JOINT BASE ELMENDORF-RICHARDSON, Alaska — Historically, battles are won by the side that carries momentum throughout the fight. Taking casualties can stop that momentum in its tracks. In Alaska, those tracks are complicated by extreme cold, ice and snow, making casualty care in arctic environments a challenge in the heat of combat.

Alaska Army National Guard Maj. Titus Rund, a flight surgeon assigned to the 207th Aviation Troop Command, spent the last several years addressing some of those challenges facing the arctic warfighter.

“Doc Rund”, as he’s affectionately known in the AKNG aviation community, in coordination with the Program Executive Office Soldier, Project Manager Soldier Medical Devices (PM SMD) and U.S. Army Combat Capabilities Development Command (DEVCOM) Soldier Center, designed a casualty care system that may revolutionize the way military medics and combat life savers execute casualty care and movement in arctic or extreme cold environments. This is accomplished by creating a “bubble of warmth” around a patient, the medic and the treatment being conducted.

“My goal is that Soldiers get the best care possible and back to their families on the worst day of their lives,” Rund said. “When time is tissue, the urgency to effectively treat patients in the extreme cold is crucial.”

The Casualty Evacuation (CASEVAC) Ecosystem’s Casualty Protection Unit sled inflates at the point of injury, acting as both an environmental shelter and a casualty movement platform ready for movement within 10 seconds.

The sled is then moved to the Casualty Collection Point shelter which creates a secondary “bubble of warmth” around the medic and patient. The built-in portal design allows up to four casualties to slide directly into the tent for expedited assessment.

The shelter also helps retain heat which has the added benefit of reducing the heat signature, making it harder for enemy forces to detect.  Rund is working with PM SMD to integrate active rewarming measures into the system’s design.

The CASEVAC Ecosystem patent was filed in December of 2022, and an early prototype was created and tested in March 2024 at the Arctic Edge medical experimentation exercise.

DOD used the most recent prototype during Special Operations Forces Arctic Medic exercise that took place near Fairbanks, Alaska from Feb. 9-22, 2025.

In partnership with PM SMD and Virginia based Ryzing Technologies, a research and development company that specializes in textiles and rigid, inflatable structures, Rund brought his vision to life and fielded the system in the austere terrain of the U.S. Army’s Yukon Training Area near Ft. Wainwright alongside some of the nation’s most elite warriors.

“This exercise was a great way for us and for this system to get the best exposure possible, and we got some great feedback from the troops throughout the exercise,” said Ryan Gundling, the principal engineer for Ryzing Technologies. “This environment was particularly useful in developing several different use cases for the ecosystem. We look forward to fine tuning it in future exercises in Alaska.”

Time and distance present significant challenges as the state’s roads and medical infrastructure off the road system are not able to support contingency operations, especially timely surgical care.

Traditional tow-behind stretchers can be cumbersome and require extra time for the patient to be loaded and secured. The inflatable design streamlines this process. The durable material allows the sled to be moved easily via snowshoe, ski or snow mobile. The inflatable design keeps the head and torso elevated, increasing the casualty’s chances of survival while en route to the next level of care.

“We aimed at testing the sled at a 500-meter distance but ended up being able to observe its effectiveness over a six-and-a-half-mile route with over 1,000 feet of elevation gain,” Gundling said. “The overall structure is solid, and this was a great test of durability for us.”

In Tactical Combat Casualty Care, medics refer to the term “golden hour” as shorthand for evacuating a patient to surgical care within 60 minutes of a traumatic injury, this is essential to a good outcome for the patient. However, current assessments on early trauma deaths conclude that this window of time may be as short as 19 to 23 minutes, particularly in arctic or extreme cold environments, where traumatic hypothermia can dramatically endanger a casualty’s survival.

In an article published in the International Journal of Circumpolar Health – Arctic Military Conference in Cold Weather Medicine, Rund asserts that arctic or extreme cold environments can cause a traumatic injury to go from being treatable to life-threatening in a matter of minutes and that managing hypothermia with a “bubble of warmth” is a top priority, second only to massive hemorrhaging in the triage of care.

According to Rund, the goal of his research and prototype is to raise awareness,

stimulate research, drive technological innovation, jumpstart development of new equipment and training, and generate requirements that can be actioned by DOD.

As an active-duty physician in the AKARNG, Rund submitted this design concept to the DOD. The DOD then filed for U.S. and international patent applications. The specialized device could be available for units to purchase by the end of the year.

  akng, Alaska, Arctic, care, casualty, cold