Building the Elite

A 5-Day H2F Immersion Program

By LTC TYLER PATTERSON CPT NATHANIEL PISER

Article published on: October 1, in the Fall 2025 Issue of the infantry journal

Read Time: < 13 mins

In 2024, the Army fielded a Holistic Health and Fitness (H2F) Performance Team to the 3rd Mobile Brigade (MBDE), 25th Infantry Division as one of the first brigades to drive toward the program’s goals: improve Soldier readiness, increase lethality, and prevent injuries.¹Field Manual 7-22, Holistic Health and Fitness, defines the Army’s H2F program as a comprehensive initiative designed to improve Soldier readiness by addressing physical, mental,

nutritional, sleep, and spiritual domains of well-being.²

Notes

1. Asami Terajima, “Intense Fighting, Lack of Resources Leave Wounded Soldiers on Their Own,” Kyiv Independent, 12 April 2024, https://kyivindependent.com/unequipped-and-outgunned-ukrainian-military-often-cant-evacuate-its-wounded/.

2. Michael Wissemann, “Large-Scale Combat Operations Will Bring New Medical Ethical Challenges,” War on the Rocks, 8 December 2023, https://warontherocks.com/2023/12/large-scale-combat-operations-will-bring-new-medical-ethics-challenges/.

3. Department of Defense Close Combat Lethality Task Force, https://www.benning.army.mil/tenant/CCLTF/; COL (Retired) Daniel S. Roper, “Regaining Tactical Overmatch: The Close Combat Lethality Task Force,” Association of the United States Army, April 2018, https://www.ausa.org/publications/regaining-tactical-overmatch-close-combat-lethality-task-force.

4. Tanisha M. Fazal, Todd Rasmussen, Paul Nelson, and P.K. Carlton, “How Long Can the U.S. Military’s Golden Hour Last?” War on the Rocks, 8 October 2018, https://warontherocks.com/2018/10/how-long-can-the-u-s-militarys-golden-hour-last/.

5. Terajima, “Intense Fighting;” Carlotta Call and Oleksandr Chubko, “Under Fire and Understaffed: The Fight to Save Ukraine’s Wounded,” The New York Times, 2 August 2023, https://www.nytimes.com/2023/08/02/world/europe/ukraine-war-casualties-wounded.html.

6. Stacy A. Shackelford, Jennifer M. Gurney, Audra L. Taylor, Sean Keenan, Jason B. Corley, Cord W. Cunningham, Brendon G. Drew, Shane D. Jensen, Russ S. Kotwal, Harold R. Montgomery, Erika T. Nance, Michael A. Remley, and Andrew P. Cap, “Joint Trauma System, Defense Committee on Trauma, and Armed Services Blood Program Consensus Statement on Whole Blood,” Transfusion, July 2021, https://pubmed.ncbi.nlm.nih.gov/34269445/.

7. U.S. Medical Research and Development Command, “Combat Casualty Care Research Program,” n.d., https://mrdc.health.mil/index.cfm/program_areas/medical_research_and_development/ccc_overview.

8. Anne Sailliol, Christophe Martinaud, Andrew P. Cap, Corinne Civadier, Benoit Clavier, Anne-Virginie Deshayes, Anne-Christine Mendes, Thomas Pouget, Nicolas Demazeau, Marine Chueca, François-Régis Martelet, Sylvain Ausset, “The Evolving Role of Lyophilized Plasma in Remote Damage Control Resuscitation in the French Armed Forces Health Service,” Transfusion, January 2013, https://pubmed.ncbi.nlm.nih.gov/23301975/#:~:text=Freeze%2Ddried%20plasma%20was%20developed,with%20French%20blood%20product%20guidelines; TCCC Combat Lifesaver, National Association of Emergency Medical Technicians, https://www.naemt.org/education/trauma-education/naemt-tccc/tccc-cls-guidelines-and-curriculum; D. Maher, “Innovations from the Battlefield: Tourniquets,” Journal of Military and Veterans Health 28/4 (December 2020), https://doi-ds.org/doilink/05.2021-95761283/JMVH Vol 28 No 4.

9. Ben Connable, “Russians Do Break: Historical and Cultural Context for a Prospective Ukrainian Victory,” War on The Rocks, 25 September 2024, https://warontherocks.com/2024/09/russians-do-break-historical-and-cultural-context-for-a-prospective-ukrainian-victory/.

10. E. Brooke Lerner and Ronald M. Moscati, “The Golden Hour: Scientific Fact or Medical ‘Urban Legend?’” Academic Emergency Medicine (August 21), https://pubmed.ncbi.nlm.nih.gov/11435197/.

