How militaries can improve medical logistics planning Strategy& is part of the PwC network
Contacts About the authors Dubai Haroon Sheikh Partner 971-4-390-0260 haroon.sheikh Ashish Labroo Principal 971-4-390-0260 ashish.labroo London Bob Mark Partner 44-20-7393-3477 bob.mark Bob Mark is a partner with Strategy& in London working with clients in the public and private sectors, primarily in defense and security in Europe and the Middle East. He has extensive experience in leadership, strategy development, organizational design, transformational change and large-scale efficiency programs. This experience spans the U.K., U.S., and the Middle East where he has been responsible for innovative thinking in major acquisition, logistics transformation and publicprivate commercial programs. Haroon Sheikh is a partner with Strategy& in Dubai and the leader of the firm s defense and operations practices in the Middle East. He is an expert on military logistics and supply chain improvement strategies. His work has been recognized in the highest military circles and institutions, in the region. Sophie Brenner was a senior associate with Strategy&. Stephen Howe was an advisor with. This report was originally published by in 2013. Strategy&
MEDICAL LOGISTICS PLANNING IS POORLY DEVELOPED Military planners are familiar with the four Ds of operations destination, distance, demand, and duration. However, they are less familiar with calculating medical logistics requirements. Typically, they make a relatively basic determination of medical supplies. For example, for a mission involving 1,000 soldiers, they will assume a worst-case scenario in which all 1,000 receive modest injuries and require certain medical supplies. Under this thinking, severely wounded soldiers will be evacuated for treatment outside of the theater of operations. The logistics supply system can come under strain, particularly in the early phases of operations, because of high priority medical demands. Commanders often require that wounded soldiers remain in-theater, due to insufficient replacements being available. Non-combat injuries are also a significant factor, as are medical care requirements for local civilians a growing need given the kinds of missions that Middle East militaries are likely to undertake. ADOPT A COMPREHENSIVE, SIX-FACTOR APPROACH Instead of grappling with an overburdened supply system, Middle East militaries should instead adopt a more comprehensive approach to anticipating their medical logistics needs. More specifically, there are six factors that medical staff, commanders, and decision makers should take into account while planning their operations, support, and resource requirements (see Exhibit 1). The first factor is the population at risk due to the operation. In addition to military personnel, this includes civilian staff, multinational forces, prisoners of war, and detainees (in compliance with international law). Military forces must also sometimes provide medical treatment to local civilians who are affected by their operations. This may entail additional materiel holdings for treating children, the elderly, and medical conditions not usually seen within a military population. The second factor is the naturally occurring rate of disease and non-battle injuries that a force will sustain during an operation. Planners need to use peace-time statistics to estimate the number of personnel likely to report sick each day, along with the percentage hospitalized even the toughest and fittest troops cannot escape the law of averages. This rate will also be affected by the operational climate and level of hygiene practiced particularly under field conditions along with the intensity of pre-combat training. The third factor is health intelligence, which includes different information components: topography, epidemiology, and health infrastructure. If health intelligence fails, commanders may lose a higher percentage of their force to disease, and deployed medical units may be unprepared to address a specific health risk. Health intelligence requires that medics be part of the theater reconnaissance group to identify health threats in the area of operations, including diseases and industrial and environmental hazards. Identifying these threats often requires intimate knowledge of the local geography. Examples include malaria; a lack of potable water; or hazards due to chemical, biological, radiological, or nuclear threats. This reconnaissance is essential to mitigate health threats and prepare countermeasures. Based on health intelligence, military planners may deploy extra resources, prescribe a period of acclimatization, amend vaccination and immunization plans, or order specific health training. When operating as part of a coalition, troops can get much of this critical information from other coalition forces or from the host nation. 1
BROADER PLANNING MEANS BETTER PREPARATION The fourth factor is the battle casualty estimate. This is calculated by operational planners with the assistance of operational analysis specialists. This medical estimate is informed by the number of live casualties of friendly forces and prisoners of war. Medical personnel should assess patterns and common types of wounds based upon available intelligence and analyses of the effects of specific weapons, and should shape the medical support plan accordingly. The fifth factor involves operational commanders working with medics to determine the theater holding policy. This is the maximum number of days a patient will remain under treatment in-theater before returning to duty. Field hospital beds are scarce, especially given the typically limited capacity for providing critical care. A complicating factor is that casualties from the local population remain in-theater until the local health system can take up their care. Therefore, if the casualties condition means they will not be fit to return within a specified time frame, the best policy is evacuation at the first opportunity. This maintains maximum capacity and capability in-theater. If, however, one day is added to the theater holding policy because of low evacuation capacity, then this can require an increase in field hospitals capacity of as much as 15 to 20 percent in the event of high-intensity casualty rates. The sixth factor involves building in a reserve to meet the demands of major incidents that could produce mass casualties. These can result from hostile action or an incident, such as a plane crash that leads to many injured survivors. We believe that military commanders should familiarize themselves with the broad scope of planning parameters that medics use in generating advance logistical requirements for operations. Senior medics should be involved during all phases of planning operations because this is a highly complex process. The result of this new approach to medical logistics planning will be a force that is more prepared for the uncertainties involved in military operations and better positioned for success. Exhibit 1 Six Factors Build an Accurate Estimate of Medical Logistics Demand 1 2 3 4 5 6 Medical Estimate Population at Risk Disease & Non-Battle Injuries Health Intelligence Battle Casualty Estimate Theater Holding Policy Mass Casualties Medical Demand Estimate Source: 2
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