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Highlights

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.

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Recommendations

Recommendations for Executive Action

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

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