Disguised Among the Sea: The Implications of Artificial Islands on Casualty Care in the Indo-Pacific.

This article focuses on the implications of China's "gray zone tactics," particularly the construction of artificial islands in the South China Sea, on U.S. military combat casualty care in the Indo-Pacific region. These tactics, which fall below the threshold of kinetic military force, threaten to disrupt casualty evacuation, medical resupply, and trauma care by extending China's military reach and complicating U.S. operational control. To address these challenges, the article recommends developing a robust Combatant Command Trauma System (CTS) tailored for the Indo-Pacific Command (INDOPACOM), enhancing global health security cooperation with regional partner nations, and implementing irregular or guerrilla trauma care systems suited for austere and clandestine environments. These strategies require long-term investment in training, partnerships, and capability development to ensure effective medical support during potential large-scale combat operations or low-intensity conflicts in the region.