US military looks underground to protect wounded troops as drones force changes to wartime medicine

Editor’s Note: This story consists of photographs and descriptions of military medical simulations that could be disturbing for some readers.

“What happened to my leg?”

The younger soldier seemed down to gauze soaked in pretend blood wrapped round his knee, the place his left leg now ended. His eyes squeezed shut as he threw his head again and groaned.

A bunch of US troopers leaned over him, calling out updates: blood strain, accidents, standing. He’d been rushed from the entrance strains, helmet nonetheless strapped beneath his chin as he laid on a military stretcher.

The medical personnel had been instructed the soldier, and his dark-furred animatronic working canine that laid just a few ft away, lacking a part of his personal left limb and whining, had been injured in an improvised explosive system blast. After a fast triage each the person and the pup had been lifted on stretchers and rushed into an empty constructing close by that had change into a makeshift emergency room with small groups swarming the wounded. Less than an hour later, after being sedated and stabilized, they had been loaded right into a Humvee barreling again from the entrance strains to a area hospital arrange underground.

The hope was that the subterranean medical location would protect them from enemy drones or missiles, threats which have change into ubiquitous on the trendy battlefield. Nearly half of the American casualties within the battle with Iran have been the result of drone attacks, and within the Ukraine battle, Russian forces have repeatedly targeted medics, suggesting medical personnel will not be deemed off-limits by a possible adversary.

Without options to protect the wounded and people caring for them, future wars may see huge will increase in casualties and claw again many years of medical progress which have saved numerous lives.

Just hours prior to the scene of medical triage, the wounded soldier had been in a tent down the highway at Fort Hood, Texas, getting Hollywood-like make-up utilized to his leg, which was bent on the knee to give the impression of an amputation.

On a whiteboard close to the again of the tent, a casualty schedule of types was crammed out with dry-erase marker. “DRONE STRIKE” was written in blue on the high of the board, scheduled for 4:00pm that day. On the far left, varied accidents had been jotted out: “Burns,” “blunt chest,” “eye injury.”

The elaborate simulation was a key a part of the first Medical Brigade’s expansive coaching train final month aimed toward enveloping troops in a sensible situation to assist troopers put together for future wars, and even wars already began. Everything from helicopters to pretend bodily organs doused in blood had been included to strive to put together troopers for what they could face on the battlefield. The train held on Fort Hood from March 23 to April 1 — referred to as Operation Silver Lightning — sought to follow new methods largely pulled from watching current conflicts.

During energetic operations within the first six weeks of the Iran battle, US medical personnel had been moved round repeatedly to protect them and their operations, a supply acquainted with the state of affairs instructed NCS. And the common drone and missile assaults made it troublesome for US forces to conduct what would in any other case be routine transfers of wounded personnel to Landstuhl Regional Medical Center in Germany.

In prior campaigns, the military had realized that speedy medical care and evacuation from the entrance strains, treating troops within the “golden hour” after they maintain accidents, saves lives. The wars in Iraq and Afghanistan included the event of sprawling area hospitals fed by prepared evacuation in operations the place the US had close to whole management of the skies. That equipment saved numerous service members, however with cheap drones likely a fixture of future wars and up to date proof that medical personnel may be focused, the Army is being pressured to think about new methods of offering speedy medical care.

“We’re not going to enjoy the same advantages that we did in the Middle East, and primarily in Iraq and Afghanistan,” Lt. Gen. (Ret.) Paul Friedrichs, a physician and former Joint Staff Surgeon, instructed NCS.

Col. Werner Barden, commander of the first Medical Brigade which carried out the train at Fort Hood, instructed NCS that watching the conflicts in Ukraine and Iran has confirmed military fight medicine has to adapt. The footprint have to be smaller and extra dispersed — no extra sprawling area hospitals. And troopers and leaders alike can have to work to decrease their electromagnetic and thermal signatures, the sort of tell-tale markers radiated by machines and our bodies that militaries can simply observe.

“In today’s world, it takes one person, one drone, to create an event…that could disrupt the way we do things,” Barden instructed NCS. “So — hide in plain sight.”

At the guts of the underground area hospital arrange for the train was a group finest described as the real-life model of the favored Seventies tv present, MASH.

