CarltonPresentation

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Published on April 24, 2008

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Slide1:  Texas A&M University System Integrative Center for Homeland Security The Threat Factor and a Viable Response Dr. Paul K. Carlton, Jr. Lt. Gen, USAF, Ret 25 June 03 Overview:  Overview Current Threats The AFMS Tailored Response The Israeli Response Real World Response “Filling the Gap” A Viable Solution Final Thoughts New Major Concepts:  New Major Concepts Threats AF - Modular Building Blocks “Surge Response” Solutions Regional Response CRAF/CREMA Legislative Initiative Evolution of an Idea:  Evolution of an Idea Evolution of a person's reaction to a new idea: Indignant rejection Reasoned objection Qualified opposition Tentative acceptance Qualified endorsement Judicious modification Cautious adoption Impassioned espousal Proud parenthood Dogmatic propagation HK Silver, 1965 Homeland Security Evolution:  Evolution of a person's reaction to a new idea: Indignant rejection Reasoned objection Qualified opposition Tentative acceptance Qualified endorsement Judicious modification Cautious adoption Impassioned espousal Proud parenthood Dogmatic propagation HK Silver, 1965 Homeland Security Evolution Independent Missions:  Peacetime Benefit Wartime Readiness Independent Missions Independent Missions Military USA Interdependent Missions:  Peacetime Benefit Wartime Readiness Interdependent Missions Interdependent Missions Inherently Governmental! Military USA Finding a Balance:  Balanced Surge Capacity Scale Finding a Balance Efficient Effective Finding a Balance:  Current Surge Capacity Scale Finding a Balance Efficient Effective Not Balanced! Slide10:  Texas A&M University System Integrative Center for Homeland Security Current Threats Current Threats to the Medical System:  Current Threats to the Medical System Aging “baby boomers” exhaust medical resources Uninsured and underinsured result in huge disparity in medical care Epidemics– AIDS, West Nile, Foot and Mouth disease, Multi-drug resistant TB, SARS Terrorism Whatever is done must be “ALL HAZARD” Slide12:  Global War of Terrorism Chapter 1 World Trade Center 1993 Chapter 2 Afghanistan Enduring Freedom Chapter 3 Iraq Operation Iraqi Freedom World Trade Center & Pentagon 2001 Slide13:  We Know Their Targeting Process Texas A&M University System Integrative Center for Homeland Security Al QuedaTarget Selection Pyramid :  Al QuedaTarget Selection Pyramid What’s Important? Target Selection :  What’s Important? Target Selection Specialist pick target areas Military Technical Transportation Medical Financial Religious Computer communications “In the future, we believe, the number-one objective in target selection will be to further severely damage the U.S. economy.” Stungis/Schori, Mar 2003 Ample Causes for Concern:  World Trade Center - 1993 Khobar Towers - 1996 Oklahoma City - 1995 Atlanta Olympic Park - 1996 Tokyo Subway - 1995 Ample Causes for Concern Why The Threats Exist:  Why The Threats Exist US borders are relatively “open” Security has been tightened in recent weeks Creating chaos & fear is a common motive We do have some enemies…and they are serious Easy to transport & deploy biological agents Detection is difficult and often delayed Inexpensive Lethal “I personally believe that the next decade is a decade of Homeland Defense.” John Hamre, Former Deputy Secretary of Defense Slide18:  Some Potential BW Agents Botulinum Toxin Plague Ricin Smallpox Anthrax The Will of the Enemy:  The Will of the Enemy Suicide bombers – an uncommon resolve Attacks are deliberate and calculated Individuals are “revered” by their peers / community Weapons suspected to involve chemicals (crude) “[The Bomber] was shot dead by police as he lay grievously wounded on the street after triggering the explosives hidden under his coat. With what little life he had left, he was crawling towards the second, even bigger bomb…” Source: “Bomber Planned Chemical Attack,” The Sunday Times – 10 Dec 01 (McGrory/Walker) Intelligence Threat:  Intelligence Threat Federal Bureau of Investigation (FBI) tracked seven times the number of WMD-related threats last year than they did in 1996* 1996 – 37 threats 2000 – 257 threats VP Cheney announced creation of Office of National Preparedness in May 01 (division of FEMA) in response to