MEDICAL LOGISTICS MANAGEMENT
OBJECTIVE
Give
Medical Service Corps (MSC) officers general information and identify related
reference material for the medical logistics functions. Using the Readiness
Sustainment Verification Program (RSVP), MSC officers will be able to
demonstrate knowledge of competency in logistics management of materiel and
equipment to include: managing patient movement items; procurement procedures
involving separation of assets; equipment repair processes; war reserve
materiel management, cargo and load planning; facility management; vehicle
management; and contracting support.
INDEX
|
TOPIC |
PAGE |
|
Materiel
Management and Procurement |
2 |
|
First
Aid Kit Management |
13 |
|
Contracting
Support |
15 |
|
WRM |
20 |
|
Vehicle
Management |
25 |
|
Cargo Management
and Load Planning |
30 |
|
Equipment
Management and Repair |
36 |
|
Facility
Management |
39 |
|
Post
Evaluation |
44 |
MATERIEL MANAGEMENT AND PROCUREMENT
OBJECTIVE
Provide basic terminology,
reference sources, and information on materiel management and procurement as it
relates to MSC officers.
INTRODUCTION
Supplies and materiel are required by the Air Force (AF) to properly support its weapon systems, facilities, and people. The AF must effectively manage its materiel resources from the time they are ordered until they are released for use. AFPD 23-2 and AFMAN 23-110, Volume 5, provide policies for ordering, receiving, storing and issuing materials, and ensuring stored materials do not harm the environment.
The medical supply section has a dual role: first as a customer of the wholesale suppliers, such as the Defense Logistics Agency (DLA) and the General Services Administration (GSA) and secondly, as a supplier to retail customers-unit/facility section/using activities.
OVERVIEW
Information on various aspects
of medical logistics:
·
Appointments,
Accountability and Responsibilities
·
Acquisition
·
Inventory
·
Shortfall
Coordination
·
Issue/Turn-In,
Disposal of Excess Supplies/Equipment, Defense Reutilization and Marketing
Office (DRMO)
·
Separation
of Assets
·
Storage
·
Hazardous
Materials (HAZMAT)
·
Purchasing
Options – Host Base Account, Blanket Purchase Agreement (BPA), International
Merchant Purchase Authorization Card (IMPAC)
·
AF
Medical Logistics Letter (AFMLL)
·
MEDLOG/Computer
Output Products
·
Support
Agreement
REFERENCES
DoD 4160.21-M Defense Reutilization and Marketing
Manual
DoD 4210.15 Hazardous
Materiel Pollution Prevention
DoDI 6050.5 DoD
Hazardous Communication Program
AFJMAN 24-204 Preparing Hazardous Materiel for
Military Air Shipment
AFI 32-7042 Solid
and Hazardous Waste Compliance
AFI 41-209 Medical
Logistics Materiel and Services Support
AFI 41-214 Air
Force Medical Logistics Letter (AFMLL)
AFPD 23-1 Requirements
and Stockage of Materiel
AFPD 23-2 Supplies
and Materiel Management
AFPD 23-5 Reusing
and Disposing of Materiel
AFPD 41-2 Medical
Support
AFMAN 23-110, V5 AF Medical Materiel Management System -
General
AFM 67-1 Automated
Data System (ADS) Management Procedures
AFI
41-201 Medical
Logistics System (MEDLOG): 1008/AJ Users Manual
AFMAN 23-110 USAF Supply Manual
AFI 23-111 Management
of Government Property in the Possession of the AF
AFOSH 127-8 Medical
Facilities
Base Hazardous Waste
Management Plan
Hazardous Material Pharmacy
Implementation Plan
PRESENTATION
A. Appointments, Accountability and Responsibilities
The medical logistics officer’s reporting structure varies in peacetime settings depending on component affiliation and unit/facility set up. In contingencies, the structure also has variables depending on where one is assigned, i.e. theater commands, operational and bare bases, and mission taskings. The main objective remains constant: for the using activity to receive outstanding materiels and service support in a timely manner.
