The experience of Ukrainian military medical personnel in their ongoing fight against Russian forces has highlighted gaps in their military medical systems, some of which may also exist in the U.S. Army’s medical systems. While there has been much talk of transitioning from a counterinsurgency mindset to one of large-scale conflict, many assumptions are made in discussions of medical capabilities and evacuation concepts for a fight against a peer. Air medical evacuation capability, for example, is frequently assumed, as is the reliability of communications and the proximity of medical assets to front-line units, headquarters elements, and logistics elements. Given the anticipated nature of conflict against a peer, however, many of these assumptions may prove false. The U.S. Army should mitigate the loss of medical advantages that it has enjoyed in previous conflicts by implementing a number of changes within divisions to reduce preventable deaths and return more soldiers to the fight.