Monday, May 27, 2024

Prepping for future battles requires advances in battlefield care

Before every war there is discussion among experts, mostly inside the military, about gaps in our preparedness. That conversation is going on now. The public isn’t hearing much of it, because most people aren’t going to conferences on military topics. But I go to them, and I always leave thinking this needs to be a wider conversation.

Last week, I was at a conference about our military’s medical capabilities, including its ability to keep wounded warfighters alive in the type of war we haven’t fought in 70 years. We may be in a war with China within the next few years, with lots of casualties. Secretary of State Antony Blinken has been in China in recent days to try to lower tensions. But our military is preparing for large-scale, lethal battles in the Western Pacific.

Antony Blinken and Xi Jinping

That was the possibility hanging over the conference I was at in Chapel Hill. The “Medical, Biomedical and Biodefense: Support to the Warfighter Symposium” was co-sponsored by the North Carolina Biotechnology Center and the North Carolina Military Business Center. There were a lot of high-ranking officers and civilian Department of Defense officials at the Friday Center, because the military has a vast medical complex preparing for war. Its leaders are trying to communicate to industry what they need and hear what industry is working on. Time may be growing short, high-level diplomatic handshakes Monday in Beijing notwithstanding.

A different kind of war

One of the presentations that stuck with me most was delivered by Col. Tyler Harris, a Womack Army Medical Center surgeon at Fort Liberty in Fayetteville. Harris has had five combat zone deployments. He is surgical specialty advisor to the Army’s Medical Central Simulation Committee.

Col. Tyler Harris

A war with China is not going to be like Iraq or Afghanistan, where our forces controlled all domains, and casualties could be quickly evacuated by helicopter to medical facilities. “We had a massive overmatch against our adversaries in that situation,” Harris said.

In a large-scale conflict with an adversary such as China, every domain — land, air, sea, space and cyber — will be contested and everything we do will potentially be seen or sensed by enemy satellites and drones. Harris made reference to the second Nagorno-Karabakh war in 2020 between Azerbaijan and Armenia as the template for what future wars will look like. Azerbaijani drones loitered over the battlefield, hunting Armenian signals, and when they found them, killed at  “machine speed,” as Harris put it. “That’s what we’re going to face,” he said.

This will make treating and evacuating casualties far more challenging, and the military has to prepare for that, said Harris.

A recent military exercise estimated as many as 100,000 casualties in large-scale combat operations, and “that is probably a floor, not ceiling.” These are Korean War-scale U.S. casualty numbers, which were in a three-year span, not the lower U.S. casualty rates of conflicts of the past two decades.

“Also, I want you to notice on that slide,” Harris told the room,  “we are severely undermanned medically to deal with that, right?”

It will be difficult to fly medevac helicopters into the battle zone “because everything will get shot down. Whether that’s logistics or medevac, there’s going to be times when we can’t get to you.”

“You’re going to see medics, physicians . . .  all of it overrun because we’re going to have too many people that are too seriously injured to take care of, with not enough resources. So, part of that is the implication that we’re going to need more capability further forward.”

Single-use devices, for example, may not be practical, he said. “It’s prepackaged, it’s nice and sterile, but once I use it, it’s gone.  I may not be able to get another. Maybe that’s not the right answer for this environment.”

The military needs help

A lot of the thinking about medical care in the future fight is happening at Fort Liberty, among Harris and his colleagues at the Army’s largest installation by population. The leading-edge companies Harris was talking to at the conference were sitting about 90 minutes north of Liberty, where the Army is wrestling with these problems.

Harris mentioned the recent work in the influential military publication Joint Force Quarterly discussing the challenges in great detail by Lt. Col. George Barbee, director of force innovation and modernization for the Joint Medical Unit/Joint Special Operations Command at Liberty. The National Defense University publication — basically the joint chiefs chairman’s scholarly journal — is not something that most medical-device makers know about, but the military’s looming future-fight medical challenges are in Barbee’s article from last fall, for anyone in industry R&D to read.

