As the U.S. military prepares for the next era of conflict—most likely in the Indo-Pacific and against a peer adversary like China—Congress and the Department of Defense must ensure that transformation does not come at the cost of survivability. Toward that end, Sen. Ted Cruz (R-TX) has introduced the Retaining Essential Support for Combat and Unified Evacuation (RESCUE) Act of 2025, a critical safeguard for the Army’s dedicated medical evacuation (MEDEVAC) capability.
The RESCUE Act is not just about aircraft. It’s about preserving the confidence, morale, and survivability of the greatest fighting force the world has ever seen. It reaffirms MEDEVAC’s doctrinal purpose, preserves its structure, and ensures that future force design protects this essential function.
MEDEVAC’s Success
Before the advent of dedicated MEDEVAC, battlefield mortality, the percentage of wounded troops who died from their injuries, was alarmingly high. In World War II, the average time from injury to hospitalization was 12–15 hours, and mortality for severely wounded soldiers hovered around 30 percent. Even with the introduction of helicopters in the Korean War, mortality remained at 25 percent, as aircraft were neither dedicated nor medically configured.
Everything changed in Vietnam. The UH-1 “Huey,” a dedicated evacuation aircraft, flying under the callsign DUSTOFF and staffed with trained medics, slashed evacuation times to under an hour. Mortality dropped to 10 percent, and the concept of the “awarded the Congressional Gold Medal in recognition of the Army helicopter ambulance pilots, crew chiefs, and medics known by the callsign DUSTOFF, who, while unarmed and under fire, rescued over 900,000 United States, South Vietnamese, and allied wounded during the Vietnam War, saving lives at extraordinary risk to their own.
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Their legacy is more than history. It is a living standard that dedicated, doctrinal MEDEVAC capability is not optional; it is an operational and moral imperative. We honor that legacy best by ensuring it survives intact, not in name only, but in protected doctrine, leadership structure, and force design.
In Iraq and Afghanistan, the US military’s joint medical system delivered its most effective performance in history. Across all services, the Joint Health System—led by Army DUSTOFF crews, Air Force Critical Care Air Transport Teams (CCATT), Navy Role 2 providers, and Marine Corps enablers—achieved the highest battlefield survivability rates ever recorded. Over 90 percent of service members with potentially survivable wounds returned home alive.
US forces treated more than 50,000 wounded troops across both theaters and saved an estimated 30,000 to 35,000 lives through rapid MEDEVAC and timely en route care. While each service contributed vital capabilities, DUSTOFF crews ensured immediate response and continuous coverage by operating with mission-exclusive focus, dedicated aircraft, and medically trained personnel under clinical command and control.
In 2009, the Department of Defense reinforced these efforts by directing combatant commanders to evacuate critically injured patients to the nearest treatment facility within 60 minutes. Army leaders invested in dedicated evacuation platforms, trained medics to serve as flight paramedics with advanced clinical skills, and enforced the golden hour standard as doctrine. That mandate alone reduced case fatality rates by about 35 percent during peak operations in Afghanistan. MEDEVAC’s integrated, life-saving capability must remain a core combat function, not diluted into a general-purpose aviation task.
We’ve Been Here Before
History shows that if we ignore its lessons, we repeat its mistakes. The Army learned these lessons the hard way—yet here we are again, poised to repeat the same costly mistake.
Despite the many significant and positive modernization goals within the Army Transformation Initiative (ATI), cutting MEDEVAC would be a dismal mistake. In the face of rising global threats and internal inefficiencies, the Army is undergoing its most sweeping reorganization in a generation. The Secretary of the Army’s May 1 directive makes clear that modernization is survival, and Vice Chief of Staff Gen. James Mingus emphasized at the Army Aviation of America Summit that “some of these cuts hurt. But not making them would hurt more.”
Among the cuts is the MEDEVAC force structure. Under the latest Army Structure, the Army is again reducing the size of each MEDEVAC company from 15 to 12 aircraft, mirroring the same decision made two decades ago.
