Patients are evacuated by ground to air and by ground.

JMAR, APS, JDF, and JSLIST are just a few of the considerations that concern joint MEDLOG managers in their support of PMTAFs, FSSGs, the EMFP, and ASMCs in the KTO.

If you understand what was just said, then you can start work immediately as an effective medical logistics manager in the Kuwait Theater of Operations (KTO). If you don’t understand it all, that’s OK, you can be trained.

What was just said—“translated”—is that the Joint Medical Asset Repository (JMAR), Army Pre-positioned Stocks (APS), the Joint Deployment Formulary (JDF) (pharmaceuticals), and Joint Service Lightweight Integrated Suit Technology (JSLIST) (“MOPP [mission-oriented protective posture] gear,” or protective suits) are just a few of the considerations that concern joint medical logistics (MEDLOG) managers in their support of the Army’s area support medical companies (ASMCs), the Navy’s Expeditionary Medical Facility Portsmouth (EMFP), the Air Force’s preventive medicine teams (PMTAFs), and the Marine Corps’ force service
support groups (FSSGs).

These acronyms demonstrate that the different armed services speak different “languages.” They also have different medical organizations and medical equipment. These differences are deliberate, as each service supports different military missions. However—and this is a crucial point—all of these different medical organizations are working well together to provide required healthcare at high standards in the KTO.

Creating Joint Force Medical Support

In the KTO and in support of Operation Iraqi Freedom (OIF) II, the 8th Medical Brigade (Forward), according to its mission statement, “provides joint command and control of all medical units to provide health service support across the full spectrum of military operations, JRMO [Joint Medical Regulating Office], [and] JRSO&I [joint reception, staging, onward movement, and integration] and to manage Class VIII [medical materiel] in the Kuwait Theater of Operations.” The 8th Medical Brigade is an Army Reserve unit headquartered in New York City.

The 8th Medical Brigade’s joint medical task force organization includes Army (Active component and activated Army National Guard and Army Reserve), Navy, Air Force, and Marine Corps units. These units are diversified in their service, missions, and home stations. They provide levels I, II, and III healthcare, air ambulance, veterinary, preventive medicine, combat stress control, and medical logistics support. [Level I care includes immediate lifesaving measures and medical evacuation to supported medical treatment elements and includes battalion aid stations. Level II care is performed at the brigade and division levels. Level III care is the first level of care with hospital facilities.]

The 8th Medical Brigade’s Logistics Section, according to its mission statement, is tasked “with a sense of urgency and cost reduction, to provide comprehensive medical logistics support to 8th Medical Brigade assigned and attached units in matters of supply, maintenance, transportation, and services.”

During the period January to May 2004—the “surge” period of OIF that this article covers—over 250,000 military personnel moved into and out of the Southwest Asia theater, most through the KTO. During this period, the joint medical task force experienced some important successes. Joint medical units were integrated quickly into the task force. “Left seat-right seat rides” (redeploying units turning over responsibilities to deploying units) went well. The high quality of health service support continued unabated, regardless of whether it was provided by Army, Navy, Air Force, or Marine Corps personnel. In some areas, the quality of health service support actually increased. Service members from different units exchanged information, including recommendations for improving health service support. Some service members were able to provide additional training to other unit members, such as combat lifesaver and healthcare specialist training. Some service members with required skills were easily transferred to another service’s unit to fill temporary or emerging needs.

In short, all of the medical units deployed to the KTO with a mission, all service members deployed to support that mission, and, most importantly, all the pieces came together nicely to provide quality health service support to all service members in the theater. The joint forces assigned to the 8th Medical Brigade’s joint medical task force organization adapted quickly to the Army way of doing medical logistics business, including requisitioning supplies, maintaining equipment, and maintaining health service support in the theater.

However, the 8th Medical Brigade also faced some challenging issues during this period that had to be addressed and resolved quickly. What follows is a “top 10” list of issues faced and lessons learned while the brigade implemented joint medical logistics programs in the KTO from January to May 2004, as well as recommendations for improving future joint medical logistics support.

