The Future of CASEVAC

Uncrewed Ground Vehicles on the Battlefield

By COL Johnny Paul

Article published on: July 1, 2025, in the July 2025 Issue of The Pulse of Army Medicine

Read Time: < 9 mins

Banner source: U.S. Marine Corps by Cpl. Malia Sparks

For much of its history, the U.S. Army has relied on good old-fashioned grit and sweat to evacuate wounded soldiers. Casualty evacuation, or CASEVAC, has always been about using whatever transport was available - whether horses, trucks, or helicopters - to get the injured off the battlefield. However, for the past 20 years, thanks to air superiority in Iraq and Afghanistan, the Army has leaned heavily on MEDEVAC.¹ Dominance in the skies meant medical helicopters could swoop in with a flight medic and their equipment, evacuate casualties quickly, and move them right to a surgeon, even bypassing the traditional roles of care.

As we prepare for large-scale, high-intensity warfare, things are changing. In a future fight against a peer adversary, air superiority is not a given. That means CASEVAC, moving the wounded with whatever assets are at hand, becomes the primary method of evacuation and “has to be part of the new normal.”² And yet, despite its importance, CASEVAC lacks a clear champion in the Army. No single proponent is responsible for its oversight and standardization.³ Recognizing this gap, organizations like the Medical Capability Development and Integration Directorate (CDID), the Fielded Force Integration Directorate (FFID), and the Directorate of Training and Doctrine (DoTD) are stepping up to rewrite doctrine, improve training and exercises, and develop new capabilities to clear the battlefield of casualties efficiently.

Enter uncrewed ground vehicles (UGVs), the next big thing in battlefield CASEVAC. These robotic workhorses aren’t just about high-tech flash; they’re about saving lives. Imagine a forward aid station running low on supplies. The artificial intelligence-enabled forward logistics element detects the need for resupply and immediately dispatches a CASEVAC UGV. Loaded with fresh whole blood and critical medical gear, it navigates rough terrain and active combat zones, reaching wounded soldiers faster than ever before. These aren’t just remote-controlled toys; they’re smart. They will be able to reroute in real-time to avoid threats, relay patient vitals to medics waiting at a safer location, and work alongside aerial drones for better battlefield awareness. Humans will still be in charge, making the tough calls, but these machines are game changers, ensuring that supplies arrive on time and casualties get out alive.

When the battlefield gets too hot for a traditional evacuation, soldiers have always found creative ways to get the wounded out. World War II is a prime example. Medics trudging across the muddy fields of Europe wasn’t exactly an ideal way to move casualties. Instead, they fit casualties into the M3 half-track and other armored vehicles. These weren’t high-tech medical vehicles; they were the same clunky, smoke-belching armored personnel carriers that had just rumbled across the beaches of Normandy.⁴

Fast forward to Vietnam and troops using the M274 mechanical mule to carry casualties out of danger.⁵ It wasn’t elegant, but it worked—just like today’s uncrewed ground vehicles (UGVs), which are taking this old idea and giving it a modern twist. Instead of soldiers braving open terrain to drag a casualty to safety, UGVs can do the job without risking more lives, proving that when it comes to battlefield innovation, necessity really is the mother of invention.

An M274 mechanical mule being used to service a UH-1D helicopter. Source: NARA 111-CCV-490-CC35513. 6 July 1966.

Uncrewed Ground vehicle CASEVAC In Action

Picture a Ukrainian soldier with the 3rd Assault Brigade holding the line when an explosion rocks his position. Shrapnel tears through his leg, and he’s down and unable to move, bleeding heavily. He applies a tourniquet and calls for help. Moments later, an aerial drone hovers over him, rapidly triaging him, automatically dispatching a UGV.

Through the smoke and debris, the robotic vehicle maneuvers its way to the trench, steered remotely by an operator using the aerial drone to provide overwatch. The soldier pulls himself onto the platform, covering himself with a thermal blocking blanket as the UGV reverses course, dodging mines and debris, guided by its aerial partner. Two kilometers later, it reaches the casualty collection point where medics rush to stabilize him in a protected position. The battlefield is chaos, but the system works—he’s made it.

Ukraine's Rapid Innovation In UGVS

By the fall of 2023, Ukrainian forces recognized a major problem - evacuating casualties under constant drone surveillance and long-range artillery was nearly impossible.

