Journal of Business Continuity & Emergency Planning

Journal of Business Continuity & Emergency Planning Volume 10 Number 2
Healthcare logistics in disaster planning
and emergency management: A perspective
Jerry D. VanVactor
Received (in revised form): 5th July, 2016
US Army Medical Service Corps, Washington, D.C., USA
E-mail: [email protected]
Jerry D. VanVactor is an active duty healthcare logistician in the US Army medical service
corps. He is a doctor of health administration and holds masters degrees in business
administration and healthcare management.
Dr VanVactor has served with distinction in the
US military since 1989 in many healthcare and
supply-chain management roles.
A bstract
This paper discusses the role o f healthcare
supply chain management in disaster mitigation
and management. W hile there is an abundance
o f literature examining emergency management and disaster preparedness efforts across
an array o f industries, little information has
been directed specifically toward the emergency
interface, interoperability and unconventional
relationships among civilian institutions and
the U S Department o f Defense (U S D oD ) or
supply chain operations involved therein. To
address this imbalance, this paper provides U S
D o D healthcare supply chain managers with
concepts related to communicating and planning more effectively. It is worth remembering,
however, that all disasters are local — under the
auspice o f tiered response involving federal agencies, the principal responsibility fo r responding to
domestic disasters and emergencies rests with the
lowest level o f government equipped and able to
deal with the incident effectively. A s such, the
findings are equally applicable to institutions
outside the military. It also bears repeating that
every crisis is unique: there is no such thing as
a uniform response fo r every incident. The role
o f the U S D o D in emergency preparedness and
disaster planning is changing and will continue
to do so as the need fo r roles in support o f a
larger effort also continues to change.
Keywords: US Department of Defense,
homeland security, healthcare, supply
chain, collaboration, preparation, planning, interagency, interoperability
INTRODUCTION
There is pervasive support among academic literature concerning just how
vital crisis management, disaster planning and emergency preparedness have
become for many industries. There could
be an underlying concern that the US
Department of Defense (US DoD) and
healthcare logistics (or supply-chain)
institutional cognisance should evolve
concerning threats to national security
posed by natural, technological/accidental
and adversarial/human-caused crises; and a
greater mindfulness may be necessary concerning supply-chain management’s role
in preparedness and response efforts related
to Defense Support to Civil Authorities
(DSCA).1 Leaders should remain ever
mindful of the military profession’s principal mission of providing senior levels of
Jerry D . Van Vactor
Journal of Business Continuity
& Emergency Planning
Vol. 10, No. 2, pp. 157-176
© Henry Stewart Publications,
1749-9216
Page 157
Healthcare logistics in disaster planning and emergency management
governm ent w ith expertise in the design,
generation, support and ethical application
o f land, sea and air pow er. 2 T h e mission
o f the U S D oD is not principally DSCA;
rather, w ar-fighting and the preparation
thereof is its prim ary focus. Som e m ight
argue, however, that stricter consideration
o f D SC A should be nested am ong factors
related to hom eland security and hom eland defence, w ith those instances o f the
aforem entioned threats to national security m ore routinely considered. 3
W hile this may seem intuitive to some
senior leaders, planning for and m anaging
a variety o f crises can prove challenging
for those for w h o m em ergency m anagem ent is not a routine aspect o f daily
operations. For example, the average
com bat arms, service support and support
com m ander is n ot going to evaluate risk
w ithin the context o f disaster im pact. As
difficult as it may seem, this inform ation
could potentially present an entirely new
concept for som e leaders. U nderstanding
the role played by healthcare supply-chain
managers during disaster and em ergency
planning is o f critical im portance given the
variety and rising frequency o f incidents
that could challenge national security, and
the m anner in w hich such concepts are
w ritten into extant doctrine and guidance
publications.
This quasi-case study adds tw o prim ary
concerns to an extant body o f knowledge.
First, this paper is w ritten w ith emphasis
upon the involvem ent o f U S D oD healthcare logistics personnel in em ergency
m anagem ent and planning. D SC A has
only recently been included am ong m ilitary doctrine and varying degrees and
levels o f planning; such inform ation may
not be fully understood by those w ho do
not actively consider such operations in
their day-to-day activities.4 O f note, also,
is a seem ed lack o f emphasis upon healthcare supply-chain m anagem ent’s inclusion
in disaster and em ergency m anagem ent
considerations; this is o f course directly
correlated to the experience level and level
o f involvem ent in em ergency m anagem ent and planning o f the person o f w hom
this type o f interaction is asked. N o t all
supply-chain leaders are as inform ed or
educated in such m atters or at the same
degree o f understanding.
Secondly, this w ork takes a trem endous
step toward emphasising collaboration and
inculcating com m unity-w ide resilience
am ong an array o f interagency stakeholders
once disaster response is required. This is
especially pertinent given the increasing
mindfulness related to such concepts as
w hole-of-governm ent involvem ent in disaster m itigation and the emphasis upon
precision m edicine (an em erging approach
for disease treatm ent and prevention that
takes into account individual variability in
genes, environm ent and lifestyle5). W hile
n ot exactly applicable in the present discussion, the im portance o f exploring how
healthcare can better avail itself w hen
crises prevent ready access to routinised
care suggests that the inclusion o f precision m edicine may be apropos w ithin a
macro-analysis o f population health and
the availability o f resources during periods
o f unknow n circumstances.
W hile there are regulatory constraints and lim itations im posed on the
US D o D ’s involvem ent in disaster m anagem ent, permissive and legal m ilitary
involvem ent occurs (in m any instances)
m ore frequently than som e leaders m ight
believe or know — healthcare is often and
routinely included am ong such response
efforts at b o th state and federal levels o f
responsibility.
T hrough an academ ic lens, the relationship am ong planning processes from
a m ulti-agency m indset is reviewed and
expounded upon. Planning needs to be
done long before an event’s occurrence;
contingency plans m ust be know n, understood, rehearsed and easily im plem entable
Page 158
am ong an array o f m ultidiscipline stakeholders. Plans cannot be w ritten at the
highest levels o f com m ands w ith an
assumed expectation that the m ost ju n io r
leader am ong every organisation will
understand bo th context and applicability
at the tim e o f a crisis. Indeed, w ithin the
m ilitary decision-m aking process, efforts
and guidance are routinely hnearised,
top-driven and mission control-centric
planning. Such a m odel seems counterintuitive w hen com pared and contrasted to
the US D epartm ent o f H om eland Security
(DHS) steady-state protection process,
w herein planning is multidisciplinary,
focused upon, encourages m ultiagency
engagem ent, and m uch m ore collaborative. Elem ents o f each m odel are related
to one another and the ensuing discussion
dem onstrates how both m odels could be
com plem entary w ith respect to incident
m anagem ent w hen leveraged appropriately w ithin a logistics context.
METHODOLOGY
A quasi-case study approach was used in
evaluating the interface betw een em ergency m anagem ent and disaster planning
and the US D o D institutional acum en.
