The investment made by our military in providing the best medical services possible for our warriors is inspiring. After a decade of conflict, federal medicine is not resting on its laurels but continues to refine and improve its global system of care. I recently had an opportunity to serve as a physician consultant to a medical-war gaming exercise designed to challenge the next medical-command staff being deployed to Afghanistan. The exercise involved demanding scenarios developed from real-world incidents. The deploying staff managed each scenario under the scrutiny of experts from every aspect of deploying medical care, from logistics to public affairs. What a tremendous opportunity for these leaders to meld as a medical-battle staff prior to taking control of the “real deal.”

I extend my congratulations to the military medical leaders who have developed this exercise for deploying command elements. Any leader involved in an exercise of this type will immediately see the intrinsic benefits from this type of preparedness training.

I did have one persistent, unsettling thought throughout the exercise. As a student of history, I can say with some certainty that the next war to challenge our federal system of medicine will be nothing like the current conflicts. I have always been concerned that our medical response tends usually to be based on assumptions rooted in the medical lessons of the previous war. Since the Korean conflict, we have had the technological edge and the assurance that our air and sea lanes are free of molestation as we faced our enemies. I think it is fair to say that our present, incredible wartime medical response has, at its foundation, the assumption that the American military will always have uncontested control of movement in and out of the battle space. Will that always be true? Can we assume such freedom of medical supply and evacuation capability in a true, peer-to-peer conflict? Will we be ready to medically respond and meet or exceed our “ less than 10% died of wounds” success with a sudden change in the present conditions we take for granted in battlefield medicine?

George Allen’s understanding of the need to be prepared for anything allowed him never to coach a pro football team to a losing season in 14 seasons. We can be justly proud of our medical record in the present conflict; let’s be sure to be prepared for whatever challenges are revealed in the next conflict.

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