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Medical Logistics: Notes From Iraq

Army healthcare providers depend on medical logisticians to get the right materiel to them in a timely manner so that they can provide adequate care for the Soldiers in their units. To do this correctly, logisticians must know their customers and foresee their future needs to ensure that items are readily available. This is not a problem in garrison, but it can be complicated when working in an austere environment.

The Army’s training courses for medical logisticians provide an overview of this demanding field, but nothing compares to on-the-job experience. When I arrived at my unit, I was assigned to supervise a regimental medical supply office (RMSO) in the 3d Armored Cavalry Regiment. It consisted of five military occupational specialty (MOS) 68J medical logistics specialists (three of whom were noncommissioned officers [NCOs]) and one MOS 68A medical equipment repairer. We were responsible for supplying more than 77 customers across northern Iraq. These customers included two level II and five level I aid stations. The RMSO maintained 171 lines of stock and processed approximately 800 orders per month.

While preparing for deployment, I was unsure of what to expect when my unit arrived in Iraq. Would I have enough bandages? How long would it take to get resupplied? What could I do to make my team more productive and customer focused? Now, looking back on the deployment, I see that I made some good decisions and some that reflected my lack of experience. Having learned many things the hard way, my goal is to pass on my experience to help other new medical logisticians in future deployments to Iraq.

Prepare for the Worst

We used our requisitioning history to develop a packing list for the deployment. My office packed a BOH Environmental field pack-up (FPU) storage container system and shared a 20-foot military-owned demountable container (MILVAN) with our headquarters element. The FPU has shelves and drawers that are useful for the small items like bottled medications and fragile items. (I highly recommend that all medical supply offices have at least one of these containers.) The bulk items were placed in white Tri-Wall containers in the MILVAN. We brought eight of these containers full of IV [intravenous] fluid, combat tourniquets, and emergency bandages. The Tri-Walls are good not only for transport; we used them as customer pick-up boxes as well.

Even though we had received an authorized stockage list (ASL) from the unit we were replacing, the list did not seem to include the items my customers were using during training at the National Training Center at Fort Irwin, California. While the supplies we brought ensured our preparedness, the quantity was excessive. When we arrived in Iraq, we found that certain items that were bulky and expected to be in high demand were in excess at the warehouse and customer levels. I suggest that future units limit their load to just the FPU container. The Iraqi theater of operations has matured in its logistics capabilities, and now, once the medical supply account is established, ASL items arrive 7 to 10 days from the order date.

ASL

Every customer should be given a copy of the ASL and the theater formulary. The customer must understand the importance of using the national stock numbers provided for stocked items when ordering. Items that are not on the list will take an extremely long time to arrive, if at all. The theater also has a list of restricted items, such as litters, aid bags, and headlamps, that require letters of justification to order, so medical supply offices and their customers should stock up on these items before leaving home station. We ordered more than 200 litters, half of which we distributed to our customers before deployment. We used the rest for blocking and bracing the other MILVANs. Various transition teams needed litters, and our ability to supply them without lengthy administrative procedures ensured their mission readiness and helped establish a rapport that lasted for the duration of the deployment.

The ASL that we acquired upon arrival in Iraq needed much work. The warehouse was disorganized and had too many lines. Many of the medications on the shelf were either expired or covered in dust, making them unusable. We built additional shelving and placed shower curtains over the medications to help keep them clean. By performing a 100-percent inventory, using location cards, and watching our requisitions, we were able to reduce the inventory by more than 53 percent in the first 4 months. Because we are more streamlined, we continually see a demand satisfaction rate of over 98 percent.

Automated Ordering Systems

We hit the ground prepared to the use the Defense Medical Logistics Standard Support Customer Assistance Module (DCAM). But we discovered that our supplier was still using the older Theater Army Medical Management and Information System. To complicate matters, we had no Internet connection during the transition period. Once connectivity was established, the fielding team for DCAM converted our systems to run the program. This system still had minor imperfections but allowed us to order supplies efficiently. Most of our customers did not have the computers or bandwidth to place orders in DCAM, so we accepted manual requisitions using Department of the Army Form 3161, Request for Issue or Turn-in, and inputted the orders into the system at the RMSO level, which reduced our ability to accomplish other tasks.

With so many different customers, we found it challenging to track their orders just using standard document numbers. Staff Sergeant Anthony Louis and Sergeant Tyron Hale, my office managers, devised and implemented a coding system using customer and order numbers. For example, customer number 25’s first ordered item would be coded 2501 and the next item would be 2502. Then, as we received an item from the forward distribution team, we clearly marked the document number on the item’s box as we inventoried it from the materiel release order, which made it easier to sort the items and place them in the customers’ pick-up boxes in the warehouse.

Medical Maintenance


I had the most to learn about medical maintenance. The amount of emphasis placed on medical maintenance during training is inadequate at all levels for the challenges encountered by a brigade or RMSO. The RMSO is authorized one biomedical technician, and ours was assigned directly from advanced individual training. These technicians are taught the fundamentals of repairing equipment but not about standing up a shop at the RMSO level. They mostly learn about hospital maintenance, and they typically are supervised by a senior medical maintenance NCO or warrant officer.

