From Vietnam to Afghanistan, Army aeromedical evacuation – affectionately referred to as DUSTOFF – has been defined by its adaptability to ever-changing battlefield conditions and ingenuity in support of patient outcomes. The early use of helicopters to transport patients during the Korean War was, in and of itself, a remarkable innovation. The integration of medical personnel in those helicopters in Vietnam helped save hundreds of thousands of lives. Advancements in aircraft design and medical equipment, paired with increased training requirements, have resulted in a demonstrably improved survival rate upwards of 90 per cent in Iraq and Afghanistan.

Today is no different. Aeromedical evacuation must continue unabated in what has become a highly competitive, hyperactive and all-domain operating environment. An increased dispersion of friendly forces over greater distances, especially in the Indo-Pacific, has placed emphasis on aerial support for evacuation requirements. The Army medevac enterprise, which includes the United States Army Aeromedical Research Lab (USAARL) and the Medical Evacuation Concepts and Capabilities Division (MECCD), continues to diligently pursue several lines of technological effort, and pursue them well. However, it is ultimately the operational units – where the mission itself occurs – that should lean into new opportunities to test, train and execute medevacs. The quickening pace of change on the battlefield requires that innovation be at least partially derived where it is most sorely needed – the source. This is tactical innovation.

BG Jeffery VanAntwerp, 25ID Deputy Commanding General for Operations, said: “The world is a dangerous place, and our adversaries are constantly working to gain an advantage over us. To stay ahead and deliver on our promise to defend this nation, we must innovate; and in the military – and the Army in particular, our innovation engine is our people. Our people and our partnerships are our asymmetric advantages. So, it is super imperative that we partner our soldiers and their ideas and challenges with the capabilities of our teammates in academia and industry to generate the capabilities needed to stay ahead.”

Perpetual motion

Charlie Company 3rd Battalion 25th Aviation Regiment (Lightning DUSTOFF) and Lightning Labs, the 25th Infantry Division’s (25ID) modernization program, have coordinated for much of the past year to pursue tactically driven innovation as a primary line of effort. In 2022, the Lightning DUSTOFF team partnered with four universities to tackle soldier-identified problem sets, filed three patent applications with five more on the way, is coordinating for the integration of five new technologies into upcoming field exercises, and is working a long-term research partnership with a Stanford University research laboratory. We hope the following look at these noteworthy, yet accessible, opportunities will encourage other operational units to pick up the mantle of tactically driven innovation in a manner that is uniquely their own.

CPT Duncan Miller, C/3-25 Lightning DUSTOFF Operations Officer, spoke about the need for constant change and innovation. “In a time where the future of the battlefield is rapidly changing, it is vital that we lean forward on innovation and creative modernization efforts to medically keep pace with the demands of armed conflict. Our company takes to hear the importance of innovation so it can continue its job safely and successfully.”

Collaboration is key to progress

Engagement with academic institutions across the country, typically as part of engineering capstone courses or the Hacking 4 Defense program, has enabled Lightning DUSTOFF to rapidly explore several tactical and strategic-level challenges of interest. As part of a 25ID Educational Partnership Agreement with the University of Hawaii at Manoa, four undergraduate and graduate student teams tackled medevac-affiliated problems over the course of a semester; those were: optimizing flight scheduling, reducing risk of rotor-collisions in urban helicopter landing zones, increasing safety during SkedCo helicopter hoist operations, and developing an improved fuel sampling device for the UH60M.

Each student team developed a minimal viable prototype and final report, shared with both the medevac company commander and installation commanding general for potential implementation. Similar relationships were fostered with the University of Chicago (precision aerial drops through jungle canopy), Arizona State University (improved patient tracking in the field), and University of Texas at Dallas (optimized medevac aircraft dispatching). Whether a project continues past the end of the semester is a function of the students’ findings, but in any case, their efforts provide an in-depth and informative look at the problem in question for the unit. When interest in a problem or family of problems requires more time or expertise than a student team can necessarily provide, direct engagement with research laboratories paves a way forwards. To wit, Lightning DUSTOFF, and the Stanford Intelligent Systems Laboratory (SISL), are discussing a multi-year research agreement to examine and evaluate MEDEVAC dispatch policies in unique geographies with contested operating environments.

Necessity is the mother of invention, and perhaps the greatest necessity of all is the ability to evacuate our wounded expeditiously

Jeff Hui, UH Manoa Instructor, commented: “The partnership between the 25th Infantry Division, Lightning DUSTOFF, and UH Manoa is invaluable. The students get to work on live problems, with real world outcomes and consequences. In turn, they can bring fresh perspectives to their DoD sponsors, and they are often able to completely reframe the problem. This semester we are working on two helicopter safety problems. In both cases, the students interviewed the relevant crew, but they also studied how the fire departments, the coast guard, and foreign helicopter teams handle safety. This diverse perspective allowed them to introduce new solutions to help mitigate risks for crew landing in unfamiliar territories as well as medevac situations.”

Meaningful change requires not only problem exploration, but solution implementation. There is an abundance of technical talent and enthusiasm for the medevac mission in the private sector and Army DEVCOM communities. Integrating early and often with development efforts has enabled Lightning DUSTOFF to directly support user evaluations and requirements building for various initiatives to include MEDHUB, STARLINK + STUN, the Vita Rescue System, and Project Crimson. All five technologies are being considered for soldier evaluation on the Hawaiian Islands across multiple field exercises in 2024.

MEDHUB is an innovative communication platform that uses existing Blue Force Tracker networks to transmit patient information to hospitals while enroute, effectively reducing errors in patient handover. STARLINK + STUN combines satellite internet and a secure communication layer that operates through frequency hopping. The Vita Rescue System is a ducted fan stability safety system for helicopter hoist operations, and Project Crimson fields UAS capable of executing medical resupply missions across large distances. Lightning DUSTOFF’s mission is to become the proverbial proving ground for technologies that support aeromedical evacuation operations in some shape or fashion.

Promoting creativity and innovation

Great ideas can come from anyone, anywhere, irrespective of rank or position. Soldiers possess the tactical knowledge to identify key opportunities to improve their own mission sets. When encouraged and provided with the necessary resources to do so, they can surprise with their creativity. Intellectual property is often considered the realm of research laboratories, but efforts to encourage Lightning DUSTOFF soldiers to think critically and build unencumbered have resulted in a slew of patent applications, three of which have recently been accepted by Army DEVCOM for acquisition and additional filings. Inventions include a machine-learning-based imaging tool for capturing aircraft avionics data in real-time, several variants of a day heads-up display specifically designed to enhance multiship flying, a nametape and uniform recognition device for ease of installation facility access, several unique designs for enhanced aircraft safety features, and more.

Necessity is the mother of invention, and perhaps the greatest necessity of all is the ability to evacuate our wounded expeditiously. It should therefore be little surprise that tactical innovation runs deep, not just through Lightning.

As author Jon T. Hoffman posits in A History of Innovation: ‘It is the soldiers in the field – those who have to fight – who should play a major role in determining what equipment they need to have and how they will operate.' Doing so might just mean saving lives.