DEPARTMENT
OF THE ARMY
HEADQUARTERS, 44TH
MEDICAL BRIGADE
AFVH-XA-CO
MEMORANDUM FOR
Commander,
SUBJECT: After
Action Review,
1.
The following significant issues surfaced during the first 90 days of Operation
Desert Shield which have not previously been forwarded.
2.
The After Action Review will be broken down and distributed to the appropriate
agencies (DA,
JEROME V. F 0 U S T
Commanding
AFTER ACTION REVIEW
I.
DEPLOYMENT/ ARRIVAL
a. Preparing to Load the Boat
b. Loading the Boat
c. Liaison Teams
d. Command and Control
e. Unit Arrivals
f.
AACG & ALCE OPS
g. Arriving to Destination
h. Reception or Vehicles at Port
i. AOR Orientation
j. Inadequate Theater Information
k. Site Selection
l.
m. Pre-Positioned Vehicles and Equipment
II. PERSONNEL AND ADMINISTRATION
a. Critical PROFIS Positions
b. MILPO Data Base
c.
d.
e. PROFIS Pt1 Officer
f. Unit Top Heavy With NCOs
g. Organic Vet Assets
h.
i.
j.
k. Inadequate Forms Management
l. Mail
III.
LOGISTICS
a. Prevailing Bureaucracy
b. Forklifts
c. Barrier Material
d. Shipping Containers
e. Basic loads
f. Stockage level of CPOGs
g. Lack of Secure and Temperature Controlled Storage
h. Desert Effects on Dental ~1aterial
i.
Infrastructure or Engineer Support
j. Lack of Clear Guidance on Obtaining
k. Transportation Priority
l. Transportation Organic
m. Lack of Fuel Hauling
n. Distribution Assets
o.
IPBO Property
p.
Class IX Repair Parts
AFTER ACTION REVIEW (CONT)
IV.
MTOE CHANGES
a. Insufficient MTOE for 74th Med Det
b. Senior Food Inspection Technician for 483rd
c. Organization of Dental Treatment Teams
d. Staff Positions
e. Veterinary MTOE for JA and JB Teams
f. No Computer Authorized for Veterinary MTOE
g. Shortage of Fuel Handlers
h. Bulk Fuel and Water Storage
i.
Materials Handling Equipment
j.
Required TO&E Strength for MRO
k. MTOE Modifications
v.
SECURITY
a. Medical Units do not Have Sufficient Personnel for
Security
b. Brigade Headquarters Guard Force
VI.
GENERAL
a. No Communications Plan for MEDEVAC
b. Strategic Aero-Medical Evacuation
c. Soldier Care
d. MEDSOM Quality Control
e. Sick Call
f. Return to Duty
g. Contamination Detection
h. Area Support
i.
Blood System
j. Toilets on Wards
k. Poor Signal Communication With
L Team Elements
l. Joint Medical Regulating System
m. Unforseen Demands for Supplies/Stocks
n. Reporting Requirement for AOR
DEPLOYMENT/ARRIVAL
ISSUE:
Preparing to Load the Boat
DISCUSSION: Logmars produced and delivered late (after vehicle at
port). Port officials put logmars on our equipment.
RECOMMENDATION:
Have logmars pre-printed and on hand of immediate use
on deployment. .
ACTION: Corps
DEPLOYMENT/ARRIVAL
ISSUE:
Loading the Boat
DISCUSSION:
No accurate information on what went on
what boat
RECOMMENDATION:
Full time Brigade representative at the port to monitor equipment load
status.
ACTION:
Corps -
DEPLOYMENT/ARRIVAL
ISSUE:
Liaison Teams
DISCUSSION:
Command and Control liaison teams are required early in the deployment to
remain abreast of the concept of the operation and changing support
requirements. Additionally, they will assist in support planning, preparing
units locations and passing requirements to subordinate units prior to their
deployment.
REMCOMMENDATION:
Headquarters units deploy a liaison team to the theater early to
enhance-planning and deployment of subordinate units.
