Picture yourself as an infantry Soldier on the front lines in large-scale combat. Unlike your predecessors in the war on terrorism, who enjoyed freedom of maneuver and air superiority, you fight on a battlefield made transparent by drones. Moving forward, you are spotted and hit by an armed, small, unmanned aircraft system (sUAS) controlled by an enemy miles away. Gravely wounded but alive, you administer self-treatment and signal for evacuation. Knowing that medical personnel are a prime target, you are not surprised when the autonomous robotic vehicle deployed by your unit arrives, with friendly sUAS providing overwatch. Having drilled autonomously supported self-extraction, you pull yourself into the robotic vehicle, which delivers you to a protected casualty collection point. The on-site medic uses novel technologies to stabilize you for the next 72 hours until evacuation to a subterranean surgical team.
This is not the future. This is the reality of combat in Ukraine today. It is a significant departure from how the U.S. Army has operated over the last 25 years. The above-mentioned capabilities reflect how we are adapting to prepare for the next fight. Grounded in our why and with large-scale combat operations (LSCO) in mind, the Army Medicine Enterprise (AME) is continuously transforming to ensure we deliver combat-ready care to the Army and the joint force.
Continuous Transformation
AME is continuously transforming to ensure Soldiers receive world-class care on the battlefield, to return Soldiers to the fight, and to overcome contested logistics. In LSCO, gone are the luxuries of rapid medical evacuation from the theater of operations back to the continental U.S. This influences AME’s approach to adapt doctrine, organization, training, materiel, leadership, personnel, facilities, and policy to win at the pace of change. AME provides critical capabilities in both the sustainment and protection warfighting functions. The sustainment warfighting function includes medical treatment, medical evacuation, hospitalization, and medical logistics. The protection warfighting function provides operational public health, combat and operational stress control, dental services, laboratory services, and veterinary services. Medical command and control ensures effective and efficient management of medical resources and operations to support the overall mission.
Brilliant at the Basics: Elevating Training and Equipping
Effective treatment at the point of injury is the decisive factor in successful combat care. Prolonged evacuation times, contested logistics, and large numbers of casualties require all personnel to operate at the top of their abilities to deliver medical support. All units must train and equip Soldiers to deliver life-saving self-aid and buddy aid. Organic medics must train and sustain clinical decision-making and procedural skills to optimize survival of their fellow Soldiers. Timely initial assessment and proficiency with triage must be decisive to clear the battlefield, preserve life, and maximize return to duty.
Army educators are experimenting with virtual, augmented, and mixed reality to bring the next generation of medical simulation training to increase medical competencies for all Soldiers. The Army recently graduated its first class of enhanced combat medics, who are prepared to handle prolonged care, disease, and non-battle injuries, and to provide whole blood at the point of need. We will scale that capability across the force. We also continue to increase the number of paramedic-trained combat medics across our formations who have expanded scopes of practice.
Leveraging Partnerships: Health Security Cooperation
LSCO will present challenges for Role 2, 3, and 4 medical capabilities and capacity. To address this shortfall, AME is building a robust medical network through our theater medical commands across the total force. Multilateral meetings with partner surgeons general build trust, opening the door for cooperation, with the goal of achieving interoperability. Global health engagements during competition support theater security cooperation, laying the foundation for theater management of prolonged casualty care, evacuation, and convalescent care. This ability to treat wounded far forward reduces strain on personnel replacement systems while keeping experienced Soldiers in the fight.
Evacuation and Treatment in Contested Environments
Multimodal casualty and medical evacuation capabilities must operate across contested ground, air, and maritime domains. Our military treatment facilities will modernize to be mobile, protected, and employed in novel ways, such as underground and concealed locations.
Adapting Combat Stress Control to Evolving Challenges
Lessons learned from Ukraine tell us that a new paradigm of combat stress has emerged with the sound of drones constantly overhead and medical facilities, equipment, and personnel indiscriminately targeted. LSCO will challenge medical personnel with triage, who will make the hard decisions of applying limited medical supplies to maximize the return-to-duty potential of the wounded. This requires agile, adaptive, and realistic training to indoctrinate our forces to the realities of modern combat.
Overcoming Contested Logistics
To deter our adversaries, the Army must have sufficient “magazine depth” to sustain and prevail in conflict. Adopting the term from our combat arms brethren, medical magazine depth describes the availability of fully staffed and equipped hospital beds, blood products, evacuation platforms, and medical supplies. AME’s logisticians are working diligently with our joint partners to improve interoperability and resilience in the medical supply chain. We are prioritizing redundancy, strategic stockpiling, and partnerships. Observing medics in the Armed Forces of Ukraine as they use non-Food and Drug Administration-approved medications to successfully treat their wounded, we will seek safe avenues to provide cutting-edge therapies and devices to save lives.
Bio Surveillance and Counter Measure Developments
America’s Army prides itself on its expeditionary capabilities to engage our enemies away from the homeland. Multiple drug-resistant bacteria now infect almost 100% of Ukrainian casualties. Active screening for and early notification of bacterial infections acquired from combat are an integral part of force health protection. To prevent a microbial attack on the homeland, we will invest in rapid novel therapy development and infection prevention and control for drug-resistant bacteria.
Rethinking Casualty Reception
As our wounded return to the homeland through an inter-theater air medevac system, battle tested and continuously refined since World War II, they will flow into War Department (DOW) and Department of Veterans Affairs hospitals. The National Disaster Medical System (NDMS) employs civilian hospitals to provide additional capacity if additional casualty reception is required. AME is urgently working with our sister Services, the Joint Staff, the Defense Health Agency, the Uniformed Services University, and the Department of Health and Human Services to ensure the NDMS is ready to receive the tens of thousands of casualties projected for LSCO in Europe and the Indo-Pacific.
Decision Advantage Through Integrated Sensing
Underlying all our transformation is a robust data strategy to enable commanders to make decisions informed by the AME. The Army does not need a medical common operating picture. Instead, medical equities must be integrated with the Army’s Next Generation Command and Control as part of the integration, data, and application layers.
Our Why
AME is integral to mission success. From accessions at military entrance processing stations, to ensuring the medical readiness of Army formations, to inspecting the food that Soldiers and families consume on military installations, to taking care of DOW’s military working equids and dogs, to the unwavering commitment and bravery of our men and women who run to the sound of the guns to take care of our nation’s wounded, AME keeps faith with the all-volunteer force.
The Army will bring its exquisite medical capabilities to the joint fight. AME strengthens the will to fight by inspiring warfighters to trust that the best care in the world is with them and their families at home and on the battlefield.
AME is continuously transforming to deliver combat-ready care.
This We’ll Defend.
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LTG Mary Izaguirre is the 46th surgeon general of the U.S. Army and the commanding general of U.S. Army Medical Command, Joint Base San Antonio-Fort Sam Houston. Previously, she served as commanding general of U.S. Army Medical Readiness Command, East. She deployed multiple times to Iraq and Afghanistan. She is a doctor of osteopathic medicine, board-certified in family medicine, and is a Fellow of the American Academy of Family Physicians. She has three master’s degrees: one in public health from the University of Washington, one in military arts and science from the U.S. Army Command and General Staff College, and the third in national security and resource strategy from the Eisenhower School for National Security and Resource Strategy.
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This article was published in the fall 2025 issue of Army Sustainment.
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