Most deaths on the battlefield happen before a warfighter gets to the first medical facility, which is a battalion aid station, Harris said, and most of those deaths are caused by bleeding. But around a quarter of those folks could be saved if they could get care quickly enough, he said. And that is why Barbee, Harris and others are focused on improving what they call Tactical Combat Casualty Care. More training is key, so for example, medics can deal with the kind of bleeding that can’t be stopped with a tourniquet or pressure dressing, known as “noncompressible hemorrhage.”

“Non-compressible hemorrhage is a real issue and something we’re still struggling with and need to do a lot of research,” said Harris.

“How do we train people in high-level tactical combat casualty care ubiquitously across the force? How can we get threshold blood forward quickly and in large volumes, maybe all the way to the point of injury on the battlefield?”

“We’ve already talked about early blood administration, but I’m going to stomp my foot and say there’s a training gap. We’ve got to train those far forward soldiers, just like they did in World War II, to give blood on the battlefield and to do it early.”

He spoke of the need to use autonomous aircraft to bring supplies to the battle zone. “ We predict based on what’s going on in the battle, what medical supplies you need and deliver those supplies before they’re asked for. Those kinds of things are things folks in this room can get after.”

As he said that, I thought of something I saw down in Robeson County last year, a team of robotics experts from a Carnegie Mellon spin-off company watching their autonomous drone try to land safely in difficult terrain, hovering, looking down and making decisions on its own. This was the kind of thing that would carry blood to the battlefield, saving lives. That’s what I had been looking at the Emerging Technology Institute in Red Springs, about 45 minutes south of Fort Liberty. The future fight’s logistics, if it is ready in time. I also thought of Secmation, a Raleigh company that provides cybersecurity for autonomous systems, making it harder for the enemy to prevent that drone from bringing blood to warfighters.

Beyond that, Harris said, the military also needs autonomous and semi-autonomous diagnostic and therapeutic devices, devices on a patient that can begin treatment.

The need to hide

One big problem that military medical providers will have in a future fight is hiding from enemy surveillance. Medical equipment puts off signals. An enemy who detects those signals can target medical facilities.  Moreover, the enemy knows that medical personnel are usually close to warfighters; their equipment signals can give away warfighters’ location, and make them vulnerable to attack.

“So masking our signals is another thing that’s going to become more and more important in the future,” Harris said.

The larger technological problem was discussed by Brig. Gen. William Glaser, director of the Synthetic Training Environment Cross-Functional Team, one of the Army Futures Command’s CFTs.

“The proliferation of [unmanned aerial systems] and space assets has made the battlefield very transparent,” he said.  “If you can see them, you can kill them.  They can see us, they can kill us.”

William Pike, science & technology manager at the Army’s Combat Capabilities Development Command, said, “One of the principles that’s being pushed more and more to us is prolonged casualty care.

“With the concept of fighting a near-peer competitor, we may not be able to get a medevac to an injured casualty quickly. So units may have to maintain contact with that casualty for much longer periods of time. Rather than a 30-minute gunfight and medevac within an hour, that ‘Golden Hour,’ now we’ve got to deal with maintaining contact with that casualty for perhaps 72 hours. There’s no official timeline on that.”

However, he said, “Our medics really haven’t been trained to do that. So we’re working on how do we better our simulations to help them get that.”

A local story

This is a local story, all of the above. Around 27% of the U.S.-based Marines are at the North Carolina coast, at bases from Havelock to Jacksonville. Around 11% of the U.S.-based Army lives in Fayetteville, at Fort Liberty. If there is a large-scale conflict, many of 120,000 active-duty, reserve and National Guard war fighters in North Carolina will be deployed, sooner or later. So what they were talking about last week at the Friday Center is the combat medical care that our friends, neighbors and loved ones may need.


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