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Planning for 21st Century Military Medical Readiness
Executive summary of Dr. Stephen C. Joseph, assistant secretary of defense for health affairs, , Monday, March 27, 1995

The Department of Defense published the first Medical Readiness Strategic Plan in February 1988 in response to directives outlined in the National Defense Authorization Act of 1987. Since then several landmark events underscore the need to revise our strategies for enhancing and sustaining medical readiness.

Radical changes in the international security environment beginning in 1989 signaled the end of the Cold War and the beginning of a new world order. The implications of this shift in focus are apparent in many actions under way for some time: development of new military strategies, major armed forces reductions and the revision of service missions, roles and responsibilities.

Operations Desert Shield and Desert Storm, 1990-1991, though successful, highlighted persistent medical support problems. Several reports by the DoD inspector general, General Accounting Office and other agencies called for dramatic changes and improvements.

Congress and a new administration initiated sweeping changes and management initiatives to realign and streamline the military. The Bottom-up Review, Defense Planning Guidance, Section 733 Study and aggressive health care reform initiatives mandated change to accommodate declining defense budgets and structure.

The purpose of the Medical Readiness Strategic Plan 2001 is to provide DoD with an integrated, coordinated and synchronized plan for achieving and sustaining medical readiness through the year 2001 and beyond. It is the DoD guide book by which we will achieve a fully capable military health care system ready to support the continuum of military operations.

MRSP-2001 is a long-range plan that supports execution of the full array of strategic planning documents from the National Security Strategy of the United States to the Defense Medical Programing Guidance and associated service medical program objective memorandums. We will use MRSP-2001 as the compass for articulating requirements and resources, and for developing policies and procedures. Medical readiness success will be measured against the objectives outlined in MRSP-2001.

MRSP-2001 is organized in nine major functional areas. Each functional area and associated subarea is introduced with a concise narrative highlighting the background, current status and objectives developed by the MRSP-2001 functional area panels. A detailed action plan is provided for each functional area objective; action plans highlight the objectives, the tasks to be accomplished and the primary action offices responsible for executing the objectives.

The assistant secretary of defense for health affairs coordinated the development of the MRSP-2001 as a collaborative effort between all sectors of DoD. This included representatives from the Office of the Secretary of Defense, the Joint Staff, unified commands, the military services and other defense agencies. Nine joint panels, over 130 military and civilian personnel, convened to thoroughly review key defense guidance, studies, reports and lessons learned; formulate major strategic objectives; and produce detailed supporting action plans for implementation.

The department intends to continuously monitor the status of DoD medical readiness. Aggressive development and implementation of an effective oversight/evaluation mechanism is fundamental to the success of the entire MRSP-2001. Chapter 10 of the plan outlines the actions we plan to pursue.

Functional Areas in Brief

Planning. The military medical departments must develop, enhance and sustain coordinated and synchronized policies, doctrine and training that facilitate medical planning, resourcing and execution of joint and combined operations. Successful joint initiatives include the establishment of a functional medical annex in the operations plan and implementation of the Joint Medical Planner's Course.

Renewed efforts must be made to develop joint medical doctrine which supports line commanders and the war-fighting commanders in chief. Modern automated planning tools are lacking along with trained and experienced medical planners. The services must critically evaluate and define medical planner career specialties and development plans.

Specific objectives include:

 

  • Ensure true joint planning is the norm and is driven by integrated, forward-thinking doctrine.
  • Provide medical planners with the tools they need to develop effective, executable plans.
  • Ensure an inventory of qualified, interchangeable medical planners.

Requirements, capabilities and assessment. The Medical Planning Module is the only standardized tool used to determine wartime health services requirements. The MPM also generates the vital data used for planning, programing and budgeting decisions. Major improvements are needed, including capabilities to accommodate multiple scenarios and force changes -- and current, validated and integrated casualty rate figures. The Joint Staff development of the Medical Planning Execution System to replace the MPM must move forward rapidly and anticipate future planning module requirements.

