NSIAD-92-175 Operation Desert Storm: Full Army Medical .
United StatesGeneral AccountingOfficeWashhqton,D.C. 20548National Security andInternationalAfPairs DivisionB-249273.1August l&l992The Honorable Beverly ByronChairman, Subcommittee on MilitaryPersonnel and CompensationCommittee on Armed ServicesHouse of RepresentativesDear Madam Chairman:This report responds to your request that we review the Army’s effectiveness in deployingmedical units in support of Operation Desert Shield/Desert Storm. As we promised in testimonyon this subject before your Subcommittee, this report is a more detailed discussion of theproblems that the Army encountered in mobilizing, deploying, and supporting medical units inthe theater of operations. It contains recommendations to the Secretary of the Army forimproving the readiness and operational effectiveness of Army medical units.We are sending copies of this report to the Chairmen of the House and Senate Committees onArmed Services and on Appropriations, the House Committee on Government Operations, theSenate Committee on Governmental Affairs, the Secretary of Defense, and other interestedparties. We will also make copies available to others upon request.This report was prepared under the direction of Richard Davis, Director, Army Issues, who maybe reached on (202) 275-4 141. Other major contributors are listed in appendix III.Sincerely yours,Frank C. ConahanAssistant Comptroller General
Executive Summa PurposeBecause of the high number of U.S. casualties expected during OperationDesert Shield/Desert Storm, the U.S. Army deployed about 23,000 medicalpersonnel and shipped millions of dollars of medical materiel to the PersianGulf. The Chairman of the Subcommittee on Military Personnel andCompensation, House Armed Services Committee, asked GAO to assess theArmy’s effectiveness in deploying medical units and providing medicalservices during this war. She requested that GAO determine whether (1) theArmy had experienced problems in identifying, mobilizing, and deployingmedical personnel; (2) medical units had their required equipment,supplies, and transportation support; and (3) medical units were able toevacuate and direct patients to appropriate hospitals.BackgroundTo support combat forces in the Persian Gulf, the U.S. Army deployed198 medical units, such as hospitals, air and ground ambulance companiesand detachments, logistical support units, and special surgical teams.These units were in addition to medical aides and battalion aid station staffof individual combat divisions.Army medical units deployed to the Gulf region in two phases. The first,consisting of active duty units, began in August 1990. The second phase,which began in November 1990, involved active duty units from Europeand Reserve and National Guard units from the United States.Active duty doctors and nurses, are assigned to medical treatment facilitiesduring peacetime to care for dependents, retirees, and Army personnel butare scheduled to deploy with different units to provide casualty care in aconflict.Resultsin BriefThe Army had to overcome numerous significant problems to makemedical units operational before the start of the ground war. For example,many doctors and nurses in active, Reserve, and National Guard units whowere scheduled to deploy could not do so for a variety of reasons. First, thepersonnel information systems used to identify doctors and nurses forassignment to active units contained incomplete and outdated information.Second, units’ peacetime status reports did not adequately reflectpersonnel deficiencies. Finally, many doctors and nurses had not trainedduring peacetime to perform their wartime missions, resulting in doctors’and nurses’ being unfamiliar with their units’ missions or equipment. TheArmy also faced equipment and other logistical support problems. Evenwith a massive effort to field equipment and supplies to hospital units,Page 2GAO/WXAD-92-176Army Medical CapabilityinDesert Stem*
