Private Richard Alexander “Dick” Henderson MM was forever immortalised in the now famous painting by Horace Moore, which shows a stretcher bearer and his donkey during the Gallipoli campaign. Incorrectly attributed as ‘Simpson’ and his donkey, this portrait and the ubiquitous mythology associated with it have nonetheless raised the profile of an unfortunate and very real aspect of human-to-human warfare; clearing casualties from the battlefield.
In todays’ warfare, combat health has become a specialist field, reaching well beyond retrieving the injured. Due to its specialised nature and the long and expensive training pathway for practitioners, the workforce is typically a protected asset.
So what might the combat health effect look like in 2040, enabled by robotic and autonomous systems (RAS or ‘drones’)? What follows are a selection of vignettes of what we consider to be within the art of the possible.
Autonomous medical evacuation
CPL Clarke sighed in relief, after loading the casualty into the SIMP50N UAV-A, he knew his job was done and his patient was in the hands – remotely at least – of the specialists in the Role 3. ‘How did we ever get by without these remote care and telemedicine capabilities?’
Our expectation is that by 2040 operational heavy-lift Vertical Take-off and Lift (VTOL) capability will have been through its first iteration of configuring for Aeromedical Evacuation (AME). This is essential to enable the mass required to clear the battlespace of casualties, currently a significant choke point in the ability of a commander to continue in the fight.
However in 2040, a deployed Unmanned Aerial Vehicle – Ambulance (UAV-A) does more than just move the casualty to a combat health facility, it is a combat health facility. It assesses the casualty situation and may be guided or overseen by a clinical specialist who provides telemedicine from the deployed hospital. Damage control procedures may be undertaken in flight, using robotic surgery – a technical capability even today – with AI controlled anaesthetics. This addresses a key component to battlefield trauma survivability, which is getting the casualty to the right care ASAP.
Security for Casualty Evacuation
‘As SIMP50N rapidly flew to the Role 3, its aerial countermeasure sensors recognised a threat and deployed its layered system of protections, surviving contact and getting to the casualty’
Mobility and Protection is a principle of health support. Providing security for and protecting evacuation assets currently requires a sacrifice of manoeuvre capability. We believe this is another opportunity for RAS in 2040.
The laws of armed conflict aren’t likely to remove the protections that allow free movement of evacuation platforms and establishment of deployed health facilities. Even so, the rogue actor does not abide by internationally accepted norms, such that it is necessary that all deployable medical systems carry RAS aerial counter measures. These include ‘Smart Flares’ that not only deploy when an ordinance is inbound, they proactively and sacrificially seek out the incoming missile.
Another on-asset protection is non-kinetic human counter-measures via drone swarm. When ground-based opponents see a medical RAS approaching and target it, the swarm of mosquito-bots carry a shrill and piercing sound which, in the spirit of manoeuvre warfare, consistently ‘bugs’ the opponent with targets too fast, too many, and too small to be disabled; drawing enemy attention away from the medical scenario and causing discomfort for the antagonist.
Airborne hospital platform
SIMP50N docked at Airborne Hospital 3 (AH3) and the casualty was immediately rushed into theatre; human and machine combined in perfect unity to save a life.
The first two vignettes are feasible based on the trajectory of current technology, so what may be a stretch goal? RAS for combat health in 2040 will see unmanned ‘heavy-lift’ VTOL systems deploy to a casualty automatically when a biological distress anomaly is received at the airborne hospital ship. The casualty will be carefully gathered up and removed from the battlefield. Once back on the hospital ship, an integrated emergency department, operating theatre and intensive care unit of human and machine will coalesce to bring life-saving care.
Additionally the hospital ship will act as a C4ISR platform, casting an encrypted localised next-generation network that envelops the forward operating environment, in which thousands of biological and environmental sensors are collecting and transmitting data. Edge computing provides individual on-asset continuous processing of human performance and human factors, monitoring not just physiological fitness to fight, but psychological and ‘spiritual’ distress.
At all times, commanders and clinicians understand the health of the force.
Medical resupply and telehealth support
CPL Clarke back at the casualty collection point, unloads the resupply drone of blood and other key Class 8 items. He debriefs with the Senior Medical Officer aboard the AH3 and receives the news that his patient is doing well. This immediately puts him at ease, he did a good job, now onto the next one.
Perhaps the simplest application for RAS is Class 8 resupply forward to where it is needed. In 2020 this has already been proven effective. The Zipline on-demand drone delivery system gets blood and other lifesaving ‘just-in-time’ medical products where they are needed, while maintaining cold-chain storage protocols.
Additionally these types of capabilities can be augmented with telehealth capability, such as the Ambulance Drone in the Netherlands that delivers a lifesaving Automated External Defibrillator (AED) for a patient suffering cardiac arrest and a trained medic on the other end of a video hook-up to coach the first responder through it. Or the ‘Little Ripper’ drone which can deliver Artificial Intelligence (A.I.) enabled support to persons struggling in waters offshore.
By 2040 the ADF should have taken this tech that is currently available through COTS solutions and combined them, within a networked battlespace to achieve combat health specific effects.
Across the four short vignettes above we have highlighted potential utility of RAS in the combat health environment from point of injury through to medical logistic resupply. Some are likely achievable pre-2040 and some are stretch goals. But the key takeaway is that the sky is no longer the limit when it comes to looking after the ADF’s most important asset; people.
About the Authors
Paul Grant (@paulgrant) is the interim Chief Health Information Officer for the Australian Defence Force (ADF), contracted through KPMG Australia to establish a sustainable health information office, as principal health analyst in support of the Surgeon General, ADF and to provide health domain data stewardship as the ADF implements its health strategy.
Photo attribution: Horace Moore-Jones (1867/68-1922)