Objective: A virtual reality (VR)-based training system for combat musculoskeletal trauma care (CMTC) was meticulously crafted to enhance trainees’ theoretical understanding, familiarity with care processes, and decision-making abilities in the realm of combat musculoskeletal trauma management. Method: Scenario scripts, descriptions of injuries, and foundational management plans for care under fire and tactical field care were constructed. Subsequently, the CMTC system was developed employing tools, such as Maya, Photoshop, Unity, SQLite, and Visual Studio. Finally, the system was tested by 30 civilian nurses. The trainees’ knowledge, satisfaction, and system usability were evaluated using the theoretical question bank module, questionnaire, and system usability scale (SUS). Results: This research resulted in the establishment of five types of processes for CMTC in the contexts of care under fire and tactical field care. The study indicated that the trainees’ scores after training (75.67 ± 6.91) was higher than before training (69.17 ± 10.91), p < 0.001, the t-statistic was −5.022. The resultant SUS score was 70.4 ± 9.40. An overwhelming 96.67% of the trainees expressed satisfaction with the teaching quality. Conclusion: The CMTC system, developed in alignment with Tactical Combat Casualty Care (TCCC) guidelines and infused with cutting-edge equipment and technologies, provides an interactive and modular simulation training experience. Its strengths include higher reality, enhanced safety, repeatability, cost-effectiveness, and the provision for performance analysis. Besides, it has good accessibility and reliability, and can cultivate students’ autonomous learning ability and deepen their understanding.