The 549th Hospital Center conducts a change of command inventory of one of its surgical medical assemblages at Camp Humphreys, South Korea, July 1, 2022.
The 549th Hospital Center conducts a change of command inventory of one of its surgical medical assemblages at Camp Humphreys, South Korea, July 1, 2022. (Photo Credit: Chief Warrant Officer 4 Kevin O’Reilly) VIEW ORIGINAL

Before the fielding of the Global Combat Support System — Army (GCSS-Army), the medical logistics community fielded medical technology for the Army utilizing the medical assemblage construct without developing line item numbers (LINs). This construct negated the ability to populate authorizations on the modified table of organization and equipment (MTOE) or to cultivate the maintenance master data file (MMDF), rendering maintenance and property management within a multitude of standard Army logistics management systems impossible to use following regulatory guidance and good business sense for many decades. In these situations, medical maintainers and customers often viewed this equipment as buried or hidden in the set.

To overcome this master data gap, the medical equipment maintenance community developed an offline MMDF referred to as the MMDF-plus to enable legacy maintenance management systems such as the Standard Army Maintenance System (SAMS) or the unit-level logistics system — ground. The method was to create a dummy LIN for each piece of medical equipment, manually insert the dummy LIN into the Logistics Support Activity’s (LOGSA’s) flat-file standard MMDF found on their website, distribute the MMDF-plus to the rest of the medical equipment maintenance community via email, then upload the MMDF-plus into each SAMS system. This methodology successfully allowed medical equipment maintenance to occur using standard Army maintenance systems. However, numerous MMDF-plus versions meandering about the enterprise for several decades caused data consistency issues within LOGSA’s various online management products. Unfortunately, there was no workaround for property management beyond the medical assemblage resulting in medical equipment either not being placed on the property book or being assessed as excess.

Toward the end of the GCSS-Army development and the beginning of its fielding, the medical equipment maintenance community realized in consultation with the Combined Arms Support Command that the MMDF-plus would not be an effective workaround to enable GCSS-Army functionality. The preferred solution was the medical equipment maintenance community engaging in effective business process reengineering initiatives to adjust the medical business to meet GCSS-Army’s best business process, in this case, developing and cultivating an effective LIN management program to populate the enterprise’s master data construct in coordination with the program manager of medical devices.

Since the medical logistics system developed a disciplined process to develop and cultivate LINs for medical equipment, numerous maintenance functions have been realized within GCSS-Army without the need for workarounds and are seen as a great success to the medical equipment maintenance community responsibilities, such as the scheduling of services, work order management, and shop operations of medical equipment. Moreover, critical property functions such as medical equipment fielding utilizing GCSS-Army’s post-good receipt now possess permanent document numbers for historical preservation tied to MTOE authorization, ultimately increasing accountability, visibility, and accuracy. Additionally, adopting LIN management to account for medical equipment enabled functions within the Army Enterprise Systems Integration Program platform. Most notably, the Decision Support Tool now possesses the ability to manage lateral transfers and unserviceable turn-in dispositions of medical equipment, and the medical materiel quality control program is now tied to an equipment record within the Modification Management Information System, significantly increasing quality control management for medical technology and materiel, greatly improving patient safety. Moreover, the medical logistics community has embraced the bill of materiel (BOM) process within GCSS-Army to itemize its medical assemblages without the need to cross reference components within other standalone medical logistics-centric systems such as the Medical Materiel Information Portal (MMIP).

Since the medical logistics community has embraced BOM, LIN, and MTOE development to enable Army systems, is the medical assemblage still relevant?

Even today, the medical assemblage is best described as a hodgepodge, often vast sets of durable, nonexpendable, and expendable material that, in theory, represent particular medical uses, such as surgical, radiology, pharmacy, or ground evacuation. However, many medical devices still need an MTOE authorization, resulting in medical equipment being assessed as excess or susceptible to double counting.

