Presented to 35th IFPA Fletcher Conference

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DoD Medical Support to Civil Authorities
UNCLASSIFIED
29 Oct 04

• Presented to 35th IFPA - Fletcher Conference

Lloyd E. Dodd, Brig Gen Command
Surgeon NORAD-USNORTHCOM Peterson AFB, CO 80914
lloyd.dodd_at_northcom.mil [phone] (DSN
692- Fax -7227
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Overview

• DoDs role and USNORTHCOM mission
• A bit about the N-NC SGs office
• Medical concept of operations (CONOPS) and
  guiding principles for DoD support
• Way ahead

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DoD Areas of Responsibility
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USNORTHCOMs 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

DeterPreventDefeatMitigate
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Commanders Intent

• There is no difference between war and peace in
  this AORwe are at war every day
• We must continue to improve the system every
  daylives depend on it
• Failure to advance the ball is not an option
• A key to success is building relationships

Gen Eberhart, May 03
USNORTHCOM IOC 1 Oct 02 FOC 11 Sep
03
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Role of MedicsOur PD

• Advise NORAD-USNORTHCOM CC and staff on all
  medical issueswith 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

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Vision
Preserve and protect the health of the force,
their families, and the communities we serve.
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NC Principles (HD/HS)

• Policy from Pentagon doctrine, CONOPs, planning
  at NC
• In civil support role local state PFA
  DoDusually
• 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 DoDs 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.
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Layered Response Concept
High
National Response
Capabilities and Resources
Regional Response
Low
Minimal Low Medium High
Severe
Categories of Escalating Health Threats
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How DoD Fits In
Normal DoD Response
High
National Response
Capabilities and Resources
Regional Response
Low
4-6 Days
Time
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How DoD Fits In
Normal DoD Response
Immediate Response Authorities
High
National Response
Capabilities and Resources
Regional Response
Low
Hours
4-6 Days
Time
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How DoD Fits In
Normal DoD Response
Immediate Response Authorities
High
Standing EXORD(s)
National Response
Capabilities and Resources
Regional Response
Low
Hours
4-6 Days
Time
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How DoD Fits In
Normal DoD Response
Immediate Response Authorities
High
Standing EXORD(s)
Catastrophic Incident Response Supplement
National Response
Capabilities and Resources
Regional Response
Low
Hours
Hours-1 Day
4-6 Days
Time
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How DoD Fits In
Normal DoD Response
Immediate Response Authorities
High
Standing EXORD(s)
Catastrophic Incident Response Supplement
National Response
Capabilities and Resources
Regional Response
Low
Guard
SAD, Title 32
SAD, Title 32
SAD, Titles 32, 10
Friendly Forces
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Types of DoD Assistance

• Subject matter experts
• Physicians, nurses, med techs
• Lab and lab personnel
• Respiratory and other techs
• Bedsfacilities
• Equipment
• Blood and pharmaceuticals
• Public health teams
• Vaccination/med distribution teams
• Patient movement
• Manpower

Single expert to 10s of thousands of troops and
more, but
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Limitations to DoD Support

• Resource competitive environment
• Often takes timemaybe 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
• Were the Pros from Dover complex
• Potential lack of technical sophistication
• Lack of common culture, language, systems
• There is a cost

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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

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HURRICANE/TYPHOON EXPLOSION VOLCANIC
ERUPTION RADIOLOGICAL EVENT SNOWSTORM/SEVERE
FREEZE DROUGHT TORNADO POSTAL WORK STOPPAGE
EPIDEMICS
Defense Support of Civilian Agencies
TERRORISM INSURRECTION CIVIL DISTURBANCE EARTHQUAK
E FIRE FLOOD COUNTER-NARCOTICS OIL
SPILL POTUS/VPOTUS/FLOTUS SUPPORT
SUNAMI/TIDAL WAVE METEOR IMPACT LANDSLIDE/MUDSLIDE
CHEMICAL HAZARD SPACE DEBRIS IMPACT ANIMAL
DISEASE MASS IMMIGRATION NSSEs
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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 continuevertically and
  horizontally
• International public health planning a must
• Exercise at all levelsstart with tabletops
• Public-private interactions must improve
• Re-invigorate and support public health
  infrastructures
• Individual and family planning and volunteering

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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!

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(No Transcript)
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Getting to a PDD
DHS tracks and makes recommendations
NCs DWC tracks
EMO
Gov formally asks for aid
TAG and NGB tracks
Event
SCO appointed
POTUS signs PDD
DoD Entities Respond Under Immediate Authorities
CIRS?
Economy Act
Stafford Act
Some Agency Heads Can Execute per prior authority
and HSPD 5
PFA, PFO and FCO appointed
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Assembling the Players
OCsOCsOCs.
FIRST
FEST
DOS
POTUS
HHS
IIMG
DHS HSOC
NC
DEST
DoD
WMD-CST
Fed IA/IIMG
JFCOM
Event
Gov formally asks for aid
PFO cell (JFO?)
JS
POTUS signs PDD
DoD Entities Respond Under Immediate Authorities
SERT
DFO established with FCO, SCO, DCO ( DCE)
CERT
PFA, PFO and FCO appointed
JRMPO rolls into DFO
CDC ERT
NC designates TSB/CC as DLO or DCO
S/R/EPLOs
CONUSAs
FORSCOM
Services
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Once PDD in Effect
DHS
NC/DoD
DHHS
PFO
Gov formally asks for aid
Event
JRMPO, EPLOs, ESF8
POTUS signs PDD
DoD Entities Respond Under Immediate Authorities
SCO
ARF
FCO
DCO
PFA, PFO and FCO appointed
No
Legality Lethality Risk Impact Cost Appropriatenes
s Readiness
Services JFCOM
Bounds of tasking? Resources on site?
NC
Mission analysis
Yes
NGB
MA
JDOMS
JS
DoD on site executes
Coordinates
SecDef/ASD (HD)
NC/JFCOM
MA
FORSCOM/Services
Approves/Signs EXORD
Sources as necessary
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Suppose Its Really Big
Gov formally asks for aid
PFO
DHS
Event
JRMPO, EPLOs, ESF8
POTUS signs PDD
Services
DoD Entities Respond Under Immediate Authorities
SCO
ARF
FCO
DCO
PFA, PFO and FCO appointed
NC
TF-East
1st Army
JDOMS
JTF/CC
FORSCOM
TF-West
5th Army
SecDef/ASD (HD)
JTF-CS
NORTHCOM
NC/JFCOM/NGB
CONUSAs also have significant C2 role in regional
events
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In Simplified Summary