CHAPTER V
Medical Supply
Realignment of Medical Supply Activities
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 agenciesorganized on a functional basis. Medical supply was incorporated within thefunctional systems although in each instance the command surgeon objected to thechange, contending that there would be a serious deterioration in support tomedicalfacilities and medical units.
Under the new system, supply management activities for USARPAC werecentralized at the Inventory Control Point in Hawaii. The Inventory ControlPoint was responsible for controlling of all requisitioning of supplies withinthe command and for the centralized maintenance of records on the status ofsupplies for the Eighth U.S. Army in Korea as well as for U.S. Army units inJapan, Hawaii, and Okinawa.
Medical Materiel Support of the Troop Buildup
The disadvantages in treating medical materiel as just another category ofsupply items were quickly and unequivocally exposed in 1965 when Army medicalmateriel units were faced with an expanded support mission-the buildup of U.S.Army troops in Vietnam. One of the most significant supply problems at the onsetof the buildup was a lack of adequate medical supply personnel in the theater aswell as the lack of continuity in key positions resulting from the 12-monthVietnam tour of duty.
The 8th Field Hospital at Nha Trang was responsible for medical supplydistribution to the medical units in Vietnam. This unit was augmented by a smallstaff which was not adequate to provide the necessary control over thetremendous requirements being generated practically overnight. This situationwas compounded by the protracted delay in deployment of the 32d (Field Army)Medical Depot which, although "ready" in July 1965, was not deployeduntil late October. One supply detachment had been deployed in July and anothershortly thereafter,
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but these detachments did not have a sufficient depth to manage supplyactivities in a theater of operations the size of Vietnam.
With the escalation of U.S. efforts in Vietnam, greater dependence was placedupon the Ryukyu Islands as the offshore base to support units in Vietnam. Asupply detachment was deployed to Okinawa in August, and in November 1965, the70th Medical Depot was deployed to augment and expand the operation of themedical depot in Okinawa.
The Surgeon General, handicapped by insufficient strength and control ofmedical supply, co-ordinated with CINCPAC to establish a system of automaticshipments of medical materiel to Vietnam. These shipments, initiated in July1965, were based upon schedules developed to support forces which were deployedfrom the continental United States to Vietnam. The materiel shipped consistedprimarily of medical resupply sets and later, after their development, includedoptical resupply sets. The automatic supply support system continued for aperiod of approximately 10 months, with peakloads of resupply occurring fromNovember 1965 through January 1966. This system, although only a temporarymeasure, was not so successful as anticipated. Delays in shipment from CONUSports and in off-loading procedures at Vietnam facilities and the splitting ofthe medical resupply sets into various shipments on board vessels were the majordifficulties experienced.
Investigation of Malfunctions in the Medical Supply System
By mid-1965, the Army medical materiel supply system was close to a completebreakdown because of the lack of qualified medical logistics personnel inVietnam, the shortcomings of the medical resupply system related previously, andthe inability of a centralized supply management activity in Hawaii to meet themedical materiel demands in Vietnam. In November 1965, the Vice Chief of Staffdirected The Surgeon General to investigate and recommend appropriate measuresto resolve these difficulties and end the shortages occurring in Vietnam andother subordinate commands within USARPAC. A representative of The SurgeonGeneral investigated and found that the Inventory Control Point, USARPAC, couldnot provide pertinent data on the medical supply situation within USARPAC.Consequently, requisitioning objectives were being computed without the fullknowledge of subordinate command conditions, environment, or professionalrequirements. In fact, to insure adequacy of objectives, subordinate commands hadto review their records constantly and thus engage in duplication of effort. Theinvestigation revealed that the Inventory Control Point provided littleassistance to the subordinate commands or to the surgeons who were responsiblefor the health of troops in those subordinate commands. The report indicatedthat 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 thedirection of the subordinate command surgeons to support peacetime and wartimeoperations.
The status of medical supply in each of the subordinate commands disclosedlarge numbers of medical items with zero balances (complete lack of stock). Thissituation necessitated submitting large numbers of high priority requisitions toCONUS to obtain vitally needed stocks rapidly.
The report further indicated that the rapid buildup of troop strength inVietnam had placed a serious drain on available medical materiel stocks in theDSA (Defense Supply Agency) system. For example, of the 6,000 to 7,000 medicalitems on hand, DSA was out of stock on about 1,500 items and these were articlesneeded in the field to administer first aid. Delays in shipments andout-of-stock conditions became more serious as the buildup progressed. InOkinawa, the offshore support base, for example, zero balances rose from 16percent in December 1964, to 28 percent in March 1965. Unfortunately, TheSurgeon General was not fully informed of the deficiencies until complaints werereceived from Vietnam and other USARPAC areas.
