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Joint Logistics Course

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  1. Joint Medical Logistics LTC Scott Ehnes Joint Staff J4/HSSD Joint Logistics Course

  2. Briefing Content – Yes / No / Maybe

  3. Agenda & Purpose PURPOSE: To provide an overview of Joint Medical Logistics. • Joint Force Health Protection • Medical Logistics Overview • Joint/Defense Medical Logistics Activities • Medical Logistics Functional Areas • Planning • Medical Supply Support & Distribution • Medical Logistics Information Systems • Medical Maintenance • Optical • Blood Management • Cameroon Relief Exercise • Questions

  4. Joint Force Health Protection Mission Enhance Joint Force readiness by delivering integrated Joint health service support to maximize the Joint Force Commander’s freedom of action. End to End Supportability

  5. Joint Force Health Protection To provide a fit and healthy force, protected from disease and injury, when and where the mission requires it. FORCE HEALTH PROTECTION • HEALTHY & FIT FORCE • Periodic Health Assessment • Individual Medical Readiness • Health Promotion • Stress Management • Pre/Post Deployment Health Assessment • PREVENTION & PROTECTION • Immunizations and Countermeasures • Safe & Healthy Working Conditions • Protective Equipment • Assess/Mitigate Hazards • Health & Environment • Surveillance • Risk Communication • MED/REHABILITATIVE CARE • Scalable, Modular, Joint Medical Capabilities • First Responder • Forward Surgery • Theater Hospitalization • En Route Care • Definitive Care JOINT CENTERED, BALANCED APPROACH: PREVENTIVE AND CURATIVE The life-cycle health maintenance program for the human weapon system.

  6. Joint Patient Movement Joint Casualty Management Joint Performance Enhancement Joint Health Surveillance, Intelligence, and Preventive Medicine Joint Theater Medical Command and Control Joint Force Health Protection MedicalCommand & Control Hospitalization Combat Stress Joint Medical Capability Areas* Medical Operating Capabilities*(*Service Provided) Evacuation Joint ForceHealthProtection PreventiveMedicine Area MedicalSupport Veterinary Dental Laboratory MedicalLogistics Joint Medical Logistics and Infrastructure Support

  7. Tactical Environment & Missions • Asymmetric / non-linear battlefield • Widely dispersed operations • Increased contractor support • New enemies • Evolving missions • Joint, inter/intra-agency & multinational • Unsecured supply lines • Resource pressure

  8. LEVEL V LEVEL IV LEVEL III MTF DVA LEVEL II MTF LEVEL I CSH EMF EMEDS FST FRSS ASMC MEDICS CORPSMEN AID STATIONS STP Levels of Care (Old) FROM POINT OF INJURY TO REHABILITATIVE CARE CONTINUUM OF ENROUTE CARE

  9. Taxonomy of Care (New)

  10. Joint Force Health Protection CONOPS OV-1 Version 24 EXPEDITIONARY OPERATIONS HOME BASE OPERATIONS PREVENTIVE MEDICINE INTELLIGENCE PREVENTION & PROTECTION SURVEILLANCE Medical Support to Mission COAs MEDICAL & REHABILITATIVE CARE JHSIPM HEALTHY & FIT FORCE JHPE SUSTAIN & ENHANCE HUMAN PERFORMANCE JMC2 JCM Pre & Post Deployment Assessments ExpeditionaryForces FIRST RESPONDER FORWARD RESUSCITATIVE CARE THEATER HOSPITALIZATION DEFINITIVE CARE Patient Movement beyond JOA EN ROUTE CARE Patient Movement within JOA JPM – Joint Patient Movement JMC2 – Joint Medical Command & Control JHSIPM – Joint Health Surveillance, Intell, & Prev Med JHPE – Joint Human Performance Enhancement JMLIS – Joint Medical Logistics & Infrastructure Support JCM – Joint Casualty Movement JPM DEFENSE MEDICAL LOGISTICS ENTERPRISE HEALTH SERVICE SUPPORT JMLIS

