presented to 35 th ifpa - fletcher conference dod medical support to civil authorities unclassified...
TRANSCRIPT
Presented to 35th IFPA - Fletcher Conference
DoD Medical Support to Civil Authorities
UNCLASSIFIED
Lloyd E. Dodd, Brig GenCommand SurgeonNORAD-USNORTHCOMPeterson AFB, CO 80914
29 Oct 04
[[email protected]](719) 554-8153 (DSN 692-Fax -7227
2
Overview
• DoD’s role and USNORTHCOM mission
• A bit about the N-NC SG’s office
• Medical concept of operations (CONOPS) and guiding principles for DoD support
• Way ahead
3
DoD Areas of Responsibility
4
USNORTHCOM’s MissionUSNORTHCOM’s Mission
• Conduct operations to deter, prevent, and defeat threats and aggression aimed at the United States, its territories, and interests within the assigned area of responsibility; and,
• As directed by the President or Secretary of Defense, provide military assistance to civil authorities including consequence management operations
Deter…Prevent…Defeat…Mitigate
5
Commander’s Intent
• There is no difference between war and peace in this AOR…we are at war every day
• We must continue to improve the system every day…lives depend on it– Failure to advance the ball is not an option
• A key to success is building relationships
Gen Eberhart, May 03 USNORTHCOMIOC: 1 Oct 02
FOC: 11 Sep 03
6
Role of Medics…Our PD
• Advise NORAD-USNORTHCOM CC and staff on all medical issues…with broad interpretation of “medical”
• Anticipate, as much as possible, threats of disasters, natural or otherwise
• Forge plans and relationships before the event– Understand and provide key support to components– SG role in the deter, prevent, defeat phase– Pre-event consequence management planning
• Coordinating DoD medical response during and after event as requested by local, state, and other federal agencies
– Within DoD and across all agency boundaries– Full range of consequence management
• Attend to the health and welfare of the people in the commands• Make the system better every day
7
Vision
Preserve and protect the health of the force, their families, and the communities we serve.
8
NC Principles (HD/HS)• Policy from Pentagon; doctrine, CONOPs, planning at NC• In civil support role: local state PFA DoD…usually• DoD (NC) only participates when requested…
– And authorized, including Immediate Response, EXORDs, (?) CIRS– DoD flies wing to the Primary Federal Agency ( formerly LFA)
• Layered, tiered, flexible response• Sometimes we move beds; sometimes we move patients• Regionalizaton approach to multiple/pandemic events• Should emphasize DoD’s natural roles, skills and structures• Cannot purchase resources that do not directly support our primary
warfighting mission• Pre-event planning and relationship building are required
USNORTHCOM must maintain significant situational awareness, & be able to mobilize a wide spectrum of rapid
responses.
9
Cap
ab
ilit
ies
and
Res
ou
rces
Lo
wH
igh
Layered Response Concept
Metropolitan Medical Response Systems
State Response
Local Response, Municipal and County
Minimal Low Medium High Severe
Categories of Escalating Health Threats
Regional Response
National Response
10
Cap
ab
ilit
ies
and
Res
ou
rces
Lo
wH
igh
How DoD Fits In
Metropolitan Medical Response Systems
State Response
Local Response, Municipal and County
Time
Regional Response
National Response
“Normal” DoD Response
4-6 Days
11
Cap
ab
ilit
ies
and
Res
ou
rces
Lo
wH
igh
How DoD Fits In
Metropolitan Medical Response Systems
State Response
Local Response, Municipal and County
Time
Immediate Response Authorities
Hours
Regional Response
National Response
“Normal” DoD Response
4-6 Days
12
Cap
ab
ilit
ies
and
Res
ou
rces
Lo
wH
igh
How DoD Fits In
Metropolitan Medical Response Systems
State Response
Local Response, Municipal and County
Time
Immediate Response Authorities
Hours
Regional Response
National Response
Standing EXORD(s)
“Normal” DoD Response
4-6 Days
13
Cap
ab
ilit
ies
and
Res
ou
rces
Lo
wH
igh
How DoD Fits In
