The US military is woefully unprepared for the catastrophic casualties of a major Pacific war

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12-03-2025

US military healthcare is unprepared for high numbers of wounded in a potential Pacific conflict.
The National Disaster Medical System needs revitalization to boost military-civilian medical ties.
US military experiences in combat casualty care over the past two decades won't translate.
There are a lot of unknowns when it comes to great-power war, but one thing is fairly certain: the casualties would be horrific.
The US military's healthcare system, however, is woefully unprepared to handle the numbers of wounded that could come with large-scale, high-intensity combat against a major military power like China in the Pacific, military health experts told Congress on Tuesday.
"The Military Health System does not have the capacity to care for every casualty," Paul Friedrichs, a retired Air Force general and former Joint Staff Surgeon, said of the high numbers of wounded troops who would stream back to the US from war.
The Pentagon did not respond to Business Insider's request for comment in time for publication.
Getting the US military healthcare system better prepared and developing the much-needed relationships with civilian medical institutions before it's too late is going to be a very heavy lift, Friedrichs and others told the Senate Armed Services Committee. He added that the current challenges are more than it can handle.
"We don't have the capacity to care for the people in peacetime right now," he said, arguing that "to think that somehow we can do this on our own is another mistaken belief."
Friedrichs touted the usefulness of the National Disaster Medical System, originally created to boost national casualty preparedness in the event of large-scale warfare by increasing interoperability between military and civilian medical facilities.
But the program has been overlooked for years and now needs drastic attention as part of a broader national medical effort.
"We're short 300,000 nurses nationally. The projections are we will be short 130,000 doctors by 2035. There is no way that we can do this individually," Freidrichs said.
When the NDMS was originally created in the Cold War era, lawmakers realized that a war effort could not rely solely on the military's healthcare system, Friedrichs said. Rather, it would need to be augmented with the veteran's health administration and civilian partners, including hospitals and academic institutions.
Such partnerships have fallen to the wayside, the panel said.
"We need to put our foot on the gas," echoed retired Air Force Colonel Jeremy W. Cannon, a professor of surgery at the University of Pennsylvania, noting "we don't have five years, 10 years, 20 years. We need the solution really now."
"No one in the DoD truly owns combat casualty care," he added, making it harder for the military to even begin to better prepare.
That military healthcare experts have expressed such concerns about combat casualty care may come as a surprise to some after two decades of war in the Middle East.
During the height of combat in Iraq and Afghanistan, American air supremacy and regional support infrastructure meant troops could often be evacuated for higher-level medical care within the "golden hour" window.
But the logistics of warfare, including triage for the injured, is poised to be dizzyingly complex in the Pacific, especially as the US faces a severe shortage of ships. The US has just two hospital ships that are in need of replacement.
And that's not even factoring in threats posed by enemy activity.
Adding to the complexity is that the military's health system remains siloed in their healthcare operations and training, without a truly meaningful "joint" approach to healthcare, said Friedrichs.
Jointness helps various parts of the military more easily work together, and creates standardization that can make fighting wars and taking care of the wounded easier and more effective.
And the challenges don't stop there. Just 10% of military general surgeons are receiving the patient volume and variety needed to keep their medical skills sharp and prepared for combat injuries. In the absence of active warfare and without sufficient training opportunities to work in facilities like civilian emergency rooms or other surgical facilities, medical skills are becoming rusty.
"We're actively falling into the trap of the peacetime effect," Cannon said, noting that in a Pacific war, the US military could see up to 1,000 troops killed and wounded each day for months, overwhelming the systems in place. Neither the military health system nor the civilian sector could absorb such extreme numbers in their current capacities.
"Many of these patients will have survivable injuries," Cannon said. "Yet one in four will die at the hands of an unprepared system."
Read the original article on Business Insider