11. Russ S. Kotwal, Jeffrey T. Howard, Jean A. Orman, Bruce W. Tarpey, Jeffrey A. Bailey, Howard R. Champion, Robert L. Mabry, John B. Holcomb, and Kirby R. Gross, “The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties,” JAMA Surg (January 2016), https://pubmed.ncbi.nlm.nih.gov/26422778/.

12. George A. Barbee, “The Strategic Survivability Triad: The Future of Military Medicine in Support of Combat Power,” Joint Force Quarterly 107 (25 October 2022), https://ndupress.ndu.edu/Media/News/News-Article-View/Article/31973/the-strategic-survivability-triad-the-future-of-military-medicine-in-support-of/.

13. Remy Ourdan, “War in Ukraine: The Complicated Evacuation of the Wounded from the Frontline,” Le Monde, 5 December 2023, https://www.lemonde.fr/en/international/article/2023/12/05/war-in-ukraine-the-complicated-evacuation-of-the-wounded-from-the-frontline_6313820_4.html.

14. Brig Gen Alex Grynkewich, U.S. Air Force, “The Future of Air Superiority Part II: The 2030 Problem,” War On The Rocks, 5 January 2017, https://warontherocks.com/2017/01/the-future-of-air-superiority-part-ii-the-2030-problem/.

15. Russ S. Kotwal, Harold R. Montgomery, Bari M. Kotwal, Howard R. Champion, Frank K. Butler, Robert L. Mabry, Jeffrey S. Cain, Lorne H. Blackbourne, Kathy K. Mechler, and John B. Holcomb, “Eliminating Preventable Death on the Battlefield,” Arch Surg 146/12 (December 2011), https://jamanetwork.com/journals/jamasurgery/fullarticle/1107258.

16. Department of Defense Instruction 1322.24, Medical Readiness Training, 16 March 2018 and 15 February 2022, https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/132224p.pdf?ver=pDae3SN8brdnRhNUZFrztw%3d%3d.

17. Army Regulation 350-1, Army Training and Leader Development, June 2025, https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=1030846.

18. Navy Marine Corps (NAVMC) 35.18D, Operations and Readiness, 3 December 2018, https://www.marines.mil/News/Publications/MCPEL/Electronic-Library-Display/Article/2158067/navmc-350018d/.

19. Kotwal et al, “Eliminating Preventable Death.”

20. 75th Ranger Regiment, “Medical Training,” n.d., https://www.benning.army.mil/Tenant/75thRanger/Medical-Training.html; LTC D. Max Ferguson, “Blood Types and Titers Saving Lives on the Battlefield with Blood Far Forward,” Military Review, March-April 2024, https://www.armyupress.army.mil/Portals/7/military-review/Archives/English/MA-24/Blood-Types/Blood-Types-UA.pdf.

21. Russ S. Kotwal, Harold R. Montgomery, Ethan A. Miles, Curtis C. Conklin, Michael T. Hall, and Stanley A. McChrystal, “Leadership and a Casualty Response System for Eliminating Preventable Death,” The Journal of Trauma and Acute Care Surgery (June 2017), https://pubmed.ncbi.nlm.nih.gov/28333833/.

22. Kotwal et al, “Eliminating Preventable Death.”

23. Barbee, “The Strategic Survivability Triad.”

24. Clayton Lewis, Matthew Nilan, Charles Srivilasa, Ryan M Knight, Joseph Shevchik, Brad Bowen, Ty Able, and Peter Kreishman, “Fresh Whole Blood Collection and Transfusion at Point of Injury, Prolonged Permissive Hypotension, and Intermittent REBOA: Extreme Measures Led to Survival in a Severely Injured Soldier — A Case Report,” Journal of Special Operations Medicine (Summer 2020): 123-126, https://pubmed.ncbi.nlm.nih.gov/32573748/.

25. Ferguson, “Blood Types and Titers.”

26. Sgt Sarah Stegall, U.S. Marine Corps, “Valkyrie: Emergency Fresh Whole Blood Transfusion Enhances 15th MEU Medical Capabilities,” USMC News Service, 2 February 2021, https://www.marines.mil/News/News-Display/Article/2489777/valkyrie-emergency-fresh-whole-blood-transfusion-enhances-15th-meu-medical-capa/.

27. 1LT Sydney L. Thorpe, “Soldiers Attend Special EMT Training,” 2 June 2022, https://home.army.mil/jackson/about/news2/soldiers-attend-special-emt-training.

28. Clinical Practice Guidelines (CPGs), Joint Trauma System, the Department of Defense Center of Excellence for Trauma, https://jts.health.mil/index.cfm/PI_CPGs/cpgs.

29. Ferguson, “Blood Types and Titers;” Ripal Shah, “Role of Antibody Screening in High Titer Group O Donors,” IP Journal of Diagnostic Pathology and Oncology, https://www.jdpo.org/html-article/19077.