Integrating Army Medicine

By August 22, 2016Army ALT Magazine, Logistics
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USAMMA finds efficiencies in medical materiel procurement, fielding and sustainment to reduce the logistical footprint and optimize readiness with limited resources.

by Col. David R. Gibson

In the Army, we often refer to combat and support capabilities as “the tooth” and “the tail.” We are constantly seeking ways to improve the ratio between the war­fighter and support elements, to maximize the amount of combat power we can project while minimizing the logistics tail. Fielding equipment and materiel that minimize the support and sustainment tail while increasing critical space required for early-entry combat operations increases force agility, adaptability and even lethality.

Although we talk about tooth-to-tail to describe the ratio of combat power to support structure, operations in Iraq and Afghanistan have shown us that battlefields are no longer linear. Soldiers are at risk of illness and injury throughout the force, whether their jobs are in combat arms or a support specialty and whether they are far forward or in a base camp.

Army medicine must integrate medical capabilities throughout the force—placing medical capabilities in both medical and nonmedical units and arrayed in a fashion that enables stabilization, forward resuscitation and medical evacuation—all across an integrated continuum of care that spans from point of injury to stateside health care facilities. To make this possible, we must have the right medical materiel on hand, in the right place, fully operational and easily sustainable, and with Soldiers and providers trained to appropriately employ it when required. All of these conditions are critical in the minutes following an injury, and failure to meet any one of these conditions can mean the difference between life and death.
Army medical capabilities can be found throughout the generating and operating force structure, with combat medics standing side by side with warfighters in the tooth, and medical teams integrated throughout the tail with varying degrees of medical capabilities. In fact, Army medics make up the second largest military occupational specialty, outnumbered only by infantry Soldiers. We serve the entire system to ensure we have a ready medical force and a medically ready force. With the entire Army facing a period of constrained funding and dramatic force downsizing, the tooth, the tail and everything in between is being scrutinized to ensure optimal combat capabilities without jeopardizing our ability to sustain or medically protect and project the force.

INTENTS AND PURPOSES

INTENTS AND PURPOSES
Pfc. Sang-woo Park, training specialist, Headquarters and Headquarters Company, 19th Expeditionary Sustainment Command, helps lay out a new AirBeam shelter during the Assault Command Post setup. Working with the U.S. Army Medical Materiel Development Activity, USAMMA will modernize a large portion of the structures that make up its field medical hospital systems. These new shelters are lighter, faster to set up and have a longer lifespan than the rigid-frame tents they’re replacing. (Photo by Pfc. Woo-hyeok Yang, 19th Expeditionary Sustainment Command Public Affairs Office)

CENTRALIZED MANAGEMENT
To accomplish the mission with limited resources, the U.S. Army Medical Materiel Agency (USAMMA), a subordinate agency of the U.S. Army Medical Research and Materiel Command (USAMRMC), has evolved many of the ways it does business.

One example is the way USAMMA is centrally managing medical materiel, including sensitive potency and dated (P&D) materiel such as pharmaceuticals. Deploying medical units need to have this materiel on hand immediately to provide their required capability. However, unlike much of the nonmedical materiel that the Army stocks, P&D items cannot be stored indefinitely, nor can many of the items be bought in large enough quantities and shipped at a moment’s notice should a contingency arise.

To be ready and able to support global contingency missions worldwide, these types of supplies are maintained in preconfigured packages by unit type so they can be shipped to support deploying units. Although this seems like a costly strategy, centrally managing a collection of this materiel by unit type enables the achievement of a risk-based balanced approach to maintaining rapid deployment capability while offsetting a significant procurement and maintenance requirement for P&D items.

Currently, the Army has 274 echelons-above-brigade (EAB) medical units. If each of these units bought all of its own medical materiel, the Army would need to spend $126 million in upfront procurement costs. Additionally, if each EAB unit had to sustain (i.e., conduct inventory, restock, replace items) its own perishable medical stocks, the Army would spend about $31 million each year.

