Medical Logistics Sustainment in Multidomain Operations

By Lt. Col. Mark SanderAugust 1, 2023

Medics with the 82nd Airborne Division’s 1st Brigade Combat Team retrieve notionally-wounded paratroopers from a Black Hawk medevac helicopter operated by the 101st Airborne Division’s 159th Brigade, Jan. 23, 2012, at the Joint Readiness...
Medics with the 82nd Airborne Division’s 1st Brigade Combat Team retrieve notionally-wounded paratroopers from a Black Hawk medevac helicopter operated by the 101st Airborne Division’s 159th Brigade, Jan. 23, 2012, at the Joint Readiness Training Center, Fort Johnson, Louisiana. (Photo Credit: Sgt. Michael J. MacLeod) VIEW ORIGINAL

In modern military operations, logistics are vital to ensure the right resources are available at the right place and time. Logistics’ critical role in warfare is particularly relevant in multidomain operations (MDO). The MDO concept is built upon the premise that the joint force cannot assume uninterrupted superiority in any domain, whether land, sea, air, space, or cyberspace. Recent updates to Field Manual 3-0, Operations, further highlight the military’s focus on MDO. The future fight will require highly capable and dispersed units to create and exploit temporary windows of advantage.

MDO requires a high level of coordination and integration among different military units and agencies, all working on synchronizing military capabilities across domains to gain a decisive advantage over the adversary. In turn, Army medical logistics must overcome several challenges to meet the military’s future operational demands.

Rapidly Changing Environment

Military units may need to move quickly from one theater of operation to another or adapt to a new type of threat. This means medical logistics must be flexible enough to adapt to changing requirements, supporting a variety of health care capabilities, and fast enough to move through distribution channels because large stores of medical supplies are difficult to move and maintain.

Limited Resources

Medical logistics also operates in a commercially based product environment where the healthcare industry supports multiple larger stakeholder efforts, including hundreds of millions living in the U.S., with many of the same materials. Military medical logistics must be efficient and effective in delivering the necessary medical supplies and equipment, even as a minor stakeholder in the market. Competition for the same products and resources used by all echelons of health care means excess built into the supply chain may be harder to achieve, and resources may need to be distributed with late notice to optimize availability for multiple simultaneous downstream requirements. Delayed delivery until the time of need to conserve scarce resources creates risk in ongoing sustaining operations.


MDO requires the integration of different military capabilities across domains. There are no dedicated transportation channels for medical supply in common commercial and military transportation channels. Medical logistics must be integrated into the overall joint logistics system to ensure typical medical supplies and equipment are available when and where they are needed and casualties from joint forces can be cared for by adjacent medical forces and capabilities.

Supply Chain Security

Medical logistics must be designed to ensure medical supplies and equipment are secure and protected from theft or sabotage, especially now that we understand the potential for scarcity. Healthcare operations can be systematically targeted by cyberattacks, compromising sensitive individual and force data, and interrupting efforts to care for wounded service members. The strategic industrial base also does not use a classified communications user interface, so those essential networks also present known vulnerabilities.

To overcome these challenges, medical logistics must implement five key elements:

Centralized Controls. The Army medical logistics system should be centrally controlled to ensure medical supplies and equipment are available when and where they are needed based on priorities to optimize outcomes. This requires a robust logistics management system to track medical supplies and equipment throughout the supply chain and authorize the reallocation of limited resources to support priorities.

Efficient Distribution System. The distribution system should be efficient to ensure medical supplies and equipment are delivered to the correct location at the right time and in good condition. This requires a well-coordinated system that can respond quickly to changing requirements, minimizing risks of conditions affecting the quality of healthcare products.

Robust Communication System. In MDO, communication is critical to ensure relevant operational data are translated into medical supply requirements and that centralized distributors make effective allocations to minimize supply deficits and competition for scarce resources. This requires a robust communication system that can operate across different domains and provide a common operating picture.

Security. The Army medical logistics system must be designed to ensure medical supplies and equipment are secure and protected from theft or sabotage. This requires a comprehensive security plan that covers the entire supply chain.

Training. Medical and logistics personnel must be trained to operate in a multidomain environment. This requires specialized training programs that can prepare personnel for the challenges of MDO.

Final Thoughts

MDO requires coordination and communication across different domains. As the Army continues evolving its plans to fight and win in a multidomain environment, medical logistics must continue integrating into the sustainment enterprise.

Supply chain management is crucial to ensure timely and efficient medical supplies and equipment delivery to the battlefield. Army medical logistics should use advanced technologies such as radio frequency identification and GPS tracking to monitor and manage medical supplies and equipment movement from the source to the battlefield. This also improves the fidelity of the common operating picture and speeds aggregated decision-making by centralized authorities in reacting to changing environments.

MDO may involve a wide range of medical situations, from minor injuries to complex trauma cases. Army medical logistics should standardize their medical capabilities to include specialized equipment, personnel, and facilities to meet the diverse medical needs of MDO. The Army partially achieves this with special programs pre-positioning common items and equipment globally to enhance responsiveness and resource availability. Enhancing projects with common resupply in configurations that can be applied in multiple domains quickly reduces the risk of competition and industrial base delay in a developing contingency.

MDO environments are often unpredictable and rapidly changing. Army medical logistics should increase their flexibility and adaptability to respond quickly to changing circumstances and adjust their medical logistics accordingly. Achieving velocity in an unpredictable environment can be attained by configuring common materiel at multiple locations in the supply chain, so they can be rapidly employed by users, loiter in transit vehicles to be applied in another domain, or be reallocated to another storage location in anticipation of a contingency. This deliberate decentralization of materiel storage with an improved common operating picture contributes to a more resilient supply chain, diffusing risk across multiple nodes.

Finally, the Army must continue to invest in training and education. Army medical logistics personnel should receive training and education on MDO to ensure they understand these operations’ unique challenges and requirements. This will enable them to make informed decisions and effectively manage medical logistics supporting MDO. Non-medical logisticians should also be able to support predictable and common configurations of materiel and integrate tactical teams of medical logisticians to enhance optimized supply chains.

By implementing these recommendations, Army medical logistics can effectively support MDO and provide timely and efficient medical care to Soldiers on the battlefield.


Lt. Col. Mark Sander currently serves as the commander of the U.S. Army Medical Materiel Center-Korea. He entered active service in the Army Medical Service Corps with an ROTC commission as a second lieutenant. He earned a Bachelor of Science in crime, law, and justice from the Pennsylvania State University and holds a Master of Business Administration from the University of Pittsburgh. His military education includes the Command and General Staff Officer Course, Army Medical Department Officer Basic and Advanced Courses, and the Health Service Materiel Officer Course. He has received technical certifications in joint logistics, support operations, intermediate systems acquisition, defense support to civil authorities, strategic studies, joint humanitarian operations, and joint planning.


This article was published in the Summer 2023 issue of Army Sustainment.


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