FORT DETRICK, Md. - For Soldiers, taking stock and maintaining Army field equipment is more straightforward for items they see and use every day, such as weapons or vehicles.

Medical materiel can be more complex, because Soldiers often don't touch medical devices - unless they are needed to save lives.

Accounting for some medical devices can be challenging when they are embedded in different sets, kits and outfits designed to enable combat readiness.

While each medical set as a whole is easier to track, medical devices contained within the sets also must be accounted for enterprise-wide to ensure they are properly maintained.

"Accountability and visibility will allow increased maintenance readiness of medical devices," said Chief Warrant Officer 5 Jesus C. Tulud, who serves as director of Medical Maintenance Policies and Analysis (M2PA) within the Army Medical Logistics Command.

"Ready and available medical devices permit combatant commanders a true assessment of their capabilities," he said.

For example, the Army issues a ground ambulance set. It includes a variety of materiel, including durables, expendables and nonexpendable medical items.

Certain items - like thermometers, field-portable oxygen generators or suction machines, different from one-time use items like bandages or gauze - cannot be thrown away and require services, like scheduled maintenance, recertification or repair.

"That's where we come in to handle," said Master Sgt. Joshua L. Varnes, a non-commissioned officer overseeing medical devices for the AMLC. "The AMLC supports the servicing of medical devices."

The newly activated AMLC, a major subordinate under the Army Materiel Command, was created through an Army restructuring last year. Headquartered at Fort Detrick in Frederick, Md., the command was ceremoniously activated Sept. 17.

Systemic changes

Previously operating under the U.S. Army Medical Materiel Agency (USAMMA), now a direct reporting unit to the AMLC, logisticians have grappled with accountability issues as a new management system was rolled out in phases over the past decade.

The new enterprise system, Global Combat Support System-Army (GCSS-A), combined three other systems that tracked inventory, maintenance-specific items and financial records.

That brought improvements, but Varnes said challenges have persisted in educating non-medical units about updating the Army's property catalog to ensure maintenance plans for medical devices can be built and tracked - a requirement for many items under the U.S. Food and Drug Administration.

Scott Harder, a senior biomedical equipment specialist for M2PA, stressed the importance of identifying and appropriately logging devices contained within different sets.

"To have a maintenance plan for a device, it has to have a record with a GCSS-Army serial number," Harder said.

In addition to equipment not in the GCSS-A system, there are also legacy devices that were due to be taken out of service and replaced, but remain in use in the field, according to Jack Rosarius, director of the Medical Maintenance Management Directorate for USAMMA.

"We're spending money maintaining legacy equipment that should have been turned in and missing items that were never placed on the property books," he said.

While it's mostly "minor equipment," it still presents a "patient safety issue," Rosarius said.

Working toward compliance

To help remedy the ongoing situation, Varnes said units have been asked - in accordance with an executive order and subsequent directives passed down by Army headquarters - to open their sets and pull out items identified as "maintenance significant" to be logged.

Under the order, HQDA EXORD 010-15, the Army sought to establish formal accountability in accountable property systems of record for nonexpendable components of systems to support the configuration of GCSS-A for materiel readiness reporting.

Medical devices subject to the order can be identified by their Materiel Category Structure Code (MATCAT) with a "C" appearing as the first character and a "1" as the third character, which signifies that a device is repairable.

One way the code can be found is by entering its National Stock Number (NSN) and/or National Item Identification Number (NIIN) into the Medical Services Information Logistics System (MEDSILS) database.

A search brings up that item's catalog information, including its MATCAT.

Devices with a first character "C" and third character "1" should be brought to each unit's property book officer, who would then enter an adjustment to ensure those devices appear individually for each unit's property book.

"Once it's added to the books, then whoever the maintenance manager is for that organization can go and build a maintenance plan [in GCSS-A]," Varnes said.

M2PA officials take a holistic approach to ensure maintenance plans are in place and executed correctly in a timely manner. However, to enable those actions, there must be a record on the property book first.

Each maintenance plan is tailored to the specific device. Some require yearly maintenance, but others are more frequent.

In some cases, certain equipment requires specially trained technicians to service them, making it important that medical logisticians know where the devices are located in the field to arrange for needed maintenance or repairs.

'People can die'

Is it really that important? Varnes didn't mince words in his affirmative response and explanation why.

"Because people can die," he said. "You're talking about the same type of devices, where if you stopped breathing, a medical professional would put this on you so you can breathe."

Accountability across the system helps keep troops safe and ensures they have the right equipment for whatever circumstance may arise.

As an example, Harder said there could be a recall notice issued for malfunctioning wires on a defibrillator used to "shock" patients with a certain heart rhythm.

"We could identify the ones that have issues, figure out who has them and get them the message about how to repair it," he said. "... But if a Soldier at the unit didn't know and didn't extract the device and put it into the property book, we can't track it."

In the field, units must identify a device and create a record in GCSS-A, confirming on their end that they have it. That allows the device to be shown and tracked in the system, which enables M2PA officials to monitor and coordinate required maintenance procedures.

Harder also said items not logged correctly could be seen as "excess" devices, potentially creating "another can of worms" that could result in shifting equipment to other units and jeopardizing crucial resources.

'Always getting better'

Despite orders from Army leadership, M2PA officials still estimate about 50% of the Army's maintenance-significant medical devices remain unaccounted for within the system.

Varnes said medical logisticians remain committed to getting the word out to improve the enterprise's overall operation and accountability measures.

Varnes said he got a better understanding of the situation about a year ago while working with the Army's 6th Medical Logistics Management Center. There, he helped put together a training program to teach non-medical units about how to set up medical maintenance programs.

In many instances, the Army's directives to identify devices from sets and appropriately log them in property books wasn't being correctly followed, but it was clear that units weren't simply ignoring requirements or dodging compliance.

"It's just that they didn't know," Varnes said. "... It's always getting better. We just want to educate people as much as we can."