This podcast contends that the US Army should coordinate agile and expeditious Joint medical evacuation operations in the Indo-Pacific and develop novel capabilities to do so effectively. Keywords: medical evacuation, maritime operations, novel capability, World War II, Joint health service Host (Stephanie Crider) You are listening to Decisive Point. The views and opinions expressed in this podcast are those of the guests and are not necessarily those of the Department of the Army, the US Army War College, or any other agency of the US government. I’m talking with Mahdi Al-Husseini, Samuel J. Diehl, and Samuel L. Fricks today, authors of “Bridging Sky and Sea: Joint Strategies for Medical Evacuation in the Indo-Pacific,” which was published in the Spring 2025 issue of Parameters. Al-Husseini was previously the director of the Medical Evacuation Doctrine Course for the Department of Aviation Medicine. He’s now a PhD student at Stanford University in aeronautics and astronautics, with a follow-on as an experimental test pilot. Diehl was the commander of the 3rd Battalion, 25th Aviation Regiment, and following the US Army War College, where he’s currently a student, he will be assigned as Medical Command G5. Fricks serves as the chief of the Medical Evacuation Concepts and Capabilities Division and is responsible for air and ground evacuation modernization. Welcome to Decisive Point, gentlemen. Samuel L. Fricks Thank you. Samuel J. Diehl Thanks. It’s great to be here. Host Why did you write this article, and why is now the time? Fricks The character of war is changing rapidly. Observations from the battlefield in Ukraine have shown that traditional ways of doing things don’t work, necessarily, when you’re under constant observation. Why we wrote the article was, we have to change the way that we do medical evacuation, specifically—or especially—in the Indo-Pacific, in order to really have a chance. Mahdi Al-Husseini One of the ways we open up the article is by saying what is old is new again, and what is new changes everything, and I think that’s especially true in the context of medical evacuation in the Indo-Pacific. When we look back at World War II, which I would argue is one of the best case studies that we have, in terms of this particular problem set and this particular theater, a lot of what was true and relevant then continues to be true and relevant now. And, we see that on the tactical level. We see that on the strategic level. We see that across echelons and across mission sets. And yet, despite that, I think so many things as, no doubt, Colonel Diehl and Colonel Fricks will allude to in a little bit, so many ways that our enemy operates has changed, right? And, those things need to be considered as well. And so, what we’re dealing with here is, I think, a very gnarly problem, and one that affects the lives of servicemembers. You know, I do think we’re at something of a junction point, and we need to be able to ensure we have the resources, the doctrine, the training necessary to ensure that when that next conflict comes, we are prepared for it. And, that’s another reason we really wanted to bring this article out to a larger community. Samuel J. Diehl And, I’ll give credit to Mahdi where it’s due that when I took command in May of 2023, he was already working towards a degree of experimentation and integration—both with joint partners, as well as with the Army Theater Sustainment Command—about how we tackle this problem, sort of at the micro/tactical level, more effectively from an integration standpoint, but then also how do we integrate and test new technologies? As a career MEDEVAC [medical evacuation] pilot, I thought what he was doing was really exceptional, but I also understood institutionally, you know, where Colonel Fricks is coming from [in saying] that we have, you know, something of an obligation to get this information out there. There’s a host of articles out now bemoaning the expectation that there is no more golden hour, that casualties will likely increase in a different conflict in the future, but we haven’t really taken many steps concretely to address that problem. It’s known but then, also, there are elements, where I’ve discussed with Mahdi, where we evolved in World War II, but our organizations—our authorities, in some cases—haven’t necessarily evolved to catch up to some of the capabilities that we currently have. So, capturing how do you exercise C2 [command and control] of these assets across joint and combined organizations is incredibly important. I think it’s important, probably, to just start with why is medical evacuation important? We probably lose some degree of understanding—because we’ve taken it for granted in the last 25 years—that there are strategic implications for how we preserve our combat strength. And, we’ve done it historically very well, but it has implications for how we fight, right—how commanders can exercise audacity, how they can prevent culmination, and then how our individual soldiers see themselves on the battlefield. The risk that they’re willing to take reflects, right, their understanding and appreciation for how their medical system is going to take care of them. Host Tell me a little bit more about what you all are advocating for, not only in your article, but if there’s anything beyond that that you want to touch on, I’d love to hear it. Al-Husseini One of the luxuries I have here is having folks like Colonel Fricks and Colonel Diehl, who are, legitimately, I would argue, titans of the MEDEVAC enterprise. So, I think all of us will have something of a different perspective. You know, I’ll kind of broach this from the tactical level—as somebody who was formerly, and very recently, a platoon leader and an operations officer in a MEDEVAC company—one of the challenges that we ask ourselves, we talk a lot about LSCO [large-scale combat operations], right, is to what extent do I have control, you know, in my foxhole and in my organization with the kind of impact that we want to have, given the challenges that we discuss in the article. When we talk about, you know, how do we enable medical evacuation to be effective over long distances, where the patient numbers are far beyond anything we’ve seen potentially, again, since World War II, where we have an enemy threat that is dynamic, that is evolving, whose weapon systems while, maybe known to us, we haven’t necessarily faced directly? And those are tough, right? Especially, I’ll tell you, as a captain, as a platoon leader, as a section leader in a MEDEVAC company, I don’t have control over the acquisitions pipeline, right? So, I don’t have control over materiel, but what I do have an impact on is training. And, one thing we try to advocate for in the article that is true for MEDEVAC, but also extends to other missions, is, you know, we can think critically about capability. And [that is] one of the things that the JCIDS [Joint Capabilities Integration and Development System] does very well. There’s a formal definition in there that kind of talks about capability in terms of integrating ways and means and means and ways. That’s something we also talk about in the article. And, one of the things we advocate for is—even on the tactical level—to kind of think about, given, you know, the materiel that we do have, right, given the equipment that we have, given the force structure that we currently have, how can we think creatively about challenging problems and find ways to make a difference and to demonstrate potentially new capabilities given the things we already have? So, to be a little bit more specific, you know, one of the things we talk about in the article, for example, is an exercise that we ran at the 25th Infantry Division, which we call MEDEVAC Projects Week. In that effort, what we effectively did was we demonstrated this concept of a maritime exchange point where we were able to use an Army watercraft to bridge the transport of a pace ship between two aircraft—hypothetically coming from different islands. We had an existing setup in terms of what our force structure looks like. We know, you know, our aircraft have certain capabilities. We know we have a relationship with our watercraft teams—in this case down in Honolulu. How do we bring them together? How do we network, you know, all these various pieces of the puzzle effectively and in ways that can make a difference? And so, one thing that we certainly want to bring to bear is this idea that even on the tactical level, there are ways to experiment and to consider how we use the things that sometimes we take for granted, but how do we use our existing units or our existing equipment to do new things in a way, in this case, in the case of MEDEVAC, impacts real-world patients in real-world conflicts? Fricks Yeah, just to build off what Mahdi indicated there, we also have to embrace, kind of, the new technologies, right, especially when it comes to autonomous systems. We’ve all seen the directives that are coming out, you know, unleashing drone dominance and such, and medical needs to be a part of that. The problem, though, is that we really lack the policy that addresses moving casualties on an autonomous system. You know, there’s an ethical piece to it and there’s a policy piece. But, I think we would agree that we’d like to use it just like you would have used, you know, the helicopter in Korea. Remember, if you’ve ever seen MASH, they put the casualties on the outside of the aircraft, right, with no en route carrier. If we did that today, it would be considered w...
