A U.S. Army paratrooper moves a casualty toward cover and concealment to conduct combat casualty care.

Cuts to the military medical budget over the years and delays in implementing reforms across the Defense Department health system have undermined the Pentagon's ability to care for troops in wartime, a panel of experts warned Congress on Tuesday.

The system, which provides health care for 9.6 million beneficiaries, including roughly 1.3 million active-duty service members, is struggling with what is known as the "peacetime effect" -- making sure that physicians, nurses, medics and corpsmen have needed military training and experience needed to care for troops during conflicts.

It also is dealing with systemic changes initiated in 2017 that have not been fully realized, leaving hospitals short-staffed and patients seeking care elsewhere, witnesses said at a Senate Armed Services Committee hearing on military medical combat readiness.

Read Next: Lawmakers File Bills to Create Space National Guard, Taking Trump Up on Promise[1]

The Defense Department began reorganizing the military health system nearly a decade ago with a plan to focus the service medical commands on troops and training medical forces for garrison and wartime operations, with the Defense Health Agency managing support services, facilities and health care for family members and other beneficiaries.

Staffing miscalculations, combined with the COVID-19 pandemic and a budget that has not kept up with medical inflation, has left the system unprepared for trauma medicine, retired military trauma surgeons and the first director of the Defense Health Agency said.

Retired Air Force[2] Reserve Col. Jeremy Cannon, who deployed to Iraq and Afghanistan and currently manages a trauma training partnership between Penn Medicine and the U.S. Navy[3], said just 10% of military surgeons currently are combat ready -- a result of not having enough patients or a variety of cases.

"If we maintain the status quo and enter a pure conflict unprepared, we will condemn thousands of warfighters to preventable death. Without urgent intervention, the [military health system] will continue to slide into medical obsolescence," Cannon said.

In 10 years, the budget for military health facilities has declined by nearly 12%, according to committee chairman Sen. Roger Wicker, R-Miss., while medical inflation has risen an average of 5.1% per year.

A concerted effort to rein in health costs in the last decade has greatly affected military physicians' ability to provide care and maintain their skills, said retired Air Force Major Gen. Paul Friedrichs, who served as the Joint Staff Surgeon from 2019 to 2023.

"Health care is not cheap. The mistaken belief that somehow military medicine can be done at a lower cost than in the civilian sector and be ready for conflict is just that," Friedrichs said.

In late 2023, then-Deputy Defense Secretary Kathleen Hicks issued a memo calling for the system to bring patients back into military treatment facilities[4] -- family members and retirees who left either by their own choice because they faced challenges getting care at military hospitals and clinics or were forced out with the increased emphasis on active-duty personnel.

The former officers said that, although those patients usually don't present opportunities for practicing trauma skills, care for acute and chronic conditions helps military medicine maintain proficiency.

For example, Friedrichs said, similar skills are needed to reconstruct or remove a bladder that has been damaged by a gunshot wound as are used to operate on a patient with bladder cancer.

"We need our military medics taking care of sick patients. That is how we have done it historically to maintain the proficiency of surgeons or critical care nurses or the medical logistics staff. ... It's not a perfect analog, but it is the best surrogate," Friedrichs said.

In addition to bringing back patients and keeping hospitals staffed, the military health system should ramp up efforts to become premier trauma centers in their communities, they added.

Cannon said the system should establish "five to six" high-volume military facilities that serve as centers for trauma and burn care and are part of the national emergency preparedness system, open to military and civilian emergencies.

Currently, Brooke Army Medical Center in San Antonio, Texas, is the DoD's only highest-level trauma center, although other hospitals, including Walter Reed National Military Medical Center in Bethesda, Maryland, have received lower-level trauma designations.

Retired Air Force Lt. Gen. Doug Robb, who served as the first head of the Defense Health Agency, and Friedrichs also added that the Defense Department and the Department of Veterans Affairs[5] should increase the level of their partnerships, working together to treat patients in co-located or integrated facilities.

"What I think is really important is that we have to create a capability," Robb said.

Friedrichs, who commanded the joint venture DoD-VA hospital in Anchorage, Alaska, said success has been achieved in similar partnerships in Pensacola, Florida, and at Travis Air Force Base[6] in California.

"We want access to critical care patients for our proficiency, and the VA wants access to resources, which is either excess capacity on space or in staff, and so I think that's continued movement forward," he said.

The three urged lawmakers not to shutter any pipelines for medical personnel training, given the shortage of providers in the military and civilian sectors, and they pressed for the creation of a Joint Trauma System responsible for spearheading combat casualty care.

Currently, according to Cannon, no single command heads up this important mission.

"In 2017, the Joint Trauma System, or JTS, was codified in law. This committee must now strengthen the statutory language to affirm that JTS owns combat casualty care and to provide this precious resource with both top-down authority and bottom-up support," Cannon said.

