May 19, 2024

ALTA, Norway — Hospital Corpsman 2nd Class Zachery Matthews often sleeps with an IV bag close to his chest at night when he’s in a cold place. Corpsmen who work in environments like the Arctic said they keep essential medical fluids near their bodies, using their natural heat to keep them warm. In trauma care, seconds matter and there is no time to wait for liquids to thaw.

On Saturday, Matthews helped lift a Norwegian soldier onto a gurney; another needed intubating. Noise and energy flowed through the medical tent as X-ray machines snapped, surgical instruments clinked and those fluids Matthews often kept close to his chest were passed back and forth between American and Norwegian hands, ice free.

Matthews, along with six other U.S. service members, are part of a U.S. Navy shock trauma platoon — a specialized unit that acts as a mobile emergency room on the battlefield — taking part in NATO’s massive Nordic Response 2024 exercise. That day, alongside the Norwegian military, they demonstrated what they would do if the unit received several casualties at once in a simulated, but nonetheless serious, exercise.

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With the second anniversary of the invasion of Ukraine passing two weeks ago and NATO forces — along with the U.S. and Norwegian soldiers Military.com interviewed on Saturday — exercising close to Russia’s border now, the war has helped reshape the way some military trauma professionals think about casualty care.

“It’s looking like, gone are the days of being able to set up massive field hospitals that won’t be a target and where you’re going to need to pack up and move quickly,” U.S. Navy Lt. Kathleen Laboa, the officer in charge of the shock trauma platoon, told Military.com as her corpsmen helped hurry patients into the operating room of the field tent where Norwegian medical teams simulated emergency surgery.

Over the last 20 years, the U.S. has fought counterinsurgency wars that — relative to the level now seen in Ukraine — allowed for robust and uncontested medical processes. Now, as the U.S. prepares for large-scale, conventional conflicts, the realization that those systems need to change has set in.

“Unfortunately, a lot of this is based off of the data that we had from the last conflicts in the last 10-20 years,” she said, pointing to blast injuries from improvised explosives devices as a hallmark injury of the Global War on Terror. There is a dearth of information available outside of those wars, she said, but “believe it or not, we’re getting a ton of data from the casualties coming out of Ukraine.”

She pointed to artillery shells, mortars, as well as other heavy ordnance used by Russia that have wrought havoc on the Ukrainian battlefield. And while the Ukrainians pioneered drone use during that war, Russia has increased its own production and used them to deadly effect. Mines, too, have caused serious injuries and death.

Those who survive those weapons are often left with burns, shrapnel injuries and — in increasing numbers — lost limbs. While American service members experienced those types of injuries during the Global War on Terror, the staggering volume of wounds suffered in Ukraine have placed pressure on its medical systems. In just two years, many tens of thousands of Ukrainians are estimated to be amputees due to the war, and the country’s once-fledgling prosthetic industry has grown to meet the need.

Members of the shock trauma platoon said that they have watched the global events unfold and have thought about how they would meet their own needs during a potential conflict of their own.

“The biggest takeaway is, we’re going to have to flex, we’re going to have to change,” Matthews said. “With medicine always evolving, we’re looking at prolonged field care as our next option. How are we going to keep that casualty without a medevac for multiple hours? Are we going to bring out the loadout we need? [Are] there going to be different loadouts we need to try out with medical gear?”

Laboa said her team is learning that medical assets need to be maneuverable. Time is a paramount factor in trauma care. Installments such as the medical tent she helped direct can take up to six hours to set up, she said, adding that “you can’t really afford to waste that time.”

To reduce those time constraints, she said her team is working to provide specialized medical professionals closer to the front so patients can receive care sooner. Working out of urban environments, non-medical structures and undesignated vehicles like turning a van into an ambulance, she said, were all things the shock trauma platoon was eyeing.

The flow of medical operations in Alta, Norway, where the units are participating in NATO’s Nordic Response, is tiered. Corpsmen down at the front with the line units assess injuries and determine if a Marine or sailor needs additional care. If they do, they are processed into field tents, such as the one Laboa and Matthews are working out of. If they need even more care, they are sent to a Norwegian civilian hospital.

That partnership has been a boon for the Americans and Nowegians working together, they said. The shock trauma platoon and the Norwegian medical team started their first simulations Saturday morning and representatives from both units told Military.com the unity has been smooth since.

Blood and fluids, such as the ones Matthews spoke about, work differently in cold temperatures, and the Norwegians know how to manage it, he said. Even things such as making sure American stretchers can fit in Norwegian medical vehicles, and vice versa, is a critical piece of integration to check for.

Normally, the shock trauma platoon would not have a surgical element and would be able to treat two or three urgent casualties at a time. With the Norwegians, that number has increased, and the medical unit is bolstered by an operating room that can perform emergency surgeries right there in the tent. The Americans also provide another skilled emergency team in the field tent to process and work on patients.

“I think it’s important for us to work together because if there is a war, if there is an Article 5, NATO needs to protect the members,” Norwegian Maj. Richard Sädem, the company commander of the field hospital, told Military.com. “It’s important that we do this during peacetime — working together, working together as closely as we can.”

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