The 555th Forward Resuscitative Surgical Detachment was operating the emergency and working rooms, which weren’t a lot rooms however areas mere ft away from each other in a tunnel filled with hospital beds and surgical gear.

Lt. Col. James Graggs, commander of the 555th and an emergency room physician, hovered across the working desk the place function enjoying volunteers lay beneath a small tub of “organs” that had been laid on high of them, giving the docs simulated inside accidents to kind by means of.

While troopers clad in surgical gear and scrub caps labored on one affected person present process “surgery,” Graggs, with a handgun holstered on his hip, walked over with a big syringe stuffed with pink liquid, spraying it into the bathtub to simulate inside bleeding.

“He’s bleeding out!” Graggs yelled, stepping again as the docs swarmed.

The 555th, nicknamed the “Triple Nickel,” is likely one of the Army’s surgical detachment groups that deploy alongside different models and brings intensive surgical and trauma capabilities nearer the entrance strains in a battle.

Unlike the wars in Iraq and Afghanistan, the place US plane may sometimes fly anyplace with out substantial threat, future conflicts will virtually actually see threats to planes and helicopters that make it troublesome to rapidly evacuate wounded troops. Bringing the life-saving functionality of the 555th and models prefer it as shut to the entrance strains as attainable might be the distinction between life and loss of life.

Doing that, nevertheless, may additionally imply making a goal for an enemy and additional exposing medical troops to threats of fixed drone assaults. One answer the Army is attempting is utilizing makeshift underground areas just like the one employed for this train.

“The new assumption moving forward is, it’s possible to be in contact with enemy forces regardless of your position if you’re deployed,” George Barros, director of innovation and open-source tradecraft on the Institute for the Study of War instructed NCS. “There’s not going to be a permanently safe ‘Green Zone’ like in the GWOT (Global War on Terror) days, because the adversary’s ability to reach out persistently has grown substantially.”

The evolution of the drone menace was displayed early within the battle between the US and Iran, when an Iranian drone struck a tactical operations heart in Kuwait and killed six US troopers. While senior Pentagon officers mentioned on the time that the constructing was fortified, a supply acquainted with the location mentioned it was solely surrounded by concrete obstacles that would offer safety from automotive bombs however had nothing to defend it from drones or missiles.

Protecting medical forces and the troops they’re treating requires not solely in some cases going underground but in addition decreasing their digital signatures — a problem in an setting the place service members want to use issues like X-ray and CAT scans to deal with sufferers. Being underground helps cut back that signature, however it’s nonetheless one thing the Army is working to enhance.

Soldiers are additionally taking a cue from how Ukrainian forces have tried to counter Russian assaults.

Between the beginning of the battle in Ukraine in 2022 to April 2025, there have been practically 2,000 assaults on Ukrainian well being care infrastructure, and 428 assaults on medical evacuation autos, the World Health Organization estimated according to a report released by the Army in 2025.

It’s “a documented fact,” Barros mentioned, that Russia “does not play by the same rules or have the same level of respect for laws of armed conflict.” Marking emergency medical autos with pink crosses, for instance, solely attracts extra consideration and will make these personnel a goal — as may erecting giant medical services within the area.

“We have gotten very comfortable in the last 10 to 20 years sitting at these huge hospitals … But what we discovered in the most current conflicts, over the last five to seven years, is we’re a big target,” Barden mentioned. In Ukraine and in Iran, he mentioned, “we’ve realized that the enemy is targeting those nodes.”

Ukrainian medical models have been “working out of basements of building and stuff that one, provide a layer of protection, but two, kind of mask who they are and what they’re doing,” Barden defined.

“So,” he mentioned, “we are doing the same thing.”

Pushing some area hospital capabilities underground is a technique to deal with issues about drones and missiles — however it comes with its personal challenges. Some attainable options examined out by the troops at Fort Hood had been fairly easy: troopers rode bikes down the lengthy tunnel between the therapy space underground and the place casualties had been being delivered outdoors each to save time and area as one thing like a golf cart may take up an excessive amount of precious room within the tunnel. Barden defined that the unit pulled out an outdated area phone that might be used to higher talk as there was no mobile or satellite tv for pc reception deep within the tunnels.

