SAC MEDICAL LESSONS LEARED

File: 970207_aadco_010.txt
Page: 010
Total Pages: 14
CATEGORY: Planning

ISSUE ITEM #:

SUBJECT: Requirements Deviation

BACKGROUND: The UTICA and the plan for the contingency
hospitals were predicated on a nuclear ground war in Europe.
Contingency hospitals need to have flexibility and mobility
not tied to one scenario. Staffing should be based on a
realistic role of rapid medical stabilization of patients in
the field, continued stabilization along medical evacuation
routes and definitive care in the United States at fixed
facilities. Modern medical technology limits the amount of
pre-placement of medical equipment since equipment quickly
becomes obsolete. Internist and family medicine physicians
should out number surgeons and be the lead providers at out
of theater contingency hospitals. The following specialties
must be represented to support the internists and family
medicine physicians. Those specialists include, general
surgeons, orthopedic surgeons, ENT specialists, urologists,
OB-GYN surgeons, psychiatrists, radiologists, and
anesthesiologists. Physical therapists are vital for burn
therapy and orthopedic injuries. Surgeons should predominate
at the battle field medical treatment facility and at the
fixed, state-of-the-art 4th echelon hospitals. Surgeons
should be assigned only to augment other medicine physicians
at medical treatment facilities located along the medical
evacuation route. The UTICA needs to have a feed back
mechanism. The deployed unit needs to be able to call up
resources based on actual need, not a manning document. The
supplying MAJCOM needs to have direct communication with the
deployed unit to fine tune staffing. Substitutions should
not be made based on filling slots on a manning document.
Substitutions should be based on real needs. Substituting
OB-GYN physicians for surgeons when only a very limited
amount of surgery could be done was not good management of
resources. Psychiatric services are basic to any medical
deployment. Psychiatrist deployed with contingency hospitals
need trained nursing support to care for hospitalized
patients.

DISCUSSION: Many providers of care deployed to contingency
hospitals could have been better utilized at other locations
(including their home unit). OB-GYN physicians, histo-techs,
and cyto techs are some AFSCs we need to re-look. The mix of
specialties at contingency hospitals was probably not the
most effective for this war.

ACTION RECOMMENDED: UTCs should not be the sole determiner
for staffing contingency hospitals. Perhaps a core such as
the ADVON team could be standardized. Then, based on an in
theater assessment of the war scenerio and location of the
contingency hospital the remaining staff specialists could be
determined.

SUGGESTED OPRs HQ USAF/SGHR