LSCO in USINDOPACOM Theater: A Forward Resuscitative Surgical Detachment Deployment

By CPT Nathan D. Brindley

June 10, 2026 | Pulse of Army Medicine, 2026 E-Edition

Read Time: < 7 mins

ABSTRACT

With tensions rising in the Indo-Pacific and facing peer or near-peer adversaries, the U.S. Army is severely lacking in its ability to deliver expeditionary medical assets in the event of an amphibious landing. This article presents possible solutions to two areas of concern. The first concern is the delivery of forward surgical assets onto contested islands while lacking air superiority. The second is the evacuation of those casualties from shore back to the naval ships providing landing support. The premise of this proposal is that the development and pending implementation of the new USMC ACV (Amphibious Combat Vehicle) will result in a surplus of the previously used AAVs (Amphibious Assault Vehicles). Both factors would be essential in the event of LSCO in the Indo-Pacific theater.

Amphibious Assault Vehicles have been a cornerstone of U.S. capability since WWII, giving us a true operational advantage by moving troops and supplies from ship to shore. As AAVs phase out and the ACV comes online, we need to ensure our operational advantage is still effective and employ the platform to enhance our medical capabilities and patient evacuation capacity. The operational environment in INDOPACOM is just as challenging today to navigate and maneuver as it was 80 plus years ago and strategically using the ACVs will increase our success in medical operations.

PROVIDING SURGICAL CARE

Medical capabilities may be enhanced through a few modifications to our AAVs. In fact, these vehicles have significant enough interior dimensions to support a surgical suite. Removing the internal seating will create a large open space in the interior of the vehicle. That space may then be transformed into a surgical suite, allowing surgeons to perform damage control surgery under the protection of armor while maintaining mobility and further reducing the time needed to jump and begin surgery once the jump is complete. The concept of using non-conventional medical vehicles for surgical suites is not unprecedented. In fact, it is currently employed by elite medical units, such as the Joint Medical Unit (JMU) and other non-governmental agencies operating around the world. There are numerous instances of these organizations using the CV-22 Osprey as a surgical suite, a platform with very similar cabin space. Additionally, the vehicle’s engine should provide the surgical suite with sufficient power to operate critical medical equipment without the need for an external generator.

IMPLEMENTATION

The proposed implementation of this idea would involve assigning four vehicles to an FRSD. Two of the vehicles would be utilized as surgical suites, and two AAVs would operate as a command-and-control vehicle and makeshift ICU with the ability to transport four litter patients or six ambulatory patients, or a combination of 2 litter/3 ambulatory patients in the event of relocation necessity before evacuating any post-operative patients. To facilitate the transportation of patients, some minor modifications to the vehicle would be required before full implementation. These modifications would include creating a litter-mounting system along the interior of the vehicle, similar to the one already used in an M113. The ideal formation for this implementation would be to position the four vehicles in a box, leaving sufficient space in the center to accommodate the placement of the ATLS section of the FRSD, as shown in Figure 1. By having the vehicles in such a formation, it would provide the maximum possible cover for medical personnel, thereby reducing the risk of additional casualties and providing quick access to surgical suites if needed. Additionally, the presence of four AAVs would better facilitate split operations if the tactical situation required it.

MEDICAL EVACUATION

With only minor modifications, AAVs can facilitate the transportation of four litter patients or six ambulatory patients or a combination of two litter/ three ambulatory patients per AAV. The number of patients the vehicle could transport may be determined by comparing its interior dimensions to those of an M113. The U.S Army could theoretically take the surplus of the USMC’s AAVs and retrofit them to allow for transportation of the wounded from a contested beach to a naval vessel where they could be stabilized aboard the relative safety of the ship off the coast. In addition to the armor that the AAVs provide, the tracked nature of the vehicle facilitates the ability to move inland over suboptimal terrain, allowing for the faster evacuation of patients further inland who are unable to be reached by conventional wheeled vehicles. The idea of utilizing amphibious landing craft as a casualty evacuation (CASEVAC) platform is not without precedent as it was successfully implemented during the Second World War (Snyder 1945).

SHORTFALLS/ POSSIBLE SOLUTIONS

One of the largest constraints is that the Army currently has no AAVs in its inventory, and it would require the full implementation of the new ACV before they can be repurposed. Secondly, the height of the vehicle is a concern, as it is only 5.5 feet. This is a suboptimal height for most surgeons to operate for extended periods. This issue can be mitigated by opening the top hatch if the tactical situation allows. This positioning of the surgeon would increase the average length of surgery due to the limited views the surgeon would have. In fact, it could increase the average case length by 15-30 minutes. The increase in case length is based on interviews with general surgeons with experience in operating in confined spaces, such as those described above. The confined space would also limit the surgical technician’s ability to “turn over” the surgical suite in preparation for the next case, reducing the total number of cases that can be performed. However, the benefit of having surgical assets assist in an amphibious operation far outweighs the loss of total case hours related to the size of the space. The third significant constraint is the addition of 12 personnel to operate the vehicles as well as the further training of soldiers to operate and maintain AAVs. To mitigate this, the Army could use USMC personnel to operate the vehicle until a formal program can be developed. Additionally, if the armaments were to remain in place on the vehicles, it would facilitate the FRSDs’ ability to supply their own operational security through the employment of the already equipped weapon systems. This would reduce the dependence of other combatant commanders on providing additional security. Finally, operating in such confined mobile spaces is foreign to most, except for those in elite medical units. This lack of experience would lead to significant shortcomings. One possible solution to this would be to place an FRSD among the various MEUs (Marine Expeditionary Units) that are currently underway. This would serve a few major functions. First, it would expose Army personnel to amphibious operations and allow for the development of a formal doctrine. Secondly, it would enable the training of joint force operations, particularly when conducting ship-to-shore operations. Finally, it would allow the units to practice operating in confined spaces and identify additional shortfalls that cannot be foreseen at present.

RECOMMENDATIONS

If this proposal is adopted, the recommendation would be to acquire two AAV platoons, a total of 8 AAVs, and to begin employing one FRSD per deployment of the MEUs out of 1 Marine Expeditionary Force (MEF). This would enable Army medicine to refine the doctrine further and identify additional shortcomings that may not have been foreseen. Additionally, it would demonstrate proof of concept and develop the doctrine necessary to scale up in the event of LSCO in the Indo-Pacific.

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