oversight

Use of Ambulance Trains and Assigned Personnel

Published by the Government Accountability Office on 1971-05-13.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

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             COMPTROLLER       GENERAL      OF      THE   UNITED     STATES
                             WASHINGTON.     D.C.     20548




B- 170 847




Dear   Senator    Proxmire         :

        This is our report    on the use of ambulance    trains    and
assigned     personnel.  We made the review     in response     to your
request    of September    15, 1970.

          We plan to make no further      distribution     of the report    un-
less copies are specifically       requested,      and then we shall make
distribution      only after your agreement       has been obtained      or
public announdement         has been made by you concerning          the
contents     of the report.

                                                                   Sincerely   yours,




                                                                   Comptroller     General
                                                                   of the United   States

The Honorable       William         Proxmire
United States     Senate




          50TH ANNIVERSARY                 1921- 1971
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                    COMPTROLLERGENERAL'SREPORTTO                                 USE OF AMBULANCE TRAINS AND
I                   THE HONORABLEWILLIAM PROXMIRE                                ASSIGNED
                                                                                        PERSONNEL
 I                  UNITED STATESSENATE                                          Department   of the Army B-170847
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                    DIGEST
                    ------
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  I                 WHYTHE REVIEW WASMADE
  I
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  I                        By letter       dated September 15, 1970, Senator William Proxmire requested
  I                        the General Accounting               Office   (GAO) to ascertain      the correctness   of in-
  I
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                           formation       furnished         to him concerning     an Army hospital     train--the  22d
  I                        Medical Ambulance Train--while                 it was stationed     at Walson Army Hospital,
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                           Fort Dix, New Jersey. (See app. I.)                     The information    concerned the
   I                       train's      movement, the activities             of the medical corpsmen and other per-
   I                       so-@       assigned to it, and the cost of the train.
    I                              --.I.-A-c_a,4 ..Cli,_, r,_    __l _ _       -~
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                    FINDINGS AND CONCLUSIONS
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                          The Office      of the Surgeon GeneraJ of the Army said that the train was
    I                     activated     to transport    patients   between Walson Army Hospital        and Val-
   I                      ley Forge General Hospital,          Pennsylvania;  to  give
                                                                  and for contingent    personnel    training
                                                                                       mo~f~;"~~ff~.&"ij"n-pur-
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    I                     in ambulance train operations;
    I                               -Some personnel at Fort Dix and in the Office           of the Surgeon Gen-
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                          mxpressed            doubt that the train was intended to be used to transport
    I
    I                     patients    to Valley Forge General Hospital          (See pp. 6 and 9.)
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    I                      Information           obtained    by GAO concerning      the 22d Medical   Ambulance   Train
    I                      showed that:
    I
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        I                        --It       did not    move from the     training   site at Fort Dix during the pe-
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                                        riod from     the date of its      arrival,   July 17, 1969, until it was re-
        I                               turned to     New Cumberland     Army Depot, Pennsylvania,    for storage,
        I                               March 16,     1970.   (See pp.     6 and 11.)
        I
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        I                        --Army records set the train's     cost at about $1.1 million--$994,000
        I                           spent primarily in 1952 and 1953 to purchase the cars and $126,000
        I
            I                       in 1967 and 1968 for renovation     of these cars, (See pp. 6 and 18.)
            I
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            I                    --Personnel    assigned to the train were used primarily      at the Walson
            I                       Army Hospital    at Fort Dix in their    duty specialties.   A limited
            I
            I                       amount of indoctrination    and training     in the use and operation  of
            I                     \ the train was given to those personnel.         (See pp. 6 and 12.)
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            I       Tear Sheet
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     ' --Plans  for supporting  the training mission were inadequate with re-
          spect to necessary funding and personnel   and logistical support.
          (See ppO 6 to 73.)

       --The train    probably   would have been unable to perform a transporta-
          tion mission    between Fort Dix and Valley Forge General Hospital
          because the railroad     tracks and roadbed were not suitable  for pas-
          senger car service.      (See p* 9.)

       --Costs  associated     with   activating   the train   were about    $67,600.
          (See p. 13.)

     GAO also inquired  into operation   of the 20th Medical Ambulance Train
     which was the only train  in active   status within     the United States at
     the time of this review.   This inquiry     showed that:

       --In contrast   to the 22d Medical Ambulance Train,   the 20th            had been
           adequately supported and maintained  in a 24-hour standby             status.
           (See pp. 14 and 15.)

       --There was some question       that it could have fully   supported   an opera-
          tional    requirement.    Engines with steam generators   needed for full
          operation     of the train were not readily  available.     (See pp- 15
          and 16.)

       --The availability   of military    aircraft   of the Air Force's Aeromedi-
          cal Evacuation  Service,    in GAO's opinion,   made future   use of the
          20th Medical Ambulance Train improbable.         (See pp. 14 and 17.)

     There were 96 cars in Army inventory          to support   10 ambulance trains.
     The cars cost about $11.8 million,         including    about $1.3 million      for
     renovation.    In 1970 arrangements       were made for supplying     and install-
     ing air conditioning     on kitchen-dining       cars for $140,000.     Installation
     of the units,    procured for $80,000,      was suspended pending a reevalua-
     tion of the requirement     for ambulance trains.         (See pp. 18 and 19.)


AGENCY ACTIGNS__-
               AND LWRESGLVE3 ISSUES
                         -___1__
     The Surgeon General,    in September 1970, initiated    a reevaluation of the
     requirement  for ambulance trains.    At that time, GAO was informed    that
     the concept for use of ambulance trains     would not change but that the
     number of trains  required   might be decreased.     (See p* 20.)

