A Western trainer says talk of ‘golden hour’ would be laughable to Ukrainian forces. It’s already gone there, and the West may not see it again.

• Western armies have long been able to get wounded troops critical treatment during “golden hour.”
• But US officials warned that it could be gone in future wars. In Ukraine, it already is.
• A British Army official who helped train Ukrainians said they’d have likely laughed if “golden hour” came up.

Ukrainian soldiers would likely find any talk of “golden hour,” the window for getting wounded troops life-saving trauma care, laughable, a Western trainer told Business Insider.

Medical treatment within the “golden hour” — the first 60 minutes after a severe injury — can mean the difference between life and death. In recent wars, US forces could rely on air superiority to make medevac flights possible. In future conflicts, generals warn, that luxury may vanish. In the Ukraine war, it already has.

Maj. Maguire, an officer involved with the UK-led Operation Interflex training for Ukrainian troops and new recruits, told Business Insider that “deep in the British mindset” is the idea that if a soldier is injured in battle, a medical team will come get them.

“You tell that to a Ukrainian and they can just laugh at you,” he shared. In Ukraine, there’s “no chance” of a golden hour.

Maguire, who spoke on the condition that Business Insider only use his rank and last name to discuss the training, led an Interflex subgroup last year that worked with Ukrainians who already had some warfighting experience. He also spent years writing reports for the UK and its allies about tactics used in Ukraine, their significance, and the potential value for Western forces.

If you’re a wounded soldier in Ukraine, “you might get out in the night, but if we drive an ambulance up, the Russians are going to shoot at it,” Maguire said.

Combat medics and soldiers in Ukraine have told Business Insider that Russia deliberately targets medics and their vehicles. And international bodies, including the United Nations, have accused Russia of systematic attacks against healthcare. Russia has denied these allegations.

For soldiers and their comrades trying to keep them alive, the threats mean “you’re stuck” in the field. Soldiers thus need additional medical training to keep wounded troops alive.

In Afghanistan, UK forces had the Medical Emergency Response Team, a dedicated unit of doctors, nurses, and paramedics that flew Chinook helicopters out to rescue the wounded.

In Ukraine, neither side has control of the air. Surface-to-air missiles threaten aircraft, and the skies are full of drones that threaten vehicles, making movement for all troops much harder.

A US Army veteran fighting in Ukraine with the call sign Jackie previously told Business Insider that “we have a golden three days.” He said a friend hit by shrapnel could not leave a trench for four days. He said the injury would have been an “easy fix” if the soldier had received care faster, but instead his leg was amputated.

Another American veteran who became a combat medic in Ukraine told Business Insider that when he was in Iraq, he felt confident that even if he got “really messed up,” there was a good chance he’d survive. In Ukraine, he said, “it’s a gamble every time you step off on a mission.”

A war involving Western countries would likely look different from this conflict. NATO has far more airpower, weaponry, and troops to commit to a fight, but a peer-level war is expected to be exceptionally bloody with mass casualties. For many, “golden hour” care won’t be possible, just like in Ukraine.

Western militaries are thus studying the war, and the British military is learning what it can from troops going through the Interflex training, which has been provided to over 58,000 Ukrainians.

Maguire said the war has changed how the British military trains its own, including on medical skills. In Ukraine, you have to “keep everyone alive in the mud, and that requires a higher basic level of skill than I think we had in the British Army team medic cadre.”

It’s not that everyone has to be a paramedic, he said, but he has seen a shift in British thinking and training, including making it more “gritty” with simulated blood and actors portraying critically wounded troops.

It’s getting “a lot more complex,” he said. It’s not just applying a tourniquet; it’s also knowing what to monitor and look for to keep an injured soldier alive for 6 hours, for 24 hours, or longer.

He has observed a growing realization that “we may be required to die on our jobs,” and training of British troops has become more physical, “a bit more aligned to the demands of conventional war as opposed to the demands of counterinsurgency, which we previously had.”

It’s not the only way the UK is learning from working with Ukraine, Maguire said. He said the Ukrainians had demonstrated more flexibility and “tactical imagination” than the British Army typically does, in a way that was influential.

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