ACTION: Corps
DEPLOYMENT/ARRIVAL
ISSUE:
Command and Control
DISCUSSION:
The medical group and battalions were brought into theater at approximately the
same time of following their subordinate units. This didn’t allow them the time
to assist and properly prepare to receive their units, resulting in delays in
the deployment to their tactical location.
RECOMMENDATION : Headquarters units be brought into theater early in
the flow to allow them the opportunity to prepare for the receipt of their
units.
ACTION:
FORSCOM
DEPLOYMENT/ ARRIVAL
ISSUE: Unit
Arrivals
DISCUSSION:
Subordinate unit arrival dates should be evenly spread over time. The
existing time phased force deployment list placed four TOE hospitals in country
within one week. Neither the Medical Brigade nor the area support units are
capable of providing necessary support (transportation -billeting) to properly
accept four units at once. This problem is compounded, when high priority
is given to combat-units. Medical personnel were forced into substandard living
conditions and equipment was subjected to excessive and abusive handling as a
result of poor phasing. There have been
many very slow weeks since initial deployment that no
major units were scheduled for arrival.
RECOMMENDATION:
Improve management of the TPFDL
ACTION:
FORSCOM
DEPLOYMENT/ARRIVAL
ISSUE:
AACG & ALCE OPS
DISCUSSION:
ALCE could not provide info on incoming aircraft even when given mission
numbers. AACG had no control on inbound cargo. Units literally have to hunt for
cargo.
RECOMMENDATION : Get control of AACG/ALCE. Establish standards and
control on inbound cargo. Use locator system and accountability procedures.
ACTION:
ACofS. Logistics and COSCOM
ISSUE:
Arriving to Destination {
DISCUSSION: No
one to meet soldiers
RECOMMENDATION : Have assigned Brigade liaison at air field to notify
units coordinate transportation and be available to aide new arrivals.
ACTION:
ACofS, SPO
ISSUE:
Reception of Vehicles at Port
DISCUSSION:
Equipment arriving at port is marshaled into a common area broken down only by
type of equipment (rolling stock, milvans, etc...).
There is apparently no control over the equipment and theoretically, any unit
could drive away with any piece of equipment regardless of who actually owns
it.
RECOMMENDATION : MSC’s place a representative
at the port who maintains a register of equipment by unit, bumper number, and
location in the marshalling area. Units will then submit signature cards to the
representative and will sign for their equipment when they pick it up.
ACTION:
ACofS, LOG
ISSUE:
AOR Orientation
DISCUSSION:
Briefings by Middle East expert and commo with deployed element were inadequate
for providing info to main body personnel regarding AOR.
RECOMMENDATON
: Deploying units should receive
AOR orientation prior to deployment.
ACTION: Corps
ISSUE:
Inadequate Theater Info
DISCUSSION:
Inadequate information to later deploying units on local requirements
discovered by ADVON/CORPS, etc. E.G. civilian clothes for
contracting agents. Requirements to buy off local
economy, etc.
RECOMMENDATION:
Higher HQs ADVOr~ should develop practical info
packages containing requirements, conditions and issues to pass to rear for
later deploying units
ACTION: Corps
ISSUE: Site
Selection
DISCUSSION:
The location of the 47th Field Hospital at Shaikh-Isa
Air Base in
RECOMMENDATION:
Unit locations should be determined by the Commanders intent consistent with
the tactical plans.
ACTION: FORSCOM
ISSUE:
DISCUSSION:
The doctrinal area support concept for non-divisional units works only if there
are other Army non-divisional units in the area.
Current Army Doctrine calls for non-divisional
RECOMMENDATION
: Always deploy functional
ACTION: FORSCOM
ISSUE: Critical
PROFIS Positions
DISCUSSION:
PROFIS Specialists not idenitified early. PROFIS
Commanders not board selected. not PCC qualified. not trained for mission. Corps level ‘specialists not intergrated into unit training.
RECOMMENDATION:
Select key PROFIS fillers (CDRs, Corps PM, Corps Vet,
etc). School them for mission (Pre-Command course, C&GSC, etc). Annual training with unit.
ACTION:
OTSG/
ISSUE: MILPO Data
for PROFIS Fillers
DISCUSSION:
PROFIS fillers from off-post units arrived without personnel info. MILPO and
SIDPERS data could not be updated. This effects OER’s,
zones of eligibility, etc.
