Logistics Support for
Operation Iraqi Freedom
by Lieutenant Colonel Timothy E. Bateman
Song H. Gotiangco
logistics support in an Army hospital is a “behind-the-scenes” operation.
If all goes well, no one notices. Hospital activity revolves around
patients, compliance with standards prescribed by the Joint Commission
on Accreditation of Healthcare Organizations, and a plethora of interstaff
The Landstuhl Regional Medical Center (LRMC) in Germany, with a staff
of 2,000 Department of the Army civilians and military and contractor
personnel, is the
largest U.S. military medical facility outside of the United States. It is a
joint operation, although not designated as such. Personnel from the Air Force’s
86th Medical Squadron and the 212th Mobile Army Surgical Hospital (MASH) hold
some of the key command and staff positions.
Although the performance of LRMC’s mission, “To serve as America’s
beacon of healthcare for its sons and daughters abroad,” has been strained
the last several years by conflict, the center continues to be a solid bulwark
for Army medicine. Between October 2001 and October 2002, more than 1,000 casualties
from Operation Enduring Freedom (OEF) were treated at LRMC. This story was documented
in the October–December 2002 U.S. Army Medical Department Journal. However,
the staff barely had a chance to read it because, at the time, it was conducting
a military decisionmaking process in preparation for a
larger mission—supporting Operation Iraqi Freedom (OIF).
It became apparent early during the military decisionmaking process that the
212th MASH, several surgical teams, and many LRMC Army and Air Force personnel
would have to deploy to support OIF. To support the casualty projections for
OIF, the 160-bed LRMC would need 150 more beds, supporting medical equipment
and supplies, backfill for the deployed personnel, and augmentees.
The Air Force subsequently deployed a 150-bed unit type code (UTC) hospital to
LRMC. Army and Air Force backfill personnel, along with the 94th General Hospital
(Augmentee Force), began arriving in February 2003.
The entrance point for all patients at LRMC is the Deployed Warrior Medical Management
Center (DWMMC), an innovative and highly successful tool that transitions patients
from the aeromedical evacuation process into the LRMC patient process. The DWMMC
was manned to support OEF with internal LRMC assets. However, it was severely
understaffed to support both OEF and OIF patients.
During the military decisionmaking process, the LRMC’s Department of Nursing
identified tasks that had to be completed before a large patient increase could
be accommodated. The Logistics Division organized the tasks and presented proposed
logistics missions to the hospital Chief of Staff for approval. Those logistics
• Conduct all previously assigned peacetime table of distribution and allowances
• With additional personnel, support expanded TDA functions for an increased
patient population for an indefinite time by purchasing both medical and nonmedical
equipment and supplies to support contingency operations; relocating hospital
services and staff; integrating the Air Force UTC hospital and
follow-on Department of Defense hospital support package into the LRMC; providing
support to the DWMMC and additional staff; and preparing to combine selected
TDA functions so all tasks and missions can be performed without the additional
LRMC Logistics Division Organization
Unlike most other Army medical centers, LRMC’s Logistics Division is made
up mostly of military personnel rather than civilians. The division has a headquarters
section and five primary branches. The Medical Material Branch provides medical
and nonmedical materiel using the Defense Logistics Agency and private vendors
to purchase stock. The Environmental Services Branch provides housekeeping, linen,
transportation, and hazardous material management services. The Facility Management
Branch provides buildings and grounds maintenance and manages construction projects,
utilities, and project design. The
Management Branch provides life-cycle management of equipment,
property accountability, clinical engineer management, and medical
The Logistics Readiness Branch develops and coordinates logistics
support plans and manages staff assistance visits and inspections.
This branch is the force
that binds the other branches and the hospital in contingency operations. As
such, it developed, coordinated, and tracked all logistics contingency requirements
for LRMC in conjunction with the OIF military decisionmaking process. This allowed
the chief of the Logistics Division to plan how to integrate those contingency
missions into the division’s core TDA missions.
During the military decisionmaking process, the Logistics Readiness Branch received
requirements for over $2 million worth of equipment. Other logistics requirements
were identified for new working space, housekeeping services, linens, medical
materiel, transportation, and relocation services. The requirements were based
on a limited budget and a low casualty figure. No additional staff arrived at
LRMC during the military decisionmaking process, so the staff worked hundreds
of overtime hours conducting product research, preparing statements of work,
and completing purchase requests and commitments.
When the 150-bed Air Force UTC hospital arrived, the Logistics Readiness Branch
assembled it, inspected all equipment and supplies, and carefully repacked it
for relocation at LRMC. At about the same time, 22 office and storage trailer
units and 4 shower and latrine trailer units arrived. After electrical, communications,
and plumbing lines were installed, the relocation phase began in earnest.