Eseelltivesummarymany did not receive equipment and supplies or received only partialshipments. Shortages of transportation and materiel-handling equipmentlimited hospital mobility, and the evacuation of casualties was hampered bylong distances, poor communications, and a lack of navigationalequipment. As a result, the Army’s ability to provide adequate care had thewar started earlier or lasted longer or had the predicted number ofcasualties occurred would have been questionable.Principal FlndingsPersonnelInformationSy&mhcompl&or Out ofDateinformation in the Professional Officer Filler System was incomplete andoutdated because the units, U.S. Army Forces Command (which overseesthe units and validates their requirements), and U.S. Army Health ServicesCommand (which manages the system) did not follow required procedures.The Army, consequently, could not provide all the necessary doctors andnurses within 72 hours of notification, as required. During the first phaseof deployment, this system should have enabled the Army to identify andassign 100 percent of the doctors and nurses needed for the 40 activemedical units selected for deployment. However, it could identify only46 percent of them. In the second phase, the Army experienced similarproblems when it began to deploy medical units from Europe.PersonnelWereNondeployableMany doctors and nurses assigned to medical units were found to benondeployable for Operation Desert Shield/Desert Storm. Personnel werenondeployable for numerous reasons, such as unacceptable physicalconditions, noncurrent skills, and mismatches in medical specialtyrequirements. Some officers had not taken required basic training, andsome had incomplete medical training.Deficienciesin Unit StatusReportsIn many cases, unit commanders did not reflect in their unit status reportspersonnel deficiencies that could affect mission capability, as required byArmy regulations. Therefore, managers and decisionmakers did not knowthe actual status of the units. If these reports had been accurate, the Armymight have either not mobilized deficient units or attempted to have therequired personnel at the mobilization stations when the units arrived.Page 8GAO/NSIAD-92-176Army Medical Capability in Desert Storm
Executive &unmaryMany PersonnelNot Trainedfor Wartime M issionsMany doctors and nurses had not been trained during peacetime toperform their assigned wartime jobs. Many lacked basic soldiering skills,had no training in treating chemical casualties, had not participated in fieldtraining, and were not familiar with their units’ missions or equipment. Inpeacetime, Reserve and National Guard units are required to train ondesignated weekends and during a 2-week training exercise. However,during training, many of these doctors and nurses had been assigned toArmy hospitals to supplement hospital staffing.SomeHospitals Never FullyEquipped or SuppliedDeployable hospital sets that had been stored for emergencies were shortcritical equipment. For example, of the 19 hospital sets deployed fromstorage facilities in Europe, the average set contained only 60 percent of itsrequired equipment, with one set having only 28 percent. The missingequipment was to be sent to the units in theater; however, some hospitalcommanders said that their units had either received their missingequipment and supplies late or never received them at all. 4 lack of supplydiscipline and requisitioning problems exacerbated the shortage ofsupplies.In-TheaterSupply CentersDid Not OperateAccordingto Doctrine and FacedOtherProblemsArmy medical supply centers in the Persian Gulf could not adequatelyrespond to the demands of in-theater units. The doctrinal mission of thesesupply centers is to serve only as resupply points for Army medical units.However, during Operation Desert Shield/Desert Storm, they were alsorequired to act as initial supply points for Army medical units and asresupply points for Air Force, Navy, and Marine Corps medical units. Thecenters were neither trained nor equipped to adequately respond to theseextensions of their mission.SomeHospitals Could NotFollow DoctrineSome hospital units, lacking sufficient mobility, could not perform theirmissions. Because of the speed of the battle, weight and configuration ofthe hospitals, and the shortage of trucks and materiel-handling equipment,some Mobile Army Surgical Hospitals and Combat Support Hospitalsmoved only a portion of their bed capacities and surgical capabilities inorder to be able to provide surgical support.Page 4GAO/NSLAD-92-176 Army Medical Capability in Desert Storma
