Department of Defense[DOD] - 5 of 6

Execution of DSCA Medical Operations

As an ESF#8 Support Agency, DoD will coordinate DSCA activities through its chain of command. The focus of DoD medical support is to save lives, decrease morbidity, and restore essential health services in collaboration with State and local health authorities.[17] The level of the medical response approved by SecDef will vary, based on the type and scale of the emergency and national security considerations. However, a clear focus must remain on transition to other Federal or civilian medical support organizations because DoD would typically be the capability of last resort in most natural disasters. DoD response is provided through one of the two following methods.

1. Immediate Response

Acute situations may require response prior to detailed DoD coordination. Imminently serious conditions resulting from any civil emergency requiring immediate action to save lives, prevent human suffering, or mitigate great property damage is covered under the immediate response provision in DoDD 3025.18 as previously discussed.[6] When such conditions exist and time does not permit approval from higher headquarters, local military commanders and responsible officials from DoD components are authorized to take necessary action to respond to requests of civil authorities. Figure DoD-6 depicts the primary governing criteria for an Immediate Response mission.

Figure DoD-6[6]

Medical Immediate Response is usually coordinated locally based on existing memorandums of agreement but can also be executed by non-MTF medical units or personnel assigned to such facilities as National Guard armories and (T10) Reserve Centers, especially in response to an inextremis circumstance. DoDD 3025.18 and the JCS Standing DSCA EXORD authorize Immediate Response activities to continue for 72 hours before obtaining higher level authorization to provide continued support.[6]

2. DSCA Mission Assignment Execution

Once the Stafford or Economy Act has been enacted, DoD's role as an ESF#8 supporting agency is executed through NDMS and non-NDMS DSCA tasking.

  • NDMS: DoD is one of the four Federal departments with NDMS responsibilities. The first element of NDMS, Medical Response, is not a DoD responsibility and is principally conducted by deployable HHS NDMS teams, although requests for surge medical capability from other Federal departments, such as from DoD or VA, may be utilized to augment these teams. DoD supports the remaining two major NDMS components:[18]

    • Patient Evacuation: DoD is the lead agency, providing aeromedical evacuation, primarily provided by AMC strategic fixed wing assets through USTRANSCOM as depicted in Figure DoD-7. All other modes of patient movement (e.g., rotary wing, ground ambulance) are currently managed and coordinated through FEMA's National Ambulance Contract.

      Figure DoD-7[19]

      Terms in Figure DoD-7 not previously used in this report are defined in Table DoD-3.

      Table DoD-3[20-21]
      Abbreviation Definition
      PM SAT
      Aerial Port of Embarkation
      Global Patient Movement Requirements Center
      In-Transit Visibility
      Joint Patient Assessment & Tracking System
      Joint Patient Movement Team
      Joint Patient Reporting Team
      Patient Movement Situational Awareness Team
      Patient Movement Request
      Tanker Airlift Control Center
      (US)TRANSCOM Regulating and Command &Control Evacuation System
    • Definitive Care: DoD and the VA have Memoranda of Agreement with NDMS participating civilian hospitals throughout the country. NDMS hospitals currently provide approximately 3,700 beds of the estimated NDMS total hospital bed capability of 93,000.[22]

  • Non-NDMS: Units are advised to execute approved DSCA missions through issuance of orders through the appropriate chain of command. Each of these orders specifies the mission the unit is to perform, the higher DoD headquarters under which the unit is performing the mission, initial deployment and execution timeframes, movement and unit support information, and other mission-specific special instructions. These missions may include providing internally-focused, unit-level FHP&R / HSS or externally-focused public health / medical assistance to the affected population, either directly in support of local or State authorities, or by assisting other Federal ESF#8 assets, such as NDMS teams and other missions such as mortuary affairs assistance.

In addition, non-Federal assistance can be provided by National Guard medical units deployed under individual State-to-State, regional multi-State agreements, or through EMAC under the command of the supported State's Adjutant General. One of the baseline principles addressed previously in this section is that DoD forces performing DSCA missions remain under SecDef (DoD) command and control. In the past, this has resulted in a parallel military command structure: non-federalized (i.e., SAD and T32) National Guard units under the control of the Governor via the State Adjutant General, and T10 forces under a designated DoD commander, which has the potential to result in unintended duplication of effort, extended planning and execution timeframes, and other hindrances to an effective and efficient consolidated DSCA effort. A recently adopted "Joint Action Plan for Developing Unity of Effort" is intended to remedy this through the establishment of a Contingency Dual Status Commander (CDSC), a State-identified General Officer who, after certification, is the designated SAD / T32 / T10 JTF commander, providing an integrated command and control structure for all non-federalized National Guard and T10 DoD forces deployed into the JTF AOR.[23-24] (Lt Col L. Erdman and LT C. Anderson, DoD [U.S. Northern Command], personal communication, 2011 Jun 26)

"Expectations of Response"

DoD military units train for executing missions based on the Universal Joint Task List and individual Service-level task lists, which focuses on DoD's warfighting responsibilities.[25] An initiative under development known as the Civil Support Task List is intended to also address DSCA missions.[26] Once deployed to a disaster, DoD medical units execute their assigned missions in accordance with applicable DoD or Service-level health care provider credentialing, licensing, and training requirements, of which a representative sample is listed in Table DoD-4.

Table DoD-4[27-40]
DoD Army Navy Air Force

DoDD 6000.12E (Health Service Support) 6 Jan 11 [27]

DoDD 6000.13 (Medical Manpower and Personnel) 30 Jun 97[28]

DoD Instruction (DoDI) 1322.24 (Medical Readiness Training) 12 Jul 02[29]

DoDI 6025.13 (Medical Quality Assurance [MQA] and Clinical Quality Management in the Military Health System) 17 Feb 11[30]

Army Regulation (AR) 40-1 (Composition, Missions and Functions of the Army Medical Department) 1 Jul 83[31]

AR 351-3 (Professional Education and Training Programs of the Army Medical Department) 15 Oct 07[32]

AR 40-68 (Clinical Quality Management) 22 May 09[33]

Bureau of Medicine and Surgery Instruction (BUMEDINST) 1500.29 (Navy Medicine Command Training Program) 24 Sep 10[34]

BUMEDINST 1500.19B (Navy Medical Corps Integral Parts of Training) 6 Aug 07[35]

BUMEDINST 1520.34A (Continuing Education Programs for Medical Corps and Nurse Corps Officers) 17 Mar 97[36]

BUMEDINST 6320.66E (Credentials Review and Privileging Program) 29 Aug 06[37]

Air Force Instruction (AFI) 41-106 (Medical Readiness Program Management) 1 Ju 11[38]

AFI 41-105 (Medical Training Programs) 9 Nov 10[39]

AFI 44-119 (Medical Quality Operations) 24 Sep 07[40]

Another mechanism assisting in workforce management is the Centralized Credentials and Quality Assurance System (CCQAS), a web-based DoD-wide credential, privilege management, risk management, and adverse actions system sponsored by ASD (HA).[41-42]

An important liability protection for DoD providers is the Federal Tort Claims Act, a statute contained in Title 28, U.S. Code which authorizes tort suits to be brought against the Federal government for injuries caused by the negligent or wrongful act or omission of any Federal employee acting within the scope of his employment, in accordance with the law of the State where the act or omission occurred. One of the three major exceptions, under which the Federal government may not be held liable, even in circumstances where a private person could be held liable under State law, is the Feres doctrine, which prohibits suits by military personnel for injuries sustained incident to service.[43] Additional protection may also be provided by "Good Samaritan" or other such statutes in the State where the disaster has occurred.

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