     However3 when the reevaluation      was completed in January 1971, the Sur-
     geon General concluded that ambulance trains         were no longer required
     in the United States for either      a mobilization     situation    or a domes-
     tic emergency.   He said that the primary factor          in his decision   was
     the Air Force's confidence     in its ability     to transport    patients  by
     airlift.   (See p. 20.)
       The ikputy Assistant     Secretory   Q-F thz Army (Manpo\ce~ ii-rd ,,..>\
                                                                              rJ~~-!~\-ve Psi-
       fairs)    agreed with GAO's cQt?clUSiQns 011 the 20-i-h and 22d hkdjcal            Am-
       bulance Trains,      The 20th  Medical   i4mbbllar~e   Train   was deactivated      in
       March 1971.     The nine trains    in stowage     were  giveri  te the   Army   Materiel
       Command in January 197: for fina'l       dispcsiticn.        (See ppa j3 and 17 and
       app. II.)

       GAO believes     that,  during the implementation     of the Gavcrrim?nt's     I?S-
       tablished    procedures   fog disposing  of excess equiy:xnent, consider-
       ation should be given to the possibTiitj          of mr:k"ng the trsi ns an:! thei in
       equipment available      ~PBcammuniti?s  that 3ack r,d~q~ia!:r; roc?dical faciJ .i -
       ties.     (See p. 20.)




Tea   Sheet




                                              3
                         contents
                                                             Page
DIGEST                                                         1
CHAPTER

  1        INTRODUCTION                                       4

  2        THE 22D MEDICAL AHE3ULANCE       TRAIN             6
               Events prior to activation                     7
               Problems of using the train for trans-
                   portation    purposes                      9
               filitary      support of the 22d unit         10
               Personnel assigned to the 22d unit and
                    their duties                             12
               Costs of activating       the 22d unit        13
               Conclusion       and agency comment           13

  3        THE 20TH MEDICAL AM3ULANCETRAIN                   14
               Support of the 20th unit                      14
               Description  of the train                     15
               Personnel assigned to the 20th unit    and
                 their duties                                16
               Conclusions and agency comments               16

  4        ADDITIONAL APFAS CQVEPEDIN TJ!OZREVIEW            18
               The Army railway medical car inventory        18
               Reevaluation   of the requirement  for
                 ambulance trains                            20
               Transportation   of patients  from Fort Dix   21

  5        SCOPEOF REVIEW                                    22

APPENDIX

      I    Letter dated September 15, 1970, from
              Senator William Proxmire to the General
             Accounting Office                               25
  II       Letter dated &rch 15, 1971, from the Deputy
             Assistant  Secretary of the Army (finpower
             and Reserve Affairs)  to the General Ac-
             counting Office                                 26
COMPTROLLERGENERAL'SREPORTTO                      USE OF AMBULANCE TRAINS AND
THE HONORABLEWILLIAM PROXMIRE                     ASSIGNED PERSONNEL
UNITED STATESSENATE                               Department of the Army B-170847


DIGEST
----_-

WHYTHE REVIEW WASMADE
    By letter   dated September 15, 1970, Senator William Proxmire requested
    the General Accounting    Office   (GAO) to ascertain      the correctness   of in-
    formation   furnished  to him concerning     an Army hospital     train--the  22d
    Medical Ambulance Train--while      it was stationed     at Walson Army Hospital,
    Fort Dix, New Jersey, (See app. I.)          The information    concerned the
    train's   movement, the activities     of the medical corpsmen and other per-
    sonnel assigned to it, and the cost of the train.


FINDINGS AND CONCLUSIONS
    The Office     of the Surgeon General of the Army said that the train was
    activated    to transport   patients   between Walson Army Hospital           and Val-
    ley Forge General Hospital,        Pennsylvania;    to give personnel       training
    in ambulance train operations;        and for contingent       mobilization      pur-
    poses.    Some   personnel  at   Fort Dix  and   in the  Office   of    the Surgeon    Gen-
    eral expressed doubt that the train was intended to be used to transport
    patients   to Valley Forge General Hospital           (See pp. 6 and 9.)

    Information  obtained     by GAO concerning      the 22d Medical     Ambulance    Train
    showed that:

      --It   did not    move from the     training   site at Fort Dix during the pe-
         riod from     the date of its      arrival,   July 17, 1969, until it was re-
         turned to     New Cumberland     Army Depot, Pennsylvania,    for storage,
         March 16,     1970.   (See pp.     6 and 11.)

       --Army records set the train's     cost at about $1.1 million--$994,000
          spent primarily in 1952 and 1953 to purchase the cars and $126,000
          in 1967 and 1968 for renovation     of these cars. (See pp. 6 and 18.)

       --Personnel   assigned to the train were used primarily      at the Walson
          Army Hospital   at Fort Dix in their    duty specialties.   A limited
          amount of indoctrination   and training     in the use and operation  of
          the train was given to those personnel.        (See pp. 6 and 12.)
        --Plans for supporting   the training mission were inadequate with re-
           spect to necessary funding and personnel   and logistical support.
           (See pp* 6 to 13.)

        --The train    probably would have been unable to perform a transporta-
           tion mission between Fort Dix and Valley Forge General Hospital
           because the railroad   tracks and roadbed were not suitable  for pas-
           senger car service.    (See p. 9.)

       --Costs  associated     with   activating   the train    were about    $67,600.
          (See p. 13.)

     GAO also inquired  into operation  of the 20th Medical Ambulance Train
     which was the only train  in active status within      the United States at
     the time of this review.   This inquiry   showed that:

       --In contrast   to the 22d Medical Ambulance Train,   the 20th had been
           adequately supported and maintained  in a 24-hour standby status.
           (See pp. 14 and 15.)

       --There was some question       that it could have fully   supported   an opera-
          tional    requirement.    Engines with steam generators   needed for full
          operation     of the train were not readily  available.     (See pp. 15
          and 16.)

       --The availability  of military    aircraft   of the Air Force's Aeromedi-
          cal Evacuation Service,    in GAO's opinion,   made future   use of the
          20th Medical Ambulance Train improbable.        (See pp* 14 and 17.)