The appointing official as specified in AFR 20-14 appoints an MSC officer as the Director, Medical Logistics (DML). A materiel manager is also appointed. The DML may also be the manager. The most important document of transfer is the special order or letter of appointment signed by the installation commander appointing the medical manager. This is where one derives his/her authority. The DML is responsible for the overall process management and supervision of assigned personnel. The materiel manager is the accountable officer for the medical stock record account and retains accountability until the account transfers to a successor or terminates. Effective operations of the account are dependent upon complete, current, and accurate records. In the Air Reserve Component (ARC), the materiel manager is most likely located at the active duty host base. The host base is primarily charged with most functions that need centralized processing. Working with the assigned host base is essential for logistics functions to operate smoothly and efficiently and provide effective support to mission taskings.
The DML establishes procedures for the controlling and safeguarding of medical items that require special accounting, storage, shipment, and issue precautions.
Logistics personnel working under the direction of the DML have specific responsibilities.
· Establish inventory stock levels based on audit results so that the level for each stocked item is a balance between the cost of carrying the inventory and the cost of being without the item when needed.
· Request assignment of national stock numbers (NSN) to repetitively procured items.
· Inspect incoming shipments to verify the materiel received is what the customer ordered and prepare discrepancy reports for damaged items or materiel received in error.
· Store materiel providing adequate protection and facilitate ease of handling and retrieval.
· Mark equipment and durable supplies to clearly indicate they are medical facility property.
· Deliver materiel to the using activity according to an agreed upon schedule.
· Issue equipment to the using activity upon acceptance by biomedical equipment maintenance support.
· Accept unused and unneeded materiel from using activities.
· Inspect, classify, and monitor materiel as they receive, issue, store, or ship it; process materiel complaints from using activities.
· Remove defective or suspected defective materiel from using activities and serviceable inventories; suspend the materiel from issue, and report to the host base.
For more information on roles and responsibilities refer to AFMAN 23-110, Volume 5. Details can be found on the entire chain of command responsibilities in Chapter 1.
B.
Acquisition
Knowledge
of funding sources is essential. Congress provides public funds to federal
agencies with specific limitations on the use of the funds. Purpose, time and
amount affect funds allocation. Contact your local finance section or resource
management office for assistance in understanding what rules apply for the
money available to your organization.
Most
often medical logistics is given approval authority for routine local purchase,
except for new drugs. Reviewing all new local purchase requests is important to
ensure one stays within the boundaries established by the local
contacting/finance authorities and to track budget impact of these purchases.
Local purchase request forms should be used to process acquisitions. See AFMAN
23-110, Volume 5, Chapter 16, Attachment 2 for an example format.
Acquisition
is a cradle to grave process for getting the medical equipment necessary to
accomplish the mission. Approval authority for most equipment items rests with
the unit/facility commander. The
commander is authorized to approve requests for EXPENSE medical equipment
costing less than $100,000. INVESTMENT equipment (over $100,000) must be approved
at higher headquarters, forwarded through the unit/facility commander.
Once an
item is acquired it must be received and processed correctly. Medical supply is
responsible for processing incoming shipments and in-unit/facility turn-ins,
maintaining a file of contracts and purchase orders, moving property to either
the delivery area or the applicable storage area, and preparing and
distributing required receiving and turn-in documents. Receiving also works with Base Contracting
to coordinate on Local Purchase receipts.
C.
Purchase
Options
1. Local Purchase
Local
purchase policy comes from contracting policy and applies to all military
services, the DLA, and the GSA. Local purchase of an item can now be done if
the purchase is in the best interest of the government in terms of quality,
timeliness, and cost. There are some exceptions such as: 1) War Reserve
Materiels (WRM) requirement items necessary for the wartime mission, and/or
required to support a unit deployment mission 2) Items directly related to the
support of a weapon system or its support equipment 3) Items with special
security characteristics, and 4) Items of a dangerous nature, such as,
explosives or munitions. In some cases approval is needed before making local
purchases. Check with your contracting
office for direction.
Local
purchases can be made by using the IMPAC card or the Form 9. More details are
available in AFMAN 23-110, Volume 5, Chapter 16 and in the contracting section
of this module.
Sometimes
a waiver must be requested for certain purchases (i.e. furniture not purchased
from UNICOR for a specific reason).