The recommendations come as the Trump administration has launched an effort to reduce the size of the federal workforce. An estimated 5,400 Defense Department employees were expected to lose their jobs[7] in the first round of cuts, including some from the Defense Health Agency.

Wicker and the committee's ranking Democrat, Sen. Jack Reed of Rhode Island, said they would consider crafting legislation to help improve readiness, and they urged the Defense Department to continue pursuing reforms.

"We must stop scapegoating the Defense Health Agency. The DoD must request adequate resources to ensure that the department's hospitals and clinics are properly staffed and equipped. This is the best way to ensure that the military health system is ready for the potential demands of large-scale combat operations in the future," Wicker said.

Reed added that the system must be fixed to ensure that U.S. forces aren't caught without access to care, especially in remote locations where medical responders might not have access to logistics and support.

"The Department of Defense made progress to break through [its] inertia in 2023 when it issued a memorandum with specific directions to stabilize and improve the military health system. ... More work remains to be done, and I hope that the Trump administration will continue the momentum in this area," Reed said.

Related: Pentagon's Top Doc Defends Military Health System Budget, Lays Out Plans for Improvements[8]

© Copyright 2025 Military.com. All rights reserved. This article may not be republished, rebroadcast, rewritten or otherwise distributed without written permission. To reprint or license this article or any content from Military.com, please submit your request here[9].

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The Armed Services Vocational Aptitude Battery (ASVAB) examinees from Yokota High School take the test at Yokota Air Base, Japan.

Military.com | By Konstantin Toropin[1]

Published

This is a breaking news story and will be updated.

Locations set up across the country to give military entrance exams to potential recruits have been forced to close or reduce hours due to Defense Secretary Pete Hegseth halting the use of government travel for civilians, according to a notice and email reviewed by Military.com.

The Army[2] has managed the Military Entrance Testing program, which is designed to aid recruiting[3] and make it easier to administer the entrance exam, known as the Armed Services Vocational Aptitude Battery, or ASVAB[4], to potential recruits for all the military branches. The service did not immediately provide information on closed locations and curtailed operating hours, but the changes were recently announced by the U.S. Military Entrance Processing Command.

"The suspension of civilian employee travel has impacted Military Entrance Testing (MET) Site operations," a post to Facebook by the Military Entrance Processing Command[5] announced Friday. The command said it was "conducting analysis to determine which MET sites can remain operational using alternative means."

As a result of Hegseth's halt on civilian travel, potential recruits now have to travel to a Military Entrance Processing Station to take the test that is a critical prerequisite for enlistment, which in some parts of the country could mean driving for many hours.

When asked about the halt, officials for Hegeseth referred Military.com to a memo written by Darin Selnick, who is performing the duties of under secretary of defense for personnel and readiness, that was issued March 5[6] and restricted almost all civilian travel.

Related: Pentagon Caps Civilians' Government Charge Cards at $1, Limits Travel as Part of Trump Cuts[7]

Military Headlines[8] Army[9] Military Entrance Processing Station - MEPS[10] Department of Defense - DoD[11] Pentagon[12] Pete Hegseth[13] Recruit[14]

© Copyright 2025 Military.com. All rights reserved. This article may not be republished, rebroadcast, rewritten or otherwise distributed without written permission. To reprint or license this article or any content from Military.com, please submit your request here[15].

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Packages of red blood cell units sit inside a walk-in refrigerator in the Blood Transshipment Center at Al Udeid Air Base, Qatar, Jan. 13, 2016.

The Defense Department's deep research and development arm is exploring ways to hack U.S. service members' blood so they can fight harder and longer in what could represent a major step toward engineering troops with seemingly superhuman capabilities.

The Defense Advanced Research Projects Agency's Red Blood Cell-Factory program, unveiled[1] in December, is developing a medical device that could feed "biologically active components" into U.S. troops' red blood cells. Those doses, when triggered, could help them overcome injury or illness on the battlefield.

That could help troops operate in the harshest environments, from extreme cold to disease-ridden jungles to even subterranean environments, according to RBC-Factory program manager Dr. Chris Bettinger.

"This is all about reimagining how we can protect service members," Bettinger tells Military.com. "We want to answer the question: To what extent can we endow red blood cells with compounds in a stable way, and have those red blood cells serve as a durable, circulating project to contain and release that compound?"

As Bettinger explains it, red blood cells are an ideal delivery vehicle for biological compounds like peptides and proteins because they can circulate reliably in the human bloodstream for months. In practical terms, DARPA envisions using a pre-deployment[2] regimen to customize some of a service member's red blood cells to deal with threats specific to where they're headed, not unlike the military health system's area of operations-specific vaccination recommendations[3].

