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In 1987 the United States Air Force (USAF) had 119 medical treatment facilities (MTFs)-81 with inpatient capabilities. Today, the USAF has 74 MTFs with just 14 inpatient facilities world-wide. This 83% reduction of inpatient facilities during the past 20 years and the focus on outpatient care has produced fewer nursing leaders with the requisite knowledge, education, training and experience required to lead theater hospital nursing operations. This is a critical because the skills nurses need for deployment are honed in hospital environment. The purpose of this paper is to justify the need to add a colonel chief nurse (CN) requirement to the EMEDS manpower detail based on three underlying principles. First, USAF and civilian guidance require a CN to lead nursing operations. Second, the doctrine that drove EMEDS development has significantly changed over the past ten years. The linear battlefield no longer exists, casualty flows have changed and joint operations require theater hospitals to have consistent capabilities regardless of service-origin. Third, colonel CNs are authorized in all but one USAF hospital and are best prepared to lead nursing operations in theater hospitals. This paper offers an operationally-based, standards-driven justification for deploying the best-prepared nursing leaders to lead nursing operations in USAF theater hospitals. It concludes with a recommendation to add the CN requirement to the EMEDS unit type code along with additional recommendations on how to better administratively and operationally prepare CNs for deployment.