this troubling trend FBI reported ~2100 threats during one week in Oct 01 Data not “to scale”; displayed for effect *Source: AF Medical Operations Center Special Report, 13 Aug 01 Relative Weight to Lethality Comparison:  Relative Weight to Lethality Comparison Anthrax has significant weight: lethality ratio It is readily available and inexpensive It can be deployed easily and effectively It is not “controlled”; making detection / tracking more difficult for authorities Office of Technology Assessment, 1993 Relative Costs of Massive Lethal Deployment:  Relative Costs of Massive Lethal Deployment JAMA 262:644-648, 1989 Cost to kill 1 square kilometer Iraq’s Arsenal:  Iraq’s Arsenal Iraq’s arsenal between 1985 and 1990: 25 biological weapon missile warheads 166 400 lb aerial bombs filled with anthrax, botulinum toxin, or aflatoxin 19,000 liters of botulinum toxin solution 8,500 liters of anthrax solution 2,500 liters of aflatoxin solution 18 major biological weapons sites before the Gulf War Source: Air Force Magazine 2002 ½ TEASPOON ANTHRAX – OCT 01 = >$700M IMPACT Smallpox:  Smallpox Smallpox: Quarantine and vaccination is a must Early detection is key to limiting propagation Smallpox Outbreak— New York City, 1947:  Smallpox Outbreak— New York City, 1947 5 APR 1947: Unrecognized hemorrhagic case from Mexico spreads to 2 others 18 APR: 500,000 vaccinated in 1 day 21 APR: President Truman immunized 26 APR: 12 cases, 2 deaths Commissioner Weinstein: without prompt vaccination “the hospitals would have been filled to overflowing” 3 May: 6,350,000 New York City residents vaccinated Three Forms of Anthrax:  Three Forms of Anthrax Cutaneous From spores entering through breaks in the skin Treatment with antibiotics reduces fatality to less than 1 percent Seen commonly in Texas and the Southwest Gastrointestinal From eating uncooked meat from infected animal Least likely to occur; can be fatal in 25-60% of those exposed if left untreated Very uncommon in our country Inhalational With immunization prior to exposure followed by antibiotics, survival almost 100 percent Even without immunization, if started early, antibiotics bring survival up to 90 percent If symptomatic, even with antibiotics, recovery is rare, with mortality rate exceeding 80 percent Seen mostly in hide tanners and wool sorters industry Anthrax Vaccination:  Anthrax Vaccination Historical background on Anthrax Highly lethal unless treated in first 24 hours after exposure Bacterial spores can lie dormant for decades in soil Antibiotics required in vaccinated and unvaccinated population May be 6th plague of Moses “All Cattle Died” Status of Anthrax Vaccination/Immunization Program (AVIP) Contracted manufacturer has had many challenges (BioPort) US military personnel receive series of 6 shots (as needed) BioPort labs opened by FDA Feb 02 and producing vaccine now Potential attack affecting 10-100k’s; could be saved by vaccine Bottom line: Antibiotics can improve outcomes; vaccination is still important! Additional Concerns:  Additional Concerns Emerging bio agents Ebola Japanese encephalitis Cyclospora and Cryptosporidium E. coli (enterovirulent strains) Prions – “Mad Cow Disease” Multi-resistant microorganisms Other toxins “Flesh-eating” streptococci Algae (“Red Tide”) and mushroom toxins “Dirty Bombs” A Credible Fear?:  “Dirty Bombs” A Credible Fear? Little if any detection devices field tested U.S. businesses and medical facilities lost track of nearly 1,500 pieces equipment with radioactive parts since 1996 Russia and Pakistan are two most likely sources of radioactive material for al Qaeda Discovery of 10 radioactive containers at border crossing in Kasakhstan 40 Russian suitcase nuclear bombs still missing Several other credible sources exist! Source: Washington Post, June 2002 and Lieberman Bill Moscow Theater Terror The Facts:  Moscow Theater Terror The Facts 23 Oct 02, 40-50 gunmen take 700 hostages in Moscow Theater Identified themselves as members of Chechen Army Demand end to war in Chechnya 27 Oct 02, opiate fentanyl gas discharged by Russian Special Forces into theater Result: All gunmen and 118 hostages killed Gas intended to prevent terrorists from triggering explosives strapped to their waists/rigged around the theater Rumored other substances in gas Sources: CNN, Fox News, Late Line News Moscow Theater Terror What If...:  Moscow