  11. Joint Force Health Protection Outcomes Expansion Campaign Early Entry Stability Retrograde • Decrease Mortality in the Platinum Ten Minutes • Optimized Evacuation of Casualties • Reduce time from point of Injury to treatment • Increased Medical Readiness of Soldiers and Units • Reduce DNBI with Advanced Medical Surveillance • Prevention of Casualties with Protective Agents • Improved Situational Awareness • Tailored Units with Equipment of Reduced Cube/Weight • Reduced Sustainment Requirements (O2 Generation/ Advanced Fluids) JOINT CAPABLE HOSPITALIZATION Effects COMBAT STRESS CONTROL ADVANCED TRAUMA MANAGEMENT EMERGENCY MEDICINE FHP INTEGRATION AND SYNCHRONIZATION SPECIALTY SURGICAL CARE EVACUATION Effects ROUTINE SICK CALL SERVICES CLASS VIII SUPPLY AND DISTRIBUTION MANAGEMENT BLOOD MANAGEMENT PATIENT HOLDING PREVENTIVE MEDICINE DENTAL INITIAL RESUSCITATION AREA LAB SUPPORT AREA SUPPORT Level I & II FHP Effects HOST NATION SUPPORT as Directed CONSULTATION SERVICES DISTRIBUTION MEDCAP OPS PATIENT REGULATION MED PLANS AND OPERATIONS

  12. Medical Logistics Functions • The medical logistics mission is to provide the specialized product and services required to support military healthcare across the full range of military operations • A fully integrated system of support: • Medical supply chain management • Acquisition and total life cycle management of medical equipment and assemblages • Medical equipment maintenance and repair • Optical fabrication and repair • Storage and distribution of blood and blood products • Life cycle management of medical facilities and real property • Medical contracting and services • Business processes and systems support both operational and institutional environments

  13. Class VIII Commodity • Requirements are driven by healthcare demands • Includes pharmaceuticals; medical-surgical, dental, optical and laboratory supplies; blood; and repair parts for medical equipment • Commercial, non-standard products • DLA business framework provides direct access to industry • No single market source for sub-commodities • Expensive • Requirements difficult to predict - Vary with mission, casualty/patient load, clinical services provided • Potency dating & special handling requirements • Affected by rapid changes in technology and clinical practice • Critical to outcome of patient / casualty care

  14. Defense Medical Logistics Center • Tenet Organizations • Service MEDLOG Organizations • Navy Medical Logistics Command • US Army Medical Materiel Agency • Air Force Medical Logistics Office • DLA/DLA Troop Support • 6th Medical Logistics Management Center • Joint Medical Logistics Functional Development Center • Promotes cooperation • Increases collaboration • Enhances shared understanding • Increases interoperability • Increases efficiencies • Joint Operations Center

  15. Defense Medical Logistics (DML) Committees • Defense Medical Logistics Proponent Committee (DMLPC) • Functional proponent of medical logistics operational policy & business process improvements • Rotational chair – Service MEDLOG Chief • Service MEDLOG Chiefs & Organizations • Joint Staff • ASD (HA) • DLA • Defense Health Systems Support • Defense Medical Materiel Program Office • Medical Materiel Executive Agency (MMEA) / Defense Medical Logistics Supply Chain Council (DMLSCC) (upon approval of DODI 5101.nn) • Forum to promote, develop, & achieve an effective & efficient medical supply chain to support the FHP mission across the ROMO • Co-chaired: DLA & ASD (HA) • DMLPC members • COCOMs • Interagency invitees (VA, HHS, Homeland Security) • Other functionals/organizations as required

  16. Strategy Map

  17. Planning

  18. Evacuation Landstuhl Army Regional Medical Center 3500nm / 7hr 32min 1415nm / 3hr 37min Samarkand, Uz Incirlik Walter Reed Army Medical Center VA 1486nm / 3hr 52min 91W/ 18D In Theater Health Services Forward Surgical Tm CONUS Base: Medical Centers, Scientific Expertise OPLAN Development • Annex Q (Medical Services) • Appendixes: • Joint Patient Movement System • Joint Blood Program • Hospitalization • Returns to Duty • Medical Logistics (Class 8A) System • Force Health Protection (FHP) • Host Nation Support • Medical Planning Responsibilities & Task Identification

