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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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Highlights

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.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense 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.
Closed – Not Implemented
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.
Department of Defense 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.
Closed – Not Implemented
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.
Department of Defense 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.
Closed – Not Implemented
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.
Department of Defense 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.
Closed – Not Implemented
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.

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Topics

National Defense
Emergency medical servicesHealth care servicesHospital administrationMilitary hospitalsPatient care servicesPhysiciansQuality assuranceStandards evaluationProtocolsStandards (health care)