Theater Terror What If... Condition of hostages Starved of oxygen, dehydrated, hungry, stressed Lack of appropriate medical response On scene doctors not informed of type of gas used Wrong type of antidote administered Effects of large dose of Fentanyl not known Bottom Line: Medical Responders must receive proper training and be privy to all information to be effective! “It’s clear that perhaps with a little more information at least a few more of the hostages may have survived”. Alexander Vershbow, US Abassador to Moscow Source: Late Line News Slide32:  The Afghanistan Connection “Mega” Terrorism:  “Mega” Terrorism 11 Sept 2001 19 killed 3,000 150 dead per attacker $500K investments leveraged $600B fall in stock market CAN YOU TOP THIS? CIA say Al Queda Ready to Use Nukes:  CIA say Al Queda Ready to Use Nukes Al Qaeda’s goal is the use of chemical, biological, radiological or nuclear weapons to cause mass casualties June 3, 2003 Source: Washington Times “Mega Terrorism” CIA say Al Queda Ready to Use Nukes:  CIA say Al Queda Ready to Use Nukes Al Queda terrorists and related groups are set to use: chemical biological nuclear weapons. June 3, 2003 Source: Washington Times CIA say Al Queda Ready to Use Nukes:  CIA say Al Queda Ready to Use Nukes “Terrorist CBRN: Materials and Effects” report quoted as saying – “have a wide variety of potential agents and delivery means to choose from for chemical, biological and radiological or nuclear (CBRN) attacks” June 3, 2003 Source: Washington Times Tracking Down Al Queda:  Tracking Down Al Queda CIA plays vital role -- Counterterrorism Center aka “nerve center” Developed “Worldwide Attack Matrix” Root out Al Queda cells in 80 countries Use of deadly force/ break-ins/ psychological warfare Teamed with Jordan, Pakistan, Egypt, Algeria, Morocco, and Yemen Executive order established “blank check” US News and World Report Inside Al Queda:  US News and World Report Inside Al Queda 2 types of Al Queda Ideology - fuels network of radical Islamists drawing inspiration from bin laden Organization - finite, Mafia-like grouping with own rules/finances/"made" members Only 180 sworn allegiance to bin laden Finances Foundation of charities, mosques, fund-raisers, and businesses Saudi Arabia's wealthiest men: three billionaire bankers, industrialists, and former government minister The Results:  US News and World Report The Results CIA Predator tracked leaders in Kabul Result: Airstrike destroyed building, killing close to 100, including Mohammed Atef, al Qaeda's longtime military commander Video/document find in Kabul Result: Stopped militant attack against U.S. interests in Singapore Computer document find in Sarajevo Result: History of moving weapons, money, and people and organizational chart The Results:  US News and World Report The Results America locked up nearly 1,000 Al Qaeda members at Camp X-Ray Result: Interrogation efforts led to capture of “dirty bomb” suspect Jose Padilla Pakistan raid on safe house Result: CDs, address books, financial records, and satellite phone (led to capture of Khalid Shaikh Mohammed) Slide41:  Recent Al Qaeda Attacks Oct-Nov 02 French tanker bombing (5 Oct) Shooting of U.S. Marines in Kuwait (7 Oct) Bali bombing (12 Oct) Shooting of U.S. diplomat in Jordan (28 Oct) Shooting of U.S. nurses in Lebanon (2 Nov) Shooting of U.S. soldiers by a Kuwaiti policeman (21 Nov) Bombing of hotel in Mombasse, Kenya (28 Nov) Shooting at an Israeli airliner with surface to air missile in Kenya (28 Nov) …And The Trend Continues Jan – June 03:  …And The Trend Continues Jan – June 03 3 American missionaries killed in Yemen 2 Americans ambushed in Kuwait Suicide bombing in Israel (23 dead) 21 killed in Tunisian synagogue 34 killed (8 Americans) in Riyadh, Saudi Arabia 42 killed in Casablanca restaurant - Morocco, May CIA report, NBC The Future Threat Inside Al Queda 4 April 03:  The Future Threat Inside Al Queda 4 April 03 Captured leader Khalid Sheikh Mohammed (KSM) continues to give vital information Mastermind of WTC l and ll, USS Cole Named 12+ Al Queda operatives Insight into terrorists C2 Possible Al Queda targets White House Israeli embassy in Washington Chicago's Sears Tower Bridges in Manhattan, St. Louis and San Francisco Inside Al Queda Tomorrow’s War? 4 April 03:  Inside Al Queda Tomorrow’s War? 4 April 03 U.S. allies in war against Iraq will be