Chapter 13 provides a historical account of the evolution of emergency management in America and the basic framework for current concepts of operations. This chapter discusses selected federal response organizations and agencies, supporting programs for state and local emergency managers, and response capabilities. With the near-exponential growth in disaster management capabilities and initiatives that have occurred since the terrorist attacks of 2001, it would be impossible to discuss all of the many federal capabilities to any significant degree. Thus this chapter focuses on the agencies of principal interest to public health, medical emergency managers, and health care professionals.
A more-detailed presentation of current concepts of federal operations is provided, as well as a discussion of some of the more significant issues and challenges facing the federal sector in responding to disasters or catastrophic emergencies of any type.
Principal federal agencies
Although virtually all of the federal executive branch agencies have capabilities and expertise that could be brought to bear in a disaster to save lives, reduce pain and suffering, and otherwise mitigate the effects of these events on the human condition, five stand out as supporting programs that provide the most-direct support in this endeavor:
U.S. Department of Homeland Security (DHS)
U.S. Department of Health and Human Services (DHHS)
U.S. Department of Defense (DoD)
Department of Veterans Affairs (DVA)
American Red Cross (ARC)
Department of Homeland Security
The organizational structure and overarching functions of the DHS are described in Chapter 13 . Among the many provisions of the Homeland Security Act of 2002, three important programs were initially transferred from DHHS to DHS: the National Disaster Medical System (NDMS), the Strategic National Stockpile (SNS) program, and the Metropolitan Medical Response System (MMRS). Despite restructuring the organizations, after 2004, only the MMRS remains under DHS oversight, although now as part of the Homeland Security Grants Program (HSGP). In addition, even though it maintains many of its autonomous functions, the Federal Emergency Management Agency (FEMA) was transferred into the Emergency Preparedness and Response Directorate of the DHS in 2003 and was subsequently reorganized after Hurricane Katrina in 2006.
Homeland Security Grants Program
As part of Homeland Security’s mission of building and sustaining a secure nation, FEMA and DHS oversee the HSGP. The HSGP, reorganized in 2012, incorporates three grant programs, including the State Homeland Security Program (SHSP), Urban Areas Security Initiative (UASI), and Operation Stonegarden to support the five missions of prevention, protection, mitigation, response, and recovery. The Metropolitan Medial Response System, although previously funded as its own entity before 2012, is now incorporated into these three programs. The SHSP has made over $401,000,000 available to all 50 states, the District of Columbia, and territories of the United States, whereas the UASI made over $587,000,000 available to both high-threat and high-density urban areas. Combined, these three programs have provided over $1 billion of funding to implement the National Preparedness System.
Department of Health and Human Services
The DHHS is the federal agency that has the responsibility of protecting the health of the nation and providing essential services to all U.S. citizens. The DHHS has an annual budget of $940.9 billion (2015 fiscal year) and employs more than 76,000 personnel. It administers more than 300 programs in 11 operating divisions and is the parent organization for the Commissioned Corps (CC) of the U.S. Public Health Service (USPHS).
The DHHS has a long history of providing disaster response and preparedness activities both domestically and internationally. The DHHS is the lead federal agency for coordinating the federal health and medical response services (Emergency Support Function #8), as described in the National Response Framework (NRF) ( Box 17-1 ). The Public Health Threats and Emergencies Act of 2002 authorizes the DHHS secretary to take appropriate actions if a public health emergency is determined to exist and to establish a Public Health Emergency Fund. Other statutes authorize the U.S. Surgeon General to make and enforce regulations to “prevent the introduction, transmission, or spread of communicable diseases from foreign countries into States or possessions, or from one State or possession into any other State of possession.”