Metropolitan Medical Response Systems
State Response
Local Response, Municipal and County
Time
Immediate Response Authorities
Catastrophic Incident Response Supplement
Hours Hours-1 Day
Regional Response
National Response
Standing EXORD(s)
“Normal” DoD Response
4-6 Days
14
Cap
ab
ilit
ies
and
Res
ou
rces
Lo
wH
igh
How DoD Fits In
Metropolitan Medical Response Systems
State Response
Local Response, Municipal and County
Friendly Forces
Immediate Response Authorities“Normal” DoD Response
GuardSAD, Title 32 SAD, Title 32 SAD, Titles 32, 10
Regional Response
National Response
Standing EXORD(s)
Catastrophic Incident Response Supplement
15
Types of DoD AssistanceSubject matter experts
Physicians, nurses, med techsLab and lab personnel
Respiratory and other techsBeds…facilities
EquipmentBlood and pharmaceuticals
Public health teamsVaccination/med distribution teams
Patient movementManpower
Single expert to 10s of thousands of troops and more, but…
16
Limitations to DoD Support• Resource competitive environment• Often takes time…maybe days (or worse)
– Today, still evolving internal DoD Cold War structures and processes
• Public perceptions– Military “takeover” and mistrust of government– GIs all trigger-happy and default to brute force– “We’re the Pros from Dover” complex – Potential lack of technical sophistication– Lack of common culture, language, systems
• There is a cost
17
National Guard• Guard has the lead in homeland security and is actively
restructuring to optimize response capabilities• Every congressional district has a Guard asset• WMD-Civil Support Teams (CSTs) growing in concept and
capabilities– 23 person team can diagnose and recommend Rx– 33 now; soon to have at least one per state
• CBIRF-like Enhanced Response Force Package (CERF-P)– Up to 120 people– 12 now; soon to have at least one per state
• Expeditionary Medicine (EMEDs) team per FEMA region• Regional medical planners being put in place• At least two major regional exercises per year
18
HURRICANE/TYPHOONHURRICANE/TYPHOON
EXPLOSIONEXPLOSION
VOLCANIC ERUPTIONVOLCANIC ERUPTION
RADIOLOGICAL EVENTRADIOLOGICAL EVENT
SNOWSTORM/SEVERE SNOWSTORM/SEVERE FREEZEFREEZE
DROUGHTDROUGHT
TORNADOTORNADO
POSTAL WORK STOPPAGE POSTAL WORK STOPPAGE EPIDEMICSEPIDEMICS
TERRORISMTERRORISM
INSURRECTIONINSURRECTION
CIVIL DISTURBANCECIVIL DISTURBANCE
EARTHQUAKEEARTHQUAKE
FIREFIRE
FLOODFLOOD
COUNTER-NARCOTICSCOUNTER-NARCOTICS
OIL SPILLOIL SPILL
POTUS/VPOTUS/FLOTUSPOTUS/VPOTUS/FLOTUS
SUPPORTSUPPORT
Defense Support of Civilian AgenciesDefense Support of Civilian Agencies
SUNAMI/TIDAL WAVESUNAMI/TIDAL WAVE
METEOR IMPACTMETEOR IMPACT
LANDSLIDE/MUDSLIDELANDSLIDE/MUDSLIDE
CHEMICAL HAZARD CHEMICAL HAZARD
SPACE DEBRIS IMPACTSPACE DEBRIS IMPACT
ANIMAL DISEASEANIMAL DISEASE
MASS IMMIGRATIONMASS IMMIGRATION
NSSEsNSSEs
19
Dodd Sermonizing• Within DoD, planning must be across components and functions in
open, outcome-oriented manner– Collaboration must involve Reserve and Guard– Focus on faster, smarter, better integrated processes
• Improve inter-agency and federal-state mutual understanding, communication, and collaboration
• Planning at municipal, county, state, and regional levels must continue…vertically and horizontally
• International public health planning a must• Exercise at all levels…start with tabletops• Public-private interactions must improve• Re-invigorate and support public health infrastructures• Individual and family planning and volunteering
20
Bottom Line
• Bad guys are actively planning bad things today• DoD has a potential role (with plusses and minuses)
– DoD resources might range from one SME to multiple medical TFs
• This will only work well if we all work together– Progress is being made within DoD and at the IA level– Progress is being made at the state and community levels
• Our obligations are legal, ethical and moral• If we do our job right, a lot of people will live that might not
otherwise• We might not have a lot of time!
