Previous IFPA-Fletcher Conferences
National Security
Strategy and Policy:
Planning for and Responding to Threats to the U.S. Homeland
October 28-29, 2004
Ronald Reagan Building
and International Trade Center
Washington, D.C.
Brigadier
General Lloyd E. Dodd, USAF,
Command Surgeon, U.S. Northern Command
Introduction By: Dr. Charles M. Perry
Brigadier General Lloyd E. Dodd: But only this morning do we get to the most important part of the whole conference and that is, naturally, medicine. So we’re going to talk about not just medicine but consequence management; specifically, how DoD, through NORTHCOM, supports civil authorities in a consequence management disaster situation. We do have a role, and I’ll point that out to you. It is not an unlimited capability role, and I’ll point that out to you as well.
The map of the world, the DoD, with some measure of hubris, has divided up into different regions, and we will say we have an EUCOM, we have a SOUTHCOM, we have a PACOM. We’ve had commanders responsible for geographic areas for a very long time, all areas of the world except North America. Now, that did not mean that DoD did not support civil authorities in North America, but in fact it was a number of different DoD entities that supported this country.
Until we had NORTHCOM, there was no single officer the President could put his finger on and say “You have the responsibility for homeland defense and supporting civil authorities in this nation.” And so, as was mentioned yesterday, this is a unique entity, it’s a new entity.
Twice yesterday, to my count, we talked about the mission of NORTHCOM, but we never really showed it to you, so I'm going to show it to you this morning. NORTHCOM has a two-part mission. The first part is very similar to any regional command. This basically says we are going to protect American interests in our area of responsibility. In this area of responsibility, this AOR, we’re talking about homeland defense. This bullet is our classic “we’re going to keep the bad guys out of San Francisco” bullet. We’re going to take out cruise missiles that are launched from off the coast. We’re going to protect America from outside entities as much as possible. From a medical perspective, this would include force health protection, medical, critical infrastructure protection, all leading to the whole issue of mission assurance.
That’s extremely important, but what really attracted me to the command was the second bullet. The second bullet is, as directed by the President, or the Secretary of Defense, we provide military assistance to civil authorities. Now, ladies and gentlemen, that is a remarkable bullet, because never before in the history of our country has a military entity, a command, been given the responsibility, clearly in writing -- this is right out of our Unified Command Plan -- to support civil authorities.
We have to figure out how best to do that. From my perspective, this occupies about 85% of my time. When we talk about support to civil authorities, we’re talking about forming relationships. I actually measured one week; 70% of the time I spent that week was working on relationships, trying to make the second bullet work. This is Public Health, this is Food and Ag, this is the whole issue of forming those ties and establishing the processes that it takes for the Department of Defense to support civil authorities.
Last May, General Eberhart at a commanders’ call, gave the following comments, which really drive a lot of our behavior in Northern Command. We are at war every day in this command. At NORTHCOM, I wear combat boots every day, flight suits or BDUs. We do that because we understand that the bad guys are out there, and they are actively prosecuting their war against us, real time, right now. So we have to continually improve the system. If we don’t improve the system, people will die that shouldn’t die.
Because we have relatively few assigned forces, and because we’re in an area of responsibility with a wealth of medical and other capabilities, the way we get things done is through relationships. For the medics, our shop, last year we wrote our position description, our mission, if you will. And basically it’s pretty much as many of you would write if you sat down in the same situation. You’d say, first, we advise the leadership. We, before the event do our best to figure out what bad things can happen. We try to form those processes and relationships that will identify and give us access to capabilities when something does happen. Then, when something does happen, we coordinate medical response within DoD and we interface between DoD medicine and medicine of other federal agencies and below.
We do this not just in a terrorist situation, but these same rules, these same philosophies, the same mission applies to a peacetime situation. And we have been supporting hurricane and wildfire relief efforts. And if there’s a national pandemic of flu, we’ll be engaged, with many of the same processes that we would use in a terrorist incident. So in a sense we’re talking about Dr. Walks’s dual use, processes that work in peacetime and in times of war. We make the system better every day. Again, that’s part of our moral obligation. Here is our vision [on slide]. Not just pretty words.
