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Filling the Gap in Combat Medic Training

By Master Sgt. William R. Szabo

Indiana Army National Guard

July 27, 2026

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A combat medic treats a Soldier's knee inside a medical facility.

Master Sgt. Michael McGouldrick, a combat medic instructor, 1st Infantry Division, treats an Iraqi army soldier's knee at an Iraqi army patrol base near Mahawil, Babil province, Iraq, Jan. 2, 2007. Combat medic initial training is based on the past 20 years of fighting in a COIN environment. It's heavily based on trauma management at the point of injury. (U.S. Army photo by Staff Sgt. Sean A. Foley)

The U.S. Army combat medic specialist (68W) initial training is based on the past 20 years of fighting in a counterinsurgency (COIN) environment. It's heavily based on trauma management at the point of injury (POI). While this training is effective for initial treatment, it doesn't prepare medics for follow-on treatment.

The Department of War (DoW) shifted its focus to Large-Scale Combat Operations (LSCO) against near-peer adversaries. There have been concerns raised from all levels regarding the inadequacy of training in relation to prolonged field care (PFC).

Conflict in a LSCO environment would mean substantially increased casualty numbers compared to those in the conflicts in Iraq and Afghanistan and medics capabilities will be stretched thin.

This article explores current initial combat medics' training structure, analyze its limitations in the LSCO environment, and recommend changes that will increase their effectiveness and wounded Soldier survivability.

Combat Medic Specialist Training

Beginning in the early 2000s, the combat medic training was focused heavily on COIN and small-unit operations in Iraq and Afghanistan. It's remained relatively unchanged since then.

After Soldiers finish basic training, they arrive at Fort Sam Houston, Texas, to begin 16 weeks of Advanced Individual Training (AIT). The first eight weeks of AIT encompass emergency medical technician (EMT) basic training (Army National Guard [ANG], n.d.).

This gives trainees a basic understanding of the medical field. Trainees who fail this nationally recognized certification must pursue a new MOS. Those who pass advance to the "Whiskey" eight-week training phase.

Soldiers carry a simulated casualty on a litter during combat field training.

Students evacuate a "casualty" during combat field training, Sep. 29, 2022. After Soldiers finish basic training, they arrive at Fort Sam Houston to begin 16 weeks of AIT. The first eight weeks encompass emergency medical technician (EMT) basic training. (U.S. Air Force photo by Tristin English)

It's during these final weeks that trainees receive more advanced medical training. Unlike the first part of the course, the Whiskey phase focuses more on combat medicine. The skills taught include combat casualty assessment, basic pharmacology, and certain lifesaving interventions including IVs and airway management (Knisely, 2023).

The basic pharmacology curriculum is based on a flow chart principle. If a patient's symptoms present this way, then give this amount of drug X. Trainees aren't told why they give a certain drug or taught nuances advanced providers would know. The model focuses on cookie-cutter, POI care, not PFC.

Transitioning to LSCO

Col. Matthew Fandre, MD, author of Military Review article Medical Changes Needed for Large-Scale Combat Operations (2020) stated, "Assessing the medical realities of LSCO requires a significant shift in expectations from the counterinsurgency environment."

LSCO involves high casualty rates, a degraded evacuation environment, and lack of air medical evacuation (MEDEVAC). What that means for line medics and Role 1 (battalion aid station) medical treatment facilities (MTF) is longer evacuation times and more patients.

Standard combat medics are trained to treat patients and get them in front of a surgeon within an hour, often referred to as the "Golden Hour."

A combat medic treats a casualty aboard a medical evacuation aircraft.