Such an approach was determ ined m ost
apropos in that clearly identifiable inform ation and actions, w ithin a bounded system
o f regulated activities, could be evaluated
to provide a deeper understanding o f disaster m anagem ent and planning.6,7 Said
qualitative inform ation was then com plem ented w ith a directed, focused literature
review o f related term s and topics to
broaden b o th the research and the reader’s
understanding. In this instance, the m ethodology enabled a focused representation
based upon potential gaps in capabilities
and opportunities for professional grow th
concerning em ergency m anagem ent and
disaster planning.8 This m ethodology was
also determ ined best in that it perm itted
a constructive approach in the exam ination o f phenom enological concepts related
to im proving leaderships’ understanding
o f perceptibly under-explored areas o f
potential concern.
A n invitation was extended to approxim ately 20 senior m ilitary leaders and
em ergency m anagem ent professionals
in the collection o f qualitative feedback
(an interview w herein anonym ity was
assured and m aintained; see A ppendix A).
Feedback captured during each interview
was then nested am ong a convenience
sample o f existing hterature (>50 works)
to develop an im proved understanding o f
processes related to healthcare logistics’
involvem ent in em ergency m anagem ent
and planning. W hile a broader array
o f literature could be found related to
supply-chain m anagem ent, logistics and
healthcare supply-chain m anagem ent, few
works could be used that truly synthesised all three phenom ena into specified
research findings. T h e inform ation extrapolated from the associated literature review
and participant feedback was then used to
develop findings and im plications in an
effort to aid m ilitary leaders in evaluating
U S D oD involvem ent in disaster m itigation and response w hen such involvem ent
is w arranted and permissible w ithin federal
law.
DISCUSSION
All disasters are local; u nder the auspice o f
tiered response involving federal agencies,
principal responsibility for responding to
dom estic disasters and em ergencies rests
w ith the lowest level o f governm ent
equipped and able to deal w ith an incident
effectively. W hile governm ent response
and intervention are often critical to com ­
m unity-w ide recovery subsequent to a
disaster, it is im portant to rem ain mindful
that every disaster is local w ith regard to
resource availability and m anagem ent. For
Healthcare logistics in disaster planning and emergency management
example, when federal agencies respond
to a state or local crisis under a menu of
state or local needs, to fill gaps in capabilities, this does not equal a federal response.
The response would remain a state or local
response using federal resources.
Likewise, all crises are unique; the same
response will not be required, in a uniform
fashion, for every incident. When managing disaster responses, the operational
environment is uncertain, complex and
dynamic; business as usual as a means
by which resources are often managed
may not be fully applicable during every
scenario.9 For example, a family coming
home after an outing to find their entire
house flooded due to a burst water main or
faulty plumbing (individual family crisis)
will not provoke the same level of response
as a hurricane with the resultant cascading
events extending across multiple municipal, county and state boundaries. While
individual families, in the latter scenario,
still have individualised responsibilities to
be and remain prepared for such occasions, the magnitude of a situation incites
an array of responses. Regardless, an array
of scenarios could be considered emergencies (disasters) nonetheless — individual or
otherwise.
Crises bring an array of issues, concerns
and complexities into an environment that
may have not been considered adequately
prior to their occurrence.10 One concern
relates to resilience levels among contemporary organisations. Resilience, in
the context of this paper, relates to the
amount of mindfulness related to prior
errors that have occurred and mitigating
risks before previously identified issues
worsen or potentially cause more harm.11
Resilience, however, is an outcome related
to how people consider mitigating such
risks versus attempting to prevent them
from ever occurring.12
Catastrophic disasters of varying size
and severity continuously bring dramatic
reminders that a better understanding
of preparedness, readiness and how to
improve individual, organisational and
community resilience might be necessary.13 For example, between 2010 and
2014, there were more than 300 major
disaster declarations, more than 60 emergency declarations, and more than 240 fire
management assistance declarations14 filed
with the Federal Emergency Management
Agency (FEMA) throughout the USA (see
Table l).15
To what regard this information is relevant for US DoD leaders and personnel
should be intuitive, yet it continues to
prove a source of significant misunderstanding, misgivings and concern for some
senior military and government leaders.
The mission of the nations military is
not primarily DSCA focused, but to
‘provide the military forces needed to
deter war and to protect the security of
our country’.16 Readers and military professionals would do well by knowing and
remaining attentive to the facts that many
of the aforementioned incidents occurred
in close proximity, on, or involved military bases and personnel. Such risks could
be easily thought of as potential concerns
for national security when local forces are
occupied with reacting to crises versus preparing for war or the deterrence thereof.
The face of US DoD involvement in
emergency preparedness and disaster planning is changing and needs to do so
continuously as the perceptible need for
roles in support of a larger effort continues
to change as well. As one senior leader
stated in a personal correspondence, ‘the
DoD has lots of stuff; everybody wants
more stuff, but they don’t know what to
do with it or how to use it once they get
it’. Many civilians have little understanding
of the levels of planning and responsibility
with which military leaders are entrusted;
military officers can do much more than
help fight wild-fires or drive Fiumvees
Page 160
VanVactor
Table 1: Disaster declarations 2010-2014
Year
Earthquake
Extreme
temperature
Fire/Wildfire
Flooding
Hurricane/
tropical storm
Severe storm
00
Tornado
Tsunami
M M M E F M E M E M E M M E M
2014 1 1 1 33 30 1 2 27 2 12
2013 4 28 41 2 2 36 1 9 12
2012 2 71 19 16 14 25 2 1 8
2011 2 1 1 113 53 7 22 16 43 4 5 24 1 3
2010 1 17 51 4 2 3 38 16
M — major disaster; E — emergency; F — fire management assistance
to assist people affected by uncontrollable
floods and snowstorm s. T h e US D oD
can arrive in a disaster locale very quickly
w hen called upon and if prepared to do so,
but this support m ust be requested under
extant bureaucratic requirem ents before it
can be an approved source o f help. Asking
the right questions concerning w hat m ilitary forces can do, w hat is required by
a com m unity, and how best to get the
right m aterial to a population in need
becom es challenging if planning is not a
routine function o f organisational operations. To w hat degree, am ong m ilitary
planning staff, should this rem ain a topic
o f discussion?
A m ong contem porary operational
environm ents, leaders should know that
disasters may take m any forms — outbreaks o f fast-spreading infectious diseases,
any variety o f natural disasters from snowstorms to tsunamis, technological incidents
that span a w ide spectrum o f nuclear
reactor failures to m is-shipped chemicals,
adversarial events such as acts o f terrorism ,
crim inal violence and o ther such events
— all, and m any m ore, should serve to
heighten priorities in planning, preparing
for and responding to m ajor operational
disruptions. O th er contem porary factors
can im pact crisis m anagem ent as well, such
as m arket volatility, outsourcing, singlepoint sourcing, and variations in supply
and dem and am ong an array o f markets.
