Cover: Improving Trauma and Critical Care Proficiency and Readiness for Air Force Personnel in Critical Medical Specialties

Improving Trauma and Critical Care Proficiency and Readiness for Air Force Personnel in Critical Medical Specialties

A Pacific Air Forces Perspective

Published Feb 21, 2024

by Lisa M. Harrington, Edward W. Chan, Carl Berdahl, Matthew Walsh, Sean Mann, Jonah Kushner, Shreyas Bharadwaj, Mark Toukan, Thomas Goughnour


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Research Questions

  1. What factors currently affect medical personnel's readiness for a time of war?
  2. How is information regarding readiness currently gathered and shared?
  3. What could be done to better improve readiness overall?

Most U.S. Air Force medical personnel spend their time at military treatment facilities (MTFs) caring for patients whose ailments are far less complex or urgent than the severe trauma-related injuries they would see in war. This mismatch between peacetime and wartime medical care necessitates a deliberate effort on the part of the Air Force Medical Service (AFMS) as a whole and the Pacific Air Forces (PACAF) to ensure that personnel in critical medical specialties receive the training and hands-on clinical experience they need to save lives in a high-casualty environment. The goal of this research project was to investigate approaches for increasing readiness and proficiency.

To develop a portfolio of readiness building activities, the authors analyzed manpower and personnel data, reviewed Comprehensive Medical Readiness Program (CMRP) checklists and relevant literature, engaged in discussions with the stakeholder community, and developed models of the assignment system and of skill acquisition and decay. They present their findings and recommendations for the future and have developed a prototype framework to demonstrate a possible method for deciding which readiness building activities and assignment policies to employ.

Key Findings

  • Personnel in the Western Pacific tend to be more experienced, on average, than those in locations in the continental United States, but undermanning combined with skill decay in remote regions can have a significant impact on readiness.
  • Deployments have been opportunities to develop proficiency, but these opportunities are declining; the impact on proficiency needs to be better understood, and other options to develop currency and readiness need to be utilized.
  • CMRP checklists do not fully function as intended; there is no real standard against which to measure readiness, measure improvements in knowledge or skills, or identify areas of concern.
  • No single organization has visibility over the types of readiness activities currently being used throughout the MTFs and major commands, lessons learned, or investments being made and required; information sharing occurs primarily on an ad hoc basis.
  • Training activities are perhaps the easiest options to increase currency because they can focus directly on trauma and critical care, have low manpower costs and time commitment, and require little coordination outside the Air Force.
  • Readiness activities in the practice category include a wide variety of options for placing medical personnel in settings that require more-intensive patient care.
  • Assignment policies could contribute to readiness for the Western Pacific without having a negative effect on other locations.
  • Using a systematic framework to match different types of personnel according to their priority ranking, and constraints on participation and activities, could enable the AFMS to take a holistic view of different strategies for building readiness.


  • The Air Force should treat the readiness of medical personnel as an enterprise problem requiring an enterprise-wide solution.
  • The AFMS, in collaboration with the Air Force Personnel Center, should view assignments over the course of a career as a key component in the development of the proficiency and readiness of its personnel.
  • PACAF should continue to advocate for activities and policies that enhance proficiency of wartime skills and readiness for potential conflict.
  • The AFMS should undertake a comprehensive assessment of the requirements for medical simulation across the spectrum of modes, levels of complexity, and needed outcomes, including infrastructure and support.

Research conducted by

This research was commissioned by Pacific Air Forces and conducted within the Workforce, Development, and Health Program of RAND Project AIR FORCE.

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