Preparing for the Future of Combat Casualty Care

Opportunities to Refine the Military Health System's Alignment with the National Defense Strategy

by Brent Thomas

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Research Questions

  1. How has the picture of global threats evolved over the past decade?
  2. How might the capabilities of future adversaries drive different compositions of casualty streams from those seen in past conflicts?
  3. Are expeditionary medical treatment facilities prepared to receive these casualties and provide adequate care or transport?
  4. Is the current MHS medical logistics and sustainment posture optimized for the likely requirements of a future fight?
  5. Does the special mission of homeland defense introduce additional stressors that the MHS should consider?
  6. Could the demands of a future fight tax the industrial base for medical supplies that the MHS requires to care for combat casualties?

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.

Key Findings

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.

Recommendations

  • Prepare combat casualty care for a rapidly evolving set of global threats, including advanced missile systems with the capability to generate more trauma casualties than U.S. forces have encountered in a century.
  • Forecast requirements for care on the future battlefield, including likely casualty distributions in the aftermath of large-scale blast events.
  • Enhance treatment options at and near the point of injury by, for example, enhancing first responders' skills and expanding capacity at field hospitals.
  • Evaluate the benefits of an expanded posture of prepositioned medical assets to ensure that supplies and expeditionary facilities are immediately accessible in key threat regions.
  • Consider options to improve the resilience of medical logistics and sustainment capabilities, including civilian and contract labor, U.S. military personnel, and agreements with partner nations.
  • Prepare for homeland support and homeland defense missions and understand the rights and authorities for managing casualty flow both within the MHS and between the MHS and civilian health care facilities.
  • Build resiliency into the industrial base for medical supplies by exploring options to diversify partnerships and invest in manufacturing efficiencies to ensure that surge demand can be met in a large-scale contingency.
  • Prepare for a new set of threats and medical operations in austere environments.
  • Support additional clinical interventions, such as additional training for first responders and explicit return-to-duty protocols for patients suffering from concussions.

Table of Contents

  • 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

This research was sponsored by the Office of the Secretary of Defense and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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