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Medical Logistics Transformation in Korea

Over the last 2 years, a series of organizational changes has resulted in a significant transformation of military medicine in Korea. The establishment of a provisional Army Medical Department activity (MEDDAC), Army dental activity (DENTAC), and Army district veterinary command (DVC) is improving the quality of life of service members and their families on the Korean peninsula. On the operational side, the transformation of the 18th Medical Command (MEDCOM) Headquarters (Korea) to the 65th Medical Brigade (Korea) has enhanced modularity and provided the warfighting commander with greater ability to tailor specific medical capabilities under multifunctional medical command and control elements. As operational medical units are being restructured, the Army medical logistics community continues to provide support to both operational medical units and institutional healthcare organizations. The activation of the U.S. Army Medical Materiel Center-Korea (USAMMC–K) established the crucial link between strategic and operational medical logistics units needed to create a single business framework during both peacetime (under the Korean armistice) and wartime.

A New Medical Structure in Korea

Activating the MEDDAC, DENTAC, and DVC, under a memorandum of agreement signed by the commander of the Eighth U.S. Army, Lieutenant General David Valcourt, and the commander of the Army Medical Command, Major General Gail Pollock, on 2 November 2007, was the starting block for Korea’s medical transformation. As a direct result of this memorandum, medical commanders will no longer be required to plead for augmentation and specialty support; they now have the authority to lay out their requirements, directly hire multidisciplinary medical professionals, and thus build a medical capability that provides more precise care for service members, their families, and Department of Defense (DOD) civilians.

Medical units in the 18th MEDCOM actually began transforming in October 2006, when the 121st General Hospital converted to an echelons-above-corps combat support hospital. Since then, other 18th MEDCOM transformational changes have included the 52d Medical Evacuation Battalion’s inactivation and the 168th Area Support Medical Battalion’s conversion to a multifunctional medical battalion in October 2007. In October 2008, the 18th MEDCOM Headquarters (Korea) transformed to the 65th Medical Brigade (Korea).

The restructuring of the operational medical force has included the inactivation of functional medical battalions (including medical logistics battalions) in favor of multifunctional medical command and control headquarters at the battalion, brigade, and theater levels. Theater-level Army medical logistics organizations, which habitually support all services and designated coalition partners, will be linked by the Defense Logistics Agency (DLA) directly to commercial sources of supply at the national level.

The DLA strategic acquisition and distribution framework, which enables Army medical logistics organizations to reach directly to commercial sources (rather than to traditional wholesale-level inventories), was formalized through the implementation of DOD Directive 5101.9, DOD Executive Agent for Medical Materiel. This directive designated the director of DLA as the executive agent for medical materiel for DOD. Under the executive agent, designated Army medical logistics organizations serve as theater lead agents for medical materiel, managing theater distribution of medical materiel and providing intensive management of medical commodities as part of an integrated theater healthcare system.

The medical transformation resulting from all of these changes will provide warfighting commanders with a highly responsive, capable, and interoperable medical system that is fully integrated throughout the continuum of care. This system is designed to minimize morbidity and mortality within the U.S. Armed Forces while maintaining the smallest possible medical footprint.

The 16th Medical Logistics Battalion

Korea’s final medical transformational change occurred on 30 October 2008 with the inactivation of the 16th Medical Logistics Battalion (the last medical logistics battalion in the Army force structure) and the establishment of USAMMC–K. Until then, the 16th Medical Logistics Battalion had provided U.S. Forces Korea (USFK) organizations and U.S. Department of State activities with medical logistics support under a single integrated medical logistics management memorandum of agreement signed by all of the services.

The battalion provided medical logistics support under the armistice and during hostilities, including medical materiel management, storage and distribution coordination, optical fabrication, medical maintenance (organizational level through depot level), blood (both frozen and liquid) storage and distribution, and command and control of assigned and attached units. The battalion managed $4.4 million of inventory, stocked approximately 2,300 different line items, processed between 6,000 and 8,000 materiel release orders each month, fabricated over 1,500 single-vision and multivision lenses on a monthly basis, performed over 500 scheduled and unscheduled medical equipment services per month, and maintained a zero-balance rate between 2 and 4 percent.

The 16th Medical Logistics Battalion was a table of organization and equipment unit with an authorized strength of 195 Soldiers augmented by 33 civilian personnel and 22 Korean augmentees to the U.S. Army (KATUSAs). During wartime, the unit’s strength was authorized to expand to 312 U.S. military personnel, supplemented with approximately 262 Korean Service Corps personnel. The battalion conducted medical materiel operations using the DLA Defense Working Capital Fund (DWCF). DLA, as the DOD Executive Agent for Medical Materiel, nominated the battalion to be the U.S. Pacific Command (PACOM)-Korea theater lead agent for medical materiel. The battalion also provided support to forces in Japan as well as naval vessels afloat.

U.S. Army Medical Materiel Center-Korea

One of the most challenging issues for Korea ’s medical community was preparing for the inactivation of the 16th Medical Logistics Battalion. It was projected that Korea’s transformed medical logistics capabilities and capacities in fiscal year 2009 would not be able to meet USFK’s requirements during peacetime, nor would they be able to support medical logistics missions outside the peninsula. If nothing was done to prevent this, each service would be required to establish strategic medical logistics support capabilities to sustain service-specific operational forces once the single integrated medical logistics manager (the 16th Medical Logistics Battalion) was inactivated.

