Operation Iraqi Freedom AAR
“Lessons Learned”
LTC David West, Deputy Director,
Proponency Office for Preventive
Medicine – San Antonio
Agenda
1. Background
2. Center for AMEDD Lessons Learned
3. Preventive Medicine Lessons Learned
1. Background.
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Program directed by BG Perugini, CG, AMEDDC&S
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Goal: To capture medically related lessons learned during
OIF & make them available to leaders.
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Process: Through a series of Rock Drills determine what
unit leaders perceived as problems. Provide SMEs to
evaluate each problem.
Deliverables:
1. Distill numerous lessons learned to a few key issues,
and address “near” issues (OIF2) using existing
Integrated Concept Teams.
2. Publish evaluated and consolidated comments from the
AARs on the AMEDDC&S Lessons Learned website,
an on-line system to allow convenient archival and
retrieval of lessons learned and lessons observed.
OIF AAR Timeline
- Rock Drills:
1. 7 – 9 OCT Level 1 & 2 (Div and below)
2. 15 – 17 OCT Level 3 (Corps)
3. 20 – 22 OCT Level 4 (CENTCOM, CFLCC, 3d
MEDCOM)
4. 12 – 14 NOV RC and RMC
- AAR: 14 – 19 DEC. Issues identified during the Rock Drills
were brought forward to the AMEDD senior leadership
Rock Drill Facilitators for 14 Medical Functional
Areas:
Combat Health Log
Blood MGT
MEDEVAC
CBT Stress Control
Lab SVCS
PVNT MED
MED Treatment
Dental SVCS
VET SVCS
Hospitalization
MED C2
Communications
Computers
Intelligence
FIXES TO OBSERVATIONS
DOTMLPF Domains:
Doctrine
Organization
Training
Materiel
Leadership
Personnel
Facilities
2. Center for AMEDD Lessons
Learned
- All OIF observations or lessons learned resulting from the
multiple rock drills held at he AMEDDC&S are available
at: http://lessonslearned.amedd.army.mil/
- Interactive site; lessons learned, AARs, SOPs, etc from
numerous operations can be retrieved, and new
information can be added
Phase I/II/III
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OIF AAR Issue
ISSUE: Line Command emphasis for PM
DISCUSSION: A number of line units believe field sanitation is a medical
responsibility and that PM units/personnel should address these issues.
Many units did not deploy with DEET, mosquito nets, and other PM
supplies. Many units tried to order the items right before deployment but
were unsuccessful. Other units just did not plan on deploying with these
items.
LESSON LEARNED: Line Commanders have not completely accepted
PM as their responsibility with medical in support.
RECOMMENDATION: Obtain Army leadership support that PM is
everyone soldiers’ responsibility, especially that of the Commander.
Educate CDRs that if the investment is not made at the front end, the
workload in theater to address PM crises will be significant; ounce of
preventive is worth a pound of cure.
DOTMLPF IMPLICATIONS: DTL
RESPONSIBLE AGENCY: LEAD: TSG to brief topic at PreCommand Course and get CSA and G-3 to emphasize at PreCommand Course also; + other actions; ASSIST: AMEDD C&S,
Combatant Command/DIV/BDE Surgeon
Phase I/II/III
OIF AAR Issue
• ISSUE: PM personnel availability
• DISCUSSION: PM personnel (enlisted/officers) were not
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available at the multiple base camps and divisional units which
encountered sanitation and hygiene problems. Some units did
not have PM support until June 03. Mosquitoes were very bad in
Baghdad and flies in other areas. PM doc should not be located at
MSB but at the Division Main or Rear where communications to
provide PM guidance and oversight is better.
LESSON LEARNED: There was inadequate PM coverage in OIF.
RECOMMENDATION: Locate the PM doc at the Division Main or
Rear to better communicate PM guidance to divisional units.
Improve communications between the PM assets in theater and
the customers. Get sufficient PM assets into theater and push
them down to BDE level.
• DOTMLPF IMPLICATIONS: DTL
• RESPONSIBLE AGENCY: LEAD: Combatant
Command/Division/BDE Surgeons; ASSIST: AMEDD C&S
Phase I
OIF AAR Issue
• ISSUE: Units deployed with inadequate PM supplies such as
DEET, permethrin, mosquito nets, etc.
• DISCUSSION: Units deployed with inadequate PM supplies
because they were not stocked at the unit level and orders
submitted before deployment were not filled because supplies
were not available in the quantities required.
• LESSON LEARNED: Units are deploying with inadequate basic
PM supplies such as permethrin, mosquito nets, DEET, etc
because of inadequate on hand supplies and an inadequate
supply system.
• RECOMMENDATION: Units need to maintain a basic load of PM
supplies, and these supplies should be identified as CTA items.
