In April, Chinese leader Xi Jinping inspected the People’s Liberation Army’s (PLA) Army Medical University (AMU), located in the city of Chongqing, underscoring China’s intensified focus on enhancing battlefield medical capabilities as the nation incorporates lessons learned from observing the conflict in Ukraine into its military medical system. Xi gave a short speech to a group of PLA officers and NCOs during his inspection tour. The speech emphasized the “importance of orienting towards the battlefield, the army, and the future, improving the level of education and training, security capabilities, and striving to build a world-class military medical university.” The university’s faculty, staff, and students also briefed Xi on different achievements and areas the university conducted research on. The university students and staff demonstrated and exhibited various pieces of combat medical equipment for Xi during his visit.
Emphasis on Front Line/Combat Medicine
The staff briefed Xi about AMU’s current situation and the various medical treatment disciplines used on the battlefield. They also set up displays of first aid equipment used to treat “war injuries” and demonstrated various first aid procedures. Xi examined the demonstrations and displays while he discussed them with the AMU staff and students.
During the inspection, Xi “gave a series of important instructions on vigorously promoting medical research and innovation” to the students and staff. Xi’s instructions included points on how to enhance tactical medicine on the battlefield and increase the PLA soldiers’ combat effectiveness. Xi also urged the staff and students to strengthen “the construction of healthcare and security.” He then asked the staff and students to provide “strong service to the combat effectiveness of the troops and to increase the physical and mental health of the officers and soldiers.” Xi said these two points would ensure that the PLA’s actual action is to win modern conflicts.
Jiang Jianxin, an academic for the Chinese Academy of Engineering, researcher, and Director of the AMU’s Combat Trauma Medical Center, was one of the staff members that met with Xi to discuss the development of medical treatments at the university. Jiang said that China should aim at future wars and focus on “serving the strong PLA to win.” Furthermore, Jiang said that he will enhance his scientific research using “forward-looking and key subversive technologies” to develop breakthroughs in battle trauma medicine. Jiang also pointed out that high-quality scientific research results will be key to the PLA’s development. He participated in an equipment demonstration with his colleagues during Xi’s inspection. He noted that Xi was “very concerned about the capacity building of first aid for war injuries at the tactical level” and also asked about their studies.
Jiang’s area of research is the development of treatments for blast injuries for the PLA and new, more efficient field surgery techniques and procedures to meet the needs of modern war medical support. He developed new techniques for the prevention and treatment of trauma infections. Jiang also created new technologies for “precise diagnosis and treatment” to decrease the risk of serious complications from injury treatment.
As a delegate to the Two Sessions in 2020, Jiang put forward three proposals for the development of grassroots or unit-level military doctors. Jiang’s first proposal is to expand the professional development of military doctors to create a professional and technical evaluation system. His second proposal is to create a “hierarchical diagnosis and treatment system to create medical practice opportunities” for military doctors. The third proposal is to establish a talent flow mechanism for unit-level military doctors. Jiang said the three proposals will allow for the construction of the military doctors to be activated so the position can “truly achieve the goal of taking the PLA as the soul and medicine as the foundation.”
Hu Wendong, an Air Force Medical University professor and researcher, also participated in the inspection after he and his team returned from a unit survey about aviation safety and security. Another group of professors and students went to the Southern Theater to conduct medical research into healthcare and PLA soldiers’ requirements. Hu said the university “should focus on the frontiers of aviation security, strengthen research in the aerospace medicine field, and train doctors to shape people on the future battlefield.” He said that it would allow the university to develop professional medical personnel who could seamlessly move from the institution to the PLA and then to the battlefield.
Hu is considered an expert in aerospace medical engineering, psychology, and the development of psychological assessment technology. He was also the Director of the People’s Liberation Army Air Force (PLAAF) Medical University’s Teaching and Research Department for Aerospace Medical Equipment. Hu is now the Executive Deputy Director of the PLA Psychological Assessment Technology Center, the Director of the PLAAF Psychological Rehabilitation Center, and a counselor for the PLAAF Medical University’s Psychological Counseling Center. His area of research is developing new techniques and equipment to develop and improve the physiological and psychological assessment systems to evaluate pilots for the PLA. Hu also led the team that developed eight models of physiological and psychological assessments for the selection of pilots, taikonauts, and other PLA units. He also conducts research to evaluate how officers and soldiers psychologically and physiologically cope when their units deploy and live in remote areas.
