 I would like to make an announcement. The depots in the medical supply system no longer stock. The 5,000 different false teeth in varying moles and shades formerly kept on hand. The depots have lost their bite. Or as you will soon see, they do stock almost everything else that medical personnel may require. In fact, those teeth are provided to military customers on contract direct from manufacturers. In part one of this two-part series, we discussed the organization and administration of the medical supply system. Now we're going to take a look at the system in operation. This is a typical depot of the type from which the Army obtains medical materiel. Its warehouses are filled with thousands of different items. Yet the Army does not procure these supplies nor does it own them nor are they specifically designated for the Army. Confusing? Not really. You see, the great majority of all medical materiel for the Army, the Navy and the Air Force, is purchased by one central organization. The Defense Personnel Support Center and managed by its Directorate of Medical Materiel. While the depots themselves are under the operational control of either the Defense Supply Agency or the Army Materiel Command, the supplies on hand remain the property of the Directorate of Medical Materiel of DPSC and are available to all the military services. So while this depot does, on occasion, serve the Army, it serves the Navy and the Air Force as well. However, these supplies are not simply issued to using units. Instead, they are sold. CONUS depots house the largest and most varied stocks of medical supplies in the world. More than $200 million worth of equipment, drugs and other medical materiel. These depots carry a complete line of almost all the medical items listed in the federal catalog. Basically, the major mission of a depot is a simple one. It receives, stores and sells supplies to using units. To carry out this mission, it uses an elaborate interlocking system of labor-saving devices. The depot has several other lesser missions as well. It is a storage point for repair parts, stocking items ranging from small gauges to more than $2 million worth of x-ray tubes. The depot is an assembly point for more than 200 kits, chests and assemblages, some of which are seen here. Each of them is designed for a specific purpose. All of the items stored in the various depots are listed in the federal catalog. Since the names used in the catalog frequently differ from those used in civilian institutions, where medical and paramedical personnel are trained, the picture provided is of great value to them in identifying and ordering the item they want. Each depot serves many military installations. The entire purpose of the medical supply system is to get quality medical materiel down to the user level as quickly and efficiently and economically as possible. The system used at Fort Knox is typical of that at many army installations. In the hospital supply office, one officer fulfills two functions. He is both the post-medical supply officer and the hospital chief of supply and services division. In carrying out these dual responsibilities, one of his main jobs is the administration of funds. Each year, as post-medical supply officer, he programs for and receives just so much money for medical materiel. This is stock fund money, part of the army stock fund, which is used to provide materiel in his warehouses to support all using units for which he is responsible for in addition to the hospital itself. There are more than 20 other medical activities at this post. Dispensaries, clinics, T-O and E units, off-post satellites, which all obtain supplies from the post-medical supply officer. Since the supply officer has a limited amount of stock fund money and probably less than he requested, he must live on a budget like everyone else. It is up to him to follow all the basic principles of good management in maintaining a stock of medical materiel. He must store materiel properly. He must avoid overstocking of dated materiel. He must make sure that dated materiel are issued normally on a first in, first out basis so that they are used before their expiration date. If materiel like these are wasted, stock fund money is wasted. Money which could be better used for the purchase of other needed materiel. Therefore, it is up to the post-medical supply officer to handle stock fund money carefully to see that it goes as far as possible. Stock fund money, however, is only half of the funding story. For while it is used to provide materiel in his warehouse, the supplies themselves are not issued. Instead, they are sold to using units which purchase them with consumer funds. These consumer funds therefore are extremely important. Each year, every post-medical activity, including the hospital itself, receives an allotment of consumer funds. The chief of supply and service division uses these funds to purchase supplies for the using units of the hospital from the warehouse which he operates as the post-medical supply officer. He does business with himself, so to speak. For the most part, the supplies purchased for the hospital go to the laboratory or to the central materiel service where a wide variety of medical supplies are prepared for use and stored or to the pharmacy. It is extremely important at every level of operation that these funds are not abused. For example, if pharmacy personnel allow medical supplies to be wasted through over-stockage, lack of inventory control, or lack of control of medicines, consumer funds are lost, and the result may affect both the quality and quantity of medical supplies available. Adequate controls must be established over medical material throughout the medical supply system if we are to assure that the use of funds is not abused. In the event of an emergency, should any conflict arise between administrative procedures and the welfare of the patient, the patient always comes first. Regardless of the money or supply policies involved, regulations are specific in stating that needed items of medical supply must be obtained as quickly as possible. Providing the best medical care is always the primary consideration. This patient, for instance, suffered a serious back injury. Among the items of supply requested by the doctor were three fairly typical items. Morphine, a bladder evacuating syringe, and a circoelectric turning frame. But each item came from a different source. The morphine was available in the emergency room drug cabinet where a small supply of frequently needed drugs and medicines is kept on hand. If, for any reason, there had not been enough morphine in the drug cabinet, more would have been available in the pharmacy where the bulk supplies of drugs and medicines are stored. The bladder evacuating syringe and the circoelectric frame were obtained by the doctor simply by requesting that his service get them for him. And as frequently used items, both were available in central material service. Everything needed for the treatment of the patient was soon on hand. But it wasn't as easy as it appears. Many sources of supply were used for this one patient. Take a look at the supply procedures that were necessary to assure that the essential items for treatment were available at the hospital when they were needed. The morphine and the bladder evacuating syringe, standard items of medical supply, were requisitioned by the post-medical supply officer from the depot. Requisitions are placed directly on the defense personnel support center. The urgency of a requisition is identified by the priority indicator. High priority requisitions are emergency requisitions and must be filled as quickly as