This is a very full slide, but this one slide, if you go through it, will give you everything you need to know about Department of Defense’s concept of operations supporting civil authorities. First off is that policy comes from the Pentagon. Now, in theory, policy for NORTHCOM comes from HD, homeland defense. Policy is telling those of us who execute just what we should be doing. The Assistant Secretary for Homeland Defense, Mr. McHale, was here yesterday and did a marvelous job articulating the responsibilities and perspectives of his office. Making policy is one of his significant responsibilities.
In actual practice, our medical policy comes from many sources within the Pentagon -- Health Affairs, Reserve Affairs, SOLIC, some of the other policy branches. The policy comes from the Pentagon, but the execution, figuring out how to execute at the theater level, is NORTHCOM’s responsibility. So we do the doctrine and the concept of operations, which outlines how we’re going to do what the Pentagon has told us to do.
We do the broad planning. Then we go to those agencies that are the NORTHCOM action arms -- JTF Civil Support, JTF National Capitol Region, and those other entities that are actually going to get their fingernails dirty. We go to FORSCOM, which is our land component, and actively plan with them down to the tactical level.
It’s important to note that by and large most incidents in this country remain local, and that’s a very good thing. If the local capabilities are overwhelmed, the state becomes involved. If the state capabilities are exceeded, the state may go to the President and request a Presidential Disaster Declaration. Then the President identifies a primary federal agent, and only if that primary federal agent asks DoD to come in do we come in. In almost no situation would DoD be the federal agent that charges in and takes control.
Instead, we’re going to be flying wing to FEMA or EPA or DOE, or some other federal entity, and again providing those services and capabilities they ask us to bring to the table and that the Secretary of Defense personally approves us to bring it to the table.
We try very hard to get the right forces, to the right place, at the right time. Simple sentence. Sounds easy. In truth, it is a very challenging thing to do.
We have a wonderful establishment for going to war overseas. For supporting
civil authorities in this country, we are having to create a new
set of processes that allow us needed flexibility.
Sometimes it makes sense to move beds into an area. Sometimes, depending on the situation, it would make more sense to move enough medical capability in to stabilize the patients and then move them out to the NDMS beds that are already vacant and identified in the region. So, every situation is different and the responses must be tailored to the needs of that specific event.
The other very important bullet on this slide is that we live under rules of engagement that say DoD cannot buy new resources solely for this new civil support mission. The manpower ceiling for the military doesn’t change for this additional mission. The total budget to the military doesn’t change for this. All the articulated requirements for homeland security come “out of hide.” We are thus dual and triple tasking existing resources within the Department of Defense to support homeland defense and homeland security efforts.
Pictorially, it looks something like this. If there’s a situation, by and large it’s handled locally. If you happen to be in one of the 120 Metropolitan Medical Response cities, you have additional resources and training and equipment, which gives you that much more capability. Next, states will then roll in their assets as needed. Regional response is becoming increasingly important. The federal government is more and more looking at how regionally focused and managed response can support the country. By the federal government, I mean DHS, HHS, VA, DoD and other agencies all thinking and acting regionally. You will soon see much more inter-agency regional response planning and integration.
Next, if you look at the standard processes currently used to get Department of Defense assets to the scene of a disaster, you might expect our arrival in a four-to-six-day timeframe. It doesn’t happen overnight, because remember all the things that have to happen first -- a primary federal agency has to be declared, they move in, they evaluate the situation, and only then request DoD assistance. Now NORTHCOM might well have excellent situational awareness of the situation, but we cannot become involved until officially requested and that participation is approved at the SecDef level
There are, however, things that we in DoD can do earlier under certain circumstances. We have had, for many years, the ability at the local installation level to support the community immediately adjacent to a military base or post, and just the surrounding community, on an as-needed basis. In other words, if the community says “We need DoD troops out here to save lives, reduce suffering or preserve critical infrastructure,” the military installation commander can immediately do that on his or her own authority. But it takes a request in some form, preferably written, from downtown. The local military can support the community for two or three days, usually, under these rules. By that time, other resources should be coming into the area.
