When the newly-organized Army Medical Logistics Command (AMLC) was activated last September, my focus was clear: prepare the organization to provide medical materiel and data from the strategic support area (SSA) to deliver effects at the tactical point of need in support of the operational force. Knowing we would soon operate in a contested multi-domain environment, we needed to rapidly improve our ability and capacity to deliver those effects.
Organizational change is never easy, especially the kind we were undertaking to systemically reform operational medical logistics. We expected long days, bumpy roads, and obstacles along the way. What none of us ever truly anticipated was a global pandemic. Less than six months into the command’s development, we found ourselves at the center of the Army’s support to the whole-of-government response to the novel coronavirus. AMLC continued throughout the summer to provide medical materiel to support ongoing and future operations across multiple global combatant commands.
COVID-19 is not the battle we forecasted but it provides us with a unique opportunity to test our ability to deliver effects from the SSA in a contested, real-world environment.
Developing the Army’s Home for Medical Logistics Since October 2018, we have witnessed a period of significant change as Army Medicine realigned delivery of fixed-site healthcare under the Defense Health Agency (DHA). This included the restructuring of U.S. Army Medical Research and Materiel Command (USAMRMC) and the creation of AMLC.
Over a nine-month span, the Army reorganized and inactivated USAMRMC. Headquarters, Department of the Army, Execution Order 013-19 called for the immediate transfer of USAMRMC to U.S. Army Materiel Command (AMC). A subsequent operations order 19-121 directed that USAMRMC “reorganizes to ensure compliance with Army future force modernization” and “develops a detailed plan to transfer medical research and development/program management to Army Futures Command.” By June 1, 2019, MRMC was redesignated to U.S. Army Medical Research and Development Command (MRDC) under Army Futures Command (AFC).
To support operational medical logistics and forces in the field, the order also called for the creation of AMLC, a direct-report unit to AMC, which was activated on Sept. 17, 2019. The new AMLC was formed as a headquarters over three medical logistics subcommands: U.S. Army Medical Materiel Agency, U.S. Army Medical Materiel Center-Korea (USAMMC-K), and U.S. Army Medical Materiel Center-Europe (USAMMC-E).
The creation of AMLC was part of several larger Army Medicine reform efforts to ensure medical readiness, support wartime requirements, and enhance the quality of care for Soldiers and their Families. Additionally, the Army sought to centralize medical logistics with the other sustainment functions inherent within AMC.
AMLC generates medical materiel readiness for the Army. Partnered with multiple stakeholders, AMLC ensures medical forces have the specialized equipment and materiel needed to continue the best care for Soldiers, on and off the battlefield. AMLC sustains health services support for the operational Army units and joint forces, in support of large-scale combat operations (LCSO), through integrated medical materiel distribution, forward-positioned stocks, centralized medical materiel management, and data management.
Sustaining Strategic Support Area Operations
Today, AMLC serves as the Army’s primary medical logistics and sustainment command. It provides strategic oversight of medical materiel within the Army prepositioned stocks (APS), forward-positioned stocks, operational projects, and medical maintenance operations located across four continents. AMLC supports AMC across four lines of effort within the SSA construct:
Industrial Base Readiness:
- Provide sustainment-level repair, calibration, and recapitalization of medical equipment and medical special purpose test, measurement, and diagnostic equipment (TMDE-SP)
- Deploy medical maintenance experts to operational environments to provide forward repair and maintenance support
Strategic Power Projection:
- Manage and sustain medical APS, forward-positioned stocks, and other medical materiel readiness programs
- Provide forward-operating optical fabrication, including standard issue and frame-of-choice glasses, inserts for gas masks and eye protection, and flight goggles for pilots
- Coordinate medical foreign military sales (FMS) in collaboration with U.S. Department of State to strengthen our allied partners and ensure interoperability
Supply Availability and Equipment Readiness:
- Oversee the distribution of medical materiel
- (e.g., supplies, equipment, and assemblages) across the Army and joint medical forces
- Distribute vaccines and provide cold chain management training
- Support medical materiel quality control and hazard recall messaging
- Provide theater-level medical logistics support to Army and joint medical forces
Data Analytics and Logistics Information Readiness:
- Facilitate the Army’s transition from the legacy medical logistics enterprise resource planning system (ERP) into Global Combat Support System-Army (GCSS-Army), to be completed no later than the end of fiscal year (FY) 2022.
- Manage and update the medical materiel catalog
- Provide technical business support and record system training
Fighting COVID-19
The first confirmed U.S. case of the highly-contagious novel coronavirus was Jan. 21. By March 11, the World Health Organization (WHO) declared a global pandemic. For many Americans, this was the start of the battle. At AMLC, the fight began weeks earlier.
