are evacuated by ground to air and by ground.
JMAR, APS, JDF, and JSLIST are just a few of
the considerations that concern joint MEDLOG managers in their
support of PMTAFs, FSSGs, the EMFP, and ASMCs in the KTO.
If you understand what was just said, then you can start work
immediately as an effective medical logistics manager in the
Kuwait Theater of Operations (KTO). If you don’t understand
it all, that’s OK, you can be trained.
What was just said—“translated”—is
that the Joint Medical Asset Repository (JMAR), Army Pre-positioned
Stocks (APS), the Joint Deployment Formulary (JDF) (pharmaceuticals),
and Joint Service Lightweight Integrated Suit Technology (JSLIST)
(“MOPP [mission-oriented protective posture] gear,” or
protective suits) are just a few of the considerations that
concern joint medical logistics (MEDLOG) managers in their
support of the Army’s area support medical companies
(ASMCs), the Navy’s Expeditionary Medical Facility Portsmouth
(EMFP), the Air Force’s preventive medicine teams (PMTAFs),
and the Marine Corps’ force service
support groups (FSSGs).
These acronyms demonstrate that the different armed services
speak different “languages.” They
also have different medical organizations and medical equipment.
These differences are deliberate, as each service supports
different military missions. However—and this is a crucial
point—all of these different medical organizations are
working well together to provide required healthcare at high
standards in the KTO.
Creating Joint Force Medical Support
In the KTO and in support of Operation Iraqi Freedom (OIF)
II, the 8th Medical Brigade (Forward), according to its mission
statement, “provides joint command and control of all
medical units to provide health service support across the
full spectrum of military operations, JRMO [Joint Medical Regulating
[and] JRSO&I [joint reception, staging, onward movement,
and integration] and to manage Class VIII [medical materiel]
in the Kuwait Theater of Operations.” The 8th Medical
Brigade is an Army Reserve unit headquartered in New York City.
The 8th Medical Brigade’s joint medical task force organization
includes Army (Active component and activated Army National
Guard and Army Reserve), Navy, Air Force, and Marine Corps
units. These units are diversified in their service, missions,
and home stations. They provide levels I, II, and III healthcare,
air ambulance, veterinary, preventive medicine, combat stress
control, and medical logistics support. [Level I care includes
immediate lifesaving measures and medical evacuation to supported
medical treatment elements and includes battalion aid stations.
Level II care is performed at the brigade and division levels.
Level III care is the first level of care with hospital facilities.]
The 8th Medical Brigade’s Logistics Section, according
to its mission statement, is tasked “with a
sense of urgency and cost reduction, to provide comprehensive
medical logistics support to 8th Medical Brigade assigned and
attached units in matters of supply, maintenance, transportation,
During the period January to May 2004—the “surge” period
of OIF that this article covers—over 250,000 military
personnel moved into and out of the Southwest Asia theater,
most through the KTO. During this period, the joint medical
task force experienced some important successes. Joint medical
units were integrated quickly into the task force. “Left
seat-right seat rides” (redeploying units turning over
responsibilities to deploying units) went well. The high quality
of health service support continued unabated, regardless of
whether it was provided by Army, Navy, Air Force, or Marine
Corps personnel. In some areas, the quality of health service
support actually increased. Service members from different
units exchanged information, including recommendations for
improving health service support. Some service members were
able to provide additional training to other unit members,
such as combat lifesaver and healthcare specialist training.
Some service members with required skills were easily transferred
to another service’s unit to fill temporary or emerging
In short, all of the medical units deployed to the KTO with
a mission, all service members deployed to support that mission,
and, most importantly, all the pieces came together nicely
to provide quality health service support to all service members
in the theater. The joint forces assigned to the 8th Medical
Brigade’s joint medical task force organization adapted
quickly to the Army way of doing medical logistics business,
including requisitioning supplies, maintaining equipment, and
maintaining health service support in the theater.
