Blood supplies, autonomous systems shape US Army’s Indo-Pacific combat care plans

U.S. Army combat medical teams are experimenting with ways to prolong care in preparation for a possible fight in the Indo-Pacific theater , where vast distances and limited evacuation platforms affect a patient’s timely access to surgical care.

A fight in the Indo-Pacific would look different from past wars, such as Iraq and Afghanistan, making maintaining the “Golden Hour” standard difficult.

Instead of requiring medical care and evacuation to a surgical facility to occur within 60 minutes of a traumatic combat injury, the 18th Theater Medical Command, based at Fort Shafter, Hawaii, is rethinking the term to mean bringing advanced care to the point of injury.

The “tyranny of distance” in the region makes implementing the Golden Hour challenging since it accounts for over 50% of the world’s surface, 18th TMC Maj. Gen. E. Darrin Cox told Military Times on Monday during AUSA 2026 .

“In the past, what [the Golden Hour] has meant is getting someone from the battlefield to a [medical] facility in that 60 minutes, so here in the Pacific, that may not be possible,” Cox said. “So what we’re talking about when we say Golden Hour is the pathophysiology of injury and bringing care to that patient in that time before pathology becomes deranged.”

As autonomous systems become increasingly relevant in militaries across the globe, the command is experimenting with ways it can assist patients with prolonged care at the point of injury, while keeping in mind the possibility of an attack.

Blood Storage and Distribution

Even though warfare and medical care are both “human endeavors,” Cox said, autonomous systems are a part of the future. The systems can help deliver care through managing a patient’s vital signs, triaging patients, delivering blood or monitoring a patient so a provider on the ground can take care of others.

“We’re experimenting with autonomous delivery of blood and other Class A medical supplies,” Cox said. “They’re experimenting in Ukraine with autonomous evacuation of injured folks off the battlefield, so there’s a lot of work in that area.”

“Not everything in Ukraine is directly applicable to the maritime environment you find yourself in the Pacific, but we take what we observe, we learn those lessons, and then we try to apply it to the operating environment that we’re in,” he continued.

Alongside experimenting with autonomous systems, the 18th TMC is working with joint partners and allies to ensure access to blood distribution facilities, storing it west of the International Date Line.

“We were able to successfully bring blood from Japan to Australia last year during the Talisman Saber exercise ,” Cox said. “That demonstrates developing those networks where we can move blood from potential storage locations to the points of need as different operations would surge.”

In critically injured trauma patients, blood and its components are necessary at the point of injury, Cox said, whether it’s blood provided by other countries for American use or stored ahead of time in a facility.

The best option is fresh whole blood, but that requires collection on scene, which has a limited supply, and refrigerated fresh blood has a limited lifespan. Another option is frozen products, both blood and plasma, but they need to be thawed with specialized equipment.

Cox highlighted that many partners in the Pacific, like the Philippines, are developing their own armed forces blood program where they have a stockpile of blood in military hospitals and accept donations. America is looking to have blood-sharing agreements with some joint partners, like Australia and Japan, which have a similar testing protocol to America’s and allow for the U.S. to use blood procured locally on U.S. casualties.

“We’re also with our partners in the Philippines,” 18th Command Sgt. Maj. Jennifer Francis told Military Times. “We ensure that we share what we’re doing in the field, so that we can enhance their own capability. So we’ve made huge strides there in the Philippines.”

Training on New Concepts

Ensuring that the combat medics are familiar with these concepts and innovations ahead of a conflict takes training on “anything and everything” related to the options, she said.

The Army has multiple “echelons of care,” but it all begins with basic self-care training and the more advanced Combat Lifesaver training before some reach the combat medic level.

“Once you get to tactical combat casualty care, that’s a little bit more robust,” Francis said. “They have the basic application of tourniquet[s], and then going through some of the head-to-toe trauma.”

In the Indo-Pacific theater, the overall medical care is not significantly different, unlike the environment, prompting the 18th TMC to continue to innovate through technology and training to keep trust with soldiers.

The 18th utilizes an 8th Forward Resuscitative and Surgical Detachment, or FRSD, which is a 20-person team that can execute surgery in the theater, Cox said, and the command is tinkering with different configurations of tents versus fixed mobile containers that can be taken on or off an Army watercraft, land or underground.

At the May 2026 Land Forces of the Pacific Symposium and Exposition in Hawaii, the 8th FRSD demonstrated a care simulation on a cut suit which modeled a surgical unit aboard a vessel.

Boats or ships should transport patients because evacuating by air en masse would be less likely, Army medics told Military Times at the event. The team began using autonomous small multipurpose equipment transports, or SMETs, uncrewed, eight-wheeled robotic combat vehicles guided with a remote control, to carry patients.

Cristina Stassis is a reporter covering stories surrounding the defense industry, national security, military/veteran affairs and more. She previously worked as an editorial fellow for Defense News in 2024 where she assisted the newsroom in breaking news across Sightline Media Group.