• DOTMLPF IMPLICATIONS: DTML
• RESPONSIBLE AGENCY: LEAD: AMEDD C&S, ASSIST:
OTSG/MEDCOM
Phase I/II/III
OIF AAR Issue
• ISSUE: PM supplies (i.e., DEET, Permethrin, lip balm, sunscreen,
water test kit, fly bait, disinfectants, doxycycline, vaccines, etc) were
not being resupplied to units
• DISCUSSION: Units were not getting resupply of PM supplies
despite requisition submission. Doxycycline resupply arrival cut too
close to where only days of stockage remained.
• LESSON LEARNED: Resupply system is broken.
• RECOMMENDATION: Preposition of such supplies as well as
push packages. MEDLOG needs to identify the problem areas of the
resupply system and fix it. They need to be more responsive to
customers. Need to identify cold chain for vaccine storage.
• DOTMLPF IMPLICATIONS: DOTMLF
• RESPONSIBLE AGENCY: LEAD: AMEDD C&S, ASSIST:
OTSG/MEDCOM
Phase I/II/III
OIF AAR Issue
• ISSUE: PM Policies and Practices
• DISCUSSION: PM policies were often confusing & contradictory;
e.g. the use of doxycycline issued for malarial prophylaxis was
unclear (one tablet/day was the instruction whereas the bottle
instructions said two tablets/day & also stated that it should not be
taken for more than 4 months). Some units took methoquine, while
others took primaquine. Soldiers were issued Ciprofloxacin for
anthrax prophylaxis and took it instead of doxycyline for malarial
prophylaxis.
• LESSON LEARNED: PM and other medical policies impacting the
soldier must be clear (KISS) and minimize impact on soldier mission
focus.
• RECOMMENDATION: Determine the medical countermeasures
absolutely required for soldiers to deal with disease threats and
develop easily understood policies using risk communication and
good marketing techniques. Obtain support of Surgeons.
• DOTMLPF IMPLICATIONS: DTML
• RESPONSIBLE AGENCY: LEAD: OTSG, AMEDD C&S, ASSIST:
MEDCOM
Phase I/II/III
OIF AAR Issue
• ISSUE: Theater malarial chemoprophylaxis policy
• DISCUSSION: There were conflicting guides for malarial
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chemoprophylaxis as to the use of doxycycline, mefloquine, or
other medications. One division surgeon initiated a different
chemoprophylaxis regimen compared to other units. Selection of
the chemoprophylactic agent was made so close to deployment of
units that it did not allow time for medical logistics to procure,
pack in unit dose and field to units efficiently. There was
uncertainty on the approp chemopro for aviators.
LESSON LEARNED: There was confusion in terms of the
theater malarial chemoprophylaxis policy. Decision on the
chemoprophylactic agent was made late burdening the medical
logistics system to respond effectively.
RECOMMENDATION: Issue one clear policy for malarial
chemoprophylaxis for all theater units to follow. Decision on the
malarial chemoprophylactic agent(s) needs to be made early on to
permit medical logistics to procure, repack and distribute
efficiently.
DOTMLPF IMPLICATIONS: DTML
RESPONSIBLE AGENCY: LEAD: OTSG, ASSIST: MEDCOM
Phase I/II/III
OIF AAR Issue
• ISSUE: Wild Dogs/Animals and Rabies
• DISCUSSION: Units encountered problems with wild
dogs/packs, bats, and cats and the potential for soldiers to get
rabies. One unit reported that one soldier with bat bite, had to
send soldier to Kuwait for the vaccination series resulting in lost
to unit for 4 weeks. Some soldiers feed the dogs and kept them as
pets which should not be allowed.
• LESSON LEARNED: The large numbers of wild dogs and other
animals are potential source for rabies.
• RECOMMENDATION: Remove or neutralize wild dogs and other
animals which are potential rabies threat to soldiers. Don’t feed
the animals and do not make pets out of them.
• DOTMLPF IMPLICATIONS: DTL
• RESPONSIBLE AGENCY: LEAD: AMEDD C&S, ASSIST:
OTSG/MEDCOM
Phase I/II/III
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OIF AAR Issue
ISSUE: PM units have too few truck sprayer system to deal with
disease vector threat
DISCUSSION: Mosquito, sand fly, and filth fly infestations were often
problems. Under MRI the Ento and Sani units were combined. The OIF
TPFDD requested “PM Det”. The units deployed were either Sani or MRI
units which fell in on MF2K PM (Sani) APS. This resulted in insufficient
numbers of truck mounted sprayers and vehicles. The issue was further
compounded by a low Operational Readiness Rate for the sprayers.
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LESSON LEARNED: Inadequate disease vector control during OIF in
terms of truck mounted sprayers.