However, the 8th Medical Brigade also faced some challenging
issues during this period that had to be addressed and resolved
quickly. What follows is a “top 10” list of issues
faced and lessons learned while the brigade implemented joint
medical logistics programs in the KTO from January to May 2004,
as well as recommendations for improving future joint medical
Increasing TAMMIS Use
Medical units in the KTO did not uniformly use the Theater
Army Medical Management Information System (TAMMIS) Customer
Assistance Module (TCAM) to requisition medical supplies. Some
units used other methods such as email and paper requisitions,
which were inefficient, slowed replenishment of medical supplies,
and hindered the supply system’s ability to stock items
based on true demand. Joint units scheduled to deploy and report
to the brigade had been trained on the use of TCAM and were
expecting to use it, but some of the hardware and software
in the theater did not incorporate the latest TCAM configurations.
Requisitions were not passed through the 8th Medical Brigade’s
6th Medical Logistics Management Center (MLMC), which impeded
resupply since an item is not ordered until a requisition has
a valid requisition number.
Here are some recommendations for improving use of TAMMIS—
• Direct units to use TCAM.
• Use customer assistance visits (including visits by Department of the
Army G–4 and G–6 and Program Executive Office for Enterprise Information
Systems contractors) to each unit to examine unit hardware and software, configure
them to the latest versions, and provide training as required.
• Route requisitions through the 6th MLMC.
A MEDLOG team in theater would have been very beneficial. This recommendation
applies to all 10 issues.
Speeding Theater Distribution
Medical logistics theater distribution was cumbersome and slow. The process was
not working as well as it should have. Supplies moved through the U.S. Army Medical
Materiel Center Europe (USAMMCE) and the U.S. Army Medical Materiel Center Southwest
Asia (USAMMC–SWA) to the aerial port of debarkation, theater distribution
center, central receiving and storage point, Camp Doha, Kuwait, supply support
activity (SSA), and finally to the unit. Urgently needed medical supplies arrived
at their destinations late or not at all. Some supplies just sat until they were
Recommendations for fixing these problems include the following—
• USAMMC–SWA should email or call customers in advance of shipments.
• Pure pallets should be used for shipping whenever possible. [Pure pallets
are loaded with materiel for only one unit.]
• The aerial port of debarkation should call customers when supplies arrive.
• Customers should pick up supplies when notified of their arrival.
• A plan should be implemented to upgrade delivery procedures for class
VIII supplies to medical level I and II troop medical clinics and the level III
hospital in the KTO.
Providing Class II and III Supplies
Class II (clothing and individual equipment, such as insect nets) and III (petroleum
and chemical products, such as the insecticides Permethrin and Deet) support
to the population at risk did not go smoothly. Some soldiers did not have what
they needed. Supplies of some of these items were stocked in theater in preparation
for combat operations, but there were few requests for them. Other items, such
as insect nets, were in short supply in the theater. Additional items that all
deploying soldiers should have had were JSLIST (they did); 180 days’ worth
of prescription medicines (most did not); medical biological and chemical defense
materiel (they did); and interceptor body armor (most had the outer tactical
vest, but few had the small arms protective inserts).
Recommendations for improving class II and III supply include the following—
• Ensure that class II and III items are issued (or on hand) to all service
members at their mobilization sites.
• Emphasize to leaders, and advertise in theater, the availability of these
items and the need to use them to prevent disease and nonbattle injuries.
• Move supplies forward to deployment camps for distribution to units needing
• Have the theater deployment/redeployment coordination cell (DRCC) make
these items “items of interest.” [Items
of interest are items that have the attention of senior leaders and therefore
are managed carefully.]
Supporting Units Arriving Without Equipment
Some units arrived in theater weeks ahead of their equipment. Equipment often
was not shipped from mobilization sites until units were validated to deploy.
Units in the theater without their equipment were not able to perform their missions
fully. They also could not complete additional, required in-theater training,
such as convoy live-fire exercises.
Recommended solutions for remedying these problems include the following actions—
• Ship unit equipment from the mobilization site to the deployment site
earlier in the process.
