DOD Health Care:

Requirements for Emergency Services Adequate and Generally Attainable

HRD-88-94: Published: Sep 28, 1988. Publicly Released: Sep 28, 1988.

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In response to a congressional request, GAO reviewed the Department of Defense's (DOD) emergency services directive to determine: (1) how the directive's requirements compared with civilian standards for emergency care; and (2) its implementation status.

GAO found that: (1) civilian experts believed that the directive's requirements for physician staffing, training, treatment protocols, patient transfer agreements, and quality assurance exceeded civilian standards; (2) two of the eight military hospitals it visited did not fully meet the requirement for experienced emergency room physicians in primary and patient care specialties because they did not understand the requirement; and (3) although some hospitals did not meet life-support certification requirements, they expected to be in compliance by the September 1989 deadline. GAO also found that: (1) the Navy expected to comply with certification requirements for its ambulance technicians by 1989; (2) the Army and the Air Force were uncertain about their ability to meet technician requirements; (3) most military hospitals did not implement treatment protocol requirements, and six hospitals did not have patient transfer agreements with nearby civilian hospitals; and (4) all the hospitals had emergency room quality assurance programs.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: DOD stated that current requirements in its Emergency Services Directive provide adequate guidance to the granting of clinical privileges for physicians based on experience and training. DOD disagreed that any further guidance is needed.

    Recommendation: To help ensure maximum implementation of DOD requirements, the Secretary of Defense should direct the service secretaries, in conjunction with the Assistant Secretary of Defense for Health Affairs, to give hospitals further guidance concerning what constitutes 1 year's experience in a primary or patient care specialty.

    Agency Affected: Department of Defense

  2. Status: Closed - Not Implemented

    Comments: DOD disagreed that additional guidance is needed on these issues and stated that any uncertainities at local commands should be resolved by September 1989, the implementation date of the DOD Emergency Services Directive. DOD stated that the IG will make emergency protocols and transfer agreements part of hospital inspections.

    Recommendation: To help ensure maximum implementation of DOD requirements, the Secretary of Defense should direct the service secretaries, in conjunction with the Assistant Secretary of Defense for Health Affairs, to give hospitals further guidance concerning the purpose of emergency room protocols and the purpose and content of patient transfer agreements, including when such agreements are appropriate.

    Agency Affected: Department of Defense

  3. Status: Closed - Not Implemented

    Comments: This recommendation is being addressed through military inspectors general, JACHO, and civilian external peer review. The joint-service Quality Assurance Committee has provided a forum for exchange of information. The Office of Inspector General (OIG) has closed this case and it expects no action based on DOD input.

    Recommendation: The service secretaries, in conjunction with the Assistant Secretary of Defense for Health Affairs, should assess the effectiveness of the differing service approaches to diagnostic and treatment protocols.

    Agency Affected: Department of Defense

  4. Status: Closed - Not Implemented

    Comments: This recommendation is being addressed by ongoing actions. Monitoring mechanisms are in place for the national EM7-A certification with service IG, JACHO, and the civilian peer review program. Military treatment facility quality assurance programs provide additional monitoring and evaluation mechanisms. OIG has closed this case and, based on the DOD response, expects no action from DOD.

    Recommendation: The service secretaries, in conjunction with the Assistant Secretary of Defense for Health Affairs, should monitor hospitals' progress in attaining national emergency medical technician-ambulance certification and, if necessary, take steps to ensure compliance.

    Agency Affected: Department of Defense

 

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