Assessment of health and medical needs
Surveillance of health care issues
Acquisition and distribution of medical care personnel
Acquisition and distribution of health and medical equipment and supplies
Food, drug, and medical device safety
Worker health and safety
Mental health assessment
Development and dissemination of public health information
Water safety, including wastewater and solid waste disposal
Victim identification and mortuary services
DHHS disaster response and preparedness activities are conducted in the Operating Divisions and the USPHS CC. Coordination is performed at the Office of the Assistant Secretary for Preparedness and Response (ASPR) within DHHS. The DHHS, along with the National Institutes of Health (NIH), also convenes the National Science Advisory Board for Biosecurity, which guides the development of systems for biosecurity-research peer review, guidelines for identification and conduct of research that might require security surveillance, professional code of conduct for scientists and laboratory workers, and materials to educate the research community about biosecurity.
National Disaster Medical System
The NDMS is a public-private partnership between the DHS, FEMA, the DHHS, DoD, DVA, and civilian hospitals and health professionals. The NDMS serves two primary functions: it is a backup to military health care operations in the event of overwhelming combat casualties, referred to as the Integrated CONUS (Continental United States) Medical Operations Plan (ICMOP), and it coordinates the provision of national health care resources to casualties resulting from disasters in the United States and its territories. Originally established by Memorandum of Understanding in 1984, the NDMS was codified into law in 2002. There are three components to the NDMS: (1) on-site health care operations, (2) medical evacuation, and (3) definitive care at participating hospitals in unaffected areas. The NDMS may be activated by a presidential declaration of a national emergency. It may also be activated at the direction of the secretaries of the DHS, DHHS, or DoD.
On-site augmentation to local or state health care operations are provided principally through the mobilization of any of the approximately 85 Disaster Medical Assistance Teams (DMATs). The number and capability of DMATs are evolving continually as new teams are being formed and established teams are augmenting their capabilities. Most medical teams are composed of more than 100 physicians, nurses, and allied health care personnel who are sworn in as temporary federal employees and who volunteer their time to prepare and train for emergency operations. In the event of activation, they become federal assets, with attendant liability protection. The majority of DMATs provide general clinical operations either in disaster areas or on scene or as augmentation staff to local hospitals. A number of specialty teams exist, including burn, pediatrics, crush injury, and mental health teams. Four disaster veterinary assistance teams (DVATs) and 10 Disaster Mortuary Operational Response Teams (DMORTs) are also components of the NDMS. One DMORT is specially trained in the handling of contaminated or contagious remains, with three Disaster Portable Morgue Units (DPMUs) staged in the United States to augment DMORT operations. These DPMUs contain a morgue and workstations, as well as prepackaged equipment. There are also three larger National Medical Response Teams–Weapons of Mass Destruction (NMRT-WMD) located in North Carolina, Colorado, and California. These teams are specially equipped and trained to assist local emergency response organizations in the event of terrorist events involving chemical, biological, or radiological substances. When deployed, DMATs are self-sustaining for 3 days and are supported by management support units (MSUs) for resupply.
Medical evacuation operations are coordinated by the DoD. Medical regulation is managed by the Global Patient Movement Requirements Center (GPMRC) at Scott Air Force Base in Illinois. This is the same system used to evacuate military casualties in peacetime or during combat operations worldwide. Actual medical evacuation occurs primarily through the use of fixed-wing U.S. Air Force assets, such as the C-141 Starlifter and the C-17 Globemaster III (each of which can accommodate in excess of 50 litter patients), under the auspices of the Commander, the U.S. Transportation Command (USTRANSCOM). Nontraditional or Commercial Air Carrier (CAC) air evacuation platforms or ground conveyances can also be used, as required. Most DMAT members have training in basic fixed-wing and helicopter operations as they pertain to the evacuation of patients.
Definitive care is provided by the 1600 hospitals that have voluntarily agreed to support NDMS operations. In all, approximately 100,000 beds (including the staff to support them) could be made available throughout the United States. Cooperating hospitals are coordinated through regional federal coordinating centers (FCCs), which are managed by the Veterans Health Administration (VHA) or the military services hospitals.