future targets “The Spanish will not be safe even in their homes...attacks and bombs against innocent civilians are a legitimate weapon” Muhammad Umar Bakri, Al Queda spokesman Casablanca targeted Spanish assets! May 03 War of civilizations “The world is not divided into east and west or north and south. On one side is Islam, and on the other those who do not believe in the divine laws.” Umar Bakri, leader of Al-Muhajirun Occupation of Iraq has serious implications on war on terror Evidence of Syrian, Jordanian, and Egyptian fighters in Iraq Inside Al Queda “Only A Call Away” 4 April 03:  Inside Al Queda “Only A Call Away” 4 April 03 Established C2 network activates cell with phone call Jewish synagogue on the Tunisian island of Djerba Suicide bomber killed 21 French/German tourists Simple call from Khalid Shaikh Mohammed to Nizar Nawar The Hunt Continues! :  The Hunt Continues! Latest terror suspect -- Adnan Gulshair El Shukrijumah "Wherever he is in the world, we think he might be a key al Qaeda operative targeting U.S. interests.” U.S. Official Possibly the next Mohamed Atta, lead 9/11 hijacker Also known as “Jaffar the Pilot” A New Form of Warfare? Iraqi Suicide Bombers :  Mar 30, 2003 -- Iraqi non-commissioned officer driving taxi kills 4 U.S. troops using suicide bomb Iraq awarded bomber and his family: Paid 100 million dinars ($34,000 U.S) to family Posthumously promoted to Colonel and awarded two medals Numerous volunteers Islamic Jihad volunteers have gone to Baghdad for similar bombing missions Will affect Homeland Defense mission... A New Form of Warfare? Iraqi Suicide Bombers Iraqi Suicide Bombers Headed to the U.S. :  "We will use any means to kill our enemy in our land, and we will follow the enemy into its land." Taha Yassin Ramadan Iraqi Vice President, March 2003 Iraqi Suicide Bombers Headed to the U.S. Is This the Phone Call? Slide49:  San Antonio Express~News 30 March 2003 Slide50:  Iraq Posted on Wed, Apr. 02, 2003 Militants leave signs of chemical arms The Kurdish Islamic militant group attacked in northern Iraq last weekend also is accused of links to al-Qaeda and Hussein. By Jonathan S. Landay Knight Ridder News Service HALABJA, Iraq - U.S. specialists have found evidence that a Kurdish Islamic militant group linked by the Bush administration to al-Qaeda was concocting chemical weapons in the mountains of northeast Iraq, a U.S. military commander said yesterday. The special-forces soldiers also found recipes for three forms of chlorine gas and for ricin, a deadly toxin derived from castor beans, American intelligence officials said, speaking on condition of anonymity. U.S. aircraft, 100 American special-forces troops and more than 8,000 Kurdish fighters on Friday swept the Ansar al-Islam (Partisans of Islam) militants out of the sliver of territory they had held for two years in northern Iraq's autonomous enclave. The Philadelphia Inquirer Slide51:  Washington Times April 7, 2003 Pg.1 Terrorists Said to Seek Entry To U.S. Via Mexico By Bill Gertz, The Washington Times A group of al Qaeda terrorists is attempting to infiltrate the United States from Mexico to conduct attacks in the country, The Washington Times has learned. At least 14 al Qaeda members are said to be in Mexico, sand officials who spoke on the condition of anonymity. The al Qaeda members are working with Mexican organized crime groups, such as drug-trafficking organizations, in an attempt to enter the United States covertly, the officials said. TEXAS Slide52:  Assistant US Attorney General Confirms Safe Houses discovered in Mexico City Al Queda taught spanish and how to cross Mexican/American Border Source: Joe Porto, Anti-terrorism Task Force, 8 April 03 Al-Qaeda to Raid U.S. Source: Dallas Morning News, May 9, 2003:  Al-Qaeda to Raid U.S. Source: Dallas Morning News, May 9, 2003 A London based Arabic weekly, Al Majalla, is reporting an interview with a purported new spokesman for al-Qaeda. Thabet bin Qais says the terror network has completely reorganized. He says old operatives have been replaced by new ones who are planning an attack against the United States on the scale of Sept. 11. “The Americans only have predictions and old intelligence left. It will take them a long time to understand the new form of al-Qaeda,” says Mr. bin Qais Western officials remain convinced that al-Qaeda poses a threat despite the