As DEPMEDS come on line, training of our personnel to man the platforms becomes an important priority. Fleet Hospital Operations Training is a newly established course presented at the Naval School of Health Sciences, San Diego Detachment, Camp Pendleton, California. This course is designed to teach fleet hospital staff members the principles of fleet hospital assembly and operations in a combat environment. To reach initial operating capability at least 40% of the hospital staff must be trained. The remaining staff will be trained as soon as possible after delivery of each hospital. Our goal to train 100% of the staff of each hospital has been achieved for the first hospital. The Camp Pendleton facility, which used elements of a 250-bed CBTZ fleet hospital, will train approximately 3,000 active duty and reserve personnel annually. Each of the 18 classes a year will consist of approximately

165.

Retraining will be provided every third year.

Living in the field, personnel learn to assemble fleet hospital components and become familiar with the equipment in their functional areas during realistic medical exercises. The school site, remote and austere, is largely self-supporting and is representative of the environment that can be expected in the rear of a combat zone. Training is conducted in a phased manner to simulate actual deployment of a fleet hospital. A detachment of Construction Battalion personnel (SEABEES) arrives on site first and assembles the base camp portions of the fleet hospital. A hospital command team also arrives to supervise the hospital's assembly. Next, an advance party of non-medical and medical personnel reports to assemble the support services portions of the hospital, followed lastly by the rest of the course participants who assemble the medical portions of the hospital. In total, the training cycle lasts 10 days. training for each of these groups in hospital assembly is

After

completed, a medical exercise is conducted to provide experience

in operating the facility and its equipment.

Other important milestones have been achieved in readiness training:

At the completion of FY 87, 4,067 Navy active duty and reserve medical personnel, including 2,671 physicians, had received training in the Tri-Service Combat Casualty Care course. This course teaches personnel to function on a battlefield during a mid- to high-intensity conflict by placing staff in realistic combat situations;

All members of the Hospital Ship Full Operating Status medical treatment facility crew will undergo a three-part training regimen which includes orientation training for the ship and medical treatment facility, fire-fighting and

damage control training, and a course in shipboard

familiarization training;

Training provided by the Surface Warfare Medical Course ensures that medical officers assigned to the staffs and ships of Navy surface units have the necessary education to appreciate the special needs of deployed units and their personnel. The course is taught at San Diego, California and Portsmouth, Virginia, during three week training sessions each summer for those assigned to surface ships for the first time. As of December 1987, a total of 142 personnel were trained for their sea duty assignments;

MEDICAL READINESS STRATEGIC PLAN

The House Armed Services Committee's Report on the Fiscal Year 1987 National Defense Authorization Act directed the development of an integrated plan for curing the ills of the wartime medical readiness system by 1992. The Assistant

Secretary of Defense (Health Affairs) has developed such a plan and forwarded it to the Services for implementation. Full

implementation of the plan will require resources not presently Your support will be needed if the plan is to be

available.

fully implemented.

The need for resources notwithstanding,

there are many elements of the plan which can be implemented without additional resources. They require the Services to work closely together to coordinate planning and implementation.

I think we all agree that the Strategic Plan contains many items which must be accomplished. We should also agree that we must continue to perform the many things which presently consume our time, energy, and resources. The question which remains is, where do we find the resources to implement the many important initiatives in the strategic plan? Among the resources required to implement these plans is manpower. For example, many of the action plans require dramatic increases in the tempo of training operations. What must be kept in mind is that each additional hour of training requires an hour away from some other function, most notably, patient care. Any new function we do must come from some other function.

The Medical Readiness Strategic Plan brings together many of the most important medical readiness issues in one omnibus plan. The specific resources required to fully implement the plan have not yet been identified. However, there is no doubt that implementing the plan will require additional resources and your long term support.

