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The U.S. Army uses Combat Support Hospitals (CSHs) — mobile, deployable hospitals housed in tents and expandable containers — to provide surgical and trauma care close to combat action. CSHs typically operate as hospitals only when deployed, and deployments occur only once every three to five years under the Army's rotational cycle. When not deployed, CSHs keep a partial set of equipment at home station for training or possible local emergency medical missions, while the remainder of the unit's equipment is in long-term storage at a site in the high desert of Northern California. This strategy of providing equipment for CSHs has created maintenance and obsolescence challenges. Nondeployed CSHs have old, poorly maintained equipment that is seldom or never used. Further, the Army has not programmed sufficient funds to keep all its CSH sets technologically current; in practice, deploying units do not deploy with their own equipment, but instead receive new medical equipment when deploying or take ownership of existing, upgraded equipment that is already deployed. RAND Arroyo Center researchers developed a new equipping strategy for the Army's CSHs, proposing three options for home station equipment sets: an “Expanded” design that provides more surgical and trauma capability and capacity; an “Enhanced” design that provides roughly the same amount of equipment but improved medical capabilities; and a “Lean” design that provides only enough equipment for some individual and team training. The research team also proposed changing the equipping strategy of deploying CSHs to eliminate much of the unit-owned equipment now residing in long-term storage. Deploying units would instead draw on a shared pool of up-to-date and well-maintained equipment. The proposed strategy would reduce total equipment costs from $1 billion to less than $700 million, leaving the Army with sufficient funds to continually upgrade and maintain both home-station and shared equipment.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    CSH Personnel Perspectives on Equipping and Maintaining Combat Support Hospitals

  • Chapter Three

    Alternative Designs for Home Station Equipment Sets

  • Chapter Four

    Alternative Equipping Strategies

  • Chapter Five

    Assessing the Costs and Risks of Alternative Strategies

  • Chapter Six

    Toward an Improved CSH Equipping and Maintenance Strategy

  • Appendix A

    How CSHs Currently Engage in Training to Achieve and Maintain Individual and Collective Skills

  • Appendix B

    Survey Questions

  • Appendix C

    Development of Alternative Designs for Home Station Equipment Sets

  • Appendix D

    Data Sources for Procurement and Upgrade Costs

  • Appendix E

    Procurement Options to Manage Cost Growth and Obsolescence Risk in Medical Equipment

  • Appendix F

    Simulation of Flows of CSH Units and Equipment in ARFOR GEN Cycle

Research conducted by

The research described in this report was sponsored by the United States Army and conducted by RAND Arroyo Center and RAND Health.

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