Medical Materiel Management in Overseas Commands: 1962-66

After the reorganization of the Department of the Army headquarters in 1962, supply activities in overseas commands were consolidated within supply agencies organized on a functional basis. Medical supply was incorporated within the functional systems although in each instance the command surgeon objected to the change, contending that there would be a serious deterioration in support to medical facilities and medical units.

Under the new system, supply management activities for USARPAC were, centralized at the Inventory Control Point in Hawaii. The Inventory Control Point was responsible for controlling of all requisitioning of supplies within the command and for the centralized maintenance of records on the status of supplies for the Eighth U.S. Army in Korea as well as for US Army units in Japan, Hawaii, and Okinawa.

Medical Materiel Support of the Troop Buildup

The disadvantages in treating medical materiel as just another category of supply items were quickly and unequivocally exposed in 1965 when Army Medical materiel units were faced with an expanded support mission the build up of US Army troops in Vietnam. One of the most significant supply problems at the onset of the buildup was a lack of adequate medical supply personnel in the theater as well as the lack of continuity in key positions resulting from the 12-month Vietnam tour of duty.

The 8th Field Hospital at Nha Trang was responsible for medical supply distribution to the medical units in Vietnam. This unit was augmented by a small staff which was not adequate to provide the necessary control over the tremendous requirements being generated practically overnight. This situation was compounded by the protracted delay in deployment of the 32d (Field Army) Medical Depot which, although "ready" in July 1965, was not deployed until late October. One supply detachment had been deployed in July and another shortly thereafter,

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but these detachments did not have a sufficient depth to manage supply activities in a theater of operations the size of Vietnam.

With the escalation of US efforts in Vietnam, greater dependence was placed upon the Ryukyu islands as the offshore base to support units in Vietnam. A supply detachment was deployed to Okinawa in August, and in November 1965, the 70th Medical Depot was deployed to augment and expand the operation of the medical depot in Okinawa.

The Surgeon General, handicapped by insufficient strength and control of medical supply, coordinated with CINCPAC to establish a system of automatic shipments of medical materiel to Vietnam. These shipments, initiated in July 1965, were based upon schedules developed to support forces which were deployed from the continental United States to Vietnam. The materiel shipped consisted primarily of medical resupply sets and later, after their development, included optical resupply sets. The automatic supply support system continued for a period of approximately 10 months, with peakloads of resupply occurring from November 1965 through January 1966. This system, although only a temporary measure, was not so successful as anticipated. Delays in shipment from CONUS ports and in off-loading procedures at Vietnam facilities and the splitting of the medical resupply sets into various shipments on board vessels were the major difficulties experienced.

Investigation of Malfunctions in the Medical Supply System

By mid-1965, the Army medical materiel supply system was close to a complete breakdown because of the lack of qualified medical logistics personnel in Vietnam, the shortcomings of the medical resupply system related previously, and the inability of a centralized supply management activity in Hawaii to meet the medical materiel demands in Vietnam. In November 1965, the Vice Chief of Staff directed The Surgeon General to investigate and recommend appropriate measures to resolve these difficulties and end the shortages occurring in Vietnam and other subordinate commands within USARPAC. A representative of The Surgeon General investigated and found that the Inventory Control Point, USARPAC, could not provide pertinent data on the medical supply situation within USARPAC.. Consequently, requisitioning objectives were being computed without the full knowledge of subordinate command conditions, environment, or professional requirements. In fact to insure adequacy of objectives, subordinate commands had to review their records constantly and thus engage in duplication of effort. The investigation revealed that the Inventory Control Point provided little assistance to the subordinate commands or to the surgeons who were responsible for the health of troops in those subordinate commands. The report indicated that the medical commodity group was not large enough

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to require management within a centralized and functionalized system; however, it, was important enough to require extraordinary management under the direction of the subordinate command surgeons to support peacetime and wartime operations.

The status of medical supply in each of the subordinate commands disclosed large numbers of medical items with zero balances (complete lack of stock). This situation necessitated submitting huge numbers of high priority requisitions to CONUS to obtain vitally needed stocks rapidly.

The report further indicated that the rapid buildup of troop strength in Vietnam had placed a serious drain on available medical materiel stocks in the DSA (Defense Supply Agency) system. For example, of the 6,000 to 7,000 medical items on hand, DSA was out of stock on about 1,500 items and these were articles needed in the field to administer first aid. Delays in shipments and out-of-stock conditions became more serious as the buildup progressed. In Okinawa, the offshore support base, for example, zero balances rose from 16 percent in December 1964, to 28 percent in March 1965. Unfortunately, The Surgeon General was not fully informed of the deficiencies until complaints were received from Vietnam and other USARPAC areas.

