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Lieutenant Commander Stephen L. Koenig, Supply Corps, U.S. Navy
What would you do if your car broke down and the service station told you, “Sorry, we can’t fix it because we don’t have the necessary technical manuals,” “We can’t identify the parts,” or “We don’t have the spare parts?” You probably would never deal with that service department again. That same scenario has been played out numerous times over the past years with shipboard medical and dental equipment. Too often the Navy has procured equipment without comprehensive technical manuals, provisioning technical data, adequate spare part support, or maintenance material management (3M) documentation. The reasons for this seemingly haphazard procurement include rapid changes in technology, expediency, and our routine selection of the lowest-priced model.
The Bureau of Medicine and Surgery’s (BuMed) primary mission is to provide the highest quality medical and dental care to all Navy and Marine Corps operating forces. To meet this objective, Navy doctors and dentists serving on board ship or ashore with the Marines must have equipment that is well designed, logistically supportable throughout its life cycle, and able to withstand the unique rigors of shipboard and combat operating environments. We can obtain quality equipment that is logistically supportable by adhering to the basic principles of the Navy’s Integrated Logistic Support (ILS) Program. In
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To provide the highest quality medical and dental care to the fleet, Navy doctors and dentists must have equipment that is well designed, logistically supportable, and able to withstand the rigors of shipboard and combat environments. The first step is adherence to the Navy’s Integrated Logistic Support Program.
the last two years, Navy Medical Logistics has embarked on a rigorous program to bring fleet medical and dental equipment within standard Navy ILS doctrine.
Navy medicine’s journey into ILS was precipitated by three events.
The first was the Chief of Naval Operations August 1990 message that cited examples of ILS deficiencies for new ships and systems being introduced into the fleet. It directed the fleet commanders to introduce new equipment only when proper support was in place. Less than full adherence to ILS and lifecycle management policies resulted in reduced reliability, maintainability, and readiness. Second, a letter from the President, Board of Inspections and Survey to Chief, BuMed, reported numerous examples of shipboard medical equipment not performing satisfactorily. The letter noted two reasons for equipment degradation: equipment design that was incompatible with the dynamics of ship’s motion and poor or nonexistent proprietary specific consumable and repair parts support. Last, but most important, was the dissatisfaction and frustration of fleet medical and dental personnel over the poor reliability and maintainability of their equipment.
BuMed launched its ILS campaign by hosting a Fleet Medical and Dental Logistics Conference on 7 March 1991. For the first time, the conference brought together all the key logistic activities to discuss support of afloat medical and dental equipment. The primary objective
Proceedings / October 1992
munications center. Medical equipment must be able to adapt to the motions, vibrations, and environmental uniqueness of shipboard existence. Personnel who are qualified to operate and maintain the equipment also are essential.
Furthermore, an inventory of key spare parts should accompany such equipment. Medical spare parts inventories on board ships need to be coordinated by a central authority and constantly matched against a medical equipment casualty reporting system. Such information must be integrated into the development of medical parts inventories. In addition, a planned maintenance schedule for each piece of equipment should be designed prior to its placement on a ship and monitored at intervals by knowledge- e personnel. At best, medical systems assessment teams logically should inspect the competence level of those
who operate and maintain this equipment.
The functional integrity of medical equipment must be monitored continuously. It cannot be considered operationally ready unless subjected to periodic use. Unfortunately, much of the equipment on board CRTSs lies fallow, except for limited use during deployments. If unused during in-port and routine cruising conditions, it will deteriorate. On the other hand, operation of some medical equipment can be very expensive. As one shipboard medical officer noted, while commenting upon a blood chemistry analyzer in his laboratory, “If I ran that machine for any length of time, it would totally consume all of my [operations target] funds.”
It is also evident that the types agd models if medical e^uipipent vary {rorjh.ship to snip, \yith time,[$oi]pq may
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was to identify the status of the ILS process. The conference proved extremely successful and the attendees identified specific items that required immediate attention. Areas identified included: equipment standardization, development of allowance parts lists (APLs), increased 3M coverage, and the necessity for close cooperation between the engineering, supply, and medical communities.