When this is the case coordination through contracting channels is
required.
Most requests for equipment will be made on an AF Form 601, Equipment Action Request, with needed justification and company literature attached. More information on equipment justifications and approval can be found in AFMAN 23-110, Volume 5, Chapter 18. Make sure all requests are fully coordinated before submitting for purchase.
2. The IMPAC Card is meant to accommodate small purchases for mission support requirements in a more timely and cost effective manner. Without exception, the IMPAC card will only be used to pay for authorized US government purchases.
The GSA, Federal Supply Services, has awarded a single schedule contract for government-wide Commercial Credit Service. The contract provides commercial credit cards and associated services to military members and federal civilian employees to pay for official government purchases. All acquisition, supply, and finance regulations apply to IMPAC purchases and cardholders must comply with them when purchasing from commercial sources.
· Ensure that funds are available to pay for items being purchased.
· Document all purchases in a log.
· Ensure that the supply or service is not one that must be purchased from a required source of supply IAW Federal Acquisition Regulation (FAR) part 8. If a required source is available the item(s) must be purchased there.
· Ensure that the price includes delivery and set up charges.
· Rotate sources.
· Ensure that a reasonable price is obtained by comparison shopping.
· Purchases not exceeding $2,500 are exempt from the Buy American Act and Small Business Set-Aside Program.
The IMPAC card may be used to purchase supplies, equipment, and non-personal services up to the micro-purchase level, which is currently $2,500. Some unique exceptions may be made when approved through contracting channels.
The AF member using an IMPAC card at an overseas base should be aware of mandatory procedures. When outside CONUS, purchases for non-medical items should be made through base supply whenever possible. If base supply is unable to meet the timeline requirement or provide the service and the IMPAC will be used, every effort must be made to purchase items locally. If all avenues for procuring the needed material though supply or local sources are exhausted, then certain procedures must be followed when ordering from a CONUS source. Contact the contracting office for guidance or refer to the USAF Internal Procedures for Using the IMPAC card, section 3.2.17.1.
Use of the IMPAC card for contingency/exercise operations is limited and often not possible. In many contingencies, credit instruments will not be acceptable to host nation vendors or services providers and cash payments must be made. See other applicable rules in the internal procedures handout. Contact the contracting office for additional assistance.
The using activity appoints the cardholder(s) and approving official. A Letter of Appointment is signed by the medical commander and then processed through the base IMPAC Program Coordinator along with the formal application form for the card. Contact the local contacting representative for exact format. After appointment has been approved, training must be completed before the card can be issued. At a minimum, a four-hour training session is required for new cardholders; refresher training is also required as long as one remains a cardholder.
3. Blanket Purchase Agreement (BPA)
The contracting section of this module will discuss BPA processes and actions.
D.
Inventory
and Discrepancy Coordination
Operating inventory is maintained to provide selected materiel for use when and where it is needed. An inventory policy is necessary to minimize the high cost of too much or too little stock on hand. Control policies and decisions must be made based on local needs, economic investment in inventory, customer requirements, and the medical mission.
Periodic,
most often annually, inventory level assessments must be accomplished for all
property (WRM, equipment and controlled items). Details on inventory procedures
can be found in AFMAN 23-110, Volume 5, Chapter 12. The objective of a physical
inventory is to verify stock record balances against actual stocks on hand.
When the accuracy is below 95% a new inventory will be conducted within six
months.
Discrepancies
must be reported accurately and promptly when they relate directly to problems
with supplies and equipment items. Make reports to shipper, manufacturer,
vendor, or contractor through the appropriate base office (if needed). Refer to
AFMAN 23-110, Volume 5, Chapter 9.
E.
Issue/Turn-in
1. Issue
Bench stock is expendable items the using activity needs to conduct normal business activities. Expendable items are those that are consumed in use or lose their identity when attached to another assembly. These items are issued out to the using activity with the oldest items issued first when dated item controls apply. Medical supply coordinates with the using activity to establish bench stock lists, reviews on-hand balance, replenishes, and delivers the items. The shelf life of medical commodities is important to monitor. Each medical supply account will rotate stock to ensure that expiration dated items with the earliest dates are issued first.