With this said, it is difficult to visualize the make-up of a medical assemblage, even for the medical professional. Thus, a notional Mobile Protected Firepower assemblage can articulate this obscure method. This assemblage could contain a variety and quantity of vehicles, such as the Abrams tank and Bradley fighting vehicle, along with an assortment of weapon systems and communications equipment. In order to use all the vehicles, weapons, and radios in the set, a variety of durable items like tools, antennas, and cables are needed. Additionally, there are items with expiration dates, which are tracked through lot numbers. These include various types of ammunition, batteries, fuel, and food necessary to support combat operations. A cursory review of what a notional Mobile Protective Firepower assemblage would require could easily exceed hundreds of lines of materiel with various special handling instructions making it challenging to assess shortages, readiness, and hand receipt management beyond the assemblage.

Knowledge is vital, and ambiguity is heresy. It is inconceivable that a broad group of military professionals would understand the technology that resides within the Army function or is assembled, such as aviation, armor, missile, or communications, outside of a formal, commonly understood system of accountability. Thus, the goal is to structure the Army’s systems so that knowledge management occurs effectively. Defining, issuing, reporting, and accounting for property using numerous accounting concepts, such as but not limited to associated support items of equipment (ASIOE), components of end item (COEI), basic issue items (BII), and additional authorization list (AAL), or developing a contingency LIN or unit basic load (UBL), are how the tasks of property accountability and knowledge management are achieved within complicated structures and information management systems.

Numerous tanks are not placed within a tank assemblage to revert to the notional Mobile Protected Firepower assemblage analogy. Still, they are major end items with the machine gun and radio designated as ASIOE to the tank and authorized separately on the MTOE where if any of the components to the major end item is rendered non-mission capable or missing, the functional relationship is compromised until the component is repaired or replaced. Moreover, the tank, machine gun, and radio each possess its own BII or AAL, whereas each tank and machine gun possesses its own tools, cables, and antennas. Lastly, it would be inconceivable and vastly inefficient for each notional Mobile Protected Firepower assemblage to possess a stock of fuel, batteries, food, and ammunition. To account for this materiel, the Army developed contingency LINs for difficult-to-store or cost-prohibitive materials, such as ammunition; chemical, biological, radiological, and nuclear materials; and sustenance. These predeveloped contingency LINs can be authorized during a time of need to sustain a combat operation adequately. UBLs can ensure material availability to sustain specific units or situations during peacetime or forward stationed units such as in South Korea.

By capitalizing on the recent successes of LIN development and the adoption of GCSS-Army’s BOM construct, the medical logistics community is positioned to structure medical technology into more manageable schemes. For example, the radiographic fluoroscopic medical assemblage consists of a radiographic fluoroscopic unit, anesthesia unit, oxygen generator, sevoflurane vaporizer, and many other major end items. Each piece of medical equipment should be removed from the medical assemblage in totality and designated as a major end item, and then other devices would be made ASIOE or COEI to that item. In this instance, the oxygen generator could be assessed as ASIOE, and the sevoflurane vaporizer assessed as COEI to the anesthesia unit. Like the tank analogy, each end item requires durables and expendables such as tools, pads, and leads, along with an assortment of hoses and cables, which are all placed within the broader medical assemblage, no matter its status, often requiring a clinical expert to assess the medical assemblage’s readiness. To complicate readiness assessments, Army Regulation (AR) 220-1, Army Unit Status Reporting and Force Registration — Consolidated Policies, paragraph 5-4, assesses assemblage readiness by fill rate, where if an assemblage is filled more than 90 percent, the assemblage is assessed as ready for combat. Using this logic, if a radiographic fluoroscopic medical assemblage is missing a critical component, such as the breathing circuit to the anesthesia unit, or even a major end item, such as the radiographic fluoroscopic unit itself, the medical assemblage is assessed to be more than 90 percent complete and rendered ready for combat.