RECOMt1ENDATION:
Provide PROFIS info sheets to gaining commands, full ORB, DA Form 2 and 2-1.
Each service member could bring a floppy disk to load. should
be PROFIS regulatory requirement.
ACTION: ACofS, P&A/OTSG
ISSUE:
DISCUSSION:
Effectiveness of large organizations is increased by teamwork. Deployment added
new player (PROFIS, Personnel plus-ups).
RECOMMENDATIONS:
Train with designated PROFIS at least annually. Develop “’Buddy System”
(organic member -new member). Maintain continuity of existing teams from MEDDAC’s when possible. Deve10p mental
approach toward
ACTION: Letter to
ISSUE:
DISCUSSION:
PROFIS officers and enlisted personnel were arriving on a variety of
RECOMMENDATION : Before individuals are deployed, a message needs to
come out from Department of the Army level describing how
ACTION:
.
ISSUE: PROFIS PM
Officer
DISCUSSION: The
above slot should have been filled earlier than C+69. There was no staff
Preventive Medicine (PM) physician above division level until that time. One
result was that each newly arriving division. or corps
unit did not have the benefit of preventive medicine lessons learned by
divisions which preceded it. There was no integrating pm representation at the
Corps level to help minimize the following situations which occurred:
• Major outbreaks of diarrhea and
dysentery plagued every large unit after arrival. Soldier readiness in this
fast maturing theater was impaired and medical treatment assets consumed
unexpectedly large amounts of medical supplies and drugs. to
the point of depletion.
• No coherent, Corps-wide policies
were developed nor were actions taken to reduce the risks of such illness for
newly arriving units.
• High-level medical participation
was absent from the contracting process, which resulted in the construction of
thousands of out- door latrines with major design flaws. The use of these sub-
standard latrines worsened overall sanitation and provided fertile breeding
grounds for flies.
• Medical (PM) input was absent
from site selection for, and preparation of, troop staging areas in the Corps
rear. The overcrowded, unsanitary encampments were associated with disease
outbreaks and terrible morale. Late arriving PM detachments were hard pressed
to overcome deplorable camp conditions and had no representation at Corps level
to focus command attention of these issues.
• The deployment of Corps PM detachments greatly antedated the arrival of the PM officer
at the Corps level medical brigade.
• Corps-wide, centralized planning
for immunizations (immune serum globulin and influenza vaccine) was greatly
deployed.
The PROFIS system
should have provided an appropriate fill, early in the operation, for the PM
position in the 44th t1edical Brigade. It did not.
RECOMMENDATION:
Health Service Command (
ACTION:
ISSUE:
DISCUSSION: Of
those 716 MOS personnel assigned to the Brigade headquarters, or those borrowed
from other Brigade units, none are adequately trained for the Brigade
RECOMMENDATION: A
garrison training plan must be established for assigned 71G MOS personnel to
include participation in a hospital based program, and a hospital exported
training program to the Brigade.
ACTION:
ISSUE:
DISCUSSION:
A patient administration officer, 67E, in at least the grade of 0-3, must be
permanently assigned to the Brigade headquarters. This position is vital
to establishing MRO procedures,. training
programs for 7IG MOS personnel, and exercising these In both a garrison and field setting.
RECOMMENDATION:
OTSG/Officer assignments/Brigade coordination
ACTION:
OTSG
ISSUE: Unit Top
Heavy with NCOs
DISCUSSION: This
unit (483rd Med Det (VS)(JB)), was organized and pieced together by
7th MEDCOM with the idea that fill personnel would be selected up to
two grades above the required MTOE rank structure for each position. The original
reason for this decision was to insure plenty of experience and expertise
within the unit. However the decision resulted in a unit, which was Top heavy
in NCOs. Unit cohesion was hurt because of the conflicts between the NCOs. Unit
morale was hurt because NCOs were required to perform menial details and duties
due to a lack of lower enlisted personnel.
RECOMMENDATION:
That any future unit sent to this theater be made up
of excellent, competent senior NCOs, with an adequate number of lower enlisted
personnel to perform the work, to include the menial details and duties.
