DOD Needs Better Assessment of Military Hospitals' Capabilities to Care for Wartime Casualties


Book Description

GAO reviewed the Department of Defense's (DOD) efforts to provide medical facilities for American casualties who would be returned to the United States for medical care in the event of a war in an overseas area. The latitude provided in DOD guidance on the wartime use of military hospitals in the continental United States (CONUS) permits significant differences in the way the military services determine the extent of care that could be provided in their facilities if a war began. Under DOD guidance, the services have adopted different: (1) transition plans for converting individual hospitals to handle wartime casualties; (2) methods for identifying capacity of individual hospital facilities to expand the care for wartime work load; (3) stockpiling policies for medical materiels to meet mobilization expansion requirements; (4) types of buildings as wartime assets to augment hospital capacity; and (5) policies for retention of closed hospitals as future mobilization facilities. As a result of these differences, DOD does not have an accurate assessment of the medical mobilization capacity of CONUS military facilities. Recently, DOD has given little consideration to mobilization in configuring new hospitals, and its construction planning has been directed primarily to meeting design requirements for peacetime operations. Economic feasibility studies performed by the services before undertaking hospital construction projects have been used primarily to select the most cost-effective means of meeting peacetime military medical care needs. Design concept studies performed to determine configuration of new hospitals before construction are oriented to meeting peacetime performance requirements.







National Defense


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Adrenal cortical extract (ACE) products were once recommended in the treatment of Addison's disease and for several other indications including hypoglycemia. In January 1978, the Food and Drug Administration (FDA) advised drug firms marketing ACE products that the drug represented a substantial risk of undertreatment because of its low potency and the resulting potential hazard to patients. A review of current well-known textbooks on medicine and endocrinology showed a unanimous preference for using synthetic compounds in the treatment of both the chronic and acute phases of Addison's disease. GAO could not find any medical support for using ACE products in the treatment of hypoglycemia. The regulatory actions taken by FDA against ACE were within its legal authority under the Food, Drug, and Cosmetic Act and were not unreasonable. The use of alternative procedures would have afforded all interested parties a better opportunity to comment on FDA findings and proposed actions; however, the affected drug firms had an opportunity to challenge FDA findings and did not.




Wartime Medical Care


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A National Trauma Care System


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Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.




Preparing for the Future of Combat Casualty Care


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The Military Health System needs an agile, resilient, and global network of treatment and storage facilities and transportation assets, as well as knowledge of gaps and risks that could hinder effective medical support for future combat operations.




GAO Documents


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Catalog of reports, decisions and opinions, testimonies and speeches.




Military construction appropriations for 1982


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