Specific objectives include:

 

  • Establish planning factors for second through fifth echelon medical facilities based on the Time, Task, Treater clinical data base. Validate all MEPES planning factors annually.
  • Develop a mechanism to assess requirements and capabilities for combatant commanders, services and the Joint Staff.
  • Develop a methodology appropriate for each service to ensure a match of casualty rate development and application across the full range of operational situations.
  • Include medical requirements in all wargaming activities; and develop interfaces between wargaming tools and existing and future medical models.
  • Develop a method for linking real-world patient load data with modern patient condition codes, enabling planners to forecast medical workload and resource requirements.
  • Re-engineer the POM development process to allow time for appropriate CinC input and time to calculate and validate medical requirements in support of the illustrative planning scenarios.

Command, control, communications, computers and information management. The military medical community must redouble its effort to develop a standardized, integrated and seamless system of medical command and control within the Global Command and Control System. As a minimum we must develop and publish doctrine for medical support communications and information systems; enhance planning, exercising, modeling and simulation; and exploit employment of advanced information technology.

We must define our integrated communications requirements, develop an acquisition strategy which accommodates advanced technology add-ons and provides us with reliable and continuous voice, text, data, visual and position location communications.

Finally, we must move quickly into the future by developing a modern medical information system. This includes development and deployment of an individually carried data device and fielding of the Theater Medical Information System.

Specific objectives include:

 

  • Ensure the medical structure has a robust, seamless and assured communications capability within the global communications architecture.
  • In accordance with the command, control, communications, computers and intelligence for the warrior concept, consolidate medical command and control requirements into a single interoperable capability to be part of GCCS.
  • Satisfy the validated requirement for an updatable, individually carried data storage device with read/write capability.
  • Satisfy the validated requirement for a seamless medical information system serving contingency support and beneficiary care across all echelons.

Logistics. Medical logistics organizations, policies and procedures supporting joint medical operations must keep pace with new defense strategies and logistics demands. Modern business practices must be developed which exploit commercial logistics bases and just-in-time inventories.

With the completion of the major procurement phase of Deployable Medical Systems we must now focus on sustaining and modernizing our deployable medical equipment. The single integrated medical logistics management systems must be enhanced with automated support systems linked by integrated communications. We must aggressively implement an interim standard medical logistics system while simultaneously working to develop the long-term Defense Medical Logistics Standard Support system. Joint medical logistics doctrine must also be addressed.

Specific objectives include:

 

  • Develop and update acquisition and support plans that support the full spectrum of military operations.
  • Ensure that DEPMEDS, other medical assemblages, medical sets, kits, and outfits and nonmedical material are maintained, refurbished and modernized in a timely manner to provide quality medical care and capability to support operational requirements.
  • Provide medical logistics information management systems and communications systems which allow the transmission and exchange of logistics data within a theater of operations and with the supporting base (communications zone or the continental United States).
  • Develop common baselines for computing medical materiel sustainment requirements and reporting unit or platform medical materiel readiness. Integrate this information into joint medical planning processes.

Medical evacuation. Our medical evacuation systems must be comprehensively reviewed to ensure we have trained and ready resources capable of supporting the continuum of care. We must assess our total ground, sea and air evacuation requirements and maximize the potential for each platform to support military operations.

It is imperative for the Army to evaluate requirements and modernize its evacuation capabilities in order to meet its assigned battlefield missions.

The Air Force must review the roles and missions, sustainment, modernization and reporting capabilities of its intra- and intertheater evacuation aircraft. We must develop the ability to access Aeromedical Evacuation Civil Reserve Air Fleet sooner in the mobilization process to complement an overcomitted C-141 fleet.

Our final product should be seamless and fully integrated, with appropriate command and control mechanisms that facilitate proper allocation and employment of modern evacuation platforms. Specific objectives include:

 

  • Ensure timely availability of required personnel or units to accomplish the medical evacuation mission.
  • Define patient evacuation requirements and develop enhanced medical evacuation capability that accommodates shorter theater evacuation policies by all services.
  • Develop CONUS casualty reception and distribution plans as well as intraregional execution methodologies.
  • Develop an integrated capability for medical evacuation that includes rotary-wing, fixed-wing, land and sea assets.
  • Develop joint doctrine for the joint use of evacuation assets to include dedicated air ambulance support to Marine Corps contingency operations, and establishment of a theater patient movement requirements center.
  • Develop joint doctrine for the entire medical evacuation system to ensure all levels of evacuation are interoperable and integrated into a seamless system and provide in-transit visibility of patients.
  • Develop and execute a program to procure and/or modernize evacuation platforms.
  • Ensure patient movement items are standard and interoperable among the services and are operable aboard evacuation aircraft by developing a system to certify, track, maintain and recover PMI.
  • Identify integrated patient transportation command and control systems to ensure seamless patient transfer and maintain visibility throughout patient movement.