ACTION:
ISSUE: Organic
Veterinary Assets
DISCUSSION:
Currently the 44th Medical Brigade has an organic 6 man veterinary
service JA team, 248th Med Det (1 officer, four food inspection
specialist and one animal care specialist). By doctrine, FM,8-27
Veterinary Service, this JA team is designed to support 20,000 personnel or
one/two divisions. Once the XVIII Airborne Corps is fully deployed (100,000
personnel) there are inadequate veterinary assets organic or identified to
support the Corps operation. For this exercise, a veterinary service JB team,
483rd Med Det was deployed from
RECOMMENDATION:
Identify a veterinary service JB team to support the X
ACTION: FORSCOM;
Force Development
ISSUE:
DISCUSSION:
A TOE position for a 67H MOS officer to act as a ~1RO is filled, but the
officer is working elsewhere. 7IG MOS personnel are being used in positions
outside their MOS position.
RECOMOENDATION: “Either
re-align existing personnel into their valid TOE position and/or duty, or where
valid vacancies exist, submit personnel replacement requisitions.
ACTION:
ISSUE: Inadequate
Forms Management
DISCUSSION: Prior
to deployment, the units assembled and loaded quantities and types of forms,
based primarily on historical experience of unit personnel. It quickly became
apparent that the quantities brought were insufficient in many cases, and in
other cases, required forms had been omitted. There is n~ system in place for
the distribution and re-supply of blank forms.
RECOMMENDATION:
Corps should establish a Forms Supply Point, pre-packed in milvans
for shipment to theatre. The responsible element must solicit Health Care
providers, as well as administrative areas, to provide a listing of forms
required, and estimates of the number required to support a 30 day operation.
These forms should be shipped with the unit if at all possible, and
coordination for re-supply.
ACTION: Corps
ISSUE: Mail
DISCUSSION: The
arrival of mail was non-existent for the first two weeks on the ground in
RECOMMENDATION:
master contingency plan be established for future deployment areas. This plan
must be developed early in the planning process prior to the deployment of any
soldiers if reasonably possible. Definite consideration needs to be given to
host nation support and proper staffing levels to ensure realistic success for
timely delivery of mail.
ACTION: DA/FORSCOM LOGISTICS
ISSUE: Prevailing
Bureaucracy
DISCUSSION:
Processing general supply/service request for standard items and local purchase
items has become a bureaucratic nightmare. Requests must be ‘hand carried to as
many as eight different’ organizations prior, to acceptance by the source of
supply. The distribution system is untimely and totally unreliable for relaying
requests between organizations.
RECOMMENDATION: “Streamline”
the system back to pre-exercise standards.
ACTION: Corps
ISSUE:
Forklifts
DISCUSSION:
Hospital units require the use of a forklift on a daily basis for establishing
the facility, down load of medical supplies and the maintenance and positioning
of the U-PACs and environmental control units.
RECOMMENDATION:
Forklifts be leased for the duration of the exercise and that MHE be added to
the hospital TOEs.
ACTION: Corps/MMC
ISSUE: Barrier
Material
DISCUSSION:
Combat Service Support units have low priority for barrier material in the
theater. Supplies of sand bags and concertina wire are not adequate to build
appropriate defenses
RECOMMENDATION: That
combat service support units stockpile barrier material
at home station and ship it in with the rest of the unit equipment.
ACTION: Corps,
G-4
ISSUE: Shipping
Containers
DISCUSSION: The MEDSOMs were not authorized adequate
RECOMMENDATION:
Change MEDSOM authorization documents to reflect adequate number of MILVAN
containers.
ACTION: Force
Development,
ISSUE: Basic
Loads
DISCUSSION:
RECOMMENDATION: Units must be given specific guidance on basic load amounts
prior to deployment.
ACTION: Corps
LOGISTICS
ISSUE: Stockage
Levels of CPOGs
DISCUSSION:
Requisitions for extra CPOGs to accommodate patients were denied at G-4.
Usually the only chemical protection item that a patient brings is a protective
mask.
