JUANA SUMMERS, HOST:
There have been hundreds of thousands of casualties on both sides of the war in Ukraine, and by some estimates, more than 80% are now caused by drones. The millions of small exploding attack drones have changed the nature of battlefield medicine. Jay Price of member station WUNC says the U.S. military is taking notice.
JAY PRICE, BYLINE: When U.S. troops were wounded in Iraq and Afghanistan, they could put their hopes on something comforting - the Golden Hour, as it's called - the military's policy to try to evacuate the seriously wounded to higher level trauma or surgical care within 60 minutes. Now the nature of modern warfare is putting an end to that.
TARAS: (Through interpreter) We'd be more than happy to have the Golden Hour, but we're more happy sometimes to have a golden day. A person can be without any type of aid, even medical aid, for a week.
PRICE: Speaking through an interpreter, that's Taras, a Ukrainian military surgeon who asked to be identified only by his first name to prevent Russian intelligence from making him a target. He and four other members of a Ukrainian military surgical team were giving a seminar at Fort Bragg. Their audience of more than 400 included U.S. Army medics and others involved with combat casualty care.
TARAS: (Through interpreter) Here are the results of a delayed evacuation.
PRICE: He looked back over his shoulder at a slide showing a soldier with toes blackened by frostbite.
TARAS: (Through interpreter) The enemy is constantly monitoring the sky and the situation and is ready to strike with drones at any time....
(Through interpreter) ...To strike the vehicle that is performing the evacuation.
PRICE: It was 12 days before the man could be brought from the front lines to the forward field unit where Taras was working. By then, he had developed gangrene, and his leg had to be amputated. Another slide showed a wounded soldier with a tourniquet on his thigh to keep him from bleeding to death. Limb injuries are common from attack drones which drop explosive charges or explode after diving into their targets. The standard medical goal is to get tourniquets off within two hours, but this one was in place for seven. And Taras said, sometimes they're left on for days.
The Ukrainians were brought to the U.S. with federal funding by a UNC Chapel Hill military-civilian partnership called Carolina MEdiC. It helps train military medical workers, including special operations medics. Nate Stokes, a former army medic himself, is the UNC program's manager.
NATE STOKES: We have to get better at providing better care closer to the front line for longer periods of time. And then we have to force protect that care because we're not going to be able to get the patients away as often or as quick as we'd like.
PRICE: For years, the U.S. military has been preparing for conflicts with sophisticated adversaries such as China that could create similar challenges for casualty care, especially the difficulty of evacuating wounded troops, keeping them alive longer until they can be, and getting supplies like fresh blood to the front lines.
JENNIFER GURNEY: We have to change our tactics, our procedures, our mindset about how we approach the new battlefield.
PRICE: Colonel Jennifer Gurney, an army surgeon, leads the Pentagon's Joint Trauma System, which is tasked with improving combat casualty care. The wounded will still need help quickly, so in terms of physiology, the Golden Hour hasn't changed.
GURNEY: But the Golden Hour operationally has, and how we optimize our battlefield trauma system to mitigate the risk of prolonged transport, the drone threat - you know, that's what we're working on.
PRICE: She says that that has included consulting with Ukrainians on the lessons they've learned, and a key focus, she said, is shifting more onto front-line healthcare providers such as medics, since they may have to keep patients alive not just for minutes, but hours or days, and that can greatly depend on being able to replace blood.
GURNEY: When you look at the future and how more responsibility and requirements get put onto our pre-hospital providers, you know, things start looking a lot like they did during World War II, when pre-hospital providers were transfusing blood and plasma on the beaches of Normandy.
PRICE: She said, training for that is a huge investment, but one the military is making. A potential front-line source for blood is troops, so they're now being screened as possible donors before deploying, and there's now a walking blood bank training curriculum for all the services. So the military has been working on the key issues, but hurdles remain.
GURNEY: You know, we don't really have enough people, and I do think that Congress and senior leaders need to hear that our military health system and the number of critical wartime specialists that we have is low. And, you know, we're downsizing everywhere, as opposed to saying we need to be having more critical wartime specialties.
PRICE: While drones are creating problems, they also may be part of the solution. The Ukrainians already are using some to deliver supplies and, in some cases, even using armored ground drones to evacuate the wounded. For NPR News, I'm Jay Price at Fort Bragg, North Carolina. Transcript provided by NPR, Copyright NPR.
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