21
22
Getting to a PDD
Event
DoD Entities RespondUnder Immediate
Authorities
POTUS signs PDD
DHS tracks and makes recommendationsNC’s DWC tracks
TAG and NGB tracks
SCO appointed
Economy Act Stafford ActSome Agency HeadsCan Execute per prior authority and HSPD 5
Gov formally asks for aid
PFA, PFO and FCOappointed
EMO
CIRS?
23
Assembling the Players
Event
DoD Entities RespondUnder Immediate
Authorities
POTUS signs PDD
Gov formally asks for aid
PFA, PFO and FCOappointed
DFO establishedwith FCO, SCO,DCO (& DCE)
NC designates TSB/CC as DLO or DCO
JRMPO rolls into DFO
PFO cell (JFO?)
POTUS HHS
DoDFed IA/IIMG
CDC ERT
SERT
CONUSAsFORSCOM
NC
JFCOMJS
FEST
DEST
S/R/EPLOsServices
OCs…OCs…OCs….
DOS
WMD-CST
IIMG
CERT
FIRST
DHSHSOC
24
Once PDD in Effect
Event
DoD Entities RespondUnder Immediate
Authorities
POTUS signs PDD
Gov formally asks for aid
PFA, PFO and FCOappointed
FCO
PFO DHHSNC/DoD
DCO
Bounds of tasking?Resources on site?
DoD on siteexecutes
MA #
NC
JDOMS
MA #
No
Yes
SecDef/ASD (HD) NC/JFCOM
LegalityLethalityRisk ImpactCostAppropriatenessReadiness
Mission analysis
Coordinates
Approves/Signs EXORD Sources as necessary
JRMPO, EPLOs, ESF8…
SCO
DHS
FORSCOM/Services
JS
ServicesJFCOM
NGB
ARF
25
Suppose It’s Really Big…
Event
DoD Entities RespondUnder Immediate
Authorities
Gov formally asks for aid
POTUS signs PDD
PFA, PFO and FCOappointed
FCO
PFO DHS
JRMPO, EPLOs, ESF8…
DCO
JTF-CS
TF-East
TF-West
NORTHCOM
1st ArmyFORSCOM
NC
SecDef/ASD (HD)
NC/JFCOM/NGB
SCOServices
JDOMS
CONUSAs also have significant C2 role in regional events
JTF/CC
5th Army
ARF
26
In Simplified Summary…<F
unct
ion
>
Emergency Services DispatchMedical Military/ Civilian
Emergency Rooms, EOCs, &Hospitals
Military/ Civilian First RespondersOn-Scene Commander/ DCG StaffCivilian Incident Command Center
Local Government(Municipal & County Emergency
Operations Centers)
Does the VictimRequire a Level of CareGreater Than What is
Available?