arrests of key figures and the loss of its base in Afghanistan. “…(al-Qaeda) is a severe threat to this nation,” Pasquale D’Amuro, FBI Counterterrorism chief. The “Foreign” Connection :  The “Foreign” Connection 155 suicide bombings (carried out by 250 people) in Israel since 1993 “Foreign” Connection Palestinian terrorist groups recruited foreigners to by-pass Israeli security Countries include: Britain, Pakistan, Peru, and Germany Al-Queda serving as recent recruitment base/training Bottom Line: Foreign recruits will play a vital role in the success of terrorism in the future! Source: Telaviv Notes 20 May 2003:  20 May 2003 Israeli Attacks 5 Suicide bombers in one day! Border closed! Unknown number dead! Terrorism is Alive!! “Al-Qaeda war not over” FBI chief says:  “Al-Qaeda war not over” FBI chief says Not won by any stretch of the imagination Al-Qaeda still seeks to attack us Has capacity to do it Will we be attacked by terrorists in the future? YES!!! Source: USA Today - Thursday, May 1, 2003 Robert Mueller, FBI Director Al Qaeda Attack Highly Probable, U.S. Says:  Al Qaeda Attack Highly Probable, U.S. Says There is “high probability” that Al Qaeda will attempt an attack with a biological,chemical, radioactive or nuclear weapon in the next two years, the U.S. said in a report to a U.N. Security Council committee. June 10, 2003 Source: Los Angeles Times Slide58:  All Threat Approach The Norwalk Virus:  The Norwalk Virus First appeared in Norwalk, OH in early ’70’s School outbreak of vomiting and diarrhea Only affects humans Source: contaminated food/water Causes viral gastroenteritis; symptoms last 24-48 hrs Occurs in institutional/group settings Schools, nursing homes, hospitals, cruises, dorms The Norwalk Virus:  The Norwalk Virus First appeared in Norwalk, OH in early ’70’s School outbreak of vomiting and diarrhea Only affects humans Source: contaminated food/water Causes viral gastroenteritis; symptoms last 24-48 hrs Occurs in institutional/group settings Schools, nursing homes, hospitals, cruises, dorms Recent Norwalk Outbreaks Canadian Hospitals:  Recent Norwalk Outbreaks Canadian Hospitals Toronto, December 7, 2002 50 health facilities 34 established cases 3 emergency rooms and 1 cardiac unit closed Ontario, December 20, 2002 St. Mary’s Hospital 32 staff members and 24 patients affected 5th floor closed for several days Source: Miami Herald, CNA.com Financial and Public Health Disaster!:  Financial and Public Health Disaster! Results: Significant revenue losses No contingency plans in place Dramatic reduction in available hospital beds Norwalk virus could have been deadly chemical/biological attack What have we learned? A viable option must be explored! Rhode Island Nightclub Fire The Facts :  Rhode Island Nightclub Fire The Facts 20 Feb 03, West Warwick, RI “The Station” nightclub caught fire with 250-300 people inside Results: 99 dead 150+ injured Deadliest U.S. nightclub fire since 1977 Rhode Island Nightclub Fire Medical Response :  Rhode Island Nightclub Fire Medical Response Burn patients sent to 11 regional hospitals including Rhode Island Hospital, RI Kent Co. Memorial Hospital, RI Mass. General Hospital, MA Response teams delivered on scene medical care EMT Fire Off-duty doctors/nurses Rhode Island Nightclub Fire Impacts/Costs :  Rhode Island Nightclub Fire Impacts/Costs Impacts Validated theory of “Surge Capacity” Local hospitals overwhelmed Patients sent to other states for care Tested response plans to possible terrorists attacks Costs Prior to disaster, R.I. hospitals had already lost $22M Underinsured/no health insurance Delivery of long-term care necessary Source: Boston Globe, The Phoenix Rhode Island Nightclub Fire Lessons Learned :  Rhode Island Nightclub Fire Lessons Learned Patient surge must be addressed! Can happen in peace time Terrorist attack is not only cause Use of all available resources is a must! Hospital beds Response personnel Bottom Line: We must prepare for all possible disasters. We should organize, train, and equip to meet the surge dilemma in any crisis! Tracking a Killer :  Tracking a Killer Severe Acute Respiratory Syndrome (SARS) Source: New York Times, Apr 2003 SARS The Facts :  SARS The Facts Symptoms Fever Cough Aches/pains Shortness of breath Fatigue In last 3 months... Spread from China to over 25 countries/regions Affected over 3,457 people thus