Basic Concepts 

A JTF Surgeon’s ability to monitor and affect the workings of the medical logistics system will increase several fold if he/she understands basic terms and considerations. 

Supply Classes 

All medical officers should know the classes of supply. 

Class I       Rations and food supplies

Class II      General supplies

Class III     Petroleum, oils, lubricants (POL)

Class IV      Engineer and constructions supplies

Class V       Ammunition

Class VI      Personal items

Class VII     Major end items (tanks, trucks, etc.)

Class VIII    Medical supplies

Class IX      Repair parts

Class X       Supplies for civil-military support

Occasionally, medical logisticians may refer to Class VIIIA and Class VIIIB. Class VIIIA is medical materiel. Class VIIIB is blood and blood products. 

Most military medical material used during deployments is supplied through the Defense Logistics Agency (DLA). These items are often referred to as standard items, and each is identified by a 13-digit NSN (XXXX-XX-XXX-XXXX). The first four digits represent an item’s federal supply class (FSC), a group of like items. The major medical FSCs are: 

6505 - Drugs, biologicals, and reagents

6510 - Bandages 6515 - Medical supplies and equipment

6520 - Dental supplies and equipment

6525 - Radiological supplies and equipment

6530 - Surgical supplies and equipment

6532 - Medical clothing and linen

6540 - Ophthalmic supplies and equipment

6545 - Medical sets, kits, and outfits

6550/6600 - Laboratory supplies and equipment

The next two digits identify an item’s country of origin. Each NATO country has been assigned at least one two-digit number. U.S. items are identified by the digits 00 or 01. 

The last seven digit number is a unique serial number.

Critical Items 

Surgeons should tell their Class VIII manager which items are critical to the success of the medical mission. It is appropriate to require that these supplies receive additional attention, intensive management, and continuous monitoring. While surgeons should not hesitate to insist upon daily updates of their supply status, they should also remember that when everything is a number one priority, nothing is a number one priority. When developing a list of critical supply items, the following candidates should be considered. 

Anesthetics and oxygen.
General anesthetics, inhalational
General anesthetics, injectable
Local, regional, segmental anesthetics
Oxygen and/or cylinders

Antibiotics and sulfa drugs 

Broad spectrum antibiotics, injectable
Broad spectrum antibiotics, oral
Penicillin
Sulfonamides

Biologicals Anticoagulants 

Corticosteroids
Hemostyptics
Hyperimmuneglobulin
Insulin
Tetanus antitoxin
Vaccines

Blood substitutes and infusion materiel 

Dextrose solutions and electrolytes
Infusion sets
Plasma expanders

Gastrointestinal remedies 

Antacids
Antidiarrheal drugs
Antidysenteric drugs
Antiemetics

Hypnotics, sedatives, and tranquilizers 

Muscle relaxants

Narcotics, analgesics, and antispasmodics 

Analgesics, injectable
Analgesics, oral
Antispasmotics
Morphine, injectable
Morphine, substitutes

Nuclear, biological, and chemical (NBC) defense agents and drugs that affect the nervous system 

Analeptics
Antihistamines
Atropine
Cardiotonics
Nerve agent antidote
Oximes
Pyridostigmine bromine
Vasoconstrictors

Surgical dressing materiel 

Bandage, gauze roller
Burn dressings
Casting materiel
Cotton wool, absorbent
First aid dressings
Gauze, absorbent
Splinting materiel

Surgical materiel, other 

Antiseptics Detergents
Disinfectants
Suture and ligature materiel

Syringes and needles

Inventory Management 

As a general rule, logisticians are reluctant to tie up warehouse space to store materiel unless there is a strong likelihood that the supplies will be requested and eventually used. There are a variety of models used to calculate stockage levels. All consider the time it takes to order and transport supplies, the amount of supplies that can be consumed in a given period, and the importance of maintaining a safety level in case the transportation or production system breaks down. 

Consumption Rates 

All logisticians are interested in estimated consumption rates of the commodities that they manage. They are interested in these rates, not to manage stock levels and ensure supplies are on hand (inventory management models do that), but rather to estimate transportation and storage space requirements. 

As explained in FM101-10-1, Staff Officer’s Field Manual: Organizational, Technical, and Logistical Data, the generally accepted consumption rate for medical materiel (medical dental, veterinary, repair parts, and equipment) in ground operations is 1.22 pounds per person per day. However, this rate should be used with caution and only if current real data are not available since combat intensity, climate conditions, local sanitation, and other factors significantly influence consumption. 

Consumption rates are also important when planning the support requirements of medical facilities. The Army Medical Department Center and School (AMEDDC&S) has developed the rates and formulas shown in Tables 9 and 10 for Army DEPMEDS hospitals. This information should be somewhat relevant for other service DEPMEDS facilities as well. 

Table 9. Army DEPMEDS Facility Fuel Consumption Rates 

Medical Materiel Distribution 

There are two distinct methods used to manage medical materiel replenishment. One way of providing replenishment stocks is to "push" a previously prepared block of Class VIII supplies, based upon estimated usage requirements, forward to a treatment facility. While all services use this distribution method, it is most frequently employed by the Navy and Marine Corps. These services refer to the prepackaged supply or equipment blocks as authorized medical allowance lists (AMAL) or authorized dental allowance lists (ADAL). Advantages to this method are that the requester spends little time generating paperwork and that prepackaged supplies can be rapidly shipped with minimal handling. Unfortunately, often entire packages of supplies are requested when only several components are actually needed. This can create a situation within a command where one facility has far more of an item than it can ever hope to use, while another unit may have none since warehouse stocks are depleted. Additionally, the relatively long time required to pack these blocks and the amount of warehouse storage space that they require often limit the number that are available and ready to ship. 

The other method of managing medical materiel is line item accounting. In line item accounting, medical facilities and units use standard MILSTRIP procedures to request individual items of supply or equipment from the supply source. Advantages of this method, which is usually automated, are that it delivers critically needed supplies to users who actually need them. Additionally, it rapidly identifies trends of supply consumption and makes the medical materiel status of the command readily visible to surgeons and medical materiel managers. On the negative side, line item accounting requires more consumer expertise and attention. If medical facility staff members are inattentive or ignorant of MILSTRIP procedures, the system will bog down. 

Joint Pub 4-02.1, JTTP for Health Service Logistic Support in Joint Operations describes medical logistics operations in a joint environment.  For many scenarios, the unified command will have tasked one of its service components to provide Single Integrated Medical Logistics Management (SIMLM). This means that that service’s supply organizations are responsible for managing the Class VIII distribution system during the operation. If this is done, most likely the Army will be identified as the single medical logistics manager. The Army uses, almost exclusively, the automated line item accounting system called the Theater Army Medical Management Information System (TAMMIS) to manage medical supplies. If JTF service components expect to request and receive medical supplies and equipment from an Army Class VIII supply source, their medical facilities, units, and hospital ships need to understand MILSTRIP, line item accounting, and be familiar with TAMMIS or an automated inventory management system that is easily converted or modified to send requests in MILSTRIP format. 

Medical Materiel Management Units 

Only the Army and Marine Corps have Class VIII management units that deploy in support of military operations. 

One medical logistics company is found in the supply battalion of each Marine Corps FSSG. These units also provide medical maintenance support. 

The Army uses medical logistics battalions to provide medical supplies, medical maintenance, blood storage and distribution, and optical fabrication. Some of these battalions are tailored to provide forward corps level support. Each forward battalion can support a force of up to 160,000 and is capable of processing almost 150 short tons of medical materiel daily.