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Rethinking Who Leads CASEVAC train units and staff on how to command, control, and employ
Efforts to revise CASEVAC doctrine requires identifying the these elements. This integration will allow the Army to im-
right proponent to champion DOTMLPF-P initiatives. With- prove CASEVAC capabilities and capacity within current unit
out the right proponent, the development of CASEVAC will structure while identifying challenges to their employment.
result in disjointed or ineffective outcomes. Doctrine must in-
clude principles and techniques that promote effective training General Andrew Poppas, Commanding General of U.S. Army
strategies and execution at echelon, using available equipment Forces Command recently stood down and is now Western
and vehicles across the entire joint force. Commanders are re- Hemisphere Command. We identify it as such in COL Barbee's
sponsible for CASEVAC, a non-medical mission as stated un- affiliation, so we should use that nomenclature here and in the
der ATP 4-02.13, Casualty Evacuation, and enshrined under future as well, best captures the importance of realistic train-
a commanding officer’s responsibility for the welfare of their ing at the division level: “If you haven’t trained on them, if
Soldiers in 10 USC, Section 7233. As articulated in doctrine you don’t know the full capacity and capabilities, then you’re
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and law, this responsibility implies that CASEVAC falls to ma- sub-optimized.”2 General Poppas went on to observe, “You
neuver commanders from the company to corps levels to plan can read about it, but until you see them in real life, and you
and resource based on operational demands. synchronize them in the fight in time and space, then you’re
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not going to be effective.” As the Army increases division
Selection of either the U.S Army Sustainment (SCoE) or U.S. participation in CTC rotations, including the DSB and CAB is
Army Medical Center of Excellence (MEDCoE) as the pro- the first step to exercise realistic CASEVAC, which forces units
ponent may result in DOTMLPF-P reforms or capabilities and staff to synchronize capabilities. Beyond this integration,
development that favors parochial interests of the sustain- the Army can include watercraft, test future concepts such as
ment or medical community over potentially broader, more unmanned and robotic autonomous systems for CASEVAC,
far- reaching, operational requirements outside the span of and integrate corps and medical brigade headquarters to test
knowledge and control within those respective CoEs. This also future CASEVAC capabilities and concepts. Evaluating these
creates a conflicting line of responsibility that may undermine capabilities and concepts will provide lessons that inform fu-
the maneuver commander’s ability to integrate CASEVAC into ture tactics, techniques, and procedures to improve CASEVAC
mission sets. The Sustainment CoE and the Medical CoE have capability and capacity across the enterprise.
supporting expertise and responsibilities, and their efforts sup-
port the maneuver commander. The maneuver commander Divisions Lack Capacity to Regulate Casualties
determines requirements and execution of unit operations. Unfortunately, divisions and corps lack sufficient personnel to
Combined with the responsibility for the welfare of their Sol- regulate casualty evacuations at the scale experienced during
diers and CASEVAC, this makes the U.S Army Maneuver Cen- World War II or WFXs conducted by the MCTP. Of the 12–13
ter of Excellence (MCoE) the logical choice to serve as the personnel assigned to the surgeon section within divisions and
CASEVAC proponent. corps, only two personnel have expertise in managing patient
evacuation and regulation. At the division level, there is the
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Scaling CASEVAC Training aeromedical evacuation officer and a patient administration
The Army must prepare maneuver commanders for the dif- officer, and at corps, an aeromedical evacuation officer and a
ficulties they will encounter in planning, resourcing, and ex- patient administration non-commissioned officer. Notwith-
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ecuting CASEVAC during Combat Training Center (CTC) standing, neither organization has the manpower to regulate
rotations. This starts with ownership within the maneuver patient movement, and the remaining personnel within each
community and includes a deliberate, iterative, and incremen- surgeon section are likely to be engaged in managing other
tal training strategy to train leaders on planning and executing medical requirements.
CASEVAC from the platoon to corps levels. Training at the di-
vision level must press beyond simulation, the current MCTP Past organizational structures do not offer great alternatives
War Fighter Exercises (WFX) model. These rotations offer an to fill this gap. The Division Support Command (DISCOM)
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opportunity to exercise CASEVAC capabilities that currently (formerly a command responsible for providing logistics sup-
exist but are not fully realized. port to its respective division area from the 1980s to the early
2000s) included a medical battalion and division medical
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The division may be task-organized with a division sustainment operations center. The division surgeon (dual-hatted as the
brigade (DSB) and combat aviation brigade (CAB). 17,18 Com- medical battalion commander) controlled one main support
bined, both units have significant CASEVAC and MEDEVAC medical company and three forward support medical compa-
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platforms that maneuver commanders could use. A 2020 study nies.2 The division surgeon and the division medical oper-
found that the DSB and CAB, (if adequately task-organized, ations chief (who principally controlled the division medical
trained, and resourced) can transport up to 8,944 ambulatory operation center [DMOC]) in the DISCOM headquarters (see
or 3,476 litter patients in a single lift. The DSB is a “building Figure 1), would leverage his battalion staff and the DMOC to
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block” organization, capable of providing mission command coordinate air and ground evacuation as well as other health
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for any combination of light-medium truck companies, com- service support and force health protection functions. The
posite truck companies (light), and composite truck companies division surgeon, in coordination with the DMOC chief, could
(heavy) that provide a large number of medium tactical vehicles direct staff efforts toward regulating patient movement on de-
and trailers “ideal for quick loading and transportation of litter mand (Figure 1).
or ambulatory patients.” Likewise, the CAB is authorized as a
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heavy lift company, an assault helicopter battalion, and a com- However, a similar DMOC structure today would likely not
bat aviation company capable of transporting casualties using significantly change the division’s capacity or capabilities to
CH-47s (Chinooks) and UH-60A (Blackhawks). The DSB plan and control CASEVAC or MEDEVAC. The basic structure
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and CAB can be integrated with divisions in CTC rotations to and assigned personnel of the DMOC (see Figure 1) are not
Solving the Problem of CASEVAC | 11