capable of replacing the infrastructure, which will degrade in the meantime – a transition to analog mode will be necessary. Exactly as we are seeing in Ukraine today.
How many medics does the military health service have now, and how many should there be?
There are about 880 of them, there should be at least 1600.
Most of the wounded in Ukraine are admitted to civilian hospitals. Therefore, a natural step should be the integration of the military and civilian communities.
Such initiatives are already underway. The Ministry of Health is launching a project called the National Center for Medical Personnel Development in Tactical Medicine. The Military Institute of Medicine (WIM-PIB) is its leader, and three medical universities are participating. This marks a breakthrough, as the competencies of medical personnel will largely determine the effectiveness of the healthcare system during armed conflict.
At the same time, we are building something unprecedented in the Polish system – nearly two years ago, the institute began working with local governments, which, in crisis situations, are the frontline in managing healthcare resources on the ground. Together, we are developing a new framework for civil-military cooperation in the area of medical support – from preparing personnel and infrastructure, through identifying critical locations in terms of expected medical losses, to communications, transport logistics, and the supply of blood, medicines, and medical supplies. A true operational map of the country's medical preparedness is emerging, unlike anything we've seen before.
However, these initiatives do not constitute a coherent, integrated structure. More effective coordination at the central level is essential – closer cooperation than before between the Ministry of National Defense and the Ministry of Health in terms of guaranteed funding, developing uniform guidelines and standards applicable to all healthcare providers within the national medical security system, in accordance with the principle of central coordination and local agency.
I return to the first question. Are we prepared for war, given that plans, assumptions, and programs are only just being developed? I have the impression that these four years of war in Ukraine have slipped through our fingers.
We have fragmented system elements – many valuable initiatives are underway, but they do not yet form a coherent, integrated whole, with individual components prepared, verified, and interconnected. We have individual bricks, but we don't yet have a wall – and the time available to build one is not infinite.
Source: rp.pl | 22/02/2026 07:54
Photo: Petro Zadorozhnyy / State Border Guard Service of Ukraine