Theater Support Outside the Continental U.S.
In early January, before COVID-19 began to receive widespread U.S. media attention, AMLC medical logisticians in Korea had their sights set on emerging health trends. A novel virus was spreading quickly in Asia and the medical logisticians started to plan for the worst-case scenario, which included having to equip 66,000 people—including U.S. Forces Korea (USFK) and Eighth Army—with personal protective equipment (PPE) and sustain the theater. USAMMC-K executed early mass procurement of needed medical supplies and PPE, including surgical masks, gloves and gowns, sending the demand signal to the industrial base and Defense Logistics Agency-Troop Support (DLA-TS). USAMMC-K also requested and received authorization to access a portion of wartime stocks.
Early anticipatory work to set the theater was a key component of our ability to stay ahead of the requirements. Had this team waited until COVID-19 cases started appearing in South Korea in late January, they would have been competing with many others for the same limited supply of medical materiel.
Much like USFK has done for the Army, USAMMC-K led the way in this fight. They used solid forecasting and honed instincts to ensure the right amount of the right materiel was in the pipeline and synced with DLA-TS to support the USFK commander’s operational requirements. In parallel, our team in Europe started the necessary movement to set the theater for U.S. European Command (USEUCOM), U.S. Central Command (USCENTCOM), and U.S. Africa Command (USAFRICOM).
Both USAMMC-K and USAMMC-E serve as theater lead agents for medical materiel (TLAMMs). Designated by the joint staff, these units create efficiency and serve as the theater distribution center for medical logistics during peacetime or upon transition to hostilities in their respective theaters. USAMMC-K serves as the TLAMM for Korea and USFK. USAMMC-E serves as the TLAMM for USEUCOM, USCENTCOM, and USAFRICOM. In the continental U.S., AMLC does not serve as the TLAMM. That role is designated to U.S. Army Medical Command. Regardless of designation, AMLC’s mission is to project materiel and capability to Army forces and the joint force, as required, and its growing capacity was on full display as the COVID-19 fight reached the homeland.
Medical Materiel Distribution. As cases began to increase within the U.S., AMLC was called to provide defense support of civil authorities (DSCA) through U.S. Army North (USARNORTH) as the joint forces land component command for U.S. Northern Command (USNORTHCOM).
By March, AMLC teams distributed medical supplies for three Army hospital centers supporting New York and Washington states, two of the states initially hit hardest by COVID-19. This mission included support to Army medical professionals from 531st Hospital Center, from Fort Campbell, Kentucky, 627th Hospital, from Fort Carson, Colorado, and 9th Hospital Center, from Fort Hood, Texas. AMLC’s unit deployment packages (UDPs) included potency and dated items tailored to each medical team’s needs. These included everything from syringes and suction tubes to blood products and oxygen, intended to bolster these units’ capabilities to deliver health care support where it was needed most.
We also worked closely with U.S. Forces Command (FORSCOM), theater sustainment commands (TSCs), and expeditionary sustainment commands (ESCs) to identify medical materiel and equipment gaps and ways to reduce shortages. Partnering with the materiel developers at U.S. Army Medical Materiel Development Activity, AMLC teams dug into depot-level inventories and warehouses to pull medical devices in most critical need. AMLC biomedical equipment specialists at the medical maintenance operations divisions (MMODs) worked quickly to assess the devices and prioritize calibration and repair of ventilators, oxygen generators, suction apparatus, and patient monitors.
In Europe, USAMMC-E leadership created a PPE materiel warehouse to support their three combatant commands’ missions. This effort increased the speed and efficiency of distributing PPE. Through June, this project was responsible for the storage and distribution of over 1 million pounds of CL VIII (medical) materiel in response to the COVID-19 pandemic.
In Korea, teams continued to support the global response effort to COVID-19 on multiple fronts. Through June, USAMMC-K issued over $450,000 worth of PPE and over 130,000 specimen collection kits to support USFK and USAMMC-E’s efforts, in support of USEUCOM, USCENTCOM, and USAFRICOM.
Leveraging Army Prepositioned Stocks. Meanwhile, AMLC continued to provide worldwide support to the pandemic response. In Europe, AMLC issued medical materiel out of Army prepositioned stocks—including ventilators, patient monitors and hospital beds—for use at Landstuhl Regional Medical Center, Germany. We also issued field hospital sets to several locations overseas, including the USCENTCOM area of operations, to augment Army capacity across the globe. AMLC prepositioned ventilators and ventilator resupply kits at various locations stateside for USNORTHCOM.
