Medical Readiness:

Efforts Are Underway for DOD Training in Civilian Trauma Centers

NSIAD-98-75: Published: Apr 1, 1998. Publicly Released: Apr 1, 1998.

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Pursuant to a legislative requirement, GAO evaluated the effectiveness of the Department of Defense's (DOD) demonstration program that would provide trauma care training for military medical personnel through one or more public or nonprofit hospitals, focusing on: (1) the status of the demonstration program and DOD's actions to meet the legislative provisions; (2) other initiatives aimed at training military personnel in trauma care; and (3) key issues that DOD should address if it decides to expand its trauma care training program.

GAO noted that: (1) it is too early to assess the effectiveness of DOD's demonstration program because it has only been in place since November 1997; (2) as of March 1, 1998, only four surgeons had completed their training rotations; (3) DOD has not finished the evaluation tool it is developing to assess the program's effectiveness; (4) due in part to the program's late start, DOD's actions to implement the program have not been fully consistent with the legislative provisions; (5) DOD missed the April 1996 implementation milestone and issued a report on its proposed demonstration program to Congress 5 months late; (6) DOD did not seek an agreement with the civilian center to provide health care to DOD beneficiaries that is at least equal in value to the services provided by the military trainees; (7) DOD officials believed that such an arrangement might have jeopardized the willingness of hospital officials to enter into the program; (8) GAO identified several other initiatives that might be used in assessing the feasibility of training military personnel in civilian trauma centers; (9) unlike the current demonstration program, these other initiatives have not limited their training to general surgeons; (10) the collective experiences of these programs, together with those of the demonstration program, could provide DOD valuable information in determining the feasibility and effectiveness of training military personnel in civilian trauma centers; (11) DOD will need to address several issues, none of which appear to be insurmountable, if it decides to expand its trauma care training program; (12) questions have arisen over physician licensure requirements; (13) two issues concern whether: (a) civilian trauma centers have the capacity to train large numbers of military personnel; and (b) military trainees can obtain sufficient experience, since they will compete for training opportunities with the centers' own personnel; (14) the first issue cannot be addressed because DOD has not yet estimated the number and type of medical personnel that might require trauma training; (15) DOD could deal with the second issue by selecting civilian centers that are understaffed because of their large caseloads; (16) in the longer term, better information will be needed on wartime medical requirements, the personnel requiring trauma care training and their priority for such training, and the desired frequency of refresher training; and (17) the biggest challenge DOD may face is determining how best to balance need for wartime medical training with the substantial needs of its peacetime health care system.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD believes that no additional data is needed to evaluate the feasibility of providing trauma care training to surgeons in civilian centers. However, it acknowledges that the effectiveness of this training is unknown. DOD will continue trauma training programs. Although a new memo of understanding has not been negotiated for the Sentara Norfolk General Hospital program and the legislative authority for the program at Sentara has expired, DOD has an ongoing program at that location.

    Recommendation: Additional data are needed to evaluate the feasibility and effectiveness of providing trauma care training to military personnel in civilian centers. Because the authority for the demonstration program at Sentara Norfolk General Hospital expires on March 31, 1998, the Secretary of Defense should consider negotiating a new agreement for a similar program.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: DOD's Combat Trauma Surgery Training Committee/Metrics Subcommittee established a set of standardized metrics to utilize as a tool in the assessment of trauma care training. DOD has broadened the scope of its evaluation and has a pilot program to train forward surgical teams at Ben Taub Trauma Center in Houston, Texas. The study will be used to help develop the long term strategy and determine the training requirements for other military medical personnel-nurses, medics, orthopedic surgeons, and anesthesiologists. Negotiations with Martin Luther King Hospital in Los Angeles, California and Crowley Shock Trauma Center in Baltimore, Maryland, are under way. A trauma care training program for reserve components is in process to ensure equivalency with active component training.

    Recommendation: The Secretary of Defense should: (1) expedite DOD's efforts to establish an evaluation tool to assist in this assessment; and (2) broaden the scope of the evaluation to include other individual programs that have provided trauma care training to general surgeons as well as other medical personnel.

    Agency Affected: Department of Defense

  3. Status: Closed - Not Implemented

    Comments: DOD has decided that the trauma care training concept is feasible and will be expanded as needed. DOD completed an analysis of the Joint Trauma Training Center's experience at Ben Taub Trauma Center in Houston, Texas. The study included a training matrix of skills for assigning qualified personnel as trauma surgeons or to military trauma teams. The matrix was used by three services to establish their individual trauma training centers. DOD has not officially linked the training metrics to a personnel database, but plans to research potential options. Although DOD is evaluating Reserve Component trauma training at De Paul Health Center in St. Louis, Missouri, there are no metrics to assess this training. DOD plans to complete its strategic plan (metrics) by December 2002.

    Recommendation: If DOD determines that the trauma care training concept is feasible and decides to expand such training in civilian trauma care centers, the Secretary of Defense should develop a long-term strategic plan that establishes goals and identifies actions and appropriate milestones for achieving these goals. This plan should: (1) establish criteria for selecting locations for trauma care training that would maximize the experiences of military trainees; (2) identify which medical personnel should receive trauma care training and the frequency of such training; and (3) develop a mechanism to identify those military medical personnel who are likely to deploy early in a conflict so that they can receive priority for medical wartime trauma care training. This plan should also address the training needs of the active and reserve components.

    Agency Affected: Department of Defense


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