Strategic National Stockpile
The SNS, originally authorized as the National Pharmaceutical Stockpile Program by Congress in 1998, has as its goal the rapid mobilization and provision of pharmaceuticals and other medical supplies to areas affected by public health emergencies or disasters of any cause. The SNS program has a number of elements, including scientific review, education, training, and technical and logistical support. The primary material components of the SNS are the 12-hour push packages and managed inventory (MI) supplies.
Twelve push packages, preconfigured and under environmental and security safeguards, are strategically placed throughout the United States. They can be deployed to arrive at a suitable airfield nearest to a disaster within 12 hours of release by the secretary of DHS or DHHS. Push packages are large caches that require more than 5000 square feet of storage space that may be transported by air or ground conveyance. Supplies include antibiotics, antiviral agents, and airway and intravenous supplies. Ventilators, stored separately, may be shipped as needed. Vaccines, also stored separately, may be shipped with or without the entire cache. In 2003 regionally placed chemical agent antidotes were established under the CHEMPACK program to provide for more timely arrival. These CHEMPACKs are provided through the SNS program, but are managed by the jurisdictions in which they are placed.
If specific supplies are known to be needed in advance of push package shipment, these may be obtained through MI stocks, which are maintained by pharmaceutical or medical supply corporations that have contracts with the federal government. The MI program was used in the wake of the Anthrax mailings shortly after 9/11. MIs were designed, however, to be follow-on packages of specifically needed supplies to arrive 24 to 36 hours after the push packages.
All states are required to develop and exercise plans for the request, acquisition, storage, staging, distribution, and dispensing of SNS caches to prophylaxis or vaccination centers or area hospitals. Caches will be accompanied by a small team of medical logisticians referred to as technical assistance response units (TARUs).
The Office of the Assistant Secretary for Preparedness and Response
Created under the Pandemic and All-Hazards Preparedness Act of 2006 and reaffirmed in 2013, this office assumed the functions of the ASPR for Public Health Emergency Preparedness. It provides ( ) interface between agencies within the DHHS and other federal departments, agencies, and offices and ( ) interface between the DHHS and state and local entities responsible for public health and emergency preparedness. The ASPR ensures that health and medical vulnerabilities are identified and prioritized within the DHHS; that DHHS preparedness programs are coordinated and integrated with other federal programs; and that response activities are coordinated within the DHHS and integrated with other federal, state, and local response. The ASPR also oversees the development of the National Health Security Strategy; released first in 2009, it serves to guide the nation on building community resilience and strengthening and sustaining health and emergency response systems. The office also maintains a scientific group that oversees the development and procurement of all SNS medical countermeasures.
The ASPR works with state and local officials to enhance health and medical preparedness, and it coordinates various federally funded preparedness activities. The DHHS has established guidelines, benchmarks, and competencies to serve as markers of preparedness.
The ASPR also oversees the Biomedical Advanced Research and Development Authority (BARDA) and Project BioShield. These divisions provide an integrated approach to developing medical countermeasures against chemical, biological, radiological, and nuclear threats. As part of the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, the secretary is permitted to use unapproved products during emergencies and to appropriate funds for security countermeasures of the SNS.
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality’s (AHRQ’s) mission is to improve the quality, safety, efficiency, and effectiveness of health care by sponsoring, conducting, and disseminating research that relates to the aforementioned mission. The AHRQ has a number of disaster-related functions within the DHHS, with an emphasis on bioterrorism (BT)-related issues. The organization has funded BT-related research, conducted a variety of audio conferences for clinical providers, issued evidence-based practice reports, and distributed issue briefs based on the audio conferences. The AHRQ also provides technical support to the ASPR during responses.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the world’s foremost public health organization. It has had significant experience in responding to disasters and public health emergencies globally. It also has a major role in disaster-response mitigation through its leadership in disease-prevention activities. The CDC is the national leader in the areas of epidemic outbreak response, disease surveillance, environmental health, public health laboratory readiness, and public communications. In conjunction with the Agency for Toxic Substances and Disease Registry (ATSDR), the CDC serves as the DHHS lead for infectious disease response, chemical and hazardous materials exposure, vector control, radiological monitoring, and public (risk) communications. Moreover, the CDC has the lead scientific responsibility for the SNS.
