Recent Issues and Advances in Aeromedical Evacuation (MEDEVAC)

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Use of Quality Tools To Re-engineer the Aeromedical Evacuation (AE) System
Colonel Carroll R. Bloomquist, USAF, MSC
Chief Executive Officer
Aeromedical Evacuation & Contingency Medical Plans and Requirements
Office of the Command Surgeon
Headquarters, Air Mobility Command
United States Transportation Command
Scott AFB, IL - USA
IL-62225-5319
SUMMARY
The element of change pervades each of our activities; defining
change should be accomplished in a logical fashion using
definitive tools. A number of quality tools are available to
produce rational, well-defined change in a large complex
system. One of these methods, the Theory of Constraints
(TOC) will be the focus of this paper with regard to designing
and implementing change for the United States (U.S.)
Department of Defense @OD) aeromedical evacuation (AE)
system. Improvements in the US. AE system may provide a
systemic benefit to multinational operations.
BACKGROUND
Several contingency operations between 1985 and 1994 have
offered the opportunity to employ the global evacuation systems
and processes of the United States. The casualty evacuation
system involves the regulation (i.e., finding the appropriate
destination for tlie patient) and the subsequent inovement of tlie
casualty within and from each echelon to units providing
niedical care. The individual patient may then be returned to
duty in the combat environment or repatriated for follow-on
care. The evacuation systeni involves many transportation
subsystems including surface, both land based and sea based, as
well as rotary wing and fixed wing aeromedical evacuation.
This paper will focus on the fised wing, common-user service
provided globally for U.S. military forces but playing an
increasing service role to United Nation forces and other multi-
national forces where the U.S. is a partner. This service will be
referred to as the aeromedical evacuation system.
The AE system plays a key role in U.S. national strategy.
While the contingency planning requirement for medical care
has declined since the end of the cold war, AE requirements
have not decreased. In fact, rapidly mobile forces and predicted
short engagements dictate a decreased forward medical
presence with the alternative that theater Commanders will be
niore dependent on the AE system to link casualties to life-
saving medical care. As military operations have assunied a
more mobile, responsive posture, AE responsibilities have
expanded. Typically, operations involving U.S. forces include
an AE presence from the outset, and AE res onsibilities remain
until all forces are no longer in harm's way. P
The United States Department of Defense delegates advocacy
for AE to the Air Mobility Command (AMC). As agent of the
Commander, AMC, tlie Command Surgeon is tasked with
oversight of all planning, organizing and equipping activities
required, to ensure the AE force is capable of executing its'
contingency mission and peace-time tasking. Following
Operation DESERT SHIELD/STORM, the AMC Surgeon took
several innovative steps to resolve challenges that surfaced
during the deployment, employment and execution stages.
These changes involved redesigning and restructuring the
modules used to build both the theater specific AE system and
the global overlay or the strategic AE system (i.e., changing the
organization construct of the system), redesigning the basic and
follow-on education and training programs, and modernizing
the equipment and supplies supporting the system to allow
mission accomplishment. The world environment continues to
demand requirements for further change to increase flexibility,
responsiveness and capability.
THE CHANGE PROCESS - AN OVERVIEW
While these actions were constructive and corrected specific
deficiencies, systemic issues remained. A more formal process
was required to get to core problems and define resolution.
One specific method to confront the continuing process of
change is a quality tool called systems thinking or the theory of
constraints. "The Theory of Constraints - Applied Systems
Thinking" was developed by Dr. Eliyahu M. Goldratt and
published in his book, "The Goal" in 1984.2 To provide a
detailed look at remaining and continually changing issues, the
Command Surgeon contracted with the Theory of Constraints
(TOC) Institute3 to educate staff members on progressive
quality techniques and to facilitate the staffs' transition of AE
from a "cottage industry" to an industrial based system, a force
structured, trained, and equipped to satisfy the contingency
requirements and peace-time needs of the twenty-first century.
By working through the TOC techniques the work group linked
the endless interdependent events comprising the AE system
and identified changes necessary to form a seamless system for
tlie future; similar definition has been accomplished in defining
and refining the medical regulating processes. The
Paper presented at the Aerospace Medical Panel Symposium on "Recent Issues and Advances in Aeromedical
Evacuation (MEDEVAC)" held in Athens, Greece, from 3r.d to 7th October 1994.