Medical logisticians in Iraq and Afghanistan are currently operating with the luxury of a mature logistics infrastructure in a forward operating base-centric theater of operations. This maturation has resulted in a significant decrease in negative observations and after-action review comments about medical logistics challenges. However, what would happen if U.S. forces began another offensive operation in a different global “hot spot”? Have they learned from the shortfalls and mistakes in brigade-and-below connectivity and in medical logistics real-time offensive operations that occurred in Operation Desert Storm and the initial stages of Operation Iraqi Freedom?

I served previously as a medical company commander in Operation Iraqi Freedom and an observer-controller at the National Training Center at Fort Irwin, California, and I have visited combat training centers and conducted one-on-one interviews with many Soldiers in theater. I learned from those experiences that, should U.S. forces start an offensive fight elsewhere, they would learn quickly that they have failed to develop a permanent solution for class VIII (medical supplies) connectivity or real-time logistics management for brigade-and-below medical units. “Three-peats” are only good when talking about sports championships, not medical logistics blunders.

Two Army Battle Command System (ABCS) components—Force XXI Battle Command-Brigade and Below (FBCB2) and Battle Command Sustainment Support System (BCS3)—could provide valuable logistics information to medical personnel. However, this currently is not possible because ABCS and Army Medical Department (AMEDD) digital medical logistics systems do not have interface capabilities.

ABCS Systems

FBCB2 is a digitized battle command information system that includes both software and hardware for providing on-the-move, real-time, and near-real-time battlefield information to maneuver, fires, and effects commanders, operations support commanders, and force sustainment commanders, leaders, and Soldiers. This system is designed to give leaders and Soldiers enhanced battlefield situational awareness to the lowest level.

BCS3 is designed to interface with FBCB2 to provide operations support and force sustainment commanders, leaders, and Soldiers with the logistics management tools and information needed to support maneuver commanders. BCS3 includes tools for readiness, combat power, convoy movement control, in-transit visibility, transportation and logistics alerts, main supply route status, course-of-action analysis or the military decisionmaking process, and G–3 operations.

Although BCS3 can interface with FBCB2 and has secure and unsecure interface capabilities for logistics management and brigade-and-below logistics, the two systems are useless to brigade support medical company or task force medical platoon leaders and planners. These systems need a medical logistics interface tab.  The medical logistics interface tab is a set of tactics, techniques, and procedures that I developed that uses the FBCB2 text-messaging capabilities and closed-circuit network to send class VIII requests to the brigade support medical company.  This has been field-tested as a tool for making medical logistics work when the TAMMIS (Theater Army Medical Management Information System)/DMLSS (Defense Medical Logistics Standard Support) Customer Assistance Module (TCAM) fails and the “sneaker net” (hand-carrying logistics information on diskette from one computer system to another) is too slow.  [TCAM is used for digital ordering and tracking of medical supplies.] Now the system needs to be formalized as a “tab” under the existing FBCB2.

AMEDD Systems

AMEDD recently developed enhanced digital tracking systems to use with the Medical Communications for Combat Casualty Care (MC4) system and TCAM.

In a separate endeavor, AMEDD is transitioning all of its current operating systems over to the Army Medical Command (MEDCOM) Battle Command System, which will operate in the future under one network called the LandWarNet (the Army’s share of the Department of Defense Global Information Grid). MEDCOM does not plan to link its battle command systems at brigade and below to any of the maneuver brigade combat team (BCT) systems using ABCS.

Medical Logistics System Shortcomings

The MEDCOM Battle Command System’s inability to interface with any of the ABCS systems at brigade and below is a critical flaw. As stated by the AMEDD lessons learned chief, Lieutenant Colonel Jeffery L. McCollum, USA (Ret.), “BCTs are the base for future fights . . . synchronization and tracking of class VIII is so important—the Soldier’s life may depend on it.”

The MEDCOM plan for transitioning to the MEDCOM Battle Command System adds three operating systems to existing TCAM and MC4 requirements. These systems—the Composite Health Care System II-Tactical (CHCSII–T), Theater Enterprise-Wide Logistics System (TEWLS), DMLSS, and the U.S. Transportation Command (TRANSCOM) Regulating and Command and Control Evacuation System (TRAC2ES)—will be used at the battalion aid station, which is located at the maneuver task force level. Adding these systems to the MEDCOM Battle Command System will further complicate the problem that task force medical platoon leaders face in logistically and tactically synchronizing their efforts with the battalion task force and brigade.

This chart shows how the proposed medical logistics interface tab would link medical and logistics information systems.

Legend ABCS = Army Battle Command System AFATDS = Advanced Field Artillery Tactical Data System AMDPCS = Air and Missile Defense Planning and Control System ASAS = All Source Analysis System BCS3 = Battle Command Sustainment Support System BDE = Brigade BN = Battalion BSMC = Brigade support medical company FBCB2 = Force XXI Battle Command-Brigade and Below GCSS-Army = Global Combat Support System-Army MC4 = Medical Communications for Combat Casualty Care MCS = Maneuver Control System MED = Medical MEDCOM = Army Medical Command MEDLOG = Medical logistics NIPRNET = Unclassified but Sensitive Internet Protocol Router Network PLT = Platoon SIPRNET = Secret Internet Protocol Router Network SSA = Supply support activity SVR = Server TCAM = TAMMIS (Theater Army Medical Management Information System)/ DMLSS (Defense Medical Logistics Standard Support) Customer Assistance Module TF = Task force TMED = Telemedicine

In the future, medical platoon leaders will need an operational understanding of eight digital operating systems—BCS3, FBCB2, TCAM, MC4, CHCSII–T, TRAC2ES, TEWLS, and DMLSS. Five of these—TCAM, MC4, CHCSII–T, TRAC2ES, and TEWLS—will not interface with any of the maneuver ABCS being used by the battalion task force.