Increasing TAMMIS Use

Medical units in the KTO did not uniformly use the Theater Army Medical Management Information System (TAMMIS) Customer Assistance Module (TCAM) to requisition medical supplies. Some units used other methods such as email and paper requisitions, which were inefficient, slowed replenishment of medical supplies, and hindered the supply system’s ability to stock items based on true demand. Joint units scheduled to deploy and report to the brigade had been trained on the use of TCAM and were expecting to use it, but some of the hardware and software in the theater did not incorporate the latest TCAM configurations. Requisitions were not passed through the 8th Medical Brigade’s 6th Medical Logistics Management Center (MLMC), which impeded resupply since an item is not ordered until a requisition has a valid requisition number.
Here are some recommendations for improving use of TAMMIS—

• Direct units to use TCAM.
• Use customer assistance visits (including visits by Department of the Army G–4 and G–6 and Program Executive Office for Enterprise Information Systems contractors) to each unit to examine unit hardware and software, configure them to the latest versions, and provide training as required.

• Route requisitions through the 6th MLMC.

A MEDLOG team in theater would have been very beneficial. This recommendation applies to all 10 issues.

Speeding Theater Distribution

Medical logistics theater distribution was cumbersome and slow. The process was not working as well as it should have. Supplies moved through the U.S. Army Medical Materiel Center Europe (USAMMCE) and the U.S. Army Medical Materiel Center Southwest Asia (USAMMC–SWA) to the aerial port of debarkation, theater distribution center, central receiving and storage point, Camp Doha, Kuwait, supply support activity (SSA), and finally to the unit. Urgently needed medical supplies arrived at their destinations late or not at all. Some supplies just sat until they were picked up.

Recommendations for fixing these problems include the following—

• USAMMC–SWA should email or call customers in advance of shipments.
• Pure pallets should be used for shipping whenever possible. [Pure pallets are loaded with materiel for only one unit.]
• The aerial port of debarkation should call customers when supplies arrive.
• Customers should pick up supplies when notified of their arrival.
• A plan should be implemented to upgrade delivery procedures for class VIII supplies to medical level I and II troop medical clinics and the level III hospital in the KTO.

Providing Class II and III Supplies

Class II (clothing and individual equipment, such as insect nets) and III (petroleum and chemical products, such as the insecticides Permethrin and Deet) support to the population at risk did not go smoothly. Some soldiers did not have what they needed. Supplies of some of these items were stocked in theater in preparation for combat operations, but there were few requests for them. Other items, such as insect nets, were in short supply in the theater. Additional items that all deploying soldiers should have had were JSLIST (they did); 180 days’ worth of prescription medicines (most did not); medical biological and chemical defense materiel (they did); and interceptor body armor (most had the outer tactical vest, but few had the small arms protective inserts).

Recommendations for improving class II and III supply include the following—
• Ensure that class II and III items are issued (or on hand) to all service members at their mobilization sites.
• Emphasize to leaders, and advertise in theater, the availability of these items and the need to use them to prevent disease and nonbattle injuries.
• Move supplies forward to deployment camps for distribution to units needing them.
• Have the theater deployment/redeployment coordination cell (DRCC) make these items “items of interest.” [Items of interest are items that have the attention of senior leaders and therefore are managed carefully.]

Supporting Units Arriving Without Equipment

Some units arrived in theater weeks ahead of their equipment. Equipment often was not shipped from mobilization sites until units were validated to deploy. Units in the theater without their equipment were not able to perform their missions fully. They also could not complete additional, required in-theater training, such as convoy live-fire exercises.

Recommended solutions for remedying these problems include the following actions—

• Ship unit equipment from the mobilization site to the deployment site earlier in the process.
• Create a “pool” of weapons and equipment in the theater so deploying units can complete any required in-theater training.
• Use stay-behind equipment (equipment left in theater by redeploying units) to the maximum extent possible to alleviate shortages.

