The National Defense Strategy (NDS), published by the Office of the Secretary of Defense roughly every four years, outlines the direction that the U.S. Department of Defense (DoD) will take to prepare for the global security environment in which it will operate.1 The NDS, itself, is informed by the executive branch’s national security plans and concerns, which are captured in a separate document known as the U.S. National Security Strategy. As such, the NDS informs investments to modernize the force, adapt the U.S. global force posture, and amendments to military policy and strategy to keep them aligned with future challenges.

The Growing Risk of High-Intensity Conflict The 2018 NDS notes that such potential adversaries as China, Russia, Iran, and North Korea have been investing in long-range, precision missile systems. In response, DoD senior leaders have shifted their thinking about requirements for future combat to ensure the resilience and, ultimately, success of U.S. forces in high-intensity conflict environments. One key element of that planning falls to the Military Health System (MHS), which must ensure that combat casualty care can surmount challenges to medical support that may arise in this future battlespace.