Medical Maintenance Requirements in Special Forces Groups

by Captain Thomas S. Wieczorek

    Army Special Forces groups have many organic medical capabilities, including medical, dental, veterinary, lab, x-ray, preventive medicine, medical operations, and medical supply services. They need these diverse capabilities because of the types of missions they execute and because the austere environments in which they operate require them. However, it is important to note that, in spite of all of these medical capabilities, Special Forces groups do not have any type of organic medical maintenance support.

    In a garrison environment, Special Forces groups must rely on the installation medical support activity for medical maintenance support. However, when deployed, the groups have to develop their own plans to handle medical maintenance requirements. Would Special Forces groups benefit from having their own medical maintenance support, such as a medical equipment repairer (MER) with military occupational specialty (MOS) 91A? These groups have unit-level automotive maintenance support and even limited maintenance capabilities for communications, parachutes, and combat diving equipment. I believe they should have their own medical maintenance support as well.

Medical Maintenance Overlooked

    The Army has seven Special Forces groups: five are Active Army units, and two are Army National Guard units. These groups all fall under the control of the U.S. Army Special Forces Command (Airborne), a major subordinate command of the U.S. Army Special Operations Command (USASOC). Because USASOC is its own major Army command (MACOM), it does not fall under the control of the U.S. Army Forces Command (FORSCOM) as do the majority of Army combat forces. Because most medical doctrine writers focus on the medical functions within FORSCOM units, smaller organizations, like USASOC, do not have the benefit of detailed medical doctrine, especially medical maintenance doctrine. Thus, medical maintenance does not receive adequate attention or is overlooked altogether.

    In June 2000, the Army special operations community published its own medical field manual (FM). FM 8-43, Combat Health Support for Army Special Operations Forces, along with USASOC Regulation 40-6, Health Services: Medical Supply Policies and Procedures (Draft), are the only two special operations-specific medical publications that contain medical maintenance information. Unfortunately, neither document addresses the tactics, techniques, and procedures for conducting medical maintenance in a deployed setting. FM 31-20, Doctrine for Special Forces Operations, does mention a few planning considerations for medical maintenance, but it does not go into detail. So how can a Special Forces unit write a field standing operating procedure that contains medical maintenance guidelines when higher level doctrine does not address them at all?

What the Experts Say

    In a confidential e-mail survey of the officers or noncommissioned officers (NCOs) in charge of medical maintenance coordination for six of the seven Special Forces groups in the Army (one of the National Guard groups did not have an officer or NCO to handle medical logistics and maintenance issues at the time of the survey), three stated that they do not have a requirement for organic medical maintenance, while the other three stated that they did.

    The groups that indicated they did not have a requirement provided three reasons. First, they noted that the periods of their deployments typically were not long enough to require medical maintenance. Second, they stated that they coordinated for any required maintenance before the actual deployment. Third, they maintained that often the most sophisticated equipment that requires maintenance, such as x-ray equipment, is not taken on missions.

    However, of the three groups that denied the requirement for organic medical maintenance, two admitted that they would have a requirement if the deployment was battalion-sized or larger and of long duration. The prevailing theme in all six surveys was that no one wanted to lose a current authorization for any of their current MOSs in order to gain a slot for an MER. However, if their table of organization and equipment (TOE) authorized an MER without having to lose any other authorization, they gladly would take one.

What the Numbers Say

    An objective way to analyze if the Special Forces groups require an MER is to look at manpower requirements criteria (MARC). Specifically, in the area of medical maintenance, the U.S. Army Force Management Support Agency (USAFMSA) outlines a standard formula for determining manpower requirements (see chart above). The first step in this process is to determine the annual maintenance man-hours (AMMHs) for each piece of medical equipment in a Special Forces group. These numbers can be found in a database maintained by USAFMSA, which is accessible on line at http://www.usafmsardd.army.mil. The next step is to multiply the AMMHs by the TOE-authorized quantities of each piece of equipment. The product of these two figures yields the numerator for using the MARC formula (A X B on the chart).

