Page 15 - JSOM Winter 2025

area. With appropriate urgency and willingness to accept new Capabilities Integration and Development System (JCIDS) to
ideas, the Army can boost efforts to transform approaches to ensure operational endurance and tempo. Only by thinking dif-
CASEVAC by taking advantage of the concepts and recom- ferently about who leads CASEVAC and evaluating every mode
mendations below. of transportation, conceptual or current, can the Army enhance
flexibility and simplicity for the maneuver commander to take
Concept 1: Create Asymmetric Outcomes action to ensure timely movement of patients.
Asymmetric outcomes or payoffs refer to reducing the down-
side and increasing the upside. Nassim Nicholas Taleb used Concept 3: Bias for Action
this term, coupled with antifragility. One tactical example is
from the Soviet–Afghan campaign. The Mujahedeen knew The concept of bias for action refers to the act of moving or
that if they wounded one Soviet soldier, it would take four motion that creates time, space, and opportunity for an out-
soldiers to tend to and carry that casualty. As an operational come. A 2014 study of 6,547 patients highlighted this risk by
example, the Japanese used kamikaze aircraft, which used hu- finding that 95% of patients with fatal wounds required sur-
man pilots willing to sacrifice themselves to guide their planes gical intervention in 23 minutes, and only half survived the
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into American ships during the Pacific Campaign in World first hour. Risk is always present, but the opportunity to save
War II. The advent of kamikaze aircraft created guided mis- lives is fleeting, and the window to do so is small. The military
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siles decades before the technology existed to develop cruise weighs risk in action but not risk in inaction. Stated differently,
missiles. Fast forward to present day, Ukraine’s early adop- especially in the context of military medicine in support of the
tion and use of suicide drones to inflict enormous casualties warfighter, the risk of doing nothing is more significant than
on the numerically superior Russian Army has contributed to the risk of doing something. That bias also creates and main-
the Ukrainian war’s relative stalemate. These examples of tains the “tempo” of war at the tactical and operational levels.
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asymmetric outcomes highlight the potential competitive ad-
vantages of asymmetric outcomes. Using AI and unmanned Although defeated at the strategic level in World War II, the
autonomous systems (UAS) presents a unique opportunity to German Army (particularly the 7th Panzer Division) created
increase capabilities and capacity in CASEVAC while decreas- and maintained “tempo prestissimo” (rapid tempo). This was
ing the number of people required to operate systems, equip- achieved through bias for action by the 7th Panzer Division
ment, and vehicles with these capabilities. Thinking differently and inversely and inadvertently a lost opportunity by U.S.
about creating asymmetric outcomes is critical for the Army Forces to remove uncertainty from combat. The last exam-
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to maintain a competitive advantage against adversaries with ples for bias for action is drawn from the Israel and Hamas
asymmetric advantages, such as geographic distance or numer- War. Since the onset of conflict, the Israeli Defense Force (IDF)
ical superiority. has rapidly innovated a new medical digital application to re-
cord and maintain medical data on wounded soldiers visible
Concept 2: Think Differently to hospital staff prepared to receive the patient, used drones
Thinking differently refers to creative and critical thinking and to transport blood to save over 380 lives, and pushed whole
applying it to see and solve the problem. Why have we always blood far forward on the battlefield. In the space of 2 years,
loaded our ambulances from the rear? Is it because we have the IDF rolled out medical innovations that would have taken
always done it this way since the horse and cart? In the 21 the U.S. Army far longer to accomplish. 32–35 These are im-
st
century, with our technology, it would be easier to load pa- portant concepts that our Force can adapt as the Army takes
tients from the sides with a system that folds up and down like action to revise CASEVAC doctrine, expand the integration
a pivoting ladder. This system allows both sides to be loaded of CASEVAC in training, and evaluate how the current force
simultaneously; you could work on patients if you had to, and structure can support CASEVAC. The recommendations be-
loading and unloading will be smoother, faster, and safer. In low offer actionable opportunities to modernize CASEVAC.
2023, the Assistant Secretary of Defense for Special Operations
and Low-Intensity Conflict distributed a concept paper on Recommendation 1:
non-standard medical support. It was a three-pillar approach. Revise the Current CASEVAC Doctrine
The third pillar discussed enhancing U.S. operational flexibility The Army must develop concepts and doctrine that support
through increasing nontraditional medical care, non-standard CASEVAC opportunities in support of joint warfighting. Exam-
evacuation, and non-standard equipment and supplies. 27,28 ples include shore-to-ship, ship-to-shore, tail-to-tail in multi-
modal platforms, and robotics in semi to fully autonomous
To enhance U.S. operational flexibility and simplicity, the platforms. CASEVAC doctrine must outline how command-
Army must also think differently about who should lead ef- ers perform CASEVAC using existing force structures from the
forts to develop flexible CASEVAC solutions. While numer- division to theater army levels. These concepts also support
ous medical elements of CASEVAC may lead some to identify opportunistic sustainment functions, resupply, and backhaul.
MEDCoE as a proponent, the requirements of the maneuver The Army must integrate these systems in a whole of force
commander should take precedence. Maneuver commanders, approach to prevent silos and stovepipes.
as suggested by the concept paper, need operational flexibil-
ity for non-standard evacuation. This begins by establishing a A whole of force approach includes primacy of CASEVAC over
unified approach to CASEVAC that delineates the MEDCoE MEDEVAC, streamlining command and control of patient
as the lead proponent, with other CoEs supporting prioritiz- evacuation, considerations on integrating CASEVAC with med-
ing maneuver requirements. In the fog of war, which is inher- ical logistics and overall sustainment, personnel manning to
ently chaotic and uncertain, maneuver commanders will need organize and reconsolidate the force, and ensuring unfettered
diverse options to move casualties from division-deep and close management through command, control, and communication
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areas. The entire spectrum of equipment and vehicles must in- networks. A 2023 article discussed the future of military med-
clude considerations for casualty evacuation through the Joint ical evacuation and nicely defined nine “decision problems”:
Solving the Problem of CASEVAC | 13