  19. Admissions skip MTF MTF Admissions evacuate DIH MTF MTF DIH Admissions evacuate MTF MTF DIH evacuate Discharged Return to Duty JMAT - OPLAN Requirements Modeling Joint Medical Analysis Tool (JMAT) • Features: • Casualty modeling • Resource requirements • Evacuation policy impact • Network flow • Medical Treatment Facilities location CONUS COMMZ Combat Zone Population at Risk Casualties • Considers resources in terms of: • Beds • Healthcare provider specialties • Supplies • Evacuation assets • Patient Movement Items (PMI)

  20. Medical Supply Support & Distribution

  21. Medical Logistics Support • Strategic: • The Defense Logistics Agency (DLA) is the Executive Agent for Class VIII • DLA Troop Support • Operational: • Theater medical logistics is planned & executed by the Single Integrated Medical Logistics Manager (SIMLM) and the Theater Lead Agent for Medical Materiel (TLAMM) • Tactical: • Deployable Medical Logistics Units

  22. DLA Class VIII Support Medical/Surgical Pharmaceuticals Every Day and Every Crisis Capital Equipment Readiness

  23. Executive Agency OIF OEF Web Based Ordering (ECAT) Prime Vendor Transition to Commercial Business Practices FY 09 FY 08 FY 07 FY 06 FY 04 FY 03 FY 02 FY 01 FY 00 FY 99 FY 98 FY 97 FY 96 FY 95 FY 94 FY 93 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 Traditional Support Commercial Solutions DLA Sales in $ Millions

  24. DLA Support Strategies PLUS PLUS Peace Time Surge Sustainment Warstopper Funded • Prime Vendor • Depot • Direct Vendor Delivery • Electronic Data Interface • Service Stock • Vendor Managed Inventory (Service Owned) • PV Surge • Contingency Contracts • Corporate Exigency Contracts (CEC) • Vendor Managed Inventory (DLA Owned) • PV WRM Opportunity For Improvement Warstopper Funding: Key Enabler • New Acquisition Desert Storm Today - 2009 Contingency Contracts New Acquisition Depot Stock PV Surge New Acquisition Prime Vendor Depot Stock

  25. DLA Troop Support Medical Logistics Portal

  26. TLAMM Anorganization or unit designated by the Executive Agent (EA) to support the COCOM Functional responsibility, designated by EA to an organization or unit Executes Class VIII storage & distribution functions on behalf of DOD EA TLAMM designation conveys use of DLA stock fund (DWCF) Provides assistance to COCOM/SCC Class VIII supply chain planning SIMLM A mission assigned by a COCOM to a Service Component Command to support other Services Develops the HSLS plan & requests forces necessary to execute Scope includes all medical logistics functions specified by the CCDR Incorporates designated TLAMM into Concept of Operations Provides C2 of operational MedLog units in theater SIMLM & TLAMM

  27. SIMLM & TLAMM

  28. Deployable Medical Logistics Units • Army Medical Logistics Company • Provide direct support to Bde/Div/Corps units: • Class VIII materiel support • Spectacle/insert fabrication & repair • Medical equipment maintenance • Forward Distribution Teams • USMC Medical Logistics Company • Provide direct support to Marine Expeditionary Forces: • Class VIII materiel support • Medical equipment maintenance

  29. AidSta AidSta AidSta Air Force EMEDS Vendors EMF PV Navy Army CSH MedLog MedLog Medical Supply Chain Overview • Acquisition management • Contingency contracts • Vendor pay • Product data • Business intelligence • Interagency coordination National Overseas Geographic Combatant Command Continental United States Theater En-route Care Theater Theater Hospital • Order fulfillment • Supply chain management • Customer support Operational AreaCustomers Air Force Forward Surgery Vendors BrigadeCombatTeam PV Navy FST BSMC Army BMSO First Responder

