This guide is mainly for medical Senior NCO’s and Officers to prepare their unit for a more successful CTC rotation (and subsequently, a deployment) while avoiding common mistakes. Junior 68W may gain information from this to prepare themselves, but success will come from getting your unit involved in training.

“How could I better prepare for CTC as a 68W?” 

Preparing for LSCO drives us to think differently. Let’s touch on a few things for the more junior medics as it’s a good refresher. The skillset and foundation of knowledge that a 68W must possess isn’t changing, but the ability to think critically is! You are going to be expected to work autonomously from your providers; what this means is, it’s incumbent upon junior medics to drill, drill, drill on triage. What is the point of triage? To do the most amount of good in the least amount of time for the most amount of people given what capabilities and supply are at your disposal. You must have a mindset of performing triage to get the most minimal patients back in the fight quickly, and to allocate resources to those priority patients who have a shot at returning. It is inherent that you are an active participant in MEDSTAT reporting, as well as being knowledgeable of the BDE MEDCOP/MEDCOS, so that you know (without having to ask) where your unit stands on supply in time and space (and allocation of external resources). 

Practice MASCALS! The only way to get better is through sets and reps. You can train in the medic’s office on a Tuesday morning, long before any STX or FTX arrives. Grab 10 of your closest friends, print out some casualty cards, and attach them to the patients. Leave the room and go take a lap. Do some pushups. Stress your body a little so your mind has to react under a higher heart rate. Leave the lights off (everything is harder in the dark) and practice your formulas and work through triage to get comfortable. Sets and reps. Over and over again until you are sick of performing triage. Work it into your scenario that you only have xxx amount of CLVIII supply, and you aren’t getting resupplied anytime soon. How does that affect your decision making? Simply put, there is no such thing as reverse triage. It is, simply, triage. OC/T’s can tell who shows up having not practiced at all, and those who put the reps in to try to make chaos work. Don’t waste your training value by having the first time you experience 20+ patients to be at the CTC rotation. Be prepared so that your AAR comments can be a refinement of skills and not a complete rebuild which can detract from the overall iteration. 

Medics should regularly practice these assessments through drills and simulations, emphasizing speed and accuracy under pressure, especially in chaotic, high-stress scenarios. Having a pre-packed MASCAL kit with triage tags, airway supplies, bleeding control tools, and reliable communication gear is also crucial—every second counts, so knowing your equipment layout can make a life-or-death difference. Team coordination plays a key role; defined roles and streamlined communication protocols ensure smoother operations. Working as a team with multiple medics can be more difficult than working alone at first due to lack of role assignment and practice.


Practicing concise patient handoffs and clear radio or verbal reports strengthens situational efficiency. It’s also vital to stay aware of changing conditions—triage is dynamic, and priorities may shift as new information comes in. Perhaps most importantly, medics must mentally prepare for the emotional weight of these events. The goal is to do the most good for the most people, which often means making difficult decisions quickly. Regular after-action reviews and mindset training can help build the resilience needed to perform effectively in such high-stakes environments.

Senior medics, put your most junior medics at the head of the table and have them run the trauma scenarios. Talk everything out loud. We have to get back to being comfortable in the uncomfortable. A solid 68W is one of the most finite resources the Army has; we can’t waste their time. Let’s get back to training.

For the senior medics, OIC’s and providers: 

12+ months out:  Sit down with your higher echelon and start planning for the rotation. Work on
( surprise, NCOs, you can do this too!) your MEDCOS/MEDCOP and do your own MDMP/TLPs internal to your role of care. Force your BDE Surgeon cell to push information so that YOU can provide bottom up refinement for decision making. Be aware of any CLVIII and medical maintenance deficiencies so you can make a quarterly plan to catch up. 

6-8+ months out: Take good notes at your LTP. Send the right representative to LTP, and if they are PCSing soon, ensure they pass on the info! Start reaching out and communicating with your OC/Ts at your designated CTC. They are here to assist you and want to see you succeed in training. We are all on the same team! 

Get your MEDLOG straight. Orders for a CTC should be on the horizon at this point; this gives you time to get what you need (both for real world and notional training). Historically, units arrive at a CTC with 40-60% of the CLVIII filled; this is a problem if you want to maximize your training potential when you get there. 

Get air MEDEVAC training on the schedule (hot and cold load).  