When requesting expendable items, use an AF Form 2005, Issue/Turn-in Request or AF Form 1445, Materials and Equipment List to order supplies and the DD Form 1348-6 for local purchase requests.
2. Turn-In/Disposal of Excess
Supplies and Equipment/DRMO
Equipment custodians request turn-in of equipment on the Custodian Authorization/Custody Receipt Listing (CA/CRL) by completing and coordinating the AF Form 601 or AF Form 2005 (whichever is applicable) for the specific transaction. The Air Reserve Component (ARC) Equipment Management Section is most often located at the active duty host base. Coordination through the designated host base will be necessary for both turn-in and issue of items. The property custodian prepares turn-ins for pick-up. The property turned in to Base Supply must be complete, reasonably clean and tagged with the correct condition code.
The
policy for disposal of government property is relatively simple. The only items
that may be disposed of as trash are items that have no required
demilitarization actions and no potential value to the government through
future use or resale by the DRMO, either in its current configuration or for
its basic materiel content. All other materiel, serviceable or unserviceable,
must be turned in to Base Supply or DRMO for disposition. All items requiring
demilitarization will be turned in to DRMO on a separate DD Form 1348-1A and
not batched together on one form.
Computer
equipment designed for turn-in must follow certain steps. There is a standard
method of accounting for systems on the Automatic Data Processing Equipment
(ADPE) account. When turning in these assets, coordination with the base
communications squadron ADPE Equipment Custodian Officer (ECO) is a must before base supply will process
the item(s).
F.
Separation
of Assets
Separation of Assets deals with the appropriate handling, storage and transportation of all types of assets used by a medical unit/facility. This is not a distinct topic from other areas covered throughout medical logistics activities. However, it is worth mentioning separately from these areas because of its high visibility and importance. There are specific handling, storage and transportation directives that must be followed in order to meet established standards. Examples: Dirty linens cannot be maintained in the same area as clean linens. When oxygen is in an area, flammable items must be handled in specific ways or not in the same area at all. For more detailed information, start by referring to DLAM 4155.5 or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Health Services Inspection (HSI), and Occupational Safety and Health Association (OSHA) standards on hazardous materials, linens, vehicles, WRM, immunizations, oxygen, cleaning supplies, chemicals, biohazard waste, etc.
G.
Storage
Determining the condition, security classification, and identification of items received, stored, issued, shipped and transferred is important when considering how to store items. Storage of medical materiel involves careful planning to ensure effective use of available space and maintain proper storage conditions. Adequate warehouse facilities must be made available for medical materiel storage. These facilities must provide the required security and environmental controls. Warehouses must be clean and orderly at all times. Arrange materiel so it is protected against theft and the deteriorating effects of weather, light, moisture, extreme temperatures and vermin. Evaluate procedures and activities to ensure adequate space is designated for loose, bulk, controlled, refrigerated, flammable, and other special storage items. Additional guidance for storage of supplies is in AFMAN 23-110, Volume 5, Chapter 23.
A central locator listing of assigned stored items should be maintained. Storage of different types of medical assets should be addressed appropriately. Different methods of storage are required depending on what the item is-immunizations, controlled drugs, WRM, supplies (medical or non-medical), equipment (medical or non-medical), furniture, computer systems and vehicles. Refer to AFMAN 23-110, Volume 5 for specific storage directions. Handling of controlled medical items is found in Chapter 14.
H. Hazardous Materials (HAZMAT) and Hazardous Waste (HW) Management
This is another key area for the medical logistics section. To be qualified as a handler and/or certifier for HAZMAT, attendance at base level classes is mandatory. All section staff must attend initial and refresher classes. Steps for preparing HAZMAT must be in place to ensure compliance with all safety, security, and legal requirements. Certified handlers must follow the logical steps when preparing material for shipment to avoid mishandling or frustrated cargo. When delays occur, critically needed supplies and equipment may not be where they are needed. AFMAN 23-110, Volume 5, Chapter 25 will provide some information on HAZMAT and HW management; AFJMAN 24-204 provides guidance and procedures for preparing hazardous material for shipment aboard military aircraft to ensure that such materials are packaged, marked, and prepared properly for transportation; Title 49 Code of Federal Regulations (CFR) Part 173 regulates the movement of hazardous materials in the US.