Victim/ Observer NotifiesEMS System of ImmediateEmergency Care Needs
Victim/ Observer NotifiesEMS System of ImmediateEmergency Care Needs
EMS DispatchReceives Notificationfrom Victim/ Observer
EMS DispatchReceives Notificationfrom Victim/ Observer
EMS Dispatch NotifiesControl Centers via
Prescribed ReportingProcedures
EMS Dispatch NotifiesControl Centers via
Prescribed ReportingProcedures
Medical Military/Civilian Emergency
Rooms ReceiveNotification from EMS
Dispatch
Medical Military/Civilian Emergency
Rooms ReceiveNotification from EMS
Dispatch
Coordinate the Activities ofSupport Teams at theMedical and AlternateTreatment Facilities
Coordinate the Activities ofSupport Teams at theMedical and AlternateTreatment Facilities
EOC DeterminesAdditional Response
Capabilities & DispatchesAdditional Medical Assets
to the Scene of the Incident
EOC DeterminesAdditional Response
Capabilities & DispatchesAdditional Medical Assets
to the Scene of the Incident
OSC Establishes IncidentBoundaries upon Arrival atAccident Site and Manages
Incident Following ICSProtocols
OSC Establishes IncidentBoundaries upon Arrival atAccident Site and Manages
Incident Following ICSProtocols
Is the Request forAssistance Validated?
Medical EOCs NotifyChains of Command/County Emergency
Management Center ofActions Taken in Support
of Incident Response
Medical EOCs NotifyChains of Command/County Emergency
Management Center ofActions Taken in Support
of Incident Response
Information Receivedfrom Multiple Control
Centers and theOn-Scene
Commander
Information Receivedfrom Multiple Control
Centers and theOn-Scene
Commander
First RespondersNotified of Incident &Receive Instructions
to Proceed to theIncident Site
First RespondersNotified of Incident &Receive Instructionsto Proceed to the
Incident Site
State Government(Emergency Operations Center)
Victim/ Observer
On-Scene CommanderCoordinates ResponderActivities at the Scene &
Keeps Local EOCInformed
On-Scene CommanderCoordinates ResponderActivities at the Scene &
Keeps Local EOCInformed
Conduct Hot Zone Triage& Treatment
Gross Decon
Conduct Hot Zone Triage& Treatment
Gross Decon
Military OSC & DCGStaff/ Civilian ICS
Members Notified toAssemble at the
Established Staging Area
Military OSC & DCGStaff/ Civilian ICS
Members Notified toAssemble at the
Established Staging Area
Determine EmergencyCare
Needs, Identify AdditionalResources Needed
OSC & DCG StaffBriefed on Situation
En-route to theAccident Site
OSC & DCG StaffBriefed on Situation
En-route to theAccident Site
YES YES
Federal Government
Response Process for Known CBRNE Contamination
Do FirstResponders
Need AdditionalResourcesOn-Scene?
Medical EmergencyOperations Center (MOC)
is Activated
Medical EmergencyOperations Center (MOC)
is Activated
Transport toHospital forTreatment
Transport toHospital forTreatment
Victim/ ObserverAssesses Incident
Victim/ ObserverAssesses Incident
Emergency RoomNotified by FirstResponders of
AdditionalRequirements
Emergency RoomNotified by FirstResponders of
AdditionalRequirements
YES
First Responders NotifyER of Additional
Assistance/ Advise &Remains On-Site
First Responders NotifyER of Additional
Assistance/ Advise &Remains On-Site
NO
Notifies StateEmergency OperationsCenter and Issues aFormal Request for
Assistance
Notifies StateEmergency OperationsCenter and Issues aFormal Request for
Assistance
USNORTHCOM
Do Sufficient ResourcesExist to Manage the
Incident?
YES
State EOC ReceivesNotification from
County RequestingAssistance
State EOC ReceivesNotification from
County RequestingAssistance
Do Sufficient ResourcesExist to Manage the
Incident?