These capabilities, the Immediate Response Authorities, are on the books now and are perfectly legitimate. But that still might not be enough for a very big event, because not all bases are equipped for major, community-wide disaster response efforts. And so we in DoD are looking at other potential tools. Remember I told you the Secretary of Defense had to personally approve all DoD forces committed to an area other than the immediate response authorities. That instrument which he uses is an “Execute Order” or “EXORD.” We also recognize there might be times, particularly in the National Capital Region, where maybe we can’t afford to wait for all the paperwork to go though to get to that EXORD, so we prepare one in advance. The local commander, in this case Major General Jackman who was here yesterday, understands that, under certain very specific circumstances, he will have the authority to immediately launch the troops and their formidable capability in support of the local disaster response leadership. This tool is called a “Standing EXORD” and is in the final stages of the DoD approval process.
Next, the Catastrophic Incident Response Supplement is a new part of the National Response Plan and was not part of the older Federal Response Plan. This is a recognition of the fact that something could happen that’s truly cataclysmic -- 100,000 dead, 100,000 injured, 300,000 people displaced. Obviously the federal government is going to get involved instantly. And to make this response rapid and effective, all federal governmental agencies, have agreed to pre-designate and pre-commit certain resources in support of such a cataclysmic disaster. Frankly, we’re still planning as to best manage a response of this magnitude. The Department of Defense has pre-designated the Joint Task Force—Civil Support as our primary response in support of this supplement, should we ever have to implement.
We talked a lot about the National Guard yesterday, and the importance for the Guard is reflected by the fact that almost any time DoD Title 10 forces arrive, we would expect to find the National Guard already there, whether they're in state active duty or Title 32 status. The Guard can do more in Title 32 status than it can in Title 10, and we recognize and appreciate that.
Here is a slide that outlines the types of medical assistance that DoD might bring to the table,. I’ll just let you scan through that. If I were sitting out here where you are, I'd say, “that’s a pretty impressive list.” The bottom line says we can bring a single subject matter expert in, we can bring in small public health teams, or, worst case, we can conceivably bring in multiple taskforces of thousands of people each. However, I would be less than candid if I didn’t tell you there are some significant challenges to bringing in massive levels of support. I mentioned earlier that the manpower top line of DoD doesn’t change with this new civil support mission. Internally, DoD is a resource competitive environment. Those assets that I might want for consequence management may already be in use elsewhere and may simply not be available. Air ambulances, psychological support teams, other things that are very important to a civil disaster may already be in use elsewhere in the world. There may be times when DoD might have the capability, but not be able to bring it immediately to a situation here in the States.
I've talked about our processes and the fact that we are working very hard to improve the quality of those processes to make our assets both rapidly and effectively available. Today, we are eons ahead of where we were 18 months ago, but we’re a long way from where we want to be. We still have a solid two or three years worth of work before I can look you in the eye and say, “We’ve got it licked, and all the problems are fixed so that we have the best possible response system in place.” Today, we can bring a considerable capability to bear rapidly in a consequence management situation. We, in medicine, can technically perform as our charter requires. But as both a medical and a military professional, I have to say that that’s simply not good enough for me to be satisfied.
When you establish a new office, as we were able to do, the first thing you do is articulate the opening door requirements, and those opening door requirements are those things that you absolutely have to do, at a minimum, to be able to execute to your charter. We in the NORTHCOM Surgeon’s office did that, as you can see on this slide. But the initial set of responsibilities we set for ourselves was, perforce, a very reactive set of responsibilities. Initially, we NORTHCOM medics were very few in numbers and even fewer of us had any great experience in the interagency consequence management system.
As we matured as a medical entity, we began to develop the organizational sophistication to then ask, “Okay, now, what is the next generation of responsibilities that we want to take on? Now we’re going to start being proactive. Now we’re going to form those relationships, those agreements, those processes, we’re going to practice them, we’re going to exercise them until we know we can do a better job than we did last year.” We’re in that mode right now, in the Surgeon’s office, and this slide shows our direction for the future as we work to improve our processes to accelerate the movement of needed DoD capabilities into the civilian communities.
I’ve shown you the assets and capabilities that the DoD might be able to bring to a disaster scene, but I now need to share with you some of the limitations we face, as well.
I’ve already talked about the competition for resources and the fact that we often, for a variety of reasons, may take days to appear on the scene, but some limitations might not be so intuitive. Public misperceptions with regard to DoD, fears, stereotypes, and misapprehensions might be one such area for consideration. One of the things that actually bothered me a little bit when I got into this job was the fact that, even today, many of our communities are very mistrustful of the federal government. Many of our communities seem reluctant to have federal troops in their streets. I know it may sound odd, but there are still folks in this country who are uncomfortable with a major military presence.
