Defense Health Care: Actions Needed to Define and Sustain Wartime Medical Skills for Enlisted Personnel
GAO-21-337
Published: Jun 17, 2021. Publicly Released: Jun 17, 2021.
Fast Facts
DOD's more than 73,000 enlisted medical personnel serve in roles ranging from paramedics to imaging technicians, and must be ready to use their wartime medical skills to care for injured and ill servicemembers.
However, DOD could do more to define, track, and assess wartime medical skills. For example, the Army does not consistently track skills training in its official system, and none of the services have developed targets for training completion. As a result, DOD lacks information on the preparedness of enlisted medical personnel to perform their lifesaving roles.
Our 30 recommendations are to help improve training, assessment, and more.
Army medical personnel conduct medical evacuation training
Highlights
What GAO Found
The military departments have not fully defined, tracked, and assessed wartime medical skills for enlisted medical personnel. The departments have defined these skills for 73 of 77 occupations. However, among other issues,
- the Army and the Air Force have not defined skills for numerous highly-skilled subspecialties that require additional training and expertise, such as Army Critical Care Flight Paramedics. Subspecialty personnel are key to supporting lifesaving medical care during deployed operations.
- The Army does not consistently track wartime medical skills training for enlisted medical personnel in its official system.
- The military departments are not able to fully assess the preparedness of enlisted medical personnel because, according to officials, they have not developed performance goals and targets for skills training completion.
As a result, the military departments lack reasonable assurance that all enlisted medical personnel are ready to perform during deployed operations.
The Department of Defense (DOD) has not fully developed plans and processes to sustain the wartime medical skills of enlisted medical personnel. While the Defense Health Agency (DHA) has initiated planning efforts to assess how the military departments' three primary training approaches sustain readiness (see figure), these efforts will not fully capture needed information. For example, DHA's planned metrics to assess the role of military hospitals and civilian partnerships in sustaining readiness would apply to a limited number of enlisted occupations. As a result, DHA is unable to fully assess how each training approach sustains readiness and determine current and future training investments.
Approaches to Train Enlisted Medical Personnel's Wartime Medical Skills
DOD officials have identified challenges associated with implementing its training approaches. For example, DOD relies on civilian partnerships to sustain enlisted medical personnel's skills, but DOD officials stated that licensing requirements and other issues present challenges to establishing and operationalizing civilian partnerships. DOD has not analyzed or responded to such risks, and may therefore be limited in its ability to sustain wartime medical skills.
Why GAO Did This Study
DOD has over 73,000 active-duty enlisted medical personnel who must be ready to provide life-saving care to injured and ill servicemembers during deployed operations, using their wartime medical skills.
Senate Report 116-48 accompanying a bill for the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review DOD's efforts to maintain enlisted personnel's wartime medical skills. This report examines, among other objectives, the extent to which (1) the military departments have defined, tracked, and assessed enlisted personnel's wartime medical skills, and (2) DOD has developed plans and processes to sustain these skills and assessed risks associated with their implementation. GAO analyzed wartime medical skills checklists and guidance; reviewed plans for skills sustainment; and interviewed officials from DOD and military department medical commands and agencies, and nine inpatient military medical treatment facilities.
Recommendations
GAO is making 30 recommendations, including that military departments fully define and implement wartime medical skills for enlisted medical personnel subspecialties, track skills training, and establish performance goals and targets for training completion, as appropriate; and that DOD develop metrics to assess how military medical treatment facility workload and civilian partnerships sustain these skills and assess risks to skills sustainment. DOD concurred and described some related actions, as discussed in the report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of the Army | The Secretary of the Army should ensure that the Commanding General, U.S. Army Medical Center of Excellence, takes corrective action to define wartime medical skills for enlisted medical subspecialties with an expeditionary role. (Recommendation 1) |
Open
The Army concurred with this recommendation and stated in a November 2023 update that implementing actions were underway, with an estimated completion date of December 31, 2023. However, the Army has not yet provided documentation of such actions. We will update the status of this recommendation once we confirm what actions the Army has taken.
