Managing class VIII (medical materiel) on the battlefield has always been a challenge, especially for divisional units. Even with today’s modern technology, getting medical supplies to the user is often a difficult task. To streamline this process and empower levels I and II medical elements, the Army Medical Department (AMEDD) developed the Theater Army Medical Management Information System (TAMMIS) Customer-Assisted Module (TCAM) and mandated that it be the system for ordering class VIII at brigade level and below. With adequate planning and command emphasis, TCAM can be a significant enabler in getting critical medical supplies to the right place at the right time on the battlefield.

A Soldier in the field operates a TCAM terminal. The terminal is plugged into the wireless Combat Service Support Automation System Interface (CAISI), which interacts with a Very Small Aperture Terminal (VSAT) to provide Internet access.

What Is TCAM?

TCAM is a Windows-based, point-and-click application specifically designed to allow providers of levels I and II medical care to research class VIII requirements, submit orders via the Internet, and maintain an inventory database. (Level I medical care includes immediate lifesaving measures provided by trauma specialists with military occupational specialty 91W, healthcare specialist, assisted by self-aid, buddy aid, and combat lifesaver skills, or by a physician or a physician’s assistant at the battalion aid station. Level II medical care includes all care provided by level I and adds laboratory, x-ray, dental, and patient-holding capabilities. This level of care typically is provided by medical companies and troops of brigades, divisions, separate brigades, armored cavalry regiments, and area support medical battalions.)

TCAM enables users in units providing levels I and II medical care to access information on the operations of their higher medical supply activities and retrieve real-time data. Many features that were unavailable to them in the past are now accessible. For example, TCAM can be used to—

• Obtain an up-to-date catalog that includes suppliers’ on-hand balances, complete item descriptions, photos, and any available substitutes.
• Build stock record tables, which allow users to build, update, and track their on-hand balances and dues-in.
• View and print the status of orders.
• Maintain an automated class VIII document register.
• Set up subaccounts for subordinate customers.
• View quality control messages that pop up automatically when certain items are ordered.
• View the maximum release quantity of selected items and see if the items are stocked.

People often assume that a special computer and equipment are required to use TCAM. Not so; all a user needs is a desktop or laptop computer with a Windows-based operating system, free updated software, and any Internet browser. (TCAM Version 3.0 can be downloaded from www.medlogspt.army.mil/index.html. Click on “Site Map,” then on “AMEDD Log Systems” and “TCAM 3.0.”)

TCAM is the fastest, safest, and most accurate way for medical units to process class VIII data. It is currently being fielded to all units across the Army, and it is already the standard in Kosovo, Afghanistan, and Iraq. In some areas, medical supply activities use TCAM exclusively to request and receive class VIII supplies.

All levels I and II medical facilities are familiar with disk or hard-copy information transfer, both of which are often called the “sneaker net.” Adding Soldiers and vehicles to convoys to carry these data on a disk or in hard-copy form exposes those Soldiers to some of the most dangerous areas on the modern battlefield. Data can be transferred digitally with TCAM without putting a single Soldier in danger.

A CAISI is set up in a field environment (above). One main CAISI system in a unit is connected to the VSAT (below), and other elements that have CAISI systems can interface with the main CAISI to establish Internet connections.

Implementation Hurdles

So why isn’t TCAM the standard in every brigade’s day-to-day business? After reviewing myriad after-action reports from recently deployed medical units; observing many units in training at the National Training Center at Fort Irwin, California; and interviewing a number of subject matter experts, I found that most of the levels I and II medical units in the current areas of operations have at least tried to use TCAM. Some have had more success than others, but most met with difficulty at some point. Problems occurred at the operator level and continued all the way up to the division level. Through research and observation, we have uncovered many of these problems. Some obstacles that seem to be common to all units include—

• A lack of dedicated access to the Internet.
• Insufficient number of IP (Internet protocol) addresses available to permit TCAM terminals to access the Internet on the unit’s local area network.
• Inability to transfer data because of network security protocols, or “firewalls.”
• Insufficient knowledge and training among operators to troubleshoot and overcome operator-level problems.

Keys to TCAM Success

How can units overcome these obstacles and implement TCAM as the standard? The answer to this question is twofold. First, units must plan properly and coordinate all of the external requirements needed for TCAM to function properly. Second, there must be strong command emphasis on getting units to comply and make the system work. These two elements go hand in hand and must be present simultaneously to be effective.

Several key areas must be considered when planning for TCAM implementation. First, the user must have access to the nonsecure Internet. This can be done by VSAT (Very Small Aperture Terminal), TACLANE (Tactical Local Area Network Encryptor), or a commercial browser. Medical planners must make their communications requirements known to the signal community early on so that TCAM framework requirements can be factored into the overall brigade signal requirements. These requirements include —

• Providing TCAM terminals with dedicated IP addresses.
• Factoring TCAM terminals into the overall signal architecture.
• Locating TCAM terminals within the distance constraints of the category V (CAT V) cable from the signal node (typically 100 meters). [CAT V cable supports frequencies up to 100 megahertz and speeds up to 1,000 megabits per second.]
• Coordinating with the signal community to ensure that firewall ports used for FTP (file transfer protocol) operations are open. [FTP is a communications protocol that governs the transfer of files from one computer to another over a network.]

If medical planners can resolve these issues with the signal community, they then can focus on the other contributing factor to getting TCAM running: command emphasis.

When new and innovative systems such as TCAM are implemented, challenges and friction sometimes impede progress and delay acceptance. As a result, units resort to doing “business as usual,” which, in this case, means defaulting to the sneaker net. When this happens, future attempts to troubleshoot the new system are eventually stopped unless strong command influence dictates otherwise. We see this trend time and time again with the fielding of new systems in the military. Unless the command team decides to follow up and check on the implementation of a new system regularly, the Soldiers usually get the job done in ways that are most familiar to them—the old ways.

For example, when attempting to transfer maintenance data for the first time by FTP, brigade combat teams (BCTs) at the National Training Center often struggle with the process because they are not familiar with it. Problems occur, and they default to the sneaker net. Although this method works, it doesn’t provide timely and accurate data transfer. Without command attention, the units abandon any attempts to use FTP simply because they don’t know how. It usually takes a senior member in their chain of command, usually the brigade executive officer, to enforce the “new brigade standard” and mandate that all units transfer data by FTP. Eventually, as the units become familiar with FTP and gain confidence in it, they use the FTP process efficiently to provide the BCT leaders with accurate and timely information.

This training scenario undoubtedly is repeated when other BCTs attempt to implement TCAM. 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.

Until recently, an automated class VIII system was not available to medical units below level III (hospital care). However, TCAM is now the AMEDD standard, and it is being used successfully by many units across the Army, especially those that are deployed. Under the Army’s new BCT structure, TCAM will be the tool used by brigade medical supply officers to manage class VIII stocks, so knowing how to use it will become even more critical.

TCAM, like any new equipment fielded in the Army, has some shortfalls. However, with proper planning and appropriate command attention to its implementation, it can be a powerful enabler across the Army.
ALOG

Captain Michael S. “Sean” Smith is an observer-controller at the National Training Center at Fort Irwin, California. He served previously as commander of the forward medical support company of the 2d Brigade Combat Team, 3d Infantry Division (Mechanized), during the initial phases of Operation Iraqi Freedom. He has a bachelor’s degree in biology from Lincoln University in Missouri, and he is a graduate of the Army Medical Department Officer Basic Course and the Combined Logistics Captains Career Course.