far (36 in US) Killed over 182 (0 in US) Actions taken to prevent spread... Mandated quarantines Restricted air travel SARS Quarantine Measures :  SARS Quarantine Measures China Everyone exhibiting symptoms (including foreigners) must be hospitalized Students examined daily Singapore Infected restricted to home with web cams watching movement Taiwan All China travelers and visitors to hospitals must have temperature taken $72 bounty for reporting suspected case Canada Newspaper ads requesting suspect cases to stay home USA No measures taken U.S. Possible Future Quarantine Measures :  U.S. Possible Future Quarantine Measures Federal Quarantine Act passed in 1878 Used to stop immigrant at a frontier or citizen at state border List now includes SARS and other hemorrhagic fevers Drawbacks Infected hide for fear Economic disaster Nation-wide irrational fears Solution! Treat suspected cases with respect and continue to educate population on benefits to enter quarantine voluntarily Slide71:  The Threat Is Real Texas A&M University System Integrative Center for Homeland Security Slide72:  The Will The Means The Emotion Of course we will see this in our country Slide73:  WAR IN IRAQ CONTINUES WHAT WILL HAPPEN HERE? Slide74:  Threat Brief Demands Action We Must:  We Must Be aware of the threat Educate and Train for the threat Organize Medical Response Not accept status quo Slide76:  Air Force Medical Service Tailored Response Texas A&M University System Integrative Center for Homeland Security Slide77:  This new approach to medical thinking led us to the lowest DOW rate in the history of warfare in Enduring Freedom action in Afghanistan KIA 18 DOW 1/107 USAF Expeditionary Medical Support:  USAF Expeditionary Medical Support 24 EMEDS facilities in 12 countries. 214 beds ranging from small clinics to theater hospitals, supporting 65,000 personnel. Deployed chemically-protected EMEDS. Five CP-EMEDS were set up in high threat areas to provide a shirtsleeve working environment in the event of attack with chemical or biological weapons. Deployed 1,822 medics from 58 different AFSCs. 1,370 short-tons of medical equipment (valued at $108M). Assets were deployed in less than 60 days. Handled 640 combat casualties. Source: AFCS U.S. Air Force Aim Points, 29 April 03 RESULTS USAF Expeditionary Medical Support:  RESULTS USAF Expeditionary Medical Support Achieved lowest disease & non-battle injury rate in military history. Almost 20% lower than Operation Desert Shield/Storm. Aeromedical Evacuation operations were the most aggressive evacuation efforts since Vietnam. AE moved more than 2,000 patients (including 640 battle casualties) on 200 missions in first 35 days of OIF without using dedicated AE aircraft. Source: AFCS U.S. Air Force Aim Points, 29 April 03 RESULTS USAF Expeditionary Medical Support:  RESULTS USAF Expeditionary Medical Support Senior Leaders are saying… The medical support for this operation has been absolutely phenomenal – true professionals doing great things with little recognition. I love EMEDS. They pack so much capability in such a tiny footprint, I didn’t have to choose between bombs and bandages. (CFACC, Apr 03) Source: AFCS U.S. Air Force Aim Points, 29 April 03 Modular Units of Capability: Providing What’s needed, When needed:  Modular Units of Capability: Providing What’s needed, When needed The Crisis Defines the Response Optimizes Resources Maximizes Options for Commanders CRITICAL CARE Surgical TEAMS SPEAR PAM Teams Staging/Crews Comm Expanded Beds +10 and +25 Staging Aug +20 Bed Slide82:  How to Handle the “Surge” Theater Casualty Movement “STRATEGY” 1991:  Theater Casualty Movement “STRATEGY” 1991 BAS CCP BAS Ship BAS Mother Hosp USA/AF Rotary Wing Rotary Wing Fixed Wing AE AF MFST CCAT FST MFST CCAT FST Theater Casualty Movement “TACTIC” 5 Dec 01:  Theater Casualty Movement “TACTIC” 5 Dec 01 BAS Ship CCP Ship BAS Mother Hosp USA/AF Rotary Wing Rotary Wing Fixed Wing AE AF Navy Resuscitative MFST CCAT FST MFST CCAT FST FST CCAT I. II. III. IV. FSB MFST CCAT Theater Casualty Movement “STRATEGY” 1991 :  Theater Casualty Movement “STRATEGY” 1991 FSB FSB Mother Hosp USA/AF Rotary/Fixed Wing Rotary/Fixed Wing Fixed Wing AE (Strat) AF FST CCAT FSB MFST MFST CCAT MFST CCAT FST FST Theater Casualty Movement “STRATEGY” :  Theater Casualty Movement “STRATEGY” Combat Support Hospital Combined Hospital