Aim: To provide analyzes of practical implementation of Prolonged Casualty Care (PCC) and Damage Control Surgery (DCS) principles in Ukrainian frontline medical settings (MEDEVAC, Role I and Role II) under prolonged evacuation conditions during 2022–2024. Materials and Methods: Clinical data were collected from multiple combat zones, focusing on indications for DCS, surgical interventions, postoperative complications, and patient outcomes. Results: Among all casualties treated at Role II facilities, 43% underwent DCS procedures, often dictated more by tactical constraints than by medical necessity. The mortality rate in the DCS group was 5.9%, comparable to that of patients undergoing Early Total Care, definitive surgery on day of admission. The most frequent complications included intestinal anastomotic leaks, hernias, pneumonia (9.2%), acute kidney injury (10.4%), and anemia requiring transfusion (7.2%). Challenges in timely evacuation due to hostile drone activity, attacks on medical personnel, and terrain limitations led to a critical shift in trauma care paradigms. Conclusions: Modern war dictate wider implementation of PCC and DCS.