Improving Unit Maintenance Capabilities

Some units arriving in theater with their ground equipment did not have organizational or direct support maintenance capabilities, including the Unit Level Logistics System (ULLS)–S4 or ULLS–G (Ground). As a result, these units were not equipped in theater to maintain their ground equipment, which prevented them from fully performing their missions.
Solutions to this problem include—

• At the camp of any unit without organic maintenance capability, assign other units to provide organizational and direct support maintenance and repair parts support to that unit.
• Provide ULLS–S4 or ULLS–G to units at their camps.
• Work with units’ higher headquarters to establish the maintenance capabilities they need.
• Consider expanding support to include ULLS and property book items.

Managing DODAACs

Some units deployed without Department of Defense Activity Address Codes (DODAACs), which prevented them from requisitioning supplies and equipment while in the theater. As a fix, some of these units started using the same DODAACs as the redeploying units they were replacing. However, these DODAACs were theater specific. (The redeploying units would use their peacetime unit DODAACs when they returned home.) The result was that two units would be using the same DODAAC temporarily. If no further action was taken, the DODAAC would be deleted within 60 days after the redeploying unit returned home and the deployed unit would again be without a DODAAC.

Recommendations for improving management of DODAACs include these actions—
• Each service component must ensure that its units have DODAACs before they arrive in theater.
• Units can still get DODAACs in theater by coordinating with their service component (including by email).
• The 8th Medical Brigade’s headquarters also can assist in getting DODAACs, including transferring a redeploying unit’s DODAAC to the brigade’s theater unit identification code.
• “Generic” (not unit specific) DODAACs can be assigned to units and then remain in use in the theater when the units initially receiving those DODAACs redeploy.

Taking Advantage of Stay-Behind Equipment

Several problems affected the use of stay-behind equipment (SBE)—
• Equipment maintenance was lacking in theater because of high operating tempo and insufficient organic maintenance capabilities.
• Equipment shortages were not replenished in a timely manner.
• SBE not in use often was not stored properly in the theater.
• SBE requirements were not thoroughly scrubbed. For example, when joint inventories were conducted with losing and gaining units, some SBE was not required (such as radio sets and chemical detectors).
• Lateral transfers can be done only within the same service, which made it impossible to make such transfers between Army components and the other services.
• Some SBE designed and made for field use was used in fixed facilities.
In spite of these problems, SBE is a good thing and can save time, manpower, and money. Units deploying to the theater can fall in immediately on SBE, eliminating the need to pack, ship, receive, assemble, and prepare for use the same equipment.
Recommended solutions for improving use of SBE include the following—
• Use the medical logistics support team (MLST) and SSA contractor support to augment any required medical equipment maintenance. [An MLST is a slice of a medical logistics battalion or company and typically has 6 to 12 soldiers.] Organizational support and direct support units can be used to augment the required maintenance of any rolling stock equipment.
• Perform a 100-percent inventory and preventive maintenance on all medical equipment sets before bringing them to the theater. Continue to perform inventories and preventive maintenance on all medical equipment in theater, and requisition to fill any shortages. Perform a 100-percent inventory of SBE between losing and gaining units. Requisition shortage list items.
• Store medical SBE not in use in more appropriate storage than military-owned, demountable containers (MILVANs), which can be very hot and humid and thus can contribute to equipment deterioration.
• Continually scrub current and future SBE requirements for additions or deletions. This process should address joint force requirements.
• Have COMPO [component] 1 (active duty), 2 (National Guard), and 3 (Reserve) property book officers manage their respective property books. A similar arrangement should be considered for joint forces SBE.
• Use SBE, including air ambulances and vehicles, as often as possible when there is a match between the mission and the equipment.
• Use SBE as often as possible to standardize medical equipment at troop medical clinics.

Containers are stacked at the KTO Theater Distribution Center. Such containers are not the best storage sites for stay-behind medical equipment.

