New Trauma Care System: DOD Should Fully Incorporate Leading Practices into Its Planning for Effective Implementation

GAO-18-300 Published: Mar 19, 2018. Publicly Released: Mar 19, 2018.
Jump To:
Fast Facts

DOD researchers found that about 24% of military servicemembers who died in combat from 2001-2011 could have survived if better and more timely trauma care had been available.

To help reduce preventable deaths and disabilities, DOD is planning for a new trauma care system. However, we found that DOD's planning documents do not fully incorporate certain practices, like clear goals and strategies, that could help the department more effectively implement its new system.

We recommended that DOD fully incorporate leading practices into its ongoing planning to help ensure the success of its efforts to improve trauma care.

Servicemembers Train for Rapid Medical Evacuation

Photo of uniform servicemembers carrying a person on a stretcher near a helicopter with a red cross.

Photo of uniform servicemembers carrying a person on a stretcher near a helicopter with a red cross.

Skip to Highlights

What GAO Found

The Joint Trauma System (JTS) implementation plan submitted to Congress by the Department of Defense (DOD) in August 2017 includes a description of the four elements required by the National Defense Authorization Act (NDAA) and an overview of implementation activities. For example, it indicates how the Army's current JTS Defense Center of Excellence will become part of DOD's new JTS.

However, the plan and other supplemental planning documents prepared to date do not fully incorporate leading practices for planning as identified by prior GAO work. GAO has previously found that implementation plans incorporating these leading practices—goals, strategies to achieve goals, risks that can affect goals, and plans to assess progress toward goals—help ensure organizations achieve their objectives. For each of the four required elements, GAO found that these leading practices either were partially incorporated or had not been incorporated:

  • Element 1—Serve as the reference body for all trauma care provided across the military health system. DOD documents include specific goals, such as consolidating data from multiple trauma registries. They also include some strategies to achieve the goals, such as identifying lead offices and time frames to complete specific actions. However, the documents provide limited details on actions DOD plans to take, and do not indicate how DOD plans to address risks or assess its progress.
  • Element 2—Establish standards of care for trauma care services. DOD documents include a goal to develop, publish, and assess clinical practice guidelines that serve as standards of trauma care. These documents also describe how the new JTS will continue to produce, update, and monitor adherence to the guidelines. However, they do not fully indicate plans to address risks, such as ensuring effective dissemination.
  • Element 3—Coordinate the translation of research from DOD centers of excellence into standards of clinical trauma care. DOD planning documents do not incorporate any leading practices for this element. DOD officials told GAO that clinical standards incorporate relevant research and that officials responsible for trauma care standards routinely interact with officials responsible for research. Officials expect this practice to continue under the new JTS.
  • Element 4—Coordinate the incorporation of lessons learned from trauma education and training partnerships into clinical practice. DOD planning documents do not incorporate any leading practices for this element. According to officials, DOD must first establish a separate directorate responsible for partnerships with civilian trauma centers before determining how to incorporate lessons from partnerships into the new JTS.

According to DOD, the JTS implementation plan is a general overview of implementation activities, and planning efforts are ongoing. By not fully incorporating leading practices in its planning documents, DOD may be missing opportunities to ensure that the JTS is effectively implemented, to provide more effective trauma care across the military, and to help reduce trauma-related deaths and disabilities.

Why GAO Did This Study

Traumatic injury is a major cause of death and disability in the military, but improved trauma care has the potential to improve these outcomes. DOD has worked to improve trauma care over time, such as by establishing a Joint Trauma System Defense Center of Excellence to examine trauma care and share best practices.

To improve trauma care across DOD, the NDAA for Fiscal Year 2017 directed DOD to establish a new JTS within DOD's Defense Health Agency. The NDAA requires that the new JTS include four specified elements, and also required DOD to submit to Congress an implementation plan that included the four elements. The NDAA also included a provision for GAO to review DOD's planning for the new JTS.

GAO assessed whether the implementation plan includes the four required elements and the extent to which DOD's planning efforts to date reflect leading practices from prior GAO work, such as identifying goals and strategies to achieve those goals. To conduct its work, GAO assessed DOD's implementation plan and other supplemental planning documents identified by DOD, and interviewed DOD officials.

Skip to Recommendations


GAO recommends that DOD incorporate leading practices in its planning to guide implementation efforts. DOD agreed with the recommendation.

Recommendations for Executive Action

Agency Affected Recommendation Status
Defense Health Agency To fully implement the four required elements of the new Joint Trauma System, the Director of the Defense Health Agency should fully incorporate leading practices--including establishing goals, planning strategies to achieve goals, identifying and addressing risks, and assessing progress--in its planning to guide implementation efforts. (Recommendation 1)
Closed – Implemented
Consistent with GAO's recommendation, the Defense Health Agency has incorporated leading practices--establishing goals, planning strategies to achieve goals, identifying and addressing risks, and assessing progress--in its final plan for implementing the four required elements of the new Joint Trauma System. The Defense Health Agency's Corrective Action Plan for responding to GAO's recommendation and its Joint Trauma System Organizational Assessment Final Report, published in October 2018, describe how each of these leading practices are incorporated into its plan.

Full Report

GAO Contacts