Page 16 - JSOM Winter 2025

asset planning and dispatching, fleet management, capabil- Modernizing CASEVAC doctrine, training, and structure re-
ity assessment, casualty estimation and planning, evacuation quires a sense of urgency. The Department of Defense has
chain management, collection of right casualties from the right struggled to modernize and transform to match the pace at
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place at the right time, command and control, combat casualty which our adversaries are innovating. The Army is in an in-
36
care, and resource allocation-relocation. Adding data collec- terwar period. The U.S. needs to prioritize resources and trans-
tion as the tenth decision problem (using air traffic control formation efforts against peer adversaries capable of inflicting
methodology for patient movement) will make this a better many casualties. Leaders across Training Doctrine Command,
holistic planning model for developing CASEVAC concepts Forces Command, and Army Futures Command must trans-
and doctrine. 37 form the CASEVAC enterprise that creates asymmetric out-
comes, thinking differently about solutions to CASEVAC, and
Recommendation 2: Develop a Joint Medical Common having bias for action.
Operating Picture (MEDCOP)
During World War II, the extensive CASEVAC network in the These interrelated and synergistic concepts allow the Army to
European and Pacific Theaters required visualization and co- transform how it uses CASEVAC to maximize efforts to re-
ordination from the tactical to strategic levels. Although coor- build combat power and preserve combat fighting strength.
dination of CASEVAC was successful using radio, telegraph, To achieve this, the Army must revise its current doctrine to
and analog communication, modern advancements such as reprioritize CASEVAC, expand the integration of CASEVAC in
drones, high-speed aircraft and missiles, and space-based ob- training, and evaluate how the current force structure achieves
servation necessitate the development of a shared MEDCOP. synergy between CASEVAC and MEDEVAC. By adopting a
The Army does not have a MEDCOP that depicts casualty whole of force approach, the Army can streamline command
streams and integrates with commonly used command and and control and leverage emerging technology, like AI and UAS,
control platforms like MAVEN smart systems or other com- to enhance its capacity and capability to evacuate casualties.
mand platforms. While this gap is known, Commanders and These efforts will increase the ability of maneuver commanders
staff will require a means to visualize CASEVAC demand sig- to execute CASEVAC, providing flexible options for them to
nals, resources, and streams across vast geographic areas, le- clear the battlefield, heal the wounded, and reconstitute forma-
veraging multi-modal evacuation and command boundaries tions, ultimately providing a competitive strategic advantage for
at echelon. The joint force will be challenged to synchronize the joint force in future conflicts and national strategic resolve.
CASEVAC resources and requirements without a common
medical operational picture. Author Contributions
Both authors conceived this paper and worked jointly towards
Recommendation 3: Expand Integration of its submission.
CASEVAC in Training
The Army’s Forces Command and Training Doctrine Com- Disclaimer
mand should expand integration and evaluation of planned This article was cleared by U.S. Army Western Hemisphere
and opportunity CASEVAC using large elements of the DSB Command PAO.
and CABs into division-level CTC rotations and nest with
Corps WFXs. The division can utilize the DSB and CAB to Disclosures
practice CASEVAC while using enhanced CASEVAC training The authors have indicated they have no financial relation-
environment to test future concepts, such as UAS. Additionally, ships relevant to this article to disclose.
the Army should exercise trains and watercraft as evacuation
platforms during CTC rotations. Trains and watercraft could References
expand evacuation distances beyond the CTCs to achieve real- 1. Hodgetts T, Naumann DM, Bowley DM. Transferable military
ism in patient transfers between echelons, evacuation methods, medical lessons from the Russ-Ukraine war. BMJ Mil Health.
2023. doi:10.1136/military-2023-002435
and physical domains. 2. Kotwal RS, Howard JT, Orman JA, et al. Effects of a golden hour
policy on the morbidity and mortality of combat casualties. JAMA
Surg. 2016;151(1):15–24. doi:10.1001/jamasurg.2015.3104
Conclusion 3. Department of Defense. Casualty by type, overseas contingency
The U.S. Army’s approach to CASEVAC is insufficient to meet operations, and principal wars in which the United States partic-
large-scale conflict demands. History teaches that great power ipated, World War II. Defense Casualty Analysis System; Septem-
ber 9, 2024. Accessed February 6, 2025.https://dcas.dmdc.osd.mil/
wars are longer and deadlier than expected. The nation-state dcas/app/conflictCasualties
that can reconstitute in theater is the nation-state that will 4. Cooper H, Santora M, Schmitt E, Kanno-Youngs Z. Troop deaths
have a competitive edge during great power conflict. This is and injuries in Ukraine war near 500,000, US officials say. The
a strategic imperative for the United States, as only 23% of New York Times. August 18, 2023. Accessed February 6, 2025.
Americans are qualified to serve and lower when considering https://www.nytimes.com/2023/08/18/us/politics/ukraine-russia-
war-casualties.html
those willing to serve. According to FM 4-0, Sustainment 5. Cancian MF, Cancian M, Heginbotham E. The first battle of the
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Operations, “theater medical planners may anticipate a sus- next war: Wargaming a Chinese invasion of Taiwan. Center for
tained rate of 3,600 casualties per day,” planners should plan Strategic and International Studies; January 9, 2023. Accessed Feb-
39
to replace 25% or up to 800 of the total daily casualties. Re- ruary 6, 2025. https://www.csis.org/analysis/first-battle-next-war-
placement requirements at this rate are beyond the joint force’s wargaming-chinese-invasion-taiwan
generational and institutional memory. The Army must exam- 6. Cosmas GA, Cowdrey AE. The Medical Department: Medical Ser-
ine how it approaches similar problems in history—how to vice in the European Theater of Operations. US Army Center of
Military History; 1992.
ensure flexibility and simplicity and how to address demands 7. Condon-Rall ME, Cowdrey AE. The Medical Department: Medi-
for casualty evacuation against adversaries seeking their own cal Service in the War Against Japan. US Army Center of Military
asymmetric outcomes. History; 1998.

14 | JSOM Volume 25, Edition 4 / Winter 2025