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As reported in the 2022 Biden-Harris National Security Strategy, China is perceived as the primary U.S. competitor with the intent and means to become the world's greatest superpower. China's efforts, which are at odds with America's ambition to maintain its global influence, are complemented by ostensibly harmless "gray zone tactics," defined as coercive geopolitical, economic, military, and cyber activities below the use of kinetic military force. Such tactics may be utilized with seemingly innocuous intentions, but in reality, they can complicate U.S. combat casualty care in the event of an Indo-Pacific conflict. One tactic of particular impact is China's development of artificial islands throughout the South China Sea. By creating these islands, China is expanding its reach beyond its continental borders. These islands, alongside China's well-developed naval and missile capabilities, will cause disruptions to U.S. casualty care staging, medical resupply, and aeromedical evacuations. To mitigate those threats, the USA should implement a robust regional Combatant Command Trauma System, improve global health security cooperation with local partner nations, and implement irregular or guerilla trauma systems that meet medical needs in impromptu, clandestine settings. Operational recommendations based on these efforts could include pre-positioning tactical combat casualty care and damage control resuscitation supplies and developing with nearby host-nation evacuation platforms such as small boat operators. These solutions, among others, require years of training, relationship-building, and capability development to institute successfully. As a result, U.S. Military leaders should act now to incorporate these strategies into their irregular warfare, low-intensity conflict, and large-scale combat operation toolkits. [ABSTRACT FROM AUTHOR]

As the US national security strategy focuses on Sino-American campaigning in the Indo-Pacific, enhancing the US DoD combatant command trauma system by incorporating Ally and partner nations represents a critical opportunity for improving geostrategic alliances and building partner-nation capacity. With the potential for a theater-wide war, the current security environment highlights the importance of developing a robust trauma system capable of (1) optimizing global health engagement, (2) increasing trauma care readiness, (3) enabling interoperability between the United States and partner nations, (4) enhancing interagency partnerships, and (5) supporting integrated deterrence. This article offers a framework to transform the existing command trauma system into a global trauma system that allows the Department of Defense, working with Allies and partners, to support casualty care in the Indo-Pacific and beyond. [ABSTRACT FROM AUTHOR]