Medical Planning Considerations in Consequence Management

By Marghella, Pietro D. | Frontiers of Health Services Management, Fall 2002 | Go to article overview

Medical Planning Considerations in Consequence Management


Marghella, Pietro D., Frontiers of Health Services Management


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SUMMARY * THE JOB OF military medical planners is to prepare for the unthinkable and then establish a response that allows the civilian system of healthcare to continue to function. This article provides information and perspective that civilian healthcare providers can gain from their counterparts in the military.

Two issues need to be considered simultaneously: preparedness, in the form of force health protection, and response, applying consequence management. The critical need for ongoing planning is clear. However, three things remain true despite our best planning efforts: individual behavior drives the response to mass casualty events, flexibility is the key to the success of any plan, and interagency coordination and trust is vital for an effective response.

MAKE NO MISTAKE about it: the events of 9/11 have ushered in the "era of the asymmetrical threat." The United States has been forcibly awakened to the nightmarish reality that chemical, biological, radiological, nuclear, or high explosive (CBRNE) weapons of mass destruction can and will be used against us in asymmetrical, or unconventional attacks, often with horrendous effects. Gone are the days of linear warfare, in which one force engages another and dear demarcation exists between combatants. Whether a civilian airliner crashes into one of our skyscrapers or biological agents are disseminated among an unsuspecting population, we must face the fact that the unthinkable is now reality. Since the September ii attacks, preparing ourselves for the unknown and expecting the unexpected has altered the dynamics of our daily lives, and unconventional thinking may be our only recourse for coming to grips with these awful threats.

What is involved in thinking outside the box to help us understand and respond to these new (and now omnipresent) threats? First, we must recognize that the future is now. We no longer have the luxury of time to expend intellectual capital on the overthe-horizon "what ifs." Part of our urgency to achieve collective preparedness has to be the immediate recognition of three things: (i) what may have previously bordered on the absurd in terms of threats to this nation are now possible; (2) another attack could occur tomorrow, or even a few minutes from now, and this time it may be much worse than the 9/11 attacks; and (3) at the present, we are not even close to being collectively prepared to effectively counter or mitigate the effects of another such "event."

Medical professionals may look at those three points and surmise that for collective protection, money is to be made by banking on the familiar concepts of "prevention" and "treatment." Trained medical personnel know that the best results can be achieved by making equal investments in both protecting potentially targeted populations before an attack and ensuring that adequate response mechanisms are in place to support them after an attack has occurred. In the face of the modern asymmetrical threat, the U.S. military has come to call these measures "force health protection" and "consequence management."

For the purposes of this article, I will take a closer look at some Department of Defense (DOD) initiatives that focus on preparedness for attacks, consequence management, the role of the medical (or in the military vernacular, the "health service support") community, and the importance of medical planning to ensure we maximize our consequence management capabilities.

CONSEQUENCE MANAGEMENT DEFINED

Before considering recommendations to help establish an understanding of the threat posed by weapons of mass destruction (WMD), we must first define the term "consequence management" and the stated focus that can be found in that definition. Consequence management is defined as measures to protect public health and safety, restore essential government services, and provide emergency relief to governments, businesses,

and individuals affected by the consequences of [WMD] agents. …

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