The future of tactical casualty evacuation

During exercise Vigorous Warrior 2026 in Estonia, the future of tactical casualty evacuation was on display on 12 June. The new iMEDCAP system is able to autonomously locate and evacuate casualties using both unmanned aerial vehicles (UAV) and unmanned ground vehicles (UGV). It is even capable of providing treatment during evacuation under the supervision of a medical doctor.

What sounds like science fiction is, in fact, a real project involving 24 partners from nine countries which has been funded by the European Union since 2023 (European Defence Fund, GA No. 101121421). Under the scientific leadership of the Technical University of Munich and medical leadership of the Dept. of Anaesthesiology of the Bundeswehr Central Hospital in Koblenz, numerous innovative organisations have joined forces to contribute their expertise to the project. Experts in drone technology, sensor systems, patient monitoring, data processing, robotics, software development, transport, and, last but not least, medicine are working together to revolutionise the evacuation of wounded soldiers from areas rendered inaccessible by enemy fire or contamination.

Search and rescue

The first step at the point of injury is to locate the casualty and determine whether they are still alive. To achieve this, the iMEDCAP system can deploy a reconnaissance drone equipped with thermal imaging capabilities. Once the casualty has been located, a second drone uses advanced radar technology to establish whether the person is breathing. The radar sensor detects chest movements with millimetre precision, even when the casualty is wearing body armour. The drones used are currently operated remotely by trained personnel. As part of the iMEDCAP system, they provide important information for situation assessment and the planning of the subsequent medical evacuation chain. Based on the data collected, personnel at the Patient Evacuation Coordination Centre (PECC) decide whether to deploy the unmanned ground vehicle equipped with a patient transport module for evacuation.

On route to the casualty 

The THeMIS unmanned ground vehicle (UGV) carries the patient transport module on tracks to the casualty. The iMEDCAP system automatically plans the best route for the UGV, drawing on data collected by the reconnaissance drone. It dynamically adapts this route, taking into account evolving operational conditions without operator intervention. The UGV itself is equipped with an iMEDCAP autonomy kit composed of two LiDAR (Light Detection and Ranging) sensors, an inertial measurement unit (IMU), and state-of-the-art algorithmic solutions in order to autonomously navigate through challenging terrain even in GNSS-denied conditions. Once it reaches the casualty — who has already received initial first aid through self or buddy aid — they are placed on the stretcher inside the transport module and loaded into the unit.

Vital sign monitoring and treatment inside the patient box

The patient transport module is far more than a means of transportation. It is packed with advanced technology and the casualty is covered by a textile laminate offering protection against external influences and weather conditions. Continuous monitoring at a level similar to that provided in clinical settings allows rapid identification of life-threatening changes to trigger appropriate interventions. For that purpose, the box contains a robotic system that enables monitoring of patients and emergency interventions during evacuation. This is done using wearable smart devices or via a robotic arm. For example, a smart tourniquet is available that can be tightened remotely. The robotic arms use a rail system to precisely apply devices such as autoinjectors or a tension pneumothorax relief device at the correct location on the patient’s body. The same rail system is used to move additional sensors, such as a 3D body scanner, CBRN sensors, a diagnostic camera, or an eye-tracking sensor, across the casualty's body. All diagnostic information is compiled and forwarded to a telemedicine specialist. This specialist must initiate or confirm every invasive procedure. Vital signs data is automatically transmitted from the point of injury to medical treatment facilities and command and control locations. On top of that, iMEDCAP uses vital signs data to generate automated triage suggestions, helping prioritise casualty evacuation based on the severity of injuries.

Taking to the air

Once the UGV reaches the casualty collection point (CCP), and provided the casualty remains stable enough for onward transport, the future-oriented transport module is transferred to the “Grille”, an unmanned aerial vehicle (UAV) and flown to the next medical treatment facility. This process is also fully autonomous. The “Grille” has a range of 50 kilometres and can carry payloads of up to 175 kilograms. Powered by an electric motor, it can be converted from its stowed-for-transport configuration to flight-ready status by two soldiers in just 15 minutes.

Conclusion

Russia's war of aggression against Ukraine has demonstrated how increasingly difficult it has become to maintain the so-called "Golden Hour" for casualties near the front line. The iMEDCAP system is designed to be deployed rapidly and as close as possible to the point of injury, enabling continuous patient monitoring and early intervention without unnecessarily tying up or endangering personnel. The employment of autonomous evacuation systems can thus prevent medical personnel, who in the Ukraine war no longer benefit from protected status and have instead become priority targets, from being exposed to danger. Such systems not only reduce the frequency with which medical teams must enter dangerous areas but can also significantly lower the risk of injury to those providing care. It is an approach well worth pursuing further.

Disclaimer: The project iMEDCAP is funded by the European Union (Grant Agreement No. 101121421). Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them.