| | Triage for Civil Support: Using Military Medical Assets to |
| | 2,96 | | MB | Respond to Terrorist Attacks |
| | 204 | | stron |
| | 4576 | | ID | RAND Corporation |
| | 2004 | | rok |
| | Contents |
| | Prefaceiii |
| | Figuresix |
| | Tables xi |
| | Summary . xiii |
| | Acronymsxxi |
| | CHAPTER ONE |
| | Introduction 1 |
| | Background. 1 |
| | Research Objectives and the Influence of September 11. 2 |
| | Research Methods 3 |
| | Terminology 4 |
| | Terrorism 4 |
| | CBRNE Versus Weapons of Mass Destruction. 4 |
| | How This Report Is Organized 5 |
| | CHAPTER TWO |
| | The Military Health System and Military Support to Civil Authorities . 7 |
| | The Two Primary Missions of the Military Health System 7 |
| | The Military Health System Missions Share Resources. 8 |
| | Military Medical Assets 9 |
| | Mission Medical Assets.10 |
| | Infrastructure Medical Assets.11 |
| | DoD Organization, Guidance, and Planning .11 |
| | Organization for Military Operations11 |
| | Guidance .16 |
| | Planning 16 |
| | Limitations to Consider When Planning for Military Assistance .18 |
| | Military Assets May Be Engaged in Other Missions .18 |
| | Military Assets Are Maintained at Various Levels of Readiness Based on Wartime Requirements 18 |
| | |
| | CHAPTER THREE |
| | The Evolution of Structures, Systems, and Processes for Domestic Preparedness19 |
| | Recommendations from National Commissions19 |
| | New Players and New Roles in Homeland Security 21 |
| | The Office of Homeland Security and the National Strategy21 |
| | The Department of Homeland Security .22 |
| | Homeland Security Presidential Directive-5 .22 |
| | The National Response Plan .23 |
| | The Role of DoD in Response: An Overview.24 |
| | The National Disaster Medical System 24 |
| | Other DoD Directives Related to Civil Support.24 |
| | The Director of Military Support 25 |
| | The Assistant Secretary of Defense for Homeland Defense25 |
| | U.S. Northern Command25 |
| | CHAPTER FOUR |
| | Legal and Other Barriers to Military Support to Civil Authorities .27 |
| | Constitutional and Historical Bases for Use of the Military Domestically27 |
| | Statutory and Regulatory Authorities Enabling the Use of Military Assets to Support Civil Authorities |
| | 28 |
| | Constitutional Authority .28 |
| | Congressional Authority: Posse Comitatus Act and Its Progeny.28 |
| | Congressional Authority: Civil Disturbance (or Insurrection) Statutes29 |
| | Congressional Authority: Counterdrug and Related Statutes 30 |
| | Congressional Authority: Disaster Relief and The Stafford Act .31 |
| | Congressional Authority: Counterterrorism and Weapons of Mass Destruction 32 |
| | Congressional Authority: Quarantines, Evacuations, and Curfews 33 |
| | Congressional Authority: New Authority for Use of the Reserve Components .34 |
| | Constraints on the Exercise of Explicit Authority34 |
| | Executive Authority: The President’s Residual Authority36 |
| | Executive Authority: Martial Law 37 |
| | Executive Authority: Executive Order38 |
| | Executive Authority: DoD Policy on Military Assistance in Civilian Emergencies 38 |
| | Legal Liabilities Implicated by the Use of Military Medical Assets to Support Civil Authorities.39 |
| | Liability Under the Federal Tort Claims Act of 194639 |
| | Liability Under Section 1983 and Bivens for Violations of Constitutional Rights.41 |
| | Liability Related to the Management of Property, People, and Information 42 |
| | Distinguishing Between Homeland Defense and Civil Support 43 |
| | Nonlegal Constraints on the Use of the Military .44 |
| | Diffuse Nature of Authority44 |
| | Reluctance to Seek Federal Assistance44 |
| | Apprehension About Military Assistance.44 |
| | Cultural Barriers45 |
| | Capabilities .45 |
| | Requirements Identification45 |
| | Contents vii |
| | Conclusions .45 |
| | Recommendation46 |
| | CHAPTER FIVE |
| | Military Medical Support to Civil Authorities: Historical Case Studies 47 |
| | DoD’s Role in Medical Response .47 |
| | Research Methods for Case Studies .48 |
| | Hurricane Andrew Background .49 |
| | Government and Military Response to Hurricane Andrew .51 |
| | Hurricane Marilyn Background.55 |
| | Government and Military Response to Hurricane Marilyn.55 |
| | Tropical Storm Allison Background 58 |
| | Government and Military Response to Tropical Storm Allison 59 |
| | What Lessons Can Be Learned from These Case Studies? 62 |
| | A Conceptual Framework for Response.64 |
| | Decentralized Versus Centralized Response64 |
| | Civilian Versus Military Response .66 |
| | CHAPTER SIX |
| | Exercise-Based Studies of Potential Military Medical Support to Civil Authorities 69 |
| | Objective 69 |
| | Exercise Methods70 |
| | Exercises Were Based on an Established Methodology 70 |
| | The Analytic Framework for the Exercise 72 |
| | The Design and Testing Process Included Consideration of a Menu of Potential Issues73 |
| | Terrorist Attack Scenarios 74 |
| | The Georgia Exercise: Smallpox Attack .75 |
| | Background.75 |
| | Georgia Emergency Response Services .76 |
| | The Threat and the Scenario .76 |
| | The Exercise 77 |
| | Exercise Results: Issues and Observations 80 |
| | The California Exercise: Radiological Dispersion Device Attack .83 |
| | Background.83 |
| | California Emergency Response Services.84 |
| | The Threat and the Scenario .85 |
| | The Exercise 85 |
| | Exercise Results: Issues and Observations 90 |
| | Conclusions .94 |
| | CHAPTER SEVEN |
| | Conclusions and Recommendations .97 |
| | Conclusions .97 |
| | Recommendations. 100 |
| | APPENDIX |
| | A. Interview Protocol 103 |
| | B. Organizations Interviewed and Exercise Participants. 105 |
| | C. DoD Directives Related to Civil Support 113 |
| | D. Materials Used in Georgia Exercise . 115 |
| | E. Smallpox Model Used in the Georgia Exercise . 167 |
| | F. Excerpt of Quadrennial Defense Review . 171 |
| | Bibliography 173 |