UK military and NHS hold war casualty return wargame with U.S. and Canada; more than 100 take part to review lessons from Ukraine

UNITED KINGDOM

Britain's Defence Medical Command last week held a wargame bringing together the armed forces, the National Health Service (NHS), civilian healthcare providers and U.S. and Canadian military and civilian medics to test plans for hospitals in mainland Britain to receive and treat troops wounded in overseas operations. Cyber & Specialist Operations Command (CSOC), part of the Ministry of Defence, said in a press release on the 20th (local time) that "More than 100 military experts, clinicians and civil servants" took part. Participants also addressed medical lessons from the war in Ukraine, such as expanding hospital capacity, large-scale rehabilitation and mental health support. The Ministry of Defence plans further exercises over the coming months.

Defence Medical Command tests route for troops treated overseas to reach civilian hospitals at home

The starting point of the wargame was the treatment of troops wounded on overseas battlefields after their return to Britain. According to the press release, the exercise, led by Defence Medical Command, examined how the military, the NHS and healthcare providers would jointly care for returning military patients in "a range of future operational scenarios." Participants assessed plans for civilian health services to take over and treat troops returning home after receiving emergency treatment overseas at the point of injury, "after potentially travelling vast distances."

The British government described the aim of the exercise as strengthening Britain's capability to treat military personnel injured in conflict. A photo caption from the event said military and civilian healthcare providers from across Britain, the United States and Canada attended. The Ministry of Defence photo set attached to the press release is titled "2026.10.15 RAMP Wargame." The ministry did not disclose the number of casualties assumed in the exercise or the names of participating hospitals.

The ministry described the exercise as part of "routine preparedness planning." The press release said the exercise supports the "whole-of-society approach" to resilience, readiness and national security emphasized in the Strategic Defence Review (SDR). It also said the exercise is part of an ongoing British and international program to maintain medical readiness in step with the changing character of war. Lessons from the wargame will feed into future planning across the military and civilian health services.

Minister Lord Coaker stresses cooperation among military, NHS and allies: "It takes all of us working together"

On the government side, Defence Minister Lord Coaker spoke. Lord Coaker said, "Keeping people safe takes more than one organisation—it takes all of us working together." He said the exercise put that cooperation into practice by bringing the Ministry of Defence, the NHS and allies to one table.

Lord Coaker stressed, "By testing our plans now, we are building the trusted relationships and readiness needed to protect our country and care for those who serve."

Participants examine Ukraine war medical lessons, including expanding hospital capacity and large-scale rehabilitation

A major focus of the wargame was the war in Ukraine. According to the press release, participants addressed medical lessons from Ukraine including the difficulty of expanding hospital capacity, maintaining civilians' access to healthcare, large-scale rehabilitation, the types of injuries expected to require treatment, and mental health support.

Defence Medical Command separately listed what it is learning from the war in Ukraine. These include ways to protect field hospitals, equipment and medical personnel from attack, advanced trauma training, more resilient supply chains, and the development of new technologies such as portable ultrasound devices and uncrewed evacuation systems.

Surgeon General Major General Phil Carter, who is serving as interim Chief of Defence Medical, said wargames like this are central to planning the Operational Patient Care Pathway. Carter explained that the pathway enables the Ministry of Defence, the NHS, health services and allies to handle returning casualties while continuing to care for civilian patients. He said, "The war in Ukraine reinforces the need to keep learning, adapting and innovating," adding that training together regularly strengthens readiness and national resilience.

NHS also reviews how to maintain regular care while receiving military patients

Speaking for the civilian side was Dr Mike Prentice, National Director for NHS Resilience. Prentice said, "The NHS has a vital role to play in the UK's preparedness for future conflict." He said the NHS is working closely with the Ministry of Defence to test plans, identify potential challenges and strengthen the partnerships it will rely on in a crisis.

Prentice stressed, "Preparing together now means we can ensure the NHS is ready to care for military personnel returning home, while continuing to meet the needs of the public - whatever the circumstances."

Defence Medical Command invests £50 million from Defence Investment Plan in dried blood and clotting autoinjectors

Equipment investment is also under way. The latest press release said Defence Medical Command is investing in dried blood products that make it easier to restore blood supplies on the battlefield, tranexamic acid (TXA) autoinjectors that trigger blood clotting at the point of injury to reduce bleeding, and improvements to modern field hospital equipment and casualty care equipment.

According to the command's July 8 press release, the British government will put £50 million into military medical capability over the next four years under the Defence Investment Plan (DIP) announced on June 30. The largest share, £20 million, goes to Tactical Combat Casualty Care (TCCC) equipment and will be used to buy battlefield medical kits to reduce preventable deaths and improve care at the point of injury. The rest is £10 million for dried blood products, £10 million for TXA autoinjectors and £10 million for field hospital equipment. TXA autoinjectors are devices that rapidly administer a clotting agent on the battlefield to improve survival from severe bleeding. The field hospital equipment budget will be used for a large-scale strengthening of deployable medical capability. The dried blood budget supports the Blood Far Forward project, which moves lifesaving transfusions closer to the battlefield and reduces reliance on refrigeration. The Defence Investment Plan also includes a plan to invest at least £3 billion in joint support capabilities and military medical capabilities in 2030-2035. This includes combat medicine and protection against chemical, biological, radiological and nuclear (CBRN) threats.

Air Marshal Clare Walton, then Chief of Defence Medical, said the health of service personnel and operational medicine are "fundamental to military effectiveness and future fighting power." Brigadier Chris Wright, Head of Medical Operations and Capability, said the investment secured the modernization programs needed for the "Transition to War," allowing deployed medical capability to be optimized and modernized.

Defence medical leadership also changes as former Scottish health chief Leitch takes office next month

Military medical leadership is also in transition. Since Air Marshal Walton retired in July, Surgeon General Carter has served as interim Chief of Defence Medical. Cyber & Specialist Operations Command announced Major General Carter's interim appointment on July 16.

On the 14th, six days before the wargame announcement, the command announced the appointment of Professor Jason Leitch as the new Chief of Defence Medical. Leitch served as Scotland's National Clinical Director from 2015 to 2024, advising ministers on health policy and patient safety, and acted as a publicly trusted voice during the COVID-19 pandemic. Leitch will formally take office on Nov. 2, leading Defence Medical Command and overseeing implementation of the Strategic Defence Review. Leitch said he was truly honored to join Defence Medical Command and that his first priority would be to listen and learn.

Leitch has also worked as an independent health adviser and leadership consultant in Britain and abroad. General Sir Rob Magowan, Commander of Cyber & Specialist Operations Command, said Jason's appointment is an exciting new chapter for military medicine and that defence medicine will play a key role in readying the armed forces. Surgeon General Carter said Leitch has broad experience in health and healthcare management and will bring a fresh vision to the military health system at an important time. In announcing Leitch's appointment, the command said the Strategic Defence Review and the Defence Investment Plan place new emphasis on closer cooperation with health services across Britain. The summary of the same announcement said deeper cooperation with the NHS and allies will help save more lives in future operations. The command said it will draw on lessons from Ukraine in this process, such as stronger battlefield trauma training, medical supply chains and protection of field hospitals. After taking office, Leitch plans to visit defence medical units to meet personnel and see their work firsthand. Cyber & Specialist Operations Command is a Ministry of Defence command formally launched on Sept. 1, 2025, and in an official blog post marking its first 100 days it said the Defence Medical Services had introduced the Deployed Telemedicine System.