Joint Force Quarterly
Abstract
This article argues that health services support remains insufficiently integrated into planning, wargaming, and exercises for distributed maritime operations and expeditionary advanced base operations. The authors describe the common practice of “fairy dusting,” in which planners accept unvalidated assumptions about medical support, casualty movement, logistics, and sustainment in order to keep exercises moving. In a contested Indo-Pacific environment, however, high casualty rates, extended evacuation timelines, dispersed forces, vulnerable supply chains, and limited medical capacity could place severe strain on existing health services systems. Drawing on doctrine, after-action reports, and interviews with Navy, Marine Corps, medical, and logistics leaders, the article identifies gaps in exercise design, organizational understanding, multinational integration, and medical modeling. The authors recommend deliberately incorporating health services into long-term exercise plans, expanding bilateral and multilateral participation, improving gaming, exercising, modeling, and simulation tools, and strengthening education and wargaming practices for medical planners. More realistic and sustained integration of health services support, they argue, is essential to identifying risk and preparing the joint force for the demands of large-scale distributed maritime combat.
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