RECOMMENDATION: Authorize
hospitals to maintain an extra stockage level of CPOGs at one per operating bed
plus 20%.
ACTION: Corps/ACofS, LOG
LOGISTICS
ISSUE:
Lack of Secure Temperature Controlled Storage
DISCUSSION:
Obtaining field safes and larger refrigerators in which to store code Q, R
items or bulk temperature sensitive pharmaceuticals has been an ongoing
problem.
RECOMMENDATION:
Lockable security cabinets be devised and fielded. Further, Field
Hospitals (400 beds) will require large numbers of refrigerators in which to
store vaccines, biological and certain other temperature sensitive
pharmaceuticals. Develop requirement documents for RD&A for
deployment/procurement of appropriate securable field safes/refrigerators.
ACTION:
Corps
ISSUE: Desert
Effects on Dental Material
DISCUSSION: The
heat of the desert makes providing dental care all but unworkable, as dental
materials require controlled temperature. This is necessary for the general
dentists, prosthodontist, prosthodontic laboratory.
RECOMMENDATION:
Recommend that Temper Tents and air conditioning units be provided for the
larger treatment sections of the Dental Company and Dental Detachment.
(One-chair clinics can employ within hospitals and dispensaries).
ACTION: Combat
Developers -AHS
ISSUE:
Infrastructure of Engineering Support
DISCUSSION: he
only coordination that had been done on behalf of the 47th Field
Hospital was that a
RECOMMENDATION:
That a COSCOM logistics element be among the early departing units to at least
set up the logistics framework and give briefings and advice to the Commanders.
Alternatively, four or five person teams could have been dispatched by
commercial transportation immediately upon unit notification to do logistics
coordination.
ACTION: Corps
ISSUE: Lack of
Clear Guidance on Obtaining
DISCUSSION: Since
the beginning of Operation Desert Shield, the number of DCUs authorized per
individual has been an item of concern and ambiguity. The original request
submitted at
arrival in-theater, the number authorized has been changed
from two sets to four and back to two depending on the person spoken to in the
logistics chain. To date, there remain individuals in this unit without their
initial two-set issue, de- spite intense management.
RECOMMENDATION: A
written policy from Corps G-4 expressing the number of CUs authorized and
procedures required to obtain the uniforms upon their availability must be
distributed as general distribution to the lowest level possible.
ACTION: Corps
G-4
ISSUE: Transportation
Priority
DISCUSSION: Class
VIII supplies, medical unit personnel, and equipment is not receiving a fair share
of transportation assets. Medical unit personnel, equipment, and Class VIII
supplies are denied transportation due to priority movement of Class I and
Class V. This action results in increased order ship time of supplies to
requesting units, delayed establishment of medical support, in- creased
processing time, increased potential for deterioration and pilferage and denial
of medical treatment.
RECOMMENDATION:
Initiate action to obtain an equitable share of transportation assets for
medical resources.
ACTION:
COSCOM/MCC
ISSUE:
Transportation -Organic
DISCUSSION:
Inadequate vehicular assets to perform mission. Too low
on priority to get Corps support in timely manner.
RECOMMENDA
ACTION: COSCOM
MMC/Comba t Development -AHS
ISSUE: Lack of
Fuel Hauling/Distribution Assets
DISCUSSION:
During the past few weeks the hospital has responded to several incidents
involving problems with receiving Class III (b) fuel (JET-A-l). Doctrinally,
fuel should be hauled to the hospital; however, because of the lack of adequate
Army tanker/transportation assets in-theater, the mission .to haul fuel to the
hospital was handed back to the hospital to resolve. Contracted fuel service
continues to be interrupted frequently because of the incompatibility of
host-nation and
RECOMMENDATION:
An increase in
the authorized number of personnel (fuel handlers) will allow sufficient personnel
rotations for picking up, hauling and handling the fuel requirements to support
the 200 bed hospital. An alternative to an increase of personnel would be
authorizing larger hauling and storage vehicles. An increase of this nature
would reduce the number of times the fuel handlers would have to make trips to
the bulk fuel point.
ACTION: Combat
Developer/AHS/
ISSUE: IPBO
Property
DISCUSSION: Unit
deployed without IPBO property
RECOMMENDATION:
Include IPBO property on load plan.