The solution is to identify what components within the medical assemblage is BII or AAL to each end item, remove them from the assemblage in totality, and make them available under the end item’s LIN utilizing the BOM process within GCSS-Army. Moreover, the medical logistics community has developed a host of start-up documents for many medical devices. These documents’ data should also be incorporated into the devices’ BII or AAL construct for each end item utilizing GCSS-Army’s BOM process to ensure a complete understanding of the medical system’s capabilities.

Once major end items and their associated BII and AAL are removed from the medical assemblage, the remaining items consist largely of medical materiel possessing expiration dates, more commonly known as potency and dated items, tracked via a lot number. To account for this materiel, AR 220-1, paragraph 5-4, directs commands to manually omit these items from command reporting due to limited shelf life, cost, or difficulty in storing. A more effective way to manage such materiel is to develop medical contingency LINs or a UBL to account for it, similar to ammunition and food, where its management is more aligned to stock and not assessed as property. At this point, medical materiel would be broken down into manageable concepts and portioned into understandable schemes eliminating the need and the mystique of the medical assemblage, thus enabling knowledge management throughout the Army’s command and information technology reporting structures.

Beyond the current medical assemblage’s hodgepodge nature, the records that populate the medical assemblage construct within GCSS-Army’s BOM structure, the MMIP portal, or the various start-up documents do not match the procurement records offered by the numerous medical supply agencies that make up the broader medical logistics system. This gap exists because the Army’s medical supply system is modeled after the military treatment facility’s local business model. Each agency possesses its own catalog that is inherently different from the records used to develop the assemblage, as detailed in the article “Opinion: Conversation about the Medical Supply System,” published online in conjunction with the Summer 2022 issue of Army Sustainment. Moreover, national-level logistics tasks such as integrated product support and item management are performed by the medical customer at the tactical level to develop and cultivate local catalog records, resulting in considerable data variance between each medical catalog, as described in the article “Improving Medical Materiel Effectiveness: Tips and Strategies to Build Better Item Requests,” published in the Fall 2022 issue of Army Sustainment. To overcome this gap, it is the responsibility of the medical customer, such as the nurse, medic, or medical maintainer operating at the tactical level, to engage in qualitative analyses to reconcile records between the assemblage and the various medical supply agencies to assess and fill medical assemblage shortages.

The Army requires effective knowledge management of its medical technology and capabilities to enable standard Army property accountability and reporting principles. The inventory and replenishment of medical capabilities should align with standard supply management principles to achieve a comparable level of capability enjoyed by the rest of the Army.

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Chief Warrant Officer 4 Kevin O’Reilly is the brigade maintenance officer for the 65th Medical Brigade. He deployed to Iraq in 2003 with the 82nd Airborne Division, to Iraq in 2005 with the 44th Medical Brigade, and to Afghanistan in 2010 with the 1st Medical Brigade. He was chief of the Equipment Management Branch at Kimbrough Ambulatory Care Center in Landstuhl, Germany. He has a master’s in data analytics and a doctorate in business from The University of the Incarnate Word, Texas.

Chief Warrant Officer 3 Dae Kim is the 8th Army asset visibility officer. He deployed to the United Arab Emirates in 2010 with the 108th Air Defense Artillery Brigade, to Iraq in 2012 with the U.S. Army Security Assistance Command, and to Iraq in 2017 with the 10th Mountain Division. He has a Master of Business Administration from Fayetteville State University, North Carolina.

Warrant Officer Isaiah Williams is the property book officer for the 65th Medical Brigade. He deployed to Afghanistan and Kuwait with the 101st Division, 101st Sustainment Brigade, and 3rd Infantry Division, 3rd Division Sustainment Brigade. He has a bachelor’s degree in business administration with a concentration in business analysis from American Military University, West Virginia. He has earned his Certified Logistics Associate, Certified Logistics Technician, and Demonstrated Logistician certificates.

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This article was published in the Summer 2023 issue of Army Sustainment.

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