Medical Training Events and Change to Curriculum
The National Defense University Joint Service College’s Medical Service Teaching and Research Office organized a project review of teaching materials in the field of medical service. The group compiled “high-quality teaching materials” that closely covered the requirements of war and guide battlefield practices. The teaching and research department’s staff said they “continue to deepen teaching reforms,” open up the demand for talent cultivation, competence and quality objectives. The staff said they will also continue reforms to the structure of the teaching curriculum, teaching methods and means of multiple links, and to develop a new type of curriculum system that will “contribute to the cultivation of battlefield-oriented joint combat medical service and security talents.”
The Central Theater General Hospital also held a training event that simulated combat trauma treatment. The event simulated medics providing immediate care to injured frontline soldiers, evacuations to follow-on care sites, and other courses. The participants reported a calm response, close coordination between individuals, and the development of war trauma treatment capacity. The hospital’s leadership said that the next exercises will “focus on emergency protection in peacetime, wartime efficient treatment requirements, and the development of medical service detachments.” Furthermore, the leadership said the next exercises will enhance “the war trauma treatment subject research, enhance the troop’s combat effectiveness, and provide strong medical support to win wars.”
People’s Liberation Army’s Army Medical University
In 2017, the PLA created the university by merging the Sixth and Third Military Medical Universities. The university is located on the Third Military Medical University’s campus. AMU integrated the Baikou’en Medical Sergeant’s School, the People’s Liberation Army Army’s (PLAA) Urumqi Comprehensive Training Base, the Military Medical Training Brigade, and the 8th Hospital of the Tibet Military Region to form the school in Chongqing. The university is considered one of the six main military medical universities in China, along with PLAAF Medical University and PLA General Hospital’s Medical College. AMU is responsible for training medical doctors, officers, and NCOs from the PLAA, the People’s Liberation Army Rocket Force (PLARF), and the People’s Armed Police (PAP).
The university is primarily tasked with undergraduate, graduate, and postgraduate education. AMU offers 11 undergraduate majors, eight in vocational and technical education for NCOs, 12 disciplines for master’s degrees, seven professional degree categories, and nine post-doctoral degrees. The medical college is a primary command education site for officer promotions, professional training of officer positions, and officer position qualification training. The institution is also responsible for the initial and follow-on professional training of civilians working with the PLA and PAP in a medical capacity. AMU is also responsible for NCO technical and vocational education and training for pre-selected NCOs, NCO promotion training, and pre-service training. The university is responsible for training medical personnel from foreign militaries, new recruits, and national and local emergency rescue units. It is also responsible for providing standardized residency training for medical officers.
AMU is a site for training medical personnel for land warfare, for innovation in medical science and technology, for preventative medical care for the PLA, and for providing important strategic support for the PLA’s medical service. The university’s hospitals provide support to 17 military medical institutions. The college also dispatches medical teams throughout the year to remote locations in China to carry out “Red Army Doctor Border Trips.”
Xi’s Visit, Ukraine Conflict Underlines PLA’s Emphasis on Increasing Tactical Medicine Capabilities
Xi’s trip to AMU to inspect and examine the various medical equipment for tactical medicine indicates that the PLA understands the increased importance of tactical medicine and frontline care. While the PLA’s emphasis came from Xi’s requirement for it to focus on realistic training to become a military that can “fight and win wars,” tactical medicine’s increased importance stems from observing the ongoing Ukrainian conflict. The PLA suffers from a lack of experience in fighting wars; the last conflict they participated in was the 1979 Sino-Vietnamese War. This “peace disease” has a significant negative impact on the PLA’s combat capabilities, such as neglect of equipment maintenance, disregard for military knowledge, and a faint awareness of the enemy. Furthermore, Xi and other senior PLA officers still view the lack of modern warfighting experience as a major impediment to the PLA’s modernization efforts. Chief among these efforts is to develop the necessary capabilities to fight in modern warfare conditions, such as having an adequate level of tactical medicine and frontline care.