possible. The morphine and the bladder evacuating syringe as standard items were obtained as part of routine supply operation. In the case of the circoelectric frame, since it was a non-standard item, it was necessary for the physician who felt it should be stocked at his hospital to obtain the approval of both the chief of service and the local equipment board before purchase could be authorized. This rather elaborate procedure may seem like a nuisance. However, it is necessary in order to ensure that only needed items of equipment are approved for non-standard procurement. Then it is only a matter of following routine local procurement procedures. In a short time, the circoelectric turning frame arrived at the medical supply warehouse. It was not stored there, however, but sent directly up to central material service. It was ready for use when the patient needed it. Suppose we take a look now at the post-medical supply warehouse. For the most part, the items found here are the fast-moving variety, items which are frequently in demand. Some are kept on open shelves and some in bulk storage. Some are kept under refrigeration and some in a locked vault. In order to meet demands without delay, adequate stockage levels must be maintained. Part of the administration of these supplies is quite simple. The stock control system does require meticulous attention to detail. It records inventories, demand data, and serves as a basis for reordering. It provides supply information used in the preparation of supply reports required by higher headquarters. At the same time, a property book is used to keep a record accountability and the location of non-expendable items of use. This property book not only tells where items are, but also when they were issued and to whom. Narcotics, medicinal alcohol, precious metals, and radioactive substances must all be handled according to precise army regulation. These special materials must always be properly secured and logged in and signed out only by authorized personnel. Great emphasis is placed on assuring that there will be no mishandling of these materials. The army goes to great lengths to maintain proper control at all times. The system used in the handling of narcotics illustrates the care which is taken for every sensitive item. Each month, a disinterested officer is appointed to inspect an inventory, the supply of narcotics in the medical supply vault, in the pharmacy, and every ward and clinic at the medical facility. His inspection must be very thorough, to the point of checking out the narcotics at every level of control. In the pharmacy, he determines where, when, and to whom, and in what quantities. Narcotics were issued. He traces these issues right down to the ward and verifies the quantity on hand with that shown on the narcotics record. In this way, corrective action can be quickly taken if there is any mishandling. Similar procedures are followed in the management of other special materials. While it is the operator's responsibility to clean and make minor adjustments of equipment, medical equipment repairmen are assigned to the supply and service division. They make regular routine visits to using activities both on-post and off-post to inspect, adjust, lubricate, and correct minor troubles before they cause major breakdowns. If, during the inspection, the repairmen find that a piece of equipment needs major work, they make arrangements to send the item to the organizational repair shop. There, proper test instruments, tools, and parts are available to make the necessary repairs. In the case of larger items, on-site repairs are made. But there are a few items, such as poropters and x-ray tubes, that can be repaired more expeditiously and economically at a larger, fully equipped depot shop. In addition to their assigned medical duties, hospital personnel also have a planned specific mission in the event of mobilization. It is the responsibility of the post-medical supply officer to stock and secure pre-positioned medical material making up the mobilization reserve. At a medical installation, under the command jurisdiction of the surgeon general, such as Walter Reed Army Medical Center, one supply officer serves the entire post. A medical service officer, either as director of logistics or as chief of supply and service, is responsible for the entire supply mission. At Walter Reed, for example, the director of logistics is responsible not only for medical requirements, but for the needs of all the other commodities as well. Computers or electrical accounting machines are used for the preparation and maintenance of records. For every day, Walter Reed must process an enormous amount of data. This includes not only stock-level information and other supply figures, but also a great variety of medical statistics. The Walter Reed Army Medical Center carries out many special activities. Studies conducted here use a large quantity of non-standard items which must be obtained through local procurement. For example, this special device is called the body counter. It is this kind of non-standard equipment which always requires the use of procedures designed for local procurement. The body counter is used to count the radiation in a man's body. It is obviously much too specialized a piece of equipment to be found in the federal supply catalog or carried in a depot. There are many other items which are used in research projects and which would hardly be called regular items of supply. Instead, they are purchased under the provisions of Army procurement regulations which permit the purchase of non-standard items, even those with a relatively high dollar cost, providing that all regulations are followed to the letter. Overseas is another matter. Outside the United States, the Army is in complete charge of its own supply program. Medical materiel is requisitioned through the established supply channels and shipped to Army depots in many parts of the world. Supplies within these depots belong to the Army which distributes them through its own organization to using units. Distribution systems, however, may vary from one part of the world to another. For generally speaking, the Army has adapted itself to the different areas in which it is serving. In the Far East, methods of handling medical materiel are quite different from those being used in parts of Europe. Despite regional idiosyncrasies, however, basic operating principles remain the same. There are funds to be managed, depots storing supplies in bulk quantities, installation medical supply warehouses to meet using unit needs, a certain amount of local procurement, and in every situation, there are Army regulations governing the administration of medical materiel. For wherever Army medical service personnel are on duty, it is extremely important that stock fund money and consumer money be properly handled and that all supply regulations be followed. Today's medical supply system represents a carefully coordinated program designed to produce a steady flow of medical, dental, and veterinary supplies from the depot to the installation to the using unit to the patient. In handling the vast quantities of medical materiel needed to meet both peacetime and mobilization requirements, the system is efficient, effective, and economical. And all of its efforts serve only one purpose, to provide medical personnel with the supplies they need, when and where they need them all over the world. Army medical service personnel are supported by the best medical supply system in existence. However, if the system is to work up to capacity, Army medical service personnel must understand how it works and how to work with it.