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Concept of DSCA Medical Operations

DSCA medical operations are executed through a process, as outlined in Figure DoD-5, whereby Requests for Assistance (RFAs) are submitted to OSD by the Defense Coordinating Officer (DCO), assigned to the FEMA Region who deploys to the FEMA Joint Field Office (JFO), which is established to coordinate the Federal response. (If the DCO is not yet established at the JFO, RFAs can be submitted directly by an ESF Primary Agency.) An RFA certifies that all other resources have been exhausted and requests a capability, not a specific platform / system, or unit. All RFAs are reviewed and validated by OSD in consultation with the Joint Staff and, as required, NGB and / or the Services. If approved by SecDef, the RFA becomes a Mission Assignment (MA) and is transmitted as an order from SecDef to the appropriate DoD organization.

Figure DoD-5[3]
Request for Assistance

Additionally, USNORTHCOM will deploy one or more Joint Regional Medical Planners to provide the DCO with medical staff expertise and keep the Command Surgeon updated through periodic medical situation reports.

In addition to DoD forces being incorporated into a response via a bottom-up (e.g., disaster scene to SecDef) request process, DoD forces can also be employed in response to a request originating from within the DoD, through a Combatant Commander's Request for Forces (RFF), which identifies a requirement for assistance to meet an un-forecasted requirement that cannot be met by assigned forces. RFFs also require SecDef approval.

In order to facilitate rapid response and standardize the process of requesting DoD medical assistance, HHS has developed ESF#8 pre-scripted mission assignments (PSMAs) in consultation with FEMA and the Federal Interagency.[14] These PSMAs provide mutually agreed upon language to expedite deployment of response assets and allow HHS to be proactive in moving personnel and equipment / supplies in anticipation of a disaster declaration. Of the current PSMAs assigned to DoD, six are ESF#8-related, as described in Table DoD-2. (C. Music, DoD [Office of the Assistant Secretary of Defense (Homeland Defense & Americas' Security Affairs)], personal communication, 2011 Jul 11) All are predicated on the condition that all local, State, and non-DoD national assets (to include the private sector) are exhausted or do not have the capacity to meet the requirement. Importantly, "pre-scripted" does not mean "pre-approved."

Table DoD-2
(C. Music, DoD [Office of the Assistant Secretary of Defense (Homeland Defense & Americas' Security Affairs)], personal communication, 2011 Jul 11)
DoD ESF#8 Pre-Scripted Mission Assignments
PSMA # Assignment Tasking
 21 Rotary Wing Medical Patient Evacuation Provide rotary wing aircraft and personnel for Medical Patient Evacuation in support of disaster operations in response to (incident) in the State of (State).
 22 Temporary Medical Treatment Facilities Provide deployable DoD temporary MTFs in support of disaster operations in response to (incident) in the State of (State).
 23 Mortuary Affairs Provide mortuary affairs assistance to the local Medical Examiner / Coroner for remains recovery in support of disaster operations in response to (incident) in the State of (State).
 24 Activate Federal Coordinating Center Activate Federal Coordinating Center(s) in FEMA Region(s) (number[s]) in support of disaster operations in response to (disaster name / #).
 25 Activate Patient Movement (PM) Enablers Activate DoD / NGB to provide transportation to move cargo and / or passengers by air, rail, marine, or ground, in support of disaster operations in response to (disaster name / #).
 26 Aeromedical Evacuation Activate DoD to provide AE as part of NDMS to provide phased and interdependent NDMS theater patient movement in response to (incident) in the State of (State).

All six of these PSMAs are considered significant from a medical workforce perspective, with the first four of special concern to USNORTHCOM and the last two of special concern to USTRANSCOM.

Planning for DSCA medical operations is based on the employment of DoD's public health and medical response capabilities to address DoD-validated RFAs when such a capability cannot be fulfilled at the State level or by the private sector. Planning documents attempt to anticipate the circumstances and conditions that will likely exist when the plan is executed, including availability of power, food, shelter, and key personnel. Among the primary documents prepared through the DSCA planning process are:

  • Joint Chiefs of Staff (JCS) Standing DSCA Execute Order (EXORD)

  • USNORTHCOM Concept Plan 3501 (DSCA)

  • USNORTHCOM DSCA EXORD

  • USTRANSCOM DSCA EXORD

  • USTRANSCOM DSCA AE Concept of Operations

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