How does U.S. military medicine need to adapt to Large-Scale Combat Operations (LSCO) to develop a more resilient and effective medical response strategy? Historical precedent has demonstrated the feasibility of converting large civilian venues into temporary medical facilities. For example, the Hotel2Hospital Project has shown promise in developing a framework for converting hotels into temporary hospitals. Given the expected casualties of modern war, how can the Department of Defense ensure the U.S. health-care infrastructure can withstand the immense pressures of a national crisis, and what structural or organizational adjustments are necessary to account for this mass influx of patients?
Within a peer conflict, how does the medical service shift to maintaining patients in the area of responsibility (AOR) and close to the front lines for assessment and treatment to expedite a servicemember's return to duty? To facilitate this operational shift and manage hospital outflow, this research should address potential adaptations across the DOTMLPF-P (doctrine, organization, training, materiel, leadership and education, personnel, facilities, and policy) framework as a starting point for understanding current issues. Additionally, this research should account for the risk of failing to modernize medical operations to meet these new demands and assess the associated opportunity costs of any proposed recommendations.
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Badillo, Maj. Amy, "Contested Skies, Compromised Care: Airpower's Role in the Future of Patient Movement," ACSC AO, 2025.
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Badillo addresses this by explaining that in a peer conflict with anti-access/area-denial (A2/AD) environments, traditional aeromedical evacuation (AE) and the "golden hour" standard of reaching definitive care within 60 minutes will become nearly impossible due to contested airspace. To compensate for the inability to swiftly evacuate casualties, she argues that the Joint Force must prepare for warfighters to sustain personal and buddy Tactical Combat Casualty Care (TCCC) for extended periods. Because evacuation opportunities will be rare, she asserts that every available warfighter—including non-medical personnel—must be capable of performing basic lifesaving interventions to prevent disastrous attrition while patients are held closer to the front lines.
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Barry, Lt. Col. Tonya N., "The Silent Deterrence Failure: Hospital Power Loss in a Prolonged Blockade," AWC RTF, 2026.
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Addressed in Barry’s study of how medical facilities must adapt clinical protocols and equipment to provide acute care and casualty management during a catastrophic power and utility failure. She explains that in the absence of electricity and high-pressure steam, conventional hospital operations—including life-sustaining ventilators, dialysis machines, high-pressure steam autoclaves, and diagnostic imaging like CT and MRI scans—will degrade rapidly. To adapt medical response strategies for LSCO, Barry details critical procedural modifications: transitioning from definitive surgical care to battlefield "damage control surgery" focused on rapid hemorrhage control, vascular shunting, and therapeutic packing; utilizing portable, non-electric "draw-over" anesthesia systems (such as the Ohmeda UPAC or OMV50) paired with battery-powered monitors; and deploying low-tech alternatives like battery-powered surgical headlamps and manual vacuum suction devices. Furthermore, to secure critical blood supplies when digital management systems are offline, she highlights the military's use of "walking blood banks" consisting of pre-screened, low-titer O donors to supply fresh whole blood on-demand.
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Bernaola, Maj. Marby M., "Beyond a Fellowship: Building a Foundation for PACU Nurses," AFGC thesis, 2025, 51 pgs.
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Bernaola explains that as the Air Force shifts to a more expeditionary force, forward-deployed medical teams will be smaller, and medical evacuation may be significantly delayed by contested environments. To successfully maintain surgical patients in the AOR, she argues the medical service must shift away from its current practice of using inexperienced nurses for post-surgical recovery and instead implement a formalized Post Anesthesia Care Unit (PACU) fellowship. By fully training PACU nurses to handle complex post-operative emergencies and basic life-sustaining needs, they will be equipped to execute prolonged field (or theater) care and serve as the sole nurse on Ground Surgical Teams. This ensures patients safely recover close to the front lines while allowing intensive care nurses to focus on their primary critical care duties.
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Jenkins, Maj. Phillip R., "War, Wounds and Strategy: Patient Movement Lessons from the World Wars for Great Power Competition." SAASS thesis, 2025, 113 pgs.
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Asks how the medical service will shift to maintaining patients in the area of responsibility (AOR) and close to the front lines for assessment and treatment in order to expedite their return to duty during LSCO. Jenkins addresses this by explaining that in future peer conflicts, strategic evacuation (STRATEVAC) routes will likely be heavily disrupted, forcing a doctrinal shift toward prolonged in-theater care at robust Role 2 and Role 3 medical facilities. Drawing on historical lessons from the World Wars, he illustrates how the military successfully utilized layered echelons of care—such as field hospitals, clearing stations, and convalescent camps—to stabilize and retain patients in-theater. By establishing adaptable, forward-deployed medical structures that can independently manage patient flow and perform damage-control surgery, medical personnel can effectively retain, treat, and return lightly wounded personnel to the front lines while compensating for degraded evacuation pipelines.
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Taylor, Capt. Isabel, "BBP on Telehealth Capabilities in the Deployed Environment," SOS AUA 2024, 3 pgs.
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Vernon, Col. Caryn, "Critical Care on the Battlefield in 2035," AWC Strategic Studies Paper, 2020, 34 pgs.