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Without question, the commitment of materiel and personnel to saving life and limb in close support of combat troops constitutes a significant contribution to military effectiveness. This is especially true for a military force recruited from the population of a democracy. Although mechanisms dedicated to preserving both the personal dignity and individual integrity of troops do add complexity to the organization of combat support, experienced field commanders have long recognized that sustained military effort is impossible without them. Indeed, logistics, of which medical support is a key clement, is integral to sustainability. Experience teaches that these "support" considerations ultimately determine the order of battle, as well as the success of any military strategy.

Despite increasingly more sophisticated naval weaponry and the greater use of automation in military systems, we remain heavily dependent upon competent human assets to facilitate combat operations. History has repeatedly demonstrated, however, that the human costs of naval warfare can be substantial! The saving of lives in close support of combat can thus contribute significantly to a navy's effectiveness.

Any military expeditionary force, whether deployed for offensive or defensive purposes, must be prepared to manage the major and expected by-products of military action—wounded and diseased personnel.

The discipline of military medicine is dedicated to keeping our uniformed services "fit to fight." With an extensive historical, academic, and technical knowledge base of its own, it is responsible for maintaining the medical hygiene of deploying forces, as well as treatment of the unique diseases and injuries associated with combat operations. This is generally done while utilizing procedures and "ground rules" not directly adaptable from peacetime practices. Military history provides many lessons that confirm the validity of the precepts of military medicine. Unfortunately, many of these principles have lain fallow between conflicts, requiring that they be relearned at great human expense during subsequent engagements.

In any operational logistc equation, history clearly demonstrates that military medical capability, composed of sound doctrine and supported by mobilization-ready assets, is not only an integral component of an effective force but also an absolute requirement for its success. In today's Navy, unfortu­ nately, fleet medical support doctrine remains insufficiently defined, inade quately validated, end not specifically integrated into the "Line's"•warfighting concepts of operations. These limitations render it difficult to define requirements for medical readiness in the fleet. Furthermore, such ill-defined readiness goals prevent the setting of standards for measuring or reporting progress.

In response to a broad set of complex national security challenges of the twenty-first century, the Quadrennial Defense Review (QDR) report of Febru- ary 2006 advised that all the organizations, processes, and practices within the Department of Defense be given a high degree of agility, flexibility, responsive- ness, and ultimately effectiveness in supporting the joint war fighter and future national defense goals.