CDC epidemiologists and other response-team personnel (usually as part of the Epidemiology Investigative Service, or EIS) deploy in support of public health incidents. These personnel perform case investigations and contact tracing, assist with surveillance, and serve as technical advisors for issues such as vector control. CDC laboratories can perform specialized assays to identify biological and chemical agents from clinical and, in some cases, environmental specimens. The CDC also manages the Laboratory Response Network (LRN), a national network of public health laboratories, each capable of performing sophisticated testing of infectious agents. Participants in the LRN program receive training, protocols, supplies, and a secure reporting system.
Public communications can occur through a variety of CDC venues. The Morbidity and Mortality Monthly Report (MMWR) has long been recognized as a periodical that serves to notify and update professionals about public health investigations and incidents. The CDC also developed two other lines of communication. The Health Alert Network (HAN) and the Epidemiologic Exchange (Epi-X) were developed as web-based communications networks. The HAN is used to distribute information through a widespread open network. The Epi-X is more secure and is directed to epidemiologists and other public health professionals at the federal, state, and local levels. The CDC also conducts provider training through on-site courses and teleconferences.
The CDC maintains a state-of-the-art emergency operations center that serves as the information-gathering center for the agency. It provides 24-hour, daily access for local, state, and federal agencies.
Food and Drug Administration
The Food and Drug Administration’s (FDA’s) stated public health mission is “assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.” The FDA regulates the safety of biological (including the blood supply), cosmetics, drugs (prescription and over-the-counter), foods (except meat and dairy products), medical devices, radiation-emitting electronic products, and veterinary products. The FDA also has the responsibility for animal health as it relates to food safety and security.
The FDA has investigated foodborne outbreaks and medication tampering and has supported DHHS response to domestic disasters. In recent years, the FDA has played a major role in the preparedness activities against terrorism and has organized several new offices to facilitate its activities. The Office of Crisis Management (OCM) coordinates FDA emergency response activities. The Office of Emergency Operations within the OCM coordinates FDA field and headquarters activities and maintains the FDA emergency operations center.
The FDA maintains expertise to assist in areas of food safety, including the production, processing, storage, and holding of domestic and imported foods. It has worked with other federal agencies to implement a national laboratory network capable of responding to a food security incident. The FDA uses field personnel to perform food import examinations at approximately 90 U.S. ports. It collaborates with U.S. blood banks to ensure the continuous supply of safe blood. It also works with other DHHS agencies and the pharmaceutical industry to help guide the development of new medical countermeasures for BT. New regulations have facilitated the FDA approval process for new products and medical countermeasures. The FDA works with other federal agencies in developing guidance for using the countermeasures in special populations or when there is no FDA-approved product or no approved indication for a marketed product. Devices under investigational new drug (IND) status or investigational device exemption (IDE) applications can be used during an emergency.
Health Resources and Services Administration
The Health Resources and Services Administration’s (HRSA’s) involvement in disaster response has largely been the issuance of grants to improve hospital BT preparedness. HRSA grants have provided funding through state health departments to address surge capacity, communications, decontamination, and exercises related to hospital operations.
The Federal Occupational Health office is a component of the HRSA that provides clinical services, environmental health services, and employee assistance programs for federal workers. Personnel from this organization have provided postdisaster clinical and counseling services to federal employees at disaster field offices, regional offices, and headquarters.
