Readiness in Deployed Field Hospitals: Identifying Clinical Sustainment Gaps

Background: Role 3 Field Hospitals (FH) link far-forward medical assets with facilities outside the area of operations in deployed settings. We hypothesized FH readiness paradigms result in gaps in clinical skills and sustainment, particularly among enlisted personnel. Methods: A survey distributed to deployed FH clinical personnel queried demographics and clinical experience in pre-deployment assignments. It assessed perceived preparedness of self, providers, nurses, and enlisted personnel on Likert scale. Results: A total of 31 personnel responded, an 82% response rate. Officers were significantly more likely to hold full-time clinical positions stateside compared to enlisted personnel (90% vs 8%, p=0.0006). 92% of respondents without full-time clinical positions had patient contact less than once a week. Officers were more likely than enlisted personnel to agree they were adequately prepared for deployment (75% vs 50%, p=0.08). While 88% of respondents agreed that providers were well-prepared, this decreased to 50% for nurses and 37% for enlisted personnel. Notably, 69% of respondents believed that additional pre-deployment training could have prevented perceived clinical errors. Conclusions: The FH plays a vital role in providing complex care in deployed settings, and its importance will only increase in the event of large-scale combat operations. Low case volume for surgeons stateside is mitigated through military-civilian partnerships and off-duty employment, opportunities not well facilitated for enlisted personnel. Addressing these gaps in clinical experience through increased clinical opportunities for enlisted personnel is crucial to ensure optimal performance and the delivery of life-saving care in the deployed setting.