Introduction: Targeting in large-scale combat operations (LSCO) will cause collateral damage to our field hospitals, military treatment facilities (MTF), communications systems and common operating picture, medical logistics, and evacuation routes. Our formations will use distributed operations to provide a geographically expanded, less predictable approach to maneuvering friendly forces and employing capabilities in a combined arms or joint manner. The medical challenge of managing casualties across the continuum of care is intensified by the future LSCO threat and the physical distance imposed by distributed operations, especially in the Indo-Pacific area of operation. This project assessed requirements for casualty management in distributed operations and focused on point of injury (POI) care and evacuation with en route care. Abstract: Evacuation and en route care are key capabilities required for managing casualties across the continuum of care. Evacuating the large number of expected casualties across the depth and breadth of the battlefield during LSCO will challenge current evacuation assets, and as the battlefield becomes more distributed, portions of the battlefield could become inaccessible for long periods of time, thereby delaying evacuation. The Joint Services require a synchronized and responsive medical evacuation (MEDEVAC) system (ground, sea, and air) that is capable of rapidly clearing the battlefield of casualties, providing en route care that ensures the highest possible survivability rates, and effectively unencumbering maneuver elements to enable freedom of maneuver. The future MEDEVAC capability must not only employ ambulance assets with greater mobility, speed, modularity, and en route care capabilities, it should also integrate autonomous systems into capability sets and employ autonomous and semi-autonomous capabilities leveraging artificial intelligence and systems. Robotic and autonomous systems (RAS), artificial intelligence (AI), machine learning (ML), and semi-autonomous medical treatment and evacuation capabilities will facilitate and assist in the optimization of clearing the battlefield of casualties, maximizing return to duty rates, and overcoming contested logistics throughout the future operational environment. To ensure the highest possible survivability rates and unencumber maneuver elements to enable freedom of movement, future MEDEVAC platforms must provide en route care capabilities and operate throughout the continuum of care, starting at the POI. RAS within the MEDEVAC system is intended to augment the assigned medical provider to deliver care, monitor, and provide treatment decision support. Medical RAS can be a significant force multiplier, decreasing the cognitive and physical workload of the provider and increasing the number and treatment level of patients. Given the austerity of the environment, threat, operational tempo, unit dispersion, and expected casualty streams, medical units will be designed and equipped with the essential functions to deliver necessary treatment far forward, near, and at POI commensurate to the constraints of the environment. In a LSCO distributed operational environment, MEDEVAC of casualties may be delayed, resulting in medical personnel at echelon having to care for patients longer than accustomed to in previous conflicts since 2001. This will likely lead to medical sequelae not normally encountered in the current operating environment. New technologies and knowledge are needed to train medical personnel to provide this extended care. On the front lines, medical personnel will require (1) capabilities that enhance the control of non-compressible hemorrhage and treat severe or penetrating Traumatic Brain Injury (TBI), (2) capabilities that predict and detect sepsis risk in injured Service Members, (3) capabilities that prevent/ treat wound infection, (4) AI to assist with life-saving techniques, and (5) new measures to repair skin and muscle tissue. Sensors and AI-enabled triage decision tools from POI through Role 3 (theater hospitalization) could assist leaders far forward, near, and at POI to manage and analyze large amounts of data and make rapid decisions regarding the effective use of evacuation assets. Conclusions: Future medical Services need scientific research and technology to advance capability requirements to stabilize, triage, and care for casualties far forward for extended periods; evacuate those casualties through an integrated AI/ML enhanced evacuation system; and develop new treatment protocols that for en route care. The goal is to fundamentally transform and modernize the Military Health System – focused on formations, capabilities, and people – that enables Multi-Domain Operations as part of an integrated, adaptive, responsive, and resilient Joint Medical Force through 2030 and beyond.