YES
Governor Issues a FormalRequest for Assistance(RFA) to the President/Secretary of Homeland
Security
Governor Issues a FormalRequest for Assistance(RFA) to the President/Secretary of Homeland
Security
Office of EmergencyPreparedness, DHSValidates Request
from State andAdvises POTUS on
the Situation
Office of EmergencyPreparedness, DHSValidates Request
from State andAdvises POTUS on
the Situation
Federal and StateCoordinating
Officers Notified ofActivation (FCO &
SCO)
Federal and StateCoordinating
Officers Notified ofActivation (FCO &
SCO)
Disaster Field Office(Emergency Support Function 8)
Notified of DisasterField OfficeActivation
Notified of DisasterField OfficeActivation
FEMA Establishes theDisaster Field Office in
the Affected Region
FEMA Establishes theDisaster Field Office in
the Affected Region
Provide CoordinatedAssistance
to Supplement StateResources
Disaster Field OfficeIdentifies SupportRequirement forConsequenceManagement
Disaster Field OfficeIdentifies SupportRequirement forConsequenceManagement
JRMPs Deployed toAugment the DefenseCoordinating Element
Section in Support of theDCO
JRMPs Deployed toAugment the DefenseCoordinating Element
Section in Support of theDCO
Receives Tasking toAccept OperationalControl of ForcesFrom Supporting
CINCs, Services, &DoD Agencies
Receives Tasking toAccept OperationalControl of ForcesFrom Supporting
CINCs, Services, &DoD Agencies
Is There Evidence ofKnown Contamination?
NO
Hospital/ PatientTreatment
Hospital/ PatientTreatment
Further Triage/ Treatment& Communication to
Medical EOC for MoreSupport
Intensive Decon
Further Triage/ Treatment& Communication to
Medical EOC for MoreSupport
Intensive Decon
Treat & ObserveCasualties
Treat & ObserveCasualtiesEstablish Casualty
Collection Point(s)
Establish CasualtyCollection Point(s)
Transport to Hospital &Alternate Treatment
Facilities
Transport to Hospital &Alternate Treatment
FacilitiesProcess Casualties thruDecon Release Site
Process Casualties thruDecon Release Site
Manage Incident via ICSWhile
Keeping State EOC Informed
Have CasualtiesBeen Evacuated to aMedical Treatment
Facility?
YES
Local EOC StandsDown
Local EOC StandsDown
State EOC ManagesSituation
While Keeping DHSInformed About the
Situation
Have CasualtiesBeen Evacuated to aMedical Treatment
Facility?
State EOC StandsDown
State EOC StandsDown
Victim TreatedOn-Site or at
Home
Victim TreatedOn-Site or at
HomeEMS Involvement
Terminated
EMS InvolvementTerminated
ER Determines InitialResponse Capability from
within ER &Dispatches Team
ER Determines InitialResponse Capability from
within ER &Dispatches Team
Proposed Response Process for Suspected Covert CBRNE/WMD Contamination
Victim is a Self-Presenter
Victim is a Self-Presenter
HMO/ Doctors’s OfficeObtains Specimen for
Analysis
HMO/ Doctors’s OfficeObtains Specimen for
Analysis
Hospital EmergencyDepartments ObtainSpecimen for Analysis
Hospital EmergencyDepartments ObtainSpecimen for Analysis
Public Clinic ObtainsSpecimen for Analysis
Public Clinic ObtainsSpecimen for Analysis
Does Lab TestingReveal Evidence of Rare
Disease or PuzzlingSigns & Symptoms?
Information ReceivedBy Epidemiology
DepartmentRegarding Initial
Positive Identificationof CBRNE/ WMDContamination
Information ReceivedBy Epidemiology
DepartmentRegarding Initial
Positive Identificationof CBRNE/ WMDContamination
Information ReceivedFrom County
Regarding InitialPositive Identification
of CBRNE/ WMDContamination
Information ReceivedFrom County
Regarding InitialPositive Identification
of CBRNE/ WMDContamination
ReceivesNotification fromJDOMS RegardingEstablishment of a
Disaster Field Office
ReceivesNotification fromJDOMS RegardingEstablishment of a
Disaster Field Office
Deploys a DCO & DCEunder command ofUSNORTHCOM inSupport of FEMA
Deploys a DCO & DCEunder command ofUSNORTHCOM inSupport of FEMA
Receives Requestfrom 1st/ 5th Army for
CapabilityFulfillment
Receives Requestfrom 1st/ 5th Army for
CapabilityFulfillment
Mobilize Capability tothe JTF-CS Commander
Mobilize Capability tothe JTF-CS Commander
Governor Notifies FederalGovernment of Initial
Positive Identification ofCBRNE/ WMD
Contamination and Issuesa Formal RFA to FEMA
Governor Notifies FederalGovernment of Initial
Positive Identification ofCBRNE/ WMD
Contamination and Issuesa Formal RFA to FEMA
Notifies StateEmergency OperationsCenter of Initial Positive
Identification ofCBRNE/ WMDContamination
Notifies StateEmergency OperationsCenter of Initial Positive
Identification ofCBRNE/ WMDContamination
Is a PresidentialDeclaration of
Disaster Issued?
