All too frequently, the sustaining elements of combat operations, such as casualty care, are given a subordinate role or forgotten. For modern littoral warfare, which emphasizes operational maneuver from the sea without immediate lodgment ashore, old doctrinal mechanisms for medical support will require revisions, implemented by those on-site, supported by equally pragmatic and visionary leadership. Medical prescience ultimately will depend on an understanding of both the exigencies of expeditionary warfare in the littorals and modern advances in medical care, underwritten by an appreciation for lessons learned in adapting casualty care to prevailing combat environments. Programs for management of casualties in a combat theater must be engineered not only to supply speed and flexibility, but above all to be responsive to changing tactical and strategic requirements.