Executive BummaryEvacuationand RegulationProblemsDuring the war, problems arose in the effective use of ambulances and inthe evacuation of casualties. Ground ambulances could not be used asmuch as planned because of the rugged terrain, a lack of navigationalequipment, communication difficulties, and the long distances betweenhospitals and the front lines. Even the air evacuation units were taxed bythe distances from pickup points to the hospitals. The long distancesrequired frequent refueling, and crews had trouble locating fuel points.Medical regulators, who direct the evacuation of casualties, were unable toperform their mission due to a lack of adequate equipment to communicatewith ambulance units. As a result, ambulances evacuated casualties to onlyhospitals whose locations they knew. If the war had produced morecasualties, this unmanaged evacuation system could have led to theunderuse of some hospitals and the overwhelming of others.RecommendationsIn chapters 2,3,4, and 5, GAOmakes several recommendations to theSecretary of the Army to improve the mobilization, deployment, andwartime operations of medical units.Agemy CommentsIn commenting on a draft of this report, DOD concurred or partiallyconcurred with most of the findings and all of the recommendations. DODdisagreed with the overall conclusion that adequate care may not havebeen provided had the predicted number of casualties occurred or had theground war started earlier or lasted longer. GAObelieves the problems itnoted from the beginning of the deployment of Army medical units upthrough the ground war phase of Operation Desert Storm support thisconclusion. DOD also did not concur with GAO'Sconclusion that the lack ofmedical supplies had delayed mission capability. According to DOD, allhospitals had adequate supplies to carry out their missions. However,information GAOobtained indicated that medical units were lackingsupplies up to and during the ground war and that in-theater medicalsupply centers had zero balances of critical supplies just before the start ofthe ground war. DOD stated in its written response that steps are beingtaken to address the problems noted in GAO'Sreview. DOD'Scompletewritten response appears in appendix II.Page 6GAOpJSIAD-92-175Army Medical Capability in Desert Storm
ContentsExecutive SummaryChapter 1IntroductionBackgroundCaIl-up and Mobilization of Army Medical UnitsVarious Types of Army Medical Units CalIed Up and Mobilizedfor Desert ShieldOrganization of Health Care in TheaterMedical Supply System Established in TheaterObjectives, Scope, and MethodologyChapter 2Mobilization andDeplO IJ entOf MedicalPersonnel to OperationDesert ShiekU6eser-tStorm Were HinderedChapter 3Problems With theDistribution and Receiptof Equipment andMedical SuppliesAffected the Capabilityof HospitalsChapter 4Doctrinal Employmentof Hospitals LimitedY101010111415182020Automated Information for Assigning Personnel Incomplete orPerso%FErNondeployableUnit Status Reports Did Not Adequately Reflect PersonnelDeficienciesMany Personnel Not Trained for Wartime MissionsConclusionsRecommendationsAgency Comments2426Some Deployable Hospitals Were Never Fully EquippedShortages of Medical Supplies Reduced Mission CapabilityIn-Theater Supply Centers Did Not Operate According toDoctrine and Faced Other ProblemsConclusionsRecommendationsAgency Comments30313427282829383838Weight and Size of DEPMEDS Limited MobilityShortage of Support Vehicles Caused Problems in the Setupand Mobility of HospitalsEmployment of DEPMEDS LimitedConclusionsPage 6GAO/NSIAD-92-175j,4344Army Medical Capability in Desert Storm2’.l
Contents4444RecommendationAgency CommentsChapter 5ProblemsW ith PatientEvaluation andRegulation45454546Ground AmbuIances Were IneffectiveDesert Conditions Degraded Air Ambulance CapabilitiesCommunication and Navigational ShortfaIIs Impeded PatientEvacuation and RegulationConclusionsRecommendationAgency Comments494949AppendixesAppendix I: Units and Commands GAO VisitedAppendix II: Comments From the Department of DefenseAppendix III: Maljor Contributors to This Report505282TablesTable 1.1: Types and Numbers of Army Medical UnitsDeployed to the Persian GulfTable 2; 1: Additional PROFIS FilIers RequiredTable 2.2: PROFIS Requirement Changes Initiated Upon UnitAlert12Figures22231636Figure 1.1: Layout of a DEPMEDS FacilityFigure 3.1: Zero Balance Rates at USAMMCE DuringOperation Desert Shield/Desert StormFigure 4.1: Dolly Set W ith Medical Container41aPage 7GAO/NSLAD-92-175 Army Medical Capability in Desert Storm”,*‘,I:., :.,,,,
SHMEDSOMP&DPROFISTAMMISUSAMMAUSAMMCEPage 8Combat Support HospitalDeployable Medical SystemDepartment of DefenseEvacuation HospitalField HospitalGeneral Accounting OfficeGeneral HospitalHealth Services CommandMobile Army Surgical HospitalMedical Supply, Optical, and Maintenancepotency and dated itemsProfessional Officer F illerSystemTheater Army Medical Management Information SystemU.S. Army Medical Materiel AgencyU.S. Army Medical Materiel Center, EuropeGAO/NSIAD-92-175Army Medical Capability in Desert Storm
aPage 9GAO/NSLAD-92475Anni Medical Capability in Deoert Storm“,.
