After medical logistics officers found that
their plans for supplying soldiers in Iraq with chronic maintenance
medications did not work, they developed a process that ensures
soldiers will receive their medications without
having to order them.
Nearly 2 years ago, our country was faced
with a dilemma: Declare war on Iraq immediately, or allow United
to complete their inspections and proceed based on their findings.
While this decision was being made, the military forces were
busy with operational planning, which had to be conducted with
high levels of secrecy. The U.S. military already was supporting
combat operations in Afghanistan; however, establishing a logistics
support concept—particularly medical logistics support—for
Iraq was a completely different matter. Military medical materiel
managers had to keep in mind that they might have to deal with
the effects of biological or chemical weapons if the United
States went to war with Iraq. The planning phase was extremely
detailed and labor intensive. Many scenarios were discussed
before logistics support concepts were developed.
The focus of medical materiel managers during operational and
tactical planning for Operation Iraqi Freedom was combat healthcare
operations. They had to ensure
that soldiers stayed healthy and protected from diseases and biological weapons
and that the combat healthcare system could respond to combat injuries quickly.
However, they did not anticipate the duration of the deployment. What initially
had been envisioned as a “quick” war similar to Operation Desert
Storm in 1991 quickly turned into multiple deployments of 12 months or longer.
extended deployments significantly affected the maturing supply-chain management
of medical materiel; specifically, the refilling of prescription
medications that the Army identifies as chronic maintenance medications.
Chronic maintenance medications are those medications needed to treat or control
chronic health conditions of individual soldiers. Maintenance medications normally
are used on a regular, predictable schedule rather than sporadically as needed.
Examples include medications used to treat high blood pressure, high cholesterol,
disease, diabetes, ulcers, depression, and chronic pain.
Concept of Medical Logistics Support
The underlying concept for medical logistics support in Operation Iraqi Freedom
was to make the maximum use of distribution in order to relieve the forward units
of the burden of managing and moving large quantities of supplies. The goal was
to have medical units deploy with their required materiel and equipment. However,
this proved to be more difficult than expected because combat unit medical supplies,
which are generally too expensive to keep on the shelf during peacetime, were
not readily available. This placed a significant burden on the medical supply
system and commercial partners to manage the surge in requirements.
Based on the assumption that Operation Iraqi Freedom would be similar to Operations
Desert Shield and Desert Storm, guidance was issued that each soldier would deploy
with a 90-day supply of chronic maintenance medications. However, most of the
medications were consumed before the soldiers departed from home station because
the medications were issued weeks in advance of deployment. Planners had assumed
that soldiers would be able to use the Department of Defense Mail-Order Pharmacy
System for refills, but no process was ever developed and put into place to make
that a realistic alternative.
By late April 2003, the need to obtain prescription refills was becoming an overwhelming
problem in the Southwest Asia theater of operations. Nearly 10 percent of all
soldiers had prescription requirements, and it was almost impossible to predict
each soldier’s actual drug and dosage requirements because chronic medications
were not identified before deployment. With 120,000 soldiers in theater, over
12,000 prescriptions had to be refilled.
As the problem escalated, it was discovered that units did not know what specific
chronic medications their soldiers used. Once medications were consumed, the
medical materiel system could not handle the volume of requirements and process
requisitions in time to get prescription refills to soldiers. As a result, units
initially bypassed the system and reached back to home station hospitals to have
refills shipped into the theater.
To correct the problem, combat support hospital pharmacies began collecting prescription
requirements and stocking chronic medications for soldiers in their area. Units
were instructed to provide detailed listings of the chronic maintenance medications
their soldiers needed. This requirement led to a major reengineering of the deployment
process to ensure that prescription requirements are compiled in a clinical database
during predeployment processing. Soldiers now are required to deploy with 8-month
supplies of medications, and female soldiers using oral contraceptives must take
at the 21st Combat Support Hospital in Balad, Iraq,
are responsible for ensuring that soldiers have the
medications they need.
Data on chronic maintenance medications for deploying
soldiers are now captured and managed by a Web-based system called the Predeployment
and Reporting Tool (P–MART). The Department of Defense Pharmacoeconomic
Center in San Antonio, Texas, issues a P–MART report to help commanders
and medical officers accurately identify the chronic medications being used by
Once a unit has been identified for deployment, its soldiers must pass through
medical readiness checks. One such check, called the Soldier Readiness Program,
offers soldiers the opportunity to create wills, establish powers of attorney,
make financial allotments, get medical assessments that identify immunizations
they need, and verify their medical histories. After this process is complete,
each unit commander or unit medical officer provides the Pharmacoeconomic Center
by-name roster of all personnel within the unit designated for deployment.
The center generates a P–MART report that lists soldiers’ chronic
medications and the approximate dates they will need to be refilled.
The P–MART report goes a step further. Once information is captured in
the system, refills are automatically filled and shipped to the medical logistics
battalion in Iraq and then distributed to the deployed unit. Using P–MART,
the battalion receives bulk shipments of chronic medications and immediately
forwards the medications to the appropriate unit for distribution to soldiers.
Refills normally are shipped at the 4-month mark for the deployed unit. This
ensures that medications are received in a timely manner and neither the soldier
nor his unit has to initiate the request.
Deployments to combat operations present soldiers and their units with many challenges.
Fortunately, providing chronic medications is no longer one of them. Drawing
from lessons learned, the Army now has a system in place that ensures that soldiers
have the chronic medications they need and combat hospitals stock the pharmaceuticals
required by the soldiers they serve. ALOG
Major Greta L. Bennett is the V Corps
Medical Logistics Officer. She has a bachelor’s degree in business administration
from Howard University in Washington, D.C., and a master’s degree in public
administration from Troy State University in Alabama. She is a graduate of the
Army Medical Department Officer Basic Course, the Combined Logistics Officers
Advanced Course, and the Combined Arms and Services Staff School.