To prepare for multi-domain, contested environments of future near-peer conflicts, more than 130 Total Force medics integrated with combat warfighters and international partners during the nation’s largest live-fire exercise, Northern Strike Exercise 26-2, in Alpena, Michigan, Aug. 9-11.
NS 26-2 paired modern battlefield technologies with realistic combat scenarios, challenging active duty, Guard and Reserve forces to manage patient care and evacuation under combat fire.
Lt. Gen. John J. DeGoes, U.S. Air Force and Space Force Surgeon General, outlined four focus areas for Airmen in attendance: Readiness, realistic training, multi-modal patient movement and medical innovation.
“We need to medically train the way we fight,” he said. “Northern Strike packages all types of emergency response training into a single, joint, multi-domain event. The scenarios are built around no guarantee in air, sea, and logistical superiority. This operational exercise tests Airman capability to adapt in real-time while administering care under fire.”
“Readiness is number one”
Brig. Gen. James Parry, acting director of medical operations for the office of the U.S. Air Force Surgeon General and chief of staff of the Michigan Air National Guard shared the significance of the exercise. He highlighted preparedness for drone swarm attacks, utilizing iCOVER mental health training in the battlefield and providing care in hardened medical facilities as essential skills for the future fight.
“The goal is to get people realistic training to provide care under fire,” said Parry. “Readiness is our number one priority, and we need to ensure that our skills remain current even in peacetime.”
During NS 26-2, Airmen, particularly medics who have not deployed to a combat zone, experienced realistic training scenarios including attacks featuring drone swarm tactics that characterize modern, near-peer conflict, said Maj. Sarah Blackthorne, Northern Strike Air Component medical planner and Joint Governance and Policy officer.
Air Force medics demonstrated their full spectrum of lifesaving capabilities - from point-of-injury Tactical Combat Casualty Care to specialized Critical Care Air Transport Team and Ground Surgical Team capabilities - securing and treating simulated casualties at the point of injury and safely evacuating them to higher echelons of care.
“Exercises like this should be our first course of action,” Blackthorne said. “This is where we get exposed to the operational side of the military.”
In addition to CCATT operations, a unit that combines patient care, ground transportation and aerial evacuation to expedite treatment for critically injured patients, medics employed the Air Force En Route Patient Staging System. During the exercise, medics used ERPSS to hold and stabilize causalities until medical evacuation transport was available to move them to an advanced care facility.
Medics also conducted Expeditionary Medical Support training. While ERPSS focuses on staging patients for transport, EMEDS units establish modular, scalable field hospitals to provide direct, forward surgical and trauma care in austere environments during wartime contingencies, humanitarian relief, and disaster response.
Blackthorne said medics who participated in the exercise earned either initial or sustainment training certifications for ERPSS, CCATT and EMEDS capabilities.
Training for a multi-domain, future fight
According to Parry, NS 26-2 shows “future proof of concept” demonstrating that Alpena Combat Readiness Training Center is an optimal location to test medical capabilities in diverse, austere environments. While this iteration of the exercise occurred in the summer, the Michigan National Guard hosts Northern Strike in the winter to train Soldiers and Airmen in near-arctic weather conditions.
Participants agreed the exercise refined their ability to perform operational medicine, whether it was employing inherently medical skillsets or testing new tactics and technological advancements designed to improve medical response in a modern, contested environment.
“With [Northern Strike], there’s a similar underlying theme: Figuring out how the new challenges of your environment affect your ability to deliver care safely,” said Maj. Samantha Boyd, emergency physician and emergency medicine residency associate program director at Brooke Army Medical Center.
As part of a Total Force effort, participants used emerging technologies to coordinate movement of patients and supplies, including patient evacuation to an underground medical facility where they continued providing care for warfighters. For the first time - as CCATTs and GSTs exercised operating in a contested environment - medics employed a maritime drone to transport a training mannequin from shore on Lake Huron to a ship. To add realism, they adapted to maritime drone swarm attacks during the transit.
Additionally, Air Force personnel and Air Force Research Laboratory partners used variety of autonomous aerial, surface, and semi-subsurface platforms to move blood and critical medical supplies.
As a participant who led CCATT teams through a patient evacuation scenario, U.S. Air Force Lt. Col. Maritza Ruiz, TCCC program manager and chief nurse with the 916th Aerospace Medicine Squadron, said the realistic training offered invaluable experience.
“We have to be cognizant of all environmental factors while staying covered from enemy fire and focused on lifesaving treatments,” Ruiz said of the summer and winter exercises. “Both have different complexities of care, all of which we need to know and be familiar with because we can easily go to any site.”
Northern Strike: At a glance
Northern Strike is a National Guard Bureau-sponsored exercise uniting service members from multiple states, service branches and several coalition countries at its National All-Domain Warfighting Center, spanning training sites at the Alpena Combat Readiness Training Center and Camp Grayling Joint Maneuver Training Center.
NS 26-2 was the largest live-fire training event in the United States, with more than 8,500 participants across every branch, including the Guard and the Reserve, and more than 80 industry partners.
Located in northern Michigan and operated by the Michigan National Guard, the accredited Joint National Training Capabilities exercise demonstrates the Michigan National Guard’s ability to provide accessible, readiness-building opportunities for military units from all service branches to achieve and sustain proficiency in conducting mission command, air, sea and ground maneuver integration.
| Date Taken: | 09.14.2026 |
| Date Posted: | 09.14.2026 10:46 |
| Story ID: | 574287 |
| Location: | FALLS CHURCH, VIRGINIA, US |
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This work, Care under fire: Medics train for future fight at Northern Strike exercise, by Josh Mahler and Maristela Romero, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
