How do military leaders plan for war casualties?

How exactly do the 21st century’s military leaders plan for war casualties?  General Sir Richard Shirreff served as NATO’s Deputy Supreme Allied Commander Europe between 2011 and 2014.

Richard - War is a dangerous business. And you have to assume that if people are shooting at you or trying to blow you up, that you're gonna take casualties. As a commander, of course, you do everything you can to minimise the risk of casualties, but the reality is that almost invariably there will be people who are hurt, who are wounded, or people who are killed. So it's absolutely critical that the medical side is thought through and planned as an essential part of the operation. Every operation involves not only the movement of troops and vehicles and formations to get them into the right place at the right time to do the right thing, but they've gotta be properly supported with fuel, with food, with ammunition, and of course with medical support. And so medical support comes under the heading of logistics, which is everything there that allows an army or military force to operate.

Chris - And presumably the kind of medical support, you're gonna vary that according to what kind of conflict or what sorts of weapons, what sorts of engagement you anticipate seeing.

Richard - Every regiment or a battle group has a doctor who's a young captain, and at every level there'll be a medical specialist. So at a brigade level, you might have a field ambulance attached to it, commanded by a lieutenant colonel at a division, which is about 25,000 people. You'll have quite a senior colonel who is the Commander Medical who does the medical plan, who does the medical estimate. A whole range of factors are looked at in real detail, deductions are drawn, and out of that a range of courses of action are considered. One course of action is decided upon that best meets the needs of the plan and the commander's intent, and in which the disadvantages are outweighed by the advantages. And then once you know what course of action is, then you make a plan to put it in place. And that plan will bring together the assets that are particularly needed for a particular operation, which of course might change.

Chris - So presumably you are thinking about where to put things in relation to where you see the action going, how you see the action playing out so that you can, what evacuate people as rapidly as possible, anticipate what sorts of injuries you're gonna see, and therefore what sorts of care people are going to need in the short term before you can evacuate them once they've been stabilised to get them longer term help.

Richard - Yeah, I mean, the principle is that you try and treat as close to the point of wounding as possible. Every fighting soldier, tank crews, infantrymen, gunners. They're all trained with immediate battlefield first aid. And then within a section there might be one soldier who's a battlefield medic. It's a bit like being a sort of paramedic. And he can do a little bit more then of course, exactly that. Further back you've got the regimental aid post, and this is the whole point about trying to get people back as quickly as possible to stabilise them and then back through the system so they can be triaged into those who need the most urgent help as quickly as possible.

Chris - What about civilians, because they're potentially also in the geography in which you're operating, and they might become victims too. Is consideration given to them, and do you ever find that the military ends up treating civilians because they've become casualties?

Richard - Absolutely. Now clearly the priority must be to treat our military force because that's what they're there for. And it's all about treating the military force in order to ensure that not only are our soldiers treated as quickly as possible and return to battle as quickly as possible, but it's essential for morale. But yes, civilians are treated regularly and you've only gotta look at what happened in Afghanistan and indeed in Iraq, but Afghanistan, particularly where Afghan civilians were treated in military hospitals, and indeed of course it's not just civilians, but it's enemy soldiers as well will be treated in military hospitals.

Chris - They wanted to raise the Russia - Ukraine conflict. There were some people, including yourself, who said they were fearful that an invasion might be imminent because the Russian army had moved blood transfusion units and they'd also constructed field hospitals near the border with Ukraine. And people like yourself are arguing, you only do something like that if you're getting serious.

Richard - Absolutely. And it's an obvious combat indicator, the sort of level of logistic support being deployed in support of a military force. And when we saw the blood being brought forward and all the paraphernalia of military hospitals and the life, it was pretty clear that this was not just a demonstration or an exercise.