GRAFENWOEHR, Germany – U.S. Soldiers assigned to the Headquarters and Headquarters Company, 56th Stryker Brigade Combat Team, 28th Infantry Division, Pennsylvania National Guard in support of the Joint Multinational Training Group-Ukraine mission participated in a weekly mass casualty triage wargame exercise at Grafenwoehr Training Area, Germany from Jan. 14, 2025 to Feb. 4, 2025.

Each medical squad consisting of three to four combat medic specialists took a turn playing through the wargame during each week of the training period. The 56th SBCT brigade surgeon, U.S. Army Lt. Col. Urlin Mathews, developed the wargame in 2022 when he was a student at the U.S. Army War College. In studying the U.S. Army War College’s wargaming elective course, Mathews learned the history of wargaming and how these games can be effective tools for addressing the military decision-making process. Thus, Mathews’ resultant medical wargame, developed alongside a mentor from the U.S. Army War College, focuses on strategy and decision-making in a medical field environment.

“My wargame is a resource allocation, or ‘European,’ game. Examples of such games are Scythe [and] Settlers of Catan,” said Mathews. “These types of games, and thus my wargame, are most useful for exploring resource-focused decisions, planning and processes where direct combat is not the emphasis.”

The medical wargame addresses mass casualty triage in a large-scale combat operations environment where medical personnel face limited access to medical supplies and air evacuation assets, or anti-access aerial denial, while simultaneously needing to treat a large influx of patients.

According to Mathews, this wargame exposes medical personnel to simulated situations where they are never truly out of harm’s way. In the multi-week playthrough, the wargame’s senior medic, played by a squad leader, leveraged limited medical supplies, time and staff with immediate, delayed, minimal and expectant needs described on simulated patient casualty care cards.

Each game turn then brought additional simulated wounded patients to the scene, thus depicting the reality of a mass casualty situation showcasing an exceedingly abundant number of ill and injured patients. This stretched the limits of the medical team’s capabilities even more. The senior medic also fought against mission failure brought on by too many minimally-injured simulated patients not returning to the battlefield within specified timeframes.

Sgt. 1st Class Michael Hansen played the role of the game adjudicator each week of the wargame exercise. His role required him to maintain the game’s sequence, ensure that the game events occurred according to the rules and provide mentorship to his teammates playing the roles of the senior and junior medics. In acting as the game adjudicator week after week, Hansen found the wargame’s repetitions eye-opening to the importance of being ready to respond to a mass casualty environment.

“When we have actual casualties on the battlefield, they’re not going to wait until we’ve worked through the ones that we currently have; they’re going to just keep coming,” said Hansen. “While we had opportunity this game to take our time and work through [the casualties], we do need to hone our skills and speed up so we can get patients out for when we are in an actual situation handling real patients.”

All in all, by the end of the four-week playthrough, Mathews found that his wargame proved immensely successful in combining the 56th SBCT medics’ prior treatment knowledge with exposure to new scenarios they might experience in a large-scale combat operations environment.

“I couldn’t have been more pleased with the medics’ level of participation, enthusiasm and cognitive learning executing this ‘MASCAL Triage Educational Game.’”

Each of the 56th SBCT medical squads achieved the intended outcome of the game by working together through complex medical and logistical challenges to identify and treat casualties requiring evacuation from those returning-to-duty to accomplish the mission.

“I think what is really inspiring is [our] medics are already imagining how they can make the game harder and more realistic,” said Mathews. “[They are] calling the new injects as ‘expansion sets’ for future game play!”

Additional information about the mass casualty triage wargame can be found here.