MSIW in Taiwan

This week, I was invited to present at the Taipei International Military Medicine Forum. They asked me to discuss prolonged field care options for the Taiwanese defending their nation. To prepare for this talk, I did a deep dive into the local healthcare system.

Taiwan’s current hospital system is characterised by a high density of hospitals, modern medical equipment, and a well-trained workforce, including specialists in various fields. However, challenges still need to be addressed regarding the capacity to handle large-scale emergencies, particularly in conflict or disaster. This includes the challenges in conducting medical support for large-scale combat operations (LSCO). Whilst Taiwan has established disaster preparedness teams, including drills and emergency response plans, these systems may face strain under the pressures of mass casualties or sustained attacks targeting infrastructure. Thus, whilst Taiwan’s hospital system is capable in peacetime, enhancing its resilience to disruption is critical in light of potential irregular warfare scenarios.

My discussion on PFC and MSIW offers Taiwan options to enhance resilience and maintain operational effectiveness in the face of an invasion. In unconventional warfare scenarios, Taiwan’s medical strategies could focus on mobile healthcare systems, creating decentralised, underground clinics that would ensure continuity of care despite disruptions in infrastructure. Establishing well-coordinated networks of field hospitals, surgical units, and medical supply caches in dispersed and hard-to-target locations would mitigate the impact of targeted strikes on traditional healthcare facilities. Furthermore, training civilians and reserve forces in basic and advanced first aid could bolster survival rates and enhance the population's capacity to respond to mass casualties.

At the end of my presentation, the conference organisers asked my opinion on how they could prepare themselves for a conflict. My answer was twofold: First, they must enhance their military medical capabilities. They currently do not have medics assigned to the platoon level. They have limited first-aid training for their non-medics. I suggested they look to the world’s best military medical system, the US Army’s ranger regiment, where each squad has a Ranger First Responder and a SOCM 68w at the platoon level.

Second, I advised them to start teaching Stop the Bleed courses to their civilian population. During an LSCO environment, it is imperative that everyone can stop massive haemorrhages. ?

Third, I suggested that their civil defence and military adopt prolonged field care concepts. This would require their military to teach PFC to their first responders. It would also mean that they need to teach the Austere Emergency Care course to their civil defence and ambulance responders.

And, as a psychologist, I would mention the importance of psychosocial and mental health support, which would also be pivotal in Taiwan's MSIW strategy. In irregular warfare, prolonged conflict and civilian involvement often lead to significant psychological strain. Integrating psychological first aid and resilience-building programmes into medical training would address mental health challenges on and off the battlefield. Furthermore, fostering collaborations with international humanitarian organisations could provide Taiwan access to expertise, resources, and advocacy, strengthening its medical capabilities in irregular warfare while ensuring adherence to international medical ethics.

The Bottom Line: All countries would benefit from enhancing their civilian medical capabilities.