Staff Sgt. David Edens, combat medic, 1st Forward Support Medical Team, wraps a blood pressure monitor around an injured Iraqi soldier's arm during a MEDIVAC near Tall Afar, Iraq, July 17, 2006. During the Iraq and Afghanistan wars, coalition forces had air superiority and medics didn't have to treat patients continuously for hours or days. (U.S. Air Force photo by Staff Sgt. Jacob N. Bailey)

In his Military Review article Rethinking Combat Medic Training, Lt. Col. Manuel Menendez (2022) said, "Currently our combat medics are trained to provide excellent care in the first hour after injury, but they lack the skills, knowledge, and tools required to hold/monitor/treat casualties afterward."

During the Iraq and Afghanistan wars, coalition forces had air superiority and medics didn't have to treat patients continuously for hours or days. PFC wasn't used regularly at the POI or at Role 1 MTFs (Nessen, 2003). The LSCO environment spurred the PFC concept.

To ensure PFC succeeds, medical providers need more knowledge and increased skills. Combat medics critically injured patients will have to know the nuances of trending patient vitals, know more pharmacology, and possibly assist in surgery. These skills aren't taught in AIT, and once medics are in their assigned units, time and resources can be scarce.

Evolving Medical Skills

The Iraq and Afghanistan wars highlighted enhanced medical skill effectiveness. One study (Mabry et al, 2012) discovered the advantage of critical care paramedics staffing MEDEVAC helicopters in the California National Guard. Flight medics set up the aircraft in the same way they would as civilian paramedics. With this higher scope of practice, survivability rates were higher than their active-duty flight counterparts.

This improved model shows why enhanced medical skills are needed to attain higher survivability rates. Due to this study, Army flight medics must complete and pass paramedic certification. Survivability increases by placing NCOs with advanced medical knowledge and skills closer to the POI.

Preparing Medics for LSCO

In LSCO, combat medics need more rigorous education to handle the increased number of patients and treat those with more serious wounds.

Two Soldiers treat a simulated casualty during a medical exercise.

Staff Sgt. Gabriel Jeronimo (left), 412th Theater Engineer Command, and Staff Sgt. Jessica Whitehead, 429th Light Support Battalion, evacuate a simulated casualty at Joint Base McGuire-Dix-Lakehurst, N.J., April 17, 2026. It would be costly to send staff sergeants and above to the Combat Paramedic Course. But extending AIT for combat medics and expanding the curriculum would enable trainees to graduate at EMT-advanced levels. Graduates could also provide a higher level of care and have better patient outcomes in a LSCO environment. (U.S. Army photo by Steven Roussel)

One possible solution is to send sergeants and staff sergeants to the Combat Paramedic Course. Certified Soldiers will add a higher level of care and knowledge to the medical formation. Giving these NCOs that extra knowledge ensures higher survivability outcomes.

In 2023, the 38th Combat Aviation Brigade (CAB) conducted one of the first multi-echelon, multi-modal medical exercises in a LSCO environment (Stringer, 2023). As a result, flight medics, surgeons, and combat medics improved their medical skills and confidence.

This training also overcame the funding hurdle components 2 and 3 usually face. Overall, more resources must be allocated for medical training to be successful. NCOs can drive training like they did in the 38th CAB, but the Army needs higher-level medics to help educate combat medics.

The Indiana National Guard procured funding to send screened 68Ws to a local paramedic course, which resulted in medics with an advanced skill set.

Looking at the Army as a whole, it would be costly to send staff sergeants and above to the Combat Paramedic Course. But extending AIT for 68Ws and expanding the curriculum would enable trainees to graduate at EMT-advanced levels. Graduates could also provide a higher level of care and have better patient outcomes in a LSCO environment.

A combat medic holds an intravenous fluid bag while treating a patient.

Combat medics don't just need to have the knowledge, but the training to treat patients for longer periods of time in the field. Without shifting the initial training from current to future needs, the loss of life could be catastrophic. (U.S. Army National Guard photo by Staff Sgt. Jake Bailey)

Conclusion

U.S. Army Initial Combat Medic Training doesn't prepare medics for LSCO. An environment where it would likely incur mass casualties.