The Chinese military’s understanding of the necessity of having an adequate capacity for tactical medicine and frontline treatment only comes from observing both sides of the Ukrainian conflict. For example, the PLA observed the significant issues that Russia encountered when trying to provide adequate frontline care to their forces deployed in Ukraine. Chief among these issues is the lack of frontline care found at the tactical level during the invasion’s first year. The lack of frontline care prevented the Russian military from providing trauma care to wounded soldiers, which dramatically decreased their rates of survival. However, the Russian military began to rectify these issues through several means. For example, the Russian military began to place medical units as close as possible to the line of contact to increase the wounded troop’s survivability. The Russian military also began to send surgeons and traumatologists from Central Hospitals to medical battalions and detachments to conduct surgeries previously not done at trauma care’s first stage.
The PLA saw that both sides lacked adequate levels of medical supplies to send down to the tactical level. Russia encountered several issues related to sourcing medical supplies such as hemostatic dressings, tourniquets, bandages, and other devices used to stabilize Russian troops in the initial stages of trauma care. The lack of supplies caused Russia to depend on obsolete equipment and unproven methods such as rubber tourniquets, tampons, and sanitary pads for bullet wounds and other injuries. These methods caused a significant increase in the number of preventable deaths among wounded Russian soldiers throughout the conflict. Furthermore, the lack of medical supplies also led the Russian military to depend on faulty or knockoff medical equipment sold or provided by Chinese companies.
The Chinese military also observed how Ukraine secured access to and provided medical supplies for frontline units to use. Chief among the issues is the Ukrainian Military General Staff Medical Command’s view that its primary responsibility is to provide support to military hospitals instead of frontline units. The lack of medical supplies caused significant issues with the level of tactical medicine that military units provide to wounded soldiers on the frontlines. For example, the lack of certain supplies caused uneven levels of medical support to appear among individual Ukrainian units in terms of the quality of trauma care they could provide to wounded soldiers. The bureaucratic infighting that occurred between the Ukrainian Health Ministry and the Medical Command over the use of blood transfusions caused problems with the standardized trauma care that Ukrainian units could provide to injured troops.
Lessons the PLA Learned from Ukraine
The PLA studied how Ukraine secured access to medical supplies through various means that enabled it to provide better frontline care than Russia. The Ukrainian military has undertaken various initiatives to increase its ability to provide tactical medicine to frontline units since 2017. Ukraine’s creation of combat medics allowed the Ukrainian military to extend medical care to the tactical level, which increased the survival of its troops. The Ukrainian military also increased its emphasis and training on Tactical Combat Casualty Care (TCCC) for its forces. However, Ukraine also built up its stocks of medical supplies in the years leading up to the 2022 invasion. This aspect is perhaps the most significant because the stocks allowed Ukraine to provide a consistent level of tactical medicine during the first few months of the conflict. Ukraine greatly benefited from donations of medical supplies from Western countries and Non-Governmental Organizations (NGOs) after the Russian invasion. This allowed Ukraine to provide its troops with medical supplies that are of higher quality than the supplies Russia has access to.
Xi’s visit to AMU represents the PLA’s understanding that it would need to increase its emphasis on tactical medicine based on its observations of the Ukrainian conflict. For example, several of the exhibit’s tables contained Chinese-produced equipment or items that medics or soldiers would use to treat wounded on the frontlines. The displays allowed Xi to see that the AMU is developing medical equipment to increase the survivability of wounded PLA soldiers, a key component in the PLA’s modernization process. The PLA reiterated this emphasis on the tactical medicine lessons it learned from observing the Ukrainian conflict. Specifically, the lesson was how the Russian military failed to provide adequate medical equipment and training, which led to significantly low survivability among its troops, even for injuries that were easily survivable.
The PLA also understands that it would sustain a large number of casualties in Large Scale Combat Operations (LSCO), such as an invasion of Taiwan or a regional conflict with the United States. The casualties would likely be significantly more than the projected 120,000 casualties the PLA would sustain during any amphibious campaign outlined in Operational Logistics Support. However, the casualties would also increase during certain parts of the invasion, such as the initial invasion and breakout phases that would involve increased fighting, the use of loitering munitions, and indirect fires along the axis of advance. The casualty estimate would also increase because the defender would have a slight advantage compared to the forces conducting the operations, especially in easily defensible areas along the Taiwanese coast. The PLA would sustain casualties that easily exceed the 120,000 projection and likely reach 180,000 or more within the first months of any campaign.