Such factors can increase the com plexity o f
supply networks and create risks to w hich
even the nation’s arm ed forces can becom e
extrem ely susceptible (see Figure l ) . 17
A com m unity-w ide, m ulti-hazard, collaborative effort is essential in disaster
recovery and response; a supporting supply
netw ork can only be as strong as ITS
weakest link. 18 T he supply chains that
support healthcare are ju st as critical as
any other business enterprise; supply lines
m ust be sustained by b o th preventive
and em ergency measures em placed before
an incident’s occurrence. 19 A n essential
consideration am ong every logistician’s
effort is that sources o f disruption can
be segm ented am ong tw o principal categories: random disruptions w hich may
occur unexpectedly throughout a supplychain netw ork (eg natural disasters such
Page 161
H e a lth ca re lo g is tic s in d is a s te r p la n n in g a n d e m e rg e n cy m a n a g e m e n t
H – Earthquake zones (least to greatest potential)
– High w ind zones
\ . (I — Hurricane paths
â–  – Blizzard o r heavy snow fall
Sources:
USGS, USDA, OSU,
The W e a th e r C hannel,
NOAA
Figure 1
Propensity for US
milita.y bases to be
impacted by natural
disaster
as storms, earthquakes, tsunamis etc), and
prem editated disruptions w hich are often
deliberately planned to inflict damage to
the supply chain (eg acts o f terrorism ,
technological mishaps etc) .20 A n all-hazards
approach to planning in any instance can
better enable m ilitary planning by identifying w hich occurrences could produce
increased vulnerability. A t the time o f a
crisis, supply-chain professionals should
have enough advance consideration o f any
needs w ithin an affected com m unity that
will n o t be m et and determ ine how to
best fill gaps in capabilities. Regardless o f
the genesis o f the disruption, leadership
and a tenable plan are key factors in the
m itigation and response criteria after an
incident has occurred.
FINDINGS AND IMPLICATIONS
Per Joint Publication 3-28:
‘the A rm ed Forces o f the U n ited States
and D epartm ent o f Defense (D O D )
agencies may be called upon for defence
support o f civil authorities (DSCA)
to support a w h o le-o f governm ent
response in support o f civil authorities, although not specifically organized,
trained, or equipped for the support o f
civil authorities’.21
P age 162
D S C A is a doctrinal construct nested
w ithin D o D directive 3025.18 w hich
defines D oD involvem ent in crisis events
and specifies param eters u nder w hich such
support may be requested. K now ledge o f
such emphasis may n ot be as w idely com ­
m unicated or easily understood by every
leader throughout the U S arm ed forces as
som e m ight think. D SC A involves federal
m ilitary provisos related to support in activities conducted by state, local, tribal and
territorial governm ents that may simultaneously occur in the jo in t22 operations
area.23 O n e key dehneation, however, is
in the term inology concerning hom eland
defence and D SCA . H om eland defence is
defined in Joint Publication 3-27, as ‘the
protection o f U n ited States sovereignty,
territory, domesfic population, and critical
infrastructure against external threats and
aggression or other threats as directed by
the President’.24 Ordinarily, the US D oD
will rem ain the lead agency for hom eland
defence, but will serve in a supporting
role w h en conducting D SC A operations
w ith other principal agencies. D o D conducts D SC A support operations under
civilian control and in accordance w ith
the fundam ental tenets o f its professional
ethos — subordination to civilian authorities; D SCA response by D oD remains
under the directive o f the President o f
the U n ited States and the Secretary o f
Defense. Seldom will m ilitary leaders be in
charge during a disaster response.
A definitive collective consciousness
related to D SC A seems lacking, in m any
instances, and the m ost know ledgeable or
com m unicative o f duties and responsibilities associated w ith said construct seem to
be those officers in w h o m such know ledge
has been invested or am ong those assigned
in roles involving disaster m itigation and
m anagem ent. This is not w ritten as a disparagem ent o f the institutional acum en,
but to have a greater understanding o f
D SC A , one m ust first know about it, have
at least a lim ited understanding o f w hat
it is, w hat it involves, and some o f the
associated legahties, regulatory guidelines
and principles, as well as doctrinal constraints and limitations im posed upon the
m ilitary at the tim e o f a disaster’s occurrence. In essence, such know ledge requires
an ongoing collaboration betw een senior
and ju n io r military m em bers as well as
am ong m ilitary and local civilian leaders.25
B oth can learn a lot from one another.
Collaboration, in this study, is defined as
a synergistic w ork environm ent w herein
m ultiple parties w ork together tow ard the
enhancem ent o f supply-chain practices
and processes.26
T here is no longer any safe harbour in
w hich the im pact o f a catastrophic event
may be avoided. Inference can easily be
drawn that disaster and em ergency m anagem ent planning is a necessary function
o f leaders across a w ide array o f industries
and sectors; personnel am ong a variety o f
agencies need to develop a better understanding concerning how to develop
and m aintain infrastructure and processes
w ithin respective areas o f responsibility.
Just as im portant, is a need for collaborative, cross-channel com m unication am ong
m ultiple leadership levels and responsibility concerning how best to protect,
m itigate, respond to, recover and prevent
the secondary effects o f crises.
B oth the US D oD and the D H S have
planning m odels through w hich agencies
can better prepare and attain resilience.
Egli developed a m odel o f a different sort
w herein functional capabilities o f the US
D o D are nested am ong the FEM A planning guidelines to form an overarching
um brella o f resihence (see Figure 2). Six
salient points were extrapolated from both
m odels and w arrant further discussion:
(1) mission analysis, (2) course o f action
analysis and developm ent, (3) com m ander’s intent, (4) partner engagem ent, (5)
inform ation gathering and sharing, and (6)
Healthcare logistics in disaster planning and emergency management
FEMA
Functional
Planning
Guidelines
p ro te c tio n ___^ NATIO NALPREPAREDNESS c o n tin u ity
PREVENT PROTECT M ITIG A TE RESPOND RECOVER
M A R IT IM E SPACE
COAdevelopment,
analysis,and Partnerengagement
wargaming
mission
Receiptofthe Information
gatheringand
sharing
Responseand
mitigation
implementationand
EHMLIEa
DoD
functional
components
C o m m a n d e r’s in te n t
CYBER
Figure 2 Nesting
of DoD Operational
Mindset with FEMA
Disaster Planning
Guidance
Source: Egli, D. S. (2013) ‘Beyond the storms: strengthening preparedness, response, and resilience in the 21st
century’, Journal of Strategic Security, Vol. 6, No. 2, pp. 31-45. Adapted and used with permission.
response and m itigation im plem entation
and activities.
Mission analysis and commander’s
intent
To fully appreciate the military m indset
related to operational planning, tw o terms
and concepts should first be explored:
m ission com m and and com m anders
intent as they relate to mission analysis and
an overarching concept o f operations. It
should also be understood that operational
and contingency planning is a core com ­
petence for m ost military officers. M ission
com m and (an operational philosophy) and
a com m ander’s intent (a clear and concise
expression o f the purpose o f the operation and the desired m ilitary end state that
supports mission com m and) m ust first be
fram ed w ithin a context o f the nature o f
the operation and the m ilitary’s operational concept and mission.
M ilitary operations (even am id disaster
scenarios) tend to be com plex, hum ancentric endeavours ‘characterised by
continuous, m utual adaptation o f give and
take, moves and counterm oves am ong all
participants’ .27 Thus, mission com m and is
the ‘exercise o f authority and direction by
the com m ander … to enable disciplined
initiative w ithin the com m ander’s intent
to em pow er agile and adaptive leaders’ .28
Page 164
Inextricably linked to the concept o f
m ission com m and, as can be discerned, is
the com m ander’s intent.