Mother Hosp USA/AF Mother Hosp USA/AF FSB FSB MFST CCAT MFST CCAT FST FST MFST CCAT MFST CCAT FST FST Modular Units of Capability: Providing What’s needed, When needed:  Modular Units of Capability: Providing What’s needed, When needed The Crisis Defines the Response Optimizes Resources Maximizes Options for Commanders CRITICAL CARE Surgical TEAMS SPEAR PAM Teams Staging/Crews Comm Expanded Beds +10 and +25 Staging Aug +20 Bed IF STATES HAD THIS CAPABILITY Must have tools in tool box Slide88:  Disaster Occurs College Station Scenario Slide89:  Dallas Mother Hospital Houston Mother Hospital San Antonio Mother Hospital Austin Mother Hospital College Station Scenario Israeli Defense Force WMD Posture - Facility Access:  Israeli Defense Force WMD Posture - Facility Access U Family Waiting Area Intubation Station Slide91:  A Viable Solution Texas A&M University System Integrative Center for Homeland Security Slide92:  MILITARY WAR FIGHTERS Simulation used extensively “Easier” to go to real war than to do the exercise and simulation GOAL CIVILIAN SECURITY Use simulator and VR so every scenario has been played, practiced, and “real world” is easier SIMULATION AND VIRTUAL REALITY Slide93:  SIMULATION AND VIRTUAL REALITY NEW WARFIGHTERS Mayors City Officials Medical personnel Police Fire GOAL CIVILIAN SECURITY Use simulator and VR so every scenario has been played, practiced, and “real world” is easier Disaster Plan Training:  Disaster Plan Training Prepare regional units for any eventuality Chemical, biological, radioactive, natural, etc. Academic Health Center Led! AHC assumes responsibility for education and training the regions with a combination of onsite and on-campus training Courses to be established Assumes response role Disaster Plan Training:  Disaster Plan Training Establish close ties to military courses already taught and federal guidance New curriculum will need to be established Basic credential in Disaster Life Support will be developed Slide96:  Preparation for the Nation Making the Pieces Fit Slide97:  DLS First Receivers First Preparers First Responders Preparation for the Nation Making the Pieces Fit Trauma & Critical Care Pararescue Course Trauma & Disaster Course Mental Health Aspects Course Trauma & Critical Care Pararescue Course Mental Health Aspects Course Trauma & Disaster Course Public Health Course Eye Trauma Course Critical Care Transport Public Health Course Bio-Terrorism Course Mental Health Aspects Course Trauma & Dusaster Course Critical Infectious Diseases Course Bio-Terrorism Course Bio-Terrorism Course Public Health Course Slide98:  Leadership Course in Regional Disaster Response and Trauma System Management Leadership Course in Disaster Public Health and Public Health System Management Preparation, Response and Consequence Management in Disaster Critical Infectious Disease Course: Improving Outcomes for Patients and Populations Forensic Science and International Law for Public Health Care Providers Trauma and Critical Care Para Rescue Course Executive Healthcare Resource Management HIV/AIDS Planning/Policy Development Regional Health Resource Management International Health Resources Management Program (Assessment) Phase I International Health Resources Management Program (Program Design) Phase II International Health Resources Management Program (Strategic Action Development) Phase III International Health Resources Management Program (Implementation) Phase IV International Health Resources Management Program (Outcome Review) Phase V (Optional) First Preparers First Responders Preparation, Response and Consequence Management in Disaster Aeromedical Evacuation and Critical Care Transport Course Trauma and Critical Care Para Rescue Course Regional Health Resource Management International Health Resources Management Program (Assessment) Phase I International Health Resources Management Program (Program Design) Phase II International Health Resources Management Program (Strategic Action Development) Phase III International Health Resources Management Program (Implementation) Phase IV International Health Resources Management Program (Outcome Review) Phase V (Optional) First Receivers Leadership Course in Regional Disaster Response and Trauma System Management Preparation, Response and Consequence Management in Disaster Eye Trauma Management Course Hospital Focused Response