While the inadequacies and malfunctioning of the supply system were beinginvestigated, a concept study advocating a bold, new approach to the problem ofthe administrative support of a theater army, entitled "TASTA-70 (TheAdministrative Support-Theater Army 1965-70)," was under study in theOffice of the Chief of Staff. Commenting on the study, The Surgeon Generalrecommended that the Army Medical Department be given control over medicaldepots and medical inventory control activities. Approved by the Chief of Staff,The Surgeon General's recommendation was incorporated in the TASTA-70 conceptand provided the basis for the realignment of medical supply activities underthe 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 militaryactivities in Vietnam was realigned by shifting the responsibility fordetermining requisition objectives for stocked medical items and for orderingreplenishment supplies from the Inventory Control Point to the U.S. Army MedicalDepot in the Ryukyu Islands. This depot, in turn, ordered replenishment suppliesdirectly from the Defense Personnel Support Center through the USAMMA (U.S. ArmyMedical Materiel Agency), Phoenixville, Pa.
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The effect of this realignment was the routing of all requisitions formedical materiel from subordinate commands within USARPAC to the USAMMA, wherethe order was recorded and reviewed before it was transmitted to the DefensePersonnel Support Center, the agency of the Defense Supply Agency which handledmedical materiel. Thus, USAMMA was able to maintain control and "followup"on each requisition to insure that the requesting agency was kept fully informedon the status of its order and, when necessary, to expedite the delivery ofurgently needed items. USAMMA also prepared and maintained a catalog ofnonstandard items for the Pacific area. This catalog facilitated requisitioningof items that were not in the standard supply system and permitted theaccumulation of data on worldwide usage of nonstandard items to determine theneed for type classification actions.
In 1967, the medical supply section within USARPAC, the Materiel ManagementAgency, was transferred to the Chief Surgeon, USARPAC, thus completing the shiftof all medical supply activities in the Pacific command to medical channels.After this transfer, the Chief Surgeon, USARPAC, was responsible for directingall medical supply functions within the command. In each subordinate command,medical supply responsibilities were assigned to medical commanders andsurgeons; for example, in Vietnam, the Surgeon, USARV, was responsible formedical supply functions to include the operations of the 32d Medical Depot, andthe operation of the U.S. Army Medical Depot, Ryukyu Islands, was aresponsibility of the U.S. Army Medical Center, Ryukyu Islands. Similarly, theU.S. Army Medical Command, Japan, directed the functions of the 504th MedicalDepot; the 6th Medical Depot in Korea was assigned as a function of the Surgeon,Eighth U.S. Army; and medical supply activities in Hawaii were incorporatedwithin the structure of Tripler Army Medical Center.
The Depot System
As a result of this assignment of medical materiel management the Okinawadepot expanded in size and responsibilities. The depot ultimately supported U.S.Army units in Vietnam and Thailand; the Armed Forces of Vietnam, Thailand, andLaos; and AID (Agency for International Development) activities in SoutheastAsia, while also supplying military customers on the Ryukyu Islands. The amountof depot sales to customers rose from $28.5 million in fiscal year 1967 to $64million in fiscal year 1968 and peaked at $71.5 million in fiscal year 1969. Thedepot satisfied over 85 percent of the demands for stocked items during fiscalyear 1968. The depot also provided optical and medical equipment maintenancesupport to all areas which it supplied.
In Vietnam, the 32d Medical Depot, which had deployed in October 1965 andwhich received its medical materiel support from the Okinawa
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depot, provided medical materiel for units of the U.S. Army and the ArmedForces of Korea, the Philippines, Australia, and New Zealand, operating inVietnam. During fiscal year 1968, for example, the 32d Medical Depot issuedabout $30 million of medical materiel in Vietnam and filled more than 85 percentof all requisitions submitted by medical units. Shipments of medical suppliesincreased from 482 short tons per month in the first quarter of fiscal year 1968to 932 short tons per month in the third quarter. The depot's functions includedthe fabrication of single-vision spectacles-in fiscal year 1970 alone thedepot produced 170,279 pairs-and the maintenance and repair of medicalequipment of supported units throughout Vietnam. The depot operated through fivelocations (four advance depots and a base depot at Cam Ranh Bay).
