A Conventional Class VIII System for an Unconventional War
by First Lieutenant Donald J. McNeil
To support Special Forces effectively, a combat health logistician (CHL) must know his customer base. Army Special Forces conduct unconventional warfare operations that can include special reconnaissance, direct action, foreign internal defense, combating terrorism, civil affairs, psychological operations, information operations, and coalition support. Each of these operations has different class VIII (medical materiel) support requirements, which are described in Field Manual (FM) 8–43, Combat Health Support for Army Special Operations Forces. Forward-deployed Special Forces elements conducting unconventional warfare can deplete class VIII supplies rapidly because the units are in a continuous combat operations environment.
CHLs must understand the need for resupply, both routine and emergency. In addition to supporting a Special Forces group’s forward operating bases, operational detachment bravos, or operational detachment alphas, the CHL also may support a conventional unit such as a forward surgical team that is attached to the group. (An operational detachment alpha is a 12-member Special Forces team. An operational detachment bravo provides command and control of the detachment alphas within a Special Forces company.)
The CHL also should be familiar with the unit assemblage lists (UALs). The U.S. Army Medical Materiel Agency (USAMMA) Web site (www.usamma.army.mil) lists UALs for all medical sets, kits, and outfits. The CHL can type in the unit identification code and view all authorized UALs for his unit. He then can determine if his customers need to stock anything above and beyond what is listed in the UAL.
The Combined Joint Special Operations Task Force-Afghanistan medical warehouse.
Preparing for Deployment
Predeployment preparation will save a lot of time and trouble downrange. The CHL should develop a comprehensive packing list that includes shelving for stocking supplies and a printer for receipts and reports. Nonexpendable and durable equipment and supplies should be accounted for on hand receipts before deploying. This will help the CHL update shortage annexes as shortages are filled, account for new equipment and supplies being used for missions, and provide justification for refit in the event of a combat loss. The CHL should ensure that the unit has a derivative (deployed) Department of Defense address activity code (DODAAC). To ensure proper delivery of supplies, he also should make sure the “type address code” address reflects the unit’s deployment address.
The CHL may be able to use the Army and Air Force excess programs to procure equipment and supplies at little or no cost. The U.S. Army Medical Materiel Center Europe (USAMMCE) Web site (www.pirmasens.amedd.army.mil) has a free issue catalog on the Theater Army Medical Management Information System Customer Assistance Module, and the USAMMA Web site has a link for obtaining both Army and Air Force excess supplies and equipment. This is an economical way to fill shortages.
The CHL should meet with the single integrated medical logistics manager (SIMLM), which may be USAMMCE, a medical logistics battalion or company, or the installation medical supply activity, to strengthen their working relationship. He should explore all transportation options to know what supply routes are available and how to get supplies in a timely manner. The CHL should become familiar with all class VIII support in theater in case he needs something quickly; he may not have to go all the way back to the SIMLM if he knows which assets are available in theater. The CHL should be familiar with the ordering system that the SIMLM uses and, if possible, familiarize his customers with those systems to expedite ordering.
The CHL should develop reorder lists for individual units. These lists should capture the class VIII that is authorized by the UALs as well as nonstandard class VIII that is not authorized by UALs but is ordered frequently for that particular theater. Special Forces-unique, nonstandard medical items may not always be available. FM 8–55, Planning for Health Service Support, states that conservation of supplies and equipment should be a priority. However, under combat conditions, conservation of medical supplies becomes particularly critical. An austere environment requires that clinicians practice supply discipline; they must be prepared to work with and be supported by generic supplies. Lack of physician-preferred brands does not constitute a patient risk.
Since poor supply discipline may strain the health service logistics system and cause a risk to patients, supply discipline must be a command priority. UALs must be updated, maintained, and followed. Clinicians must be familiar with their UALs. Providing combat logistics requires the ability to work with available resources.
Push packages. The CHL must develop predetermined emergency resupply and trauma packages for teams and supported units.
Standing operating procedures. Before deploying, the CHL should develop both internal and external standing operating procedures (SOPs) that are conducive to both garrison and field environments. The external SOP should tell customers how the unit operates, its operating hours, class VIII requisitioning procedures, and the documentation required, such as signature cards and commander’s orders. Customers must be told which shipment method will be used for their supplies—either push or pull. If the mission requires the CHL to push pallets of supplies to customers, he should know how to palletize and operate a forklift and be hazardous-materials certified before he deploys, as this will reduce the need to rely on outside agencies for assistance
Stocking system. A supply stocking system must be developed. It can be based either on the class of drug or the national stock number (NSN). Army Regulation 40–61, Medical Logistics Policies and Procedures, suggests stocking by NSN, but whatever method that makes the operation run efficiently can be used. An inventory must be developed and kept updated.
Narcotics. Narcotics must be secured properly. A disinterested party (E–7 or above) on orders from the commander must inventory the narcotics monthly. A signature card (Department of the Army Form 1687) signed by the commander must be on file for those who sign for narcotics. The CHL should develop a memorandum of agreement stating the responsibilities of the individual drawing the narcotics, such as storage requirements, turn-in procedures, and documentation of use.
Stockage lists. Authorized stockage lists should be based on UALs and customer needs. When the unit is forward deployed, it is okay to have stocks on the shelves; combat health logistics is not just-in-time logistics. A CHL does not have the luxury of a 24- to 72-hour turnaround time using a prime vendor, as the medical logistician does in garrison. To avoid becoming a crisis manager, the CHL should establish realistic reorder points to ensure he will not run out of supplies. Requisition objectives should be monitored and adjusted as needed.
Medical equipment. The CHL must know his support chain for medical maintenance support because medical equipment must be serviced through that chain. He also should know the procedures for borrowing equipment from the Medical Standby Equipment Program while unit equipment is being serviced or repaired.
Redeployment and Recovery
The keys to a successful redeployment and recovery are knowing what materials and equipment are being shipped and having proper documentation for losses or shortages. The CHL should inventory his stocks before redeployment so he knows what is missing and can attempt to fill shortages before shipping. Accountability is paramount. Before leaving the deployment area, the CHL should have all paperwork documenting losses, such as memorandums for record for destroyed or lost narcotics, statements of damage to equipment, and reports of survey. Since a unit sometimes redeploys on short notice, inventory and shortage annexes are vital to redeployment and recovery.
The CHL should conduct a thorough after-action review. Documenting facts will enable him to maintain acceptable standards and correct mistakes or shortfalls encountered during the deployment. The after-action review should include a compilation of comments from the CHL, his coworkers, customers, and the SIMLM.
Although the face of war is changing, the current class VIII system will support it. Good logistics practices—knowing the customer and maintaining good supply discipline—can help the CHL succeed in supporting troops in an unconventional war. ALOG
First Lieutenant Donald J. McNeil is assigned to the 3d Special Forces Group (Airborne) at Fort Bragg, North Carolina. He served 10 years as an enlisted soldier and 4 years as a warrant officer. He holds a bachelor’s degree from the University of Upper Iowa and a master’s degree from Northwestern State University. He is a graduate of the Health Services Maintenance Warrant Officer Basic Course, the Army Medical Department Officer Basic Course, and the Medical Logistics Management Course.