Robots, sensors and AI on the front line

Endless waves of drones are making it extremely dangerous to evacuate the wounded from the front line in Ukraine. New medical technologies offer a solution. From robots to e-health and wearables: developments are advancing at breakneck speed out of sheer necessity.

Three weeks. That is how long three seriously injured Ukrainian soldiers were left lying on the front line last March . One of them had a serious head injury; another had a leg wound, which later froze and became infected.

Ever since the Russian army invaded the neighbouring country in February 2024 and a large-scale war of aggression began, such dramatic situations are no longer the exception. The drones dominating the battlefield make it difficult to evacuate the wounded from the front line.

For the three soldiers, new technology ultimately brought relief. A robotic vehicle managed to drive right up to the front line and load the seriously injured soldiers onto it, before delivering them to a medical post some distance away. Miraculously, the soldiers survived their ordeal, partly thanks to new technology.

It is no secret that technology is shaping the war in Ukraine. The role of new medical technology is becoming increasingly significant. From robots and wearables to remote healthcare: these are all technologies that can be used to bridge the gap between the wounded at the front and medical facilities.

New combat technology

Lieutenant-Colonel Bas Veenvliet of the Ministry of Defence is closely monitoring these developments. He is the head of the Operational Healthcare Knowledge Centre at the Ministry of Defence Healthcare Education and Training Centre in Hilversum.

‘Historically, we had the protection of the Red Cross,’ says Veenvliet. ‘Under the laws of war, the Red Cross was a protected symbol. Medical personnel were not to be military targets. A wounded person, at least in theory, received the same protection.’

In an increasing number of armed conflicts, such as in Ukraine, these rules appear to be being ignored. Both the wounded and medical personnel are being attacked. It is becoming increasingly difficult to reach the wounded, treat them and evacuate them.

This trend is exacerbated by the introduction of new combat technology. Drones dominate the front line in Ukraine, accounting for more than 70 per cent of casualties. Because of these drones, and the sensors located everywhere, a no-man’s-land has emerged, extending in some cases up to tens of kilometres behind the front line.

First aid

‘The battlefield itself has become incredibly transparent,’ says Veenvliet. ‘The British sometimes say it’s like fighting in a fishbowl – fighting in a completely transparent fishbowl. Everything is on show. Previously, that was a positive thing for a medical service, because you were protected. Now, however, it actually makes aid workers vulnerable.’

As a result, the wounded remain on the front line for longer, with all the consequences that entails. ‘According to NATO guidelines, first aid must be administered within ten minutes,’ explains Veenvliet. ‘Those wounded must be on the operating table within an hour. If that is not possible, a life-saving procedure must be carried out within two hours.’

The reality in Ukraine is different. There, the wounded remain on the front line for hours or even days. Because medical staff themselves may also be targeted, they are not readily sent out. After all, medics are not only vital but also in short supply. ‘The enemy is keen to take them out. If you send them to the front line, your healthcare system will be worn down very quickly. You’re caught between a rock and a hard place,’ says Veenvliet.

Stretcher robot

One solution is to have robots carry out the evacuation of the wounded from the front line. That way, nobody has to put their life at immediate risk. Belgium’s Royal Military Academy (KMS) has collaborated with the Estonian company Milrem Robotics on various projects, such as the European Integrated Modular Unmanned Ground System (iMUGS) project. Their robots are being used on the Ukrainian front line, including for the evacuation of the wounded.

‘When people see these robots, they often think they’ll be used as weapons,’ says Geert De Cubber, team leader of the Robotics & Autonomous Systems department within the Mechanics division at the KMS. That’s not such a far-fetched idea, especially as machine guns are actually being mounted on them at the front in Ukraine. ‘But the vast majority of missions revolve around logistics or evacuations. That’s much more useful. You shouldn’t put extra people at risk just to get supplies to the front line or to evacuate people.’

The robots are now being used both to deliver supplies to the front line and to evacuate the wounded, for example using a stretcher mounted on the robot. A driver can operate the robot remotely, and artificial intelligence can assist with navigation.

Difficult terrain

‘But it’s not nearly as easy as that. For example, a robot like that must also be safe for the injured person lying on it. We’re working with real people here,’ says De Cubber. ‘Bringing a robot close to a person is always dangerous for the person in question. The robot must, of course, be designed in such a way that, for example, no part of the body can get caught between the tracks.’

At the same time, the robot, with the injured person on board, must be able to navigate over difficult terrain. These days, that terrain consists not only of natural obstacles. Electronic warfare is also ubiquitous on the Ukrainian front, where all manner of communications, from GPS to radio signals, are being jammed. As a result, the robot often loses the signal from the operator and sometimes has to wait for hours before it picks up the signal again, possibly via a different communication system.

‘In practice, things are bound to go wrong,’ says De Cubber. ‘You have to be prepared for when that happens. This is not an easy environment to work in, certainly not when you’re carrying an injured person.’