In 2004, the Army briefed Congress on its Aviation Transformation Initiative, which integrated MEDEVAC into general aviation and reduced the number of companies from 15 to 12 aircraft. By 2008, US forces were deep into conflict in Iraq and Afghanistan. Families began flooding Congress with letters expressing outrage at long evacuation delays and insufficient coverage, and Servicemembers dying on the battlefield, particularly in Afghanistan.
Congress responded. In 2009, the Army reversed course, restoring MEDEVAC companies to 15 aircraft and adding new companies to meet battlefield demands. Gen. Peter Chiarelli’s landmark policy as Vice Chief of Staff codified the “golden hour,” decentralized launch authority, and reaffirmed that “patient care trumps all.”
Brigade commanders directed air crews to launch within 15 minutes, deferring the risk to the qualified MEDEVAC Commanders and DUSTOFF crews to do what they do best: plan as much as possible in advance and save lives, rather than leaving the wounded on the battlefield. Critically, the policy cemented the leadership role of 67J Aeromedical Evacuation Officers—leaders trained in both aviation and medical operations.
This policy did more than define a process—it upheld a sacred promise: MEDEVAC would stand ready for every warfighter, every time. As the policy put it, “The single most important factor in the execution of the MEDEVAC mission is patient care.” We learned this lesson through sacrifice and paid for it in blood.
Repeating the Same Mistake
Yet, here we are again. The ATI’s MEDEVAC plan is concerning and proposes the same failed concept: cutting the force structure, eliminating the 67J specialty, and replacing it with general Aviation officers, as well as weakening dedicated medical aircraft into multi-role platforms. Aircraft once marked with the Red Cross—protected under the Geneva Convention—may soon fly assault missions, then be re-marked for medical missions later.
In effect, the Army is attempting to erase the medical identity and doctrinal protections that have underpinned MEDEVAC’s success for generations under the guise of transformation and cost savings.
Proponents claim this will give commanders more flexibility. But history says otherwise. When we blur the line between combat and care, patients pay the price. America’s sons and daughters pay the price. Risk that should rest with field-grade MEDEVAC commanders and highly trained crews shifts instead to the wounded, waiting on the battlefield, making a call that may never come.
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It’s like tearing down a firehouse and telling the neighborhood the trucks will still show up—eventually—when someone needs them most, except this time it’s a rented U-Haul with a garden hose strapped to the back. We learned this lesson the hard way—during the height of Iraq and Afghanistan, families wrote Congress demanding answers when their loved ones were left waiting, dying on the battlefield.
A Force Multiplier
MEDEVAC is not merely a logistical support function—it is a combat enabler. When troops know a dedicated MEDEVAC team stands ready with no other mission but to save lives, it builds confidence, strengthens morale, and sustains the will to fight. That is why the RESCUE Act proposes to ensure that MEDEVAC remains a distinct, doctrinally governed capability, protected from dilution into general-purpose aviation. It requires that any proposed structural changes undergo rigorous risk assessments and consultation with the Army Surgeon General.
Preserving Dedicated MEDEVAC
Congress should ensure that any defense authorization moving forward protects the core elements of the RESCUE Act of 2025—codifying dedicated MEDEVAC in Title 10 as a doctrinal combat capability. Doing so would help settle this longstanding debate and safeguard this mission from future cuts or reorganizations that put wounded service members at risk.
Proponents of recent cuts argue that integrating MEDEVAC into multi-role aviation will increase flexibility. But history shows the opposite: weakening dedicated MEDEVAC forces ultimately shifts life-and-death risk from trained crews back to patients on the battlefield. The lessons of previous wars remind us that dedicated MEDEVAC saves lives—diluting it costs them.
America’s servicemembers deserve the certainty that when they go into harm’s way, they will not be left behind. In the next fight, the difference between life and death will not come from firepower alone—it will come from our unwavering commitment to protect the red cross on the side of a helicopter, flying with one clear mission: to give America’s sons and daughters a lifeline home, every time.
This piece originally appeared in The National Interest
