A call to restore U.S. military medical supremacy
The U.S. Senate Armed Services Committee recently asked how our struggling Military Health System (MHS) would respond to a large-scale conflict with a peer enemy. As I testified, to meet this looming threat, the MHS needs urgent intervention to get back to its singular focus on lifesaving combat care. The good news: we already have many of the building blocks in place. Let me illustrate with the story of an unexpected trauma survivor.
In 2010, U.S. Army Seargent Erik Ramirez* returned home to San Antonio, Texas, after suffering a devastating injury to his chest while serving in Afghanistan. Few patients wounded in battle had ever survived such devastating injuries, and before 2010, none had survived his specific injury—a sniper’s bullet that entered just above his body armor, crossed through his chest, and destroyed the major vessels of his right lung. The story of why SGT Ramirez came home alive to his friends and family is a decades-long tale of a few dedicated military and civilian visionaries pushing the MHS to learn from experience and to embrace cutting-edge medical innovations. In the middle of a combat zone, he was placed on extracorporeal membrane oxygenation (ECMO), a form of heart and lung bypass to rescue his failing heart after life-saving “damage control” surgery. This miraculous intervention occurred within a highly organized system that achieved combat medical supremacy—one that stopped at nothing to minimize preventable death on the battlefield and to bring every servicemember with survivable injuries home alive.
Over the past decade, our casualty numbers have thankfully waned significantly. But now our MHS struggles to maintain its edge in preparing medical teams for combat. While military hospitals provide essential medical care every day, it more commonly takes the form of preventive care and treatment for healthy patients, not time-sensitive, emergency procedures in patients with severe traumatic injuries or organ failure. In fact, a recent study found that only 10% military general surgeons are getting experience they need to be combat-ready. As a result, we now stand perilously close to letting the strategic advantage of our military medical system slip into obsolescence.
History has shown that allowing our combat medical system to fully dismantle will cost our military dearly in the next conflict. Since the start of World War II, we estimate that the decline in combat medical readiness during peacetime has cost over 100,000 U.S. servicemember lives. This means that up to one in four combat deaths over the past century were potentially preventable. Doctors, nurses, medics—in short, our entire military medical system—entered World War II, Korea, Vietnam, and even Afghanistan and Iraq unprepared, and service members died needlessly as a result.
How do we reverse this alarming repeat of history? First, we must continue to invest in the innovations that enabled the lifesaving innovations teams performed on SGT Ramirez in 2010. Founded in 2004, the Joint Trauma System (JTS) embraced our combat wounded from the point of injury through rehabilitation served as the essential bedrock. Upon this foundation we added advanced technology like heart-lung bypass. Leveraging the expertise of the JTS in five to six accredited military trauma centers would afford a strategic geopolitical advantage and build surge capacity into our MHS.
The MHS should also continue to leverage key civilian partners to train the military trauma teams we will need at scale. Over the past few years, the Health and Human Services (HHS) Pandemic All-Hazards Preparedness Act (PAHPA) has supported innovative military trauma training at civilian trauma centers including my trauma center at the University of Pennsylvania through the Mission Zero Program. This program promotes bi-directional military-civilian medical learning, support for our local community in west Philadelphia, and advanced trauma training for our Navy partners. Authorization for this program expired in December 2024. A new, expanded Mission Zero Program funded by both HHS and Department of Defense would greatly strengthen our nation’s ability to respond expertly to acts of terrorism, acts of war, and natural disasters.
Imagine two futures. In one, our MHS acts with urgency to establish high-volume military trauma centers while also continuing to collaborate with civilian centers to re-gain and even exceed the level of system-wide excellence we demonstrated a decade ago. In the other, we allow the “peacetime effect” to take hold, frittering away the ability to rescue our servicemembers when injuries occur, inevitably adding to the toll of preventable battlefield deaths when the next conflict erupts. As Edward Churchill observed after serving on the front lines of World War II, “In every new war … soldiers lose their lives and limbs because the doctor was ignorant of past experience.” We can turn away from the urgent need to restore and sustain a combat-ready MHS to our peril or embrace the challenge to re-establish our military medical supremacy. Those who serve our nation deserve medical supremacy.
*Name changed to protect patient privacy.
Jeremy Cannon is a Veteran Fellow at the Hoover Institution, Stanford University and Assistant Dean of Veteran Affairs at the University of Pennsylvania Perelman School of Medicine