Ever Wonder How Army Decides What Medical Equipment to Field?
Army clinicians and medics often ask about what the process is for deciding what equipment or supplies end up in a combat medic's kit or field operating room set. To help explain the process, the U.S. Army Medical Materiel Agency's Chief of Assemblage Management Division Marie Cochran provided plain-language answers to some of our most commonly asked questions.
What is a medical unit assemblage?
MC: Most Soldiers are familiar with sets, kits and outfits - we call them SKOs, for short. These are the packages of medical equipment provided to different units. A unit assemblage, or UA, is a list that describe what is in each SKO. Think of a UA as a recipe card that lists the ingredients of each SKO.
Is there a way to access unit assemblage lists, so a Soldier knows what is supposed to be in each set, kit or outfit?
MC: Yes. USAMMA provides a tool, accessible with a Common Access Card, which helps Soldiers understand what is listed in each UA. The tool is called MEDSILS/UA for the web: https://app.usamma.amedd.army.mil/medsils/index.cfm
The left-hand navigation bar has a direct link to Army UAs. For your most accurate results, search for the UA using the Line Item Number (LIN) listed on your unit's property book. Look for the National Stock Number (NSN) reflected on the hand receipt. In order to identify the latest version of your set identified to the LIN, we provide Bill of Materials (BOM) usage codes. The most current version is indicated by BOM usage code 4.
How does a unit know when they will be fielded/modernized?
MC: USAMMA's fielding operations team contacts units well in advance of fielding to coordinate logistics. For operational security reasons, the USAMMA fielding schedule is not a public document. USAMMA executes unit fielding schedules in accordance with Army prioritized directives as referenced in AR 525-29. USAMMA does not have the authority to change the sequence nor the prioritization of units scheduled to be fielded on the Army's list. For specific questions, please reach out to USAMMA at firstname.lastname@example.org
If a unit has an older medical equipment set or medical materiel set and would like to update it to a new one, is this possible? Or, at least, may a unit replace some of the durable or non-expendable items?
MC: The unit must first ensure their property book accurately reports on-hand balances. Unit commanders must ensure their staff has accurately identified and reported shortages in their unit status reports. Then, the unit's higher headquarters can report this information up to their combatant command (e.g., U.S. Army Forces Command) who then reports the shortage to the Department of the Army.
A unit commander can subjectively downgrade the unit's readiness rating if he/she identifies a shortfall in clinical capability. Also, the Army mandates the use of the secure Army Equipment Common Operating Picture to post Modified Table of Organization shortages, as well as Operational Needs Statements.
If the unit is deploying and its sets have reported a clinical shortfall in LIN-level medical equipment items, we need that unit to identify and communicate those shortfalls first and always through its chain of command, which may then communicate these shortfalls to USAMMA: email@example.com
When USAMMA is notified and can verify the shortage or clinical weakness, USAMMA may be directed to fill the shortage or upgrade the clinical capability pending available stock and funding.
It is the unit's responsibility to maintain and sustain their fielded medical SKOs until USAMMA is funded or programmed by Army to field the unit new SKOs or provide a sustainment package. This is normally done via line item requisition using your supporting installation medical supply activity (IMSA) or medical supply support activity (MSSA).
If a unit is not due to be fielded based on the Army's Dynamic Army Resourcing Priority List but still wants to upgrade or modernize its medical materiel, the unit commander may modernize its expendable, durable, and non-LIN devices using their own funding and working with their supporting IMSA or MSSA. Authorized LIN medical devices must be procured through USAMMA using Other Procurement, Army funding.
Why do Army clinicians and medics not always see the same U.S. Food and Drug Administration cleared devices and equipment in a field set that they might use at a Military Treatment Facility?
MC: The goal is always to provide units with the right tools to save lives on the battlefield - but that doesn't mean the right tool is the same one used in a fixed hospital. Field conditions are very different and present unique logistical challenges, including environmental considerations (e.g., extreme heat/cold, sand and debris) and transportation burden (i.e., How large or heavy is the product? Can it be transported without breaking if put in a container and strapped inside a ship or airplane? Does it require refrigeration or power?). Another consideration is medical maintenance capability and cost (i.e., How often must the device be calibrated? What is the overall cost of sustaining it?). Army Medicine's goal is to provide the right tools in the right places at the right time - without adding extra logistical burden to the operational force.
So, who decides what gets into a set?
MC: The U.S. Army Health Readiness Center of Excellence's Capability Development Integration Directorate (CDID) establishes the schedule for all medical Unit Assemblage set reviews. Typically, each UA is reviewed every three years. Set reviews can be performed in a variety of ways, including full panel reviews, partial panel reviews and administrative reviews. USAMMA works closely with subject matter experts, which includes clinicians, equipment specialists and partners from the Defense Logistics Agency, to facilitate additions, changes and updates to UAs and SKOs. Experienced field users decide what goes into an Army medical assemblage during the cyclic review process. It is the community's opportunity to fine tune sets every three years that help us keep up with technology and standard of care changes.
An important point to make is that when we are talking about medical equipment - and the possibility of adding something to a set - the conversation does not go into specific makes or models. Rather, the focus is on requirements. From this discussion, CDID determines essential characteristics for a specific capability, from which we complete a competitive procurement process in compliance with the Federal Acquisition Regulation.
What is USAMMA's role with set management?
MC: At the conclusion of a review, USAMMA staff:
- Request NSNs for all new items
- Coordinate provisioning configurations for new equipment (e.g., new equipment training; power requirements; accessories; the first 72 hours of consumables; repair parts; and testing/calibration equipment)
- Source the required products and work with vendors to procure the new equipment or items
Additionally, USAMMA is the owner and manager of the sets once they are approved. USAMMA staff are responsible for:
- Completion of cataloging and Supply Bulletin 700-20 actions (ref: https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/p708_3.pdf)
- Supporting units with maintenance on technically complicated equipment
- Identification of obsolete items and their replacements
- Surveillance of new technology
How can clinicians or medics make recommendations or provide suggestions for set updates?
MC: Any recommended changes to the components of medical assemblages outside of the regular cycle of review may be submitted to the following address in the format of an official memorandum justifying the change request:
Director, Capability Development Integration Directorate
U.S. Army Medical Department Center and School
U.S. Army Health Readiness Center of Excellence
2377 Greeley Road, Building 4011
Fort Sam Houston, Texas 78234-7731
COM: (210) 221-8600
If units have additional questions, how can they contact USAMMA?
MC: We encourage units to work through their chain of command to report issues, concerns or ask for local medical logistics support. To reach USAMMA directly, queries may be sent to: firstname.lastname@example.org