While the inadequacies and malfunctioning of the supply system were being investigated, a concept study advocating a bold, new approach to the problem of the administrative support of a theater army, entitled "TASTA-70 (The Administrative Support-Theater Army 1965-70)," was under study in the Office of the Chief of Staff. Commenting on the study, The Surgeon General recommended that the Army Medical Department be given control over medical depots and medical inventory control activities. Approved by the Chief, of Staff, The Surgeon General's recommendation was incorporated in the TASTA-70 concept and provided the basis for the realignment of medical supply activities under the command surgeons in overseas commands which began in the summer of 1966.

The Surgeon General's Plan

During the summer of 1966, the medical supply system supporting military activities in Vietnam was realigned by shifting the responsibility for determining requisition objectives for stocked medical items and for ordering replenishment supplies from the Inventory Control Point to the US Army Medical Depot in the Ryukyu Islands. This depot, in turn, ordered replenishment supplies directly from the Defense Personnel Support Center through the USAMMA (US Army Medical Materiel Agency), Phoenixville, Pa.

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The effect of this realignment was the routing of all requisitions for medical materiel from subordinate commands within USARPAC to the USAMMA, where the order was recorded and reviewed before it was transmitted to the Defense Personnel Support Center, the agency of the Defense Supply Agency which handled medical materiel. Thus, USAMMA was able to maintain control and "follow-up" on each requisition to insure that the requesting agency was kept fully informed on the status of its order and, when necessary, to expedite the delivery of urgently needed items. USAMMA also prepared and maintained a catalog of nonstandard items for the Pacific area. This catalog facilitated requisitioning of items that were not in the standard supply system and permitted the accumulation of data on worldwide usage of nonstandard items to determine the need for type classification actions.

In 1967, the medical supply section within USARPAC, the Materiel Management Agency, was transferred to the Chief Surgeon, USARPAC, thus completing the shift of all medical supply activities in the Pacific command to medical channels. After this transfer, the Chief Surgeon, USARPAC, was responsible for directing all medical supply functions within the command. In each subordinate command, medical supply responsibilities were, assigned to medical commanders and surgeons; for example, in Vietnam, the Surgeon, USARV, was responsible for medical supply functions to include the operations of the 32d Medical Depot, and the operation of the US Army Medical Depot, Ryukyu Islands, was a responsibility of the US Army Medical Center, Ryukyu Islands. Similarly, the US Army Medical Command, Japan, directed the functions of the 504th Medical, Depot; the 6th Medical Depot in Korea was assigned as a function of the Surgeon, Eighth US Army; and medical supply activities in Hawaii were incorporated within the structure of Tripler Army Medical Center.

As a result of this assignment of medical materiel management the Okinawa depot expanded in size and responsibilities. The depot ultimately supported US Army units in Vietnam and Thailand; the Armed Forces of Vietnam, Thailand, and Laos; and AID (Agency for International Development) activities in Southeast Asia, while also supplying military customers on the Ryukyu Islands. The amount of depot sales to customers rose from $28.5 million in fiscal year 1967 to $64 million in fiscal year 1968 and peaked at $71.5 million in fiscal year 1969. The depot satisfied over 85 percent of the demands for stocked items during fiscal year 1968. The depot also provided optical and medical equipment maintenance support to all areas which it supplied.

In Vietnam, the 32d Medical Depot, which had deployed in October 1965 and which received its medical materiel support from the Okinawa

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depot, provided medical materiel for units of the US, Army and the Armed Forces of Korea, the Philippines, Australia, and New Zealand, operating in Vietnam. During fiscal year 1968, for example, the 32d Medical Depot issued about $30 million of medical materiel in Vietnam and filled more than 85 percent of all requisitions submitted by medical units. Shipments of medical supplies increased from 482 short tons per month in the first quarter of fiscal year 1968 to 932 short tons per month in the third quarter. The depot's functions included the fabrication of single-vision spectacles- in fiscal year 1970 alone the depot produced 170,279 pairs- and the maintenance and repair of medical equipment of supported units throughout Vietnam. The, depot operated through five locations (four advance depots and a base depot at Cam Ranh Bay).

Despite chronic shortages of personnel and equipment, the 32d Medical Depot continued to fulfill its mission in a superb manner. By 1970, the medical supply support had reached an operational plateau as medical units and facilities received a routine replenishment of medical supplies. The Army Medical Depot, Ryukyu Islands, also continued to provide replenishment supplies to the Vietnamese Armed Forces, and military assistance supplies for Thailand and Laos forces, and for AID activities in Vietnam, Thailand, and Laos. Medical supplies valued at $71.5 million were distributed through this depot during the fiscal year.