Manpower and personnel. Our manpower systems and procedures must focus on meeting wartime requirements within assigned end strengths. We must carefully manage the appropriate mix of active and reserve component medical forces; enhance the assignment, training and sustainment of health care personnel; and right-size our service graduate medical education programs. Finally, we must continue to recruit and retain qualified health care personnel.

Specific objectives include:

 

  • Recruit and retain qualified active and reserve medical personnel to meet military medical requirements by specialty and grade.
  • Ensure a consistent set of medical deployability criteria is used by all services.
  • Develop a program to ensure that all newly accessed active and reserve medical personnel attend required entry-level military training within 12 months of accession.
  • Optimize service GME programs, ensuring they satisfy physician requirements by specialties and numbers.
  • Validate requirements and establish early authority to mobilize reserve component medical forces to integrate with active duty immediate deployment forces.

Training. We need to establish common medical training guidelines, policies, and standards which promote medical readiness. The Joint Medical Readiness Education Council must continue their efforts to define medical readiness training standards, joint training requirements and resources required; and reassess the missions, roles and responsibilities of the Joint Medical Readiness Training Center.

Simultaneously, our health care committee of the Interservice Training Review Organization must aggressively pursue a review of all functional medical technical and operations training as directed by the chairman, Joint Chiefs of Staff. Where possible, we must combine training to reduce costs. Worldwide, medical participation in joint and combined exercises has decreased; this trend must be turned around and incorporate employment of active and reserve assets.

Specific objectives include:

 

  • Establish a DoD system to provide and monitor medical readiness training.
  • Develop a mechanism to ensure DoD-wide minimum competency levels for unique specialty areas.
  • Maximize DoD-wide utilization of field medical training sites to enhance interoperability and shared training.
  • Increase opportunities for active and reserve medical interface in service-specific and joint/combined exercises. Blood. We must maintain a strong, viable Armed Services Blood Program capable of providing modern blood products to worldwide customers, supporting the full spectrum of military operations. We must continue to meet Food and Drug Administration blood regulations and guidelines; coupled with the deployment of the Defense Blood Standard System, we will greatly facilitate standardization and quality assurance in the delivery of safe blood products and services to our customers.
    We must complete development and publication of Joint Publication 4-02.1 to ensure our joint blood doctrine is employed. The frozen blood system distribution plan must be expeditiously completed to ensure designated combatant commands can meet their wartime blood requirements. Finally, we must exploit and incorporate new blood technologies as they become available to improve the efficiency and safety of the military blood program.
    Specific objectives include:
  • Maintain an Armed Services Blood Program which provides quality blood products and services to meet all DoD requirements.
  • Develop joint blood doctrine to meet combatant command requirements.
  • Complete the worldwide fielding of frozen blood to designated unified commands and develop improvements in frozen blood technology.
  • Develop and maintain peacetime blood operations which support the continuum of military operations.
  • Comprehensively update wartime blood requirements and develop programs, doctrine, policies and procedures to ensure implementation.
  • Monitor and assist blood and blood substitute research and development; incorporate new technologies as they become available.

Readiness Oversight and Evaluation. Our first priority will be to establish an oversight/evaluation mechanism to ensure successful implementation of the MRSP-2001 objectives. The ASD(HA) will charter a new TRICARE Readiness Committee chaired by his principal deputy and comprised of the principal deputy to the ASD (Reserve Affairs), the J-4 (director for logistics) of the Joint Staff, the DASD [deputy ASD] for Health Services Operations and Readiness, and the three surgeons general. The TRC will be the primary flag-level body responsible for monitoring and evaluating implementation of the strategic plan. The TRC will advise the ASD(HA) and will report its findings and recommendations to the Defense Medical Advisory Council. The specific objective is:

 

  • Establish a DoD process to monitor medical readiness.

 

Published for internal information use by the American Forces Information Service, a field activity of the Office of the Assistant to the Secretary of Defense (Public Affairs), Washington, D.C. Parenthetical entries are speaker/author notes; bracketed entries are editorial notes. This material is in the public domain and may be reprinted without permission. Defense Issues is available on the Internet via the World Wide Web at http://www.defenselink.mil/speeches/index.html