Indian Health Service
The Indian Health Service (IHS) has provided leadership in addressing disasters affecting the health and medical systems directly associated with tribal nations and reservations. In the Hantavirus outbreak on the Navajo Reservation, IHS medical personnel were active participants in the response. (Hantavirus disease was virtually unknown in the Americas until 1993 when a physician at the IHS in New Mexico reported that two previously healthy young people had died from acute respiratory failure.) In 2007, a syphilis outbreak was first noted by the IHS and reported to the Arizona Department of Health Services, ultimately leading to the identification of 35 cases. Tribal leaders and medical personnel have been actively engaged with their state counterparts in preparing for BT and emergency preparedness. The IHS Office of Urban Indian Health Programs and Office of Public Health Support address public health needs associated with disease outbreaks, as well as emergency preparedness. IHS personnel have also been deployed to domestic events.
National Institutes of Health
The NIH’s role in the nation’s health response system has been parsed out to a variety of its 27 institutes and centers. The NIH mission relates to the stewardship of medical and behavioral research. Its National Institute of Mental Health supports research in the area of response to trauma and violence. The National Institute of Environmental Health Sciences supports research directed at the health consequences of environmental toxins. The NIH also supports and performs research that enhances the understanding of the basic biology and mechanisms of immunological response to particular biological agents. The National Institute of Allergy and Infectious Diseases (NIAID) has the NIH lead on many of these activities and receives substantial funding within the DHHS to accelerate development of new and improved vaccines, diagnostic tools, and therapies against potential agents of BT. The NIH has also been dedicated to the expansion of the medical countermeasures for biological agents of terrorism. The NIAID has created the Integrated Research Facility at Fort Detrick in Maryland to carry out biodefense research especially directed at high-consequence infections. In addition to the research activities, the NIH sponsors regional centers for biodefense research and biocontainment laboratories.
Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the coordination of federal mental health services for the government. It assists in the assessment of mental health needs and the identification of mental health services that can be provided to those affected by disasters. Moreover, it provides grants to states that assist in training mental health counselors and enhancing mental health response capacity. It also produces publications related to planning, preparedness, and the mental health effects of disasters, as well as training manuals for mental health responders. SAMHSA also maintains a technical assistance center that can be accessed by responders.
Commissioned Corps of the U.S. Public Health Service
Headed by the U.S. Surgeon General, the CC consists of more than 6500 commissioned officers who have degrees in health- and medical-related professions. CC officers are distributed among all of the DHHS Operating Divisions and can be assigned to other federal agencies. The CC serves as the health care corps for the U.S. Coast Guard. CC personnel have responded internationally to a full spectrum of disasters. Two specific units merit discussion: the USPHS DMAT and the CC Readiness Force (CCRF). The USPHS DMAT has been the prototype for all subsequent DMATs and has been one of the most-deployed federal medical response units to domestic disasters. However, in 2006, a tier level of CC response teams were formed and PHS-1 and PHS-2 were renamed RDF (Rapid Deployment Force) 1 and 2. Currently, five RDF teams rotate through a monthly call for incidents. CCRF personnel receive training similar to that of the NDMS response teams and must meet additional requirements beyond those of other USPHS officers.
Department of Veterans Affairs
The DVA is a cabinet-level agency with three primary divisions: the Veterans Benefits Administration, National Cemetery System, and the VHA. The VHA is the largest health care system in the United States. Within its 23 Veterans Integrated Service Networks (VISNs) are more than 150 hospitals, 800 clinics, and 400 additional facilities, such as counseling centers. The VHA employs more than 14,000 physicians and nearly 200,000 other health care professionals. It principally exists to provide medical care to military veterans. VHA also has important roles in medical research and the education of the health care workforce.
The fourth mission of the VHA is that of emergency management. In that capacity it supports medical operations as a backup for DoD (through the Integrated CONUS Medical Operations Plan), as a supporting agency under the NRF, as a partner to the NDMS, and for continuity of governmental operations functions. It also has a unique role in fielding emergency medical response teams for radiological emergencies.
Interagency coordination and policy matters related to emergency management and response reside at the secretary level, but day-to-day management and oversight comes from the VHA Office of Emergency Management (OEM). The OEM is headquartered in Martinsburg, West Virginia. It has a staff of 25 individuals at its headquarters in Martinsburg and Washington, DC, as well as 75 field program staff. These peripheral staff members coordinate all emergency management activities within the VISNs and subordinate facilities.