to Biological Weapons and Toxins Course Critical Infectious Disease Course: Improving Outcomes for Patients and Populations Aeromedical Evacuation and Critical Care Transport Course Trauma and Critical Care Para Rescue Course HIV/AIDS Planning/Policy Development Regional Health Resource Management International Health Resources Management Program (Assessment) Phase I International Health Resources Management Program (Program Design) Phase II International Health Resources Management Program (Strategic Action Development) Phase III International Health Resources Management Program (Implementation) Phase IV International Health Resources Management Program (Outcome Review) Phase V (Optional) 17 Air Force Courses Slide99:  EMS: WMD Planning & Operations WMD/Terrorism Incident Exercise Program Mayoral Institute for WMD Preparedness Incident Management/ Unified Command (IM/UC) Threat & Risk Assessment (T&RA) PW: Planning for & Responding to WMD Incidents Senior Officials Workshop (SOW) for WMD Integrated Health & Medical WMD Training Program USAF Emergency Responder/Installation WMD Training & Exercise Program NERRTC WMD/Terrorism Curriculum Organization of State Response:  Organization of State Response Academic Health Ctrs Organize - Governor (Governor/Mayor is CINC) Train Equip Governors/Mayors To use as necessary Equipment Requirements:  Equipment Requirements “COVER SURGE” No one can afford to have dedicated equipment that sits and waits to be used in a disaster! Any equipment procured must have multiple taskings and be well utilized AHC Equipment Concept:  AHC Equipment Concept Currently 8 Academic Health Centers in Texas Each AHC would purchase 4 units Result: 32 units total located at 8 Texas AHCs Slide103:  Responding to a Disaster “4 Vans Per AHC” Denotes AHC Denotes 6 hour drive time/200 Miles Slide104:  Responding to a Disaster Denotes AHC Denotes 6 hour drive time/200 Miles 6 Hr Response 12 Hr Response 18 Hr Response Slide105:  Responding to a Disaster Denotes AHC Denotes 6 hour drive time/200 Miles 6 Hr Response 12 Hr Response 18 Hr Response Disaster Slide106:  Responding to a Disaster Denotes AHC Denotes 6 hour drive time/200 Miles 6 Hr Response 12 Hr Response 18 Hr Response Disaster Slide107:  Responding to a Disaster Denotes AHC Denotes 6 hour drive time/200 Miles 6 Hr Response 12 Hr Response 18 Hr Response Disaster Slide108:  Responding to a Disaster Denotes AHC Denotes 6 hour drive time/200 Miles 6 Hr Response 12 Hr Response 18 Hr Response Disaster Building Block Approach for Medical Response:  UNITS OF CAPABILITY TIME Building Block Approach for Medical Response 6 hr 12 hr 18 hr 8 Slide111:  -COG Regional Response Network- Local assessment and planning r i o n G u a d a l u p e C a l d w e l l C h a m b e r s D e l t a S a n P a t r i c i o M a d i s o n W a s h i n g t o n S a n J a c i n t o O r a n g e C a l h o u n R a i n s G r e g g M o r r i s S a n A u g u s t i n e F r a n k l i n C a m p G a l v e s t o n S o m e r v e l l A r a n s a s R o c k w a l l Slide112:  Responding to a Disaster Denotes AHC Denotes 6 hour drive time/200 Miles Slide113:  Let’s Merge The Circles Slide114:  r i o n G u a d a l u p e C a l d w e l l C h a m b e r s D e l t a S a n P a t r i c i o M a d i s o n W a s h i n g t o n S a n J a c i n t o O r a n g e C a l h o u n R a i n s G r e g g M o r r i s S a n A u g u s t i n e F r a n k l i n C a m p G a l v e s t o n S o m e r v e l l A r a n s a s R o c k w a l l A SAFER AND STRONGER TEXAS Academic Health Centers:  Academic Health Centers Assign Academic Health Centers to each COG Academic Health Centers:  Academic Health Centers Responsible for Medical Plan Terrorism National Disasters Simulation Immunization Rate Access to Care Quality of Training Gap Analysis of Threats with Solutions Proposal:  Proposal Academic Health Centers sign up for COGs to show support Even square miles and population Accountability is key The Future:  "The future is not some place we are going, but one we are creating. The paths are not to be found, but made, and the activity of making them changes both the maker and the destination." Author Unknown The Future Slide119:  Questions? Dr Paul K. Carlton, Jr. Lt Gen, USAF, Ret Director, Integrative Center for Homeland Security Texas A&M University Health Science Center

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