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Care in a deployed setting is often being delivered by people working outside their areas of specialty

• Those who deploy as field surgeons provide mostly primary care but must also be prepared to provide initial stabilization of trauma patients. The position is often filled by other types of specialists who do not typically do primary care or see trauma care in their home-station jobs.
• Those who deploy to forward surgical teams or combat support hospitals see trauma cases that require surgical intervention. Although these providers are deployed into the same specialties they normally work in their home stations, the nature of the work is different. With few exceptions, providers at home-station MTFs do not see fresh trauma patients.

Predeployment trauma training (PDTT) is valuable but not sufficient

• Despite a mandate that specifies that no less than 90 percent of medical providers are required to attend PDTT within 180 days of the start of a deployment, the analysis suggests that only 40 to 60 percent of providers attended.
• Opportunities for hands-on work are limited. Some courses use simulations but do not include work with human patients. Other courses include rotations at trauma centers but are too brief to allow students to do much more than observe clinical care.

The U.S. Army Medical Department has a dual mission: to care for the war wounded during times of conflict and to operate medical treatment facilities (MTFs) that provide care to service members, their beneficiaries, and military retirees. Because the injuries that require treatment during wartime can be very different from the case mix seen in MTFs, the Army asked RAND Arroyo Center to identify ways to help providers prepare for wartime missions while they are stationed at home.

Using a variety of data sources, RAND Arroyo Center quantified how providers were assigned during wartime relative to their home duties, how the types of procedures seen in theater compared with those performed at home-station MTFs, and the rate at which providers attended mandatory predeployment trauma training (PDTT). In addition, the research team interviewed previously deployed providers to gather their perspectives on how they prepared — clinically and for trauma specifically — for the deployment mission, what their roles were in theater and how their patient mix in theater differed from the types of cases they treated in MTFs, and what additional training or other preparation would have helped them for the deployment mission.

• Chapter One

  Introduction

• Chapter Two

  How Medical Education Prepares Providers for Deployments

• Chapter Three

  How Medical Treatment Facility Workload and Outside Work Prepare Providers

• Chapter Four

  Predeployment Training: Courses, Trauma Rotations, Exercises, and Prior Deployments

• Chapter Five

  Solution Options

• Chapter Six

  Findings and Recommendations

• Appendix A

  Quantitative Methodology

• Appendix B

  Qualitative Methodology

• Appendix C

  Provider Areas of Concentration and Definitions of Groupings

• Appendix D

  The Dashboard