VHA personnel have deployed to the vast majority of national disasters in the last decade, including the response to the New York City terrorist attack of 2001. These personnel have also provided support to National Security Special Events (NSSE), such as presidential inaugurations and the Olympic Games.
Executive order 12657 places an additional responsibility on the VHA to provide medical response to incidents involving radiological emergencies. The VHA has the 30-member Medical Emergency Radiological Response Team (MERRT), which can arrive at the site of a radiological emergency and is self-sustaining. As such, it is not a first-response organization, but rather, it provides supplemental medical care at hospitals and technical assistance and guidance in decontamination and monitoring. When MERRT is deployed, it is considered a federal resource.
Another initiative within the VHA is the population of the Disaster Emergency Medical Personnel System (DEMPS) database. The DEMPS is a voluntary enrollment of both full-time and retired personnel within the Veterans Affairs (VA). Individuals register in advance of disasters and serve as a pool of personnel to be activated should an event within the VA or elsewhere occur. Current employees must be released by their local facility and VISN before being used to support other requests.
The VHA also has a role in federal disaster cache management. In addition to its role as logistical manager of SNS caches, it maintains caches for its facilities’ use, and, by extension, these could be used in community-wide disasters. It also maintains caches for NSSE events, as well as a stockpile for response involving disasters that would affect the U.S. Congress.
The VHA has its greatest role in local emergency management. The VHA operates the majority of the NDMS FCCs. VHA hospitals are also charged with assisting local community health care resources in their preparedness and planning. Finally, as part of the community health care network, VHA resources would be automatically drawn into the response to a local disaster, as in Houston, Texas, in 2000, when VHA facilities accepted transferred patients from area civilian hospitals incapacitated as the result of flooding caused by Tropical Storm Allison.
Department of Defense
The DoD is identified as a support agency for nearly all of the 15 Emergency Support Functions identified in the NRF. Its component services have large amounts of material and personnel resources that could be brought to bear in response to a disaster, anywhere in the world. The Army Civil Affairs branch (primarily found in the Reserves component) even has expertise in governmental function reestablishment. In addition to the active duty component, the DoD can call on Reserve forces of all of the services, and, under certain circumstances, can federalize Army and Air Force National Guard personnel as part of its military response. To chronicle all of the many assets would far exceed the scope of this chapter.
DoD support to federal, state, or local emergency managers is governed by a number of statutes and executive orders, collectively referred to as “Military Support to Civil Authorities” (MSCA). General guidance for the use of MSCA includes the following:
Civil resources are applied first.
DoD resources are provided only when requirements are beyond the capabilities of civil authorities.
Specialized DoD capabilities requested for MSCA are used efficiently.
Military operations other than MSCA will have priority over MSCA.
National Guard forces that are not in federal service have primary responsibility for providing military assistance to state and local government agencies in civil emergencies.
DoD and the military services will not procure or maintain any supplies, material, or equipment exclusively for providing MSCA.
In general, DoD resources will not be used for law enforcement or intelligence-gathering functions.
Imminently serious conditions resulting from any civil emergency or attack may require immediate action by military commanders to save lives, prevent human suffering, or mitigate great property damage. When such conditions exist and time does not permit prior approval from higher headquarters, local military commanders are authorized to take necessary action to respond to requests of civil authorities. This is commonly referred to as “Immediate Response.”
Under the MSCA doctrine, and in line with the NRF, requests for military support are submitted by lead federal agencies (LFAs) through FEMA to the Joint Director of Military Support (JDOMS) on the Joint Chiefs of Staff. The JDOMS has the authority to task Unified Combatant Commanders, services, and defense agencies to provide MSCA support for presidentially declared disasters and emergencies. The JDOMS validates requests for military assistance from LFAs and plans, coordinates, and executes DoD civil support activities. The JDOMS controls a joint staff to conduct operations during declared disasters.