RECOMMENDATION: Ensure adequate truck sprayer systems are deployed
to theaters with significant disease vector threats. Re-examine the medical
TOE PM structure for large area ULV sprayers. Recommend 3/division
supported plus 3/corps supported. May need to be part of corps
responsibility. Ensure adequate vehicles are allocated for area PM support.
DOTMLPF IMPLICATIONS: DOTML
RESPONSIBLE AGENCY: LEAD: AMEDD C&S, ASSIST: OTSG/MEDCOM
Phase I/II/III
OIF AAR Issue
• ISSUE: CIF issued uniforms are not permethrin treated.
• DISCUSSION: CIF issued uniforms are not permethrin treated by
the manufacturer. Permethrin kits for soldier use were not
universally available to all soldiers in the theater.
• LESSON LEARNED: CIF issued uniforms are not permethrin
treated by the manufacturer. Permethrin IDA kits are not
universally available.
• RECOMMENDATION: CIF issued uniforms should be
permethrin treated. Permethrin IDA kits should be made readily
available through the resupply system.
• DOTMLPF IMPLICATIONS: DTML
• RESPONSIBLE AGENCY: LEAD: AMC, Quartermaster School,
ASSIST: AMEDD C&S, OTSG/MEDCOM
Pre-Phase I
OIF AAR Issue
• ISSUE: Policy on Blood Draw before using primaquine as a
chemoprophylactic agent
• DISCUSSION: Soldiers are not given a blood draw to identify
individual with G6PD deficiency and who should not take
primaquine. There were units who were directed to take
primaquine as their chemoprophylactic agent.
• LESSON LEARNED: Soldiers are not given a blood draw to
identify individual with G6PD deficiency and who should not take
primaquine.
• RECOMMENDATION: Re-examine the policy on blood draw to
identify individuals with G6PD deficiency and who should not take
primaquine.
• DOTMLPF IMPLICATIONS: DTML
• RESPONSIBLE AGENCY: LEAD: OTSG, AMEDD C&S, ASSIST:
MEDCOM
Phase I/II/III
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OIF AAR Issue
ISSUE: There is no central theater management of FHP assets
(EAD/EAC) to effectively address theater requirements.
DISCUSSION: There were numerous PM/occupational/environmental
health issues in OEF and OIF that required surveillance and mitigation.
These issues were not adequately addressed at the MEDCOM level. There
were many PM assets in the theater but were not under one command and
control for efficient operations. Must have a Combatant Command
process for addressing FHP/PM issues in theater.
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LESSON LEARNED: FHP/PM effort is fragmented and not integrated to
better serve the theater.
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RECOMMENDATION: Develop an 06 Force Health Protection Command
integrating PM and other assets to ensure FHP/PM issues in “Discussion”
are addressed in a seamless, proactive manner on an area support basis;
One-Stop-Shop. This is the Combatant Command process for addressing
theater FHP/PM issues.
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DOTMLPF IMPLICATIONS: DOTMLP
RESPONSIBLE AGENCY: LEAD: AMEDD C&S, ASSIST: MEDCOM,
OTSG, POPM, CHPPM
Questions?
Please submit all questions in triplicate
through the first GO in your chain of
command.
All questions will be cheerfully ignored in
the order received.
21 Oct 03
ROCK DRILL
PREVENTIVE MEDICINE OBSERVATIONS (OIF)
LEVEL 4 and 5
Areas of Interest (Examples): CENTCOM, CFLCC, 3rd MEDCOM, V Corps policies affecting the following areas of PM
interest and also developing standardized/uniform policies for all services.
Line Command Emphasis for PM
Use of DEET and Permethrin Treated Uniforms
Disposal of Human Waste and Garbage
Above Items Class III (…fly bait/disinfectants)
Hygiene (Hand Washing)
Sun Tan Lotion & Lip Balm
Water Sources
Availability of PM Supplies
Drinking Water Discipline
Soldiers Trained in PM Measures/Practices
Availability of PM Personnel
ChemoProphylaxis (anti-malarials/vaccinations…)
Source of PM Information
PM Communications
Policies on PM Practices
Data Base for Reporting DNBI
Joint and Coalition Force PM Issues
Wild Dogs and Rabies
Predeployment and Post-deployment Questionnaires & DU Exposure Questionnaire
Food Sources
Occupational & Environmental Health Surveillance
NBC Medical (Patient Decon, CP DEPMEDS, CBPS, field expedient shelter protection, protection of materiel, medic
evacuation/regulating, etc)
(Optional) NAME________________________ UNIT____________________________
CONTACT INFORMATION___________________________________________________
List your Preventive Medicine observations, potential fixes, and successes for OIF, Level 4/5: