Disaster Response

The role of the military health system in providing medical staff, equipment, and scientific expertise in the event of natural disasters or disease outbreaks

By Scott R. Gourley

WHILE SOME STILL MIGHT DEBATE THE EXISTENCE of cause and effect relationships, by most quantifiable standards, natural disasters – and the subsequent need for government disaster response efforts – are on the rise. Along with the better-known natural disasters like hurricanes, fires, or tornadoes, additional response demands may stem from the possibilities of either natural or extremist-directed pandemic crises or other attacks. Reflective of its available personnel resources, unique equipment inventories, and dedicated training programs, the Department of Defense (DOD) plays and will continue to play a critical supporting role in those response and recovery efforts.

DISASTER RESPONSE

As evidence of the rising needs for military disaster response, one recent report prepared by the U.S. Government Accountability Office (GAO) noted that fall 2017 included three of the top five costliest hurricanes on record, pointing to four sequential disasters – hurricanes Harvey, Irma, and Maria as well as massive California wildfires – with creating “an unprecedented demand for federal disaster response and recovery resources.”

While the primary mission of the DOD is to defend the nation, through its Defense Support of Civil Authorities (DSCA) responsibilities, the department is frequently asked to play a prominent role supporting civil authorities during disasters and declared emergencies.

According to the GAO, the DOD has two primary avenues of support: when requested by a federal agency – such as the Federal Emergency Management Agency (FEMA), Department of Health and Human Services, Department of Homeland Security, Department of Agriculture [Forest Service], or U.S. Agency for International Development (USAID) – and approved by the secretary of defense; and when the U.S. Army Corps of Engineers serves as the DOD coordinating and primary federal agency for public works and engineering-related response efforts. Separate from the DOD efforts, National Guard units can be brought on State Active Duty to support their own governors or other governors through state-to-state emergency management assistance agreements.

FROM HURRICANES TO WILDFIRES

September 2017’s Hurricane Maria (Sept. 16-Oct. 2/ landfall on Puerto Rico Sept. 20], a Category 5 hurricane that devastated Dominica, the U.S. Virgin Islands, and Puerto Rico, provides a number of excellent representative examples that reflect the broad scope and capabilities of military disaster response capabilities.

The Hurricane Maria military response effort was coordinated in large part by U.S. Army North (ARNORTH) under Lt. Gen. Jeffrey S. Buchanan, then U.S. Northern Command’s (USNORTHCOM’s) Joint Force Land Component Command commander.

One small glimpse of the scope of that response effort was provided by ARNORTH public affairs representatives in a late October 2017 summary: Noting the command team’s initial arrival in Puerto Rico on Sept. 28, they offered that activeduty and Reserve forces peaked in mid-October at more than 15,000.

Just over one week later, there were still more than 13,000 personnel on the ground and a total of 59 helicopters (down from 72 at the height). On the medical side, DOD support included an Army combat support hospital, an Air Force Expeditionary Medical Support System (EMEDS), and the hospital ship USNS (U.S. Naval Ship) Comfort. At the height of the response, Comfort was joined by three U.S. Navy vessels: USS Wasp; USS Oak Hill; and USS Kearsarge. Although Wasp and Oak Hill departed in mid-October as the support effort transitioned from response to recovery, the military effort retained the Kearsarge and its aircraft, along with some Seabees and a Marine Expeditionary Unit (initially the 26th MEU followed by 24th MEU).

U.S. Navy sailors and Coast Guard personnel transport a patient in response to Hurricane Dorian in the Bahamas, Sept. 6, 2019. In support of foreign disaster relief efforts in the Bahamas, the secretary of defense authorized U.S. Northern Command to provide transportation logistics for the movement of USAID and third-party humanitarian commodities and personnel throughout the region and to conduct assessments of critical transportation nodes to facilitate the delivery of humanitarian assistance and maximize the flow of disaster relief into the area.

Significantly, many of the assets noted had been “on the ground” since Hurricane Irma (Aug. 30-Sept. 13/eye passed just north of Puerto Rico on Sept. 6) and stayed to respond to the devastation of Maria.

Moreover, at roughly the same time that this critical support was being delivered across those areas affected by the hurricanes, DOD personnel were also responding to the 2017 California wildfires. Much like the damage caused by hurricanes, the California fires that year included five of the 20 most destructive wildland/ urban interface fires in the state’s history.

According to the recent GAO report, DOD officials noted that, while National Guard personnel in State Active Duty status primarily provided wildfire fighting capabilities, additional DOD commodity support and access to military bases ranged from the Defense Logistics Agency fulfilling 3,500 U.S. Forest Service orders for emergency equipment and supplies, including 5 million AA batteries, to access provided at both Travis and Beale Air Force Bases to stage ambulances and their crews.

2019 HURRICANE DORIAN

As of this writing, the most recent example of a growing DOD disaster response can be found in the immediate aftermath of Hurricane Dorian. Following initial landfall over the Bahamas’ Abaco and Grand Bahama islands from Sept. 1-2 with sustained wind speeds of approximately 180 miles per hour, the deadly system became nearly stationary.

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Based in part on satellite-based data and resulting estimates, the National Aeronautics and Space Administration (NASA) reported that as of the early hours of Sept. 3, Hurricane Dorian had been “stationary over the island of Grand Bahama for 18 hours, most of the time as a Category 5 hurricane,” with storm-total rain accumulation over parts of Grand Bahama and Abaco islands having already exceeded 24 inches.

Amazingly, it continued to get worse. By the next day, Sept. 4, NASA researchers estimated that, in addition to the massive direct storm damage, rain accumulation had exceeded 36 inches in an area that included parts of Grand Bahama Island and Abaco Island.

That same day, USAID’s Office of U.S. Foreign Disaster Assistance (OFDA) issued its initial response report, stating, “Hurricane Dorian severely damages homes and infrastructure and causes extensive flooding in Abaco and Grand Bahama,” and adding that U.S. Chargé d’Affaires Stephanie Bowers had declared a disaster in the Bahamas on Sept. 2, prompting USAID to activate a Disaster Assistance Response Team (DART) to lead the U.S. government (USG) response, as well as a Washington, D.C.-based Response Management Team (RMT) to support the DART. The DART and RMT are responding to the situation in coordination with other USG counterparts, Government of Bahamas (GoB) representatives, and humanitarian partners.

While not officially part of the DOD, an early glimpse of potential capabilities that could be applied came from the U.S. Coast Guard (USCG), which provided immediate response efforts by conducting helicopter search and rescue activities. As of Sept. 4, USCG reported the rescue of 39 individuals in Abaco and three individuals in Grand Bahama from flood-inundated areas. Along with coordinating aerial search and rescue operations, the service began to ship 250 rolls of plastic sheeting – sufficient to support shelter requirements for approximately 12,500 people – to the Bahamas aboard five Coast Guard cutters that would arrive on Sept. 5.

In terms of direct U.S. military support, the Sept. 4 briefing added that the DOD had already “made available up to $5 million in Overseas Humanitarian, Disaster, and Civic Aid funds to support USAID/OFDA-led response operations in the Bahamas, including through military air transport for humanitarian personnel and cargo.”

Three days later, on Sept. 7, 2019, the USAID/OFDA daily briefing explained, “In addition to working closely with the USCG, USAID is working with the U.S. Department of Defense (DoD) and has requested the unique capabilities of [USNORTHCOM] to provide airlift and logistics support for USAID-led humanitarian response activities. U.S. military helicopters began transporting members of the DART and critical response equipment to Abaco on September 7.”

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[Footnote: In 2018, the commander of USNORTHCOM formally received the expanded role as the DOD Synchronizer for DSCA.]

USAID’s Sept. 8 update noted the successful application of the DOD helicopter transport capabilities, stating: “With the support of the U.S. Department of Defense (DoD), members of USAID/ OFDA’s Disaster Assistance Response Team (DART), along with other relief actors, conducted aerial and on-the-ground assessments of storm-affected areas of Abaco and nearby cays on September 7 and 8. The assessments found that predominant humanitarian needs include safe drinking water, shelter support, and measures to restore power and enable access to hard-to-reach communities.”

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Along with transport, Sept. 8 seemed to reflect a transition of sorts to think about the growing medical needs being identified. Following his own visit to some of the devastated areas, U.S. Sen. Marco Rubio, R-Fla., sent a letter to USAID Administrator Mark Green, urging him to request that the hospital ship USNS Comfort be repositioned to the Bahamas as soon as possible.

A view of the U.S. Navy Hospital Ship USNS Comfort (T-AH 20) as it gets underway from Naval Station Norfolk, June 14, 2019. Comfort got underway to begin its deployment to South America, Central America, and the Caribbean in support of humanitarian and partner-building efforts.