Handling Hazardous Materials

The turn-in of medical biological and chemical defense materiel (MBCDM) during some units’ redeployment was not performed according to established procedures. These controlled substances were found at such places as washracks, dumpsters, and building garbage containers. The KTO had several designated MBCDM turn-in points, which were widely advertised. Despite these turn-in points, MBCDM was found all over the camps and posed a very serious health hazard.

Recommended solutions for better management of MBCDM include—

• Continue DRCC redeployment assistance coordination meetings to disseminate proper turn-in procedures, including who, what, where, when, and how and points of contact.
• Highlight turn-in information on the DRCC
Web site.
• Include information on MBCDM in the Commander’s Handbook, which is available to all redeploying unit commanders in the theater.
• Include information in redeployment packets, which instruct redeploying units on how to clear
the theater.
• Advertise turn-in points and make those points convenient for turning in MBCDM.

Providing Eyeglasses

No organic optical fabrication capabilities existed in the KTO after the redeployment of the 8th Medical Brigade’s Medical Logistics Battalion. This made it difficult to issue prescription eyeglasses quickly to service members. USAMMCE had to support the entire theater, supplemented by local commercial contracts—a time-consuming and expensive process.

Here are some possible solutions—

• Task the Medical Logistics Company at U.S. Army Forces Central Command–Qatar (ARCENT–QA) to provide optical fabrication in support of the Combined Joint Task Force (CJTF) in Afghanistan, CJTF–Horn of Africa, and ARCENT–QA.
• Task the Camp Doha troop medical clinic, augmented by optometry personnel from the Navy’s Expeditionary Medical Facility Portsmouth, to provide optical fabrication to the KTO.
• Use the Theater Medical Logistics Battalion to provide optical fabrication support in Iraq. This battalion is assigned to the 2d Medical Brigade in Iraq.
• Procure additional Opticast optical lens fabrication systems to support the KTO. This may require additional optical SBE in the U.S. Central Command area of responsibility.
• Plan for sufficient optometrist support.

Managing Pre-positioned Stocks

Several issues affected Army Pre-positioned Stocks (APS)—

•Transfer of some APS equipment between OIF I and OIF II units was not as well coordinated as it should have been. APS were issued to hospital, company, detachment, medical logistics, and maneuver OIF I units. OIF II and subsequent operations required serviceable medical and nonmedical APS.
• APS stocks of critical items were depleted.
• Maintenance of APS equipment needed improvement.
• There were new requirements to support
joint forces.
• APS equipment was not always ready. It deteriorates, becomes obsolete, and is lost.
Recommended resolutions to these problems include the following actions—
• Update APS plans and disseminate those plans to all concerned parties.
• Refit, refurbish, and augment APS stocks as required.
• Provide for the maintenance of APS equipment, including using the MLST, and assign maintenance responsibilities in each camp to the units that have organic maintenance capabilities.
• Scrub and prioritize current and future APS requirements.
• Use APS as much as possible whenever there is a match between the mission and APS equipment.

These 10 issues are as diversified as the units in this joint medical task force operating in the KTO. Some of the issues may apply to other, nonmedical units, and some are unique to medical unit logisticians. These issues affected every unit of the joint medical task force in varying degrees. Collectively, and in the spirit of joint services cooperation, these issues were and are being addressed head-on and resolved quickly. In the KTO OIF II medical community, and in the world of medical logistics specifically, joint service units are working together to solve logistics issues and provide effective healthcare support to the theater. ALOG

Colonel Paul R. Sparano is the Deputy Chief of Staff for Logistics of the 8th Medical Brigade (Forward) in Southwest Asia. He is a graduate of the Officer Candidate School; the Army Medical Department, Field Artillery, and Finance Officer Basic Courses; the Army Medical Department Officer Advanced Course; the Army Command and General Staff Officer Course; the Joint Course on Logistics at the Army Logistics Management College; and the Advanced Program Management Course at the Defense Systems Management College.