NATO forces would likely see heavier losses than Ukraine has in a war with Russia, a senior officer told Business Insider, and that possibility is driving a rethink of battlefield medical care.
Drones are watching much of the front line, making it nearly impossible to get wounded troops access to medical care within the “golden hour,” the critical first 60 minutes after a severe injury when access to medical care may determine life or death.
Golden hour is found only in books, said Ukrainian Col. Valerii Vyshnivskyi, the country’s senior representative to the NATO-Ukraine Joint Analysis Training and Education Centre (JATEC).
“It does not exist,” he said.
Now, there’s only a golden day or month, he continued. “The battlefield is visible 100%. That’s why medical evacuation cannot be done in the old way.”
The sky above the battlefield is filled with drones of all types executing both reconnaissance and strike missions. That saturation means Ukrainians often have to wait for unfavorable weather conditions and poor visibility to evacuate casualties. Some solutions, such as ground robots, are becoming more popular, but those systems aren’t without their problems. They are vulnerable to attack, they break down, and they are susceptible to jamming.
In a high-intensity conflict against Russia, NATO forces would probably face the same casualty evacuation issues that Ukraine is dealing with, Vyshnivskyi said. However, he believes the military alliance would suffer heavier combat losses, as such a war has the potential to be significantly more destructive.
NATO’s search for solutions
Now nearly four years into the war, neither Ukraine nor Russia has publicly disclosed how many of their soldiers have been killed or wounded in combat. However, the total losses across both sides are unquestionably high.
Ukraine has suffered an estimated 400,000 casualties, including up to 100,000 troops killed, according to figures reported over the summer. Russia’s toll is even grimmer: the UK defense ministry said last month that Moscow has likely taken more than 1.1 million casualties since its 2022 invasion and is now losing over 1,000 troops a day.
Western leaders have warned that the carnage, while presently unfolding on the battlefield and in Ukrainian cities, could expand deeper into Europe.
“Russia could be ready to use military force against NATO within five years,” NATO Secretary General Mark Rutte said in a speech last month, later adding that such a conflict would result in “extreme losses.”
NATO is becoming increasingly aware of the threat that drones pose to the treatment and evacuation of wounded troops in armed conflict, and it is preparing to meet that challenge. The alliance is working to source solutions from the medical and defense industries to save lives on a drone-infested battlefield.
Companies from 20 nations submitted 175 applications to showcase solutions at an “Innovation Challenge” hosted by NATO Allied Command Transformation (ACT) and JATEC — a key initiative that uses real-time lessons from the war to inform Western defense planning — in London last month.
Ten finalists presented ideas, which included a portable system to treat kidney failure, a jury-rigged stretcher design for evacuation over rough terrain, a secure communications portal for medics, ballistic plates for makeshift shelter, and other innovative solutions.
British Army Col. Niall Aye Maung, the medical branch head for NATO’s ACT and the medical advisor to the alliance headquarters in Brussels, referred to the ideas as a “system of systems,” where there’s no single solution for battlefield casualty treatment and medical care. Instead, they’d function together.
ACT officials are now examining how to overhaul the NATO medical system to meet the demands of a large-scale war, Maung told Business Insider — and they’re turning to Ukraine’s experience to find medical solutions, including through events like the innovation challenge.
‘Conflict is at our door’
Vyshnivskyi, the Ukrainian officer, said Western leaders and industry are starting to understand the challenges that Ukraine is dealing with on the battlefield.
However, one of NATO’s biggest problems, he said, is that building new capabilities takes far too long — much slower than the battlefield is changing.
For medical gear, the research and development process can be lengthy because items must undergo regulatory and legal processes to ensure their safety. Still, Maung said that most solutions NATO is looking for are commercial off-the-shelf products with dual-use applications in both civilian and military settings. This can speed up procurement timelines.
Quicker procurement is something NATO is exploring well beyond medical capabilities, as allies look to keep pace with the evolution of war technology on the battlefield. Drones and other emerging technologies are at the center of these efforts.
“If we want to react and innovate at speed, we have to accept and respect that the speed of innovation in commercial markets and civilian markets is a lot faster than in traditional military markets, especially if you’re looking at non-traditional armaments,” Bart Hollants, NATO’s innovation broker, told Business Insider.
As the Ukraine war continues, European militaries continue to buy up weapons and strengthen their defenses — especially nations along NATO’s Eastern flank that border Russia — and prepare for the possibility of a larger war.
Rutte, NATO’s secretary general, said during his speech last month that Europe needs “to be ready” because modern wars are “no longer fought at arm’s length.”
“Conflict is at our door,” he warned. “Russia has brought war back to Europe, and we must be prepared for the scale of war our grandparents or great-grandparents endured.”
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