Terrorism and Domestic Response: Can DoD Help Get It Right; Journal article

摘要

The DoD Military Healthcare System has physicians, nurses, and other allied personnel to meet the day-to-day needs of the active-duty force, military family members, and retirees and their beneficiaries, but it depends in large part on the civilian network through the TRICARE Management Activity. Many military hospitals have been downsized or closed over the past 10 years, leading to an even greater dependence on civilian resources. The military has a robust occupational health and deployment health program to keep active-duty servicemembers fit to fight and to care for them while they are deployed, but the number of active-duty medics is largely limited to those needed to support this rapid deployment capability. While military residency training programs have hospitals and the associated support staff, more and more peacetime military care is provided by the civilian network. DoD accepts some risk by depending on the civilian network. This risk may be appropriate in providing peacetime healthcare services, but it has considerable implications for a timely response to a terrorist incident within the United States that affects a DOD installation or civilian infrastructure that DoD depends on for force projection. Should terrorists attack a military installation with conventional weapons, USNORTHCOM has the responsibility and plans to bring in combat forces to protect that installation. The response to such an attack, however, would likely require that casualties be transported to civilian hospitals that are largely unprepared. There are three broad areas in which DoD action might reduce this operational risk, but all involve more proactive command engagement with civilian agencies and organizations: requirements-based mass casualty planning, understanding the institutional cultures of civilian partners in a regional mass casualty response, and coordinated crisis management decision making.