After more than 20 years of war in Afghanistan and Iraq, the U.S. military became accustomed to low casualty rates, with 4,986 killed in action and 52,036 wounded, yielding a fatality rate of under 10%. This high survival rate was supported by fixed bases, air superiority, and efficient medical evacuation (medevac). However, in a large-scale conflict against a near-peer adversary like China, casualty rates would be far higher. Simulations of such conflicts, like Warfighter exercises, predict a fatality rate of 20 to 30%, with 10,000 to 15,000 deaths in just eight days for a force of 100,000. A wargame predicting a conflict over Taiwan estimates 140 U.S. KIA daily, meaning in six weeks, U.S. casualties would exceed those from the wars in Iraq and Afghanistan.

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This outlines tactics to improve survivability of the Mobile Air Assault Rifle Platoon, focusing on heat mitigation in non-permissive combat environments. It examines load plans, heat conditioning, nutrition, and soldier identification for combat effectiveness. Reverse cycle physical training (PT) was used prior to JRTC 24-10 to condition soldiers for hot conditions, proving effective but with room for improvement. While this approach helped soldiers manage heat and elevated heart rates, issues like soldier load, nutrition, and prior heat casualties still led to high heat-related injuries.

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Over the past 249 years, the U.S. Army's operational environment (OE) has drastically evolved, with emerging technologies like AI, hypersonics, and robotics reshaping warfare. Strategic competitors like Russia and China are integrating these technologies with military doctrine to exploit overmatch opportunities across all domains—space, cyber, air, sea, and land. In response, the U.S. Army's Multi-Domain Operations (MDO) 2028 concept counters these threats with three tenets: calibrated force posture, multi-domain formations, and convergence. Recent events, such as Russia's 2022 invasion of Ukraine, highlight the importance of this strategy in addressing peer threats.

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As AI becomes more integrated into various sectors, military leadership must adapt to fully leverage its potential. This article advocates for a leadership model that combines human intuition with AI capabilities, emphasizing innovation while maintaining ethical standards. The integration of AI offers opportunities to enhance decision-making, operational efficiency, and strategic outcomes. However, a paradigm shift is needed, where human-AI collaboration is prioritized. By fostering this synergy, military leaders can ensure AI's capabilities are used effectively, while human judgment remains central. This approach can redefine military strategy, enabling more agile responses to threats while upholding accountability.

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In large-scale combat operations (LSCO), sustained high-intensity conflict leads to significant casualties, and adversaries may hinder the evacuation of casualties or the rotation of replacement troops, creating manpower shortages. Psychiatric casualties, however, represent a potential pool of soldiers who could quickly return to duty, increasing combat power. Current behavioral health resources are inadequate and concentrated in rear-echelon areas, which are vulnerable to enemy targeting. Psychiatric Physician Assistants (PAs) offer a solution by managing psychiatric casualties closer to the frontline, reducing the need for evacuation. Psychiatric PAs can be trained quickly and positioned within key military units to provide care at the point of injury. The Army’s force structure should be updated to create dedicated positions for psychiatric PAs in these units.

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