• Create a “pool” of weapons and equipment in the theater so
deploying units can complete any required in-theater training.
• Use stay-behind equipment (equipment left in theater by redeploying units)
to the maximum extent possible to alleviate shortages.
Improving Unit Maintenance Capabilities
Some units arriving in theater with their ground equipment did not have organizational
or direct support maintenance capabilities, including the Unit Level Logistics
System (ULLS)–S4 or ULLS–G (Ground). As a result, these units were
not equipped in theater to maintain their ground equipment, which prevented them
from fully performing their missions.
Solutions to this problem include—
• At the camp of any unit without organic maintenance capability, assign
other units to provide organizational and direct support maintenance and repair
parts support to that unit.
• Provide ULLS–S4 or ULLS–G to units at their camps.
• Work with units’ higher headquarters to establish the maintenance
capabilities they need.
• Consider expanding support to include ULLS and property book items.
Some units deployed without Department of Defense Activity Address Codes (DODAACs),
which prevented them from requisitioning supplies and equipment while in the
theater. As a fix, some of these units started
using the same DODAACs as the redeploying units they were replacing. However,
these DODAACs were theater specific. (The redeploying units would use their peacetime
unit DODAACs when they returned home.) The result was that two units would be
using the same DODAAC temporarily. If no further action was taken, the DODAAC
would be deleted within 60 days after the redeploying unit returned home and
the deployed unit would again be without a DODAAC.
Recommendations for improving management of DODAACs include these actions—
• Each service component must ensure that its units have DODAACs before
they arrive in theater.
• Units can still get DODAACs in theater by coordinating with their service
component (including by email).
• The 8th Medical Brigade’s headquarters also can assist in getting
DODAACs, including transferring a redeploying unit’s DODAAC to the brigade’s
theater unit identification code.
• “Generic” (not unit specific) DODAACs can be assigned to
units and then remain in use in the theater when the units initially receiving
Taking Advantage of Stay-Behind Equipment
Several problems affected the use of stay-behind equipment (SBE)—
• Equipment maintenance was lacking in theater because of high operating
tempo and insufficient organic maintenance capabilities.
• Equipment shortages were not replenished in a timely manner.
• SBE not in use often was not stored properly in the theater.
• SBE requirements were not thoroughly scrubbed. For example, when joint
inventories were conducted with losing and gaining units, some SBE was not required
(such as radio sets and chemical detectors).
• Lateral transfers can be done only within the same service, which made
it impossible to make such transfers between Army components and the other services.
• Some SBE designed and made for field use was used in fixed facilities.
In spite of these problems, SBE is a good thing and can save time, manpower,
and money. Units deploying to the theater can fall in immediately on SBE, eliminating
the need to pack, ship, receive, assemble, and prepare for use the same equipment.
Recommended solutions for improving use of SBE include the following—
• Use the medical logistics support team (MLST) and SSA contractor support
to augment any required medical equipment maintenance. [An MLST is a slice of
a medical logistics battalion or company and typically has 6 to 12 soldiers.]
Organizational support and direct support units can be used to augment the required
maintenance of any rolling stock equipment.
• Perform a 100-percent inventory and preventive maintenance on all medical
equipment sets before bringing them to the theater. Continue to perform inventories
and preventive maintenance on all medical equipment in theater, and requisition
to fill any shortages. Perform a 100-percent inventory of SBE between losing
and gaining units. Requisition shortage list items.
• Store medical SBE not in use in more appropriate storage than military-owned,
demountable containers (MILVANs), which can be very hot and humid and thus can
contribute to equipment deterioration.
• Continually scrub current and future SBE requirements for additions or
deletions. This process should address joint force requirements.
• Have COMPO [component] 1 (active duty), 2 (National Guard), and 3 (Reserve)
property book officers manage their respective property books. A similar arrangement
should be considered for joint forces SBE.
• Use SBE, including air ambulances and vehicles, as often as possible
there is a match between the mission and the equipment.