T h e com m ander’s intent establishes the
vision concerning an expected end state o f
operational and planning processes w hich
culm inate in the developm ent and production o f mission templates or orders.
Such vision unifies and provides direction am ong respective planning efforts.
T he focus o f such effort is on, inherently
and necessarily, the interaction betw een a
com m ander anc respective planning staff,
w hich in turn, helps the leadership decide
w hen, w here, and how to com m it US
D oD forces.
A com m ander’s intent may be som ew hat
foreign and problem atic for n o n -D o D entities. W orking w ithin a unified com m and
concept can yield issues w h en disaster
response som etim es requires a coalition o f
the w illing instead o f a w ell-defined, established organisational construct. O ften, and
depending upon roles and responsibility
w ithin the US D o D health system, personnel som etimes lack awareness o f the
functions, challenges and opportunities
facing o ther occupations, adjacent geographic and infrastructure sectors, or the
degree o f lessons that can be learned
through interagency planning related to
disaster response and m anagem ent. D u rin g
m ost disasters, the US D oD will seldom (if
ever) be the lead agency during disaster/
em ergency response efforts (regardless if
the response involves T itle 32 or T itle 10
forces).29 U nderstanding how to engage
federal partners in collaborative relationships and learning from agencies outside
the US D oD thus becom es essential.
Functions o f medical logistics
(M ED L O G ) w ithin the m ilitary include:30
• medical m aterial procurem ent and
distribution;
• m edical equipm ent m aintenance and
repair;
• property accountability and managem ent (real and personal property);
• infrastructure design, planning and
facility m anagem ent;
• optical fabrication, repair and
distribution;
• environm ental services and m anagem ent (w ithin a fixed facility);
• total life-cycle m anagem ent o f medical
m aterial and equipm ent (includes the
acquisition and procurem ent thereof);
• medical contracting support (for n o n –
clinical functions); and
• blood storage and distribution.
W ithin an array o f these functions are also
inherent roles related to the m aintenance
and m anagem ent o f the environm ent o f
care, safety, housekeeping responsibilities, and assisting w ith infectious disease
m itigation and control am ong healthcare
delivery organisations. Intuitive as it m ight
seem, little discussion can be found am ong
military doctrine about the ancillary role
logistics and the supply chain plays am ong
D SC A or em ergency m anagem ent and
planning. Also notable is a seem ed lack o f
understanding concerning the distribution
o f supply or to w h o m such support and provision can be authorised. G etting m aterial
to a hospital (or healthcare organisation) is
one thing, but distributing supplies further
tow ard an incident can be quite another.
T here is little instruction w ritten for m anaging supply dom ain operations to the last
tactical mile; that said, depending on w ho
is asked, an expectation o f understanding
seems to exist am ong an array o f m ilitary
or civilian leaders.
Healthcare is different from line logistics
in that the products and services developed
am ong healthcare operational support planning involve exclusivity am ong medical,
veterinary, dental and population health
m anagem ent and could be deem ed critical
to the success o f healthcare delivery am ong
each. Ultimately, the role o f logistics in
Healthcare logistics in disaster planning and emergency management
healthcare planning involves the science of
planning, preparing, executing, assessing
the movement, distribution, and maintenance of resources and equipment.31
Healthcare logisticians need to be involved
and invested in the specialised requirements of multidiscipline healthcare delivery
toward the reduction of morbidity and
mortality. MEDLOG is an integral component in health service support planning.
The US military continues to face a
dynamic security environment; 32 the environment within which US DoD forces
are employed continues to grow more
complex and dangerous.33’34’35 In a disaster,
time may not be available or permitted
for the commander to establish an end
state objective and, as mentioned previously, the US DoD response may be in
support of other agency requirements;
commanders and organisations may be
required to default to objectives established
among other agency efforts in support of a
population in need.
While there are a series of pre-scripted
mission assignments (PSMA) available
through US N O RTH CO M , one might
be led to ask the difficult question, if
not familiar with military planning processes or the existence of such documents,
is this enough at the time of a disaster? Additionally, how integrated are the
PSMAs with FEMA’s regionally aligned
disaster planning documents? How attuned
are the PSMAs to all-hazards planning and
mitigation? Do members of the military
(who do not regularly manage disaster
scenarios) fully understand or appreciate
the implication of the aforementioned
information? In addition, to what degree
is healthcare supply-chain management
included to ensure a continuance of material support and maintenance?
Course of action development
The complex nature of disasters will
inevitably result in inefficiencies related
to logistics and supply-chain management efforts — healthcare or otherwise.36
With emphasis often placed upon business practices during routine operations,
it is important to understand that overestimating information based on laboratory
data can result in a misguided, misdiagnosis of process effectiveness when the
proverbial chips start to fall.37 By carefully
evaluating disaster scenarios (based upon
lessons learned from previous occurrences
and incidents), planning and policy models
can enhance the quality of both response
efforts and incident outcomes.38 In other
words, supply-chain professionals can routinely learn from past events, but any effort
to create a uniform response for every
crisis should be avoided. While there may
be tenets of replicable effort, each new
crisis will likely present new and unique
challenges. This is not to imply that plans
should not be developed; indeed, planning
is essential.
Contemporary supply chains can be vulnerable even without introducing disaster
or crisis scenarios. Political upheavals, regulatory compliance mandates, increasing
economic uncertainty, rapid changes
in technology, differences in customer
expectations, capacity constraints, excessive reliance upon just-in-time logistics
(without allowing for adequate seasonal
or safety stock), globalised market forces
and natural disasters all contribute to the
dynamics associated with the management
of a supply chain.39 At times, this can
prove nearly impossible in determining the
array or level of risk because there is too
much uncertainty to quantify the threats,
vulnerabilities or consequences.40 The variables can sometimes be so complex that
information will remain unknowable even
at the time of crisis.
Pre-existing business continuity plans
and the implementation of preordained
responses involves awareness of potential
threats to operations and a predetermined
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VanVactor
response criterion by w hich the organisation reacts to an incident. R em aining
m indful o f the concept that no tw o disasters will be the same and that disasters are
n ot linear, decentralising operational decision-m aking (closer to the epicentre o f the
disaster event) w ould enable a m ore tim ely
and effective response. O ften, the pooling
o f resources, facilitating and allowing for
greater financial and operational efficiency,
and helping to ensure im proved processes
(value for m oney) could reduce the level
o f com petition am ong agencies w hen subm itting requirem ents for resources.41 This
is best facilitated through collaboration,
m ultidiscipline input and feedback, and
concerted decision-m aking.
T h e cultural com ponent o f m ilitary decision-m aking processes can be
view ed as a basis for learning; however,
the contem porary business setting w ithin
w hich healthcare logisticians function, support and sustain requirem ents
are routinely m ultidim ensional, m ultidisciplinary, and involve an interconnected
netw ork o f supply-chain agencies. In
o ther words, people can be em pow ered
effectively only if they have the requisite know ledge and context for effective
decision-m aking; systems require shared
consciousness before they can be leveraged
effectively.42 Linearity am ong netw orked
systems w ithin o ther systems becom es
almost non-existent and could certainly
be deem ed counterproductive in effective operational continuity. Organisational
resilience cannot be assessed in a vacuum;
such organisational fitness is a by-product
o f functionality and synergy w ithin a
surrounding operational environm ent.43
R equirem ents need to be evaluated,
analysed and determ ined long before an
incident occurs, but response may n o t be
relegated to a checklist response for every
scenario; again, each crisis m ay present
its ow n set o f challenges and concerns.44
M indfulness o f the relational com ponents
associated w ith interagency support assists
planners w ith im proved collaboration,
com m unication and operational synchronicity and the enhancem ent that extant
supply-chain relationships can have in a
multistage response effort.