Manpower Requirements Formula

1.  Use the following equation to determine workload-based requirements for Medical Equipment Repairer (MOS 91A)—

Where:

 

(A X B) / C = R

 

A = Annual maintenance man-hours (AMMHs) per piece of equipment
B = Density of equipment (Section II, TOE)
C = Annual MOS availability factor (from Table C
1, AR 7132)
R = Manpower requirements

 

2.  Annual MOS availability factor (AMAF) data—

TOE                                      Name                            MARC Code                            AMAF

31803L000                  Support CO, SF GP (ABN)                  33B                                 4,380

31806L000                  HQ Det, SF BN (C Det)                     13B                                 4,380

31807L000                  SF CO, SF BN (ABN)                         13B                                 4,380

 

3.  Calculations—

 

4660.1 Total AMMH / 4380 AMAF = 1.06 MERs

 

Legend:

 ABN    =            Airborne                                              GP      =            Group

BN       =            Battalion                                              HQ     =            Headquarters

CO       =            Company                                            SF       =            Special Forces

Det       =            Detachment

      The denominator for the MARC formula (the annual MOS availability factor [AMAF]) is determined by applying the MARC codes for the various Special Forces subordinate units that have medical equipment to Table C-1 of Army Regulation 71-32, Force Development and Documentation—Consolidated Policies. (The MARC code is a three-digit code located on the header data of every TOE.) In the case of the Special Forces groups, the resulting AMAF is 4,380. By doing the appropriate calculations, the manpower requirement is 1.06. In other words, according to MARC data, each Special Forces group should be authorized one MER.

    An important thing to remember is that, since the MARC data used in this study deal only with TOEs, the resulting requirement applies only to the TOEs and not to the modification TOEs (MTOEs) for each of the Special Forces groups. In other words, even if USAFMSA added an MER to the TOE, the MACOM "bill payer" (USASOC) could decide not to accept the position, in which case the position would be shown in the "Required" column of the MTOE but not in the "Authorized" column.

All Missions, All Equipment

    Some members of the Special Forces groups surveyed stated that their missions were typically of short duration. Doctrine writers and people who determine requirements for units look at many possible missions for those units, not just the typical ones. Consequently, those units need to be prepared to provide support in a longer conflict.
Medical equipment repairers from Womack Army Medical Center conduct semiannual maintenance inspections on equipment belonging to the 3d Special Forces Group (Airborne) at Fort Bragg, North Carolina. Medical equipment repairers from Womack Army Medical Center conduct semiannual maintenance inspections on equipment belonging to the 3d Special Forces Group (Airborne) at Fort Bragg, North Carolina.

    In some cases, a unit cannot wait until its mission is over to perform maintenance. Paragraph 6-20b of FM 8-55, Planning for Health Service Support, states, "Medical equipment maintenance support must be provided as far forward as possible. Ideally, equipment items should be diagnosed and repaired on site if conditions permit, either by organic MERs or by mobile support teams . . ." This would be the case especially when the Special Forces are operating in austere environments; for example, running a "guerilla hospital" during one of their unconventional warfare missions. In any event, it is critical to have the right type of support whenever the customer needs it, not just for typical missions.

    MARC data could justify adding MERs to the Special Forces groups because of the quantity of authorized equipment they possess. But what about their equipment that is not authorized on their TOEs or MTOEs? Four of the six Special Forces groups surveyed said they have a number of defibrillators and pulse oximeters that are not part of their TOEs or MTOEs but are authorized by special letters. Those items also must be captured in the units' medical equipment densities so they can be maintained properly.

    Army Special Forces groups have a legitimate requirement for organic medical maintenance, specifically MERs. The MARC numbers prove that. I believe the USASOC should add one MER (MOS 91A) and his corresponding equipment as requirements to the TOE for the medical section of the Special Forces group support company (TOE 31803L000). The groups should not have to surrender another MOS in order to obtain a 91A.

    Medical maintenance is overlooked all too frequently. The time to make sure medical equipment is working and calibrated is not after the bullets start flying on the battlefield. Having a technical maintenance professional alongside all the other medical specialists within the Special Forces groups would be the smart thing to do.

Captain Thomas S. Wieczorek is a medical logistician pursuing a master's degree in logistics management at Florida Institute of Technology's Fort Lee Graduate Center. Previously, he commanded the Logistics Support Company of the 32d Medical Logistics Battalion (Forward) at Fort Bragg, North Carolina. He has a bachelor's degree in biology from Loyola University Chicago and is a graduate of the U.S. Army Medical Materiel Agency's Medical Logistics Management Internship Program and the Army Logistics Management College's Logistics Executive Development Course, for which he completed this article.