March 4, 2026
New post on LinkedIn
A series on Small Unit Medical Planning by Lennart Bongartz and Denys Surkov
They need standardized and strong tools to plan and execute their operations, as improvisation just won’t make the cut in a high-tempo, high-casualty LSCO environment
Ukraine’s military medical system carries a heavy legacy of post-Soviet cultural tendencies, and has struggled to deliver coordinated casualty care at the frontline. Medical teams are routinely excluded from mission planning, commanders retain ad hoc control over CASEVAC assets, and the After-Action Review culture essential for improvement is largely absent. As we and our co-authors document in the Commentary (Military Medicine, 2025), these are not isolated incidents but is largely a systemic issue. In some instances, Ukrainian medical teams have adapted at an amazing pace, up to the point where they outpace NATO.
Many of the adaptations to tactical combat casualty care (TCCC) have been codified in Ukrainian medical practice guidelines and provide valuable lessons that helped shape TCCC Guideline updates primarily for point-of-injury (POI) care. On the other hand, a fatalistic attitude towards timely evacuation and thus escalating treatment can be observed, both in Ukraine and in the West. The proliferation of (fiber-optic) drones has created a zone up to 35-50 km deep, where any movement is detected almost instantly. This has led some to conclude that evacuation times of 72 hours or more is the standard planned parameter.
However, we posit that this overlooks the fact that inefficient medical planning is the rule rather than the exception, and that worst-case scenarios tend to get the attention. Where effective tactics, techniques and procedures (TTPs) have been applied – that actually make these medical interventions and casualty evacuation (CASEVAC) fall into place – they had not yet been adequately identified or appraised.
To ensure long-term systemic change, we started building a medical mission planning approach for our Ukrainian colleagues, not only to reduce the need for improvisation but also as an approach to gather future medical planning data. To liberally quote Michael Hetzler: “90% of what we do in medicine is reactive, but 80% of our succes depends on planning.”
Yet NATO is not immune either. The “command transformation” process in Ukraine has been arduous, and many even propose to reverse the flow of learning. Its own doctrine designates the Brigade as the lowest echelon for tactical planning (per APP-28). Below that — at company, platoon, and small-unit level — standardized guidance to plan medical support is heterogeneous, often audience-specific or even outdated. Existing handbooks differ in structure and analytic framing, making cross-unit interoperability difficult and reproducibility unreliable. In a multinational LSCO environment with high casualty rates and contested logistics, this gap could prove to be operationally dangerous.
The answer is not to abandon proven methodology. The U.S./NATO planning methodologies like the Troop Leading Procedures (TLP) and mission analysis frameworks like METT-TC(I) and factor analysis exist because structured planning under cognitive load outperforms improvisation. This is exactly what the Medical Planning Process (MPP) and CMPEC3 framework aim to provide. Developed through multinational operational analysis and field-validated in Ukraine, the approach closely aligns with above-described methodologies but refocuses them for the medical leaders and providers. By closely mirroring TLP, the MPP helps to align small-unit medical commanders with their tactical counterparts, creating mutual trust and benefit. The CMPEC3 framework allows for comprehensive mission factor analysis to formulate actionable outputs, leading to medical concept of operations (CONOPS).
This series walks through the main components of the construct, from mission framing to contingency planning.
Further reading:
→ Learn or Lose: Lessons from Ukrainian Training in Germany (MWI)
→ Batchinsky A, Gumeniuk K, Holcomb JB. Clues to survival in future LSCOs are to be found in the current war in Ukraine. Trauma Surgery & Acute Care Open. 2025;10:e001962. https://doi.org/10.1136/tsaco-2025-001962
→ Disruptive Medicine for Denied Battlespaces (Irregular Warfare Center)
→ Drone Warfare Requires a New Age of Battlefield Medicine (Military Times)
→ Seven Lessons for Military Planners (MWI)
→ Krueger Izaguirre, Cox, Lodi et al. To Conserve Fighting Strength in Large-Scale Combat Operations. Military Review. March 2025 Online Exclusive Article
→ Beldowicz, Bellamy, Modlin. Death Ignores the Golden Hour. Military Review. March-April 2020.
#MilitaryMedicine #CMPEC3 #MedicalPlanning #NATOMedical #SmallUnitForces #LSCO #CombatMedicine #Ukraine #ForwardMedicine #MedicalDoctrine
Professor Martin Bricknell CB OStJ JOHN M QUINN V, EMT-P, MD, MPH, PhD, CIME Dimitry Kovtunenko Konstantin Gumeniuk Al Giwa, LLB, MD, MBA, MBE, FACEP, FAAEM