Instead, USAMMA centrally manages the Unit Deployment Package (UDP) program. Essentially, these UDPs are kits of medical materiel that deploying units can use during the early phase (i.e., up to the first month) of a contingency. However, UDPs do not provide a long-term solution. Additionally, UDPs may not provide all of the Class VIII materiel (i.e., equipment and consumables) that units need. The program is supported by Defense Logistics Agency contingency contracts, which can currently only cover about 53 percent of required materiel and cannot meet early deployment timelines.

GOOD TO GO

GOOD TO GO
A Soldier at Hill Air Force Base Medical Maintenance Division refurbishes medical equipment as part of a major recapitalization. USAMMA’s efforts to recapitalize instead of replace support a sustainable model of medical supply that recognizes resource constraints while optimizing readiness. (Photo by Ellen Crown, USAMMA Public Affairs)

RECAPITALIZING VS. REPLACING
USAMRMC and USAMMA are evolving not just because of fiscal constraints and growing missions; we are also changing to continually do what is best for the warfighter and the taxpayer. One example is our recapitalization efforts. USAMMA’s operations encompass 19 locations worldwide, including three stateside medical maintenance depots: Tobyhanna, Pennsylvania; Hill Air Force Base, Utah; and Tracy, California. Besides testing, calibrating and conducting depot-level maintenance, each location also refurbishes medical equipment and devices so they can go back out to the field for use. Recapitalization can include refurbishing a device so that it is near “zero-time/zero-mile” (i.e., basically like new again). Recapitalization also can include an upgrade process that results in a newly improved model, with full remaining or extended lifespan and enhanced warfighting capability.

In FY15, USAMMA recapitalized more than 2,000 medical equipment items, saving the Army $13.2 million—the cost to replace this medical materiel instead of recapitalizing it. The largest share of those savings—$10 million—can be attributed to recapitalizing four items: physiological monitors, $3.5 million; suctions, $2.8 million; defibrillators, $2.1 million; and ventilators, $1.6 million.

To further reduce the footprint left by unnecessary medical materiel, USAMMA also has applied greater precision to fielding efforts. In the past, during times of high operational tempo, such as the height of combat in the Middle East, USAMMA would reset a unit after deployment by fielding complete new sets of equipment (i.e., full medical and dental sets). However, in FY15, USAMMA started to inventory high-value items, such as expensive medical devices or equipment, and then provide each unit with only the items it needs based on requirements.

The first two units to undergo precision fielding by USAMMA in late FY15 and early FY16 were the 550th Area Support Medical Company and the 274th Forward Surgical Team, both out of Fort Bragg, North Carolina. By getting only what they required and not all new medical materiel, USAMMA saved the Army $1.82 million for these two units alone. Four more units are slated to be analyzed and then precision-fielded by USAMMA in FY16.
This type of precision fielding exemplifies the USAMMA mindset of fielding only what is needed with an eye toward reducing excess and optimizing readiness, thus supporting a sustainable model of medical supply that recognizes resource constraints.

CHECKING THE SCALE

CHECKING THE SCALE
A Soldier in the Medical Maintenance Division at Hill Air Force Base calibrates medical equipment. Hill is one of three USAMMA stateside depots that refurbish medical equipment and conducts testing, calibrating and depot-level maintenance. In 2015, USAMMA recapitalized more than 2,000 medical equipment items, saving the Army more than $13 million. (Photo by Ellen Crown, USAMMA Public Affairs)

LIGHTER IS BETTER
Whether supporting early-entry operations or while sustaining ongoing missions, every pound and every inch counts. Fielding equipment and materiel that is lighter, smaller or easier to sustain is one key to simplifying and improving support.

As the 2015 Army Operating Concept (AOC), “Win in a Complex World,” indicates, the Army faces amorphous threats with increasingly changing technology. In many ways, the AOC provides a path for innovation.