Integration Across the Army Sustainment Enterprise. Medical logistics is a lean specialty. In order to accomplish the mission, especially during COVID-19, Army Medicine had to integrate and synchronize efforts with others. This is where the creation of AMLC and its nesting as a major subordinate command under AMC really paid off.
For example, at USAMMC-E, our team shifted to 24/7 operations, increased customer support by more than 75% from January through June, and processed more than 1 million pounds of PPE and COVID-19 test kits. To meet surge capability requirements and reduce customer wait time and improve operations, we rapidly integrated additional Soldiers from multiple units, led by 21st TSC.
Inside AMC, integration and synchronization with the other direct reporting units and teammates helped AMLC mitigate shortfalls and gaps with storage, manpower, and distribution capability while providing unique capabilities in support of the medical maintenance mission. Our close partnership with Army Sustainment Command provided mission-essential manpower to rapidly issue medical equipment and supplies from medical APS worldwide, especially in areas where we could not physically send our medical logistics support teams (MLSTs) due to travel limitations.
Collaborating with U.S. Army Tank-automotive and Armaments Command (TACOM), at Sierra Army Depot, in Herlong, California, provided essential mission support to store and distribute COVID-19 test kits and PPE. TACOM and Rock Island Arsenal’s Joint Manufacturing and Technology Center employed their additive manufacturing capability to print three different parts—totaling over 150 pieces—for ventilators that AMLC maintainers used to refurbish and rebuild ventilators at our MMODs.
Communications-Electronics Command (CECOM) produced power supplies for those same ventilators, extending the supply chain. Surface Deployment and Distribution Command (SDDC) enabled us to posture critical ventilators for shipment, and supported the repositioning of UDPs in support of FORSCOM hospitals. Logistics Data Analysis Center helped organize and integrate our data into a common operating picture for senior Army logisticians and Army senior leaders. Overall, this was an incredible team effort that high-lighted the vision of creating AMLC and aligning it within AMC.
Collaboration with Joint Partners and Key Stakeholders. The Army rarely deploys alone, so coordination among all military services and interoperability with allied partners is essential. AMLC routinely coordinates directly with:
- DLA-TS for management of strategic medical materiel acquisition, distribution, and readiness programs
- AFC and USAMRDC to integrate logistics life-cycle management functions with program management functions and activities for development and delivery of sustainable materiel solutions
- DHA in its execution of defense medical logistics programs and shared services, such as materiel standardization and data management
- Defense Medical Logistics Enterprise and U.S. Army Medical Command /Office of the Surgeon General for collaborative forums and initiatives to promote materiel standardization and joint interoperability
- Army service component commands and combatant commands for development and execution of MEDLOG portion of health service support plans
- FORSCOM and its subordinate commands for medical force modernization and readiness, and installation-level medical supply, maintenance, and optical fabrication
During the fight against COVID-19, these established relationships became invaluable. Multiple resources, from hand sanitizer to test kits to PPE, quickly became in short supply. AMLC participated in joint priority allocation boards and collaborated with stakeholders to orchestrate the deliberate, needs-based delivery of medical materiel.
Rebuilding Capacity. Sustaining any long fight takes forward-thinking strategy and sustaining the fight against COVID-19 is no different. To date, AMLC has established enhanced processes to rapidly replenish potency and dated items, as well as expendables such as tubing on ventilators. A key part of this sustainment effort includes contracts with vendors and DLA-TS that gives us procurement speed and flexibility.
We’ve also had to think creatively about how we field and sustain items. Traditionally, we are a travel team. Our model called for us to physically go to a unit or deployment location, projecting our MLSTs to inventory and issue items. In a contested environment, COVID-19 travel restrictions forced us to change our playbook.
We hosted virtual training seminars online and produced maintenance tip sheets for many medical devices to boil down the most critical details for troubleshooting these items. We’re sharing these pro-ducts directly with medical maintainers and units around the globe. Our website also serves as a repository for the tip sheets and dozens of frequently asked questions to support the medical maintenance community.
We implemented ‘telemaintenance’ virtually connecting maintainers with units in the field to assist with troubleshooting and repairing complicated medical devices. While it’s only in its early stages, we believe this effort will have an incredible impact on our ability to extend our resources and maximize the expertise inherent in the MMODs.
AMLC: The Way Ahead
As we move forward in our development as a command, we are applying key reforms in five specific areas to address challenges, close gaps, and exploit opportunities.
