Dig Deep! The Sub-Terranean Casualty Stabilization Points.

The evacuation timelines of Ukrainian casualties through the Operational Patient Care Pathway (OPCP) vary widely, ranging from minutes to days. Western Military reliance on air evacuation models has proven inefficient in the current conflict, dominated by sophisticated air defense and electronic warfare. This paper explores the adaptation of medical support in static warfare, focusing on the development of Subterranean Casualty Stabilization Points (ST CSP) by the Armed Forces of Ukraine (AFU). These facilities provide damage control resuscitation and damage control surgery close to the front lines, significantly reducing the time from injury to surgery. The ST CSPs, built with enhanced protection, represent a paradigm shift in military medical doctrine, offering a gold standard solution for casualty care in a contested environment. This study highlights the need for Western militaries to consider similar adaptations to ensure the survivability of medical force elements in future conflicts. 1) The Russia-Ukraine conflict has demonstrated the difficulty an air-denied environment poses for medical evacuation (MEDEVAC) and the requirement this will drive for placing surgical stabilization facilities close to the front line of troops (FLoT). 2) Artillery and drone munitions would preclude tented and other traditional forward solutions. 3) This paper presents ST CSP as an option that enables damage control resuscitation and surgery to be provided in otherwise prohibitive tactical environments.