ACTION:
ISSUE: Class IX
Repair Parts
DISCUSSION:
Vehicles are dead lined due to the non availability of repair parts Standards
items such as glow plugs, fuel filters and water pumps which are easily
available normally can not be procured through the supply system. An inordinate
amount of repair parts must be locally procured to keep vehicle running. Corps
level repair part units and
RECOMMENDATION:
The unit should deploy with additional PLL items based on the area of
operation. Increase unit’s PLL on high demand items prior to deployment.
Increase
ACTION: Corps,
G-4
ISSUE: Insufficient
MTOE for 74th Med Det
DISCUSSION: The MTOE
did not meet current AM team mission requirements. Critical technical equipment
including data processing equipment was not included in the MTOE. A mechanic
(63B) was not provided to support the five authorized vehicles. MTOE
restrictions delayed deployment preparations. Non-MTOE equipment items required
to meet Operation Desert Shield mission requirements were allowed only after a
special request by the Office of the Surgeon General. Prior to departure
from CONUS, no information was provided by CEN
RECOMMENDATION:
Review and revise the PROFIS listing as necessary to ensure its accuracy.
Provide mission orientations/training to A~1 team
members upon designation as PROFIS fillers. Place the 74th ~1edical
Detachment directly under its parent unit, the 44th t.1edical
Brigade, for mobilization; and relocate equipment storage to
ACTION: Combat
Development/AHS
ISSUE:
Senior Food Inspector Technician for 483rd
DISCUSSION: The
JB team, Veterinary Service Large, is not currently authorized a Food
Inspection Technician, warrant officer, ASI 640A. In fact there has been no
change in the MTOE, recognizing the addition of the warrant officer to the
Veterinary Corps, since their formation almost ten years ago. Many JB teams
located in USAREUR have warrant officer assigned under their TDAs. The Food Inspection Technician is needed within the
JB team to insure the presence of a food inspection subject matter expert to
supervise and standardize the food inspection mission.
RECOMMENDATION:
That a warrant
officer, ASI 640A, Food Inspection Technician, be authorized on the JB Team
MTOE to assist the commander in
Organizing,
supervising, and standardizing the food inspection mission.
ACTION:
AHS, TO&E
ISSUE:
Organization of Dental Treatment Teams
DISCUSSION: This
unit is responsible for area dental support of the soldiers in theater. The
current number of soldiers exceeds by at least a factor of 5 the recommended
basis of allocation. In addition the distances involved mean the large teams
must be broken down into smaller treatment sections. This increases the need
for equipment and transportation assets in order to be near our patients.
Current design is too large and inflexible. Need smaller more portable teams
with portable X-Ray system (hand held) and more transportation assets. MF2K is
a partial fix.
RECOMMENDATION:
The Dental Detachment of Med Force 2000 will answer this problem to some
extent. The one 3 chair clinic and three 1 chair clinics will enable treatment
to be provided in various locations in the corps rear area. The 9 chair section
of the Dental Company should be organized and equipped to break out into
smaller treatment sections. Additional X-Ray machines (hand held, if possible)
and additional utility vehicles (1008s) should be included. Seek acceleration
of MF2K MTOE. Request additional tentage,
transport, and equipment now.
ACTION: Combat
Developers, AHS
ISSUE: Staff
Positions
DISCUSSION: A
MASH by MTOE is not authorized a S-l or S-3. In a battalion
equivalent these positions are critical. In the 5th MASH these
positions are filled by the Chief, PAD and Assistant PAD Officer. For Desert
Shield, we deployed with a PROFIS PAD Officer as well.
RECOMMENDATION:
Include an Adjutant and an Operations Officer in the MASH MTOE
ACTION: Combat
Development/AHS
ISSUES: Vet MTOE
for JA and JB Teams
DISCUSSION: Upon
arrival in theater the unit received a copy of the new Veterinary MTOE provided
by the
RECOMMENDATION: That adequate quantities of euthanasia solution and
broad-spectrum anthelminthics, for both small and
large animals, be assigned an NSN and included in the Veterinary MTOE.