I.
AF
Medical Logistics Letter (AFMLL), AF Medical
Quality Assurance (QA) Messages, DoD Medical Materiel Quality Control (DODMMQC)
Messages, and Surgeon General’s Notice To Airman (SG NOTAMs)
1. AF Medical
Logistics Office (AFMLO), Ft. Detrick, MD,
publishes AFMLL. It is a specialized publication
issued not less than monthly, to provide timely medical logistics support
information to AF medical activities
worldwide. The publication contains information and instructions that the staff of the medical service requires
in order to make more effective and economic use of AF medical logistics. The information contained in each AFMLL
remains in effect for 24 months from
the date of publications unless sooner rescinded or superseded.
The AFMLL contains the following: technical instructions and data,
announcements concerning the pricing, acquisition, suspension, replacement,
deletion, transfer, safe handling, maintenance, and destruction of medical
supplies and equipment, a USAF Medical Logistics Directory, and other items of
interest.
2. AFMLO sends
suspension notices based on Type I, II, and III medical materiel complaints to medical activities as Quality Assurance (QA)
messages. These consecutively numbered messages
are maintained in a Quality Assurance/Risk Management (QA/RM) file. These messages contain a control number
consisting of the Julian date followed by a four digit sequential serial number. This enables recipients to maintain
accountability for all messages. These
suspension notices are also published in the AFMLL.
1.
Medical
Materiel Complaints
·
Type
I - a supply or equipment item which has been determined by use or test to be
harmful or defective to the extent that use has caused or may cause illness or
death. Immediate action is required to report such items and to remove them
from using activities and serviceable inventories.
·
Type
II - a supply item that is suspected of being defective, deteriorated, or
otherwise unsuitable for use. Expeditious action is required to report such
items and to remove them from using activities and serviceable inventories.
·
Type
III – an equipment item that is determined to be unsatisfactory because of
malfunction, design deficiency, defects, or performance. Complaints of this
type may or may not require suspension of the item.
Destruction notifications for medical materiel not previously
suspended are sent by QA messages and published in the AFMLL.
Department of Defense (DoD) Medical Materiel Quality
Control (DODMMQC) messages are consecutively numbered messages that are
maintained to ensure that all have been received.
3. SG NOTAMS are the Surgeon General’s
medical notices to airman that provide critical information and guidance on
various medical programs, issues, etc. A process must be developed to ensure they
are distributed in a timely manner to applicable personnel throughout all
levels of the organization. If these messages are not distributed to unit
personnel, a potential exists for adverse outcomes and/or non-compliance with
guidance due to failure to effectively communicate critical information.
J.
MEDLOG
While the soul of medical logistics is serving the customer, the lifeblood is computer generated reports or the MEDLOG computer system. Gaining an understanding of what reports are generated from MEDLOG will help you manage assigned accounts. A complete listing of reports available can be found in AFCSM 41-230, Volume 2, Attachment 3-6.
MEDLOG
has many levels of output product response: on-line, daily, monthly, and as
required. On-line outputs require
immediate attention. These would be such things as emergency issues,
destructions, stock number and unit of issue changes, as well as purchase
orders. Most products are generated at the end-of-day (EOD) processing and
require action the next business day.
Products generated during the end-of-month (EOM) processing are general
management tools and reports. In all,
there are over 100 reports produced by the MEDLOG system.
Three
key reports are: 1) The Medical Inventory Management Report-provides a great
deal of useful information. It has various data accumulated by requirement code
including average pipeline time, excess figures, and fill rate percentage. 2)
The monthly Stock Status Report-lists irregularities with descriptive messages
for items reviewed. The computer is programmed to flag deviations to the “norm”
in such areas as pipeline time, on-hand balances, issue history, etc. Entries
on this report require review and possible action. 3) The Medical Materiel
Requirements List-generated from MEDLOG at the EOD and EOM. It consists of five
parts: medical routine, non-medical routine, medical priority, non-medical
priority, prime vendor, and WRM requirements (WRM is prepared only when
requested). Check the list to make sure most of the orders are being sent as
routine. Priority requisitions cost more in time and money. The more priority
requests, the more the routines get delayed. Work closely with the NCOs working
this program to develop an understanding of the different reports’ contents and
uses.
