Readiness in Deployed Field Hospitals: Identifying Clinical Sustainment Gaps.

Role 3 Field Hospitals (FH) link far-forward medical assets with facilities outside the area of operations in deployed settings. We hypothesized that FH readiness paradigms result in gaps in clinical skills and sustainment, particularly among enlisted personnel. A survey distributed to deployed FH clinical personnel queried demographics and clinical experience data on predeployment assignments. It assessed the perceived preparedness of self, providers, nurses, and enlisted personnel on a Likert scale. A total of 31 personnel responded, an 82% response rate. Officers were significantly more likely to hold full-time clinical positions stateside compared with enlisted personnel (90% vs 8%, p = 0.0006). Ninety-two percent 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). Although 88% of respondents agreed that providers were well prepared, this decreased to 50% among nurses and 37% among enlisted personnel. Notably, 69% of respondents believed that additional predeployment training could have prevented perceived clinical errors. 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 that are not well facilitated for enlisted personnel. Addressing these gaps in clinical experience by increasing clinical opportunities for enlisted personnel is crucial to ensuring optimal performance and the delivery of lifesaving care in the deployed setting.