YES
NO
YES
NONO NO NO
NO
YES
NO
LOCAL & METROPOLITAN STATE FEDERAL
USNORTHCOMExercises Command &
Control via Three TieredOptions
USNORTHCOMExercises Command &
Control via Three TieredOptions
DCO ApprovesCapabilities Identification& Prepares the Requestfor Assistance (RFA) for
FEMA
DCO ApprovesCapabilities Identification& Prepares the Requestfor Assistance (RFA) for
FEMA
FEMA Submits InitialRFA for DoD Support
Thru JDOMS
FEMA Submits InitialRFA for DoD Support
Thru JDOMS
Notified of DisasterField OfficeActivation
Notified of DisasterField OfficeActivation
Tasks USJFCOM toProvide DCO and DCE
Tasks USJFCOM toProvide DCO and DCE
ASD/ HD ReceivesRFA & Validates
ASD/ HD ReceivesRFA & Validates
A USNORTHCOM Systems View - Medical Management of a Mass Casualty/ Public Health Disaster
Minimal : Influenza, food borne illnesses, endemic B. PlagueLow: Anthrax,
P. PlagueMedium: Pandemic Influenza High: Smallpox Severe: Bio-Engineered Agent
Is MilitaryAssistance Needed?
YES
NO YES
Forces Command(FORSCOM)
Notified to Preparefor Mobilization in
Support ofOperations
Notified to Preparefor Mobilization in
Support ofOperations
Conducts MilitaryOperations In Support ofthe Unified Commander
Conducts MilitaryOperations In Support ofthe Unified Commander
JFACCJFLCCJFMCC
Provides Command &Control
During Operations
Have OperationsTerminated?
YES
Redeploy &Transfer Forces
Back toSupportingCombatant
Commanders &Services
Redeploy &Transfer Forces
Back toSupportingCombatant
Commanders &Services
Tasks Services toTransfer Operational
Control of DoDPersonnel & EquipmentProviding Support to the
Unified Commander
Tasks Services toTransfer Operational
Control of DoDPersonnel & EquipmentProviding Support to the
Unified Commander
NO
Notified of Need toIdentify
Organizations thatCan FulfillCapabilitiesRequirement
Notified of Need toIdentify
Organizations thatCan FulfillCapabilitiesRequirement
Is FederalAssistance Still
Needed?
YES
Disaster FieldOffice Stands
Down
Disaster FieldOffice Stands
Down
NO
Legend
JDOMS TranslatesGuidance from the
SecDef into OperationalOrders
JDOMS TranslatesGuidance from the
SecDef into OperationalOrders
ProcessBeginningor Ending
ProcessBeginningor Ending
Pre-DefinedAction
Pre-DefinedAction
Recurring Process
DecisionInformationInput
InformationInput
YES
References:DoD Directive 3025.1 DTD 15 Jan 93DoD Directive 3025.1-M/ DTD 2 Jun 94DoD Directive 3025.15/ DTD 18 Feb 97Deputy Secretary of Defense Implementation Memorandum/ DTD 25 Mar 03The President’s Federal Response Plan (FRP) Jan 03, interim changeStafford Act, as amended, 42 USC 5121/ Sep 98Economy Act, 31 USC 1535/ Jan 96Joint Publication 3-26, Second Draft 11 Sep 03USNORTHCOM SG HLS Executive Course Presentation