Rubio shared observations from his recent trip, stating: “There remains an immediate need for medical attention and communications, however, accessibility and resources are limited, and a lack of electricity continues to plague recovery efforts. Vertical-lift of those who are injured and require treatment by trained professionals is the only solution until debris is cleared and on-shore resources can be stood up. The USNS Comfort, and its crew of trained medical staff, flight deck and ability to desalinate water, would be ideal in helping the Bahamian people. While it is currently assigned to U.S. Southern Command’s Area of Responsibility, the USNS Comfort, if requested, could be reassigned to the Bahamas and provide short-term medical treatment as runways and ports come back online. Additionally, the Bataan Amphibious [Ready] Group, already in the area, has ships that are also capable of providing air lift and medical support.” Meanwhile, DOD support to ongoing operations continued to grow. In its Sept. 10 briefing, USAID observed that DOD was “operating daily flights to transport humanitarian actors and relief commodities between Nassau and storm-impacted islands,” adding, “As of September 9, DoD ships and more than 20 helicopters had transported approximately 72 metric tons of supplies and 180 response personnel.

“DoD continues to provide extensive logistic support for humanitarian operations, with [USNORTHCOM] operating daily flights for NGO [nongovernmental organization], UN [United Nations], and DART staff, as well as humanitarian supplies, from Nassau to affected areas of Abaco and Grand Bahama,” it elaborated. “On September 10, [USNORTHCOM] helicopters supported the movement of International Medical Corps emergency medical team staff and medical supplies, as well as a joint assessment team – comprising staff from UN Office for the Coordination of Humanitarian Affairs (OCHA) and UK Department for International Development (DFID) – to Freeport. On the same day, [USNORTHCOM] facilitated a health assessment by staff from the GoB and the Pan American Health Organization in northern Abaco’s Coopers Town.”

“PROACTIVE RESPONSE”

Just as the DOD has to attempt to prepare for and position itself to face the challenges of unknown battlefields, military resources would also be applied in response to either natural or man-made crises ranging from globally spread pandemics to domestic chemical, biological, radiological, nuclear, or high-yield explosive (CBRNE) incidents to the growing threats of cyber-intrusion into our domestic security.

In the case of CBRNE preparations, the bulk of the effort falls within USNORTHCOM’s Joint Task Force Civil Support (JTF-CS). Consisting of active, Guard, and Reserve military members drawn from all service branches, as well as civilian personnel, the task force is commanded by a federalized National Guard general officer and has the responsibility to plan and integrate DOD support to the designated Primary Agency for domestic CBRNE consequence management operations.

As noted in USNORTHCOM descriptions, “When approved by the secretary of defense and directed by the commander of USNORTHCOM, JTF-CS deploys to the incident site and executes timely and effective command and control of designated DOD forces, providing support to civil authorities to save lives, prevent injury, and provide temporary critical life support.

“The mission of supporting civil authorities is not a new one for DOD,” it adds. “The U.S. military has a long history of providing assistance to civil authorities during emergencies. U.S. military forces have assisted federal, state, and local agencies during natural disasters such as hurricanes, floods, and earthquakes. The role of JTF-CS in providing assistance to the Primary Agency after a CBRNE incident is in keeping with this long and proud tradition.”

SIDEBAR:

FLOATING MEDICAL SUPPORT

In his Sept. 8, 2019 letter to USAID Administrator Mark Green, U.S. Sen. Marco Rubio, R-Fla., urged Green to request that the DOD reposition the hospital ship USNS Comfort to support hurricane relief efforts in the Bahamas.

But the fact is that the East Coast-homeported Comfort, along with her West Coast-homeported sister ship, USNS Mercy, do far more than disaster response. The two ships represent key DOD capabilities for delivering medical assistance, humanitarian assistance, subject matter exchanges, and partnership building.

A view of the U.S. Navy Hospital Ship USNS Comfort (T-AH 20) as it gets underway from Naval Station Norfolk, June 14, 2019. Comfort got underway to begin its deployment to South America, Central America, and the Caribbean in support of humanitarian and partner-building efforts.

In fact, mid-September 2019 found Comfort completing its seventh medical mission in Central America, South America, and the Caribbean, departing Grenada on Sept. 21. During the port call, the Comfort team included military and civilian personnel from the United States and partner nations, including Argentina, Brazil, Canada, Costa Rica, Chile, the Dominican Republic, Mexico, and Peru, as well as several non-governmental organizations.

During Comfort’s six-day medical mission in St. George’s, Grenada, 800 medical professionals from those partner nations and organizations joined U.S. Navy, U.S. Air Force, U.S. Army, and U.S. Public Health Service representatives to provide care for 5,060 patients at two separate shore-based medical sites as well as performing 96 surgeries aboard the ship.