And whereas some changes appear easy, long-term success would require collaboration with the protection trade and “investment in new capabilities,” Friedrichs mentioned. Better communication units, for instance, and medical gear that “can be used without putting out a radar signal” that the enemy can hint are essential for military medicine in future conflicts.

But the finances for military medicine has been “essentially a flat line” for years, Friedrichs mentioned. The want to adapt main platforms like ships, fighter jets, and tanks has received out within the closely bureaucratic budgeting course of, he mentioned, and investing in medical capabilities that will not appear essential now however can be actually the distinction between life or loss of life later have in some ways fallen by the wayside.

Adjusting how military medical forces protect themselves and their sufferers has emerged as probably the most urgent wants for brand spanking new battlefields. A report launched by the Army in 2025 outlining medical classes realized from the battle in Ukraine says the “widespread use of drones” coupled with “blatant disregard for the Geneva Conventions protecting medical personnel and facilities” signifies a dire want to prioritize defending medical property.

In addition to working in new and artistic areas, medical personnel additionally want to put together themselves for the varieties of accidents and therapy they’re possible to face in a battle plagued by drones.

It’s essential that the accidents they follow on be as reasonable as attainable, Maj. Kelly Wood, the officer overseeing the mock accidents and wounds — referred to as moulage — within the Fort Hood train instructed NCS, to make sure the medical personnel within the area are getting as shut as attainable to what they may expertise on a real-life battlefield.

“The more high-fidelity training we can provide to our medical teams, the more successful they’ll be in those real-life scenarios,” Wood mentioned.

While troopers had been ending making use of a special soldier’s amputated leg earlier within the day, as he stood on crutches, sitting throughout from him was one other younger soldier getting a pretend stomach with inside organs spilling out tied round her torso. Each function participant — on this train, volunteers from all through III Corps at Fort Hood — had a sheet of paper with them, outlining their accidents and giving them instructions on how to act.

“Make wet gurgling sounds,” one mentioned.

After the function gamers had their moulage carried out they had been taken out to an city coaching setting on Fort Hood that simulated cell area medical therapy space. That space marks the primary cease again from the entrance strains the place a wounded service member would obtain injury management surgical procedure or resuscitative care. In a simulated village — meant to appear to be it’s situated within the Middle East reflecting previous coaching for the US’ wars in Iraq and Afghanistan — troopers with 61st Multifunctional Medical Battalion would triage the wounded earlier than loading them up and sending them again for additional care.

In the dusty coaching space, it wasn’t simply fight medics leaping in to assist. Anyone with a free hand pitched in to carry a casualty or clear an space for the medical suppliers to deal with sufferers. And when the solar went down, the troopers labored within the glow of pink lights on their helmets — an try to decrease their visibility to the enemy whereas offering crucial care.

When the wounded service members had been stabilized, they had been rapidly loaded onto medical transportation Humvees and pushed in direction of the bigger area hospital for therapy. In one other occasion, the Humvees drove to an open area and waited to load the injured onto a HH-60 medical evacuation Blackhawk helicopter, shielding their sufferers as mud swirled from the rotor wash.

This area hospital would usually have been a mass of tents and buildings above floor. Instead, medical personnel had been unfold all through a sprawling subterranean community of decommissioned nuclear tunnels that run beneath Fort Hood.

The area was a stand in for a possible subway tunnel, a basement, or different subterranean areas that might present some safety sooner or later.

At the tunnels’ entrance, netting was draped throughout the opening in an effort to “camouflage” the realm and to bodily block enemy drones from getting into.

For the medical personnel, a part of the follow is simply remembering to depend on their common medical coaching regardless of the environment. There’s the psychological guidelines to tick by means of when treating the affected person in entrance of you; the chaos of the second that can’t be processed till later; the person psychological routines a soldier makes use of to focus solely on the life they’re working to save.

For Graggs, it’s a deep breath, a reminder that sufferers “die in minutes, not seconds,” and leaning on the routine therapy algorithm to assist calm his nervous programs. For Sgt. 1st Class Daniel Hurst, a fight medic and detachment sergeant of the 555th, it’s silently singing a music — any music that pops into his head — to himself.

“It’s something I’ve taught my guys, and it doesn’t have to be a song,” mentioned Hurst, who beforehand deployed to Iraq and Afghanistan. “Find something that brings you back to center and start again.”