     There were 96 cars in Army inventory          to support 10 ambulance trains.
     The cars cost about $11.8 million,         including    about $1.3 million      for
     renovation.    In 1970 arrangements       were made for supplying     and install-
     ing air conditioning     on kitchen-dining       cars for $140,000.     Installation
     of the units,    procured for $80,000, was suspended pending a reevalua-
     tion of the requirement     for ambulance trains.         (See pp. 18 and 19.)


AGENCY ACTIOTJS AND UNRESOLVEDISSUES

     The Surgeon General,    in September 1970, initiated    a reevaluation of the
     requirement  for ambulance trains.    At that time, GAO was informed that
     the concept for use of ambulance trains     would not change but that the
     number of trains  required might be decreased.       (See p. 20.)

    However, when the reevaluation      was completed in January 1971, the Sur-
    geon General concluded that ambulance trains         were no longer required
    in the United States for either      a mobilization     situation    or a domes-
    tic emergency.   He said that the primary factor          in his decision   was
    the Air Force's confidence     in its ability     to transport    patients  by
    airlift.   (See p. 20.)




                                             2
The Deputy Assistant   Secretary   of the Army (Manpower and Reserve Af-
fairs)  agreed with GAO's conclusions      on the 20th and 22d Medical Am-
bulance Trains.    The 20th Medical Ambulance Train was deactivated      in
March 1971. The nine trains      in storage were given to the Army Materiel
Command in January 3971 for final      disposition.    (See pp. 13 and 17 and
app. 11.)

GAO believes     that, during the implementation     of the Government's    es-
tablished    procedures for disposing   of excess equipment,     consider-
ation should be given to the possibility         of making the trains    and their
equipment available     to communities  that lack adequate medical facili-
ties.     (See p. 20.)
        Ambulance trains,      as defined      by the Department         of the
Army, consist      of one or more train         sections       designed    and
equipped     to provide   transportation        and emergency treatment
to patients.       An ambulance train         section     includes     a suitable
combination     of Pullman-type        ambulance railway         cars;   kitchen,
dining,    and baggage cars;       and   pullman      sleepers     for  attendant
personnel.

        Army Xegulation     40-4 provides        that, ordinarily,         ambu-
lance trains       or train   sections     be utilized    only when the use
of aircraft      is considered       not feasible.     Ambulance trains
are restricted       to the movement of patients          and attendants,
instruction      of personnel      in the operation     of ambulance
trains,     or to use in connection         with a national        disaster    or
emergency.

       The Surgeon General,         Department          of the Army, establishes
basic medical      policies     applicable        to the use of ambulance
trains   and designates        medical     installations         or activities   to
operate    the trains.       The Commanding General,              U.S. Continen-
tal Army Command, provides            training        for medical     personnel  in
ambulance train       operations      and provides         storage    facilities
and locations      for ambulance cars not maintained                  in a U.S.
Army Materiel      Command facility.

        Commanders of medical        installations       or activities        des-
ignated     to operate     ambulance trains        must ensure that ambu-
lance cars are adequately           maintained      and equipped.        The Com-
manding General,        Army Materiel       Command, provides        storage    for
ambulance cars not maintained             in a continuous       operational
status     under the jurisdiction         of the Continental         Army Com-
mand.      The Military     Traffic    Management and Terminal           Service,
when requested        by the Surgeon General          or the Continental
Army Cormmand, arranges         movement of and issues routing              in-
structions      for ambulance trains         or train    sections.




                                         4
       Army Regulation 40-4 provides that ambulance trains    or
ambulance cars be maintained in one of the following     condi-
tions:

     --reserve    storage status,  a condition to permit opera-
        tional   use within a period of approximately   30 days;

     --standby    status,   a condition   to permit operational    use
        within   a period   of approximately   24 hours;

     --operational     status, trains or cars in use for      a train-
        ing mission    or for moving patients.

      At the time of our review, 10 ambulance trains were
maintained by the Army within the United States--nine   in re-
serve storage and one in standby status at Fort Sam Houston,
Texas.    A description of the ambulance train which was in
standby status is given on page 15 of this report.
      The trains in reserve storage were positioned   as fol-
lows : four at New Cumberland Army Depot, New Cumberland,
Pennsylvania;   three at Sharpe Army Depot, Lathrop, Califor-
nia; and two at Atlanta Army Depot, Forest Park, Georgia.
The Army maintains    four ambulance trains in Germany; two
are in operational    status and two are in storage.
                               CHAPTER2

                 THE 22D MEDICAL MULANCE TRAIN

        The 22d Medical Ambulance Train (Rail) unit was acti-
vated January 2, 1969, and attached to Fort Dix, New Jersey.
It was further     attached to Walson Army Hospital,       Fort Dix,
for administration,      training,    and logistical  support.    Qf-
ficials    of the Office of the Surgeon General informed us
that the 22d unit was activated         with a mission to (1) trans-
port patients    between Walson Army Hospital,       New Jersey, and
Valley Forge General Hospital,         Pennsylvania,  (2) provide
training    to Army personnel in ambulance train operations,
and (3) provide for contingent         mobilization  purposes.    We
discussed the train's       mission with officials    at Fort Dix
and at Walson Army Hospital,          They agreed that the train was
to be used for training        purposes, but some of them expressed
doubt that the train was also intended to be used to trans-
port patients    to Valley Forge General Hospital,         The 22d
unit was deactivated       December 20, 1969.

       The train,  consisting    of six ambulance ward cars, one
kitchen-dining    car, one medical personnel car, and one bag-
gage car, was dispatched      from New Cumberland Army Depot and
arrived at Fort Dix on July 17, 1969. It remained at Fort
Dix until March 16, 1970, when it returned to New Cumberland
Army Depot for storage.