Visibility and Integration. As a commodity, Class VIII (medical) supply has long struggled with end-to-end visibility and integration into GCSS-Army, the Army’s primary enterprise resource planning system. COVID-19 did not identify this issue; it further highlighted the gap and the inability to see ourselves. The good news is that we are attacking the problem and beginning to integrate Class VIII (medical) supply into GCSS-Army, starting with our Army prepositioned stocks, so it can be managed like other commodities and provide better visibility for unit leadership. With the leadership and partnership of U.S. Army Combined Arms Support Command (CASCOM) and CECOM, we will soon integrate Class VIII (medical) supply in GCSS-Army from the tactical level back to the industrial base. This will start in 4th quarter, FY 20, with completion and full integration by the end of FY 22.
Additionally, AMLC is also partnered with CASCOM and U.S. Army Medical Center of Excellence (MEDCoE) to expand the integration of medical logistics into the sustainment enterprise, ranging across the battlefield from the SSA to the close area. Work and planning is now underway, with implementation of force design updates starting no later than FY 23.
Distribution. AMLC is responsible for operational medical logistics; however, medical logistics at stateside military treatment facilities (MTFs) remains under DHA. Nevertheless, we must work together in order to avoid procurement fratricide and inefficiency. We are currently developing a new and revised concept of support that better integrates Class VIII (medical) distribution across the entire enterprise and ensures DHA MTFs remain an alternate source of supply for deploying units that need to access on-hand materiel from these locations.
Planning and Responsiveness. AMLC is improving its demand planning capability by hiring demand planners, determining readiness drivers, and leveraging DLA’s medical contingency requirements workflow to provide more accurate information to DLA’s medical contin-gency file, which identifies joint, time-phased, “go-to-war” medical materiel requirements. Our overall purpose is to send an early, accurate demand signal to the industrial base so it can surge, when necessary, to meet the need.
AMLC is working with DLA-TS and prioritizing the Army’s medical materiel requirements, sending the right signals to the industrial base to tailor the stocks with depth starting at the strategic level. This will eventually improve synergy of stocks and depth across the operating force.
Management and Sustainment. The future of AMLC will see it develop into a life cycle management command (LCMC) with item managers, logistics assistance representatives, national-level purchasing division, and expert senior command representatives that are able to provide direct support at the corps and installation levels. Working collaboratively with program managers and materiel developers at USAMRDC, we must improve Class VIII (medical) materiel management and sustainment plans from inception through divestment or modernization.
Capability and Capacity. Perhaps the biggest lesson learned from COVID-19 is in the way it has challenged our previously held assumptions and thought processes. Traditionally, Army medical logistics planned medical materiel requirements for combat casualties and injuries or illnesses most common for service members in a battlefield environment. Understandably, the type of medical materiel required for trauma (surgical and blood) is very different from that which is required for a pandemic (ventilators and oxygen generating equipment). The burn rate, or speed at which the items are consumed, is also different. In a combat care environment, only the health care providers wear PPE. In a pandemic, the consumption rate for PPE is much higher because non-providers require it.
COVID-19 has taught us to rethink some of the planning factors for replenishment sets. We have been working closely with clinicians and pharmacists to develop new project sets to support rapid, flexible replenishment of single-use parts, such as tubing and valves, on medical devices such as ventilators. This change in thinking will not only help us better support the current pandemic response, but also shape how we sustain future combat operations.
Final Thoughts
While AMLC’s transformation was not started by COVID-19, what we have learned from supporting this fight has greatly shaped our reform efforts. Through every challenge, we have sought to find opportunities that generate readiness faster and more efficiently. In many ways, the COVID-19 support mission has provided AMLC with valuable insight of what will be required to meet the size and exponential medical materiel demand in a multi-domain environment, including LSCO.
The contested environment AMLC operates in today is a preview of the future. A huge sports fan, I often distill the challenges of the day to our commanders and staff worldwide by explaining, “there are no lay-ups.” Everything is contested on the battlefield. The road to deliver the right effects at the right time is often bumpy and we must be aggressive—but we are on our way.
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Brig. Gen. Michael B. Lalor serves as the commander of Army Medical Logistics Command, a worldwide organization headquartered at Fort Detrick, Maryland. Lalor has more than 25 years of service that include a variety of operational experiences, troop leadership, and staff assignments. He completed his undergraduate studies at University of Scranton. He has earned master’s degrees from Louisiana State University; the School of Advanced Military Studies, Command and General Staff College; and the U.S. Army War College.
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This article was published in the October-December 2020 issue of Army Sustainment.
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