ACTION: Combat
Development/AHS
ISSUE: No Computer
Authorized Under the Veterinary MTOE
DISCUSSION: The
unit MTOE lists no integral unit field computer system. We anticipated
maintaining all forms, reports, property books etc., manually by hand
writing all entries. However, since arrival in theater we have been required to
type reports, actions, prepare overheads, and maintain databases all of-which
require a computer. The modern Army unit depends on the computer .for
maintaining all correspondence.
RECOMMENDATION:
A JA team, Veterinary Service Small, MTOE should contain a minimum of one field
computer. A JB team, Veterinary Service Large, MTOE should contain two complete
field computer systems.
ACTION: Combat
Development/AHS
ISSUE: Shortage
of Fuel Handling Specialists (77F)
DISCUSSION:
Hospitals burn a significant quantity of fuel during normal operations. Storage
of significant quantities of fuel is necessary in order to sustain operations
for several days. Personnel are not on hand to properly manage, store, handle,
and distribute fuel. Health care has been interrupted due to this personnel
shortage.
RECOMMENDATION: Authorize and assign properly
trained fuel handlers to hospital units.
ACTION: Combat
Development/AHS
ISSUE:
Bulk Fuel and Water Storage.
DISCUSSION:
Hospitals require large quantities of fuel and water for daily operations of
the facility but are authorized only limited capacity for storage. In a
tactical environment,. Hospitals should have the
capability to store as a minimum a 3 day of supply for fuel and water.
RECOMMENDATION: TOE’s be changed to authorized bulk storage equipment for 3
days supply of fuel and water.
ACTION: Combat
Development/AHS
ISSUE: Materials
Handling Equipment
DISCUSSION: MTOEs have allowed insufficient MHE. Directed
toward peacetime utilization and Corps tasking for support. Too much competition for available assets. Severe effect on established hospitals and running MEDSOM.
RECOMMENDA
ACTION: Combat
Development/AHS.
ISSUE: Required
TO&E Strength for MRO
DISCUSSION:
Peacetime regulating procedures require more extensive date gathering and
transmission than that expected during hostilities. Current automation methods
(TAMMIS) are designed for operation during hostilities.
RECOMMENDATION:
For “
ACTION: Combat
Development/AHS
ISSUE: MTO&E
Modifications
DISCUSSION:
MTO&E not adequate to cover wartime requirements in personnel ( ie., aviation,
transportation/movements, etc) and equipment (especially shortage of weapons, ammo,
NBC equipment and vehicles).
RECOMMENDATION:
Units should prepare and submit MTO&E changes
ACTION: Combat
Development/AHS
ISSUE: Medical
Units Do Not Have Sufficient Personnel For Security
DISCUSSION: Medical units do not have sufficient
personnel, nor sufficient firepower to provide adequately for defense.
RECOMENDATION: Medical
units should not be required to operate independently. Medical units should be
placed in base clusters.
ACTION: Clusters
ISSUE: Brigade
Headquarters Guard Force
DISCUSSION:
Brigade Headquarters doe’s not have the enlisted soldier depth to provide its
own guard force.
RECOMt1ENDATION:
Corps MP support required.
ACTION: Corps
ISSUE: No
Communications Plan for MEDEVAC
DISCUSSION:
Division level units managing MEDEVAC missions through operational
channels. Also, many units out of range of
units monitoring 39.15.
RECOMMENDATION:
Plan early to ‘place’ FM repeater stations at key locations.
ACTION: Corps
ISSUE: Strategic
Aero-Medical Evacuation Delays Out-of-Theater
DISCUSSION: There
continues to be problems with patient regulation and strategic air evacuation
delays out-of-theater. Our physicians’ concerns rest on two basic issues that
need to be addressed medical evacuation is often not timely, per the
accepted/USAF- directed definitions of Urgent, Priority, and Routine. Decisions
are being made by non-clinicians about patient care without consulting with the
referring physicians.
RECOMMENDATION:
That sufficient strategic air evacuation asset be
allocated to this theater to allow patient evacuation out-of-theater per
definition of patient urgency categories. That a physician be assigned with or
be readily available to the theater-JMRO for routine consultation regarding
patient evacuation and that the referring physician be consulted for necessary
changes regarding his/her patient’s regulation/ evacuation.
