Objectives, Scope, and Methodology

Section 744 of the National Defense Authorization Act for Fiscal Year 1996 requires us to assess the effectiveness of DOD’s demonstration program in providing shock trauma care training for military medical personnel through one or more public or nonprofit hospitals. Specifically, we (1) determined the status of the demonstration program and DOD’s actions to meet the legislative provisions, (2) identified other initiatives aimed at training military personnel in trauma care, and (3) identified key issues that DOD should address if it decides to expand its trauma care training program. To assess the effectiveness of DOD’s demonstration program, we (1) monitored the implementation of the program by Naval Medical Center Portsmouth officials, (2) collected data on the program and the rotations through the civilian trauma center at Sentara Norfolk General Hospital, (3) interviewed the program’s trainees and Navy trauma-trained surgeon and medical school officials, and (4) discussed legal issues regarding the program with Navy judge advocate officials from both the Naval Medical Center Portsmouth and the Navy Bureau of Medicine and Surgery. Second, the program agreement does not include a provision that the civilian center provide health care services to DOD beneficiaries that are at least equal to the value of the services provided by military personnel training in the center. DOD issued its first report to Congress on July 24, 1997. DOD’s second report, due March 1, 1998, had not been issued as of March 13, 1998. Effectiveness of Program Is Not Yet Known

It is still too early to determine the effectiveness of the demonstration program in training medical personnel in trauma care. Few Rotations Have Taken Place

Only four surgeons will have completed their training rotations by the March 1, 1998, congressional reporting date. The collective experiences of these programs, coupled with those of the demonstration program, could provide DOD valuable information in determining the feasibility and effectiveness of training military medical personnel in civilian trauma centers. These issues include (1) military physician licensure requirements, (2) the capacity of civilian trauma centers to train large numbers of military personnel, and (3) concerns that military participation might detract from training civilian or other military medical graduates in civilian centers. If DOD decides to expand its trauma care training, it will need to build on the Combat Trauma Surgical Committee’s report and develop an overall strategy for wartime training capabilities. Other important DOD actions include prioritizing the personnel requiring the training, determining the frequency of refresher training, and devising a means to track trained personnel. However, the biggest challenge DOD may face is determining how best to meet the competing demands within its health care system, which will require balancing the need for providing wartime medical readiness training with the need to deliver peacetime health care services. However, this concern cannot be assessed because DOD has not (1) completed its ongoing reassessment of its medical force structure and (2) determined which personnel will be required to receive such training. DOD has not determined which medical personnel would need to be trained in trauma care.
Why GAO Did This Study

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.

What GAO Found

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.