      On the basis of available     records at the Office of the
 Surgeon General and Fort Dix and of discussions         with knowl-
edgeable personnel,    we determined that the 22d ambulance
train did not move from its training       site while at Fort Dix
and that it was not utilized     to transport    patients.       The
purchase price of the train,     including    the related costs for
renovation   (see pS 181, was approximately      $1.1 million,       and
the personnel assigned to the 22d unit were utilized             primar-
ily on duties in Walson Army Hospital while they were as-
signed to the 22d unit,     They also received limited         training
in the use and operation    of ambulance trains,        Details of
our findings   follow.




                                     6
EVENTS PRIOR TO ACTIVATION

        A conference      on ambulance       trains,      attended  by represen-
tatives    of the Army Materiel          Command, the Army Mobility
Equipment     Command, and the Office             of the Surgeon General,
was held at New Cumberland            Army Depot on September            27, 1967.
At this conference,         it was planned          that three ambulance
trains    would eventually        be utilized         by the Continental      Army
Command for training          purposes     at Fort Sam Houston,          Texas;
Fort Eustis,      Virginia;      and possibly         Fort Dix, New Jersey.

       In October    1968 two congressional      inquiries      directed    to
the Office     of the Surgeon General     expressed      concern     over the
transportation      of patients   by motor bus between airfields
and military     hospitals.     One of the inquiries       dealt     with the
transportation      of wounded servicemen     from Fort Dix to Valley
Forge General     Hospital.

       Information       obtained       during    our review        indicated     that,
early    in November 1968, the feasibility                   of stationing       an am-
bulance     train     at Fort Dix was discussed              at the Office       of the
Surgeon General.            It indicated       also that,        if an ambulance
train    were stationed         at Fort Dix, the train             would assume the
mission     of moving Army patients              directly      from McGuire Air
Force Base,which          is adjacent        to Fort Dix, to Valley            Forge
General     Hospital.         According      to records      of the Office        of ,the
Surgeon General,          the 1st Army indicated             that the capability
for proper        maintenance        of the train         was available       at Fort
Dix.

        A Department    of the Army message dated November 14,
1968, requested      the Continental       Army Command to submit any
objections     to the immediate      stationing    of the 22d Medical
Ambulance Train at Fort Dix.            The Continental    Army Command,
in its reply     dated November 19, 1968, stated          that it had no
objections.

      In reference      to the Army message of November 14, 1968,
the Commanding General,          Fort Dix, replied      to the Surgeon
General   that there was no objection            to the stationing      of the
train   at Fort Dix if necessary          funds,   personnel,     and logis-
tical   support   were furnished        by higher   headquarters.       The
Commanding General        stated    that funds and personnel         to sup-
port a unit     of this     type and its equipment       were not available


                                             7
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      at Fort Dix.  Representatives  of the Office of the Surgeon
I     General told us that the Surgeon General took no action on
11l   the Fort Dix reply because of the statement by the Conti-
7nj
,,,   nental Army Command that it had no objections  to stationing
      the train at Fort Dix.
PROBLEMSOF USING THE TRAIN FOR
TRANSPORTATIONPURPOSES

     The Penn Central Railroad delivered   the train to Fort
Dix on July 17, 1969, with the understanding   that the train
would be handled as freight   car service.

      Records at Fort Dix showed that several Walson Army
Hospital  officials,  as well as an official  of the 1st Army,
felt that the train was not needed at Fort Dix. We noted
that on July 14, 1969, an official   of Walson Army Hospital
stated that ambulance buses and helicopters    were being used
 (see ch. 4) to transport  patients to Valley Forge General
Hospital  and that the arrangements were very satisfactory.

        On September 24, 1969, a passenger service representa-
tive of Penn Central Railroad advised a Fort Dix official
that the railroad    tracks and roadbed located between Fort
Dix and Mount Holly, New Jersey, were deteriorated         and could
not be used for passenger car service,        The representative
advised also that there was no plan to repair the Penn Cen-
tral tracks and, further,      that the Reading Railroad--delivery
carrier    to Valley Forge --could transport   the train to within
only about 5 miles of Valley Forge General Hospital.

       A Walson Army Hospital       official  informed us that the
condition     of the tracks was not known until       after the train
arrivedatFort       Dix; but on September 25, 1969, a represen-
tative of the Office of the Surgeon General advised a Fort
Dix official     that the Surgeon General's office had been
aware that the railroads         would not transport   patients   on the
train due to the condition         of the tracks.    The representa-
tive also stated that the train was to be used for training
purposes only and that it was never intended for use as
transportation      for patients    from Walson Army Hospital     to
Valley Forge General Hospital.

        We found indications  that Headquarters of Military
Traffic    Management and Terminal Service had been advised          of
the condition    of the tracks prior to the arrival   of the
train at Fort Dix.




                                   9
MILITARY      SUPPORT OF THE 22D UNIT

         Our review  showed that military   personnel   were ini-
tially     assigned  to the 22d unit on January     13, 1969,    sup-
plies     and equipment   for the 22d unit were requisitioned
April     24, 1969, and began arriving    at Fort Dix on May 12,
1969.

        According     to officials    of the Surgeon General's           office
and records       at Fort Dix, the train       was to be maintained           in
standby     status--    a condition   to permit    operational      use within
a period     of approximately       24 hours.     The Army Mobility
Equipment      Command was requested       to deliver      the train     in op-
erating     condition     and to provide     necessary     training    to the
22d unit.

        We found that Mobility          Equipment    Command technicians
did not accompany the train             to Fort Dix and that,       as a re-
sult,    the train    remained      in a semistorage     condition     from
its arrival      on July 17, 1969, until          September    29, 1969.    A
railroad     equipment    specialist       from the Mobility      Equipment
Command arrived       at Fort Dix on September          29, 1969, and per-
formed necessary        maintenance       on the train.     He also con-
ducted a 24-hour maintenance              course for members of the 22d
unit on train      maintenance        operations.