  30. Medical Logistics Information Management Systems

  31. Medical logistics is managed using dedicated medical information systems and are tightly integrated within the MHS IT infrastructure due to requirements: Materiel is predominantly commercial and non-standard Subject to rapid change in technology and standard of care Business processes enable direct ordering and delivery from industry to medical logistics elements of the MHS Business processes and systems are predominantly Joint Business processes and systems support both operational and institutional environments Driven by healthcare activity Critical to outcome of casualty care Medical Logistics System Requirements

  32. Medical Logistics Systems • Supply Management: • Theater Army Medical Management Information System (TAMMIS) • Defense Medical Logistics Standard Support System (DMLSS) • DMLSS Customer Assistance Module (DCAM) • Theater Enterprise Wide Logistics System (TEWLS) • Joint Medical Asset Repository (JMAR) • Medical Maintenance: • DMLSS • Standard Army Maintenance System (SAMS) – 1E & 2E • Patient Movement Items: • Patient Movement Items Tracking System (PMITS) • Optical: • Spectacle Request Transmission System (SRTS) • Blood: • Defense Blood Standard System (DBSS)

  33. DHSS Logistics Family of Systems

  34. FDT TAMMIS TAMMIS TAMMIS Multiple Sources of Supply DCAM DCAM Prime Vendor (Pharm) Prime Vendor (MedSurg) Local Purchase Specialty Distributors Web-based vendors Manufacturers DLA Depots Germany TAMMIS or DMLSS ICU ICW LEGEND OR Request Materiel Distribution Throughput Distribution Theater Support – Order/Materiel Flow TLAMM First Responder / Forward Resuscitative Care USAMMC-SWA MEDLOG Co. DISTCNTR 6th MLMC Qatar TAMMIS MLMC MLC BMSO TAMMIS TAMMIS All LevelIIIs MLC Stocked Line HOA Kuwait CSH TAMMIS Afghanistan SOF ICU ICW XXX OR DCAM Theater Hospitalization USAMMCE

  35. Medical Maintenance

  36. Levels of Support • Sustainment • Non-organic unit biomedical maintenance personnel • MEDLOG Company • Mobile contact teams • Operational Readiness Float • TLAMM • Mobile contact teams • Operational Readiness Float • Cannibalization point • Depot • Mobile Contact Team • Unit level support on area basis • Next level or specialized support • Field/Unit • Organic unit personnel • User • PMCS • Key link in maintenance program • Biomedical Equipment Repairer • Scheduled & unscheduled services • Manage repair parts inventory & technical library • Technical inspections • JointTraining: Sheppard AFB / Medical Education & Training Center, Fort Sam Houston

  37. Patient Movement Items (PMI)

  38. Patient Movement Items (PMI) • What is PMI? • The medical supplies and equipment required to support a patient during evacuation. • PMI remains with the patient throughout evacuation (intra & inter theater) • Centralized program • Ensures availability of needed equipment • Mitigates unit property accountability issues • Focuses on 15 standardized items • Defibulators, pulse oximeters, ventilators • Blankets, IV poles, litters, litter straps • Key elements: • Inventory • Tracking • Recycle assets • Biomedical maintenance

  39. PMI Cycle CONUS PMI Center Calibrate Prepare Ship Repair Inspect Ship OCONUS PMI Center Disconnect Clean Ship to PMI Center On patient CONUS or OCONUS Hospital Theater hospital / Staging facility

  40. Optical

  41. Optical Fabrication Naval Ophthalmic Support & Training Activity (NOSTRA) Lead Service Agent for Optical Navy & Army Optical Fabrication Labs MEDLOG Company / TLAMM Spectacle fabrication, repair, & frame assembly Optometry teams Spectacle fabrication, repair, frame assembly & eye examinations G-Eyes (Government Eyewear System) Ability to reorder prescription glasses & inserts online Only available to deployed personnel Provides direct patient delivery service Average Customer Wait Time is 7 to 10 days https://g-eyes.amedd.army.mil/Default.asp Joint Training: Tri-Service Optician School (TOPS) Military combat eye protection (glasses, goggles) is a unit issue item