美国陆军战斗医疗队正在试验延长治疗时间的方法，为可能发生的印太战区战斗做准备。在印太战区，广阔的距离和有限的撤离平台会影响病人及时获得外科手术治疗。

印太地区的战争与伊拉克和阿富汗等以往的战争截然不同，因此很难维持“黄金一小时”的标准。

驻扎在夏威夷沙夫特堡的第 18 战区医疗司令部正在重新思考“创伤性战斗伤”这一术语，不再要求在遭受创伤性战斗伤后 60 分钟内进行医疗救治和送往外科手术机构，而是将其定义为将高级护理带到受伤地点。

18th TMC少将E Darrin Cox周一在AUSA 2026期间告诉《军事时报》，该地区的“距离暴政”使得实施“黄金一小时”计划充满挑战，因为它占世界表面积的50%以上。

“过去，‘黄金一小时’指的是在60分钟内将伤员从战场送往医疗机构，但在太平洋地区，这可能行不通，”考克斯说。“所以我们所说的‘黄金一小时’，指的是伤情的病理生理过程，以及在病理恶化之前为伤员提供救治。”

随着自主系统在全球军队中变得越来越重要，指挥部正在试验如何帮助伤员在受伤地点接受长期护理，同时考虑到遭受攻击的可能性。

血液储存和分配

考克斯表示，尽管战争和医疗都是“人类活动”，但自主系统是未来发展的一部分。这些系统可以通过管理患者的生命体征、进行患者分诊、输血或监测患者病情，从而帮助提供医疗服务，使现场医护人员能够照顾其他患者。

考克斯说：“我们正在试验血液和其他A级医疗用品的自主运送。乌克兰方面正在试验从战场上自主撤离伤员，所以这方面有很多工作要做。”

“乌克兰的一切经验并非都能直接应用于太平洋的海洋环境，但我们会观察并吸取教训，然后尝试将其应用到我们所处的作业环境中，”他继续说道。

除了试验自主系统外，第 18 战术医疗队还与联合伙伴和盟友合作，确保能够获得血液分发设施，并将血液储存在国际日期变更线以西。

“去年在‘护身军刀’演习期间，我们成功地将血液从日本运送到澳大利亚，”考克斯说。“这表明，建立这样的网络，使我们能够在各种行动出现紧急情况时，将血液从潜在的储存地点运送到需要的地方，是行之有效的。”

考克斯说，对于重伤创伤患者来说，受伤现场需要血液及其成分，无论是其他国家提供的供美国使用的血液，还是事先储存在医疗机构中的血液。

最佳选择是新鲜全血，但这需要在现场采集，而现场采集的血液供应有限；冷藏新鲜血液的保存期也有限。另一种选择是冷冻血液制品，包括血液和血浆，但需要使用专用设备解冻。

考克斯强调，太平洋地区的许多伙伴国，例如菲律宾，正在建立自己的军队血液计划，在军医院储备血液并接受捐献。美国正寻求与一些伙伴国（例如澳大利亚和日本）达成血液共享协议，这些国家拥有与美国类似的检测流程，允许美国将当地采集的血液用于美国伤员的救治。

“我们还与我们在菲律宾的合作伙伴保持联系，”第18司令部军士长詹妮弗·弗朗西斯告诉《军事时报》，“我们确保分享我们在前线的工作成果，以便提升他们自身的能力。因此，我们在菲律宾取得了巨大的进步。”

新概念培训

她表示，要确保战斗医护人员在冲突爆发前熟悉这些概念和创新，就需要对与这些选项相关的“一切”进行培训。

军队有多个“护理层级”，但一切都始于基本的自我护理训练和更高级的战斗救生员训练，之后一些人才能达到战斗医护兵的水平。

弗朗西斯说：“一旦进入战术战斗伤亡救护阶段，那就更全面了。他们掌握了止血带的基本应用，然后还会处理一些从头到脚的创伤。”

在印太战区，整体医疗水平与环境相比并没有显著差异，这促使第 18 战地医疗队继续通过技术和训练进行创新，以保持士兵的信任。

考克斯说，第 18 部队利用第 8 前沿复苏和外科分遣队（FRSD），这是一个 20 人的团队，可以在战区执行手术。该指挥部正在尝试不同的帐篷配置，而不是固定的移动集装箱，这些集装箱可以从陆军水上舰艇、陆地或地下装卸。

2026 年 5 月在夏威夷举行的太平洋陆军研讨会暨展览会上，第 8 远征救护服务队 (8th FRSD) 展示了在模拟舰艇外科手术单元的切割服上进行的护理模拟。

陆军医务人员在活动现场告诉《军事时报》，应该用船只运送病人，因为大规模空中撤离的可能性较小。该团队开始使用自主式小型多用途装备运输车（SMET），这是一种无人驾驶的八轮机器人作战车辆，由遥控器控制，用于运送病人。

克里斯蒂娜·斯塔西斯是一位记者，主要报道国防工业、国家安全、军事/退伍军人事务等领域的新闻。她曾于2024年在《防务新闻》担任编辑助理，协助Sightline媒体集团旗下新闻编辑室处理突发新闻。