"We could empower them with new compounds to energize and animate them to do new things," Bettinger says.

Biological interventions for military personnel have been a fixture of modern warfare for well over a century since cocaine hit the front lines[4] of World War I. Today, some American service members are still exposed to performance-enhancing drugs, whether they're authorized "go" and "no-go" pills for military aviators[5] or illicit steroids[6] for special operations[7] forces. In recent years, the Defense Department has even explored technological augmentation, from powered exoskeletons[8] to brain implants[9], to potentially enhance troop performance. A 2019 Army[10] report[11] looking at the future of the "cyborg soldier" suggested that the "introduction of augmented human beings into the general population, DoD active-duty personnel, and near-peer competitors will accelerate in the years following 2050."

But with the rise of gene editing and other advancements in medical technology, the U.S. military may now be in the middle of a bioengineering arms race[12] with those near-peer competitors, Russia[13] and China[14], in pursuit of physiological enhancements that might give troops an edge on a chaotic battlefield.

The RBC-Factory program is one of several recent initiatives explicitly focused on building biological resilience. Established[15] in 2018, the agency's PReemptive Expression of Protective Alleles and Response Elements (PREPARE) program is tasked with developing a gene editing system to allow the on-demand activation of the body's innate physiological defenses. In 2023, the agency announced[16] its Synthetic Hemo-technologIEs that Locate & Disinfect (SHIELD) program to develop preventative treatments to protect troops against the fungal and bacterial pathogens that can cause bloodstream infections following trauma like a gunshot wound or blast exposure.

The general conceit of the the RBC-Factory program -- introducing a specially engineered substance into an average service member's body to boost their performance on the battlefield -- may sound similar to the process that transformed fictional Army recruit Steve Rogers into the super-soldier Captain America (or, well, the real world example of juicing[17].) But Bettinger's description of the RBC-Factory's potential applications is more reminiscent of a different fictional character, Wolverine from the mutant X-Men: The compounds delivered through modified red blood cells could help troops heal faster and better resist disease rather than, say, run a two-minute mile[18] or do backflips off of hostile aircraft[19].

"Imagine a world where service members have red blood cells accessorized with a compound that prevents bleeding," Bettinger says. "What happens after trauma is that you have a rupturing of red blood cells in the body's vasculature. But in this scenario, you have someone prophylactically protected against bleeding, so if they do sustain a trauma, the red blood cells dump out the compound that promotes coagulation and prevents bleeding."

Bettinger points to malaria, a scourge to American service members deployed overseas to tropical environs, as another example of a potential problem the RBC-Factory program can combat. By infusing troops with red blood cells containing an antimalarial peptide, the system could help prevent an infected service member from ever feeling sick.

"In early stages of malarial infection, the red blood cells deliver a medical countermeasure on demand to restore baseline function," he says.

For now, Bettinger is quick to emphasize that the project is focused on troop protection and restoration rather than outright physiological enhancement, noting that DARPA is intentionally eschewing genetic manipulation as it looks at potential solutions.

"We're not talking about augmenting anything," he says. "It's about force protection."

A blood-borne compound delivery system could also have ramifications beyond just preventative treatments, offering a source of physiological protection in tactical scenarios where traditional medical interventions may not be available.

"You can't stockpile enough of the vaccine or antivirus capability to protect the population against that in the future," as then-DARPA director Steven H. Walker put it[20] in 2019. "But that is why you want to be able to actually have your body be the antibody factory, if possible."

As with many early-stage DARPA efforts, the RBC-Factory program is currently focused on "fundamental research" designed to simply map the contours of what's possible in terms of introducing blood-borne compounds into a service member's body. At the moment, the two-year program is in the source selection phase, with officials reviewing proposals and identifying potential performers to deliver prototypes for assessment.

Just as with discussions of performance-enhancing drugs[21] and other biological interventions[22], the program comes with a slew of thorny ethical and legal challenges[23] for Bettinger and his team to unpack. Do service members have to consent to any type of treatment, or must they simply acquiesce to orders? Can they refuse such treatments on ethical grounds? What are the long-term health effects, and how can service members make an informed decision regarding their treatment if those effects are still unknown? And if adverse effects emerge years later, who bears responsibility for a service member's care and compensation?

DARPA says it's laser-focused on exploring the ethical, legal and social ramifications of red blood cell modifications before proceeding too far down a research path.

"We try to think deeply about the impact of our research," Bettinger says before inadvertently paraphrasing "Jurassic Park"[24]: "We step back, take a deep breath, and try not to get so obsessed with whether we can do something, but if we should do something."

© Copyright 2025 Military.com. All rights reserved. This article may not be republished, rebroadcast, rewritten or otherwise distributed without written permission. To reprint or license this article or any content from Military.com, please submit your request here[25].

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