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                    "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\u2019s 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 \u201cGolden Hour\u201d 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 \u201ctyranny of distance\u201d in the region makes implementing the Golden Hour challenging since it accounts for over 50% of the world\u2019s surface, 18th TMC Maj. Gen. E. Darrin Cox told Military Times on Monday during AUSA 2026.\u201cIn 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,\u201d Cox said. \u201cSo what we\u2019re 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.\u201dAs 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 DistributionEven though warfare and medical care are both \u201chuman endeavors,\u201d Cox said, autonomous systems are a part of the future. The systems can help deliver care through managing a patient\u2019s vital signs, triaging patients, delivering blood or monitoring a patient so a provider on the ground can take care of others.\u201cWe\u2019re experimenting with autonomous delivery of blood and other Class A medical supplies,\u201d Cox said. \u201cThey\u2019re experimenting in Ukraine with autonomous evacuation of injured folks off the battlefield, so there\u2019s a lot of work in that area.\u201d\u201cNot 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\u2019re in,\u201d 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.\u201cWe were able to successfully bring blood from Japan to Australia last year during the Talisman Saber exercise,\u201d Cox said. \u201cThat demonstrates developing those networks where we can move blood from potential storage locations to the points of need as different operations would surge.\u201dIn critically injured trauma patients, blood and its components are necessary at the point of injury, Cox said, whether it\u2019s 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\u2019s and allow for the U.S. to use blood procured locally on U.S. casualties.\u201cWe\u2019re also with our partners in the Philippines,\u201d 18th Command Sgt. Maj. Jennifer Francis told Military Times. \u201cWe ensure that we share what we\u2019re doing in the field, so that we can enhance their own capability. So we\u2019ve made huge strides there in the Philippines.\u201dTraining on New ConceptsEnsuring that the combat medics are familiar with these concepts and innovations ahead of a conflict takes training on \u201canything and everything\u201d related to the options, she said.The Army has multiple \u201cechelons of care,\u201d but it all begins with basic self-care training and the more advanced Combat Lifesaver training before some reach the combat medic level.\u201cOnce you get to tactical combat casualty care, that\u2019s a little bit more robust,\u201d Francis said. \u201cThey have the basic application of tourniquet[s], and then going through some of the head-to-toe trauma.\u201dIn 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."
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