Summary

In his statement to the Military Personnel and Compensation Subcommittee of the House Armed Services Committee, the Secretary of the Navy said, "...without additional resources Navy Medicine

will continue to be in extremis'." Naval medicine relies on trained people to deliver quality healthcare to a diversified and wide-ranging population. It relies on the availability of state-of-the-art equipment to treat patients, to maintain skills, and to retain healthcare professionals on active duty. The system requires hospital facilities that meet recognized life-safety codes and have the space available for providing patient care. Unlike our civilian counterparts, however, we must prepare daily for wartime requirements by deploying physicians and nurses to train with the very units we would support in time of war. This in turn depletes our hospitals' staffing and limits the number of patients we can treat, which results in reliance on CHAMPUS. To contain the cost of CHAMPUS, we have contracted with healthcare providers to work in our hospitals, making use of available space for both inpatient and outpatient care.

CHAMPUS and most forms of contracting provide us with a much needed safety valve for meeting the healthcare needs of our beneficiaries. However, CHAMPUS and contracting are expensive and make only marginal contributions to improving our readiness status. Navy medicine needs the resources which will allow it to recruit and train active duty physicians, nurses, and other healthcare providers. To ensure we retain these professionals, we must be able to offer them well-constructed, state of the art hospitals, and a professional environment in which to practice.

Even as we grow additional active duty healthcare professionals, we will continue to search for innovative means to provide healthcare services; including contracting, direct civilian hire, and managed healthcare approaches. Commanding officers must be encouraged and guided in accomplishing this; but we must provide them with the capability--the resources. Any negative action, or any failure to act--whether it be with facility construction, manpower growth, or funding--affects the entire Naval Medical system. Meeting peacetime healthcare requirements, including the care of non-active duty beneficiaries, contributes to wartime readiness and controls costs. Those are our goals; to be ready when needed, and to provide cost effective healthcare services as we standby, ready to assist.

Senator GLENN. Thank you, Admiral.

General Becker.

STATEMENT OF LT. GEN. QUINN H. BECKER, U.S. ARMY, SURGEON GENERAL OF THE ARMY

General BECKER. I would like to, Mr. Chairman, just submit an abbreviated statement and I submit my full statement for the record.

Senator GLENN. It will be included.

General BECKER. Medical readiness is our number one priority. We are soldiers. I am a soldier, and we want to take care of our soldiers.

We are improving our posture to do that during wartime. This year we have purchased to date 101 field medical sets, that is DEPMEDS sets. That is very near the target. We will field 15 of these by the end of this year. These DEPMEDS sets of course increase the capability of our field units considerably and replace the old MUST sets.

The major problem in readiness remains in Reserve personnel. We have the New STRAP program that the Congress has given us and we just recently got the recruiters, the AGR strength that we needed to run that program. We believe that with this new program we will be able to recruit the critical specialties in both medicine and nursing that we need to fill our Reserve units. These are, of course, the orthopedic surgeons, the general surgeons, the anesthesiologists, the OR nurse, and the nurse-anesthetists. We have already had some success with this program.

Peacetime health care, of course, as Admiral Zimble said, is very tightly linked with wartime readiness. We do provide quality care. We have high quality practitioners. We have taken many measures to improve that over the last 3 to 4 years.

The 1988 budget provided by the Congress was good. It allowed us to increase our PRIMUS clinics and we appreciate this committee's help for that.

However, several deductions have been made that have put us considerably below the 1987 level. Now, we have been able to gather a little money and this afternoon or early in the morning we will release a message stating that we will continue to honor civilian prescriptions. This has been a problem out in the field, as you know. We are still short money to finish the year. We will continue to try to find the resources to, at least, return to our 1987 level of effort.

In the future, the use of CHAMPUS money in our catchment areas will give us the diversity we need to take care of our patients and I believe save a considerable amount of money.

We are suffering a physician loss at a rate higher than anticipated. There is a pay differential problem. You mention that in your statement, I believe, and that is real.

What we want to do is to use our direct care facilities to the maximum amount and thereby train our people for their wartime mission and save considerable CHAMPUS dollars.

That is the end of my statement and I stand ready for your questions.

[The prepared statement of General Becker follows:]