Executive Summary
In high-intensity, large-scale combat operations (LSCO), approximately 90% of combat fatalities occur before casualties reach a medical treatment facility. Of these prehospital deaths, 24.3% are potentially survivable—overwhelmingly due to uncontrolled hemorrhage (90.9%), with airway obstruction (8.0%) and tension pneumothorax (1.1%) accounting for the remainder. The ability to mitigate preventable combat deaths at the point of injury is not merely a clinical objective; it is a strategic necessity that directly influences the longevity of combat formations and the national will to fight. This program establishes mass TCCC training: 5,000 certified combat medics in 36 months (1,700/year), synchronized with Lithuania's 2026 conscription reform (5,000 conscripts/year) and 1st Division build-up. Four-tier system aligned with Joint Trauma System: Tier 1 (TCCC-ASM) for all soldiers, Tier 2 (TCCC-CLS) for designated combat lifesavers, Tier 3 (TCCC-CMC) for combat medics, Tier 4 (TCCC-CPP) for advanced providers including prolonged casualty care and damage control surgery. Ukrainian operational data validates urgency: the 'Golden Hour' evacuation paradigm is obsolete in contested airspace. Evacuation delays of 24-48 hours are now routine. Role 1 facilities and point-of-injury first responders perform damage control resuscitation (73%) and damage control surgery (71%) previously reserved for higher echelons. Medics must sustain casualties for hours to days, managing dehydration, electrolyte balance, and wound sepsis. TXA administration within 3 hours reduces mortality by 33%. Walking blood banks enable field transfusion. For Lithuania—with 12,401 professional military and 30,000+ reserves—every loss is felt acutely. By achieving 90% survival rate (TCCC-compliant unit standard), Lithuania extends the operational life of its formations, complicates adversary attrition calculus, and maintains the 'will to fight' intrinsically linked to perceived quality of medical care.
Force multiplication: extends operational life of formations by achieving 90% survival for treatable wounds. Maintains 'Returned to Duty' (RTD) rate preserving troop density. Strengthens 'will to fight'—personnel who believe survivable wounds won't result in death engage more effectively in high-risk maneuvers. Aligns with 'Total Defense' concept by equipping military, reserves, and Lithuanian Riflemen's Union (18,000+ volunteers) with care capabilities for contested environments where traditional infrastructure is targeted or overwhelmed.
In short: 5,000 TCCC-certified combat medics; 100 certified instructors; 90% tourniquet competency; every squad with TCCC Level 1 member; prolonged field care capability in every platoon; drone-assisted medical logistics integration; preservation of combat formations through 90% survival rate for treatable wounds
The Problem
Ukrainian casualty data shows 90% of preventable battlefield deaths occur from hemorrhage in the first 10 minutes—before evacuation is possible. The conflict has revealed critical new realities: (1) Drone warfare creates higher death-to-wounded ratio (1:1.3 vs. traditional 1:3-4), (2) FPV drones hunt individual soldiers with explosive payloads causing injuries more lethal than artillery fragmentation, (3) Russia deliberately targets medical personnel and MEDEVAC assets, (4) Air MEDEVAC impossible due to dense air defense—ground evacuation under drone surveillance is the norm, (5) Evacuation times expanded from 'golden hour' to 24-48 hours requiring prolonged field care.
Lithuania's gap spans five dimensions: (1) PERSONNEL: ~500 trained medics vs. 5,000+ needed for 1st Division plus reserves; (2) TRAINING INFRASTRUCTURE: No dedicated TCCC training centers (vs. Ukraine's 35+ certified trainers producing 750 graduates/month); (3) EQUIPMENT: IFAKs not universally issued—equipment must be on person, not stored in vehicles; (4) DOCTRINE: Current training based on GWOT-era assumptions (air superiority, fast MEDEVAC)—not adapted to LSCO; (5) PROLONGED FIELD CARE: No systematic capability for medics to sustain casualties 4-24+ hours as required in drone-contested environments.
Without action: Without this program: (1) Every preventable hemorrhage death costs both a soldier's life and approximately EUR 1M+ in lifetime costs; (2) Units without TCCC-trained members experience 40%+ higher KIA rates for wounded; (3) 1st Division lacks medical capacity for its intended combat role; (4) Lithuania's conscripts deploy with skills inadequate for drone-era warfare; (5) Interoperability with German brigade and NATO compromised—TCCC is NATO standard; (6) Morale catastrophically degrades when soldiers watch comrades die of treatable wounds.
Lithuanian Context
Lithuania occupies NATO's most exposed eastern flank, 250km from Kaliningrad, 680km from Belarus. Building division-level force (1st Division reactivated January 2025) while hosting German 45th Panzer Brigade (4,800 troops) and US rotational forces. Defense spending projected 5-6% GDP 2026-2030. 2026 conscription reform feeds 5,000 conscripts annually. With professional military of 12,401 and 30,000+ reserves, every loss felt acutely. Baltic Defence Line construction adds territorial defense dimension requiring distributed medical capability.
Suwalki Gap corridor is NATO's most vulnerable chokepoint—intense fighting with high casualties and disrupted evacuationDense forest coverage (33%) complicates air and ground MEDEVACCold Baltic climate (average winter -5C) makes hypothermia prevention critical—TCCC 'H' in MARCH protocol essentialCross-border medical coordination needed with Polish, Latvian, German servicesUrban terrain (Vilnius, Kaunas) requires TCCC adaptations for built-up areasProximity to Kaliningrad means dense air defense—air MEDEVAC severely constrained