The Medical Implications of Emerging Unmanned Aircraft Systems in Military and Combat Environments: A Narrative Review.

The widespread adoption of unmanned aircraft systems (UAS) has fundamentally altered modern combat, expanding beyond reconnaissance to include offensive strikes. Their affordability and accessibility have enabled both state and nonstate actors to integrate UAS into military operations. Despite their increasing use, the impact of UAS on military medical operations remains underrepresented in the literature. This review contextualizes current UAS capabilities and examines their implications for military medicine. The authors conducted a narrative review using PubMed, Google Scholar, and open-source materials to evaluate UAS applications in military medicine. Search terms included "drone," "unmanned aircraft system," "UAV," "UAS," "medical," "military," and "resuscitation." Resources published through December 2024 were screened for relevance. Given limited availability of peer-reviewed research involving the implications of UAS in combat, additional data were drawn from military leadership interviews, media reports, and third-party conflict analyses. This review identified 5 thematic areas: adversarial UAS impacts on force protection and medical evacuation; UAS use for medical resupply; UAS applications in casualty evacuation; integration challenges with airspace control systems; and risks of interference with medical systems from electronic warfare and counter-UAS measures. The rapid proliferation of UAS has created both challenges and opportunities across the military medical continuum. UAS have demonstrated effectiveness in delivering medical supplies, including blood products, critical medications, and portable medical equipment. Deployment of this technology onto the battlefield could significantly reduce logistical constraints in austere environments. Early casualty evacuation (CASEVAC) applications have shown promise, but there are numerous operational limitations including payload capacity, lack of onboard medical personnel, and the need for triage protocols tailored to autonomous evacuation. Additionally, adversarial UAS use presents significant risks to medical operations. Persistent aerial surveillance compromises force protection, while precision strikes and the coordinated use of large numbers of UAS threaten the ability to safely provide point-of-injury care, prolonged field care, CASEVAC, and medical evacuation. These emerging threats challenge long-held assumptions about air superiority and rapid evacuation capabilities. Counter-UAS technologies, electronic warfare, and emerging ethical considerations introduce further complexities to medical operations. As UAS continue to shape the battlefield, military healthcare systems must adapt to both the capabilities and threats they present. Ongoing research, operational testing, and regulatory developments will be critical in integrating UAS into military medicine while mitigating their risks to patient care and medical logistics.