ACTION: ARCENT
ISSUE: Soldier
Care
DISCUSSION: 5th
MASH has been soldiers deployed to
RECOMMENDATION:
XVIII Corps Surgeon should advise the Corps rear to finalize treatment on all
soldier patients before allowing them to deploy to
ACTION:
Corps Support
ISSUE: MEDSOM
Quality Control
DISCUSSION:
MEDSOM needs early consolidation of OC Section with expertise to advise units
relating to pharmaceutical procurement theater specific items (anti-venom~
-etc.)
RECOMMENDATION:
Deploy MEDSOM early. Have one 68H (Pharmacy Officer) assigned as Primary Staff.
Submit 2028 for ~1TOE change.
ACTION: ACofS, LOG
ISSUE: Sick Call
DISCUSSION:
Assigning a MASH a sick call mission creates changes throughout the
organization. Every facet of the MASH (less or complex) is turned away from its
wartime focus and modified to supply sick-call operations.
RECOMMENDATION:
Co-locate the MASH with a dispensary, while utilizing the MASH as a
trauma/surgical hospital.
ACTION: ACofS, SPO
ISSUE: Return to
Duty
DISCUSSION: The
current XVIII Airborne Corps TAC SOP and 44th Medical Brigade OPORD
clearly delineates the responsibility for returning
soldiers to their units. To practice a difference procedure during
pre-hostilities will generate confusion and cause problems once conflict
starts.
RECOMMENDATION
: Practice in peace time
(pre-hostilities) those procedures we will use during war.
ACTION: Corps
ISSUE:
Contamination Detection
DISCUSSION: The hospital
has no way of checking patients for chemical contamination prior to treatment,
other than using M8 paper to test for liquid agents only.
RECOMMENDATION:
Issue 4 each chemical agent monitors to the hospital
ACTION: COSCOM
ISSUE: Area Support
DISCUSSION: Many
patients are bypassing organic or closer MTF’s to be
seen by the 5th MASH for sick call.
RECOMMENDATION:
Corps Surgeon publishes a designated area medical support and specifically for
sick call.
ACTION: Corps
Surgeon
ISSUE: Blood
System
DISCUSSION: System
does not work.
RECOMMENDATION:
JBPO enforce blood report—distribution system
ACTION: ARCENT
ISSUE: Toilets on
Wards
DISCUSSION: No
toilets on wards. Big problem for GE patients.
RECOMMENDATION:
Portable. or DEPMEDS chemical toilets.
ACTION: OTSG
ISSUE: Poor
Signal Communications with L-Team Elements
DISCUSSION:
Command and control of Preventive Medicine L-Teams throughout the theater
(particularly forward-deployed LB teams) is extremely difficult when these
teams are attached to other units for communication support. “
RECOMMENDATION:
Provide L-Teams and the AM team with adequate communication assets.
ACTION: Corps
ISSUE: Unforeseen
Demands for Supplies/Stocks
DISCUSSION: The
priority of moving medical supplies should have been higher during initial
phases of deployment operation. Deployment operation should have been
established sooner. Support to US Marines in the theater depleted much of the
Optical stock, especially protective mask inserts.
RECOMMENDATION : Send Optical items and other class VIII items to the
theater early and in a large amount. In an operation of this magnitude, early
Optical support is essential.
ACTION: Corps
ISSUE: Joint
Medical Regulating System
DISCUSSION:
Communications, Command and Control, and lack of medical expertise.
RECOMMENDATION:
Experienced JMRO
ACTION: DA
ISSUE: Reporting
requirements for AOR
DISCUSSION: Reporting
requirements in excess of those required via OPLAN from Corps and additionally
ARCENT requirements have been levied. Some requirements are in writing, some
are not. TAMMIS will not directly provide for all these requirements.
RECOMMENDATION:
Respond only to requirements in writing. Provide only TAMMIS generated reports
(to include ADHOC reports where appropriate. Evaluate additional requirements
on basis of availability and transmission of requested data.
ACTION:
Corps/ARCENT