Several clinical and clinical support services were combined or relocated—some
within the hospital itself and some outside of the hospital. One clinic was relocated
to the Ramstein Air Base medical treatment facility. Many contracted vendors
came in on weekends, when the clinics were closed, to relocate the clinics and
clinic support services. Because navigating the many halls of LRMC can be confusing,
additional internal and external signs were posted to help direct patients and
staff. As former clinics and offices became patient-care areas, housekeeping
and facilities support services personnel were called in to make sure these areas
met Joint Commission on Accreditation of Healthcare Organizations standards.
The order to execute the expansion phase was complicated because it involved
both the Army Medical Command and the U.S. European Command, and it was critical
to complete the expansion before the patient population overwhelmed existing
beds and support. The key for this phase was the arrival of augmentees from the
94th General Hospital, backfill personnel for the 212th MASH, and personnel to
Air Force UTC hospital.
The LRMC Troop Commander assumed responsibility for finding barracks space for
nearly 800 arriving soldiers and airmen. This turned out to be one of the largest
logistics challenges LRMC faced. To accommodate everyone, two-man barracks rooms
were converted to four-man rooms, and four-man rooms were transformed into eight-man
rooms. The post hotel was converted to barracks rooms, and the barracks usually
used by LRMC units that had been deployed elsewhere were taken over by arriving
personnel. Finally, several post family housing units were converted to barracks.
The barracks bed shortage was met until deployed units returned, when it again
became acute. Permanent-party noncommissioned officers were given nonavailability
statements and moved into housing in local communities. Scheduled renovations
of barracks on other posts nearby were delayed so soldiers could move back into
The 800-person temporary force required additional dining facility support, transportation
to the main posts, and other logistics support that was so important to troop
morale. While the Troop Command struggled to meet these requirements, the Logistics
Division moved the Air Force UTC hospital to LRMC. Then, over a period of several
days, the Department of Nursing staff moved equipment and supplies into the various
wards. Once the move was completed, the medical staff began training the equipment
operators and the logistics staff conducted detailed equipment maintenance training.
Medical supplies were inventoried and added to computerized reorder lists. Highly
sophisticated new equipment, such as a computerized tomography (CT) unit, required
complex installation and technical inspections. As tons of medical supplies arrived,
the Medical Material Branch developed push packages for the operating room, surgical
clinics, and wards. The Property Management Section maintained accountability
of the Air Force UTC hospital and the hundreds of pieces of new automatic data
processing equipment and medical and nonmedical equipment arriving monthly. Several
new staff elements were created, such as the Family Assistance Center, so the
Logistics Division purchased and set up additional furniture packages to support
Patient Support Phase
Although patient support had been ongoing at LRMC since OEF, it began in earnest
in April 2003, shortly after the combat phase of OIF started. The hospital received
approximately 24 patients a day, most with combat-related injuries.
The theater aeromedical evacuation policy helped keep the workload in the Department
of Nursing manageable. Patients identified for evacuation to the United States
received life-sustaining care, were stabilized, and were evacuated within 3 to
5 days. The length of stay for other patients was longer, usually between 8 and
12 days. Before evacuating patients to the United States, every attempt was made
to provide quality medical treatment that would enable them to recover and return
to their units or elsewhere in the OIF theater as replacements.
During combat operations, the press, Members of Congress, general officers from
all services, and patients’ family members began flooding the LRMC. This
created new logistics and administrative problems for the LRMC command and staff.
The public affairs staff managed the press. The command group and the entire
Kaiserslautern military community welcomed
of Congress, and the medical and nursing staffs assisted general
officers who were
there to visit patients. LRMC’s Family Assistance Center and
the two local Fisher Houses (comfort homes built by the Fisher House
Foundation, Inc., and given as gifts to the military services and
the Department of Veterans Affairs) took care of visiting family
For the next month, the words “and evacuated to a military hospital in
Germany for medical treatment” were standard language in most national
and international news broadcasts. A learning center on post was converted to
a press control center. This building was selected because it was near the hospital
and had several rooms with required utilities and communications equipment and
a parking area large enough to accommodate media vans.
During the early phases of OIF, LRMC received thousands of donated clothing articles,
both used and new, including underwear, coats, shorts, tennis shoes, socks, pajamas,
and robes. The LRMC chaplain’s office became the receiving and distribution
point for clothing and toilet articles. The volunteer staff of the chaplain’s
office set up a mini department store to distribute the free clothes and toiletries.
Patients routinely arrived on litters wearing some form of military pajamas and
had no other clothes with them. Although most women could wear medium-size clothes,
some of the big, muscular marines needed an extra-large size in everything. Fortunately,
the Marine Corps liaison staff at LRMC had access to Marine Corps physical fitness
Patients did not have access to televisions in the contingency wards, so many
local and U.S. vendors, private organizations, and individuals donated televisions
During the requirements phase, LRMC had limited funding, so the primary emphasis
was on obtaining essential medical equipment, supplies, beds, and expansion buildings.
