As the United States' post-9/11 wars in Afghanistan and Iraq come to a close, the hard-fought gains in military medicine are now facing an uncertain future. While the medical corps made significant innovations during these conflicts, the Pentagon's attempts to cut healthcare costs by outsourcing care to civilian institutions have jeopardized the progress made.

During the early years of the wars, the military's surgeons faced challenges as they were thrust into performing procedures they had never encountered before, such as double amputations. Surgeons, who predominantly drew their experience from emergency rooms in big cities, quickly adapted to the rigors of a war zone. Despite the harsh conditions and contaminated wounds that soldiers often arrived with, the medical corps employed new tactics, like pop-up surgical teams, to provide life-saving treatment within the critical "golden hour" after injury.

The success of these innovations led to the highest survival rates for battlefield wounds in the history of warfare, according to Art Kellermann, a former dean of the Uniformed Services University. However, the gains achieved during these conflicts now face new challenges. The Pentagon's decision to outsource care from military treatment facilities to civilian institutions had unintended consequences. Military hospitals lost a significant number of patients, which in turn reduced opportunities for doctors to practice and maintain their skills. The combination of this trend and the impact of the ongoing pandemic has resulted in many clinicians leaving the military.

"Crazy ideas" were even proposed to close down the Uniformed Services University, which preserves the advancements achieved in military medicine over the past two decades, and the talented doctors behind them. Kellermann emphasizes the importance of these medical advancements, comparing them to essential gear like helmets and flak jackets. They instill confidence in U.S. troops, assuring them that they will likely survive if injured, thereby allowing them to confidently face danger.

However, a Defense Department internal memo obtained by NPR revealed that outsourcing medical care did not actually save money and instead undermined readiness. Consequently, the Pentagon is now directed to reverse course and increase medical care in base hospitals, as well as bolster medical staff.

Looking ahead, the future of wartime medicine may look very different. The ability to rapidly treat injuries during the wars in Iraq and Afghanistan was largely facilitated by U.S. air superiority, allowing for quick medivac responses. However, retired Air Force deputy surgeon general Sean Murphy warns that future scenarios may not have this advantage. He emphasizes the need to plan for scenarios where air superiority is absent, like a potential peer-to-peer fight in the Pacific region. Murphy suggests that every soldier and sailor should be trained as a medic, requiring the Pentagon to urgently rebuild its capable medical force.

In conclusion, as the post-9/11 wars wind down, the gains made in military medicine stand at risk. The outsourcing of care to civilian institutions has disrupted the medical corps and undermined readiness. However, with the recent directive to bring medical care back to base hospitals and increase staff, efforts are being made to preserve and build upon the advancements achieved. Looking forward, preparing for future conflicts where air superiority may not be guaranteed becomes an essential consideration, as the importance of military medicine remains a vital component in ensuring the survival and well-being of U.S. troops on the battlefield.