The solution? Get creative. Working with tech-savvy enthusiasts, they rapidly fielded UGV prototypes designed to transport supplies forward and bring casualties back. Early versions had limitations, including short range, line-of-sight control, and power constraints, but innovation didn’t stop there.⁶ Less than six months later, Ukrainian forces had refined their designs, integrating drone communication relays, lightweight armor to protect casualties, and the ability to deploy UGVs from larger armored vehicles.⁷

Industry also quickly responded, producing UGVs capable of carrying over a metric ton of weight while resisting electronic warfare attacks like the Tracked Hybrid Modular Infantry System (THeMIS)—a rugged, NATO litter compatible vehicle with a 12 km/h speed and a 2,600-pound payload, perfect for battlefield CASEVAC.⁸

Russia's UGV Efforts

Not to be outdone, Russia has also embraced UGVs for casualty evacuation. In December 2023, the 87th Separate Rifle Regiment deployed a homemade UGV in Avdiivka, a region marked by brutal fighting. This compact, tracked vehicle, remotely operated by Russian forces, had just enough space for a single casualty. It wasn’t fancy, but it worked. Equipped with the Volnorez electronic warfare system, it had a key advantage—jamming enemy drones to improve survivability. As Ukraine advanced its UGV capabilities, Russia followed suit, continuously refining its own designs to match the evolving battlefield.⁹

China's UGV Development

When it comes to battlefield innovation, China isn’t sitting on the sidelines—they’re rolling forward, quite literally, with uncrewed ground vehicles (UGVs), investing over $192 million dollars in 2023 alone.¹⁰ The CS/VP16 is one example; it is a 6x6 amphibious workhorse with modular capabilities, meaning it can swap between hauling supplies, evacuating casualties, or even mounting weapons. It’s all part of China’s big push to integrate automation and AI into military logistics, keeping their troops in the fight while letting the robots do the dangerous work. The takeaway? The future of battlefield CASEVAC is looking more and more like something out of a sci-fi movie—and China is making sure they’re in the director’s chair.

Why UGVS Matter To U.S. Army Medicine

The rapid deployment of UGVs brings us to this crucial point: battlefield casualty evacuation is evolving fast. For the U.S. Army, the lessons are clear. In large-scale combat operations, where the battlefield is fluid, contested, and unpredictable, clearing casualties quickly is critical, not just for survival but for maintaining lethality for the maneuver commander. UGVs directly support the Army Health System imperatives for LSCO: returning soldiers to the fight, clearing the battlefield, and ensuring resupply under contested logistics.

The Strategic Quad for Reconnaissance & Logistics (SQRL) uncrewed ground vehicle (UGV) was tested climbing gravel hills, crawling through the woods and over logs, and navigating an urban terrain site. Source: U.S. Coast Guard photo by Petty Officer 3rd Class Carmen Caver. June 4, 2024.

Training For The Future

So where do we go from here? The U.S. Army is already experimenting with UGVs, like the 10-ton tracked TRX, but success will depend on how well they’re integrated into actual operations.¹¹ That means training—not just for medical personnel but across all warfighting functions. Units receiving these vehicles must develop and rehearse battle drills that incorporate UGVs into sustainment, reconnaissance, and CASEVAC missions. Logisticians, operators, and medics must work together to refine tactics and ensure these machines improve survivability on the battlefield.

However, there’s a catch - developing medical-only UGVs could be a mistake. Single-use platforms may limit operational flexibility and make them vulnerable to targeting. Instead, the Army should focus on multi-role UGVs—vehicles that can switch between supply runs, reconnaissance, and casualty evacuation, just like our forefathers did during WWII and Vietnam. This approach ensures adaptability while maintaining logistical efficiency in dynamic combat environments.

Accelerating Transformation

UGVs aren’t just about reducing casualties—they’re about transforming how we fight and sustain forces in high-intensity warfare. The conflict in Ukraine is providing a glimpse into the future of CASEVAC, one where machines save lives faster than ever before. The Army has a unique opportunity to take these lessons and shape the next generation of battlefield medicine, ensuring that when the fight comes, we’re ready—not just with doctrine, but with technology that works when it matters most.

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