Download the full release here: No.26-1151, Israeli Defense Force Medical Lessons Learned (Apr 26).pdf [PDF - 690.1 KB]
Purpose
Since the morning of October 7th, 2023, the Israel Defense Forces (IDF), Israel National Police, and other security forces have been involved in a wide spectrum of active combat operations that have spanned the range from Large Scale Combat Operations (LSCO) to internal security and stability. Prior to the war the Israeli medical services had some significant differences to their U.S. counter parts but shared many of the same assumptions and approaches. The attacks on October 7th provided a shock to the system and forced transformation in contact. Since then, the process of transformation has continued. Although there are some differences between the operational environment in which Israel has fought and the future fight envisioned by the U.S. Army, Israel’s wars continue to provide a critical real world battle lab from which there is as much to learn now as when observations of the 1973 War transformed U.S. Army Doctrine. This is as true for military medicine as for other arms.
Introduction
This document synthesizes critical lessons from the October 7th attacks and the subsequent IDF response during the Swords of Iron War to inform U.S. force preparation for Large-Scale Combat Operations (LSCO). It is the nature of the military system that while it focuses on medical support it captures initial lessons on a range of issues including armored platforms, command and control systems, and the importance of specialist combat driving courses and driver proficiency. It highlights that effective medical support extends far beyond clinical and tactical proficiency and that adaptability is a paramount requirement for all forces including medical support. It provides lessons ranging from technical procedures that can be instituted at the Soldier and provider level to broad structural and platform focused observations.
The observations and lessons in this document result from a mix of sources including presentations and materials provided by the IDF during the 2025 Shoresh Military Medical Meeting as well as interviews during the one-week period around the meeting. These interviews included a wide range of interviewees from paramedics who were active on the ground on October 7th through the commander of police and gendarme medical services and every level in between. They also included the divisional surgeons for most IDF maneuver divisions as well as the chief medical officers for every theater command and medical officers and operators from SOF Units.
The IDF experience demonstrates that while mastery of casualty triage, treatment, evacuation, and medical logistics is foundational, U.S. Forces – particularly medical assets – must rapidly identify both critical gaps and emerging threats, adapt processes and procedures, and then proactively integrate novel techniques and technologies to mitigate risk. Initial plans will be disrupted, success hinges on rapid assessment, enabled decision-making, and proactive problem-solving.
The observations include lessons from areas of IDF success. For example, IDF’s success in rapid ground and air MEDEVAC, even in highly contested environments, was central to the IDF’s approach for medical services. This relied on threat-appropriate evacuation platform use, real-time intelligence, operational prioritization, evacuation team training, and the integration of civilian medical assets. This indicates that U.S. Forces must refine MEDEVAC procedures, leveraging technology (digital mapping, real-time tracking), enhancing training, and fostering interoperability with civilian partners.
Ruggedized tablets captured casualty care documentation in real time from the Point of Injury (POI) or Casualty Collection Point (CCP) through MEDEVAC and the roles of care. Not only did digital casualty care documentation improve care but force-wide data capture informed the development of TTPs, as well as equipment and policy changes. This indicates the value for U.S. Forces of prioritizing the development of integrated digital medical record that enables rapid documentation and data transfer to improve both individual casualty care and inform Commanders and the Joint Trauma System.
When it comes to adaptive medical logistics & resupply, the IDF rapidly adapted resupply routes and methods under fire, utilizing civilian infrastructure and innovative delivery systems (drones, all-terrain vehicles) when traditional channels were compromised. It suggests that U.S. Forces must prioritize redundant supply chains, pre-positioning of critical medical supplies, and the ability to rapidly procure and deploy novel solutions.
For rapid and accurate casualty treatment the document notes that the IDF significantly improved survival by updating trauma algorithms to immediately identify and treat casualties in hemorrhagic shock, minimize airway and respiratory procedures in the field and prioritize rapid evacuation. Therefore, U.S. Forces must evaluate treatment algorithms and prioritization of blood administration vs. airway and respiratory interventions in both evacuation-permissive and prolonged field care settings.
It also observes that the IDF’s low case fatality rate, despite higher injury scores from prior wars, highlights the prioritization of whole blood as far forward as possible through classic tactical supply chains, policy updates, and novel storage and delivery solutions (vehicle fridges, air drop from drone) and that as a result U.S. Forces should prioritize the distribution, storage, and administration of whole blood to appropriate casualties as far forward as possible.
Given the challenges of Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD), it is noteworthy that the IDF’s proactive commitment to psychological health – through commander training, timely support, and frontline mental health officer deployment – resulted in significantly lower PTSD rates than expected. This demonstrates the importance of prioritizing mental wellbeing alongside physical health and that U.S. Forces should achieve forward psychological health support by pre-positioning Combat Operational Stress Control (COSC) teams and establishing comprehensive, multi-tiered support networks, with specific attention to high-risk groups and the unique challenges of moral injury.
In the fields of operational health and force readiness, the IDF executed proactive public health measures – including robust biosurveillance, forward-positioned preventive medicine teams, and stringent food safety protocols – to mitigate health threats and maintain operational readiness. This indicates that U.S. Forces should prioritize integrating Operational Public Health throughout all operational phases, investing in innovative disease control technologies, fully utilizing highly trained Field Sanitation Teams, adhering to established food safety and sanitation standards, and ensuring readily available resources to proactively safeguard the force and enable mission success.
When it comes to employing veterinary capabilities as force multiplier, the IDF effectively integrated veterinary support into their medical operations, ensuring the health and wellbeing of military working dogs (MWD) to maintain their operational capabilities. To replicate this success, U.S. Forces must prioritize veterinary capabilities – including robust training, data collection, and telemedicine – to ensure MWD medical readiness and maximize their critical contributions to mission success.
These are but a summary of some of the observations and lessons contained within this document. Adapting the full range of lessons in this document requires a strategic investment in technology, continuous improvement, proactive engagement, and robust planning. This is not all or nothing document. While some lessons would require substantial upgrades in capabilities or changes across the range of the DOTMIL spectrum, others can be instituted today with few to no additional resources.
Despite Israel’s preparations it had to undergo a painful process of transformation in contact that U.S. now has the opportunity to avoid. The time for preparation is now. Simply possessing clinical and tactical skills is insufficient. From the observations of the Middle Eastern Wars, if the US Army is to prevail in the complex and challenging LSCO environment, it must actively cultivate a system capable of rapid adaptation and the preservation of force health – encompassing documentation, treatment, MEDEVAC, medical logistics, FHP, psychological wellbeing, and veterinary support – to ensure the well-being and operational effectiveness of its forces.
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