Chapter 1IntroductionBackgroundOn August 2,1990, Iraqi armed forces invaded and occupied the country ofKuwait. The United States, at the request of the Saudi Arabian government,deployed combat troops, including U.S. Army ground forces, to aid in thedefense of Saudi Arabia, a neighboring country of Kuwait.As support for the deploying US. Army combat forces, medical units weredeployed. To care for the predicted number of casualties, the Armydeployed about 23,000 medical personnel. In the initial phase, the XVIIICorps deployed and was accompanied by active medical units. However,before the initial deployments were completed, the U.S. Army’sinvolvement was expanded to include the VII Corps and an echelon abovecorps. This decision necessitated the call-up of Army Reserve and ArmyNational Guard medical units to provide the required medical support forthe additional Army combat troops deployed.This report covers the call-up, mobilization, deployment, and in-countryoperations and support of the hospital and evacuation units that supportedU.S. Army combat troops during Operation Desert Shield/Desert Storm.Call-up andMobilization of ArmyMedical UnitsThe Army Central Command, a subcomponent of U.S. Central Command,sent its requirements for medical support for the XVIII and VII Corps andan echelon above corps to the U.S. Army Forces Command. ForcesCommand was responsible for monitoring the readiness of units in thecontinental United States and for selecting units to deploy to the PersianGulf. Forces Command selected units in two phases, which started inAugust 1990 and ended in February 1991.In August 1990, Forces Command identified the active Army medical unitsto deploy in support of the XVIII Corps. These units consisted of hospitalunits, logistics support units, air and ground ambulance companies anddetachments, command and control units, blood supply units, as well asother types of medical units needed to meet the requirements establishedby the Army Central Command and the US. Central Command. For thisfirst phase, units began to deploy on August 9, 1990, and to arrive intheater on August 12, 1990.After defining XVIII Corps’ requirements, the Army Central Commandidentified requirements for the medical support of a second corps and anechelon above corps. Again, Forces Command was tasked with filling theserequirements. U.S. Army, Europe, assisted in filling these requirements,since VII Corps, which was stationed in Europe, had been selected as thePage 10GAO/NSIAD-92-175Am y Medical Capability in Dew-t Storma
Chapter 1Introductionsecond corps to be deployed to Saudi Arabia. Units identified during thisphase were similar in functions to those deployed during the first phase.However, most of these units were from the Army Reserve and NationalGuard. For the second phase, units began to arrive at their assignedmobilization stations in November 1990 and to deploy in December 1990.The last medical unit arrived in theater in January 1991. Of the 198 unitsand about 23,000 personnel deployed, 55 percent were from the ArmyReserve and National Guard, whiie the remaining 45 percent were fromArmy active units.Reserveand National GuardMedical Units’ReadinessReviewedPrior toDeploymentAfter the Reserve and National Guard units were alerted and called up,personnel were to report to their home stations within 72 hours forprocessing. Home stations are the facilities where units meet to conducttheir training during peacetime. The responsible Continental U.S. Army forthe Reserves or the State Adjutant General for National Guard unitsattempted to fill any shortages of personnel or equipment. Units thenreported to their mobilization stations, where Mobilization AssistanceTeams evaluated them for deployment preparedness in terms of theirModified Tables of Organization and Equipment.Modified Tables of Organization and Equipment list the units’ wartimeauthorizations for personnel by occupational specialty and equipmentrequired to perform their missions. If units were short in either category orpersonnel were not qualified for their positions, mobilization stationsattempted to correct personnel, equipment, and/or training deficiencies toenable the units to deploy to the theater of operation.Various Types of ArmyMedical Units CalledUp and Mobilized for .Desert Shield.To support combat forces in the Persian Gulf, Forces Command alertedand called up a variety of units in the Army medical corps. These unitsincludedhospital units, which provided surgical and medical treatment to patients;air and ground ambulance units, which provided transportation for patientsto the medical facilities;logistics units, which provided needed medical supplies and maintenanceof medical equipment;area support units, which provided a variety of medical support;command and control units, which coordinated and provided support fortheater operations;combat stress units, which helped to prevent or treat battle fatigue;Page 11GAOiN%4D-92-175Army Medical Capability in Desert Storm
