Operation Desert Storm:

Full Army Medical Capability Not Achieved

NSIAD-92-175: Published: Aug 18, 1992. Publicly Released: Aug 18, 1992.

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Pursuant to a congressional request, GAO reviewed the Army's deployment of medical units in support of Operations Desert Shield and Desert Storm, focusing on: (1) problems the Army had in identifying, mobilizing and deploying medical personnel; (2) whether medical units had their required equipment, supplies and transportation support; and (3) whether medical units were able to evacuate and direct patients to appropriate hospitals.

GAO found that: (1) the Army had problems in mobilizing and deploying medical personnel because information on them was outdated and unreliable, and many soldiers were undeployable or untrained for their mission; (2) the system to identify and assign active Army doctors and nurses to deploying medical units did not work, medical units did not keep their requirements current, and some units deployed without their full personnel complement; (3) some deployable hospitals were never fully equipped due to supply shortages and supply system malfunctions; (4) medical supply centers lacked supplies, trained personnel and transportation, and also experienced automation problems; (5) the size and weight of the forward hospitals and the lack of support vehicles limited the hospitals' mobility; (6) evacuation of patients from the battlefield was hampered by the rough terrain, lack of navigation equipment, communication difficulties, long distances and the shortage of spare parts for air ambulances; and (7) the effectiveness of patient management was lessened by poor communications.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: At the time Operation Desert Shield commenced, the Army was in the process of completing the development of the doctrine for a new battlefield medical infrastructure known as Medical Force 2000. The various tables of organization and equipment (TOE) for the medical units that comprise Medical Force 2000 have been developed and approved by the Army between 1986 and 1991. TheTOE is the document that contains the units' operating doctrine. The TOE addresses such relevant aspects as the unit's mission statement, capabilities, functional relationships with other units, support requirements, field doctrine guidance and references, etc. The ability to resource individual Army units is based on Army leadership priorities and the fiscal constraints with which they are faced. Because of this, many medical units do not have optimal equipment and funding priority.

    Recommendation: The Secretary of the Army should ensure that the doctrine involving the employment and configuration of battlefield hospital units is consistent with the battlefield of the future and that these units are sufficiently resourced with transportation and support assets to accomplish their missions.

    Agency Affected: Department of Defense: Department of the Army

  2. Status: Closed - Implemented

    Comments: According to the Army, its Total Army Analysis (TAA) 01 authorized 5 medical logistics battalions; 4 are scheduled to be online by the fourth quarter of FY 1994 and one in FY 1995. TAA-01 also authorized a theater medical materiel management center to be activated in the Army Reserve. In addition, the Total Distribution Action Plan and Army Strategic Mobility Plan are key initiatives related to medical support, transportation, and lift requirements. Draft Joint Publication 4-02.1, Health Service Support Ligistics in Joint Operations, establishes guidance on medical logistics support. Review of Army transportation requirements during TAA-01 resulted in the Army adopting a force packaging methodology to establish priorities for issuing equipment in conjunction with readiness objectives. An AMEDD medical reengineering initiative is under way to analyze the combat health support system and find ways to increase hospital mobility.

    Recommendation: The Secretary of the Army should develop policies and procedures for establishing medical resupply centers in theater, including when they are to be operational and who they are to support. These policies and procedures should detail the amount of resources such as transportation, automation, and personnel required to carry out their mission.

    Agency Affected: Department of Defense: Department of the Army

  3. Status: Closed - Implemented

    Comments: The Department of the Army is complying with the direction of the Assistant Secretary of Defense for Health Affairs' strategic plan. The Plan calls for an integrated program to correct the medical problems identified in Operations Desert Shield and Desert Storm.

    Recommendation: The Secretary of the Army should develop policies and procedures for equipping and supplying hospitals deployed to a theater of operations to ensure full mission capability upon arrival.

    Agency Affected: Department of Defense: Department of the Army

  4. Status: Closed - Implemented

    Comments: To ensure that the Department has sufficiently trained medical forces capable of performing its wartime mission, OASD (HA) issued specific FY 1994-1999 Program Objective Memorandum medical readiness guidance and objectives that address the training problem. The degree to which these objectives are met will depend on the program priorities and fiscal constraints imposed on the military medical departments.

    Recommendation: The Secretary of the Army should require mission-related training of the medical corps, including doctors and nurses.

    Agency Affected: Department of Defense: Department of the Army

  5. Status: Closed - Implemented

    Comments: On March 20, 1995, the Assistant Secretary of Defense for Health Affairs signed the Department of Defense Medical Readiness Strategic Plan for 1995-2001. The purpose of the Medical Readiness Strategic Plan 2001 is to provide DOD with an integrated, coordinated and synchronized plan for achieving and sustaining medical readiness through 2001 and beyond. The plan recognizes the contributions of a number of GAO products issued on the readiness and capabilities of DOD's medical forces by stating that Operations Desert Shield and Desert Storm, 1990-1991, though successful, highlighted persistent medical support problems. Several reports by the DOD/IG, GAO, and other agencies called for dramatic changes and improvements.

    Recommendation: The Secretary of the Army should establish effective controls to ensure that: (1) more accurate and complete information is maintained in the Professional Officer Filler System (PFS); and (2) personnel conditions of units, including deployability and the ability of personnel to perform their occupational specialties and wartime missions, are reported accurately.

    Agency Affected: Department of Defense: Department of the Army

  6. Status: Closed - Implemented

    Comments: The development of new air and ground ambulance units and doctrine for the modern battlefield was another element of Medical Force 2000. The TOE for the new Medical Force 2000 air and ground ambulance units has been developed and was approved by the Army in 1986. These organizations are cyclically reviewed to ensure that they are in concert with current Army doctrine or must be modified for emerging Army doctrine. The modernization of the force is based on mission priority and fiscal constraints. Currently, the Army's final buy of UH-60 Blackhawk helicopters is 300. Of these 300, 15 aircraft are to equip two National Guard medical evacuation units. Under the current UH-60 program, the Army utility helicopter fleet is 50-percent modernized, and the air ambulance fleet is 24-percent modernized.

    Recommendation: The Secretary of the Army should ensure that the doctrine for employing ambulance units and for regulating patients is consistent with the battlefield of the future and that these units are sufficiently resourced with equipment and support to accomplish their missions.

    Agency Affected: Department of Defense: Department of the Army

 

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