Combat medics don't just need to have the knowledge, but the training to treat patients for longer periods of time in the field. Without shifting the initial training from current to future needs, the loss of life could be catastrophic.

Implementing the PFC in AIT and requiring NCOs to have deeper knowledge and improved skills will improve wounded Soldier survivability. Incorporating PFC and additional clinical training into AIT would give medics the training they need to succeed.

The medical field constantly evolves, and Army combat medics need to be at the forefront, continuously improving their skills and knowledge.

An HH-60M Black Hawk helicopter conducts medical evacuation training.

An HH-60M Blackhawk crew member maintains visual contact during medical evacuation (MEDEVAC) training at Al Asad Airbase, Iraq, May 18, 2025. (U.S. Army photo by Staff Sgt. Brad Stepien)

References

Army National Guard. (n.d.). Combat medic specialist. https://nationalguard.com/68w-combat-medic-specialist

Brown, P. (2024). To conserve the fighting strength. Line of Departure. https://www.lineofdeparture.army.mil/Journals/Pulse-of-Army-Medicine/Archive/November-2024-Issue/Fighting-Strength/

Fandre, M. (2020). Medical changes needed for large-scale combat operations: Observations from mission command training program warfighter exercises. Military Review. https://www.armyupress.army.mil/Journals/Military-Review/English-Edition-Archives/May-June-2020/Fandre-Medical-Changes/

Knisely, B. M., Gaudaen, J. C., Smith, A. V., Perta, J. M., Pamplin, J. C., Quinn, M. T., & Schmidt, P. M. (2022). Evaluating medic performance in combat casualty care simulation and training: A scoping review of prospective research. Military Medicine, 188(7-8), e1664-e1672. https://doi.org/10.1093/milmed/usac250

Mabry, R., Apodaca, A., Penrod, J., Orman, J., Gerhardt, R., Dorlac, W., (2012). Impact of critical care-trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. NIH National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/22847091/

Menendez, Manuel LTC. (2022). Rethinking Combat Medic Training. Military Review. https://www.armyupress.army.mil/Journals/Military-Review/English-Edition-Archives/July-August-2022/Menendez/Journals/Military-Review/MR-War-Poetry-Submission-Guide/Journals/Military-Review/MR-War-Poetry-Submission-Guide/Journals/Military-Review/MR-War-Poetry-Submission-Guide/Journals/Military-Review/MR-War-Poetry-Submission-Guide/

Nessen, S. C., Lounsbury, D. E., Hetz, S. P., Department of the Army. Office of the Surgeon General, Borden Institute, & Walter Reed Army Medical Center (2008). War surgery in Afghanistan and Iraq: a series of cases, 2003-2007. https://medcoe.army.mil/borden-tb-war-surgery-afg-iraq

Remley, M., Loos, P., Riesberg, J., (2021). JOINT TRAUMA SYSTEM CLINICAL PRACTICE GUIDELINE (JTS CPG) Prolonged Casualty Care Guidelines (CPG ID:91). https://jts.health.mil/assets/docs/cpgs/Prolonged_Casualty_Care_Guidelines_21_Dec_2021_ID91.pdf

Stringer, Joseph MSG. U.S. Army personal communication, August 2023

U.S. Army Department of the Army. (2020). Field Manual 4-02: Army Health Systems. https://armypubs.army.mil/epubs/DR_pubs/DR_a/ARN44575-FM_4-02-002-WEB-4.pdf

Bio

Master Sgt. William R. Szabo is first sergeant for Charlie Company, 113th Brigade Support Battalion, Indiana National Guard, and is an orthopedic technologist in the civilian sector. He has served in every leadership position as a combat medic specialist, including as the Area Support Group Jordan Medical NCOIC, helping to establish walking blood banks at all the locations. He earned an associate degree in business, another in healthcare management, and completed paramedic school.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the opinions of the NCO Journal, the U.S. Army, or the U.S. Department of War.

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