World War Two ended nearly eighty years ago. Since then, DoD has not dealt with hundreds of thousands of casualties in one war. It is likely that a large-scale conflict with near-peer adversaries will overwhelm conventional medical evacuation capabilities – with orders of magnitude more casualties than in Iraq or Afghanistan. 

Current medical training fails to incorporate large casualty volumes into scenarios for several reasons. Air superiority has enabled very low casualty rates. The TC8-800 course outlines a minimum standard of training, requiring the Combat Medic (68W) to assess, treat, stabilize, triage, and evacuate only two trauma casualties. Even if the 68W had to treat a dozen or more casualties, current medical training technologies lack the interoperability and portability to enable mass casualty scenarios, removing the opportunity to incorporate advanced triage, patient management, or medical logistics considerations of large-scale combat operations (LSCO).

This paper explains why medical training must evolve to incorporate LSCO scenarios. Challenges and potential solutions enabling LSCO will be explored. Current training systems can be adapted to improve interoperability and portability. Reducing the logistical footprint of medical training aids adds flexibility, enabling a variety of casualty types. Robotics and machine learning techniques could improve the speed and accuracy of triage for mass casualty events. Beyond technology-based solutions, this paper also discusses potential policy changes to push Role II and Role III capabilities to the point of injury when patient evacuation is not possible, as well as lessons learned from WW2.