The transformation of medical logistics since Operation Desert Storm

The U.S. Army tanks rumbling across the desert of Iraq appear similar to the ones that smashed Saddam Hussein's forces in the 1991 Persian Gulf War; however, there are significant differences, including improved technology and increased precision, on the inside. The same holds true with improved technology and increased precision in the management of medical logistics.

One of the most significant changes in medical logistics since 1991 is a smaller medical footprint. Today, as part of the Army Medical Department Reengineering Initiative, 20-person forward surgical teams have replaced MASH units, and 88-bed combat support hospital (CSH) modules have created a faster and more deployable increment of the 296-bed base CSH. These smaller life-saving organizations require more flexible and timely supply packages and faster line item resupply to support the same expected patient loads. Medical logisticians are delivering such packages today in Operation Iraqi Freedom.

Improved logistics automation is key to more efficient supply-chain management. During Operation Desert Storm, the Theater Army Medical Management Information System (TAMMIS) was deployed only to medical logistics battalions, combat support hospitals and division medical supply offices in the theater. Customers of logistics units relied upon manual methods to manage and requisition medical supplies. During the mid- to late 1990s, the U.S. Army Medical Materiel Center-Europe pioneered software to extend automation to their nonautomated customers. This effort evolved into the TAMMIS front-end customer order entry capability: TAMMIS Customer Assistance Module (TCAM). Customer friendly TCAM is configured to easily reach or communicate with any medical unit in peacetime or war. This capability proved itself valuable in Kosovo, Bosnia and most recently in the Central Command area of responsibility. TCAM enables users to order medical supplies, review catalogs and check order status and on-hand balances as well as available substitutes. Battalion aid stations, medical companies and non-medical units now have an automated method to order from any TAMMIS-supported medical logistics unit. TCAM can be used anywhere in the world using an Internet connection that can be hard-wire or dial up using satellite communications or even an iridium phone. All deployed services have adopted TCAM as their single electronic order entry software. In the future, TCAM-like functionality is programmed for development in the Department of Defense tri-service medical logistics automated information system: Defense Medical Logistics Standard Support (DMLSS).

The improved automated tools are supported through significant business changes and increased integration with the Defense Supply Center Philadelphia (DSCP) Prime Vendor (PV) Program. In 1991, the medical community still relied on the iron mountain of medical materiel in order to ensure readiness. Maintaining critical materiel on hand had serious drawbacks. These drawbacks included significant storage and rotation costs, materiel potency issues, and often customer issues from clinical providers who demanded the most technologically advanced materiel. The current PV program involves four industry-leading distributors with approximately 200,000 brand-specific medical supplies. They offer next-day delivery to medical treatment facilities in the continental United States or 48-72 hour delivery to distribution centers outside the continental United States. The materiel carried by these commercial distributors is the same as the state-of-the-art materiel available and used in providers' practices within accredited military and civilian healthcare systems. This initiative not only saves storage and sustainment costs but provides physician-demanded materiel with focused distribution.

One evolving doctrinal change is an increase in medical logistics cooperation among the services in the form of the single integrated medical logistics manager (SIMLM) concept. Before development of the SIMLM concept, the services planned and executed medical supply support for theater operations independently, and medical materiel was often double ordered. The SIMLM concept has evolved to a point where the combatant commander designates a single manager to oversee medical supplies, equipment, optical fabrication, medical gases, medical equipment maintenance and repair, and blood management efforts among all services in the theater. This concept is now published in Joint Publication 4.02.1 and is currently in use in Operation Iraqi Freedom. It has resulted in improved medical logistics support, better service coordination, materiel prioritization and utilization, reduced transportation requirements and the reduced duplication of supply channels and personnel efforts. In addition, this concept has evolved into the integration of automated information management systems with all services now using TAMMIS/TCAM. This cooperation has facilitated the role of the 6th Medical Logistics Management Center and the DMLSS Joint Medical Asset Repository (JMAR) to serve as central repositories or national databases of medical materiel logistics management data for all services in theater.

Another significant change has been the impact of deferred modernization. Before Desert Storm, hospital equipment was modernized in accordance with the Army modernization plan. Because of the cost and rapid changes in medical technology, medical assets in Operation Iraqi Freedom experienced a successful just-in-time modernization by rapidly procuring the latest technology from the commercial sector in time to meet operational requirements.

Force projection initiatives since 1991 are placing medical materiel in the Army Strategic Mobility Program, providing power projection capability for Army medical units. They can now quickly deploy personnel who will fall in on unit-made sets of equipment and sustainment materiel located in key locations outside the United States. In addition, and as a result of recent chemical/biological threats, major advances have been made in the development and positioning of consequence management sets. These sets are patterned after the national pharmaceutical stockpile used by the Center for Disease Control and Prevention and developed in conjunction with the Federal Emergency Response Plan to deal with chemical and biological incidents. These sets are centrally managed, deployable and available in less than 12 hours.

Over the last 12 years, extensive changes in medical logistics have occurred in response to reducing the deployable footprint and addressing new world threats to improve the readiness of the medical force. This has been accomplished largely through partnering with the commercial sector and other services, improvements in contracting and materiel availability and the extensive use of technology and logistics automation.

[Author Affiliation]

LT. COL. MITCHELL BREW is the Executive Officer to the Director of Logistics, Office of the Army Surgeon General. DANA BAKER is the Chief, Logistics Systems Division, Office of the Army Surgeon General.