FALLS CHURCH, Va. — The future of warfare is uncertain, and tomorrow’s conflicts may not look like today’s. To prepare for this uncertainty, the Air Force is assessing how it prepares its medical forces to support the warfighter.

For the last 17 years, the Air Force honed a medical force that excels at delivering life-saving care on the battlefields of the war on terrorism, offering unparalleled medical evacuation for wounded, ill, and injured service members. The Air Force Medical Service worked closely with combatant commanders to develop the deployment platforms appropriate to those environments and adversaries.

Now as times change, the AFMS must prepare for what is on the horizon.

“Our medical readiness needs are based on the types of conflicts we engage in,” said Chief Master Sgt. George Cum, Chief, Medical Enlisted Force, office of the Air Force Surgeon General. “For the past 17 years, we’ve been fortunate to have the highest survival rate on the battlefield of any conflict in history. But, that has been in a relatively uncontested state.”

The war on terrorism takes place primarily in combat theaters where the U.S. and its allies have mostly free access to the skies and can place in-theater hospitals with few restraints. A future conflict against a peer adversary with a broad array of capabilities may restrict this access. This requires a change to the Air Force’s strategy for treating and evacuating injured service members.

The 2018 National Defense Strategy outlines these concerns, and the need for U.S. forces to adapt. For the AFMS, this process starts by coordinating closely with combatant commands to make sure Air Force Medicine meets their needs.

“The AFMS has to stay responsive to combatant commanders,” said Col. Colin Smyth, director, Expeditionary Medical Policy and Operations at the AFMS. “We conduct regular assessments of requirements, and adjust our capabilities accordingly.”

This process has already led to changes in Air Force medical deployment platforms. The Air Force deployed a new forward surgical model, the Ground Support Team, in 2017. GSTs incorporate lean, agile surgical capability with integrated logistical support, allowing them to deliver life-saving care in austere conditions over a much longer time.

“Providing care over the long term isn’t just about skills and surgical capability, it’s also about logistics,” said Cum. “How do you manage your supplies for long missions? How do you balance your work/rest cycles with a small team of medics when patients need constant monitoring? What happens when an adversary contests our ability to evacuate or resupply that surgical team?”

Air Force medicine has not had to address these questions on a large scale for many years. Even in Vietnam and the first Gulf War, U.S. forces relied on aeromedical evacuation and in-country hospital facilities to deliver higher levels of care.

“You really have to go back to Korea and World War II to find combat theaters like we need to prepare for today,” said Cum. “When we deploy medical forces forward, they need to be ready to survive on their own and deliver care for the long haul.”

Aeromedical evacuation forces must also adjust to prepare for future conflicts. With the possibility that fewer in-theater hospitals will be available, the Air Force must be ready to transport more critically injured patients.

“Evaluating combatant commanders’ requirements revealed that we need more Critical Care Air Transport Teams,” said Smyth. “We are building additional teams to meet that requirement.”

As the Air Force prepares for the future, readiness will continue to play a vital role. In future conflict scenarios, the AFMS might not have time to plan readiness cycles in advance. If a conflict begins abruptly, or entails a total commitment of forces, there may not be time for medical Airmen to spin-up their training before deployment.

“When we consider potential adversaries, it’s going to take a full effort to provide the medical capability our forces rely on now,” said Cum. “Future conflicts may limit the time for just-in-time training, or spin-up training. We need to be ready today.”

The AFMS is finding new ways to incorporate medical readiness training into medics’ everyday duties. Air Force hospitals and clinics remain vital pieces of this readiness puzzle, through training, exercises and simulations. Much like the medical teams the Air Force deploys to the battlefield, the AFMS must stay agile to remain aligned to the needs of line forces.

Cum captures his feelings on this topic with a quote from President John F. Kennedy, found at his gravesite in Arlington National Cemetery.

“There’s one inscription that caught my eye,” said Cum. “It’s from President Kennedy’s inaugural address. ‘In the long history of the world, only a few generations have been granted the role of defending freedom in its hour of maximum danger. I do not shrink from this responsibility – I welcome it.’

“More than 50 years from when he said that, I think it’s still relevant. As a medical force, we should welcome that responsibility by being ready today.”