Page 11 - JSOM Winter 2025

The Chicken, Fox, and Grain

Solving the Problem of CASEVAC

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George Barbee, DSc, EM PA-C *; Joshua Causey, MPSA 2

ABSTRACT
The U.S. Army’s current casualty evacuation (CASEVAC) to rely on MEDEVAC for all combat casualties. The military
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strategy is inadequate for managing large-scale conflicts, par- superiority and low casualty rates enjoyed by the U.S. military
ticularly when mass casualties can overwhelm evacuation against violent extremist organizations and second-rate militar-
capabilities. The Army must rethink CASEVAC to meet the ies are the exception, not the rule. World War II, with 4 years
demands of future conflicts, where the U.S. may face peer ad- of conflict against great power adversaries, resulted in 1 mil-
versaries capable of causing a significant number of casualties. lion U.S. military personnel either killed or wounded. Military
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The authors advocate that the Army should adopt a “whole planners were forced to orient policies and resources toward
of force” approach, prioritizing the requirements of the ma- maximizing combat power. The U.S. military has not faced peer
neuver commander and enhancing operational flexibility and adversaries, experienced periods of limited air dominance, or
simplicity. To achieve this, the Army should revise its current had to evacuate large volumes of casualties in generations.
CASEVAC doctrine, expand the inte-
gration of CASEVAC in training, and China is seeking to redefine the bal-
evaluate its current force structure to “History confirms that more risk is ac- ance of power in the Pacific, and
ensure it supports effective CASEVAC cepted in wars of national survival than Russia is pursuing the near-abroad.
and MEDEVAC operations. Addition- wars of choice. But today, the unat- The threat of a great power conflict
ally, the authors present three concepts: tainable public expectation may be on the scope and scale of World War
creating asymmetric outcomes, think- the sustainment of exquisite care pre- II seems more likely now than ever.
ing differently, and adopting a bias for viously afforded by the DMS [Defense Eighteen months of war between Rus-
action, which can all further improve Military System] for individual casual- sia and Ukraine has resulted in over
the Army’s CASEVAC capabilities and ties in low-intensity conflict.” 1 500,000 casualties on both sides, with
capacity. By embracing these concepts — Timothy J. Hodgetts, DN Naumann, and 270,000–300,000 wounded. China
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and recommendations, the Army can DM Bowley, Transferable military medical continues to build military capability
effectively support maneuver com- lessons from the Russo-Ukraine war and capacity to deny U.S. intervention
manders and maximize the number during a possible invasion of Taiwan
of casualties it can replace in theater, by focusing on developing “air, na-
thereby gaining a competitive edge in a great power conflict. val, and missile systems that can target China’s periphery in
a so-called anti-access/area denial (A2/AD) strategy,” enabling
Keywords: CASEVAC; MEDEVAC; large-scale conflict; large- China to impose high-cost against the U.S. 5(p.8) A recent war-
scale combat operations; asymmetric outcomes game conducted by the Center for Strategic and International
Studies in 2023 showed that a conflict between the U.S. and
China would result in the U.S. suffering more casualties in 1
month than those sustained in Iraq and Afghanistan. These
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Introduction
challenges require the U.S. to rethink casualty evacuation
The last two decades of conflict in the Middle East has set an ( CASEVAC). This article outlines how the U.S. must rethink
expectation that casualties be evacuated from the point of injury CASEVAC to meet the demands of large-scale combat opera-
to a definitive level of care within 1 hour—the “golden hour.” tions by discussing doctrine, training, and structural changes
Directed in policy in 2009 by then-Secretary of Defense Robert needed to maximize lives saved and support combat power.
Gates, this increased MEDEVAC resources in Afghanistan and
Iraq and, in turn, saved hundreds of lives. With 7,067 killed Background
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and 53,553 wounded during the Global War on Terrorism
(GWOT), low U.S. casualty rates afforded the United States the History has demonstrated the necessity of CASEVAC during
luxury to retain the “golden hour” as the standard of care and large-scale conflicts. In the first 2 months of the Normandy
*Correspondence to george.a.barbee.mil@army.mil
1 COL George A. Barbee currently serves as the Senior Physician Assistant for U.S. Army Western Hemisphere Command. LTC Joshua T. Causey
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currently serves as a Battalion Commander at Womack Army Medical Center, Medical Readiness Command-East. Both are stationed at Fort
Bragg, NC.
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