So the Army determined that a table of distribution and allowances (TDA) organization was needed to project theater medical logistics in support of the Korean theater of operations, just as the U.S. Army Medical Materiel Center-Europe in Germany supports the U.S. European Command and the U.S. Army Medical Materiel Center-Southwest Asia in Qatar supports the U.S. Central Command. This new TDA organization is USAMMC–K (Provisional).

USAMMC–K continues to use the DWCF, and it has maintained the capability for joint augmentation and rapid expansion. The center operates as the theater lead agent for medical materiel and as the theater distribution center for medical logistics in support of joint forces and the Department of State during peacetime or upon transition to hostilities for USFK and PACOM. USAMMC–K manages the theater distribution of medical materiel in close coordination with the 19th Expeditionary Sustainment Command (ESC) and the Joint Forces Sustainment Coordination Center and with the 6th Medical Logistics Management Center upon transition to hostilities. USAMMC–K also provides intensive management of medical commodities as part of an integrated theater healthcare system.

USAMMC–K is staffed with U.S. and Korean civilian employees, Korean Service Corps personnel, and borrowed military manpower from the 65th Medical Brigade, the 19th ESC, the 168th Multifunctional Medical Battalion, and the 563d Medical Logistics Company (which was activated in October 2008). USAMMC–K is colocated with the 563d Medical Logistics Company at Camp Carroll in Daegu, South Korea, providing strategic medical logistics support to operational forces located in the Korean theater.

USAMMC–K is designed to rapidly expand medical logistics support capabilities during a transition to hostilities in order to meet force structure requirements. Rapid expansion will be accomplished through augmentation by operational medical logistics units and personnel and Korean Service Corps personnel; the center may also transition to contract or civilian staffing as appropriate for the mission. Expansion capacities include assembling configured loads and push packages with subsequent throughput; providing optical fabrication and medical materiel in support of reception, staging, and onward movement operations; and performing medical maintenance and tracking of patient movement items. USAMMC–K may gain operational control, administrative control, or technical control of medical logistics companies from Army, Marine Corps, Navy, or Air Force medical logistics elements in support of its responsibilities as theater lead agent.

Impact of USAMMC–K

Future joint forces will likely operate in complex and uncertain security environments that are characterized by both conventional and asymmetric threats. International organizations and sponsored terrorist organizations will exist within these volatile, uncertain, and complex environments all over the world. U.S. Forces and coalition partners will require immediate support, including medical support, to conduct offensive, defensive, or stability operations. Medical personnel must be able to rely on medical logistics organizations to provide a timely response to their support requirements.

Without USAMMC–K on the Korean peninsula, operational units would be required to coordinate, plan, and procure their medical logistics strategic support from numerous manufacturers, maintenance facilities, and optical laboratories throughout the PACOM area of responsibility and the continental United States sustaining base. Without USAMMC–K, the response time for medical logistics support during a transition to hostilities scenario would be significant; class VIII (medical materiel) strategic lift requirements would be greater; optical fabrication wait time would increase significantly; and repair of medical equipment would require longer customer wait times.

These implications would be the same during peacetime, with the additional implication of increased organizational storage requirements for medical materiel due to longer customer wait times. Operational forces would have to invest more resources in the operations and maintenance funding associated with the increased requirements for medical materiel inventory; they would also have to increase their investment in supply facilities in order to meet the additional storage requirements.

Establishing the provisional Army MEDDAC, Army DENTAC, Army DVC, and USAMMC–K were truly the first steps in creating “normalcy” for the medical community in Korea. USAMMC–K fully supports the critical transformational efforts in Korea by creating a medical logistics organization that can provide the warfighting commander with a highly responsive, capable, and jointly interoperable medical system that is fully integrated throughout the continuum of care. This organization minimizes morbidity and mortality, and it does so with the smallest possible medical footprint in South Korea. This new organization is also fully capable of supporting the nearly 14,000 military family members and the DOD civilian employees, contractors, retirees, and service organizations throughout the Korea area of responsibility. And it executes this mission efficiently and effectively as part of the overall Army medical enterprise.

Colonel James G. “Greg” Jolissaint is the base closure and realignment transition team leader for Walter Reed Army Medical Center in Washington, D.C. He was the commander of the 18th Medical Command and command surgeon for U.S. Forces Korea and the Eighth U.S. Army from June 2006 to June 2008. He holds a B.S. degree from Louisiana State University, an M.D. degree from the Louisiana State University School of Medicine and a master’s degree from the National Defense University. He is a graduate of the Army Command and General Staff College and the Industrial College of the Armed Forces.

Lieutenant Colonel Thomas C. Slade is the director of the U.S. Army Medical Materiel Center (Korea). He previously served as the commander of the 16th Medical Logistics Battalion. He holds a B.S. degree from Eastern Michigan University and an M.S. degree from Worcester Polytechnic Institute. He was commissioned in the Medical Service Corps through the Officer Candidate School and is a graduate of the Army Command and General Staff College.

Major David L. Sloniker is the S–4 of the 65th Medical Brigade. He holds a B.A. degree from the University of Washington and an M.B.A. degree from Webster University. He is a graduate of the Army Command and General Staff College.