D ifferent from a military version o f
planning, w here direction is given and
com pliance may be expected, o ther federal
governm ent agencies recom m end guidance and inform ation is shared am ong a
coalition o f the willing. T h e notion o f
top-dow n, rigidly patterned and predeterm ined m anagerial com m uniques is largely
a legacy style o f leadership that derives
from a scientific m anagem ent m odel
developed by Frederick W inslow Taylor
in the c.-1900s.45 Some scholars w ould
argue that this is not how business is being
conducted w ithin contem porary models
or varied operational environm ents.
Seem ed centrality o f com m and or unification o f effort can often and routinely
be absent w hen m ultiple states, locales or
other federal/non-governm ental organisations (N G O s) are involved. R ecognising
that the w orld in w hich the military
functions is always changing, revised operating concepts — w herein the m ilitary
remains expeditionary, tailorable, scalable
and prepared to m eet challenges am ong a
dynam ic environm ent — are being advocated am ong strategic and operational-level
planning cells.46 Planning templates and
guidance, b o th m ilitary and civilian, are
w ritten in line w ith an array o f national
frameworks, and should be revisited and
revised periodically to provide generalisable planning considerations ancillary
to protection, preparedness, m itigation,
response and recovery efforts.
C ore com petencies related to disaster
planning and em ergency preparedness can
be found am ong such planning constructs.
C ore capabilities and targets are n o t static
and they will be vetted and refined, as
required, taking into consideration risk and
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Healthcare logistics in disaster planning and emergency management
resource requirements. Planning processes,
associated with federal disaster preparedness, is established through Presidential
Policy Directive (PPD-8). Indicated within
PPD-8 are elements regarding ‘actions
taken to plan, organise, equip, train, and
exercise to build and sustain the capabilities necessary to prevent, protect against,
mitigate the effects of, respond to, and
recover from those threats that pose the
greatest risk to the security of the nation’.47
Interestingly, PPD-8 has little to do with
the exclusivity of homeland defence and
security, but was written in response to
large-scale crises that have the potential for
generating an equally large-scale response.
Partner engagement
Healthcare logistics routinely involves
elements of planning, implementing and
controlling the most cost-effective flow
and storage of medical goods and materials (as well as related information) from
a point of origin (supply and material) to
the point of consumption. Other functions
of logistics management can encompass a
range of activities, including preparedness,
procurement, transport, warehousing,
tracking, tracing, and customs clearances
(as required).48 Add to the routine a crisis,
and efforts associated with logistics may
include alleviating the suffering of an
affected, vulnerable population. Much of
this may be less than adequately considered by those for whom supply-chain
management is not a primary skill set.
There seems to be a strong demand
for greater effectiveness and efficiency in
disaster logistics as a reasonably estimated
60—80 per cent of the expenses incurred
during crisis operations can be attributed to supply-chain activities.49 Effective
logistics management attempts to reduce
vulnerabilities by providing a seamless,
comprehensive approach, involving all
supply-chain stakeholders (prior to an incident’s occurrence), in the identification
and analysis of associated risks and points
of potential failure throughout a supply
chain.50 Risks may assume an array of identities caused by environment, technology,
humans, organisations and politics.51 The
management and mitigation of risks is
then critical to achieving supply-chain
effectiveness and efficiency for a healthcare
delivery system.52
An elimination of discipline silos
becomes all the more critical during a
crisis; this is equally important outside of
crisis as well. Regardless of the types of
patients or practitioners involved, supplychain management involves channel-wide
integration of resources to better serve customer needs.53 Supply-chain professionals
need to have pre-established relationships
with healthcare practitioners and vice versa
before an event occurs so that responding
to and recovering from crisis is not a new
concept when organisational operations
are affected by an incident. Each must
respect one another’s role and both must
value the professional perspective that can
be gleaned through response-based planning. Discipline silos, the separation of
functions of varying types of practitioner,
is sometimes perpetuated despite the
requirement for enhanced collaboration at
the time of need.54
Institutional knowledge that is generated through well-designed, well-executed
research in anticipation of, in the midst
of, and immediately subsequent to a crisis,
could be deemed critical to future organisational capacity toward better achieving
communal goals and objectives related to
preparedness, response and community
resilience.55 It is becoming increasingly
clear that the healthcare industry needs a
new resilience-based approach to supplychain management that can be integrated
into the homeland security enterprise and
built upon greater trust among governmental, public and private stakeholder
networks.56
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VanVaotor
Resilience is a broadly-defined term
that is implicitly used to encourage systems-thinking related to enhanced agency
durability and disaster resistance through
agile and adaptive approaches. Resilience,
in concept, permits more operational efficiency, demands fewer resources during
emergency response, and inculcates flexibility into common operational designs. In
healthcare, this will invariably, involve the
prevention of injury, illness, disability and
death, and the provision of as much organisational support to community recovery
efforts as is fiscally viable. One significant
barrier to effective healthcare delivery at
the time of a disaster will involve the
natural occurrence of a variety of incidents
to the types of disasters and the communities affected.57
Logisticians and operational planners
must understand key tenets of supporting
and sustaining healthcare delivery in scenarios other than inside a static healthcare
environment; implications of supply-chain
involvement can be seen among multiple
emergency support functions (see Table 2).
Healthcare logistics planning and capabilities
extend much further than just Emergency
Support Function (ESF) 8 — Health and
Human Services; although this support
function is the category in which many
healthcare operational planners seem nested.
US DoD healthcare logisticians should
understand this well and can be very adept
at managing a supply chain for an array of
service agencies and modes of healthcare
delivery. Traditionally, roles involved in
healthcare delivery and incident to disaster
planning have focused predominately on
mobilisation of resources and response
during emergencies.58,59 Implications of
healthcare supply-chain management
needs, for example, can also be assessed
among multiple ESFs. Logistically, support
roles must remain flexible (adaptive) and
agile — especially in healthcare services
and support planning.
Information gathering and sharing
One of the most widely accepted definitions of health is attributed to the World
Health Organization (WHO) as ‘a state of
complete physical, mental and social wellbeing and not merely the absence of disease
or infirmity’.60 Health is constitutive of, but
different from, wellbeing or quality of life.
Disasters, however, often require emphasis
be placed upon a community-driven need
to restore, as quickly as possible, the latter.
