COVID-19 Response
Spc. Daniel Fields, assigned to the 9th Hospital Center, takes a patient’s blood pressure reading in the Javits New York Medical Station (JNYMS). Soldiers, along with Department of Health and Human Services personnel and other federal, state and local agencies began operating a field hospital out of the JNYMS March 30 to care for non-COVID-19 patients in an effort to relieve the burden on local hospitals, allowing them to focus on coronavirus patients. (Photo Credit: Photo by Navy Chief Mass Communication Specialist Barry Riley) VIEW ORIGINAL

On April 9, 13th Expeditionary Sustainment Command (13st ESC) plunged into the COVID-19 fight. For weeks, the commander and staff monitored the developing global pandemic that was starting to take hold in the continental United States (CONUS). Up until two weeks prior, the staff was anticipating a deployment to Poland in support of the DEFENDER-Europe 2020 training exercise. About a quarter of the staff was already forward, including the support operations officer, the G-4, and the G-3 future operations chief. They were now on lockdown in Poland, awaiting a timeline for redeployment and quarantine. Additionally, all of 13th ESC’s mission command systems were in Poland.

13th ESC faced a difficult scenario. Compounding their organizational and mission command challenges, the federal response to COVID-19 was led by the Federal Emergency Management Agency (FEMA). This would mean that many systems, and much sustainment decision making, would occur outside of 13th ESC’s control. Despite significant organizational and interagency challenges, 13th ESC leveraged the military decision-making process (MDMP) and adept execution of mission command to provide sustainment to medical operations that would save American lives.

In the hours and days following the deployment order from U.S. Army Forces Command, 13th ESC pushed teams to Dallas, Texas; Detroit, Michigan; and Baton Rouge, Louisiana. Liaison officers also launched immediately to 377th Theater Sustainment Command headquarters in New Orleans and to the Task Force-Center headquarters in Battle Creek, Michigan. 13th ESC was assigned under operational control of 377th Theater Sustainment Command with a direct-support relationship to 46th Military Police Command, which established Task Force-Center under U.S. Army North, Joint Forces Land Component Command.

Concept Development

This situation was unprecedented for 13th ESC and the command needed a plan. Like any military operation, this required the staff to execute the MDMP. Mission analysis was the crucial first step to identifying the nuanced challenge that the team would face. There were few facts available and many assumptions were required just to start planning a course of action to sustain the fight in the area of operations, which encompassed the states of Arkansas, Louisiana, Texas, New Mexico, Oklahoma, Kansas, Nebraska, Missouri, Ohio, Michigan, Indiana, Illinois, Wisconsin, Minnesota, and Iowa.

The first major assumption was that 13th ESC would need to sustain multiple medical operations spread across the central part of the U.S. However, the command had little experience deploying teams smaller than an early entry command post of 50 or more sustainment professionals to a contingency operation. This was not a viable solution when the joint operations area stretched from the Gulf of Mexico to the Canadian border. The commander and staff realized that the economy of force would need to be balanced across the tyranny of distance to properly sustain the fight against the virus.

Analysis of the higher headquarters’ orders, and of sustainment operations by 3rd ESC occurring on the east coast, also indicated that 13th ESC would have to rapidly assess gaps in civilian and military sustainment infrastructure when they arrived at their mission location. Next, they had to be able to establish sustainment operations. Their key tasks, once assessment was complete, were to establish effective supply point distribution and to build stockage levels of required supplies to sustain medical operations.

The staff also realized that their teams would deploy into a whole-of-government environment where Department of Defense (DoD) forces would not be the lead federal agency. The professionals from FEMA, as well as multiple state and local response agencies, were leading local responses. FEMA operationalizes their support through a mission assignment process that directs other federal agencies to support state requirements, as necessary. The mission assignments were often coordinated so that key commodities such as Class VIII (medical materiel) were sourced by state or local authorities rather than through the Defense Logistics Agency. This arrangement had the potential to create issues because of local or state inability to source material and a lack of visibility that would have been provided by the military supply chain systems of record.

Active duty troops were not the only personnel wearing military uniforms. Before Title X forces arrived, Title 32 National Guard forces were already responding in many states. However, until dual status commanders were assigned in each state, it was difficult to coordinate Title 32 and Title X operations. Additionally, the preponderance of Title X forces came from Navy Expeditionary Medical Facilities and Urban Augmentation Task Forces which came in with very little equipment and relied heavily on both federal and local support to sustain operations.

Further complicating operations was the unpredictable nature of COVID-19. From a planning perspective, the various rates of the spread of the disease across different states made planning for future operations difficult. The mission assignment process that relied on state requests, and not necessarily the greatest need, also complicated predicting exactly where 13th ESC would have to send troops.

13th ESC also faced a novel and lethal threat that complicated force health protection. In a pandemic response plan, it is imperative to consider force health protection as an essential task in order to ensure mission execution. At the time that 13th ESC was called upon for support, there was, and remains, a significant lack of understanding of the disease. This differed from a typical deployment where theater entry guidance is specifically outlined by the combatant command based on significant data on longstanding medical concerns. The 13th ESC command surgeon pointed out that it was necessary to individually assess each Soldier’s risk of developing complications should he or she become infected with COVID-19; and then make a recommendation on their ability to support operations in areas affected by the virus.

Lastly, the potential for asymptomatic spread and the uncertain extent to which it was occurring was a limiting factor for personnel availability. Consideration had to be taken for the unknown risk of exposure while operating in areas with high rates of disease spread and potentially having 13th ESC personnel placing further strain on an already stressed medical infrastructure.

