DOD Needs Better Assessment of Military Hospitals' Capabilities To Care for Wartime Casualties

HRD-81-56: Published: May 19, 1981. Publicly Released: May 19, 1981.

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GAO reviewed the Department of Defense's (DOD) efforts to provide medical facilities for American casualties who would be returned to the United States for medical care in the event of a war in an overseas area.

The latitude provided in DOD guidance on the wartime use of military hospitals in the continental United States (CONUS) permits significant differences in the way the military services determine the extent of care that could be provided in their facilities if a war began. Under DOD guidance, the services have adopted different: (1) transition plans for converting individual hospitals to handle wartime casualties; (2) methods for identifying capacity of individual hospital facilities to expand the care for wartime work load; (3) stockpiling policies for medical materiels to meet mobilization expansion requirements; (4) types of buildings as wartime assets to augment hospital capacity; and (5) policies for retention of closed hospitals as future mobilization facilities. As a result of these differences, DOD does not have an accurate assessment of the medical mobilization capacity of CONUS military facilities. Recently, DOD has given little consideration to mobilization in configuring new hospitals, and its construction planning has been directed primarily to meeting design requirements for peacetime operations. Economic feasibility studies performed by the services before undertaking hospital construction projects have been used primarily to select the most cost-effective means of meeting peacetime military medical care needs. Design concept studies performed to determine configuration of new hospitals before construction are oriented to meeting peacetime performance requirements.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congress has not implemented this recommendation. However, Congress, through the Panel, has focused DOD attention on the importance of considering the mobilization function when planning for new hospitals. The Secretary of Defense agreed with the Panel's recommendations on mobilization and ASD/HA developed an implementation plan.

    Matter: Congress should consider the relative importance of the planned hospitals' roles in the event of mobilization, the extent of mobilization expansion flexibility being built into the new hospitals, the gain or loss of mobilization capacity resulting from the planned hospital replacements, and whether nearby civilian hospitals can be expected to support mobilization needs.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should provide guidance to the military services by permitting sufficient floor space in one-bed rooms to accommodate expansion flexibility for two beds.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should provide guidance to the military services by permitting inclusion of medical utilities to support expansion beds in military hospitals planned for readiness areas.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: The military services periodically complete capability assessments.

    Recommendation: The Secretary of Defense should require the services to complete planned capability assessments in conjunction with the updating of mobilization plans being completed in 1981.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should provide guidance to the military services by requiring that economic feasibility studies assess and weigh, in conjunction with peacetime requirements, the mobilization implications of each construction alternative under active consideration.

    Agency Affected: Department of Defense

  5. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should provide guidance to the military services by requiring that design concept studies identify bed expansion capacity targets, within peacetime sizing constraints, for building the flexibility to expand for mobilization into military hospitals.

    Agency Affected: Department of Defense

  6. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should provide guidance to the military services by basing the distribution of one-, two-, and four-bed rooms on an assessment of expected peacetime patient needs and mobilization requirements.

    Agency Affected: Department of Defense

  7. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should provide guidance to the military services by reducing, where appropriate, the number of one-bed rooms in favor of two-bed rooms to improve mobilization capacity of key readiness hospitals.

    Agency Affected: Department of Defense

  8. Status: Closed - Not Implemented

    Comments: GAO believes that, without a policy which standardizes the definition of auxiliary on-post facilities to augment hospitals in case of war, DOD may have a difficult time in providing an accurate assessment of facilities available for mobilization. DOD stated that the feasibility of using nonmedical facilities for mobilization is governed by other standards and no other guidance is needed.

    Recommendation: The Secretary of Defense should develop criteria for services' use in determining which military facilities, such as on-post barracks, housing, or schools, are suitable for medical readiness use to augment military hospitals.

    Agency Affected: Department of Defense

  9. Status: Closed - Implemented

    Comments: DOD recognized that it did not have adequate instructions for the services to follow in developing mobilization plans. DOD issued a directive on mobilization planning in April 1986, and created a Defense Medical Facilities Office in 1987 which, among other things, will develop a long-range plan for medical facilities.

    Recommendation: The Secretary of Defense should provide guidance to the military services by identifying adjustments in normal hospital operation procedures for nursing units and central surgical and medical support areas necessary to accommodate emergency expansion and compressed bed spacing during mobilization.

    Agency Affected: Department of Defense

  10. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should instruct the services to remove from their mobilization plans such designated commercial buildings as hotels and motels that have been designated for conversion to hospitals.

    Agency Affected: Department of Defense

  11. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should develop, as part of a 5-year construction plan submitted to Congress, information necessary to assess the impact on mobilization of each hospital to be replaced. For hospital replacements not included in the current DOD construction year, information provided should be identified as preliminary pending approval of planning funds for more detailed design development.

    Agency Affected: Department of Defense

  12. Status: Closed - Not Implemented

    Comments: Congress established a panel to review the criteria for sizing military hospitals. Because this panel could recommend significant changes in the criteria, this recommendation, at this time, is no longer valid.

    Recommendation: The Secretary of Defense should assess past hospital design concept studies undertaken by DOD and new hospital design concepts being implemented in civilian hospitals to identify hospital construction design practices that would enhance flexibility for mobilization expansion. Design practices found useful for this purpose could be utilized by the military services for designing future hospitals.

    Agency Affected: Department of Defense

  13. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should require the military services to reassess mobilization plans to determine if hospitals and augmenting buildings are in adequate physical condition and are operationally configured to function at planned mobilization expansion capacity.

    Agency Affected: Department of Defense

  14. Status: Closed - Not Implemented

    Comments: DOD concurred that mobilization plans should include only those inactive hospitals that can be mobilized quickly in case of war. However, DOD believes that its current criteria is sufficient to determine which inactive hospitals are adequate for combat casualty care. Consequently, DOD does not feel that it is necessary to issue more guidance on this matter.

    Recommendation: The Secretary of Defense should instruct the services to remove from their mobilization plans those inactive hospitals that cannot be efficiently equipped and operated under expanded wartime requirements, and retain rights to newer hospitals that have been excessed, but offer additional operating potential.

    Agency Affected: Department of Defense

  15. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Defense should provide criteria for the military services to use in developing mobilization transition plans for each hospital that provide for the: (1) conversion of facilities to wartime configurations; (2) stockpiling for war readiness of beds and materials to support expansion capacity; (3) phasing out of peacetime patient work loads; and (4) transition of hospital operations to designated mobilization staffs.

    Agency Affected: Department of Defense

 

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