The hardest part of maintenance, however, was stressing to the customer the importance of preventive maintenance on the equipment. Many of the items were damaged because of a lack of regular maintenance or user error, such as plugging the equipment into a 220-volt outlet. In order to educate customers on issues encountered at the user level, I would travel with my technician to the different aid stations to ensure the operators knew the proper guidelines and had the operating manuals.

Although never before authorized at the regimental or brigade level, we established an operational readiness float (ORF) program for maintenance and calibrations above the user level. We initiated the program by requesting excess older medical equipment from our higher echelon. With this excess equipment, we were able to provide customers with immediate temporary replacements while we made repairs to inoperative machines. Even though the pieces of ORF equipment were not exact replacements, this program allowed customers to maintain their mission readiness while waiting on repair parts.

Administrative Organization

Organization is essential to running a successful medical supply office, so we implemented several tools to help conduct daily business.

Medical logistics operations board. I mounted an operations board on the wall of the main office as a daily focal point for the entire shop. In the middle of the board, I placed a map of Iraq with the customers’ locations to give everyone a picture of who we were supporting and where. To the sides of the map were different trackers, such as personnel and equipment assets and statuses, supply pushes, deadlined medical equipment, parts on order, and outstanding letters of justification.

Medical logistics operations binder. I created an RMSO production binder (similar to a leader’s book) and placed in it the same trackers posted on the operations board. I reviewed the binder with my team almost daily, penciling in changes and following up on outstanding critical items. This process helped keep my team focused on the customer in a rapidly changing environment. Formats for this tool can be found on Army Knowledge Online at https://www.us.army.mil/suite/kc/11770385.

Time management. Staff Sergeant Louis established and posted office hours. We found that customers would come in at their convenience, making it difficult for us to make our runs to the forward distribution team, perform vehicle maintenance, and place orders in DCAM. So we established the hours of 0900 to 1200 for customer requisitioning and pick up and reserved the afternoons for office administration and maintenance. Once we posted and advertised these hours, we began to see a great improvement in our effectiveness and efficiency. Customers who were unable to adhere to the standard hours were always welcome to schedule appointments with the RMSO. Posting office hours would have been even more effective if we had done it early in the deployment.

Even though they are basic administrative ideals for any office, these simple tools were absolutely beneficial while we were deployed.

Other Recommendations

The following is a list of recommendations to help a new medical logistician.

1. Find a copy of The Division Medical Supply Office Handbook that was published by the Academy of Health Sciences in March 1989. Read it cover-to-cover and reference it often. Although this book is almost 20 years old, I used it almost every week.

2. As a new medical logistician, listen to the NCOs who are assigned to your shop. Most have worked in this field for a long time and have a lot of experience. I am constantly learning from mine. Remember that they are the backbone of the Army and will help make the mission a success.

3. Create a good relationship with your commander. As the only medical logistician in your brigade or regiment, it is imperative that you help him understand your shop’s mission. My staff occasionally received taskings by the command that hindered the RMSO’s missions. As the relationship grew between the command and the RMSO, these problems were reduced drastically.

4. The medical supply office needs at least one biomedical maintenance NCO and one MOS 68A Soldier at E–4 level or below. A more field-experienced maintenance technician would have been great to have, not only for management but also as a mentor for the junior technician. This was not an option for our office, so when my technician arrived at the unit, my command allowed him to work at the hospital with the senior technicians before we deployed. This was a good learning experience for him, and he also created a network for when he needed advanced technical advice.

5. Have your shop personnel take the combat lifesaver course and some of the medical sergeant’s time training. This will help them better understand the materiel they are providing to the customer and will help build rapport. It may also help in providing substitutes for certain items that may not be stocked.

6. If you are able to attend the logistics course before taking over a shop, pay close attention to the student presentations, particularly if someone’s presentation is about Lean Six Sigma. I had to research and present on the Lean Six Sigma principles during my course, and now I find that I am constantly using the ideas for my job.

7. Try to create a benchstock of medical maintenance parts based on your modification table of organization and equipment and the assigned equipment at the regimental or brigade level before you deploy. The senior biomedical technicians at home station and the Army Medical Materiel Agency’s website, www.usamma.army.mil, are great resources for building your benchstock. If we would have had these parts on arrival in theater, they would have saved my technician and customers numerous weeks waiting on supplies.

8. Continue to take Defense Acquisition University courses. I recommend that you also have your NCOs take some courses. These free online courses helped me fully understand and convey the process of acquiring and supporting new equipment to my customers.

I hope that through my growing pains of predeployment and deployment, I can help new medical logisticians. Some of these basic techniques are probably being practiced by other medical offices throughout the Army. I just want to share what I learned through test and trial and hopefully save someone many hours of frustration. Finally, if you stay customer focused, all else should be easy.
ALOG

First Lieutenant J. Mark Franklin is the regimental medical supply officer for the 3d Armored Cavalry Regiment, which is deployed to Iraq in support of Operation Iraqi Freedom. He holds a B.S. degree in organizational leadership from Southern Nazarene University and a master’s degree in human relations from the University of Oklahoma, and he is currently pursuing a doctorate in management from the University of Phoenix. He is a graduate of the Medical Officer Basic Course, Health Services Materiel Course, and Phase I of the Army Medical Department Captains Career Course.