        Shortly   after    the specialist       arrived  at Fort Dix, he
stated    that certain       support    requirements    necessary   to main-
tain the train       in standby      status    had not been provided.
Further,      on October     3, 1969, Walson Army Hospital         and Fort
Dix officials       concluded     that the necessary      wayside facility
support     and related      funds were not available        at Fort Dix.

        According       to officials        of the Office      of the Surgeon
General,     installation           and wayside     support    requirements        for
ambulance trains            include     the following:        steam lines      for
heating     cars during          the winter      months,   electrical      service
for power and illumination                 during   the hours of darkness,
communications          lines,      water lines,      compressed      air lines,
and sanitary        facilities        for disposal       of waste and sewage.

       In a meeting held on October    3, 1969, at Fort Dix,
concerning   the status   of the ambulance train  the Post Engi-
neer stated    that he estimated  that over $150,000 would be


                                          10
required      to provide        wayside    support   and that a construction
project      costing    this      amount must be approved by Headquarters,
Department        of the Army.         He stated   also that,     even with
funds and authorization,               a minimum of 90 days would be re-
quired     to provide       the necessary       support   requirements.       We
noted that the estimate              was subsequently       reduced to
 $96,400--$69,000         facility      cost and $27,400 annual mainte-
nance cost.          On October       29, 1969, Fort Dix advised        the Con-
tinental      Army Command that $96,400 was required;                 however,
we were told by a Fort Dix official,                   no reply   was received
on this mattera

        We found that Walson Army Hospital              and Fort Dix offi-
cials    further     concluded     that,    with the advent of freezing
weather,       the train    should either       be moved to a facclity
with the required          support    or be retained     at Fort Dix and
placed     in storage      status.       On October  3, 1969, Fort Dix of-
ficials      recommended to the 1st Army that the train              be re-
located      to New Cumberland        Army Depot0

        Records at the Office        of the Surgeon General       indicate
that on October        17, 1969, the Surgeon General        expressed      the
desire     that efforts     be made to provide    necessary     support      to
the train       at Fort Dix.     These records   also state     that sta-
tioning      the train    at Fort Dix takes advantage       of the aerial
port of debarkation         at McGuire Air Force Base and makes pos-
sible    the efficient      use of Army medical     personnel.

        Other records      at the Office     of the Surgeon General
show that early        in November 1969, a mobile          repair     shop from
New Cumberland        Army Depot winterized        the train      at Fort Dix
which,     in effect,    placed    the train     in a temporary        storage
status.      These rec,ords     also state     that the train       would be
removed from temporary          storage    at the end of the 1969-70
winter     and that Fort Dix would be prepared             to provide        the
necessary     services     to place the train        in standby      status.

       Walson Army Hospital       officials        told us that the train
was not utilized      for transportation           of patients    and that it
was not moved from its training               site while    at Fort Dix.    We
were also,    informed     that,  to move the train,           an engine
would have had to be requested              from the Transportation       Cen-
ter,   Fort Eustis,     Virginia,     or rented       from Penn Central
Railroad.     We were told that this was not done.
PERSONNEL ASSIGNED TO THE 2Z.D UNIT
_AND THEIR DUTIES

       The number of personnel            assigned       to the 22d unit during
the period     from January      1969 to December 1969 ranged from a
low of one enlisted          man to a high of one officer                and 39 en-
listed   men.     During most of this period,               about 27 persons
were assigned.        E$ramples of the occupational              specialties     held
by these persons        include    enlisted      clinical      specialist,     hos-
pital   mess steward,        and medical      specialist.        Three Army Med-
ical   Service    Corps officers        served as commanding officer             of
the 22d unit      at various     times during          the period.

        During     interviews       with three persons--the           only person-
nel still       at Fort Dix who had been assigned                to the 22d unit--
and with officials             of Walson Army Hospital          and Fort Dix, we
were told that the amount of indoctrination                      and training
given to personnel             in the use and operation          of the train      was
limited     and that personnel           assigned      to the unit were used
primarily       in their       duty specialties        at the Walson Army Hos-
pital.      In view of the statement               in Senator Proxmire's       let-
ter,    we inquired        into whether       the personnel      assigned    to the
train     spent their        time playing       cards.     We found no evidence
that personnel         were not kept fully            occupied   with their    of-
ficial     duties.

        From the records      at Fort Dix and Walson Army Hospital,
we identified       one brief    formal   training    period   which was
conducted     for membersof      the 22d unit.       This training     was
apparently      given by personnel      from the Mobility        Equipment
Command in late September and early               October 1969.      (See p*
10.) We were unable         to identify     other periods     of formal
training.

      The 22d unit was deactivated  on December 20, 1969, and
the members of the unit were reassigned to Walson Army Hos-
pital or other medical units at Fort Dix.




                                        12
COSTS OF ACTIVATING       THE
22D UNIT

     On the basis of records    at New Cumberland    Army Depot
and Fort Dix, the costs associated     with the activation   of
the 22d unit  and the movement of the train     from and its re-
turn to New Cumberland  totaled   about $67,600 as shown below.

                           Item
                           --                                         cost

Labor and material       expended in removal       of train
    from and return    of train     to storage                     $ 1,867
Transportation      of train    from, and return     to,
    the New Cumberland      Army Depot                               2,493
Supplies     and equipment    issued to the 22d unit                32,261a
Military     pay of personnel      assigned   to the 22d
   unit                                                             31,000b

       Total                                                       $67,621
                                                                   --.-
aSome items were returned     to Fort Dix Post Supply Office,
 or transferred    to other medical   units when the unit was de-
 activated.     We were unable to determine   the value of these
 items due to lack of documentation.
b
    Costs were available    only   for the period  July 1, 1969, to
    December 20, 1969.     Also,   most of the personnel    time was
    spent on duties    at Walson   Army Hospital.    (See p. 12.)

CONCLUSION AND AGENCY COMMENT

      Our review    of events that occurred          prior  to stationing
the train    at Fort Dix and of the circumstances             surrounding
the delivery    and support   of the train       indicates     that better
advance planning     would have diminished         the problems      identi-
fied in this report,       By letter    dated March 15, 1971 (see
app. II),    the Deputy Assistant      Secretary      of the Army (Man-
power and Reserve Affairs)        agreed with our conclusion.




