Medic! The Role of Medical Treatment in Wargames By Sean Couture

Conflict and death have been comfortable bedfellows for eons now, and it’s very unlikely that that arrangement will be changing anytime soon. It’s due to this fact that medicine and warfare also go hand in hand. Thankfully, most of us no longer have to worry about the prospect of war showing to knock on our door one day, but instead we choose to peek into its back garden through the medium of wargames.

Wargames, like most media, tend to focus more on the actual fighting in wars rather than the vast number of variables, factors and systems that surrounds them, and it’s easy to see why -- Engagements, firefights and operations are a lot easier to turn into entertainment than triage centers or communications networks. Did you take that hill from the Wehrmacht? Yes? Congrats you win! No? Sorry you lose. It’s an easy concept that’s simple to grasp. Being developed by die-hard war nerds, wargames do often take a peek into the more medical side of war and we’re here today see how stands up to the real and how it helps to improve the games that include it.

Immediate Effects

When I say “immediate effects”, I’m of course talking about injury and its treatment on the battlefield. Wounded combatants, field medics and stretcher bearers. After an engine upgrade in the late 2000s Battlefront’s popular Combat Mission series went from having a single sprite representing a whole unit of men to each soldier being rendered individually. With this innovation came the inclusion of combat medics.

The 2nd Squad of 3rd Platoon are crossing a street in Normandy to storm a barn that’s instrumental for securing the platoon’s right flank when an MG42 opens up on them. Privates Jackson, Garcia and Hall go down. Along with them a BAR, a recoilless rifle and a Thompson lay in the street. Immediately, the player is presented with a choice: Attempt to treat those wounded men along with saving vital equipment, or move? Were these games to treat this as more of a binary situation -- soldiers are either alive and combat effective, or dead and ineffective. There would be no need to pause for thought unless the threat of the MG42 is deemed by the player to be more pertinent than securing the barn.

Now let's say that the player is aware of a high number of hostile contacts moving in on the barn, and 2nd Squad is the only unit close enough to do anything about that. Once again, it’s comes down to a decision for the player that wouldn’t be there otherwise. Rush the barn to reach it ahead of enemy forces or try and recover equipment and men that may be need to fend of the enemy forces.

Lastly, we have the final version of my scenario, in which this is some ways into the first battle of an operation and 3rd Platoon has already been badly mauled in the fighting. The 2nd Squad is the the only unit left in the platoon with a high level of combat effectiveness. The player has to then decide whether or not they want to jeopardize having the whole platoon become ineffective, or if they want to risk more lives for results that will only be brought forth in the next battle.

Now that we’ve seen an example of simulated medical treatment improving a wargaming experience for the better, I’d like to shift focus over to the Graviteam Tactics series of games. Firstly, I’d like to say that I’m not here to criticize these games for not simulating this -- no game can do everything. I’m simply trying to show how simulating medical treatment could help the series. In these games, it’s very simple: If a soldier is shot, mortared or so on, they die. No fuss no bother. Now whilst I could advocate for Graviteam Tactics to take a page from the Combat Mission playbook and include medics out in the field a truly great addition to Graviteam Tactics would be aid stations and field hospitals.

Let’s say you’ve just secured a town from the Soviets, but took a fair number of casualties in the process. Naturally, your men set up aid stations to help treat the wounded and ease their suffering. But suddenly the Soviets attack with superior number and firepower -- you’ve got reinforcements inbound, but they need time to get to you. With the aid station and the wounded out of the picture, you can just give up the town before taking it back when you’ve regrouped with the reinforcements. Put the aid station back in the picture, and suddenly things become complicated: You can’t leave your men to the mercy of the Soviets. For one thing, any wounded who could be healed and returned to active duty will be lost (and anyone who’s ever thumbed through a book on the Eastern Front will know that Germany needed all the men they could get). For another, it's bad for morale to leave men -- especially wounded men -- to die. Armies are built on comradery and looking out for the man either side of you.

Field Hospitals would also add interesting gameplay choices, in the case of Graviteam Tactics. Have one too close to the front and it risks being overrun, too far behind lines and the seriously wounded will have trouble surviving long enough to make it back from the battle.

Psychological Effects

When I use the term “Psychological Effects”, I’m referring to those soldiers in proximity of the the wounded, along with the wounded themselves once they return to service. In the Hearts of Iron games, researching things to do with medical treatment increases your force’s trickleback factor. Like most wargames, units have a experience/veterancy stat that increases with combat. When units take casualties, they lose some experience to represent green recruits replacing veterans who’ve died. The trickleback modifier helps offset that.

Here’s where wargaming and reality split off, though. Historically, units have often reached a tipping point where their years of experience works against them. In the weeks after the successful D-Day breakout, it was found that some British and Commonwealth units were actually underperforming compared to their greener American counterparts. This had nothing to do with better training or USA being number one, but it was instead because these units had been in the war for so long.

Four years of fighting in humanity’s deadliest war took a heavy psychological toll on the men in those units (and even more so for men who had been wounded and returned to frontline service). The same was also reported on the eastern front, as some Soviet units lost the aggressive edge they’d gained a few years prior. The recommend cure for this across the board was very simple: R&R.

Whilst wargames have stats and bars to measure a unit’s physical exertion, they rarely to the same for psychological exhaustion. You get organization modifiers and so on to ensure armchair generals give their units a breather, but for the most part, that’s all they constitute -- A breather.

A stand out exception to this rule however is Command Modern Air / Naval Operation, or CMANO, for short. Crew and pilots must be given a minimum amount of rest depending on the amount and length of sorties they’re undertaking. This can of course mean that players will be forced to make decisions based not just on operation integrity but also on the welfare of the people under their command.

In Summary

Medical treatment in both a physical and mental capacities help to add an extra strategic layer that wouldn’t be there otherwise. One of wargaming’s strong suits is the breadth of choice it provides players and the stories that are spawned as a result. When aid stations, field medics and doctors and thrown into the mix, squads, platoons, brigades and so on begin to feel more akin to bodies of people whom your strategies rely on; rather than disposable tools that you just replace when their effectiveness depletes below a certain point. That in turn ask players to constantly think ahead over the course of whichever game they are playing. Lastly it reminds players that the strength of their strategies and by extension their armies aren’t simply determined by enemy body counts or objectives captured, but is instead weighed in how responsibly they handle their forces and how many lives they unnecessarily throw away.