Deploying Medical Units

by Major Charles H. Strite, Jr.

    Deploying medical units into a theater of operations presents an exceptional challenge for any organization. This is especially true for a corps medical brigade since its subordinate units may report directly to the brigade headquarters, with no battalion-level organization in between. Because of the limitations and sizes of the subordinate medical units, many medical brigades have a flat command and control structure and the brigade staff must act as brigade, battalion, and unit staff.

    The theater commander in chief's requirements determine the exact number and types of units deployed. Medical brigade units include—

    Other combat service support units do not face the same difficulties as a medical unit faces. However,
there are many similarities in operations. The keys to deploying any unit successfully are cooperation, well-
documented and clearly understood readiness standing operating procedures (SOPs), ingenuity, and
communication.

    Another important aspect of deploying a unit is the assistance provided by a committed garrison staff. It is the logistician's responsibility to step forward and assist, lead, and fill the void where appropriate. The S3 (operations) section normally provides the focus that drives deployments, training exercises, and garrison operations. However, when a unit receives notification of an impending deployment, this changes quickly: The S3 continues to control the organization for the commander, but the focus shifts to the S4 (logistics officer).

Mission

    Once alerted of an upcoming deployment, the S4's main task is to understand the mission of the deploying unit. This includes location, timeline, constraints, and critical information about the combat service support architecture in the theater. Once he understands this information, the logistician's task in the mission analysis, course of action development, and orders production process is to identify requirements and capabilities. This will identify the deploying unit's shortcomings, for which the S4 then must provide solutions.

Task Organization

    While the S4 is working the military decisionmaking process, he must simultaneously task organize the S4 section and analyze the logistics capabilities within the brigade to support the deploying unit.

    The S4's first task is to assist the S3 in identifying a "pusher" unit. The pusher unit will complement the capabilities of the deploying unit with logistics, training, and administrative support. In many cases, medical brigade subordinate units do not have assigned mechanics, cooks, or supply personnel. Therefore, the clinical personnel of the deploying unit will need assistance in all logistics areas, which might include unit basic load requests, unit movement operations, maintenance, and hand receipt support. By working together, the deploying unit, the pusher unit, and the S4 can meet the deployment timeline.

    The second task of the S4 is to alert higher support agencies immediately that a deployment mission has been assigned to the brigade. In most cases, the following organizations must be notified: directorate of logistics, ammunition supply point, direct support unit, supply support activity (SSA), installation medical supply activity (IMSA), U.S. Army Medical Materiel Agency (USAMMA), central issue facility (CIF), joint transportation division, corps G4, corps materiel management center, and troop issue subsistence activity (TISA).

    The third task of the S4 is to meet with the deploying unit, pusher unit, and S4 staff to assign and clarify roles and responsibilities. All parties involved must understand the deploying unit's requirements. Based on the results of this meeting, the S4 will update the S3 on the timeline and additional tasking support needed.

Filling Requirements

    Various obstacles exist when deploying a unit. For a successful deployment, the brigade and garrison must help overcome these obstacles, which are force protection and country-unique training, family readiness group issues, Soldier Readiness Program (SRP), and logistics requirements; they involve supplies, resources, maintenance, and movement operations. Typically, planners handle the SRP and logistics requirements up front because they have longer lead times. They can handle family and training issues later with little interruption, provided the SRP and logistics requirements are complete.

 
An M998 cargo vehicle loaded with medical equipment (left) and M101 trailers loaded with medical supplies (right) are ready for air transport. An M998 cargo vehicle loaded with medical equipment (left) and M101 trailers loaded with medical supplies (right) are ready for air transport.

An M998 cargo vehicle loaded with medical equipment (left) and M101 trailers loaded with medical supplies (right) are ready for air transport.

Logistics Requirements

    Class I (subsistence). Planners must compare the deploying unit's headcount to the theater days of supply (DOS) requirements. Ideally, the approved class I unit basic load (UBL), DOS, and headcount all agree. But this is not usually the case, and the unit has to resubmit its UBL request to the TISA. This request must include bottled water and meals, ready to eat (MREs). Medical units that provide food for patients also must consider potential patient densities in these numbers.

    Class II (general supplies). When planning for class II supplies, planners again must look at the deployment order and compare the UBL with theater DOS requirements. It will take a significant amount of time to acquire items identified as shortages through contracts, standard requisitions through the military standard requisitioning procedures (MILSTRIP) process, and Government credit card purchases.

