You Can’t Fix What You Don’t Measure: Quantifying Enlisted Medical Provider Expeditionary Skills Exposure at Military Treatment Facilities Versus Military-Civilian Partnerships

INTRODUCTION: Future conflicts are expected to involve prolonged evacuation timelines, austere environments, and high-acuity trauma, increasing reliance on enlisted medical providers (EMPs) to deliver prolonged casualty care (PCC). Despite comprising the majority of the military medical workforce, EMP readiness is primarily assessed using administrative metrics that do not quantify recent clinical exposure. Military treatment facilities (MTFs) often lack sufficient case volume and complexity to sustain PCC-relevant skills. This study quantified EMP clinical exposure at an MTF compared with a military-civilian partnership (MCP). MATERIALS AND METHODS: We conducted a retrospective, within-subject comparative analysis of PCC-relevant clinical skill exposure among respiratory care practitioners (RCPs) and aerospace medical service specialists (AMS). Clinical exposure was captured using the Quantitative Expeditionary Skills Tracker (QuEST), a structured self-report tool designed to document expeditionary skill frequency. Participants recorded skills performed during the two weeks preceding their MCP rotation at an MTF and throughout a 2-week rotation at a Level I trauma center MCP. Paired two-tailed t-tests compared skill frequency across environments. RESULTS: Eighty-four EMPs (17 RCPs, 67 AMS) were evaluated between January 2023 and March 2024. Both RCPs and AMS personnel performed significantly more total and PCC-relevant clinical skills at the MCP than at the MTF (P < .0001). RCPs demonstrated a 340% increase in total skill exposure, with mechanical ventilator management and ventilator transport performed 4.8 and 6.0-fold more frequently, respectively. AMS personnel demonstrated a 121% increase in total skills, with hemorrhage control, wound care, and blood product administration performed 6 to >30-fold more frequently. CONCLUSIONS: Military-civilian partnership participation was associated with substantially greater exposure to PCC-relevant clinical skills among enlisted medical providers. Quantifying clinical exposure may complement existing readiness frameworks and help identify readiness gaps not captured by administrative metrics.