Health is a concern for individuals given
an array of public and population health
management concerns and should be necessarily included among disaster planning
efforts and consideration of wellbeing.61
Ancillary to the direct patient care aspect
of restoring community health is the presence of a supporting supply chain; without
sufficient supply lines, healthcare ceases to
function effectively. The primary objective of the supporting supply chain is to
aid healthcare professionals in improving
lives, eliminating healthcare risks, alleviating suffering throughout a crisis and
maintaining human dignity.62
Contemporary healthcare supplychain models have evolved significantly
from where they once were — no longer
should healthcare entities be concerned
with only the cost and quality of items
being used during a disaster, but the
outcomes produced via direct and indirect patient care. Many changes have led
to significant increases in the globalisation, length and complexity of supply
chains, making geopolitical and economically-derived networks in the supply of
healthcare products less predictable, more
vulnerable and susceptible to unforecasted
risk throughout a crisis.63 Collaborative
planning and response become essential
when, in the face of an array of crises and
disasters, complex logistical networks and
operations make supply chains inherently
susceptible to sudden, and possibly prolonged, disruption.64
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Healthcare logistics in disaster planning and emergency management
Table 2: FEM A E m ergency Support Functions
F EM A
Emergency Support Function
Coordinating agency Implications for healthcare supply-chain management
1: Transportation Department o f Transportation Supply and resourcing o f non-standard medical
evacuation platforms; mass transportation o f sick/
wounded during/throughout a crisis
2: Communication DHS/National Communications
System
IM /IT systems through which healthcare supplies are
requested and managed
3: Public Works and Engineering D O D /U S Army Corps o f Engineers Public health implications
4: Firefighting USDA/US Forest Service and D H S/
FEMA/US Fire Administration
Many fire service agencies use medics on fire apparatus;
thus, healthcare supply would be required
5: Information and Planning DHS/FEM A Healthcare supply should be strategic and operational
planning factors
6: Mass care, Emergency Assistance,
Temporary Housing and Human
Services
DHS/FEM A Self-explanatory; healthcare supply-chain involvement
is nested within mass care requirements; public health
implications as well
7: Logistics General Services Administration and
DHS/FEM A
Healthcare supply should be strategic and operational
planning factors
8: Public Health and Medical Services Department of Health and Human
Services
Healthcare supply should be strategic and operational
planning factors
9: Search and Rescue DHS/FEM A Many fire service agencies use medics on fire apparatus;
thus, healthcare supply will be required
10: Oil and Hazardous Materials Environmental Protection Agency Public health implications
11: Agriculture and Natural Resources Department o f Agriculture Pubhc health implications
12: Energy Department o f Energy Public health implications
13: Public Safety and Security
14: Superseded by the National Disaster
Recovery Framework
15: External Affairs and Standard
Operating Procedures
Department ofJustice/Bureau of
Alcohol, Tobacco, Firearms, and
Explosive
Many pubhc protection and law enforcement agencies
use personnel as first responders until fire/EMS can
arrive on site; thus, healthcare supply would be required
Source: Federal Emergency Management Agency (2013) ‘National Response Framework’, FEMA, Washington, DC.
In the com plex environm ent a disaster can yield a pre-established standard
o f cross-functional skills, responsiveness,
and adaptive m anagem ent capability;
m ental, intellectual, physical robustness;
and ability for form ulation and use o f novel
solutions could be deem ed essential.65
Inform ation-sharing can serve as a linkage
through w hich the governm ent, com ­
m unity leadership and organisations,
conm iunity school system and families
w ork together to coordinate disaster
response efforts through resource integratio n .66 Disasters create an im pact upon the
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health of individuals and communities both
directly (death, injury, disability and illness)
and indirectly (damage to health infrastructure — including utility services such as
water, electricity and sanitation — as well
as to health systems and service delivery).57
Community and organisational preparedness and prevention involves functional
knowledge of incident command, countermeasures, mitigation, mass healthcare
delivery, and management and prioritisation of essential healthcare supply chains
and material.68 In this regard, military
health system logistics and supply-chain
management will remain in a reactive
posture and contingent upon the needs of
a specified population to whom support is
being provided — but, not always within
a singular command. It is important to
note is that the role of the military health
system s (MHS) supply chain is ordinarily
not oriented toward general population
healthcare. Rather, a military health system
supply-chain operation, under current
regulation, is specific to MHS providers
and military organisations. Military, as well
as other federal agency, leaders need to
remain mindful of supply-chain implications and understand the legal limitations
related to, integration and collaboration
necessary among agencies such as the
DHS, FEMA, DHHS and others. There is
perceptible opportunity for multi-agency
collaboration and professional growth if
supply-chain management could become
more interagency-oriented.
This becomes especially critical when one
realises that the US DoD healthcare supply
chains operate within a prime vendor procurement construct that will, invariably, be
in competition with every other geographically affected institution once disaster strikes.
The competitive position of an enterprise
(healthcare or otherwise) and the responsiveness of the supporting supply chain are
two vital elements that aid in determining
resilience.69 Disasters will routinely uncover
important knowledge gaps that could not
have been anticipated or prioritised among
extant, idiosyncratically-designed concepts
of operation or support.70 In this vein, the
time-tested military after action review is
one of the best tools for capturing experience related to disaster readiness, response
and capabilities (see Table 3). What happens
to the information extrapolated from
this tool can be the difference between a
lesson learned and a lesson observed in the
systemic conduct of preparedness and planning efforts. Information should be readily
available and shared among both military
and civilian supply-chain professionals to
plug as many knowledge gaps as possible in
advance of future crises.
Table 3: A fter action review
A fter action review
1: Intended mission/response effort What was supposed to happen?
2: Summary of events as they occurred What happened?
3: Discussion concerning any issues concerning any of the How could efforts be improved for future events/
emergency support functions – specifically safety issues occurrences?
4: Closing comments/wrap-up
Source: US Army (1993) ‘TC 25—20, A Leader’s Guide to After-Action Reviews’, US Department of Defense,
Washington, DC.
Healthcare logistics in disaster planning and emergency management
CONCLUSION
Ultimately, the primary mission of the US
military is to fight and win wars, not to
provide support to civil authorities during
a disaster. However, one pillar of US
national defence, as communicated within
the Quadrennial Defense Review, is the
protection of the homeland and to support
civil authorities on mitigating the effects
of potential attacks and natural disasters.
While planning for military operations
is a core competence for most military
professionals, and many military-centric
doctrinal manuals exist that provide planning templates for practitioners of military
planning, the US DoD will continue to
operate under a mission command mindset
and war-fighting as well as the preparation therefor will remain the principal
emphasis; national planning and response
frameworks related to crisis response, as
set forth by agencies such as FEMA, will
remain foreign to many military planners.
Planning efforts related to a battlefield,
when compared with those associated with
disaster mitigation, are perceptibly worlds
apart, and the two may not always work
without a good deal of mental effort by
both civilian and military leaders collaborating together. At the heart of a resilient
health system and healthcare recovery plan
is conmiunity-based action and decentralised logistical response.71 A resilient and
flexible health infrastructure is essential
for protecting population-centric health
during and immediately following disasters. Arguably, while active duty forces are
not wed to any particular community in
which they serve, none of the branches of
service within the US DoD has healthcare
supply-chain practices perfectly attuned to
the needs of any specific community. The
learning curve at the time of a crisis would
be incredibly steep for most US DoD
healthcare supply-chain planners.
