Training Oversights Could Leave Military Medics Unprepared for Combat, Report Finds

Simulated blood transfusion during Valkyrie whole blood transfusion training.
U.S. Navy Hospital Corpsman 2nd Class Caleb Goodman, left, and Hospital Corpsman 2nd Class Nia Crisp prepare a simulated casualty for a blood transfusion during Valkyrie whole blood transfusion training aboard Portland, May 20, 2021. (U.S. Marine Corps/Cpl. Ian M. Simmons)

The U.S. armed forces have more than 73,000 enlisted medical personnel who need to be ready to provide care in combat theaters at any time.

But neither the military services nor the Department of Defense have adequate systems in place to track these troops' preparedness, raising concerns that not all will be able to perform in operational settings, according to a report from the Government Accountability Office.

Until the DoD and the services define the skills needed for roughly 80 enlisted medical fields, including setting goals and keeping sufficient records of training and completion of programs, gaps could affect the care of U.S. troops in deployed settings, government auditors said.

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"As a result, the military departments lack reasonable assurance that all enlisted medical personnel are ready to perform during deployment operations," according to a report released June 17 by the GAO.

Two-thirds of the active-duty medical force is made up of enlisted personnel -- 73,453 service members in 77 occupational specialties that include combat medics, operating room techs, radiology specialists, lab techs, physical and behavioral health specialists, and more.

They are assigned to operational units and fill roles in the DoD's 721 hospitals, clinics and dental facilities; their primary purpose is to support military readiness.

But the GAO found disparities across the services for tracking and assessing the wartime medical skills of these personnel.

For example, the Army does not track medical skills training in its "official system" and, along with the Air Force, has not defined skills for subspecialties that require extensive training and expertise, as seen in critical care flight paramedics or surgical services.

While all three branches that train medical personnel have wartime medical skills checklists that outline training requirements for occupational specialties, the GAO found that, in some cases, the Army and the Air Force had not incorporated skills that are considered to be necessary for operating in a joint environment -- essentially having the same training and operational requirements to ensure interoperability while working together.

The Navy's enlisted medical checklists were developed at the same time as the joint skills list, and it has incorporated them into its lists and training. The Army and Air Force have incorporated some but not all joint skills into their lists.

"Without taking corrective action ... the Army and Air Force will lack reasonable assurance that subspecialty personnel have been trained on the skills necessary to perform their roles in the expeditionary environment," the auditors wrote.

The GAO also found that the Army and Navy do not consistently identify or address training gaps to sustain combat medical skills, while the Air Force sufficiently met this requirement.

The fiscal 2017 National Defense Authorization Act required the GAO to review the DoD's efforts to ensure that enlisted medical personnel maintain the skills needed for combat operations. Concern has arisen in the past decade over whether the military health system has focused on care for acute or chronic conditions in hospital settings instead of combat casualty care and readiness of the military forces.

The DoD is shifting the focus of military medical care to active-duty health services, with civilian employees or contract staff caring for non-military beneficiaries either in military hospitals or clinics -- or, where feasible, in the community through the Tricare program.

In 2018, the GAO reported that civilian staffing was an issue at military treatment facilities that affects enlisted medical personnel, who often are called in to fill administrative roles or perform duties that do not enhance their combat skills. The GAO recommended that the Defense Health Agency develop a strategic total workforce plan, but that had not been published as of February.

The GAO made 30 recommendations to the DoD and the services to ensure that personnel are adequately trained and maintain their skills levels. They included:

  • Identifying and tracking opportunities with civilian facilities to provide service members access to training in trauma care
  • Assessing available training opportunities with simulator programs
  • Taking corrective action to define wartime medical skills for enlisted medical subspecialties with an expeditionary role
  • Incorporating joint wartime medical skills into checklists
  • Using the findings on skills degradation from the DoD's project on highly perishable and mission-essential medical skills to identify appropriate training frequencies
  • Developing annual retention goals, by skill level, for enlisted medical personnel

The Defense Department concurred with the findings and provided examples of how the services were addressing the issues. For example, Army Medical Command is developing a system to better capture training and experience; the Navy has implemented ongoing assessments of enlisted proficiency; and Air Force Medical Readiness will establish more specific performance goals and targets.

-- Patricia Kime can be reached at Follow her on Twitter @patriciakime.

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