U.S. Air Force Maj. Pamela Curry, a registered nurse assigned to the 60th Medical Group, 60th Air Mobility Wing, deployed from Travis Air Force Base, Calif., briefs a civilian colleague during a shift change in the emergency room Aug. 12 at Los Angeles County + University of Southern California Medical Center in Los Angeles. Curry is deployed in support of the continued Department of Defense COVID-19 response operations.
In March, the Defender 2020 exercise was unfolding in Europe, and we were gearing up to provide support. The Combined Arms Support Command, in conjunction with the Combined Arms Command, mapped out all of the critical logistical nodes from fort to Tactical Assembly Area, and we were on the initial set of observations when our focus began to change. By early April, it became evident that the emerging COVID-19 pandemic would affect all aspects of American and military life.
As we began to shift to the realities of social distancing and implications of the new environment, units and individuals throughout the continental United States (CONUS) found themselves deploying in support of Defense Support to Civil Authorities (DSCA). I found myself in San Antonio, Texas, as part of the U.S. Army North (ARNORTH) headquarters Joint Forces Land Component Command (JFLCC) with duty as the J-4. For the first time, all 10 CONUS Federal Emergency Management Agency (FEMA) regions had declared emergencies, and Northern Command (NORTHCOM) was in support of FEMA's efforts as part of the broader federal response to the crisis in areas as diverse as New York, Seattle, and the Navajo Nation. Over the next six weeks, the team worked through several sustainment challenges as part of the operation.
Setting the Theater in COVID
In the COVID response, setting the theater took on additional significance and urgency as it directly affected our fellow citizens. Two aspects of this phase of the operation stood out: the first was the challenge of building combat power, and the second was ensuring that we were responsive to changing conditions.
Building Combat Power
ARNORTH's allocated units are primarily in the Army Reserves for the support of DSCA missions. This arrangement can be challenging in regionalized responses during the operation's initial phases; this crisis's magnitude made it especially problematic. The JFLCC worked to set conditions in 16 locations across all FEMA regions as the allocated forces began to mobilize. Active duty units geographically located near affected regions, such as the 593rd Expeditionary Sustainment Command (ESC), helped by leaning forward to support based on informal or unwritten requests. However, both actions were stop-gap efforts until reserve units could activate and deploy to meet the requirements. It was a struggle to build organizational capability, situational awareness, and relationships with local FEMA regions that were key to set the theater at the pace of the evolving mission.
Lesson Learned: Setting the theater requires early entry capability that is immediately available to rapidly deploy and establish a solid base for Joint Reception, Staging, Onward Movement, and Integration (JRSO&I). A tailored capability should be developed at a minimum that is robust enough to create situational awareness for the JFLCC commander and generate enough momentum to get units quickly through JRSO&I and into the fight.
Responsive to Change
As the nation geared up to flatten the curve, the Department of Defense (DoD) worked with FEMA on military medical providers' criteria to assist with critical capabilities when called upon to support the states. A vital part of the agreement was that DoD forces would relieve pressure on community hospitals by taking non-COVID, low-acuity patients at alternate care facilities. These patients needed a place to recover from non-COVID related illnesses without risking infection and taking up essential bed space at hospitals. The Corps of Engineers designed alternate care facilities inside convention centers or sports facilities at the request of state authorities, and
Army Field Hospitals were deployed to staff these facilities. As the units fell in on them, the Army Medical Logistics Command quickly identified, filled, and issued Medical Unit Deployment Packages (UDPs) and shipped them to link up on location to shorten the time needed to reach initial operating capability within the facilities. These UDPs were hugely helpful but were configured for large-scale combat operations and had many items that were not required for the COVID response.
As the situation developed, it soon became apparent that keeping alternate care facilities COVID-free would be nearly impossible and that low-acuity non-COVID patients were deciding not to seek medical care due to the pandemic. We built anticipated capability throughout the country, but soon it was apparent this was not the most critical type of assistance required. In response, the JFLCC commander talked to task force commanders on the ground and had the staff work different options. The resulting input and mission analysis pointed toward a change in strategy—the main effort shifted from alternate care facilities to embedding military providers from across the services into existing state facilities to augment their teams and provide much needed relief to the medical staff. The secondary effort was a branch of the first, where military providers would take over a ward or floor of an existing medical facility and run it for the state. Finally, the alternate care facility option would broaden their intake criteria to take COVID-19 positive low-acuity patients (those that had turned the corner and were recovering from the illness).
The first two efforts required that the sustainment enterprise enable life support to providers spread out around the communities, monitor personal protective equipment (PPE) burn-rates of military personnel working in civilian hospitals, and fill shortfalls as they developed. This created distribution challenges as small quantities of PPE and support had to move to multiple locations in a city. The third effort required additional focused attention. What became clear shortly after the transition was that most of the patients recovering from COVID-19 needed more than low-acuity support because the disease was unpredictable, and their condition could rapidly deteriorate. The higher levels of care meant rethinking the facilities' capabilities—especially for oxygen support. Oxygen generation became a critical limiting factor in the number of beds that could be used. While medical units' kits and UDPs had some capability, it was not nearly enough to meet the demand. Figuring out how to supply more oxygen became the focus of the sustainment community, and eventually, contracts came online that filled the requirement.
