Sensing, Shielding and Protecting the Force

Medical as a Linchpin of CBRN Defense

By MAJ Sarah S. Sanjakdar, Shane A. Kasten, Robert L. von Tersch, COL Kurt E. Schaecher, and LTC Brandon S. Pybus

July 2, 2026 | Pulse of Army Medicine, 2026 E-Edition

Read Time: < 7 mins

Abstract

The future battlefield presents unprecedented challenges, specifically in large-scale combat operations (LSCO) where communications are degraded, evacuation is nearly impossible, and medical facilities are isolated and under fire. The traditional view of military medicine as solely sustainment is outdated. In LSCO, preserving combat power requires integrating medical capabilities into the Protection Warfighting Function. Advances in biotechnology and artificial intelligence allow adversaries to engineer threats designed to circumvent our existing defenses, necessitating a paradigm shift towards far-forward medical intervention. Biological threats, insidious and difficult to attribute, can degrade a unit’s combat effectiveness before the first shot is fired. Ultimately, success on the future battlefield hinges on integrating medical capabilities into all aspects of CBRN operations, viewing medics and field labs as critical components in mission command to keep Soldiers safe and ensure victory.

A Glimpse of the Battlefield

Imagine a brigade, forward deployed into a contested environment. Communications are degraded by electronic warfare. Precision fires make evacuation impossible. Casualty numbers are rising, but Role 2/3 medical facilities are isolated, under fire, running low on blood products, and without reliable power. Medics are working in near-darkness, trying to stabilize hundreds of critical injuries without telemedicine support. Their patients are sick with an undefined illness spreading rapidly through the force, and the medical staff cannot reach back to a laboratory for pathogen identification because the networks are down. Their only option is to rely on whatever diagnostic and treatment capabilities they have on hand, right there, in the fight.

This is not a distant, hypothetical scenario. This could be the reality of large-scale combat operations (LSCO) as soon as 2027. This is the crucible in which survivability, modernization, protection, and deterrence all converge. In this environment, the line between sustainment and protection blurs, and the ability to preserve combat power at the forward edge becomes the defining factor for mission success.

The Unseen Battlefield: Redefining Protection

For decades, the Chemical, Biological, Radiological, and Nuclear (CBRN) community has focused on protecting the force from catastrophic threats. However, the nature of warfare is changing and volatile, forcing us to reconsider what true protection entails. The next conflict will be fought in a contested environment where logistical chains are brittle, air superiority is not guaranteed, evacuation is severely hampered, and the adversary will exploit every domain, including the biological.

Historically, military medicine has been viewed primarily through the lens of the Sustainment Warfighting Function: treating the wounded and managing disease to maintain the force. This paradigm is dangerously outdated. In LSCO, where the ability to replace forces is severely constrained, preventing casualties and rapidly returning Soldiers to duty is not just about sustainment; it is about preserving the combat power necessary to win. Medical capability, therefore, becomes a critical element of the Protection Warfighting Function.

While the use of chemical and biological weapons is not new, the democratization of technology has created a new era of risk. Advances in biotechnology, such as synthetic biology and CRISPR gene editing, combined with artificial intelligence, have lowered the barrier to entry for state and non-state actors to develop novel pathogens and chemical agents. These adversaries can now engineer threats designed to circumvent our existing defenses, surmount diagnostic systems, overwhelm our medical systems, and create chaos on a scale that challenges all six warfighting functions. This new reality demands a paradigm shift, viewing far-forward medical intervention not as a response to failure, but as a proactive layer of defense.

The Biological Threat: A Pacing Challenge

Among the spectrum of CBRN threats, biological agents represent a uniquely complex and compelling challenge for the future battlespace. Unlike a chemical attack, which is often immediate and geographically contained, a biological event can be silent, insidious, and difficult to attribute. A rapidly spreading pathogen, whether naturally occurring or deliberately introduced, can degrade a unit’s combat effectiveness long before the first shot is fired, creating mass casualties and psychological strain while crippling mission command. Contact with such a pathogen will not always be apparent, often taking days to weeks to take effect in a form that is detectable by current diagnostic systems.