In FY16, in collaboration with the U.S. Army Medical Materiel Development Activity, USAMMA is planning to spend more than $20 million to modernize the Army’s field hospital soft-walled Tent, Extendable Modular Personnel (TEMPER) with new air-supported TEMPER shelters. Most of the ­TEMPERs that currently make up the Combat Support Hospital stock have considerably exceeded their lifespan. The original design life was seven years of operational service and 10 years in storage, and most of the legacy TEMPERs are currently at 20-plus years. Additionally, the legacy tents are heavy and cumbersome to erect. The air-supported TEMPERs are 50 percent lighter—saving roughly 1 million pounds across the force—and cut setup time in half, to roughly 30 minutes. Additionally, the new shelters have a longer lifespan than the older tents, ultimately costing the Army less in maintenance and replacement.

CONCLUSION
One of the greatest values in doing things more efficiently is that we can increase readiness by equipping and sustaining more units. In FY16, USAMMA programmed fielding or modernization for 70 units. After leveraging these and other cost savings and efficiencies in FY16, we expect to be able to actually field or modernize a total of 142 units this year—twice as many as expected while expending the same amount.

Additionally, USAMRMC and USAMMA will continue to refine processes through a RAND Corp. study of medical materiel procurement, fielding and sustainment costs. Currently underway, this study will project the costs to maintain materiel, analyzing potential alternative supply options—for example, centralized management, technology upgrades to meet standards of care, deferred procurement and contingency contracts or agreements. This essential study, expected to yield results in September 2016, will help link materiel requirements to plans, capability assessment and risk. We need to be efficient, but not at the cost of effectiveness.

Every pound counts. Every dollar counts. But the real bottom line is how we optimize support to our Soldiers—ensuring that they have what is needed to fight and win in our complex world. To present our enemies with multiple and simultaneous dilemmas, we need to do all we can to prevent encountering our own.

For more information on USAMRMC, go to http://mrmc.amedd.army.mil/index.cfm. And for more information about USAMMA and its operations, visit http://www.usamma.army.mil/.

RIGHT PLACE, RIGHT TIME, RIGHT TRAINING

RIGHT PLACE, RIGHT TIME, RIGHT TRAINING
Spc. Logan Duty, foreground, combat medic, and Capt. Hyun Yi, physician assistant, both assigned to the 52nd Air Defense Artillery (ADA) Regiment, 35th ADA Brigade, prepare Soldiers with simulated injuries for medical evacuation during a combined base defense exercise in February at South Korea’s Suwon Air Base. Having the right medical materiel in the right place at the right time and ensuring that Soldiers are trained to use it properly can mean the difference between life and death. (Photo by Cpl. Yo Seup Kim, Korean Augmentation to the U.S. Army)


COL. DAVID R. GIBSON is the commander of USAMMA and the medical acquisition consultant to the Army surgeon general. He joined the Army in November 1986 as an enlisted infantry Soldier, receiving his active-duty commission in 1991 as a distinguished military graduate of the ROTC program at the University of Central Oklahoma. He holds a master’s degree in public administration from Murray State University, an M.S. in real estate and construction management, a master of business administration and finance from the University of Denver and a master’s degree in national security and resource strategy from the Eisenhower School – National Defense University. He also holds a B.S. in business from Central Oklahoma. He is a graduate of the U.S. Army Medical Department Basic and Advanced Courses, the U.S. Army Command and General Staff College, the U.S. Army War College Defense Strategy Course and the Defense System Management College. He is a fellow of the American College of Healthcare Executives and of the Association for Healthcare Resource & Materials Management, and holds the Project Management Professional and Certified Materials & Resource Professional designations. He is Level III certified in program management and Level II certified in life cycle logistics, and is a member of the Defense Acquisition Corps.

This article was originally published in the July – September 2016 issue of Army AL&T magazine.

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