    When determining class II needs, planners must consider office and automation supplies and common-use items such as engineer tape, cleaning items, rope, and tent pegs. They must coordinate with the CIF for an issue of organizational clothing and individual equipment (OCIE), previously known as TA 50, based on theater or regional requirements. In most instances, the unit will want to complement its current OCIE list with cold- or hot-weather items, additional force protection items such as flak vests, and environment-specific uniforms such as desert camouflage uniforms. Planners must have the hat, boot, pants, and shirt sizes of the deploying soldiers in order to assist the CIF in filling unit OCIE requirements. Moreover, they must consider the theater of operations requirements when coordinating uniform alterations, sewing, and patch requirements such as nametapes, U.S. Army tapes, shoulder flags, and additional rank and branch insignia. Planners also must coordinate with the SSA and CIF for expendable chemical defense items and chemical protective suits needed to reduce their nuclear, biological, and chemical supply and equipment shortages.

    Class III (petroleum, oils, and lubricants). Planners must ensure that the unit has adequate petroleum, oils, and lubricants available to allow initial sustainment of operations in theater. Normally, these items include several 5-gallon cans of JP8 fuel, a quart or two of oil per vehicle or generator, lubricants, and pesticides for preventive medicine units and field sanitation stocks. These items must be labeled and loaded properly to ensure safe movement.

    Class IV (construction and barrier materials). Force protection is a commander's single most critical task in a hostile environment. Unit planners must ensure that their supply lists provide for force protection. Force protection items should include concertina wire, tanglefoot, sandbags, pickets, plywood, and lumber. Requisitioning these stocks can be difficult because the units of issue are complicated.

 
Soldiers prepare a pallet of medical supplies for air transport.  A 463L pallet of medical supplies and equipment awaits air transport.

Soldiers prepare a pallet of medical supplies for air transport. 

A 463L pallet of medical supplies and equipment awaits air transport.

    To establish their class IV UBL, units must determine their perimeter defense plans. They must determine requirements for patient and survivability bunkers and fighting positions by national stock number, unit of issue, quantity, and nomenclature. Additional class IV items include dunnage for movement operations, lumber for 463L pallets, and blocking and bracing materials for military containers.

    Class V (ammunition). Medical unit planners must document ammunition requirements based on M16 and M9 weapons. Typically, the class V UBL calls for 210 M16 rounds and 150 M9 rounds per soldier with a weapon. The planners must use the documented UBL, the theater DOS, and the number of soldiers deploying to determine the ammunition requirement. Medical unit planners also should consider their smoke requirements.

    Once they know the ammunition requirement, planners must prepare for its transport. This should include the movement timeline and the transporters (who must be school trained and licensed to transport these stocks). Unit planners also must arrange for temporary storage of the ammunition and hazardous materials (HAZMAT). They also must verify the information on the Delegation of Authority Card, Department of the Army Form 1687, at the ammunition supply point.

    Class VI (personal demand items). Before deploying, medical units must contemplate the personal needs of their staff and patients. Unit sundry packs are a good source to assist in this process. Sundry packs are based on male and female individual personal use and hygiene requirements. The TISA is the source of supply for sundry packs. Planners should consider what assets will be available in theater and advise soldiers to bring personal items accordingly.

    Class VII (major end items). The unit modification table of organization and equipment (MTOE) and common table of allowances (CTA) on-hand assets represent the major end items a unit must have to deploy. Once alerted, units immediately should perform preventive maintenance on their major end items and review their hand receipts for shortages, including component shortages. Each unit's commander must decide what shortages are critical and, based on the Accounting Requirements Code, whether his supply room or the property book officer (PBO) must requisition the critical items. Expendable and durable shortages should be annotated within the Unit Level Logistics System-S4 (ULLS-S4) to facilitate a quick requisition to the appropriate SSA; nonexpendable shortages should be identified at the PBO level for a quick requisition as well. This time-consuming process will require multiple requisitioners. Units must capture these costs for future reimbursements. They also must coordinate with the PBO for a deployment unit identification code (UIC) and Department of Defense activity address code (DODAAC) to facilitate supply operations in theater. This request must go through G3 and G4 channels.