|
| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, takes corrective action to define and implement wartime medical skills for enlisted medical subspecialties with an expeditionary role. (Recommendation 2) |
Open
The Air Force concurred with this recommendation. In a November 2023 status update, the Air Force outlined a series of steps to implement this recommendation, with an estimated completion date of March 31, 2024.
|
| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, establishes guidance that requires the development of wartime medical skills for current and future enlisted medical subspecialties with an expeditionary role. (Recommendation 3) |
Open
The Air Force concurred with this recommendation. In a November 2023 status update, the Air Force stated that it will address this recommendation via an interim change to Air Force Instruction 41-106 and that action on this recommendation will be complete by March 31, 2024.
|
| Department of the Army | The Secretary of the Army should ensure that the Commanding General, U.S. Army Medical Center of Excellence, takes corrective action to fully incorporate joint wartime medical skills into Army wartime medical skills checklists. (Recommendation 4) |
Open
The Army concurred with this recommendation and stated in November 2023 that implementing actions were underway, with an estimated completion date of June 2024. We will update the status of this recommendation once we confirm what actions the Army has taken.
|
| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, takes corrective action to fully incorporate joint wartime medical skills into Air Force wartime medical skills checklists. (Recommendation 5) |
Open
The Air Force concurred with this recommendation and stated in a November 2023 status update that action to implement it will be completed by March 31, 2024.
|
| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, issues guidance requiring the incorporation of joint wartime medical skills into Air Force checklists. (Recommendation 6) |
Open
The Air Force concurred with this recommendation and stated in a November 2023 status update that action to implement it will be completed by March 31, 2024.
|
| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, takes corrective action to review and update outdated wartime medical skills checklists for enlisted medical occupations. (Recommendation 7) |
Open
The Air Force concurred with this recommendation and stated in a November 2023 status update that action to implement it will be completed by March 31, 2024.
|
| Department of the Army | The Secretary of the Army should ensure that the Commanding General, U.S. Army Training and Doctrine Command, updates its guidance to require the specification of acceptable methods of sustainment training for wartime medical skills for enlisted medical personnel. (Recommendation 8) |
Open
The Army concurred with this recommendation and stated in a November 2023 update that implementing actions were underway, with an estimated completion date of December 31, 2023. However, the Army has not yet provided documentation of such actions. We will update the status of this recommendation once we confirm what actions the Army has taken.
|
| Department of the Army | The Secretary of the Army should ensure that the Commanding General, U.S. Army Medical Center of Excellence, incorporates findings on skills degradation from DOD's project on highly perishable and mission-essential medical skills into its processes to identify appropriate training frequencies of wartime medical skills. (Recommendation 9) |
Open
The Army concurred with this recommendation and stated in a November 2023 update that implementing actions were underway, with an estimated completion date of December 31, 2023. However, the Army has not yet provided documentation of such actions. We will update the status of this recommendation once we confirm what actions the Army has taken.
|
| Department of the Navy | The Secretary of the Navy should ensure that the Surgeon General of the Navy incorporates findings on skills degradation from DOD's project on highly perishable and mission-essential medical skills into its processes to identify appropriate training frequencies of wartime medical skills. (Recommendation 10) |
Open
The Navy concurred with this recommendation and stated in a November 2023 status update that implementing actions are underway, with an estimated completion date of March 31, 2024. We will update the status of this recommendation once we confirm what actions the Navy has taken.
|
| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, incorporates findings on skills degradation from DOD's project on highly perishable and mission-essential medical skills into its processes to identify appropriate training frequencies of wartime medical skills. (Recommendation 11) |
Open
The Air Force concurred with this recommendation and stated in a November 2023 status update that action to implement it will be completed by March 2024.
|
| Department of the Army | The Secretary of the Army should ensure that the Surgeon General of the Army requires the consistent tracking of training on wartime medical skills for enlisted medical personnel. (Recommendation 12) |
Open
The Army concurred with this recommendation and stated in a November 2023 status update that it was taking steps to implement this action with an estimated completion date of January 31, 2024.