While planning is touted as an
essential ingredient in community and
organisational success commensurate with
disaster mitigation and emergency management, there seems to be no defined
planning process by agencies, outside of the
US DoD, at the federal government level.
Goals associated with protecting healthcare infrastructure and resources should
not be viewed as terminal outcomes, but
rather as componential elements in an
ongoing, dynamic process of self-management as a local community begins to
re-establish itself. 72 Business-driven goals
and objectives may adjust with changes
in the delivery systems’ effort to manage
patients’ health status, knowledge and circumstances. This is one reason why it is
vital to capture both lessons observed and
learned as events are occurring and immediately after a crisis. Analysis of potential
or past failures can sometimes surface
faulty assumptions concerning expected
outcomes versus what actually happened.
This should seldom be viewed as a bad
thing. Knowledge gained can be used to
aid organisations in unlearning adverse
behaviours and incorporating new ones,
thereby, helping to reduce future organisational vulnerabilities.73
While agencies such as FEMA or the US
DoD cannot be, singularly, the organisational facilitator of multiple communities’
planning efforts, guidance is rendered
through national planning frameworks and
institutional doctrine regarding the need
for a ‘flexible planning process that builds
on existing plans’ as a critical task for
governmental and community planners.74
For US DoD planners, disaster and emergency preparedness may not be an easily
understood construct as more is involved
than merely the mobilisation, deployment,
employment, sustainment, redeployment
and demobilisation of military forces once
a crisis event occurs. There truly exists a
need for new, more pragmatic approaches
to emergency management and planning
(even within the US DoD) because ‘the
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VanVactor
holy war against the boogeymen hasn’t
worked and isn’t likely to anytime soon’.75
APPENDIX A: INTERVIEW QUESTIONS
RELATED TO DOD HEALTHCARE
LOGISTICS AND EMERGENCY
MANAGEMENT PLANNING
(1) W hat is your role w ithin the US
DoD?
(2) W hat is your role w ith regard to disaster an d /cr emergency management
planning?
(3) Does your role involve interacting
w ith FEMA or other federal partners? If so, how?
(4) Are you familiar with national level
plans and the all-hazards plans in
the various FEMA regions? D o you
believe there are com m on capability
gaps in FEMAs all-hazards plans? If
yes, can you please describe them?
(5) Are there ways that DoD plans and
capabilities might help to fill those
gaps? If yes, how? Are there specific
actions that DoD could take to better
support the needs of FEM A’s ten allhazards regional plans?
(6) Are you familiar with DoDs
Contingency Plans, Defense Support
to Civil Authorities execution
orders, or Pre-Scripted Mission
Assignments? Are you familiar with
how any o f these documents support
FEMA and other federal partners?
(7) D o you have a working knowledge
o f DoD planning at N O R T H C O M
and how it m ight be improved to
better support FEM A’s all-hazards
plans?
(8) D o you know about D oD planning
at A R N O R T H and the National
Guard Bureau? H ow m ight this planning effort be improved in support
o f FEMA or other federal partner
all-hazards planning?
(9) W hat are the most im portant incident
response capabilities that the US
DoD could provide among various
crisis scenarios, based on how likely
or how consequential a requirement
might be?
(10) Are there ways that DoD plans
can better address how operational
capabilities support the Emergency
Support Functions?
(11) Are there ways that DoD plans can
better address installation and institutional capabilities?
(12) Are there any other comments or
suggestions you would like to discuss
regarding ways to improve DoD
support to FEMA?
References
(1) Federal Emergency Management
Agency (2014), ‘National Protection
Framework’, FEMA, Washington, DC.
(2) US Army (2013), ‘ADRP-1, The Army
Profession’, US Department of Defense,
Washington, DC.
(3) US Department of Defense (2014),
‘Quadrennial Defense Review’, US
Department of Defense, Washington,
DC.
(4) US Army (2009), ‘FM 4.02-1, Army
Medical Logistics’, US Department of
Defense, Washington, DC.
(5) National Institutes of Health (2015),
‘About the Precision Medicine Initiative
Cohort Program’, available at: http://
www.nih.gov/precisionmedicine
(accessed 20th September, 2016).
(6) Creswell, J. W. (2003), ‘Research
Design: Qualitative, Quantitative, and
Mixed Methods Approaches’, 2nd edn,
Sage Publications, Thousand Oaks, CA.
(7) Creswell, J. W. (2007), ‘Qualitative
Inquiry and Research Design: Choosing
among Five Approaches’, 2nd edn, Sage
Publications, Thousand Oaks, CA.
(8) Neuman, W L. (2006), ‘Social Research
Methods: Qualitative and Quantitative
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MA.
(9) Chang, Y., Wilkinson, S., Potangaroa,
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Healthcare logistics in disaster planning and emergency management
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(10) McChrystal, S. (2015), ‘Team of Teams:
New Rules of Engagement for a
Complex World’, Penguin Publishing
Group, New York, NY.
(11) Weick, K. E. and Sutcliffe, K. M.
(2007), ‘Managing the Unexpected:
Resilient Performance in an Age of
Uncertainty’, John Wiley and Sons, Inc,
San Francisco, CA.
(12) Ibid.
(13) Egli, D. S. (2013). ‘Beyond the storms:
strengthening preparedness, response,
and resilience in the 21st century’,
Journal of Strategic Security, Vol. 6, No. 2,
pp. 31-45.
(14) Definitions for the specific criteria
concerning each level of disaster
declaration can be found in the Robert
T. Stafford Act (Public Law 93-288),
§102, Definitions (42 USC 5122).
(15) Federal Emergency Management
Agency (2015), ‘Disaster declarations by
year’, available at: https://www.fema.
gov/disasters/grid/year (accessed 3rd
March, 2015).
(16) US Department of Defense (2015),
‘About the Department of Defense
(DOD): Mission’, US Department of
Defense, Washington, DC.
(17) Aigbogun, O., Ghazali, Z. and Razali,
R. A. (2014), ‘Framework to enhance
supply chain resilience: the case of
Malaysian pharmaceutical industry’,
Global Business and Management Research:
An International Journal, Vol. 6, No. 3,
pp. 219-228.
(18) McGrady, E. and Blanke, S. J. (2014),
‘Twelve best practices to mitigate risk
through continuity planning and a
scorecard to track success’, Journal of
Management Policy and Practice, Vol. 15,
No. 3, pp. 11-19.
(19) Jarrett, J. E. (2013), ‘The quality
movement in the supply chain
environment’, Journal of Business and
Management, Vol. 19, No. 2, pp. 21—34.
(20) Azad, N., Saharidis, G. K. D.,
Davoudpour, H., Malekly, H. and
Yektamaram, S. A. (2013), ‘Strategies for
protecting supply chain networks against
facility and transportation disruptions:
an improved Benders decomposition
approach’, Annals of Operations Research,
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(21) US Department of Defense. (2013),
‘JP 3-28, Defense Support to Civil
Authorities’, US Department of
Defense, Washington, DC, p. 1-1.
(22) The term ‘joint’, in military doctrine,
connotes activities, operations,
organisations, campaigns, planning,
and so forth, in which elements of
two or more military departments
(Department of the Army, Department
of the Air Force, Department of the
Navy (including the Marine Corps))
participate. See US Department of
Defense (2016), ‘JP 1-02: Department
of Defense Dictionary of Military and
Associated Terms’, US Department of
Defense, Washington, DC, p. 121.
