As the Army shifts focus from limited-contingency operations to large-scale combat operations against a peer or near-peer competitor, one continuing theme is the increased lethality of future conflicts. This increase in potential casualties is in stark contrast to recent military experiences beginning with Operation Desert Shield/Storm in 1991. During Operation Iraqi Freedom and Operation Enduring Freedom, casualties were almost exclusively moved via air medical evacuation and commonly received hospital care within one hour. This monograph explores the question of what happens when that "golden-hour" standard is no longer feasible in future battlefields? In the worst month of Operation Iraqi Freedom, the US military suffered 1,432 casualties; future conflicts have the realistic potential of more than 3,600 casualties per day. The purpose of this monograph is to determine current evacuation capacity and shortfalls and identify options for operational level planners on the division and corps staff in the event of a significant mass casualty situation associated with large scale combat operations. Using the lens of theory, history, practice, and doctrine, this monograph looks at the historical foundations of modern evacuation principles from the Napoleonic Wars to present day. Additionally, there are two case studies: Evacuation operations during the Normandy Campaign and an assessment of current US Army evacuation capabilities. Divisions and corps must be ready to use all tools available from the Combat Aviation Brigade, Sustainment Brigade, and Medical Brigade to allow the Brigade Combat Teams to keep focus on winning the close fight.

Approved for public release; distribution is unlimited. The opinions and conclusions expressed herein are those of the student-authors and do not necessarily represent the views of the U.S. Army Command and General Staff College or any other governmental agency. (References to these studies should include the foregoing statement.)