2-3 months out, AKA “I just found this guide right before going”: Last minute MEDLOG checks should be complete. You should have refined MEDCOS/MEDCOP at this point. Pacing items should be squared away and you should be conducting final RXLs with your crews (treatment teams are doing trauma bay rxls and evac squads are conducting ready up drills). The comms PACE plan should be finalized at this point prior to your departure. Additionally, even a couple hours on the training calendar can refresh on fundamentals and triage if it’s been awhile since some medics have reviewed skills or assessments. Stay later to get good at your job, replace PT on Thursday morning with trauma lanes outside the company, or MASCAL since you have enough bodies showing up for PT and even those on profile who can act as a patient. 




Now lets dive into more specifics, trends and comments:

“Why isn’t there more medicine at CTC?” 

The intent of CTC isn’t medicine, it’s more maneuverability, which when done poorly means more patients for the medic to deal with.   

Additionally, there are simply not enough OC/T’s available to worry about every small medical intervention done by every medic and provider, as cool as that would be. The funding and manpower would not be feasible. 

So, how do we incorporate more medicine into CTC if OC/T’s can’t be everywhere, all the time? One solution is to develop internal grade sheets for the PA/Senior Medics to grade medics on. Just because an OC/T is not around does not mean you can’t have an integrity check to see what you could have done better. You will generally be allowed to go as deep as you want to with training by the OC/T. Do not cut corners.

For example, an OC/T may not catch the slow time or mistake of each intervention but someone designated to stand back for an iteration with a clipboard can help, or a teammate can just be honest afterward. Internal standards can be as strenuous as you want them to be. If you don’t make standards, nobody will know what to aim for. An OC/T may not bring up a 4-5+ minute IV time, but if you have a unit standard of 2-2:30 minutes, that is something you could bring up during debrief. This may mean you justify training before showing up to rotation which could improve the average IV time of medics from 4:00 minutes to 2:00 – 3:00, which is a marked improvement. This could be applied to finger thoracostomy, documentation and so many other interventions. Decide what you want to focus on with training, what you could do better and measure.  

    “Training scars and bad training habits are still the scariest thing I see as an OC/T.”

I have seen too many bad training habits developed and practiced at a CTC. It’s time that platoon leadership takes back their training time and puts an emphasis on creating an environment where medics are pushed to do things the right way. We can’t afford to skip steps in this line of work. That’s how good people die.

Solution: The Army is addressing the challenge of integrating medical training into unit schedules through the establishment of the Medic Master Trainer School at Joint Base San Antonio (JBSA). This initiative aims to equip Sergeants and Staff Sergeants in the 68W MOS with the skills necessary to effectively incorporate medical training into quarterly schedules. It is important to acknowledge that sustainment units, including medical personnel, often do not receive the same prioritization for training resources and time as maneuver units. Therefore, it is incumbent upon the sustainment community to leverage their experiences and proactively plan to support combat units.

The medical community faces challenges in simulating training and practicing interventions. The absence of a “ghost medic” underscores the need for realistic training to prepare medics for critical situations on the battlefield. To advocate for training resources and funding, it is essential for medical personnel to understand and communicate in the language of maneuver units. Non-Commissioned Officers (NCOs) must be actively involved in the planning process at the Brigade and Battalion levels, such as the Military Decision Making Process (MDMP). By learning to speak the language of the 11, 13, and 19 series, medical personnel can effectively engage with the movement and maneuver community, demonstrating their value and securing buy-in. The commander may see his medics skills as a “green box” already checked that don’t need more medical training even though YOU know that isn’t accurate, so it’s up to you to sell them on justifying more training and keeping it on calendar. If using the units METL and preparation for CTC and deployment success are not enough to justify more medical training, than ensure to mention E3B/EFMB prep, as well. Don’t get discouraged, get creative and persistent.

Again, The role of a CTC is not to stress the individual skills of a 68W as much as it is to test the processes and systems of a BDE; that being said, a Senior Medic or PA is allowed (within reason) to take the training of the scenario as far as they want to. This starts with realistic home station training and should culminate at a CTC exercise, thus validating that your 68Ws are ready to rock. 

Ultimately, the role of the medical community is to sustain the warfighter. To achieve this, it is crucial to showcase the ability to enhance the capabilities of combat units, thereby securing the necessary resources to fulfill this mission.


“We don’t practice the basics.”

The simplest, most basic procedures and tactics aren’t followed. We have grown to become lazy. We make excuses. We say the budget isn’t big enough or that we don’t get enough time. Make it work. Find a way. Make it a priority that you practice the basics. The basics, and discipline, will save you in more situations than anything else. Do you think warfare means only performing with an abundance of people and supplies?