It is
important to ensure primary and alternate MEDLOG systems administrators have
been appointed and are aware of their responsibilities. MEDLOG reports are
designed to be used as the basis for managerial decisions.
The
Standard Systems Group (SSG) Medical Systems is responsible for resolving
programming or processing difficulties with the MEDLOG system. Refer issues and questions to them.
K.
Support
Agreements
AF operations often require providing or receiving support from other AF units, Federal agencies, and foreign governments. AF units will document the support required and provided by one unit to another to ensure effective resource management, unify efforts toward a common goal, and guard against jeopardizing unit mission capabilities. Contracting and the Judge Advocate General (JAG) will provide the necessary assistance when dealing with foreign government support agreements.
Support agreements will be prepared by the supplying activity to formally identify recurring support requirements based on specific support functions, related responsibilities, and reimbursement cost performed by the supplier and receiver. These agreements are negotiated and administered at the appropriate level. DoDI 4000.19 identifies categories of support service.
Refer to AFCSM 41-230 for specific procedures on accounting of property located at a detached unit/facility and for guidance on issue, turn-in, equipment maintenance and stock rotation. Normally, detached units/facilities identified for supported as detached from the host base Medical Treatment Facility (MTF) will enter into a support agreement with each other according to AFI 25-201, Support Agreements Procedures. Specific procedures will vary according to such factors as mission taskings of units, distances involved, and scope of support that can be provided. Support to the ARC includes medical equipment maintenance, medical materiel, and MEMO services. At a minimum, a using activity account and project fund management record should be set up. Again, variations will exist depending on the support agreement.
SUMMARY
Medical Logistics has an essential role in the overall success of a medical unit/facility’s ability to successfully complete mission assignments. Everything in Medical Logistics can be seen, touched, or tracked statistically. The results of section efforts can be seen every time one walks down the hallways, from the quality of building maintenance to supplies purchased to provide direct patient support. Everything in Medical Logistics has an audit trail. There are inputs, transformations, outputs, and feedback loops every step of the way. Every transaction is driven by input and results in a subsequent output; this makes the career field very technically oriented. Therefore it is important to remember that the customer is the main focus.
FORMS
AF Form 9 Request
for Purchase
AF Form 105 F-4 Due-in and Due-out Record
AF Form 616 Fund
Cite Authorization (FCA)
AF Form 1445 Materials
and Equipment List
AF Form 2005 Issue/Turn-in
Request
TERMINOLOGY
Air Force Medical Logistics Office (AFMLO) – Contact point for general
information and resolving general medical logistics problems.
Defense Logistics Agency (DLA) – Agency of the DoD with a networked comprised
of main and geographic facilities at various locations, it provides worldwide
support to all armed services. The DLA
is responsible for the wholesale management, procurement, and distribution of
items of supply common to the military departments.
Defense Reutilization and Marketing Office (DRMO) –Agency responsible for
contracting for disposal of hazardous waste, equipment and supply items. They will either dispose of items or
redistribute them
Equipment – Is an item having a life expectancy of five years or more and maintains
its identity in use and performs a function alone and costs $300 dollars or
more (medical items only).
General Services Administration (GSA) – Created in 1949. Divided into two separate
services, the Public Building Services (PBS) and the Federal Supply Services
(FSS). The FSS procures many common use
items including office supplies, paper, desks, and hand tools to name a few.
International
Merchant Purchase Authorization Card (IMPAC) – The IMPAC card is the official
Government-wide purchase card.
Local Purchase – An authorized purchase, from sources outside the DoD, of materiel
and services by a base activity for its own use or the use of the logistically
supported activity. Purchases are not
limited to the immediate geographical area in which the base is located.
Medical Expense Equipment – An item that costs $300 to $99,999 and waits for
local funding before being ordered.
Medical and Nonmedical Investment Equipment