(23) Ibid., p. viii.
(24) US Department of Defense (2014),
‘JP 3-27, Homeland Defense’, US
Department of Defense, Washington,
DC, p. GL-8.
(25) VanVactor, J. D. (2010), ‘Collaborative
Communications: A Case Study
within the US Army Medical Logistics
Community’, VDM Publishers,
Saarbrucken, GE.
(26) Ibid.
(27) US Army (2012), ‘ADRP 6-0, Mission
Command’, US Department of Defense,
Washington, DC.
(28) Ibid.
(29) Title 32 refers to National Guard
Bureau forces that have not been
federalised; Title 10 refers to active-duty
federal forces. Readers should reference
the entirety of 10 USC and 32 USC for
further clarification and legal construct
defining the activities, employment and
authority of such military forces. There
are tremendous distinctions between the
two types of forces.
(30) US Army (2009), ‘FM 4-02.1, Army
Page 174
Medical Logistics’, US Department of
Defense, Washington, DC.
(31) Ibid.
(32) US Department of Defense, ref. 3
above.
(33) US Department of Defense (2015),
‘National Military Strategy’, US
Department of Defense, Washington,
DC.
(34) US White House (2015), ‘National
Security Strategy’, available at https://
www.whitehouse.gov/sites/default/files/
docs/2015_national_security_strategy.pdf
(accessed 16th September, 2015).
(35) Perkins, D. G. (2014), ‘Army
Operating Concept and Force 2025
and Beyond’, US Army Training and
Doctrine Command, available at:
http://www.benning.army.mil/mcoe/
maneuverconference/presentation/
pdf/GENPerkins.pdf (accessed 16th
September, 2015).
(36) Goffnett, S. P., Helferich, O. K. and
Buschlen, E. (2013), ‘Integrating
service-learning and humanitarian
logistics education’, Journal of
Humanitarian Logistics, Vol. 3, No. 2, pp.
161-186.
(37) Richardson, L. G. (2014), ‘Evidence
principles: caveats in translation of
probability and risk’, Clinical Scholars
Review, Vol. 7, No. 7, pp. 114-120.
(38) Rauner, M. S., Schaffhauser-Linzatti,
M. M. and Niessner, H. (2012),
‘Resource planning for ambulance
services in mass casualty incidents: a
DES-based policy model’, Healthcare
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254-269.
(39) Saenz, M. J. and Revilla, E. (2014),
‘Creating more resilient supply chains’,
M IT Sloan Management Review, Vol. 55,
No. 4, pp. 22-24.
(40) Egli, ref. 13 above.
(41) Sheppard, A., Tatham, P., Fisher, R.
and Gapp, R. (2013), ‘Humanitarian
logistics: enhancing the engagement
of local populations’, Journal of
Humanitarian Logistics and Supply-chain
Management, Vol. 3, No. 1, pp. 22—36.
(42) McChrystal, ref. 10 above.
(43) Ibid.
(44) Bolsche, D., Klumpp, M. and Abidi,
H. (2013), ‘Specific competencies in
humanitarian logistics education’, Journal
of Humanitarian Logistics, Vol. 3, No. 2,
pp. 99-128.
(45) McChrystal, ref. 10 above.
(46) US Army (2015), ‘Army Posture
Statement’, US Department of Defense,
Washington, DC.
(47) US Department of Homeland Security
(2015), ‘Presidential Policy Directive/
PPD-8: National Preparedness’, available
at: http://www.dhs.gov/presidentialpolicy-directive-8-national-preparedness
(accessed 7th April, 2015).
(48) Bolsche et al., ref. 44 above.
(49) Lu, Q., Goh, M. and De Souza, R.
(2013), ‘Learning mechanisms for
humanitarian logisticsJournal of
Humanitarian Logistics and Supply-chain
Management, Vol. 3, No. 2, pp. 149—160.
(50) Azad et al., ref. 20 above.
(51) Ibid.
(52) Aigbogun et al., ref. 17 above.
(53) Jarrett, ref. 19 above.
(54) Moyers, P. A. and Metzler, C. A. (2014),
‘Interprofessional collaborative practice
in care coordination’, American Journal of
Occupational Therapy, Vol. 68, No. 5, pp.
500-505.
(55) Lurie, N., Manolio, T., Patterson, A. P.,
Collins, F. and Frieden, T. (2013),
‘Research as a part of public health
emergency response’, The New England
Journal of Medicine, Vol. 368, No. 13, pp.
1251-1255.
(56) Egli, ref. 13 above.
(57) Dar, O., Buckley, E. J., Rokadiya, S.,
Huda, Q. and Abrahams, J. (2014),
‘Integrating health into disaster risk
reduction strategies: Key considerations
for success’, American Journal of Public
Health, Vol. 104, No. 10, pp. 1811-1816.
(58) Bolsche et al., ref. 44 above.
(59) Dar et al., ref. 57 above.
(60) World Health Organization (1948),
‘Preamble to the Constitution of the
World Health Organization as adopted
by the International Health Conference,
New York, 19—22 June, 1946; signed
H e a lth ca re lo g is tic s in d is a s te r p la n n in g a n d e m e rg e n c y m a n a g e m e n t
on 22 July 1946 by the representatives
of 61 States (Official Records of the
World Health Organization, Number 2,
Page 100) and entered into force on 7th
April, 1948’, available at: http://w w w .
who.int/about/definition/en/print.htm l
(accessed 10th March, 2014).
(61) Ruger, J. P. (2010), ‘Health
capability: Conceptualization and
operationalization’, American Journal
of Public Health, Vol. 100, No. 1, pp.
41-49.
(62) Goffnett et ai, ref. 36 above.
(63) Aigbogun et ai, ref. 17 above.
(64) Ojha, D., Gianiodis, P. T. and
Manuj, I. (2013), ‘Impact of logistical
business continuity planning on
operational capabilities and financial
performance’, International Journal of
Logistics Management, Vol. 24, No. 2, pp.
180-209.
(65) Bolsche et al., ref. 44 above.
(66) Luo, J., Wang, A. and Yang, D. (2013),
‘ Information-sharing-based linkage
mechanism: pre-warning and relief of
West China sudden-onset disasters’,
Asian Social Science, Vol. 9, No. 9, pp.
163-171.
(67) Dar et al., ref. 57 above.
(68) Davis, M. V., Bevc, C. A. and Schenck,
A. P. (2014), ‘Declining trends in
local health department preparedness
capacities’, American Journal of
Public Health, Vol. 104, No. 11, pp.
2233-2238.
(69) Aigbogun et al., ref. 17 above.
(70) Lurie et al., ref. 55 above.
(71) Dar et al., ref. 57 above.
(72) Knight, E. P. and Shea, K. (2014), ‘A
patient-focused framework integrating
self-management and informatics’,
Journal of Nursing Scholarship, Vol. 46,
No. 2, pp. 91-97.
(73) Ojha et al., ref. 64 above.
(74) FEMA, ref. 1 above.
(75) Egli, ref. 13 above.
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