Deploying expeditionary medical assets

Air Force Journal of Logistics, Fall, 2004 by Robert E. Overstreet

While the mission of the Air Force Logistics Management Agency (AFLMA) is to enhance logistics efficiency and effectiveness, we have focused primarily on the flight-line side of logistics. A refreshing change came in early April 2003 when the Air Force Surgeon General requested that AFLMA study the establishment of central war reserve materiel (WRM) storage and deployment centers. He stated that the lighter equipment packages that make up the Expeditionary Medical Support (EMEDS) and aeromedical evacuation systems have created transportation challenges.

The EMEDS system was built in 1999 to replace the large air-transportable hospital. This new system--a lightweight, rapidly deployable, modular medical capability--is flexible enough to respond to any scenario. (2) It follows a building-block approach to attain medical capability in theater. Much of the initial EMEDS medical capability is composed of care providers with backpacks, the Prevention and Aerospace Medicine Team, Mobile Field Surgical Team, and the Expeditionary Critical Care Team. The ten-man small portable expeditionary aeromedical rapid response (SPEARR) capability is completed by the addition of the SPEARR trailer, which contains one tent with equipment and supplies. The EMEDS basic brings with it 15 more persons, two shelters, supplies, and equipment. EMEDS 10 contains 31 persons, three more shelters, and ten inpatient beds. EMEDS 25 contains 30 persons, three more shelters and 15 inpatient beds. The EMEDS capability can continue to expand with additional ten-bed packages or specialty sets. Figure 1 depicts how this capability is built based on population at risk, the number of persons for which the Air Force provides medical care.

The EMEDS system unit type codes (UTC) are stored at and deployed from many different medical treatment facilities, both in the continental United States (CONUS) and overseas. Because of the large number of origins and different aerial ports of embarkation (APOE), the time phasing of the EMEDS and aeromedical evacuation UTCs during Operation Enduring Freedom and Operation Iraqi Freedom were problematic.

The objectives of this study were to quantify the problems experienced in the deployment of EMEDS and aeromedical evacuation UTCs, identify the root causes of those problems, evaluate possible solutions, and provide a recommended solution to the Air Force Surgeon General's Office.

We assumed that only the UTCs identified by the Air Force Medical Logistics Office (AFMLO) were candidates for consolidation, and we were concerned only with CONUS-based UTCs. This study made no attempt to validate or invalidate the EMEDS or aeromedical evacuation concepts.

Limited time and conceptual complexity were significant constraints for this study. AFLMA was asked to provide initial recommendations within 4 months of its first meeting with the AFMLO. The complexity of the EMEDS and aeromedical evacuation consolidation issue could have justified multiple studies easily.

The AFMLO scoped the project to an evaluation of 31 UTCs that deployed from the CONUS and identified two consolidation options. The first option was the establishment of a central hub located at Kelly USA, and the second option was the establishment of a dual hub with one located on the east coast and the other on the west coast. They also provided copies of the time-phased force deployment data (TPFDD) for Enduring Freedom and Iraqi Freedom.

This research sought to analyze the problem UTCs identified by the AFMLO and Air Mobility Command (AMC); gather and analyze TPFDD and aerial port data to investigate problems; and once problems were determined, review possible solutions to include central storage of medical WRM. We interviewed subject-matter experts, collected and analyzed cost data (storage, manpower, and contract), and evaluated the training and mission impact of possible solutions by interviewing and observing the participants in the process.

To that end, this study relied heavily on the qualitative research design. The qualitative paradigm is an inquiry process of understanding a problem or process by building a complex, holistic picture, conducting research in the natural setting, and expressing the results in narrative form. (3)

AFMLO provided the Enduring Freedom and Iraqi Freedom TPFDDs for analysis. We reviewed these and found what seemed to be capability being requested out of sequence. During our site visit at US Air Forces, US Central Command, we asked why capability was requested in such a manner. Functionals explained that the capability had been requested correctly but, if an item missed a ready-to-load date at the origin or an available-to-load date at the APOE, the original line in the TPFDD was deleted, and a new line with a new required delivery date was established. Because of deleted requirements in the TPFDD and new required delivery dates being established when a UTC missed a key transportation date, we determined that an evaluation of the transportation data received from AMC would not provide reliable information.