Solution:  Army Regulation 350-1, “Army Training and Leader Development,” emphasizes the importance of training and maintaining proficiency in basic skills, including medical procedures. It mandates regular training schedules and assessments to ensure soldiers are competent in fundamental tasks. By adhering to this regulation, units can prioritize basic medical training and ensure it is consistently practiced. Units should regularly review and practice these medical tactics to maintain proficiency. Incorporating ATPs into training exercises can help reinforce the importance of basic medical procedures, such as triage, emergency care, and evacuation protocols. 

Regular drills and exercises focused on basic medical skills should be integrated into the training schedule. These can include first aid, CPR, wound management, and casualty evacuation drills. You can also include not just TCCC but also DNBI such as vehicle rollovers and collisions, which happen in CTC and deployments. A trauma lane without an obvious tourniquet or bleeding to stop needed can make a new medics head spin. By making these drills a routine part of training, soldiers can develop muscle memory and confidence in their medical abilities. Leaders at all levels must be held accountable for ensuring their units practice the basics, including medical procedures. This can be achieved through regular evaluations and feedback sessions. Leaders should set clear expectations and provide resources to facilitate medical training, even when budgets are tight. When faced with budget constraints, units should be encouraged to find innovative solutions to practice basic medical skills. This could involve using simulation technology, conducting joint exercises with other units, or utilizing local training areas creatively. The key is to prioritize medical training and find ways to make it effective despite limitations.

Medical personnel must also contribute to base defense and force protection in LSCO, particularly when operating in forward-deployed or isolated areas units. A well-trained medic understands not only their role in providing medical care but also the critical importance of base defense when operating in hostile environments.

In a cluster environment, medical units need to be able to defend their medical treatment facilities (MTF). Medics must understand how to employ basic individual protective equipment (IPE) like body armor and gas masks, and how to use weapons and participate in base defense operations. This means regular training on how to properly position defensive barriers, conduct small arms fire, and secure medical areas during an attack. This comprehensive approach ensures that medical personnel are not caught off guard and are capable of responding to all threats to maintain the operational integrity of their unit.

Units should foster a culture where discipline is valued and rewarded, including adherence to medical training schedules, punctuality, and attention to detail. A disciplined unit is more likely to succeed in challenging medical situations. After each training session, conduct after-action reviews to identify areas for improvement in medical procedures. Encourage soldiers to provide feedback on medical training effectiveness and suggest ways to enhance basic skills practice. Continuous improvement should be a goal for all units, especially in the medical field. By focusing on these solutions, military units can overcome excuses and prioritize the practice of basic medical skills and discipline. These fundamentals are crucial for operational success and can significantly enhance a unit’s readiness and effectiveness in various medical situations.

You’ve got to care more than the enemy.



There can be a sense of a lost passion across the force right now, and an assumption that the person next to us will help pick up the slack. Forget all that. Your country needs YOU to be the most lethal, ready Soldier that is willing to throw down at any time. I promise you that there are people training in worse conditions than us, in the dark, in the rain, on little sleep, you name it. We have to get back to having a healthy fear of what lies ahead. That healthy fear will drive us back to being the most competitive, successful, feared Army that exists. 

Solution: We have gravitated towards a society of “everyone gets a trophy”. That has become a norm. Whether it’s conducting TCCC training or watching units roll through the MSTC, I am seeing more “Go’s” given than hard conversations about why someone failed. That is OUR responsibility to take back as medical NCO’s and PA’s. We have the KSAs (knowledge, skills and attributes) to lead great training for our formations; but we MUST have the integrity to have the hard conversations with our seniors, peers and subordinates. The training that you conduct at home station should not be taken lightly: everything from ICTLs to your METL to a CTC. This is meant to prepare you for the worst day of your lives. We sincerely hope that day never comes, but for those of us who grew up in the GWOT generation, we understand fully that that day can come at any time. “Hard” is relative to the individual. So let’s start making it “hard” on ourselves again in a training environment, so we can fall back on a high level of confidence and competence in the next conflict. 

I can’t replicate the hard times my generation grew up in. I can’t make you want it more than me. And I can’t make you take my words to heart when we have a 2.5 hour AAR and I coach you on everything you need to go be a badass medical company/platoon. All I want is to be able to walk away one day and know that I tried. That I played my part and spread my passion and helped Army Medics realize their true potential. 

This isn’t meant to take away from the amazing things that I constantly see units do. I see units come to a CTC and crush it! But, it’s time for a wake up call. Danger is knocking at your door; are you prepared to open it?  

“I have a good idea to improve CTC and not just complain. Where can I post?”

Comment below what you would like to see, keeping in mind manpower limitations and funding. We can bring the feasible ones up. For example, we know the MILES patients cards could be better, and we are currently revamping those right now.