The U.S. Army Medical Research and Development Command (USAMRDC), through its subordinate institutes, operates at the forefront of this challenge. The U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID) houses the Department of War’s only Biosafety Level 4 (BSL-4; high-consequence) containment laboratory, a critical national asset for identifying and characterizing novel threats. However, the traditional model of shipping samples from the point of need back to a stateside lab is untenable in LSCO. Commanders will need answers in hours, not weeks. Our current identification timeline is a luxury we can no longer afford.

Forging The Shield: USAMRDC's Role in Far-Forward Defense

To address this critical vulnerability, USAMRDC is pioneering a new generation of medical tools and technologies designed to push protection to the tactical edge, empowering the warfighter to sense, shield, and protect the force in contaminated environments.

Sensing the Threat: Pushing Diagnostics Forward The key to countering a biological threat is speed. Recognizing this, USAMRDC is developing capabilities that transform diagnostics from a rear-echelon function to a point-of-need capability. The Diagnostic Readiness Adaptive Global Operational Network and Mobile Embedded Diagnostic Capability (DRAGON MEDIC) system is a prime example. This portable, off-the-shelf sequencing technology allows medical and CBRN forces to test for pathogens directly at the point of infection. As demonstrated in exercises like African Lion 2025, DRAGON MEDIC gives commanders near-real-time, actionable information to implement force health protection measures, tailor treatments, and preserve their force. This is a revolutionary shift from waiting for lab results to actively shaping the battlefield with immediate biological information.

Complementing this is the work on agnostic threat detection, including epigenetic markers that can help triage bacterial versus viral infections far earlier than traditional methods. By leveraging artificial intelligence and a global network of forward-positioned research institutes, USAMRDC is building a resilient Biosurveillance and Biodeterrence ecosystem that provides early warning and strengthens global health security. The USAMRDC far forward laboratories located in the AFRICOM, CENTCOM/EUCOM, and INDOPACOM areas offer a wide variety of state-of-the-art diagnostic capabilities enabling surveillance of endemic diseases and adaptable biodeterrence against any novel threats. These far-forward capabilities serve as the shield against the muddled picture of known and unknown biothreats, integrating with the overall Protection and Sustainment Warfighter Functions. In addition, far forward in-theater laboratories may be viewed as a system that could be inserted into the overarching medical readiness and treatment assets.

Countering the Attack: Chemical Defense and Advanced Therapeutics

While biological threats pose a complex future challenge, the danger of chemical warfare remains potent. The U.S. Army Medical Research Institute of Chemical Defense (USAMRICD) continues to refine and develop critical countermeasures. The handheld ChemDx device, for instance, enables rapid field detection of chemical warfare agent exposure, allowing commanders to make immediate decisions on treatment and resource allocation. This tool, now in late-stage development, dramatically reduces the burden on the medical response system.

Beyond diagnostics, USAMRICD is advancing the science of chemical casualty care by developing next-generation auto-injectors, a new injectable cyanide antidote, and evaluating FDA-approved drugs to treat refractory seizures caused by nerve agents. By using AI and machine learning to streamline the selection of novel countermeasures for complex injuries, USAMRICD is ensuring that our protective posture keeps pace with the threat.

A Call for Integration: The Future of CBRN is Medical

The scenario that opened this article is a stark reminder of the stakes. In that contested battlespace, advanced armor, superior firepower, and robust networks are not enough if the force is succumbing to an unseen enemy within. Protection in the 21st century requires a holistic, layered defense where medical capability is fully integrated with every other aspect of CBRN operations.

The work being done at USAMRDC provides the tools to make this integration a reality. However, technology alone is not the solution. The CBRN community must embrace a cultural shift. We must see the medic with a diagnostic sequencer as a sensor in the intelligence network. We must view the field laboratory as a critical node for mission command. We must incorporate medical planning and biothreat intelligence into every wargame, exercise, and operational plan.

The future battlefield will be unforgiving. Adversaries will not hesitate to use every weapon at their disposal to degrade our will and our ability to fight. By recognizing that medical is Protection, and by fully integrating the life-saving innovations of our medical research and development enterprise, we can ensure the U.S. Army is prepared to dominate in any environment, safeguarding our Soldiers and securing victory.