                                      13
                                   CHAPTER 3

                  THE 20TH MEDICAL AMBULANCE TRAIN

      Because the 22d unit had been deactivated        at the time
of our review   and the 20th Medical    Ambulance Train     (Rail)
was the only similar     unit active within   the United    States,
we made a brief    review of this unit    at Fort Sam Houston,
San Antonio,   Texas.

        The 20th ,unit was activated           March 24, 1969.        The pri-
mary mission         of the 20th unit was to move patients              between
hospitals       within    the continental      United   States     and from
aerial      or water ports       of debarkation      to hospitals.       The
secondary       mission     of the unit was to maintain          a state    of
training      and operational       readiness.       At the time of our re-
view,     the 20th unit had not been required              to implement      its
primary      mission,

       We were informed     by Army personnel         that the train      was
being maintained      in a standby      status---a    condition    which
would permit    operational      use within      a period     of approxi-
mately   24 hours.      The train   arrived      at Fort Sam Houston on
July 31, 1969, from Atlanta         Army Depot, Georgia.

        With regard    to the primary       mission    of the 20th unit,
we noted that a similar         mission     had been given to the Aero-
medical     Evacuation   Service,     U.S. Air Force.          The July to
September 1970 flight        schedule     for this     service    shows that
one of the Aeromedical         Evacuation      Control    Centers    is located
at Kelly      Air Force Base, San Antonio,          Texas.      The schedule
shows also that flights         are regularly       scheduled     from and to
Kelly Air Force Base and that,            in addition,       emergency
flights     to and from the base can be made when required.

SUPPORT OF THE 20TH UNIT

       Our review   showed that personnel      were first    assigned    to
the 20th unit     in April  1969 and that,     by August 31, 1969,
the strength     of the 20th unit had increased        to 28.    Medical
supplies   and equipment    were requisitioned     on April     21, 1969.




                                       14
        The 20th unit was provided           with support        equipment,      such
as batteries,        battery    charger,    steam generator,         and wayside
electrical     power, and administrative             equipment      such as desks,
safes,     and filing      cabinets,      The installation        of wayside
electrical     power for the train          was delayed       from July 1969
to December 1969 due to difficulties                 in receiving       materials.
Army personnel        said that,     prior    to installation        of wayside
power, the train         was maintained       in a 24-hour       standby    status
from power furnished           by the train's      diesel     generators.

        Inspection    and maintenance    support     for the train     was
provided     by the Army Mobility      Equipment     Command, Mobile Rail
Shop Number 2, Texarkana,         Texas.    Additional     maintenance
support     was provided   to the 20th unit       by the Maintenance
Division,      Fort Sam Houston.

DESCRIPTION OF THE TRAIN

      The train    consisted   of six ambulance         cars,  one medical
personnel    car, one kitchen-dining         car, and one baggage car.
Each ambulance     car was capable       of transporting      36 ambula-
tory patients     or 27 litter     patients.

        The ambulance       cars were equipped            with medical       kits    in-
cluding      numerous medical       supplies       and equipment.           In addi-
tion to the food-service            facilities         in the kitchen-dining
car, each ambulance          car was equipped           with a kitchenette
capable      of providing      food service        to personnel        in that in-
dividual       car.   All the ambulance          cars and the personnel              car
were equipped        with air conditioning.               Miscellaneous         support-
ing equipment,        such as eating         utensils,        tools,  and reserve
batteries,        was stored     aboard the baggage car.              The     only re-
quired     items not stored        on the train          were drugs and food
supplies.        The train     was provided        with outside        telephone
service.

        We found during    our review     that Fort Sam Houston did
not have an engine suitable          for moving the ambulance             train;
however,     an engine was obtained,        under contract,         from South-
ern Pacific     Railroad   Company for use in monthly            technical
inspections     of the train     which included       testing     the mechani-
cal operation      of the train.       Army officials        said that a
steam engine,      or a diesel    engine equipped        with a steam gen-
erator,     was required   to operate      the steam-powered          systems of


                                            15
the train.       They said also that,          since the train     had never
participated        in an actual     mission,     there was no definite      in-
formation     concerning      the availability        of an engine to s'upport
operational      requirements.        Furthermore,      an inquiry    at the
Southern     Pacific    Railroad     Company indicated        that it would be
difficult     to readily      obtain    a suitable     engine.

PERSONNEL ASSIGNED TO THE ZOTH
UNIT AND THEIR DUTIES

       At the time of our review9                  the 20th ,unit consisted             of
26 enlisted        personnel      and 2 officers.             Military      occupations
of 17 of the assigned             personnel        were among the medically              re-
lated    specialities,         including       clinical       and medical       special-
ists and field         medical      assistant.          Other occupations          of
personnel      assigned      to the unit were cook, clerk,                   a railway
car repairman,         an electrician,          and a rotary           wing aviator.
We were advised         that no physicians              or nurses would have been
assigned     to the ambulance train               until     it became operational.

       After   arrival    of the train    at Fort Sam Houston,                   the
Army Mobility       Equipment   Command conducted      on-the-job                train-
ing in the maintenance         and operation     of the train.                  Subse-
quently,     maintenance    was performed     by the 20th unit                  and
Fort Sam Houston maintenance          personnel.

        Since the 20th unit was not required               to perform         its
primary     mission   of moving patients,          the secondary          mission--
maintaining       the train   in a 24-hour       standby      status--was         being
performed,        To maintain    this   condition,      the 20th unit           fol-
lowed a training        schedule    which included        15 hours a week of
train    maintenance      for all available        personnel.

      The personnel   assigned    to the 20th unit    also supported
the normal additional     duties    necessary   in the administration
of Army units,    such as kitchen     police,   staff  duty,  officer
of the day, driver    of the guard,      and charge of quarters.