Equipment Standardization
Standardization of equipment across hulls is one way to achieve significant savings in life-cycle costs. Navy Medical Logistics Command (NavMedLogCom), BuMed’s equipment program manager, and Naval Sea Systems (NavSea) attacked the standardization problem from several directions. Essential characteristics standards have been revised to more tightly define acceptable equipment performance criteria. New or replacement equipment being purchased must have a shipboard performance history or be subject to Navy test and evaluation before introduction into the fleet. Additionally, medical and dental equipment lists for all initial construction outfitting must be forwarded to BuMed/NavMedLogCom for review and final approval.
NavMedLogCom has made extensive use of requirement contracts with an indefinite delivery schedule from single manufacturers for purchase of replacement equipment. Reprocurement of exiting equipment will significantly reduce overhead and life-cycle costs.
Maintenance and Material Management
The 3M program provides a means of managing maintenance and maintenance support in a manner that will ensure maximum equipment operational readiness. It also provides a means to report corrective maintenance actions. This information is used for analyzing maintenance and logistic support problems. To enhance 3M coverage on medical and dental equipment, BuMed and the Naval Sea Center Atlantic have worked to ensure all equipment has planned maintenance system coverage or is certified not maintenance significant. In the last three years, Naval Sea Center Atlantic and NavMedLogCom have combined to develop 95 new maintenance index pages and 268 maintenance requirement cards. Additionally, 2,468 technical feedback reports have been processed.
Coordinated Shipboard Allowance Lists/Allowance Parts Lists
The heart of the ILS process is the coordinated shipboard allowance list (CoSAL). It is the key fleet configuration management tool developed from the Weapons System File. It is both a technical and supply document that, when properly maintained, will provide an accurate picture of an individual ship’s configuration.
The CoSAL is a technical document to the extent that equipment, components and parts, nomenclature, operating characteristics, and technical manuals are described. It is also a supply document, as it lists the items required to achieve maximum selfsupporting capability for an extended period of time.
The nuts and bolts of the CoSAL are its APLs, therefore, BuMed has concentrated its efforts in their development. NavMedLogCom, NavSea, Ships Parts Control Center, and Naval Supply Systems Command combined efforts to produce 618 APLs. These documents have in turn been loaded to the Navy’s central configuration data base, consisting of the Weapons System File and Ships Logistic Support Information System. A CoSAL update for medical and dental equipment was distributed to applicable fleet units in July 1992.
While the medical, supply, and engineering communities have accomplished a great deal in a short period of time, ILS is an evolving process we must continue to improve. It will help ensure that the fleet has the best designed, most reliable, and fully supportable equipment available.
Lieutenant Commander Koenig is Director, Logistics Division, at the Bureau of Medicine and Surgery. Prevous tours include assistant Material Director at NSC Jacksonville; supply officer for Mine Group Two; and on board the Independence (CV-62), Maritime Prepositioned Group One, the Jesse L. Brown (FF-1089), the Wainwrighr (CG-28), and the Illusive (MSO-448).
have become outmoded, but were retained for budgetary reasons. In their reports, previous surgical teams declared the anesthesia equipment on one LHA to be archaic and recommended replacement (a recommendation that was never implemented). Of interest is the fact that the new Wasp (LHD-1) and some LHAs have reverted back to the simplified and compact field hospital anesthesia machines—in sharp contrast to their sleek and modernistic
operating rooms. . .
The repair, maintenance, and replacement policies tor ntedical equipment on the differing classes ot ships also rnay uary between commands. Such variabilities make it difficult to maintain system-wide parts inventories and define rlpatr priorities. It also is evident that a lone Ftp- rnedic»l Jquipment Repair Technician cannot diagj(o\e and repair each and every malfunction within the large number of unique pieces of medical equipment on any given ship.
Further Logistic Considerations____________________
In the event that major casualty surgical care is required, “surgical blocks” of supplies assembled by Navy medical logistics facilities generally are placed on board each ship prior to the deployment of a fleet surgical team or surgical augmentation group. For each surgical team added, another 36 or more pallets of supplies weighing sii-seven tons jnust be placed bn board to sijppo£ their initial «Jt- * nepds. A
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