The U.S. military moved away from using Army helicopters to evacuate wounded troops during Operation Epic Fury, relying instead mostly on ground transfers after concerns about Iranian drone and missile strikes, according to a Defense Department inspector general report summarized by Defense One.

Army helicopters initially supported medical evacuation operations in Kuwait and Iraq. The military later moved the aircraft because of concerns that Iranian drones and missiles could strike them. “Most evacuations during [Operation Epic Fury] were ultimately conducted by ground,” the inspector general report said, according to the account.

The shift showed how the threat from drones and missiles affected the movement of wounded troops, while also exposing the limits of the medical arrangements available to U.S. forces in the region. Evacuation decisions were tied not only to the safety of aircraft, but also to where seriously injured personnel could receive advanced treatment.

For the most severe injuries, U.S. forces relied on host-country hospitals for advanced, hospital-level care. Establishing comparable facilities on U.S. bases would have required a larger footprint, one that could have presented a more attractive target, the report said. The arrangement therefore connected battlefield evacuation with medical facilities outside the U.S. military’s own installations.

The inspector general report said U.S. Central Command rapidly developed new plans and strategies as it confronted Iranian drone capabilities. Those efforts included moving troops and materiel as locations came under Iranian and proxy attacks. The changes reflected the need to adjust military operations as the threat environment shifted.

The report’s account also underscored a longstanding concern among military medical officials that drones and other advanced weapons could make future conflicts more dangerous for U.S. troops. Medical planners have warned that casualty movement could become less predictable when air routes, ground routes and medical logistics are affected by attacks.

The experience during Operation Epic Fury gave that concern a direct operational context. Helicopter evacuations were initially available in Kuwait and Iraq, but the aircraft were moved because of strike concerns. Ground evacuation then became the predominant method for moving casualties, while the most seriously wounded could require care at host-country hospitals.

The inspector general report identified counter-drone interoperability as an area requiring additional attention. Its recommendation called for finding gaps in the interoperability of Defense Department counter-drone capabilities and determining corrective actions needed to standardize those capabilities.

That recommendation links the evacuation problem to the broader defensive challenge. Counter-drone systems must work together as U.S. forces protect personnel, aircraft, facilities and other assets. When those capabilities are not fully interoperable, commanders face more complicated decisions about where to position evacuation aircraft and how to move casualties.

The report’s findings do not describe a single change in evacuation policy across every U.S. location. They describe how concerns about Iranian drone and missile strikes led the military to move helicopters supporting operations in Kuwait and Iraq, after which most evacuations during the operation were conducted by ground. The same operation also relied on host-country hospitals for advanced care rather than building larger U.S. facilities that could be more exposed to attack.

Together, those decisions illustrate the medical consequences of operating under persistent drone and missile threats. The inspector general’s recommended focus on counter-drone interoperability addresses one part of the problem, while the evacuation experience shows how defensive concerns can shape the route wounded troops take from the battlefield to advanced treatment.