Meeting the warfighter's medical needs: logisticians and clinicians are working together to find medical technology that not only meets urgent healthcare requirements but also can be supported and maintained in field conditions

Army Logistician, Sept-Oct, 2006 by Kimberly A. Smith, Dawn L. Rosarius

The U.S. Army Medical Materiel Agency (USAMMA) selects and recommends medical equipment and materiel needed for all levels of care in support of the warfighter. In addition to experienced logisticians, engineers, and maintainers, the USAMMA staff includes clinicians to ensure that the medical equipment provided to the warfighter is not only sustainable and maintainable but also meets user expectations.

If an urgent need for a capability identified by the field requires rapid distribution of new medical technology, USAMMA uses a dual-path approach to meet the need. The first path is to find an interim solution: USAMMA selects a product that can be acquired quickly and then distributed with a minimal logistics tail. While implementing this provisional solution, USAMMA starts on the second path--to select a long-term solution. This second path is a deliberate process that may take several months to complete because it requires USAMMA to progress through a market analysis, environmental and operational testing, and an integrated logistics support analysis before final selection of a product. Inevitably, the time involved in this detailed second-path process exceeds customer expectations. So the interim solution implemented in the first path is crucial to meeting warfighter requirements in a timely manner.

This article uses two case studies to illustrate how the dual-path process works and the importance of interim solutions in meeting urgent healthcare needs.

Short-Term: Pain-Control Technology

Anesthesia providers of all three armed services identified a new pain-control technique, known as a patient-controlled analgesia (PCA) pump, for treating wounded service members being evacuated from the U.S. Central Command area of responsibility. Because the requirement for this capability originated in the theater, the Coalition Forces Land Component Command surgeon's office developed an operational needs statement that was quickly approved and passed up the chain of command.

While this process was underway, USAMMA addressed an interim solution (the first path). The USAMMA staff conferred with clinicians; quickly assessed all required consumable support items, necessary accessories, and repair parts needed to support this interim technology; and pushed that information to the theater for rapid procurement of the technology through a separate Army funding source. USAMMA also coordinated with the Defense Medical Standardization Board to expedite the needed items through the national stock number (NSN) request process so that they could be supported and reordered within the automated theater logistics system. The NSN process, which normally takes 30 to 45 days, was accomplished in less than 7 days. The NSNs of these items were immediately provided for inclusion in theater stock record catalogs.

The theater headquarters then purchased the PCA technology and distributed it to the combat support hospitals in November 2005. This process only required about a month, while it normally can take several months depending on the complexity of the equipment. The interim-solution PCA technology currently is being used with great success and is working to relieve patients' pain on long air evacuation flights to Europe and the United States.

While this rapid process was getting needed pain-control technology into the theater, USAMMA engaged in a deliberate process to select a long-term solution (the second path). Because the requirement was generated in theater on the recommendations of clinicians from all three services, the service logistics agencies worked with the Defense Medical Standardization Board to complete a comprehensive survey of PCA technology in the marketplace and evaluate available products for multiservice application.

At this time, the services have selected a preliminary pool of four products to undergo testing, including airworthiness certification, environmental and operational testing, and integrated logistics support analysis. When these analyses are complete, the service logistics agencies will reconvene to select a final product for acquisition. Once selected, this product will replace the interim solution in theater.

Long-term: Operating Room Tables

At the same time that it works to fill urgent requirements through rapid fielding of technology, USAMMA also works toward finding long-term solutions for replacing obsolete equipment or introducing new medical technology. Although both approaches are similar in terms of the process followed, the long-term approach requires additional time to ensure that the solution that is selected is fully supportable and can withstand a variety of environmental conditions.

Since about 90 percent of medical equipment for field use is commercially available, and medical technology advances significantly every 18 to 24 months, most of the items that USAMMA reviews are replacements for obsolete systems. However, if a new, previously unknown technology is being introduced, the combat developer must draft a capabilities document. Since the documentation process can take many years, USAMMA, as the materiel developer, begins a market analysis as soon as the need is articulated.