chapter1Introductionpreventive medicine units, which detected and identified health hazardsand minimized their effects;veterinary services units, which inspected foods for personnel and treatedmilitary animals;dental services units;medical professional teams, which provided special treatment, such asthoracic surgery; andlaboratory services units, which examined samples of such things as bloodand skin to determine the existence of diseases or other microorganisms.Table 1.1 provides a breakdown of the types and numbers of Army medicalunits deployed to the Persian Gulf.Table 1 .l : Type8 and Number8 of ArmyMedical Unite Deployed to the 17119044352021917072233Preventive medicineunits110314Veterinary servicesunitsDental unitsSurgical teamsLaboratory units354000106016952138935743199Type of unltHospital unitsEvacuation unitsLogistics unitsArea support unitsCommand and controlunitsCombat stress unitsTotalActiveSource: Office of the Army Surgeon General.Although all these types of units were mobilized and deployed, our reviewfocused on hospital and evacuation units and their logistical supportbecause they represented the most critical areas in the treatment ofbattlefield casualties and
Problems However, during Operation Desert Shield/Desert Storm, they were also required to act as initial supply points for Army medical units and as resupply points for Air Force, Navy, and Marine Corps medical units. . Page 6 GAO/NSIAD-92-175 Army Medical Capability in Desert Storm
'Operation Desert Slorm: Full Army Medical Capability Not Achieved (GAO/NSIAD-92-175, Aug. 18, 1992). Page 1 GAO/NSIAI) '3 189 Operation Desert Storm. B-253207 the predicted number of casualties, or had the ground war started earlier . Page 3 GAO/
*June 1991 NAVY TRAINING SAFETY High-Risk Training Can Be Safer 144300 GAO,' NSIAD-91-112 . National Security and International Affairs Division 13-239352 June 26,199l . IHJl /S Basic 1 Jnderwater Demolition/SEAL CNET Chief of Naval Education and Training WI:) Department of Defense GAO General Accounting Office Page 7 GAO/NSIAD-91.112 Navy .
Desert Brand DB Total Sealer Desert Brand DB Total Sealer 0 VOC Desert Brand Del Rion Seal and Del Rio II Desert Brand Lacquer Sealer Clear and Matte Desert Brand LT 20, LT 30, LT 33 Latex Sealer -Clear Desert Brand Master Seal (Clear, Pigmented, Tint Based and WB (water base) Desert Brand Paver Tile Sealer
"desert"- largest is the Simpson desert! Deserts straddle Tropic of Capricorn! Australian Deserts!! Spinifex desert type: desert grassland dominated by Triodia grass hummocks! Australian Deserts!! Spinifex desert type: desert grassland dominated by Triodia grass hummocks Casuarina - desert oak - N2 fixing!! Grass trees, Xanthorrhoeaceae .
- 10-15% will be on Natural History of the Sonoran Desert You already have a study guide (outlines and key concepts) Review session: Wed the 10th 11 AM Koffer 204 Natural History of the Sonoran Desert Natural History of the Sonoran Desert 1. What is a desert? 2. Desert regions and desert habitats 3. Adaptation in deserts (generally) 4.
‘ Operation Desert Storm: Full Army Medical Capability Not Achieved (GAO/r-NSIAD-92-S, Feb. 6, 1992) and Operation Desert Storm: Full Army Medical Capability Not Achieved (GAOINSIAD-92-175, Aug. 18, 1992). Page 1 GAO
Deserts range from: hot deserts, such as the Sonoran Desert, Mojave Desert and Chihuahua Desert of North . America, and the Sahara Desert of Africa; temperate deserts, as in the Takla Makan Desert of China; and cold deserts, where precipitation falls mainly as snow or fog, such as the Atacama Desert of South America, the Gobi
C181-91(1997)e1 Standard Test Method for Workability Index of Fireclay and High-Alumina Plastic Refractories C182-88(1998) Standard Test Method for Thermal Conductivity of Insulating Firebrick C183-02 Standard Practice for Sampling and the Amount of Testing of Hydraulic Cement C185-02 Standard Test Method for Air Content of Hydraulic Cement Mortar C186-98 Standard Test Method for Heat of .
