1. United States Fleet Forces Ready Fleet … Global Reach 1 Surgeon General’s Flag/SES Conference RDML Alton L. Stocks US Fleet Forces Command Fleet Surgeon 6-7 Oct 09 UNCLASSIFIED

2. United States Fleet Forces Ready Fleet … Global Reach 2 UNCLASSIFIED Health Care Support to the Fleet Families of deployed Sailors well cared for Hampton Roads Immunization Program Manager accommodating to fleet needs Tidewater Medical Coordination Council (TMCC) Operational Forces Medical Liaison Services –Working relationship with the fleet has grown in the last year –Attend TMCC quarterly meetings UNCLASSIFIED

3. United States Fleet Forces Ready Fleet … Global Reach 3 UNCLASSIFIED Access to Care OPTEMPO, short fused deployments, and underway training requirements increasing and continuously changing Medical screening and follow up appointment requirements remain constant Access to Care for Fleet Sailors requires flexibility and appreciation of a fluid schedule the Sailor has no control over Increased communication and education necessary for all parties along Recommend increased capability for Fleet Liaison to interject. Topic of discussion at next TMCC meeting 15 Oct UNCLASSIFIED

4. United States Fleet Forces Ready Fleet … Global Reach 4 UNCLASSIFIED Access to Care (cont’d) Fleet Sailors presenting to clinics with acute medical complaints are referred back to ship PCM Care delayed by unnecessary trip back to the ship and then the ER Recommendation –Increase availability of acute appointments for Active Duty UNCLASSIFIED

5. United States Fleet Forces Ready Fleet … Global Reach 5 UNCLASSIFIED Medical Hold TAD Short Term Berthing for Special Circumstances –Pandemic Influenza/H1N1 –USS IWO JIMA return to Norfolk in May 09 –COMUSFLTFORCOMOPORD 3442-09 dtd 18 Sept 09 –TYCOMS Collaborate with USFF, Numbered Fleet Commanders and Navy Region Commanders Identify the requirements necessary to develop support plans for the use of ashore facilities to accommodate Sailors with contagious signs and symptoms as in Influenza Like Illness (ILI) to CNIC Berthing for Fleet Sailors Required to Stay Ashore UNCLASSIFIED

6. United States Fleet Forces Ready Fleet … Global Reach 6 Pacific Partnership FY-10 PACOM/CPF Lead USNS Mercy, May 2010 Continuing Promise FY-10 SOUTHCOM/C4F Lead USS Wasp, July 2010 NGO Funding Humanitarian Assistance Disaster Relief (HADR) UNCLASSIFIED

7. United States Fleet Forces Ready Fleet … Global Reach 7 UNCLASSIFIED

8. United States Fleet Forces Ready Fleet … Global Reach 8 Back Up Slides UNCLASSIFIED

9. United States Fleet Forces Ready Fleet … Global Reach 9 -Early development of RFF by COCOM is necessary to ensure requirements are properly staffed by JFCOM, OPNAV and USFF. Late approval impacts on sourcing: Fewer volunteers & more Fallouts Quality of Life: Sailors & Family Preparation Training: scheduling/berthing Logistics: airlift, weapons, uniforms -Investigate alternate program for critical high demand skills (global force prioritization vs capacity modeling) Global Force Management (GFM) UNCLASSIFIED

10. United States Fleet Forces Ready Fleet … Global Reach 10 Stress Skills Family Practice Physician Internal Medicine Physician Dermatologist Emergency Medicine Physician Psychiatrist General Surgeon Anesthesiologist Clinical Psychologist Physicians Assistant Social Worker Psychiatric Nurse Practitioner Primary Care Nurse Practitioner Nurse Anesthetist Independent Duty Corpsman Psychiatric Technician SAR Technician UNCLASSIFIED

11. United States Fleet Forces Ready Fleet … Global Reach 11 Navy Augmentation Timeline UNCLASSIFIED

12. United States Fleet Forces Ready Fleet … Global Reach 12 Risk Assessment – Impact of Sourcing FP: NAVY Skill Set: CEC Subset: 240100Desig: 510X Overall Risk: HIGH Dwell AC: High Dwell RC: Moderate Readiness: High Suitability & Deployment: High Current Resource Avail.: High Capability Sustainment: High FP Approved Redline Crossed: AC community < 75% shore manning in all paybands <90% sea manning in all paybands RC community < 24 months sustainment in all paybands Additional FP Comments: IMPACT IF ORDERED TO SOURCE: Community availability is restricted due to an increase in normal unit deployments. ADHOC/JMDIA requirements are an additional demand signal. Unable to source individual sailors. USFF N1: SES A. H. Gonzalez ___ OPNAV N3: RDML(S) J.R. Haley_____ USFF N3: Mr. Mike Durkin, YC3 AC Inventory Overall Authorized Overall Assigned # Deployed # Within 6 Months of Deploying # in 1:1 Dwel l # Non- deployable # Fenced Potential Deployers 15014020 715780 93.3%14.3% 5.0%10.7%55.7% Breakdown of Fenced/Non-Deployable Number from above# 100% Non-Distributable Manning (Location Examples)10 100% Overseas (List of locations for Oversea Commands)10 75% total Type 1 (CONUS Location examples)25 90% total Sea Duty / 1:2 Dwell (Location examples)33 BA Included Percentage Breakout If Forced to Source Fenced Manning With Command & Location Examples Note: Service Augment Sailors accounted for in Deployed, Within 6 Mtns and 1:1 Dwell UNCLASSIFIED

13. United States Fleet Forces Ready Fleet … Global Reach 13 USFF Individual Augmentee (IA) Management Process 1. USFF 2. BSO 3. NMPS 4. Training 5. Drop USFF  USFF N1P Tasks BSO  BSO submits nomination to USFF N1P within 14-30 days  Nomination vetted by USFF N1P - 2 days  BUPERS 4G writes orders - 3 days NMPS  NMPS Screening begins. Added measure in addition to BSO screening  NMPS screening process has 5 days to complete  5% drop  NMPS notifies USFF N1P of drops BSO  Nominated member completes pre-deployment process  Member has 30 days to complete  15% drop  BSO notifies USFF N1P of drops Training  Training tracts vary by specialty  Timeline to complete is 3 weeks to 3 months  Deploy upon completion  1-2% drop Drop  USFF enters data into IA portal  IA portal notifies BSO and PERS 4G  PERS 4G updates NMCMPS  IA process starts over at USFF UNCLASSIFIED

14. United States Fleet Forces Ready Fleet … Global Reach 14 Fallouts Personnel fallouts severely impact Medical missions – Fallouts cause gaps in mission coverage without embedded alternates – Embedded alternates are not always feasible due to capacity Possible solutions include: – Primary and alternate nomination for each requirement – Develop an “on-deck” program managed by the Specialty Leaders Similar to the lineal number system for advancement USFF and BUMED work closely to maintain demand signal Specialty Leaders maintain and publish roster clearly identifying “next on-deck” Sailors UNCLASSIFIED