The Doctor is Deployed - LLM Publications

In the Spotlight...Here Comes the CavalryCooperation between Military and CivilianForces in Disaster ResponseBy Douglas Eliason, DOLOCAL, LOCAL, LOCAL. All disastersbegin and end locally. Allcommunities and local officials areresponsible before, during and after adisaster to ensure their communitiesare taken care of. This doesn’t meanthat individual communities have nohelp available—indeed, they don’t haveall the resources you might need in thecase of a major disaster.Mobilizing MaterialsIn the late 1990s the federalgovernment recognized that disasterresponse was somewhat fragmented,and without a common languageto ensure that we all responded ina similar way to disasters. Hence,the federal government developedthe National Response Framework.The National Response defines howcommunities, States, Tribes and theNation would respond in disasters, anddevelops a common language aboutresources needed in disasters, to ensurethat a local responder gets what heneeds.In a disaster, the response starts witha local incident commander at thesite taking charge. When all availableresources are utilized and still moreare needed, the incident commandertakes it to the next level and calls thegovernor, who issues a state disasterdeclaration. This allows the governorto reach into all the resources of thestate to support the local disasterresponse. If the state is overwhelmed,the governor has the option to askadjacent states to provide supportunder the Emergency ManagementCompact. In the case of a large disasterthat overwhelms the abilities of thestate and adjoining states, the federalgovernment will be called in to assist.The federal government, mostlythrough FEMA, can organize andprovide many of the resources requiredby an incident commander. One ofthe most important resources thatthe federal government brings to adisaster is money. Once the Presidenthas declared a federal disaster, it opensup the purse of FEMA and all theresources of the federal government.Among those federal resources are theArmed Forces of the United States.Boots on the GroundSo where is the cavalry? One of theresources that a state can use duringa disaster is the National Guard ofthe state, which is the “well-orderedmilitia” referenced in the Constitution.Those who serve in the guard areunder the command and control ofthe governor of the state, and comein at the state-level response. Whenthe federal government mobilizesto provide support in a disaster,the Department of Defense, whichregulates the uniform services of theUnited States, can call other armedforces up to support a local disaster.Where do the medical resourcesthat we need in a disaster comefrom? Under the National ResponseFramework, medical response fallsunder emergency support functioneight (ESF 8-Health and MedicalServices). Emergency support functionsare essentially a way to organizeresources under common groupings.In Oregon, ESF 8 belongs to theDepartment of Human Services, andat the Federal level, ESF 8 falls underhealth and human services. At everylevel, these agencies are responsiblefor finding the medical resources theincident commander needs.So let’s put this all together: Anearthquake and resulting tsunamirocks the town of Lincoln City. As thecity and county responds, it becomesapparent that the hospital will notbe able to function due to severedamage. Community physicians starthelping out in whatever shelter theycan find, but it’s clear to the countyhealth department that they will needadditional resources and an immediatecall goes to the state. The governor,realizing the extent of the damage,declares a state emergency.The county health officercommunicates the need to evacuatepatients from the hospital to DHSat the State Emergency OperationsCenter. As there is now a declareddisaster, the Oregon National Guard ismobilized and medical personnel beginto evacuate the Lincoln City hospitaland long-term care facilities.Medevac helicopters start theimmediate evacuation of intensive carepatients to unaffected facilities in theWillamette Valley. Field ambulancesfrom the 41st Infantry Brigade begin28 • Medicine in Oregon