CONCLUSIONS AND AGENCY COMMENTS

       In contrast    with the lack of proper     support    and ade-
quate planning     for the 22d ,unit,   we concluded     that the 20th
unit was adequately       maintained  and supported    in a 24-hour
standby   status.     However, because the 20th unit had


                                            16
never performed its primary mission and never participated
in a readiness test and because arrangements for use of a
suitable  engine were not made, there was some question as to
whether the 20th unit,   including  the train,    could have sup-
ported an operational  requirement.      Further,  it appeared
that the availability  of military    aircraft,   equipped and
staffed for in-flight  patient care, rendered. future use of
the ambulance train improbable.

       The Deputy Assistant    Secretary of the Army (Manpower
and Reserve Affairs)     agreed with our conclusions    (see
app. II) and stated that action was initiated        in December
1970 to deactivate    the 20th Medical Ambulance Train,      The
effective   date of deactivation     was March 1, 1971.




                                 17
                                  IN THE REVIEW

       In addition    to the matters related to the 20th and 22d
Medical Ambulance Trains, we reviewed the following          perti-
nent areas:       (1) the inventory,   by type9 of Army railway
medical cars and their value, (2) a reevaluation        being con-
ducted by the Office of the Surgeon General of the require-
ment for ambulance trains,        and (3) the number of patients
transferred     from Fort Dix and the method of transportation
used.

THE ARMYRAILWAY MEDICAL
--
CAR I??iVEmBRY

      At the time of our review, the Army railway medical car
inventory   within the United States consisted of 10 trains,
each comprised of nine cars, and six extra cars, as shown
with additional    data in the following table.

                                            --- Cost per        car
                            Date                                Reno-
                           pur-                                 vat i on
         Typ2    of       chased    Num-    Purchase               cost         Total
      railway
      --.         car    (note a>   ber       cost             (note
                                                                --      b)       cost

kibulance ward             1952      63         $150,000       $ 9,550       $10,051,650
Medical personnel          1967      11            3,500        15,909            213,499
Eaggage                    1953      11           30,000         2,500            357,500
Kitchen-dining             1953      10           60,000        50,000         1,100,000
Kitchen                    1953      -1           60,000          -                60,000

       Total                        96                                       $11.782.649

a~~e medical personnel    cars were manufactured              in 1938 and were used
 when purchased  in 1967.     The renaining  cars            were manufactured in
 1.952 and 1953 and were new when purchased.
b
    Cars were renovated     at Tooele Amny Depot,          Utah,   in 1967 and 1968.
    Total renovation    cost was $1,304,149.




                                           18
        On May 14, 1970, a contract was awarded to Mallory En-
gineering,      Inc., of Salt Lake City, Utah, for air-
conditioning      units for the 'kitchen-dining   cars,      Records at
the Office of the Surgeon General show that the cost of air-
conditioning      these cars will be $140,000--$80,000        for the
air-conditioning       units and $60,000 for installing       them, Of-
ficials     of the Office of the Surgeon General informed us
that a Headquarters,        Department of the Army, decision had
been made to suspend installation         of the air-conditioning
units pending the outcome of the reevaluation           of the require-
ment for ambulance trains discussed below,




                                   19
 REEVALUATIONOF THE REQUIREMENT
FmULANCE
-------       TRAINS

      The Office of the Surgeon General began a reevaluation
of the requirement  for ambulance trains on September 21,
1970 0 An official  of the Office of the Surgeon General in-
formed us that the contemplated    use of ambulance trains was
not expected to change but that a possibility     existed that
the number of trains required   for mobilization   planning
would be decreased.

      Information     obtained during our review indicated      that
the reevaluation      was to be primarily   concerned with mobili-
zation planning and the availability        of Air Force support
for providing     transportation   for patients   during mobiliza-
tion,

       On March 15, 1971, the Deputy Assistant        Secretary of
 the Army (Manpower and Reserve Affairs),        in replying     to our
 draft report,    stated that the reevaluation     of ambulance
 trains within the United States was completed January 21,
 1971. He further      stated that the Army Surgeon General had
concluded that a valid requirement no longer existed for
these trains    to be used in either a mobilization        situation
or in a domestic emergency.        A primary factor in this deci-
sion of the Army Surgeon General was the confidence ex-
pressed by the Air Force in its ability        to transport      antic-
ipated patient     loads.    On January 28, 1971, the ambulance
trains   in reserve storage in the United States were given to
the Army Materiel      Command for final disposition.

      We believe that, during the implementation    of the Cov-
ernment's established    procedures for disposing of excess
equipment, consideration     should be given to the possibility
of making the trains and their equipment available     to com-
munities that lack adequate medical facilities.




                                 20
TRANSPORTATION OF PATIENTS FROM
FORT DIX

         Patients      returning       from Vietnam      are airlifted      by the
Military       Airlift      Command to McGuire Air Force Base, which
is adjacent          to Fort Dix.         Air Force bus ambulances          are used
to move the patients              from the aircraft         to Walson Army Hos-
pital     at Fort Dix.           After    processing     at Walson Army Hospi-
tal the patients            are transported         to the Valley      Forge General
Hospital       or the Philadelphia            Naval Hospital.

        The 212th Medical          Detachment        (Helicopter      Ambulance)      was
activated      in January       1969 at Fort Meade, Maryland,                 and its
mission    included        the requirement         to provide     air ambulance
evacuation       of sick and injured            personnel      to and between
Fort Dix/McGuire           Air Force Base and Valley             Forge General
Hospital.        Fort Dix officials           informed      us that helicopter
support    for transporting          patients        was started      about July
1969.     Prior     to this,     ambulance buses equipped              to provide
medical    care were used to transport                 patients     from Fort Dix
to Valley      Forge General        Hospital.         They continue       to be used
when weather       prevents      the use of helicopters.               At   the time
of our review,          regular    ambulances        were being used to trans-
port patients         to the Philadelphia            Naval Hospital.
       The number of patients   transferred      from Walson Army
Hospital   to Valley Forge General      Hospital    and the Philadel-
phia Naval Hospital    during the period       January  1, 1968,
through   September 30, 1970, is shown below by calendar           year.