The improvement of medical support in Vietnam was based on the excellent support rendered to the 32d Medical Depot by the U.S. Army Medical Depot, Okinawa, and in-country procedural, organizational, and facility improvement. The depot installed the NCR (National Cash Register Co.) 500 computer system to mechanize stock control and inventory management at the base depot in Cam Ranh Bay and at two advance depots in Long Binh and Qui Nhon in 1967. By 1968, it was apparent that the NCR 500 computers were not adequate to provide the data necessary for decision making, plot supply trends, forecast trouble areas, or program financial inventory data. The depot therefore developed its own programs, borrowed computer time on an IBM (International Business Machines) 360 computer system in Saigon, and produced the information necessary to operate effectively in an environment that was rapidly becoming increasingly management and cost conscious.

By the fall of 1968, the 32d Medical Depot produced the first theater stock status report. The report was, developed by converting data from the NCR 500 computer system to cards which were processed in the IBM 360 system. By the spring of 1969, additional advances had been made in the automation of medical materiel recordkeeping. These advances included the preparation of theater excess reports, financial inven-

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tory feeder data, due in and due out reconciliation reports, order and shipping time studies, and interdepot redistribution of assets studies. In light of these achievements, plans were made and submitted for comparable support in 1969, and a data automation requirement to automate medical materiel management in Vietnam was approved by the Department of the Army in February 1969.

Transportation and Communication Problems

The reliable transmission of requisitions or supply information was a continuing problem within Vietnam and to a lesser degree between Vietnam and Okinawa. The primary modes of communication were transceiver, mail, and telephone. The transceiver was used between advance depots and the base depot whenever possible and mail was the alternative. Policy changes were sent to the advance depots by transceiver or mail and high-priority requisitions were telephoned to the base depot. To prevent losses of requisitions transceivered between depots, which was not uncommon, batch control techniques were established and proved highly successful.

Transporting supplies, within the depot system presented difficulties at times. The road network was poor and often interdicted by the enemy. Under these circumstances, the helicopter was used to pick up supplies from designated supply points and to deliver high-priority requisitions. Bulk quantities of resupply were packed in Conex containers and airlifted by Chinook helicopters.

Improvement of Storage Facilities

Lack of adequate and sufficient storage space for medical Supplies was a chronic problem in Vietnam. The acquisition of additional storage space continually lagged behind actual needs. The redistribution of' troops compounded matters and storage requirements for medical supplies were frequently overlooked in planning programs. During the early part of the war, there was an acute lack of sufficient covered storage space for the protection of delicate or perishable medical supplies; it was not unusual to find medical supplies being stored in temperatures above 100° F. although boxes were plainly marked not to be stored in temperatures exceeding 80 degrees. Through the vigorous efforts of the 32d Depot, these inadequacies were gradually overcome, and facilities for the proper storage of medical supplies were constructed.

The deployment of medical units and hospitals to Vietnam during 1965 and 1966 precipitated various problems in medical equipment maintenance support. The 32d Medical Depot base platoon general and

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direct support facility, which was located at Nha Trang, operated out of temporary buildings with inadequate storage and shop space. Hospitals within Vietnam had little or no maintenance capability and were, thus dependent upon the base depot for support. Although the 32d Medical Depot had, deployed to Vietnam with a prescribed load of repair parts, the supply proved inadequate because of the early approval of many complex and highly specialized items of medical equipment for use in-country. A majority of these items were nonstandard and consequently required nonstandard repair parts which were not included in the original load. During late 1966 and early 1967, the depot incorporated many standard and nonstandard items into a depot maintenance float for direct exchange by units using them; this action made repair parts available to medical facilities within the depot system.

With the establishment of backup maintenance support at the US Army Medical Depot, Okinawa, a number of problems were solved. For example, it was no longer necessary to send 100 MA X-ray tubes to CONUS for repair, a step which involved considerable delay in getting the equipment back into the depot system.

By 1968, tremendous improvements had been made in medical maintenance support and capability. The base depot maintenance section was moved to Cam Ranh Bay and new facilities were programmed for construction. Repair parts management was transferred from maintenance repair personnel to inventory managers, thus enabling the repairmen to devote more time to the actual repair of equipment. In addition, medical equipment assistance teams, composed of highly skilled technicians, responded to the needs of medical facilities for periodic technical assistance and on-site repair.