• Use SBE as often as possible to standardize medical equipment at troop
are stacked at the KTO Theater
Distribution Center. Such containers are not the
best storage sites for stay-behind medical equipment.
Handling Hazardous Materials
The turn-in of medical biological and chemical defense materiel
(MBCDM) during some units’ redeployment was not performed
according to established procedures. These controlled substances
were found at such places as washracks, dumpsters, and building
garbage containers. The KTO had several designated MBCDM
turn-in points, which were widely advertised. Despite these
turn-in points, MBCDM was found all over the camps and posed
a very serious health hazard.
Recommended solutions for better management of MBCDM include—
• Continue DRCC redeployment assistance coordination meetings to disseminate
proper turn-in procedures, including who, what, where, when, and how and points
• Highlight turn-in information on the DRCC
• Include information on MBCDM in the Commander’s Handbook, which
is available to all redeploying unit commanders in the theater.
• Include information in redeployment packets, which instruct redeploying
units on how to clear
• Advertise turn-in points and make those points convenient for turning
No organic optical fabrication capabilities existed in the KTO after the redeployment
of the 8th Medical Brigade’s Medical Logistics Battalion. This made it
difficult to issue prescription eyeglasses quickly to service members. USAMMCE
had to support the entire theater, supplemented by local commercial contracts—a
time-consuming and expensive process.
Here are some possible solutions—
• Task the Medical Logistics Company at U.S. Army Forces Central Command–Qatar
(ARCENT–QA) to provide optical fabrication in support of the Combined Joint
Task Force (CJTF) in Afghanistan, CJTF–Horn of Africa, and ARCENT–QA.
• Task the Camp Doha troop medical clinic, augmented by optometry personnel
from the Navy’s Expeditionary Medical Facility Portsmouth, to provide optical
fabrication to the KTO.
• Use the Theater Medical Logistics Battalion to provide optical fabrication
support in Iraq. This battalion is assigned to the 2d Medical Brigade in Iraq.
• Procure additional Opticast optical lens fabrication systems to support
the KTO. This may require additional optical SBE in the U.S. Central Command
area of responsibility.
• Plan for sufficient optometrist support.
Managing Pre-positioned Stocks
Several issues affected Army Pre-positioned Stocks (APS)—
•Transfer of some APS equipment between OIF I and OIF II units was not
as well coordinated as it should have been. APS were issued to hospital, company,
detachment, medical logistics, and maneuver OIF I units. OIF II and subsequent
operations required serviceable medical and nonmedical APS.
• APS stocks of critical items were depleted.
• Maintenance of APS equipment needed improvement.
• There were new requirements to support
• APS equipment was not always ready. It deteriorates, becomes obsolete,
and is lost.
Recommended resolutions to these problems include the following actions—
• Update APS plans and disseminate those plans to all concerned parties.
• Refit, refurbish, and augment APS stocks as required.
• Provide for the maintenance of APS equipment, including using the MLST,
and assign maintenance responsibilities in each camp to the units that have organic
• Scrub and prioritize current and future APS requirements.
• Use APS as much as possible whenever there is a match between the mission
and APS equipment.
These 10 issues are as diversified as the units in this joint medical task force
operating in the KTO. Some of the issues may apply to other, nonmedical units,
and some are unique to medical unit logisticians. These issues affected every
unit of the joint medical task force in varying degrees. Collectively, and in
the spirit of joint services cooperation, these issues were and are being addressed
head-on and resolved quickly. In the KTO OIF II medical community, and in the
world of medical logistics specifically, joint service units are working together
to solve logistics issues and provide effective healthcare support to the theater.
Colonel Paul R. Sparano is the Deputy Chief of Staff for Logistics of the 8th
Medical Brigade (Forward) in Southwest Asia. He is a graduate of the Officer
Candidate School; the Army Medical Department, Field Artillery, and Finance Officer
Basic Courses; the Army Medical Department Officer Advanced Course; the Army
Command and General Staff Officer Course; the Joint Course on Logistics at the
Army Logistics Management College; and the Advanced Program Management Course
at the Defense Systems Management College.