The players assume the role of a DEVGRU operator code-named ' Rabbit', Delta Force sniper code-named ' Deuce', Ranger Dante Adams and Apache helicopter gunner Brad Hawkins. The storyline follows several Tier 1 Operators working under the National Command Authority in Afghanistan during Operation Enduring Freedom. The game features a single-player campaign, in which the player will control multiple characters from both the 'Tier 1' and 'Big Military' perspectives. When the character is within the blast radius of a live grenade, a marker indicates the direction of the grenade, helping the player to flee from the frag grenade. If the player get a headshot an icon will appear to the screen. If the player stays out of fire, the player can recover. When the player has taken damage, the edges of the screen glow red. Using cover helps the player avoid enemy fire or recover health after taking significant damage, as there are no armor or health power ups. The single player includes some usable vehicles such as helicopters, jeeps and a quad bike.Ī player can be positioned in one of three stances: standing, crouching, or prone each affecting the character's rate of movement, accuracy, and stealth. The game introduces new weapons and technology to the Medal Of Honor franchise, including the M4A1 carbine, M16A4 assault rifle, the M110 Semi-Automatic Sniper System, AN/PEQ side rail-mounted laser pointer, the MP7A1 Submachine gun, and the AT4. It includes the kinds of objectives and tasks issued in real life such as raiding terrorist hideouts, hostage rescues and undercover operations. The emphasis is on realism, with EA going as far as to bring in real Tier 1 Operators from the United States military as consultants.

The game breaks away from the World War II setting of previous games in the series and is instead set in ongoing War in Afghanistan. The 2010 Medal of Honor differs from the previous Medal of Honor installments.

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