When the war began, LRMC was given unlimited funding, which was carefully managed
in a way that would survive the scrutiny of any future audit. This funding allowed
LRMC to buy patient comfort items and support the bulging staff.
As the patient load increased exponentially each month, it became apparent that
the expansion was going to be a long-term operation, so the requirements phase
was repeated with unlimited constraints. The average monthly operating bill was
over $300,000, so millions of dollars would be needed to support LRMC’s
personnel and equipment.
Medical materiel purchases became increasingly difficult during May. The supporting
contracting agency could not keep up because it still was staffed at peacetime
levels. Blanket purchase agreements with vendors were developed to lower the
number of purchase requests being processed. The Medical Material Branch’s
local procurement office, in conjunction with the Europe Regional Medical Command
Contracting Cell, located many European vendors of U.S. medical products, which
significantly reduced shipping time. However, the huge volume of medical materiel
requirements continued to be a major problem for the procurement system.
Beginning in June, the outpatient clinics began to show stress from the sustained
workload increase. Most clinics were not staffed or prepared to accept a huge
workload increase. Because the population at risk had quickly changed from active-duty
personnel to Reserve-component personnel, who sometimes were not as fit, unforecasted
requirements, such as cardiology supplies, placed a heavy demand on the medical
materiel supply system.
Seriously injured and extremely ill patients arrived with various items of medical
equipment attached to their bodies. The Patient Movement Item (PMI) system is
well prepared and works well during peacetime operations. (“PMI” refers
to the medical equipment and supplies needed to support patients during evacuation.)
However, patients from OIF soon overloaded the PMI system. In theory, PMI from
an Army combat support hospital was to be swapped at the departing airfield in
the OIF theater by the Air Force. However, Army and Air Force PMIs often are
identical and sometimes were identified incorrectly while patients were loaded
into and unloaded from aircraft or vehicles. As a result, Army PMIs sometimes
were still with patients when they arrived at LRMC and LRMC PMIs sometimes were
evacuated back to the United States with patients. Unfortunately, the Army’s
system for tracking PMI equipment is not as efficient as the Air Force’s.
In June, LRMC received approximately 50 new patients a day and the total number
of patients averaged around 200, which was more than twice the average daily
patient population before the war. Because the DWMMC was severely understaffed,
the logistics section supporting it assumed responsibility for controlling and
storing baggage and sensitive items, issuing uniforms, and providing linens,
housekeeping, transportation, and office supplies.
Baggage and sensitive item control quickly became a manpower and storage problem.
Many patients arrived on litters and were sent directly to the intensive care
unit. Their bags and personal items were moved from the patient bus to the baggage
storage area, often without identification tags. Some patients arrived with issued
or personal knives, while others arrived with their issued nuclear, biological,
and chemical supplies. Many patients arrived with only a few personal items in
trash bags, and others arrived with several duffle bags full of clothing and
Hundreds of items arrived daily, so the logistics personnel established a simple
but effective tag system and recorded the items manually in a register. As patients
were evacuated from LRMC, a second problem developed: Patient bags were not always
sent with the patient. To correct this problem, personal items of patients leaving
LRMC now are mailed at a rate of 50 pounds a day back to the patients’ last
known continental United States military unit.
Finding bed space for the flood of patients overwhelmed the LRMC’s resources.
The 415th Base Support Battalion was instrumental in providing temporary barracks
for patient use. But these barracks were at Kleber Kasserne, 20 miles away. Buses
were contracted to shuttle patients from Kleber Kasserne to the hospital and
to the post exchange and other life support activities in Vogelweh. This was
a long bus ride, and the bus ran all too infrequently, but it was better than
paying $40 for a taxi ride. As the patient population continued to expand, two-person
rooms became four-person rooms. The growing patient population created a huge
drain on linen and housekeeping support.
Now, months later, the number of patients arriving at LRMC from OIF is even higher.
Obtaining staffing to keep up with increasing patient loads is difficult. However,
the logistics support personnel at LRMC will continue to meet new challenges
by putting new systems in place to minimize patient difficulties and improve
current systems so the logistics support provided is seamless and invisible to
staff and patients.
Lieutenant Colonel Timothy E. Bateman is the Chief of the Logistics Division
of the Landstuhl Regional Medical Center in Germany. He is a Medical Services
Corps Officer and is educated in emergency medical services administration.
Major Song H. Gotiangco is the Chief of the Medical Material Branch of the Logistics
Division of the Landstuhl Regional Medical Center. She has a B.A. degree in psychology
from Trinity University in Texas. She is a graduate of the Army Medical Department
Officer Basic and Advanced Courses, the Medical Logistics Management Course,
the Combined Arms and Services Staff School, and the Army Command and General