    The PBO must create a ZRF (unit transfer request) diskette to split the deployment hand receipt for stay-behind items. The deploying unit will carry the ZRF diskette into theater for loading into the gaining PBO's Standard Property Book System-Redesign. This will give the gaining commander in chief asset visibility in his theater.

    Class VIII (medical materiel). When a medical unit is alerted of an upcoming deployment, it must examine its mission and its documented shortages of medical and dental sets, kits, and outfits (SKO). Medical and dental SKO components can range from 20 to more than 1,000 different items. A medical brigade can have several hundred medical SKO. Typically, medical units do not have sufficient resources to stock their medical and dental SKO at 100-percent fill. Therefore, units must leverage Army stocks managed by USAMMA or their IMSA prime vendor.

    Planners should be acquainted with USAMMA Supply Bulletin (SB) 8-75-S7, which discusses what sets and units are covered under the centrally managed short shelf-life program. Ordering these items can be cumbersome and time consuming.

    It is critical for units to develop a solid relationship with the supporting IMSA. They should develop a routine discussion and a documented plan detailing which assets are not maintained at the unit level. This will minimize difficulties when the unit is notified of impending deployment. Planners also must coordinate the unit's medical chemical-defense requirements with the IMSA. The IMSA then will coordinate with USAMMA for the release of critical assets.

    Class IX (repair parts) and maintenance. Deploying medical units must ensure that their equipment receives a solid technical inspection before the unit movement joint inspection. Medical and dental equipment should be inspected by the supporting medical maintenance facility. When personnel assets are limited, the brigade commander may direct other subordinate units to assist the deploying unit with mechanic support.

    Unit commanders always should know the status of their equipment. The ULLS-Ground system not-
mission-capable report should be the focus of the deploying- and pusher-unit maintenance sections. Deploying units also should verify prescribed load list status and consider the theater DOS, mission, and environment to determine if additional items should be procured.

    The unit should collect calibrations from its test, measurement, and diagnostic equipment and Army Oil Analysis Program samples from its automotive equipment. The Director of Logistics then should suspend these programs until the unit returns to the home station. The gaining Directorate of Logistics will administer these functions while the unit is deployed.

Unit Movement

    The unit movement process is the most challenging obstacle for a deploying unit. Typically, this becomes the responsibility of the pusher unit with S4 oversight. All units should have an up-to-date authorized unit equipment list based on their MTOE and CTA assets. Based on the mission and constraints placed on the deploying unit, the pusher unit will create a deployment equipment list. The pusher unit also must have trained personnel to build pallets, determine vehicle weight and center of balance, document and plan for HAZMAT shipments, and build loads for the resourced aircraft.

    Units must make maximum use of secondary loads to save valuable strategic air assets. Planners should create preplanned secondary load plans for their vehicles and trailers. Units also must have unit movement supplies and equipment to deploy. These items include cargo straps, plastic pallet covers, tape, markers, dunnage, plywood, lumber, rope, and HAZMAT declaration forms. Units that have a well documented and rehearsed movement plan will find the joint inspection process quite easy.

Setting the Tone

    The brigade S3 and S4, pusher unit, and deploying unit must share issues and status throughout the deployment process. The S4 must take the lead to ensure that the deploying unit receives the supplies and services it requires. This preparation will set the tone and conditions for the entire deployment.

    There is no substitute for unit preparedness. The unit commander must rehearse and resource the unit deployment process. He must use the unit status report to portray the readiness of the unit. Before deployment, field medical units must train seriously on the strategic deployment mission-essential task list. Many of the logistics challenges facing the medical brigade during a deployment are unlike those facing other brigades. However, many of the tactics discussed in this article can be applied to most unit deployment scenarios.

    The keys to a successful deployment are easy. Units must cooperate, have documented and clearly understood readiness SOPs, have ingenuous soldiers, and insist on solid communication. Units acting in isolation will not get through this process. Cooperation and sharing of information at all levels throughout the unit, brigade, and installation are paramount for a successful deployment. Units that do not rehearse and train on their readiness SOPs will find this process very difficult and time consuming.  ALOG

    Major Charles H. Strite, Jr., is the 62d Medical Brigade S4 at Fort Lewis, Washington. He has an M.B.A. degree from Regis University and is a graduate of the Medical Logistics Management Course, the U.S. Army Medical Materiel Agency Logistics Management Course, the Army Medical Department Officer Advanced Course, and the Army Command and General Staff College.