As a result of the mission analysis—much of which was conducted in a distributed fashion from home offices to prevent outbreak within the headquarters—the commander determined that the unit needed to provide a rapidly deployable and flexible sustainment capability. Given the sometimes difficult nature of predicting results of FEMA’s mission assignment process, planners realized that 13th ESC would have to be ready to provide sustainment support in multiple locations. This called for small multifunctional teams that could rapidly deploy and bring significant sustainment cap-ability. Forward assessment and sustainment teams (FAST) were born through mission analysis and the course of action development process to fill this need.

The mission analysis process identified likely capabilities that the FASTs needed, organically. First, FASTs must be problem-solving organizations. They would need to be made up of experienced leaders that could work outside their area of expertise by leveraging creativity and perseverance. Field grade officers were hand selected to lead the teams that were staffed with a complement of senior noncommissioned officers, warrant officers, and talented junior officers.

More specifically, the FASTs would first need to conduct joint reception, staging, onward movement, and integration of personnel supporting the DoD COVID-19 response. This process would require personnel experienced in human resources management as well as logisticians and leaders who could coordinate movement of personnel from serial ports of debarkation to their work locations.

The FASTs would also require a skilled commodity manager who could order and track any supplies required to sustain medical operations. The ESC could not send an expert in every commodity, as the distribution management center would quickly run out of personnel. The teams needed to be small and responsive to economize force and maintain rapid deployability.

As mission analysis progressed, it became clear that operational contracting support (OCS) would be critical to sustaining medical operations. Medical care was being provided in urban centers that were often significantly removed from base support installations (BSI) that were initially designated to provide life support and other sustainment needs. OCS teamed with a contingency contracting officer (CCO) and a contracting officer representative (COR) to mitigate some of the issues created by the distance between BSIs and treatment locations.

FAST Deployment

With the concept developed, the command prepared to deploy their teams. The FASTs deployed and sustained medical operations in Detroit, Dallas, New Orleans, and Baton Rouge. A team also executed a site assessment in Chicago, but ultimately no Title X forces were committed there.

The whole-of-government nature proved challenging and took FASTs out of the familiar DoD-led realm of operations. Dual status commanders (DSC)—commanders with both federal and state authority—were critical to coordinating Title X and Title 32 operations. They smoothed out issues often caused by the mission assignment process and other friction between federal and state agencies. However, dual status commanders were not always appointed throughout the entirety of the FASTs’ operations.

Regardless of whether a DSC was appointed, FAST leadership took on collaborative relationships with their civilian counterparts to informally build interoperability with state and local responders. FASTs took the time to learn the civilian processes at the Detroit alternate care facility (ACF) warehouses and then use their expertise in military supply chain management to consult on improvements to processes and procedures. This sort of collaboration had the dual benefits of enhancing Class VIII (medical materiel) efficiency and increasing the FAST’s understanding of stockage levels and the supply chain of critical medical material. FAST experts were able to achieve mission success without taking over the civilian-run portions of sustainment infrastructure.

The contracting team was also critical to the effort. Having OCS personnel, CORs, and CCOs collaborating—locally and remotely—made sustaining operations executable at the U.S. Army Corps of Engineers-constructed ACFs in the hearts of metropolitan areas. These ACFs were often built within existing infrastructure, such as convention centers or schools. They were sometimes hours away from the designated BSI that DoD had originally designated to provide life support. The contracting team was able to contract for food and lodging in close proximity to the ACFs that would have otherwise severely hindered operations if not available.


Few units plan for the complications presented to 13th ESC in March and April of 2020. While a sizable advanced party was already in Poland preparing for the largest Army training exercise in Europe in a generation, the remaining staff had to rapidly switch focus to a very real threat at home. 13th ESC staff leveraged the MDMP to create a course of action and then executed it, relying on the principles of mission command, to ensure that medical units from throughout CONUS could rapidly deploy and work to save American lives. When the next disaster strikes, 13th ESC will be ready to adapt, but with the experience and lessons learned driving an even more efficient and effective response.


Lt. Col. Jason Book currently serves as commander of the 25th Transportation Battalion, 19th Expeditionary Sustainment Command (ESC). He has a degree in political science and completed Command and General Staff College.

Maj. John Burns currently serves as G-9, 13th ESC, Fort Hood, Texas. He holds a Master of Business Administration from Wake Forest University and a Bachelor of Science in Political Science from the United States Military Academy at West Point. He has commanded at the company level and has significant experience leading joint and multinational humanitarian assistance and disaster response capacity building operations across the U.S. Indo-Pacific Command area of operations.

Maj. Kristin Fiala currently serves as command surgeon for 13th Expeditionary Sustainment Command, Fort Hood, Texas. She earned her medical degree as a graduate of Uniformed Services University of the Health Sciences and completed her emergency medicine residency at San Antonio Military Medical Center. She is a board certified emergency physician and previously worked at Madigan Army Medical Center, Joint Base San Antonio, Texas where she served as assistant program director for emergency medicine residency.

Maj. Hector Garcia has more than 18 years military service as both an officer and enlisted Soldier). He currently serves as comptroller, 13th Expeditionary Sustainment Command. Garcia holds a Bachelor of Science in Chemistry.

Capt. Jaime L. Welsh currently serves as a force protection officer for 13th Expeditionary Sustainment Command, Fort Hood, Texas. She holds a Bachelor in Business Administration and Political Science from Arizona State University. She is currently pursuing a master’s degree in international relations from Webster University.


This article was published in the October-December 2020 issue of Army Sustainment.


Army Sustainment homepage

The Current issue of Army Sustainment in pdf format

Current Army Sustainment Online Articles

Connect with Army Sustainment on LinkedIn

Connect with Army Sustainment on Facebook