Strengthening medical command decision making for readiness and resilience
March 24, 2025 - Lt Inna Platonova, Public Affairs Officer, 3rd Canadian Division / Joint Task Force West
The evolving challenges that modern battlefields present are forcing medical leaders and military commanders to rethink combat medical support strategies and redefine acceptable medical risks where achieving the "golden hour" is often not feasible.
Augmented by the latest scientific research and lessons learned from recent wars and conflicts, 1 Health Services Group (1 HSG) Headquarters designed the first‑of‑its‑kind wargame for leaders in military health services, as part of Exercise CASUALTY OVERLOAD for Medical Command Decision‑Making in Large Scale Combat Operations (LSCO).
Ex CASUALTY OVERLOAD was held at the Edmonton Garrison Officers’ Mess from Feb. 26 to 28. It brought together health services command teams from across all Western and Northern Canada, from Thunder Bay, Ont., to Victoria, B.C., including 1 Field Ambulance (1 Fd Amb), 11 Fd Amb (Victoria), 12 Fd Amb (Vancouver), 15 Fd Amb (Edmonton), 16 Fd Amb (Regina), 17 Fd Amb (Winnipeg), 18 Fd Amb (Thunder Bay), and 1 HSG Headquarters. Members from Eastern Canada’s 4 HSG were also present to observe the tabletop exercise, in order to learn and bring the lessons back to their command.
For the first time, a wargame format was applied to simulate medical command decision‑making in LSCO conditions and help understand how decisions at the unit and medical brigade level can affect casualty outcomes, including mortality rates, return to combat and overall medical survivability. Integrating lessons learned from recent conflicts, in particular Russia’s ongoing full‑scale invasion of Ukraine, Ex CASUALTY OVERLOAD highlighted current tactical and medical challenges. The Canadian Army has contributed to this discussion, with Colonel Michael John Reekie, 3rd Canadian Division Chief of Staff, sharing the most current experiences and ongoing efforts to address the evolving needs on the battlefield. The exercise also explored the moral and ethical decision‑making processes that affect medical command in high stakes combat situations.
Addressing the participants, Captain (Navy) Nicholas Gauthier, Formation Commander 1 HSG, a driving force behind the exercise, stressed the importance of the event.
“There is no greater boost to a soldier's courage than knowing, should they be injured, they will be cared for,” he said. “Our medical preparedness provides that reassurance, empowering our troops to fight with confidence. 1 Health Services Group stands ready, alongside the combat formations’ chain of command, to ensure every soldier is supported, no matter the challenge."
This truly underpinned the learning process designed as a wargame, which simulated health services support at the unit, formation and division levels for LSCO scenarios. Working together, participants focused on the tactical survivability challenges, where limited prehospital care, extended evacuation times and delayed surgical interventions threaten the survival of troops. The emphasis was on the critical importance of time and medical resource availability in influencing survivability on the battlefield, especially when resources are stretched thin.
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Members from 1 Health Services Group (1 HSG) participate in the tabletop wargame Exercise CASUALTY OVERLOAD on Feb. 27 at the Edmonton Garrison Officers’ Mess. The exercise was designed by 1 HSG Headquarters to challenge medical command teams’ abilities to manage casualty care in Large Scale Combat Operations.
Photos by MCpl Robert Mitchell, Imagery Technician, 3rd Canadian Division / Joint Task Force West
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Captain(N) Nicholas Gauthier, Commander 1 Health Services Group (centre), addresses participants during Exercise CASUALTY OVERLOAD at the Edmonton Garrison Officers’ Mess on Feb. 27.
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With members from 4 Health Services Group (4 HSG) members observing, 1 HSG members play out a scenario during Exercise CASUALTY OVERLOAD at the Edmonton Garrison Officers’ Mess on Feb. 27.
Captains Michael Hylton and Jonathan Page with 1 HSG Headquarters were the brains of the wargame. Guided by the Commander’s intent and equipped with the wargaming fundamentals and the most recent research, they devoted several months developing a unique, engaging wargame specifically designed for medical command teams to collaboratively practise both unit‑ and brigade‑level medical command decision‑making in support of a Canadian Army Division, in an intense but controlled environment.
Multiple iterations and play tests helped refine the game mechanics and the rule book. The key scenario elements included, among others, resupplying medical supplies in a contested environment, dealing with the threat of drones and other denials of movement informed by the war in Ukraine, executing medical operations in a dispersed environment, as well as incorporating the medical ethics components.
Capt Hylton is pleased with how the exercise went, where lots of collaboration and engagement was on display, with teams “actually thinking very creatively and coming up with really unique solutions to different problems.”
Chief Warrant Officer Suzanne McAdam, 1 HSG Formation CWO and member of the 3rd Canadian Division Resilience and Readiness Advisory Committee, applauded the work and emphasized that Ex CASUALTY OVERLOAD is aimed at fostering resilience and readiness among health services command teams, and helps “modernize how we think.”
She explained readiness is about applying advanced learning at tactical, operational and strategic levels where simulated scenarios help prepare for decision‑making for protracted LSCO scenarios.
Insights from recent conflicts provide valuable input into understanding the increased uncertainties and complexities of LSCO scenarios with the introduction of emerging technologies and adversary tactics such as “kill twice effect” with medical personnel targeted. The resilience comes through “becoming comfortable with uncomfortable” and wargaming creates an important learning space for that.
According to Commander Michael Lawless, Commanding Officer of 11 Fd Amb and 12 Fd Amb, the exercise was “a great opportunity to apply learnings to a real‑world scenario to ensure the preparedness and readiness of unit leadership teams, who can then take the consolidated learning back to their units to professionalize and improve real world training at the unit level.”
He particularly emphasized the benefits for the Primary Reserve, with the training empowering and “force generating trained operationally effective reservists to augment and deploy into the operational environment and deliver a meaningful contribution to the mission.”
Similarly, Major JR Kors with 15 Fd Amb enjoyed the challenge and benefits presented by the exercise. With over 40 years of service, it was a first‑of‑its‑kind exercise for him.
“1 HSG came up with a great tool to challenge us,” he said.
He appreciated how lessons learned in Ukraine were incorporated into the exercise, and emphasized the importance of not losing sight of managing resources and basics in treatment, holding and moving casualties in the battlefield.
As for the future of the exercise, it will become a recurring activity. To further advance medical decision‑making, the wargame will be shared with the Canadian Joint Warfare Centre and exported to other units for their further elaboration and use. The game can also be digitized and adapted as a learning tool for junior health services officers.
Capt(N) Gauthier is confident it will serve as a valuable tool.
“The exercise will provide valuable insights that can be used by medical command teams to refine tactical and medical response strategies for future operations.”
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Participants in the tabletop wargame Exercise CASUALTY OVERLOAD. The exercise took place at the Edmonton Garrison Officers’ Mess on Feb. 27.
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Exercise CASUALTY OVERLOAD took place at the Edmonton Garrison Officers’ Mess on Feb. 27. The tabletop wargame exercise aimed to simulate medical command decision‑making in Large Scale Combat Operations and help understand how decisions at the unit and medical brigade level can affect casualty outcomes.