Lesson Learned: First, UDPs were timely and essential to beginning mission support. Building at least two types of UDPs in the future might save resources for subsequent waves of COVID. Second, every operation has that one thing that becomes the limiting factor on the critical path to mission accomplishment–the sooner the team can figure it out, the better; no amount of wishing or hoping will make it go away. In other words, once identified, ensure that the team resources it with the maximum amount of organizational energy.
Operational Contracting
AMC's work to operationalize contracting paid huge dividends. We were able to rapidly deploy contracting support to impacted regions, conduct market research, appropriately scope contracts, and scale up contracts as required. Logistics soldiers co-located with contingency contracting officers worked together to ensure commanders' priorities were understood and met. Condition setting and close coordination between the JFLCC and maneuver commanders ensured that appropriate audibility was in place and that we didn't inadvertently compete against other organizations.
Lesson Learned: Well-coordinated operational contracting is a huge force multiplier when focused on defining and delivering requirements based on understanding the maneuver commander's desired output.
Medical Supply
The medical supply system, which is currently designed to be lean, was not prepared to handle the influx of orders required to supply a pandemic. Unsurprisingly, PPE rapidly shot up in demand as hospitals, the Department of Health and Human Services (HHS), and the DoD competed to find enough PPE for medical providers. This problem was compounded by varying definitions on the proper standard for PPE, what the Force Health Protection Posture Policy was, and how often PPE had to be exchanged—commonly called the burn rate.
Initially, some locations burned through PPE at a much higher rate than others based on differing standards. As Urban Augmentation Medical Task Forces (UAMTFs) and Medical Treatment facilities reported their LOGSTATs through the staff, the forecasting of requirements with varying burn rates became problematic at echelon, and the logistics enterprise collectively struggled with tracking LOGSTATs from the tactical and operational levels. Com-pounding this issue in reporting was that local, HHS, and DoD stocks were commingled in many locations. The mission assignment instructions for federal forces typically stated that PPE would be provided locally. Units/augmentees deployed to sites based on that assumption and an over-reliance on the availability of locally provided PPE meant that sustainment units like the 3rd ESC had to adjust rapidly to provide support as that PPE didn't materialize. Defense Logistics Agency (DLA) was responsible for the procurement of medical supplies for all UAMTFs and DoD locations. Still, we quickly found that there was limited visibility of on-hand quantities at the tactical level. The need to gain visibility of what was available, develop common burn rates, and prioritize PPE quickly became the main-effort of the sustainment enterprise—it required daily interaction at the general officer level and largely relied on manual reporting and reconciliation. This fog of war did not begin to clear until the deployment of the DLA Rapid Deployment Team and the Medical Logistics Company. Still, without a common Enterprise Resources Program, the fog never fully lifted.
Lesson Learned: First, Class VIII should be incorporated into GCSS-Army and managed like other commodities to the largest extent possible to provide visibility and a shared understanding through a common record system forecasted and reported through the LOGSTATs. Second, the sustainment community should focus on planning support to regional defense coordinating officers early in the crisis. They work with federal and state officials to write mission assignment instructions.
Medical Maintenance
As the mission expanded across the country, the JFLCC began to deploy more DoD medical equipment to support the anticipated higher acuity patient load. The equipment was primarily commercial-off-the-shelf, which led to questions about the readiness rates as we tried to anticipate maintenance requirements. For the most part, the equipment remained in good working order, with the majority of the downtime attributed to the calibration required to initialize it and confirm that it was safe to use. That being said, it was fairly uncomfortable because of the lack of visibility available for these systems. A contributing factor was the medical logistics units being some of the last to be activated and deployed. Medical Logistics Companies (once employed) needed to reconcile their books and load devices in GCSS-Army to provide a holistic picture of what devices are on hand—for this deployment, much of the maintenance tracking remained analog. The lack of expertise early in the response and a largely analog process made it difficult to see ourselves.
Lessons learned: First, medical logistics units should have deployed earlier in the Time Phased Force Deployment Data (TPFDD) to give commanders a better picture of maintenance and supply at the various locations. Second, getting all medical equipment entered into GCSS-A must be a priority to ensure that the maintenance posture is visible and well understood early in any operation.
While the JFLCC support to the COVID fight has subsided, the war against the virus is far from over. The lessons learned about the complexities of setting the theater, operational contracting, medical supply, precise definitions, medical maintenance, and the sustainment network's power will undoubtedly continue as we posture to prepare for the next wave or the next major operation. These lessons and many others will be added to the collective narrative of sustainment as we continue to prepare for whatever the nation requires. Learning, adapting, and growing as an enterprise will ensure that we are ready for the next fight and provide what is required to win.
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Brig. Gen. Jered P. Helwig serves as the director of Logistics, Engineering and Security Cooperation for U.S. Indo-Pacific Command and is responsible for the planning, coordination, and integration of strategic Logistics, Engineering and Security Cooperation in support of operations across the Indo-Pacific region. He was commissioned in the Transportation Corps and branch detailed to Armor in 1994 after graduating from Wheaton College with a Bachelor of Arts in Communications. Additionally, he has earned a Master of Science in Public Policy from Georgetown University and a Master of Science in National Resource Strategy from the National Defense University (Eisenhower School). Previous to this assignment, Helwig served as the 30th Chief of Transportation.
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This article was published in the October-December 2020 issue of Army Sustainment.
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