Lest you think I'm picking on civilians entirely, consider this bullet. Military medicine is great medicine, folks. By every objective national standard, it is seriously good medicine. And we tell our young docs that. I know you’ve never known young physicians who were the least bit arrogant, but some of our young providers may be just a tad too…self-assured and might walk in the door with an “I'm the Pro from Dover here to save you” attitude.
Initially, both military and civilian providers will wonder about the technical level of sophistication and capability of the other. Once they start working together, however, they rapidly begin to appreciate the fact that they both practice high quality medicine, and there are just system, culture, language differences that have to be overcome. This adjustment doesn’t happen instantly, but it does represent something you should consider when bringing in any outside emergency response capability.
And, lastly, there is a cost to using DoD forces. By the time we roll in, that cost is usually going to be borne, in large, by the federal government. Still, it’s something you might think about. DoD is not always the cheapest game in town, and, ultimately, we’re your tax dollars at work.
My National Guard slide. I'm not going to into details on the National Guard, because you heard a lot about them yesterday. We in NORTHCOM rely heavily on the National Guard, and if you have an opportunity to tie National Guard exercises into regional and local events, certainly do so.
This slide reflects the types of civil support activities DoD can and, sometimes, has supported.
I'm going to go through this next slide very quickly. The first few bullets focus on the importance of planning, horizontal within DoD and the rest of the federal government, vertical between the feds and the state and local experts, and international as well as national. And we have to do this. We have to break down the stovepipes. And, planning alone is inadequate if you don’t exercise. We’ve seen, I believe, just the tip of the iceberg on the potential of public/private interactions. We need to explore those avenues much more aggressively. And government/academic interactions need to be pursued much more actively. Public health infrastructure needs to be rebuilt. Because of its success in decades past, it’s been allowed to deteriorate, but a robust national public health infrastructure is critical in this national disaster response planning effort. Finally, I'm a personal big believer in family planning and volunteering in the community.
Thank you for your time and attention. God bless you. God bless America.
Thank you very much. [applause]
Questions and Answers
__: I understand this is a bio defense session, but I'd like to ask also about the nuclear, radiological and chemical response plans, because we really have only one medical community. I was interested to see the planning and actual funding of a national stockpile of bio defense agents, 747s full of push packages and vendor inventories, and I'm wondering who is stockpiling the radiological medical treatment that would be required for 100,000 deaths and 300,000 injured as a result of the ground burst nuclear attacks that were discussed yesterday, particularly given that the NORTHCOM Command Surgeon says that DoD is not going to fund things over and above what DoD needs for its own force protection. Who’s going to fund the radiological stockpiles?
DR. HUGHES: Beats me. No, I mean, obviously I'm focused on the bio side, so I cannot comment definitively in response to your question, which would be better directed, maybe, to another panel. But there are components of the CDC stockpile that have some antidotes for chemical exposure. The problem is you need those locally right away when something happens. So there are discussions, I know, ongoing, I just haven't been involved in them in terms of making supplies available at the local level should there be a radiation exposure. I just can’t be more definitive.
MR. LIBBEY: Only thing I would say to that, frankly, in the last two-and-a-half years in terms of state and local public health plans, we recognize that radioactive we need to get to, but it frankly has not had the same attention. There are some major exercises, there’s one coming up next month involving the largest metropolitan area in Texas with a field-based exercise. We hope to learn some things out of that, but we’re behind.
GENERAL DODD: The Department of Energy, likewise, will tell you that they have some significant responsibility in this area, but it's primarily focused around the nuclear reactor sites, because that’s their primary responsibility. But they do have some stockpiles of radio-protectants and therapeutics. DoD also has some medical stockpiles—nothing compared to what CDC has—but those would be available on an as-needed basis to the civilian community in an emergency situation.
But, with respect to the nuclear and radiological, because there are so few real magic bullets in either preventing or treating the effects of serious radiation exposure, we in DoD probably haven't -- and I'm perhaps speaking for Chuck down here -- we simply haven't spent the resources on the issue.