Despite chronic shortages of personnel and equipment, the 32d Medical Depotcontinued to fulfill its mission in a superb manner. By 1970, the medical supplysupport had reached an operational plateau as medical units and facilitiesreceived a routine replenishment of medical supplies. The Army Medical Depot,Ryukyu Islands, also continued to provide replenishment supplies to theVietnamese Armed Forces, and military assistance supplies for Thailand and Laosforces, and for AID activities in Vietnam, Thailand, and Laos. Medical suppliesvalued at $71.5 million were distributed through this depot during the fiscalyear.
Mechanization of Medical Materiel Recordkeeping
The improvement of medical support in Vietnam was based on the excellentsupport 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 tomechanize stock control and inventory management at the base depot in Cam RanhBay and at two advance depots in Long Binh and Qui Nhon in 1967. By 1968, it wasapparent that the NCR 500 computers were not adequate to provide the datanecessary for decision making, plot supply trends, forecast trouble areas, orprogram financial inventory data. The depot therefore developed its ownprograms, borrowed computer time on an IBM (International Business Machines) 360computer system in Saigon, and produced the information necessary to operateeffectively in an environment that was rapidly becoming increasingly managementand cost conscious.
By the fall of 1968, the 32d Medical Depot produced the first theater stockstatus report. The report was developed by converting data from the NCR 500computer system to cards which were processed in the IBM 360 system. By thespring of 1969, additional advances had been made in the automation of medicalmateriel recordkeeping. These advances included the preparation of theaterexcess reports, financial inven-
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tory feeder data, due in and due out reconciliation reports, order andshipping time studies, and interdepot redistribution of assets studies. In lightof these achievements, plans were made and submitted for comparable support in1969, and a data automation requirement to automate medical materiel managementin 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 acontinuing problem within Vietnam and to a lesser degree between Vietnam andOkinawa. The primary modes of communication were transceiver, mail, andtelephone. The transceiver was used between advance depots and the base depotwhenever possible and mail was the alternative. Policy changes were sent to theadvance depots by transceiver or mail and high-priority requisitions weretelephoned to the base depot. To prevent losses of requisitions transceiveredbetween depots, which was not uncommon, batch control techniques wereestablished and proved highly successful.
Transporting supplies within the depot system presented difficulties attimes. The road network was poor and often interdicted by the enemy. Under thesecircumstances, the helicopter was used to pick up supplies from designatedsupply points and to deliver high-priority requisitions. Bulk quantities ofresupply 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 achronic problem in Vietnam. The acquisition of additional storage spacecontinually lagged behind actual needs. The redistribution of' troops compoundedmatters and storage requirements for medical supplies were frequently overlookedin planning programs. During the early part of the war, there was an acute lackof sufficient covered storage space for the protection of delicate or perishablemedical supplies; it was not unusual to find medical supplies being stored intemperatures above 100? F. although boxes were plainly marked not to be storedin temperatures exceeding 80 degrees. Through the vigorous efforts of the 32dDepot, these inadequacies were gradually overcome, and facilities for the properstorage of medical supplies were constructed.
Medical Equipment Maintenance Support
The deployment of medical units and hospitals to Vietnam during 1965 and 1966precipitated various problems in medical equipment maintenance support. The 32dMedical Depot base platoon general and
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direct support facility, which was located at Nha Trang, operated out oftemporary buildings with inadequate storage and shop space. Hospitals withinVietnam had little or no maintenance capability and were thus dependent uponthe base depot for support. Although the 32d Medical Depot had deployed toVietnam with a prescribed load of repair parts, the supply proved inadequatebecause of the early approval of many complex and highly specialized items ofmedical equipment for use in-country. A majority of these items were nonstandardand consequently required nonstandard repair parts which were not included inthe original load. During late 1966 and early 1967, the depot incorporated manystandard and nonstandard items into a depot maintenance float for directexchange by units using them; this action made repair parts available to medicalfacilities within the depot system.
With the establishment of backup maintenance support at the U.S. Army MedicalDepot, Okinawa, a number of problems were solved. For example, it was no longernecessary to send 100 MA X-ray tubes to CONUS for repair, a step which involvedconsiderable delay in getting the equipment back into the depot system.
By 1968, tremendous improvements had been made in medical maintenance supportand capability. The base depot maintenance section was moved to Cam Ranh Bay andnew facilities were programmed for construction. Repair parts management wastransferred from maintenance repair personnel to inventory managers, thusenabling the repairmen to devote more time to the actual repair of equipment. Inaddition, medical equipment assistance teams, composed of highly skilledtechnicians, responded to the needs of medical facilities for periodic technicalassistance and on-site repair.