|
| Department of the Army | The Secretary of the Army should ensure that the Surgeon General of the Army establishes performance goals and targets for the completion of training on wartime medical skills for enlisted medical occupations and tracks performance toward achieving the goals and targets. (Recommendation 13) |
Open
The Army concurred with this recommendation and stated in a November 2023 status update that it was taking steps to implement this action with an estimated completion date of January 31, 2024.
|
| Department of the Navy | The Secretary of the Navy should ensure that the Surgeon General of the Navy establishes performance goals and targets for the completion of training on wartime medical skills for enlisted medical occupations and tracks performance toward achieving the goals and targets. (Recommendation 14) |
Open
The Navy concurred with this recommendation and stated in a November 2023 status update that implementing actions are underway, with an estimated completion date of January 31, 2024. We will update the status of this recommendation once we confirm what actions the Navy has taken.
|
| Department of the Air Force | The Secretary of the Air Force should ensure that the Surgeon General of the Air Force, in coordination with the Commander, Air Force Medical Readiness Agency, establishes performance goals and targets for the completion of training on wartime medical skills for enlisted medical occupations and tracks performance toward achieving the goals and targets. (Recommendation 15) |
Open
The Air Force concurred with this recommendation and reported in November 2023 that it had established more specific goals and targets for the completion of training on wartime medical skills for enlisted medical occupations and continue to use current tracking methods to track performance towards achieving goals and targets. To implement this recommendation, the Air Force needs to provide documentary evidence to GAO to demonstrate the actions it has taken. We will update the status of this recommendation once we confirm what actions DOD has taken.
|
| Department of Defense | The Secretary of Defense should ensure the Director, DHA, develops metrics to assess the contributions of MTF workload to sustaining wartime medical skills that include the medical care provided by enlisted medical personnel. (Recommendation 16) |
Open
DOD concurred with this recommendation. The DHA has not yet implemented this recommendation. In a November 2023 status update, the DHA stated that it will address this recommendation through development of a metric and dashboard methodology for enlisted medical personnel, with an estimated completion date of December 2024.
|
| Department of Defense | The Secretary of Defense should ensure the Director, DHA, develops the required inventory of civilian partnerships to include all partnerships in which enlisted medical personnel may participate. (Recommendation 17) |
Open
DOD concurred with this recommendation. The DHA has not yet implemented this recommendation. In a November 2023 status update, the DHA stated that it will develop the required inventory by December 2025.
|
| Department of Defense | The Secretary of Defense should ensure the Director, DHA, develops a process to identify opportunities to streamline or add military-civilian training partnerships. (Recommendation 18) |
Open
DOD concurred with this recommendation. The DHA has not yet implemented this recommendation. In a November 2023 status update, the DHA stated that it will develop a process to identify opportunities to streamline or add military-civilian training partnerships as part of its Sustain Expeditionary Medical Skills (SEMS) initiative, which seeks to evaluate and enable partnerships to optimize expeditionary medical skills development. This effort has an estimated completion date of December 2025.
|
| Department of Defense | The Secretary of Defense should ensure the Director, DHA, develops metrics to assess the contributions of civilian partnerships to sustaining wartime medical skills that include the medical care provided by enlisted medical personnel. (Recommendation 19) |
Open
DOD concurred with this recommendation. The DHA has not yet implemented this recommendation. In a November 2023 status update, the DHA stated that it will address this recommendation via the development of a set of metrics and corresponding dashboards for select enlisted medical personnel, with an estimated implementation date of December 2025.
|
| Department of Defense | The Secretary of Defense should ensure the Director, DHA, performs the proposed assessment of available simulation programs, demand for them, and gaps in clinical training and simulation requirements. (Recommendation 20) |
Open
DOD concurred with this recommendation. The DHA has not yet implemented this recommendation. In a November 2023 status update, the DHA outlined a series of actions to implement this recommendation, with an estimated completion date of September 2027.
|
| Department of the Army | The Secretary of the Army should ensure the Surgeon General develops and implements a consistent clinical readiness assessment process for wartime medical skills maintenance to identify and address gaps in training. (Recommendation 21) |
Open
The Army concurred with this recommendation. The Army has not yet implemented this recommendation. In a November 2023 status update, the Army stated that this recommendation would be addressed through a future enterprise operations, analytics, and data management platform. The Army provided an estimated completion date of January 31st, 2024 for this effort.