Another lesson that the PLA learned from observing the conflict is that it needs to increase the emphasis on teaching its medics and troops tactical medicine and TCCC. The AMU staff conducted demonstrations of combat medicine procedures to show Xi that the university is developing TCCC or a similar version for use by the PLA. The importance of the PLA improving the survivability of its troops was made especially apparent because of the significant number of casualties that the Russian military sustained from a lack of training on how to conduct self-treatment or use medical equipment. Furthermore, the PLA would prioritize developing and training in TCCC techniques because it views providing medical treatment to its soldiers as vital to improving and maintaining their morale. The various exercises that were held at the Central Theater General Hospital and National Defense University serve to show how the PLA is increasing its emphasis on training personnel in tactical medicine. The training exercises also show that the various colleges and universities are changing their curriculum for teaching tactical medicine to PLA officers, NCOs, and soldiers.
The AMU staff and PLA medical officers interviewed also pointed out how the PLA is actively addressing not only issues regarding tactical medicine but also other healthcare issues found in the Chinese military. The PLA understands that it is affected by other healthcare issues that would adversely affect its performance during major military operations. Jiang’s meeting with Xi to discuss the development of medical treatments at the AMU is significant because of his position and area of research. For example, Jiang is the director of the AMU’s Combat Trauma Medical Center, which plays a significant role in the development of treatments for injuries sustained during combat. The treatments would incorporate new technologies such as additive manufacturing, augmented and virtual reality, and robotics to create new surgery techniques and procedures. These technologies would allow the PLA to treat wounded soldiers more effectively through the new procedures. The center is also responsible for training medical officers and staff who would be directly responsible for treating wounded soldiers during combat.
Jiang’s area of expertise indicates that the PLA is serious about enhancing its tactical medicine capabilities. Jiang’s area of research is developing new blast injury treatments and field surgery techniques to enable military surgeons to treat wounds soldiers receive during combat operations. The treatments Jiang developed would be a priority for the PLA to incorporate because they would allow it to overcome any potential shortcomings in its tactical medicine capabilities. Another of Jiang’s research areas is the creation of new technologies to decrease the risk of complications from injuries, and their treatment would increase the wounded soldiers’ survivability. The technologies would be especially useful during LSCOs because of the difficulties that both Ukrainian and Russian militaries faced in moving wounded personnel to follow-on treatment at field or military hospitals.
The PLA, however, understands that tactical medicine is not the only limitation it faces that would negatively affect its medical capabilities during combat. One major issue that the PLA faces is finding individuals who can endure the physiological and psychological rigors of certain training programs, such as pilots and special forces. The PLA recognizes that its officers and soldiers previously had issues coping with the mental demands involved in pilot training and assessment programs. Their ability to mentally cope with modern combat would be tested because of the “peace disease” found throughout the PLA and the lack of modern combat experience. The intense fighting that the units face would cause most PLA units to rapidly lose their ability to conduct operations and become combat-ineffective. Evidence exists that shows Ukrainian troops develop Post-Traumatic Stress Disorder (PTSD), anxiety, and other mental issues from combat. PLA soldiers that participate in combat operations would likely face significantly higher levels of PTSD and other mental issues because of the “peace disease,” as well as the soldiers’ inability to mentally cope with modern combat. Hu’s research focuses on evaluating how PLA personnel psychologically cope when they are deployed to and live in remote areas. He would then use the research to develop techniques that would enable PLA officers and soldiers to better cope with the mental stress of combat.
Xi’s inspection of the PLA Army Military University is significant because it shows that the PLA is incorporating the lessons it learned from the Ukrainian conflict. AMU is in charge of training medical staff from the PLAA and PLARF, as well as providing medical personnel for land warfare. The university is home to centers that are responsible for the research and development of new medical equipment and techniques for use in tactical medicine, TCCC, or in field hospitals. This is important because AMU would be at the forefront of any advances in tactical medicine or techniques that resulted from lessons the PLA gleamed from the Russian and Ukrainian militaries’ performance in the conflict. The university is also an important center for the development of innovations in medical science and technology, an important part of the PLA’s efforts to develop equipment and training for use at the tactical level.