  42. Blood

  43. PLASMA WHITE CELLS PLATELETS RED CELLS Blood Introduction • Managed as fractional portions called components • Blood is a live tissue and requires special handling • Stringent storage & handling requirements • Inventory management constraints • Short shelf life

  44. As of September 2006 SUPPORTING BASE THEATER OF OPERATIONS Joint BDC (ASBBC) Joint Staff Combatant Command JBPO Allied / Coalition Hospitals Forward Resuscitative Surgery ASBPO Army BDC First Responders (unit level) Joint Task Force AJBPO BPD Theater Hospitals Air Force BDC En-route Care ASWBPL EBTS BSU BSD Navy BDC US Navy Ships USA SBPO USAF SBPO USN SBPO Civilian BDC BLOOD FLOW MLG First Responders REPORTS COORDINATION PREPOSITIONED FROZEN BLOOD Armed Services Blood Distribution System

  45. Armed Services Blood Program • Armed Services Blood Program Office (ASBPO) • Manages DoD blood program & coordinates policies/procedures • Monitors the tri-Service blood programs • Service Blood Program Office • Manage respective blood programs • Manage Food & Drug Administration Licenses • Joint Blood Program Officer (JBPO) • Enforce DoD/COCOM blood program policies • Coordinate component blood programs within their AO • Plan and execute blood program exercises & operations • Area Joint Blood Program Officer (AJBPO) • Assigned geographical area by JBPO • Enforce DoD/COCOM blood program policies • Coordinate component blood programs within AOR

  46. Blood Distribution • Blood Donor Centers (BDC) • Service BDCs (Army, Air Force, Navy) • Collect, process, provide blood products • Armed Service Whole Blood Processing Laboratory (ASWBPL) • Receive, pack, ship blood/components • Freeze/store frozen RBCs • Expeditionary Blood Transshipment System (EBTS) • Air Force operated • Central receiving point in theater • Inspect, reice, issue, & store blood products • Blood Support Detachments (BSD) • Receive, inspect, issue, & store blood products • May collect whole blood/platelets in emergencies

  47. Cameroon Relief Effort

  48. Cameroon Relief Effort - Requirements • Medical Requirement • Rules of engagement (what type of support & to who) • Patient load & type/condition • Emergency/trauma, surgical, stabilization, primary care • Human & animal • Number of locations / area of coverage / accessibility • Response speed • Force Health Protection factors • Environmental conditions • Food/water contamination / vectors • Disease prevalence • Support to US personnel (DoD & other)

  49. Cameroon Relief Effort - Capabilities • Non-DoD capabilities to meet requirements • Host Nation • Coalition / Non-Governmental Organizations / Interagency • In country / inbound • Coordinated / just shows up • DoD capabilities to meet requirements • Medical Command/Control • Hospitalization • Area Medical Support • Dental • Evacuation/Patient Movement • Combat Stress • Force Health Protection • Veterinary • Medical Logistics & Blood • Laboratory

  50. Joint Patient Movement Joint Performance Enhancement Joint Casualty Management Joint Health Surveillance, Intelligence, and Preventive Medicine PHARMACY SUPPORT MedicalCommand & Control Hospitalization Combat Stress BLOOD MANAGEMENT SUPPLY CHAIN MANAGEMENT FACILITY PLANNING PATIENT MOVEMENT ITEMS MEDICAL SUPPLIES PreventiveMedicine Evacuation Joint ForceHealthProtection Joint Theater Medical Command and Control MEDICAL MAINTENANCE Veterinary Area MedicalSupport OPTICAL FABRICATION / REPAIR Laboratory Dental MEDICAL LOGISTIC SYSTEMS MedicalLogistics MEDICAL EQUIPMENT Joint Medical Logistics and Infrastructure Support ORF SUPPORT Joint Medical Logistics Take Aways • Essential part of an integrated military healthcare system • Processes & systems: • Joint in nature • Designed for/tied to healthcare delivery & product characteristics • Support the full range of military operations • Interface with line logistics systems for distribution • Requirements driven by patient care/healthcare demands • Effective support required to save lives / treat casualties