Having taken place July 21 through August 2, Ultimate Caduceus 2025 involved more than 1,000 military and civilian personnel across three military bases: Joint Base Pearl Harbor-Hickam with Honolulu, Hawaii; Travis Air Force Base with Sacramento, California; and Albuquerque, New Mexico with Scott Air Force Base, Illinois.

The exercise created a realistic wartime crisis scenario, prompting a large-scale military patient movement response from within the Indo-Pacific, testing the integration of aeromedical evacuation hubs and Patient Reception Areas where Federal Coordinating Centers and local partners received, triaged, staged, tracked, and transported patients to pre-designated definitive care facilities.

"Ultimate Caduceus underscores our commitment to delivering world-class care and rapid evacuation for our military," said Air Force Col. Christopher Backus, USTRANSCOM command surgeon. "With our government and civilian partners, we stand ready to bring our warfighters home, no matter where they are."

Robust Network of Partners

UC25 demonstrated the collective effort required for successful patient movement operations. The exercise included participation from 15 MDG, USTRANSCOM, U.S. Northern Command, U.S. Indo-Pacific Command, Air Force aeromedical evacuation crews, Critical Care Air Transport Teams, Army Reserve Medical Command, the Defense Health Agency, Department of Veterans Affairs, and Department of Health and Human Services.

More than 20 civilian hospitals participated alongside several state and federal emergency response agencies, highlighting the critical interoperability between military and civilian medical emergency management systems.

Testing Rapid Response Capabilities

As the DOD's single manager for global patient movement, USTRANSCOM provides the world's only long-range and high-capacity patient movement capability. The patient movement system includes highly specialized aeromedical evacuation and critical care air transport teams capable of providing intensive care while airborne, supported by a federation of patient distribution hubs located across the globe.

A key component of UC25 involved testing a National Defense Medical System pilot program, actively evaluating how emergency response systems work together during a potential national crisis. The exercise provided hands-on experience for real-world events and enhanced participants' ability to interface with agencies that support large-scale patient movement operations.

Pineapple Thunder 2025

Joint Base Pearl Harbor-Hickam served as a key location for UC25 patient staging and interoperability demonstrations on July 23 - 24. As part of the exercise scenario, Joint Base Pearl Harbor-Hickam functioned as a designated Aeromedical Evacuation hub and Patient Reception Area, where Federal Coordinating Centers and the 15 MDG partnered to receive, triage, stage, track, and transport simulated patients as part of a smaller exercise within UC25 called Pineapple Thunder. 15 MDG demonstrated critical interoperability between military services and civilian partners, coordinating the onward movement of patients to medical facilities in and around Honolulu. Lead planner for Pineapple Thunder, Capt Dani Webb, said that “During last summer’s strategic offsite, 15 MDG leadership identified the need to exercise our medics’ capability to execute the first 96 hours of large-scale contingency operations by standing up and staffing the En Route Patient Staging System. Our partners at the 624th Aeromedical Staging Squadron, who own this mission set, assisted with training, preparation, and coaching during the exercise, truly exemplifying total force integration. Additionally, the fireworks incident on New Years’ Eve highlighted the need for interoperability between sister services and our civilian partners, driving the additional complexity of tying in the Army’s Prolonged Care Augmentation Detachment to enhance the capability of the ERPSS to provide staging and movement of critically injured patients.”

Prepared for Global Operations

Ultimate Caduceus has been conducted annually since 2013, with exercises previously focused on patient movement from the Middle East, Europe, and the Indo-Pacific. This year's scenario emphasized testing readiness within the Indo-Pacific region and the ability to carry out rapid patient movement throughout the area.

The exercise validated the readiness of the patient movement enterprise, assessing participants' ability to scale up forces and deploy sufficient medical assets to provide expedited transport of military patients to definitive care facilities. With an overall cost of approximately $2.5 million, UC25 represents a significant investment in maintaining this critical capability.

With the success of global operations increasingly dependent on seamless integration with allies and partners, UC25 provided a crucial opportunity to enhance interagency interoperability in patient movement. The exercise offered participating agencies insights to strengthen medical staging and response capabilities, ultimately contributing to the ability to effectively project, maneuver, and sustain the joint force across the globe.