                                              Walson Army Hospital      to
Calendar                               Valley       Forge      Philadelphia
  year                                 General Hospital -   --Naval Hospital
   1968                                          2,747                    2,239

   1969                                          2,382                    1,574

   1970 (first      9 months)                    1,904                    -_ 572
          Total                                                           4,385
                                                                          --




                                          21
                                 CHARTER5

                            SCOPEOF REVIEW

        We reviewed pertinent       reports and files relating    to the
utilization      and operation    of the 20th and 22d Medical Ambu-
lance Trains.       We interviewed      personnel having responsibil-
ity for establishing       policies     related to the use of, and the
maintenance and support of, ambulance trains;           we also inter-
viewed three persons formerly assigned to the 22d Medical
Ambulance Train, the only persons remaining on duty at Fort
Dix,      Our review was performed during September, October,
and November 1970.

      We obtained     information    at the following    locations:

     Office of the Surgeon General,          U.S, Army
     Washington, D.C.

      Fort   Dix,   New Jersey

     New Cumberland Army Depot
     New Cumberland, Pennsylvania

     Fort    Sam Houston,    Texas




                                     22
23
                                                                                                APPENDIX I




                                        September             15,   1970


The Honorable         Elmer B, Staats
Comptroller       General    of the United                      States
General     Accounting      Off ice Building
441 G Street
Washington,       D. C.        20548


Dear      Elmer:

       It has come to my attention       that,  as of last   January,
the Army maintained    at Walston   Army Hospital     in New Jersey
the 22nd Hospital   Train,   which,   according   to my informant,
never  moved an inch from the day it was ‘Ibought.

          Apparently,             the   cost      of   the train     was in excess    of a
mlllion      dollars.             Irt addition,          the medical    corpsmen   and other
personnel        assigned          to the        train     had no dot ies;    they spent
their     time playing             cards.

          Would      you    please         ascertain            if this    information     Is
correct       and,     if   it is,         has the          situ$tion      been coCrected?

          Thank      you    for     your       attention.




WP:ced




                                                 25
    APPENDIX II

                          DEPARTMENT  OF THE ARMY
                    OFFICE OF THE ASSISTANT SECRETARY
                              WASHINGTON.      D.C.   20310




                                                              MAR 15 1971


    Mr. C, N. Bailey, Director
    Defense Division
    United States General Accounting              Office
    \?ashington, D. C. 20458


    Dear Mr:, Bailey:
         On behalf of the Secretary of Defense I am replying  to
    your draft report on matters relating to the use of ambu-
    lance trains and assigned personnel by the Department of
    the Army (OSD Case j/3227).
          The Army agrees with the conclusions          of the General
    Accounting Office draft except in those incidents           noted in
    the inclosure.      Since receipt of the draft report rendered
    by your office we have completed our reevaluation           of the
    need for ambulance trains in the United States.            In light
    of the availability      of aerial support we have concluded
    there no longer exists a valid requirement           for maintaining
    this activity0      Accordingly   the Army's one remaining CONUS
    ambulance train unit was inactivated        effective    March 1,
    1971,
                                            Sincerely,



I   1 Incl
R
      Comnents          Deputy As                     cetary of the Army
W                           (Manp                     eserve Affairs)
1




                                              26
                                                                      APPENDIX II



Page   1
     GAO Position:    Some personnel        at Fort Dix and in the Office      of
The Surgeon Gzera1       expressed      doubt that the train     was intended    t;,
be used to transport      patients      to Valley    Forge General Hospital.
                   : The 22d i"Iedica1 Ambulance Train            (Rail)   was
act                 transport      patients     between Walson Army Hospital,
N* Jo, and Valley     Forge General Hospital.,          Pa, (2) to provide
training   and (3) to support       general     war mobilization    plans,

Page 1
    -MO Position:         Army records   set the trains         cnst -- purchclse
price   of??%ne cars and related         cost Zor rcnovntion         in 136? and
1968 -- at about $l,b million,
                           Ambulance Train cars were p~trchased in the
195                     ame to support     the Army PicfbiZ ization     Medical
Department      Program.     Upgrading   the cars was accomplished          in the
1967-1968     time frame for conversion         into accommodations        considered
acceptable      for furnishing      an adequate    level     of medFcal. care because
of continuing       requirements     for ambulance      trains,
Page 1
     GAO Posi.tion:        Personnel      assigned      to the train   were used
primv-a???6e             Walson Army Hospital.            at Fort Dix in their   duty
specialties.
  .
             Position:      This is in keeping            with the Army Surgeon
Gen          %TTcT       of maintaining         proficiency      In the medical
military      occupational      specialties,
La&
     GAO Position:        The availability       of military       aircraft     of the
AireForceTs      Aeromedical      Evacuation      Service,    in GAO's opinion,
makes the future         use OE the 20th Yedical.          Ambul.ance Trains
improbable,
     Amsition:             Action    was initiated       in Tlecenrber 1.?7(! to
ina'ctivateX&       70th    ?ledica'L Ambulance Train          (Rai.1).     TfW
effective      date of izaetivation        was 'I Xnrcj~ 1971,
Page 2
   AGENCY     ACTIONS AND UNRFSOLVED
   ----I____Ix-.-----              w--TSSUCS




                                             27
 APPENDIX II


confideucC expressed by the Air Force to transport     the patient
load anticipated    in general war, Accordingly,  the nine CONUS
trains   in reserve storage were passed to the United States Army
Giterief   Comnand for final disposition  on 28 Jc?nuary 1971.




                                                   U.S.   GAO   Wash.,   D.C.
                              28