|
| Department of the Navy | The Secretary of the Navy should ensure the Surgeon General develops and implements a consistent clinical readiness assessment process for wartime medical skills maintenance to identify and address gaps in training. (Recommendation 22) |
Open
The Navy concurred with this recommendation. The Navy has not yet implemented this recommendation. In a November 2023 status update, the Navy stated that it will take steps to implement this recommendation by January 31, 2024.
|
| Department of Defense | The Secretary of Defense should ensure the Director, DHA, in conjunction with the Surgeons General of the Army, the Navy, and the Air Force analyzes and responds, as appropriate, to risks to sustaining enlisted personnel wartime medical skills associated with: (1) staffing challenges at MTFs; (2) managing rotations of non-MTF personnel to MTFs; (3) barriers to civilian partnerships; and (4) challenges in providing enlisted medical personnel opportunities to train on expeditionary medical equipment. (Recommendation 23) |
Open
DOD concurred with this recommendation. DOD has not yet implemented this recommendation. In a November 2023 status update, DOD outlined a series of steps to implement this recommendation, with an estimated completion date of September 2027.
|
| Department of the Army | The Secretary of the Army should develop annual retention goals, by skill level, for enlisted medical personnel. (Recommendation 24) |
Open
The Army concurred with this recommendation and stated in November 2023 status update that implementing actions were underway, with an estimated completion date of March 31, 2024. We will update the status of this recommendation once we confirm what actions the Army has taken.
|
| Department of the Navy | The Secretary of the Navy should develop annual retention goals, by skill level, for enlisted medical personnel. (Recommendation 25) |
Open
The Navy concurred with this recommendation and stated that it had taken actions to implement it. As of November 2023, the Navy has not provided documentation to support the actions it has reported taking. We will update the status of this recommendation once we confirm what actions the Navy has taken.
|
| Department of the Air Force | The Secretary of the Air Force should develop annual retention goals, by skill level, for enlisted medical personnel. (Recommendation 26) |
Open
The Air Force concurred with this recommendation and outlined steps it plans to take to implement it in a November 2023 status update. We will update the status of this recommendation once we confirm what actions DOD has taken.
|
| Department of the Army | The Secretary of the Army should consider incorporating data on civilian pay for comparable occupations in the Army's decision-making processes for awarding retention bonuses. (Recommendation 27) |
Open
The Army concurred with this recommendation and stated in a November 2023 status update that implementing actions were underway, with an estimated completion date of March 31, 2024. We will update the status of this recommendation once we confirm what actions the Army has taken.
|
| Department of the Navy | The Secretary of the Navy should consider incorporating data on civilian pay for comparable occupations in the Navy's decision-making processes for awarding retention bonuses. (Recommendation 28) |
Open
The Navy concurred with this recommendation and stated that it had taken actions to implement it. As of November 2023, the Navy has not provided documentation to support the actions it has reported taking. We will update the status of this recommendation once we confirm what actions the Navy has taken.
|
| Department of the Air Force | The Secretary of the Air Force should consider incorporating data on civilian pay for comparable occupations in the Air Force's decision-making processes for awarding retention bonuses. (Recommendation 29) |
Open
The Air Force concurred with this recommendation. The Air Force has not yet implemented this recommendation. In a November 2023 status update, the Air Force stated that data on civilian pay are not readily available for all Air Force specialties and that their use would therefore create inconsistencies in justifying and determining retention incentives. However, the Air Force stated that it may consider incorporating such data when analyzing and justifying the awarding of retention bonuses. The Air Force provided an estimated completion date of March 31st, 2024.
|
| Department of the Navy | The Secretary of the Navy should include information on the cost of training in its decision-making process for awarding retention bonuses. (Recommendation 30) |
Open
The Navy concurred with this recommendation and stated that it had taken actions to implement it. As of November 2023, the Navy has not provided documentation to support the actions it has reported taking. We will update the status of this recommendation once we confirm what actions the Navy has taken.
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