Wearables and haptics

At the same time, defence organisations want to be able to monitor their personnel more effectively using technology. For example, wearables or portable technology can analyse soldiers’ medical conditions.

The Eindhoven-based start-up Touchwaves operates in this field. This spin-off from the TNO research institute specialises in wearables and haptics and found its first users among fighter pilots.

‘Initially, our focus was on civilian medical applications and areas such as mental health,’ says Charlotte Kjellander, founder and CEO of Touchwaves. ‘But then, suddenly, interest came from the military. We realised that our technology could help pilots to improve their concentration and perform better.’

Remote care

Sensors can also provide data for another innovation that is becoming increasingly popular on the Ukrainian front line: telemedicine and telehealth. Soldiers can then receive remote advice from medical staff on how to treat a wounded comrade. ‘It is becoming increasingly difficult to transport patients to medical facilities in war zones,’ says Hugo Kuijf, a senior scientist at TNO. ‘Evacuation routes are blocked. One solution is to bring care to the patient.’

Thanks to technology, doctors can carry out monitoring and diagnostics, even if the patient is still on or near the battlefield. Doctors can even provide advice on any medical procedures that need to be carried out immediately on the spot. Medical staff can then access data from sensors worn by soldiers to assess their condition. Using video calls or other available forms of communication, they can instruct other soldiers on what to do to begin treating the casualty.

Oxygen level

That is why the start-up is now working on sensors to be incorporated into military pilots’ flight uniforms. ‘When a pilot flies at high altitude, they are exposed to a low-oxygen environment,’ says Kjellander.

‘This can lead to disastrous situations when the pilot is flying a fighter jet. The risk of a crash is high, with the potential for loss of life and material damage amounting to hundreds of millions of euros.’

Technology can help in such situations. Touchwaves’ sensors measure the oxygen level in the pilot’s blood. If it drops too low, an alarm sounds. The pilot can then use breathing techniques to raise the oxygen level. The pilot’s suit can also vibrate slightly, which encourages deep breathing.

Vibrations can also be helpful during dogfights. ‘A pilot is already receiving a huge number of signals,’ says Kjellander. ‘They have to keep an eye on lots of screens and are constantly hearing sounds. As a result, they sometimes overlook something very important, such as a missile heading their way. That’s when vibrations can help. By causing certain parts of their body to vibrate, this technology can intuitively signal which direction a threat is approaching from.’

For the time being, the focus is on pilots, but in future, soldiers on the ground could also benefit from this type of wearable integrated into their uniforms, which continuously monitors their alertness and physical and mental health.

Plan B

This kind of telemedicine has been promised for years in civilian medicine. Doctors can provide remote advice to outlying medical posts or even perform operations remotely. For the time being, however, it has not become widespread in the medical world.

In wartime conditions, however, it may well prove useful. ‘In my view, telemedicine is never ideal, but always a Plan B,’ says Kuijf. ‘The best solution is to bring the doctor and the patient together. If that isn’t possible, remote care is an option. In the civilian sector, this will rarely be truly necessary, but in a military context, on the other hand, it is common for an injured person to be unable to see a doctor straight away. Remote healthcare is very useful in such situations.’

Act quickly

Veenvliet is most enthusiastic about how all these separate technologies can be integrated and how software can better coordinate medical care. The Ministry of Defence has a number of initiatives underway that are specifically aimed at this. ‘In the VitalsIQ project, we have built a system to digitally register casualties,’ says Veenvliet.

These days, most countries still use paper-based registration. Paper always works, of course, but it also has its drawbacks: handwriting is sometimes difficult to read or the information is recorded in a foreign language. ‘That can sometimes make it difficult to track casualties through the chain of care. Sometimes medical staff have no idea what’s written on the paper or who they’re treating. We digitised that in VitalsIQ.’

Insight

The aim is to have a single, comprehensive system in which the condition of the wounded can be monitored wherever they are, and which also integrates data from sensors, robots and soldiers. This ensures that a commander is constantly aware of what is happening and enables a faster response.

‘We want to gain an understanding of how the flow of casualties is developing; that helps us make better decisions,’ says Veenvliet. If that data is combined with recommendations from AI software, it quickly becomes clear which routes medical personnel and supplies can be moved along, which evacuation routes are safe and which are not, and where the need is greatest.

Such systems are already in use in Ukraine. The Delta system, for example, collects vast amounts of data and enables commanders to act more quickly.

‘They make decisions incredibly quickly,’ says Veenvliet. ‘They often talk about the “sensor-to-shooter” cycle there. I prefer to talk about “sensor-to-effector”, because this isn’t just about neutralising the enemy. It’s about being able to take swift action. You can save lives if you can act much more quickly using sensors and software. Data is the key. Hardware is important, of course, but data is far more important.’

Photo above: Ministry of Defence