, chief of staff for Force Health Protection and Readiness, weighs in with lessons learned from the military's response to these storms.
Hurricanes Ike and Gustav:
Real-Life Application of the Joint Force Health Protection CONOPS
The winds of hurricanes Gustav and Ike have died down but work in the aftermath goes on. Part of that work is assessing what assistance was provided by the Military Health System (MHS), what went right and wrong with that assistance, and how we can do better in the future. One thing is for sure, in addition to all the other missions of the MHS, hurricanes will keep coming and we will keep being requested to assist.
 
What does hurricane response have to do with the Joint Force Health Protection concept of operations (JFHP CONOPS)? Plenty! Although I’ve only recently studied the JFHP CONOPS, I’ll bet very few of you have—largely due to the fact that it was only recently drafted and published. As a very brief primer, JFHP is organized into six functional focus areas:
 
1. Human performance enhancement
2. Health surveillance, intelligence, and preventive medicine
3. Command and control
4. Patient movement
5. Casualty management
6. Medical logistics and infrastructure support
 
Simply put, the JFHP CONOPS examines the future warfighting context and characteristics of the future joint force in order to characterize future required medical capabilities. As I read through the CONOPS document, having recently returned from an on-site visit to the hurricane response area, I saw how effectively the document is organized and how it lays out a process for continual improvement for all types of missions, from the War on Terror to responding to disasters in CONUS.
 
Alright, enough of the CONOPS lead-in—back to the hurricane situation. Here is a summary of what we did, how well we did it, and how we can do better in the future:
 
What the MHS provided
· Leadership advice and guidance. Through the NORTHCOM Surgeon’s office, we have a nationwide array of 14 Joint Regional Medical Plans officers (JRMPOs). All available JRMPOs were mobilized to coordinate and synchronize state and Federal ESF-8 capabilities.
· Patient movement. Both within and without the National Disaster Medical System (NDMS), aeromedical evacuation units from Active Duty and Air National Guard units moved approximately 473 non-ambulatory patients out of harm’s way.
· Medical support to general evacuation effort. The Air Force’s San Antonio-based 59th Medical Wing provided medical screening and emergent care to the thousands of people evacuated from the landfall areas. 
· Medical logistics. Through the ARNORTH emergency operations center in San Antonio, the right military medical materiel was provided to the right place at the right time.
 
What went right
· The JRMPOs provided the unique “glue” that bound the interagency effort. During my trip to Texas between the hurricanes, every single agency representative I met requested more of these valuable officers.
· The Texas Military Forces, ably led in the medical context by Joint Surgeon Colonel (Dr.) Connie McNabb, proved capable of augmenting—and in many cases, replacing—Federal response assets.
· Personal initiative at all levels effectively erased policy shortfalls and ensured that patients were moved safely and quickly.
· Operational communication between military medical response experts at all levels (e.g., OSD, NORTHCOM, ARNORTH, and Texas Military Forces) provided effective situational awareness.
 
What went wrong
· The NDMS does seem adequately user-friendly to state and local medical officials.  Additionally, it does not apply to non-ambulatory patients in facilities other than hospitals (e.g., nursing homes and hospice care). Therefore, I believe we dodged a bullet so far in this hurricane season; our success is as much due to the relatively small numbers of patients requiring evacuation rather than to the effectiveness of the system.
· Medical response policies of certain interagency partners (e.g., DoD/TRANSCOM, HHS/NDMS, and DHS/FEMA) are not sufficiently interoperable to ensure seamless operations.
 
How can we improve?
· First, and perhaps most important, we need to ensure that our DoD response policies are coordinated with all agencies, both internal and external to DoD.
· We also need to lean forward to proactively work with our interagency partners on improving Federal policies. A salient example is patient movement. Whether by air, rail or bus, and whether by NDMS or non-NDMS assets, we need to do a better job of preparing to respond.
 
As of this writing, we are already taking steps to move out on plans improvement. Dr. Casscells and Ms. Embrey have empowered us to host several meetings to lead this process of policy integration. The first will be an After-Action Review of senior action officers of the MHS to identify issues and workable solutions, whether in the domains of doctrine, policy, operational guidance, or training. The second meeting will include our intergovernmental partners to review, revise, and integrate Federal policies and guidances to operationalize those improvements before the next hurricane season.
 
To conclude, I must briefly return to the JFHP CONOPS document. Its central theme is Protect the Force, Enhance the Mission. That’s a deceptively simple statement—one that elegantly sums up the strategic objective of all military medical forces. If I’ve been successful in anything during this blog entry, it’s that 1) the MHS provides a unique and vital service to our country—as was demonstrated during our response to the hurricanes, 2) no matter how good we are at providing that service, we can always do better, and 3) the Joint Force Health Protection CONOPS document is an excellent reference in understanding your role in the MHS and how you can contribute to its improvement. I’m attaching the document for those who are (or should be) interested.

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