Currently, a medical platoon stands alone in a sea of digital capability because it cannot use AMEDD digital systems to synchronize its medical logistics with any of its maneuver battalion or brigade counterparts that are using FBCB2 and BCS3. For example, battalion task forces at the National Training Center often have difficulty ordering and tracking class VIII supplies. Why do they have these problems? First, a battalion staff using BCS3 has minimal visibility of the status of a medical platoon’s class VIII inventory. Therefore, medical supplies used for logistics package (LOGPAC) and resupply operations are rarely tracked as closely as the other classes of supply that are managed digitally by BCS3. Second, a medical platoon requisitions class VIII using TCAM, which is a completely separate system from the battalion ABCS common operating systems that all other elements in the task force use. The battalion task force medical platoon is forced to operate outside of the ABCS umbrella under which they fight.

This disconnect creates additional connectivity competition problems as well as a lack of understanding by leaders and a resulting lack of command emphasis. This problem was raised by Captain Michael S. “Sean” Smith in his article, “TCAM: Making the Class VIII System Work for Your Brigade Combat Team,” in the September–October 2005 issue of Army Logistician. According to Smith, “BCT leaders are hesitant to mandate use of TCAM because it is new and unfamiliar to the leaders and Soldiers. There is little command emphasis to compel units to make TCAM the standard for Class VIII operations.”

Medical Logistics Interface Tab

Developing a medical logistics interface tab for FBCB2 or BCS3 under ABCS would allow medical platoons and brigade support medical companies to synchronize their operations with tactical commanders at brigade and below. Civilian production cost estimates for developing medical logistics interface tab software range from $2.5 million to $5 million.

Training on the FBCB2 system is currently provided by a contractor at Fort Sam Houston, Texas. Only minor changes would be required to expand this training to cover use of the new medical logistics interface tab. Computers and facilities used for training would not have to be changed. Fort Sam Houston has a training facility that can support 6 classes of 180 students each per year. This facility also provides over 6 hours of hands-on instruction in the AMEDD Basic Officer Leadership Course. The installation has 3 additional equivalent classrooms with over 100 terminals each to support larger classes if needed.

Advantages

Having a medical logistics interface tab for FBCB2 or BCS3 would reduce the need for additional and competing connectivity—specifically, Very Small Aperture Terminal (VSAT) connectivity—for the brigade-and-below maneuver elements. It also would give battalion S–4s a complete logistics common operating picture at the battalion through brigade levels for on-the-move, real-time, or near-real time situational awareness and synchronized tracking. Medical platoon leaders would no longer have to revert to analog systems, sneaker net, or work-arounds to report to battalion or brigade commanders, as illustrated in the February 2006 1–25th Stryker Brigade Combat Team lessons learned brief—

Challenges

ABCS is an extremely complex system operating on more than 1,000 computer systems within each maneuver brigade. To develop a medical logistics interface tab that would provide total battlefield analysis, software must be upgraded for FBCB2, BCS3, TCAM, MC4, and any other systems that compile data within ABCS and the MEDCOM Battle Command System.

AMEDD should reconsider its plans for future digital operating systems at brigade and below within the MEDCOM Battle Command System under the LandWarNet. Funding limitations may require AMEDD to choose between the medical logistics interface tab and TCAM. The decision would be based on which system is determined to be the more compatible, synchronized, and suitable digital system for supporting tactical commanders at brigade and below.

Extensive training covering a broad spectrum of logistics operations would be required to ensure that the chosen system (the tab or TCAM), Soldiers, and units could perform all current and future missions effectively. A new mission-essential task list and all the individual and collective tasks to support it could be difficult to develop.

Using a medical logistics interface tab would be the key to synchronizing brigade-and-below medical logistics management of all medical logistics operations at the maneuver, fires, and effects levels. This tab could provide real-time to near-real-time decisionmaking capabilities to brigade-and-below maneuver task force commanders and the battalion task force staff. It also could assist BCT medical planners in developing immediate courses of action, and it could bring the AMEDD medical logistics systems into one common operating system with FBCB2 and BCS3 under the existing ABCS for maneuver elements. The medical logistics interface tab would not eliminate the need for a medical logistics system, but it would force the MEDCOM Battle Command System to interface with ABCS systems such as FBCB2 and BCS3 under the LandWarNet at the appropriate maneuver level.
ALOG

Captain Cody R. Roberson is the 70B Course Director at the Army Medical Department Center and School at Fort Sam Houston, Texas. He has a bachelor’s degree in criminal justice from the University of Texas at Arlington and a master’s degree in management and leadership from Webster University. He is a graduate of the Army Medical Department Officer Basic and Advanced Courses and the Combined Arms and Services Staff School.