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The MHS faces a wide range of challenges in preparing to provide medical support for future combat operations

• The 2018 National Defense Strategy envisions a future threat environment that could drive large numbers of casualties, stressing deployed treatment facilities, medical personnel, prepositioned supplies, and transportation networks.
• The storage network for medical materiel might be inadequate to meet the demands of future combat operations, which could initiate with little warning.
• The MHS will need to compete for transportation assets to move supplies and evacuate casualties.
• Even with a robust global network of prepositioned medical materiel, the MHS will face logistical challenges related to maintenance and sustainment, such as replenishing stocks of perishable supplies.
• There is a risk that the U.S. civilian health care system and the industrial base for medical supplies could be overtaxed by the surge in demand that would accompany a large-scale combat scenario.

The MHS has several options to prepare for the evolving threat environment, but none is a "silver bullet" in terms of improving outcomes across the board

• There are opportunities to augment deployed medical treatment facilities in a combat theater through first-responder training, carefully considered triage strategies, and even the use of drones to deliver medical supplies.
• There are several trade-offs in terms of cost and efficiency in prepositioning medical supplies; doing so will likely require agreements with partner nations and use of contracted labor, and it might not alleviate pressure on transportation assets.
• Across the industrial base for medical supplies, there are opportunities to incentivize manufacturers to meet quality standards and surge demand.

The Military Health System (MHS), through its global network of facilities and providers, meets the health care needs of more than 9 million service members and their dependents during peacetime. It is also responsible for treating casualties during combat operations and in the aftermath of disasters and humanitarian crises. The 2018 National Defense Strategy emphasizes a need to prepare for future combat operations that could be distinctly different from those of the past few decades. The evolving security environment is characterized by precision missile strike capabilities and a risk that adversaries will target critical military infrastructure. These types of attacks could significantly degrade U.S. combat capabilities and significantly increase casualties.

There is a range of opportunities for the MHS to align its capabilities to address potential future threats. But to implement effective mitigation strategies, it requires an understanding of the numbers and types of casualties it can expect in a future combat operation, the capability and capacity to treat and evacuate casualties, the network of storage facilities and transportation assets to ensure access to medical supplies, the capacity and capabilities of the U.S. health care system overall, and gaps in the medical supply industrial base. A thorough analysis of these sources of risk highlights how the MHS can build a more agile and resilient medical support capability so that it can continue to provide the best care possible to the warfighter both at home and in combat.

• Chapter One

  The Challenges of Future Conflict Framed by the National Defense Strategy

• Chapter Two

  Challenges to Combat Casualty Care in Future Combat Operations

• Chapter Three

  Enhancing Care on the Future Battlefield

• Chapter Four

  Enhancing the Global MHS Network of Medical Supply Caches

• Chapter Five

  Improving the Resilience of Medical Logistics and Sustainment

• Chapter Six

  Preparing Medical Support for Homeland Missions

• Chapter Seven

  Improving Casualty Support Through Enhanced Resilience in Medical Supply Chains

• Chapter Eight

  Recommendations and Policy Implications

• Appendix A

  An Overview of Triage Principles

• Appendix B

  Models for Analyzing Military Medical Support Postures