DoD Medical Support to Civil Authorities

1. UNCLASSIFIED 29 Oct 04 DoD Medical Support to Civil Authorities Presented to 35th IFPA - Fletcher Conference Lloyd E. Dodd, Brig Gen Command Surgeon NORAD-USNORTHCOM Peterson AFB, CO 80914 [lloyd.dodd@northcom.mil] (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 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 USNORTHCOM IOC: 1 Oct 02 FOC: 11 Sep 03 Gen Eberhart, May 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. State Response Metropolitan Medical Response Systems Local Response, Municipal and County Layered Response Concept High National Response Capabilities and Resources Regional Response Low Minimal Low Medium High Severe Categories of Escalating Health Threats

10. State Response Metropolitan Medical Response Systems Local Response, Municipal and County How DoD Fits In “Normal” DoD Response High National Response Capabilities and Resources Regional Response Low 4-6 Days Time

11. State Response Metropolitan Medical Response Systems Local Response, Municipal and County How DoD Fits In “Normal” DoD Response Immediate Response Authorities High National Response Capabilities and Resources Regional Response Low Hours 4-6 Days Time

12. State Response Metropolitan Medical Response Systems Local Response, Municipal and County 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

13. State Response Metropolitan Medical Response Systems Local Response, Municipal and County 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

14. State Response Metropolitan Medical Response Systems Local Response, Municipal and County 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

15. Types of DoD Assistance Subject matter experts Physicians, nurses, med techs Lab and lab personnel Respiratory and other techs Beds…facilities 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…

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/TYPHOON EXPLOSION VOLCANIC ERUPTION RADIOLOGICAL EVENT SNOWSTORM/SEVERE FREEZE DROUGHT TORNADO POSTAL WORK STOPPAGE EPIDEMICS Defense Support of Civilian Agencies TERRORISM INSURRECTION CIVIL DISTURBANCE EARTHQUAKE 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

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!

22. Getting to a PDD DHS tracks and makes recommendations NC’s 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

23. OCs…OCs…OCs…. Assembling the Players FIRST FEST DOS POTUS HHS IIMG DHS HSOC DEST NC WMD-CST DoD Fed IA/IIMG JFCOM Event Gov formally asks for aid JS PFO cell (JFO?) POTUS signs PDD DoD Entities Respond Under Immediate Authorities SERT CERT DFO established with FCO, SCO, DCO (& DCE) PFA, PFO and FCO appointed JRMPO rolls into DFO CDC ERT NC designates TSB/CC as DLO or DCO S/R/EPLOs FORSCOM CONUSAs Services

24. 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 Appropriateness Readiness Services JFCOM NC Bounds of tasking? Resources on site? Mission analysis NGB Yes MA # JDOMS JS DoD on site executes Coordinates SecDef/ASD (HD) NC/JFCOM MA # FORSCOM/Services Approves/Signs EXORD Sources as necessary

25. Suppose It’s 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 1st Army TF-East JTF/CC JDOMS FORSCOM 5th Army TF-West SecDef/ASD (HD) NORTHCOM JTF-CS NC/JFCOM/NGB CONUSAs also have significant C2 role in regional events

26. In Simplified Summary…