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During confirmation hearings, Secretary of Defense Pete Hegseth emphasized restoring a warfighter ethos within the Pentagon, stating "my priorities will be optimizing lethality and improving recruiting, retention and readiness." Amid the commotion, it was easy to overlook the important link between these goals and the military's health and casualty care systems. A renewed focus on a warrior ethos is worth a closer look, including implications for the state of Minnesota and its position as a leader in health care and biomedical technology.

The military member or "soldier" has been described as the most valuable weapon system in the armamentarium, more important than tanks, jets and ships and associated weaponry. The National Defense Strategies of 2018 and 2022 describe the need for the military to prepare for multi-domain operations against adversaries which involve simultaneous battle in the domains of land, sea, air, space and cyber. As part of these discussions, the human domain is often cited as a sixth and most important domain, emphasizing the need to optimize and, when needed, repair and recover the individual service member.

Recognizing the importance of the human system, how, with an all-volunteer force, do we maximize recruiting, retention and lethality, and as Hegseth proposes, a warfighter ethos?

The Iraq and Afghanistan Wars were the longest in U.S. history and the first to be conducted without a draft. The presence of high-quality health and casualty care systems were and remain a cornerstone of recruitment and retention, and part of the deal America makes with its non-conscript military. An advanced and innovative health system also serves to optimize the individual soldier, sailor, airman and marine through military-focused human performance programs which strengthen physical and psychological resilience, prevent injury and reduce stressors and fatigue. The wars also showed that military members are motivated to complete dangerous missions because they know, in part, if injured they will be cared for by the most advanced health care system in the world. During these wars, the military's trauma system was able to quickly return many injured troops to the fight and when needed use its evacuation and trauma care capabilities to achieve the highest rates of survival and recovery in the history of war. This achievement has been cited by individual troops and commanders as being vital to recruitment and combat-effectiveness.

To optimize its health and casualty systems, the military must partner with civilian health care institutions, universities and private investment and biomedical technology sectors. In the recent past the DOD has been successful in establishing these collaborations, delivering new approaches and technologies that address military requirements and improve civilian health care. As a leader in health care and medical technology, the state of Minnesota is well-positioned to work with the DOD to optimize the military's health and trauma systems as one way to reinforce the Pentagon's warrior focus.

Minnesota's private and public health care systems rank among the top in the nation and are a longstanding source of innovation. Minnesota has an ecosystem of biomedical technology ranging from small startups to large corporations with a track record of working with physicians, scientists, engineers and patients to deliver new approaches and technologies. The state also has organizations such as Medical Alley, the Sales & Marketing Mastermind Group MedTech and the recently launched Minnesota National Security Ecosystem, among others that connect physicians with engineers, and private and public sources of funding to cultivate partnerships in medical innovation. With strategic leadership, the state's medical capabilities can be expanded to deliver products to meet military medical requirements and improve care of ill and injured civilians.

If recruitment, retention and lethality are the priorities of the new DOD leadership, achieving them starts with assuring the quality, readiness and innovative capacity of the military's health and casualty care systems — systems that help recruit the best and brightest, optimize and prepare them and when needed repair and recover them. Best-in-the-world health care is fueled by innovation and as a leader in this domain, the state of Minnesota is well-positioned to apply this expertise to strengthen the Pentagon's warfighter ethos and advance the care of ill and injured civilians across the country.

Dr. Todd E. Rasmussen is a professor of surgery and consultant of vascular and endovascular surgery at Mayo Clinic and a retired Air Force colonel who served 28 years, including multiple tours as a surgeon in the Iraq and Afghanistan Wars. Dr. Gregory J. Beilman is a professor of surgery and the Wangensteen Chair of Surgical Research at the University of Minnesota and a retired Army colonel who served 25 years, including multiple tours as a surgeon in the Iraq and Afghanistan Wars. The views expressed in this article are those of Dr. Rasmussen and Dr. Beilman and do not reflect the views of their employers.