Operationally, MSCA is directed through the U.S. Northern Command (USNORTHCOM) in Colorado Springs, Colorado, through a standing Joint Task Force-Civil Support (JTF-CS). The JTF-CS was established specifically for homeland defense missions. The two continental armies of the United States (First Army and Fifth Army) have response task forces that can deploy to the vicinity of the disaster and assume operational control over all military forces assigned to the response. In addition, USNORTHCOM has CBRNE Consequence Management Response Forces (CCMRF), which can deploy as initial response forces for a CBRNE incident.
DoD resources fall into two broad categories: (1) mass resources that can augment similar capabilities in the other federal agencies and (2) unique resources that can provide expertise and technical assistance. Its mass resources of interest to civilian medical planners include the following:
More than 75 military hospitals and more than 100,000 public health and medical professionals
Deployable medical platforms, ranging in size from the U.S. Air Force’s air transportable Expeditionary Medical Support (which can be expanded up to 25 beds each) to the two U.S. Navy 1000-bed hospital ships
Significant air assets that can be used to evacuate casualties, as described in the section on the NDMS
Caches of pharmaceuticals and medical supplies, referred to as wartime stocks, which would only be mobilized for MSCA missions in the most unusual circumstances
Specialized resources that may be brought to bear in the event of an overwhelming disaster:
Deployable public health laboratories
Specially trained response teams, such as the U.S. Army Chemical and Biological Special Medical Augmentation Response Teams (C/B-SMART), the U.S. Navy Special Psychiatric Intervention Teams (SPRINTs), or the U.S. Air Force Radiation Assessment Teams (AFRATs)
Reach-back expertise capabilities through the U.S. Army Medical Research Institute of Infectious Disease (USAMRIID) and the Medical Research Institute for Chemical Defense (USAMRICD), the Armed Forces Radiobiological Research Institute (AFRRI), or the Armed Forces Institute of Pathology (AFIP)
The DoD is in the process of restructuring the CCMRF model, while further enhancing National Guard capabilities by integrating an in-state response capacity based on the Civil Support Teams, CBRN Emergency Response Force Packages (CERFPs) and the standup of 10 NG Regional Homeland Response Forces (HRFs), one per FEMA region. These geographically distributed HRFs will improve the ability of DoD to respond quickly in case of a major or catastrophic CBRNE CM event by providing the necessary lifesaving capabilities to the incident area within hours versus days. The CERFP teams consist of approximately 186 Soldiers and Airmen. Each team has a command and control section, decontamination element, medical element, casualty search and extraction element, and fatalities search and recovery element.
Other specialized capabilities exist within the DoD because of its combat mission: for example, the Technical Escort Unit (TEU), which is trained and equipped to handle extremely hazardous materials and radiation sources, forms the nidus of the much larger Guardian Brigade, which has specific homeland defense functions. The U.S. Marine Corps includes the Chemical and Biological Incident Response Force (CBIRF), a rapid response unit trained to work in hazardous environment operations, including patient extrication, decontamination, and emergency stabilization and treatment.
American Red Cross
Chartered by Congress in 1905, the Red Cross has as its mission to “carry on a system of national and international relief in time of peace and apply the same in mitigating the sufferings caused by pestilence, famine, fire, floods, and other great national calamities, and to devise and carry on measures for preventing the same.” Each year, the ARC responds to more than 70,000 disasters of various sizes and complexities. The ARC is the LFA for the Mass Care Emergency Support Function of the National Response Plan (NRP), and it has supporting roles in the Public Health and Medical Services Emergency Support Function.
The ARC provides shelter, food, and health services, including mental health, to address basic human needs. Family and individual assistance is also given to those affected by disaster to enable them to resume their normal daily activities independently. It also feeds emergency workers, handles inquiries from concerned family members outside of the disaster area, provides blood and blood products to disaster victims, and helps those affected by disaster to access other available resources.