Logisticians and clinicians are working together to find medical technology that not only meets urgent healthcare requirements but also can be supported and maintained in field conditions.

The U.S. Army Medical Materiel Agency (USAMMA) selects and recommends medical equipment and materiel needed for all levels of care in support of the warfighter. In addition to experienced logisticians, engineers, and maintainers, the USAMMA staff includes clinicians to ensure that the medical equipment provided to the warfighter is not only sustainable and maintainable but also meets user expectations.

If an urgent need for a capability identified by the field requires rapid distribution of new medical technology, USAMMA uses a dual-path approach to meet the need. The first path is to find an interim solution: USAMMA selects a product that can be acquired quickly and then distributed with a minimal logistics tail. While implementing this provisional solution, USAMMA starts on the second path—to select a long-term solution. This second path is a deliberate process that may take several months to complete because it requires USAMMA to progress through a market analysis, environmental and operational testing, and an integrated logistics support analysis before final selection of a product. Inevitably, the time involved in this detailed second-path process exceeds customer expectations. So the interim solution implemented in the first path is crucial to meeting warfighter requirements in a timely manner.

This article uses two case studies to illustrate how the dual-path process works and the importance of interim solutions in meeting urgent healthcare needs.

Short-Term: Pain-Control Technology

Anesthesia providers of all three armed services identified a new pain-control technique, known as a patient-controlled analgesia (PCA) pump, for treating wounded service members being evacuated from the U.S. Central Command area of responsibility. Because the requirement for this capability originated in the theater, the Coalition Forces Land Component Command surgeon’s office developed an operational needs statement that was quickly approved and passed up the chain of command.

While this process was underway, USAMMA addressed an interim solution (the first path). The USAMMA staff conferred with clinicians; quickly assessed all required consumable support items, necessary accessories, and repair parts needed to support this interim technology; and pushed that information to the theater for rapid procurement of the technology through a separate Army funding source. USAMMA also coordinated with the Defense Medical Standardization Board to expedite the needed items through the national stock number (NSN) request process so that they could be supported and reordered within the automated theater logistics system. The NSN process, which normally takes 30 to 45 days, was accomplished in less than 7 days. The NSNs of these items were immediately provided for inclusion in theater stock record catalogs.

The theater headquarters then purchased the PCA technology and distributed it to the combat support hospitals in November 2005. This process only required about a month, while it normally can take several months depending on the complexity of the equipment. The interim-solution PCA technology currently is being used with great success and is working to relieve patients’ pain on long air evacuation flights to Europe and the United States.

While this rapid process was getting needed pain-control technology into the theater, USAMMA engaged in a deliberate process to select a long-term solution (the second path). Because the requirement was generated in theater on the recommendations of clinicians from all three services, the service logistics agencies worked with the Defense Medical Standardization Board to complete a comprehensive survey of PCA technology in the marketplace and evaluate available products for multiservice application.

At this time, the services have selected a preliminary pool of four products to undergo testing, including airworthiness certification, environmental and operational testing, and integrated logistics support analysis. When these analyses are complete, the service logistics agencies will reconvene to select a final product for acquisition. Once selected, this product will replace the interim solution in theater.

Long-term: Operating Room Tables

At the same time that it works to fill urgent requirements through rapid fielding of technology, USAMMA also works toward finding long-term solutions for replacing obsolete equipment or introducing new medical technology. Although both approaches are similar in terms of the process followed, the long-term approach requires additional time to ensure that the solution that is selected is fully supportable and can withstand a variety of environmental conditions.

Since about 90 percent of medical equipment for field use is commercially available, and medical technology advances significantly every 18 to 24 months, most of the items that USAMMA reviews are replacements for obsolete systems. However, if a new, previously unknown technology is being introduced, the combat developer must draft a capabilities document. Since the documentation process can take many years, USAMMA, as the materiel developer, begins a market analysis as soon as the need is articulated.

Take the operating room (OR) table used in combat support hospitals as an example. The OR table currently in use is approximately 17 years old. Parts for it are no longer available, and it is considered to be clinically obsolete. As a result, the Army Medical Department required that a new product be procured that would be both sustainable and clinically viable. In less than 6 months, USAMMA determined the availability of potential vendors, conducted a thorough market investigation, and identified two vendors that could address the stated requirements.

Surgeons and OR nurses at Walter Reed Army Medical Center in Washington, D.C., clinically evaluated both vendors’ products. USAMMA also requested that the Aberdeen Test Center at Aberdeen Proving Ground, Maryland, test both products under harsh physical and environmental conditions. After rigorous testing, the logisticians, engineers, maintainers, and clinicians at USAMMA compared these two potential products and conducted a supportability analysis. In the words of one of USAMMA’s contract engineers, Eric Abbott, the supportability analysis “examined how easy the units would be to maintain in the field, availability and expedient delivery of spare parts, availability and source of technical support . . . , and stability of the manufacturer . . . .” Although both products passed environmental and operational tests, USAMMA’s source selection board chose the one system (see photos below) that met both clinical (or operational) and supportability requirements.

The new operating room table procured under the long-term process is shown in its storage and transport position (above) and in its operational position (below).

In many acquisition programs, the needs of the equipment user and the logistician supporting that equipment may be overlooked. However, USAMMA product teams include engineers, users (USAMMA’s clinicians), logisticians, and maintainers who work side by side on a daily basis. Each of these subject-matter experts is committed to ensuring that a newly introduced product not only will function clinically as intended but also will be sustainable and maintainable in the field.

While a relatively new concept, this team approach has proven to be very successful. Deployed clinicians and Soldiers ultimately benefit by getting an interim solution to the field as quickly as possible while USAMMA works through the intricate process of selecting a commercial product. Only through USAMMA’s dual-path process can the military clinician assist or lead the selection of a product one year and use that product in the field the very next year to save a life.
ALOG

Lieutenant Colonel Kimberly A. Smith is the Chief of the Acute Care Division in the Materiel Acquisition Directorate at the U.S. Army Medical Materiel Agency at Fort Detrick, Maryland. An operating room nurse, she has a master’s degree in perioperative [surgery-related] nursing from the University of Connecticut.

Dawn L. Rosarius is the Director of Materiel Acquisition at the U.S. Army Medical Materiel Agency at Fort Detrick, Maryland. She holds a B.S. degree in electrical engineering from Loyola College in Maryland and an M.S. degree in technology management from the University of Maryland.