Triage for Civil Support

Triage for Civil Support: Using Military Medical Assets to Respond to Terrorist Attacks

Gary Cecchine
Michael A. Wermuth
Roger C. Molander
K. Scott McMahon
Jesse Malkin
Jennifer Brower
John D. Woodward
Donna F. Barbisch
Copyright Date: 2004
Edition: 1
Published by: RAND Corporation
Pages: 202
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  • Book Info
    Triage for Civil Support
    Book Description:

    Even before September 11, 2001, threat assessments suggested that the United States should prepare to respond to terrorist attacks inside its borders. This monograph examines the use of military medical assets to support civil authorities in the aftermath of a chemical, biological, radiological, nuclear, or conventional high explosives attack inside the United States. The authors focus on key questions, including under what circumstances military medical assets could be requested and what assets are likely to be requested.

    eISBN: 978-0-8330-4061-9
    Subjects: Health Sciences, Political Science

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xii)
  6. Summary
    (pp. xiii-xx)
  7. Acronyms
    (pp. xxi-xxiv)
  8. CHAPTER ONE Introduction
    (pp. 1-6)

    Even before the events of September 11, 2001, threat assessments suggested that the United States should prepare to respond to terrorist attacks inside its borders. This research on the use of military medical assets to support civil authorities in the event of a terrorist attack inside the United States was begun in spring 2001 and originally focused on only the potential consequences of chemical or biological weapons (CBW) attacks in the United States. It had already been documented at that time that some civilian medical organizations and facilities were ill-prepared to deal with a situation involving large numbers of CBW...

  9. CHAPTER TWO The Military Health System and Military Support to Civil Authorities
    (pp. 7-18)

    The U.S. military health system includes one of the largest and most complex health care organizations in the world.¹ In 1999, DoD operated approximately 465 military treatment facilities (MTFs) in the United States and overseas, including 91 hospitals and 374 clinics.²

    In this chapter, we provide an overview of the MHS. We discuss its dual missions—the readiness mission and the benefits mission—and the methods used to carry out these missions with shared resources. We also provide an overview of the types of medical resources that reside in DoD, and we discuss the DoD organization and planning process to...

  10. CHAPTER THREE The Evolution of Structures, Systems, and Processes for Domestic Preparedness
    (pp. 19-26)

    Although it may be surprising in retrospect, the 1993 attack on New York’s World Trade Center did not provide the impetus for a unified and comprehensive national response to possible additional terrorist attacks inside the United States. It took the 1995 terrorist attack in the Tokyo subway system by the fanatical apocalyptic religious cult Aum Shinrikyo to spur the U.S. Congress and others to action.¹ The Nunn-Lugar² congressional hearings on U.S. preparedness and response capabilities in the event of a terrorist attack were underway when the Alfred P. Murrah Federal Building in Oklahoma City was attacked and destroyed on April...

  11. CHAPTER FOUR Legal and Other Barriers to Military Support to Civil Authorities
    (pp. 27-46)

    This research sought to answer a key question: What are the barriers, legal or other, to military support to civil authorities, and how can those barriers be overcome, if necessary? This chapter concludes that there is ample authority for the use of the military domestically, including the provision of military medical support in the event of a terrorist attack, and that no major new authority is necessary. The analysis that resulted in that conclusion is set forth in this chapter in detail.

    Nevertheless, issues involving potential liability on the part of DoD and individual service members and various nonlegal barriers...

  12. CHAPTER FIVE Military Medical Support to Civil Authorities: Historical Case Studies
    (pp. 47-68)

    Since Shay’s Rebellion in 1787, the United States military has often been called on to provide support in domestic disaster response activities, especially when the magnitude of the disaster has overwhelmed local resources. In the event of a large-scale CBRNE attack on U.S. soil, the military would almost certainly be expected to provide medical and other support. But which military health care assets might be requested, and which should be deployed? Without a historical example of a major CBRNE attack in the United States to guide us, we sought to draw lessons from priornaturaldisasters.

    In this chapter, we...

  13. CHAPTER SIX Exercise-Based Studies of Potential Military Medical Support to Civil Authorities
    (pp. 69-96)

    In support of our overall research objectives, we designed and conducted two exercise-based studies of potential military medical support to civil authorities in the event of a large-scale terrorist attack. Although these two exercises focused on very specific types of attack, a smallpox attack in Georgia and a multifaceted radioactive “dirty bomb” attack in California, both provided insights on the likely consequences of large-scale attacks, in those two states and elsewhere in the country, using other types of weapons.

    The overall objective in both cases was to design and conduct an exercise that would bring together key local, state, and...

  14. CHAPTER SEVEN Conclusions and Recommendations
    (pp. 97-102)

    As of this writing, the subjects covered in this report continue to evolve rapidly. The states continue to develop and refine their emergency plans, and the federal government continues one of its most significant reorganizations ever, including the creation of the U.S. Department of Homeland Security, as the country responds to recent events, in particular the attacks of September 11, 2001. The Department of Defense is part of this evolution. Notably, the Office of the Assistant Secretary of Defense for Homeland Defense and NORTHCOM continue with their efforts to address developing homeland security issues and missions. In this chapter, we...

  15. APPENDIX A Interview Protocol
    (pp. 103-104)
  16. APPENDIX B Organizations Interviewed and Exercise Participants
    (pp. 105-112)
  17. APPENDIX C DoD Directives Related to Civil Support
    (pp. 113-114)
  18. APPENDIX D Materials Used in Georgia Exercise
    (pp. 115-166)
  19. APPENDIX E Smallpox Outbreak Model Used in the Georgia Exercise
    (pp. 167-170)
  20. APPENDIX F Excerpt of Quadrennial Defense Review
    (pp. 171-172)
  21. Bibliography
    (pp. 173-178)