Do not pretend that refusing to learn battlefield trauma lessons from the IDF is some noble stand. It is a luxury belief that would be paid for by 19-year-olds
January 26, 2026 11:20
Four retired senior British Army officers have reportedly urged the prime minister to impose a comprehensive arms embargo on Israel and to “cut all military collaboration with Israel forthwith”, including links with Israeli defence firms.
In the same political climate, the UK has also taken steps to prevent Israeli students from attending one of Britain’s flagship defence courses. You may agree or disagree with any Israeli policy, and you can hold Israel to any standard you believe is appropriate. However, a blanket attempt to sever military-to-military contact with the Israel Defence Forces is not a serious way to protect British troops. It is, in fact, a notable way to ensure that British soldiers die needlessly in the next war Britain cannot escape.
Here is the uncomfortable truth: when it comes to saving young men and women after they have been torn apart by blast and shrapnel, Israel has been learning, adapting and delivering at a pace and scale that the British Army simply has not had to sustain in recent years.
The IDF’s own combat medicine data from recent conflicts shows a steady decline in the “case fatality rate” (the proportion of casualties who die) across major operations, even as injuries have become more severe. That is what a learning medical system looks like when tested under fire.
Consider the first lesson: blood, not “drips”, saves lives. For decades, armies (and civilian ambulances) often reached for clear IV fluids first. Doctors call these fluids “crystalloids” – essentially sterile saltwater solutions used to increase circulating volume.
They are not useless, but they have a fatal limitation: they do not carry oxygen, and they do not contain the clotting components that stop catastrophic bleeding. In mass trauma, too much crystalloid can dilute the body’s ability to clot, cool the casualty, and worsen shock.
The IDF’s data indicates a significant doctrinal shift away from crystalloids and towards blood-based resuscitation. During the Second Lebanon War, 92.7 per cent of casualties receiving resuscitation fluids were treated with crystalloids. In Protective Edge (2014), that figure was still 83.3 per cent. In the current war (Iron Swords), only 29.8 per cent were treated with crystalloids, reflecting a clear move towards resuscitation centred around blood products, especially whole blood.
“Whole blood” matters because it is what the body actually loses: oxygen-carrying red cells, plasma proteins, and platelets that form clots. The challenge is not the concept; it is creating a system capable of delivering whole blood safely, repeatedly, and at scale. Israel has achieved this.
When the war began, whole blood was rapidly distributed first to ground evacuation teams at the divisional and brigade levels and, after about three months of successful operational use, was further expanded to the battalion level with proper training, certification, cold-chain management and forward stockholding.
The outcome signal is clear. Comparing casualties treated with plasma alone to those treated with whole blood (with or without plasma), the IDF report found that whole blood was linked to lower mortality within the first 24 hours after injury, with an absolute risk reduction of 13.8 per cent and a significantly lower adjusted risk of death (reported as HR 0.23) compared to plasma alone. The report also notes that whole blood tended to arrive later than plasma because plasma was available at every medical stage, whereas whole blood was only accessible from battalion level upwards. This underscores the need to improve access to whole blood, rather than abandon it.
The IDF data shows that although many casualties who received blood products got only one unit, more than 10 per cent received more than three units, despite brief evacuation times. That one statistic should alert every British planner. It demonstrates that “blood far forward” is a logistics issue, a training challenge and a command responsibility. It necessitates tough decisions regarding storage, supply, wastage, certification and the authority to transfuse at the point of wounding.
Now consider the second lesson: sometimes the most life-saving action a medic can take is not to perform the dramatic procedure. Airway management exemplifies this. Intubation (inserting a breathing tube into the windpipe) can be lifesaving but is also technically challenging in the field, and, critically, it can destabilise a casualty already in profound shock from blood loss.
The IDF’s own analysis is frank about the realities: intubation is a complex procedure in the pre-hospital combat environment, and when the IDF examined success rates during the war, it found about 74 per cent success for intubation and 61 per cent for cricothyrotomy (the emergency surgical airway).
More important than the numbers is the doctrine behind them. The IDF report explicitly warns that deep shock caused by bleeding is not an indication for a “definitive airway”, and that attempting it in such a situation can pose significant risk to the casualty.
If someone is dying because they have no blood left to pump, sedating them and placing them on positive-pressure ventilation could be the final push over the edge. The priority is to stop the bleeding, restore oxygen supply with blood, and act quickly to get to surgery.
The third lesson concerns honesty in measuring performance. Too often, militaries cite a single large figure: the case fatality rate (CFR). However, CFR can be misleading if you do not consider what types of injuries are involved. If casualties are less severely wounded, CFR decreases even if your system has not improved. The IDF’s data addresses this issue by showing CFR decreasing while the proportion of severely injured survivors increases.
Across three conflicts, the IDF reports CFR decreased from 14.3 per cent (Second Lebanon War, 2006) to 9.2 per cent (Protective Edge, 2014) to 7.2 per cent (the current war). Over the same comparisons, the proportion of casualties with a very high Injury Severity Score (ISS over 15) increased from 10.5 per cent to 15.3 per cent to 22.3 per cent. That combination of fewer deaths, but more severe injuries, is the statistical signature of a system that is saving people who used to die.
The IDF’s own summary is that decisions and clinical actions taken under fire, and the capacity to implement evidence quickly in extreme conditions, saved the lives of 600 soldiers who would not have survived in earlier conflicts. If Britain is serious about duty of care, it should want to study that system in painful detail: what was carried, who was trained, where blood was stored, who could authorise transfusion, when to intubate and when not to, how data was collected, and how practice changed mid-war.
Britain is not starting from zero. The Defence Medical Services are well respected, and the UK is investing in capabilities that are heading in the right direction.
NHS Blood and Transplant’s latest annual report highlights work on the Ministry of Defence “Blood Far Forward” programme, which aims to deliver blood and plasma within 30 minutes of injury in active war zones, along with the development of dried plasma and a significant UK trial (SWiFT) examining whole blood in frontline trauma. UK military researchers are also investigating how many service personnel could supply low-titre group O whole blood through emergency donor panels. This is essential, unglamorous groundwork for any forward whole-blood capability.
Israel has been forced to manage everything from start to finish, at scale, in real time, and it has the data to show what worked, what failed, and what changed.
It is hard to imagine a more damaging decision for the British Army than shutting the door on that knowledge because some out-of-touch retired officers believe that cutting contact is a moral stance worth taking, even at the cost of British lives.
If you want to argue about arms exports, do it. If you want to debate strategy in Gaza, do it; but do not pretend that refusing to learn battlefield trauma lessons from Israel is some noble stand. It is a luxury belief, held safely at home, that would be paid for by 19-year-olds on a future battlefield bleeding out while a medic reaches for the wrong tool.
The Jewish community understands what moral confusion cloaked as virtue looks like, and what it truly means to hold life as sacred.
If the British Army adopts a forward whole-blood system, approaches “saltwater drips” with scepticism, becomes more disciplined about when not to intubate, and judges success by the number of severely wounded people it saves, it will not be “helping the IDF”. Instead, it will be fulfilling its primary duty: bringing British soldiers home. For that reason, it would be madness to ignore the valuable lesson.
Andrew Fox is a military expert who served in the British Army from 2005 to 2021
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