Homeland Security Watch

News and analysis of critical issues in homeland security

February 26, 2016

Friday Free Forum

Filed under: General Homeland Security — by Philip J. Palin on February 26, 2016

William R. Cumming Forum

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24 Comments »

Comment by William R. Cumming

February 26, 2016 @ 10:15 am

With 10 debates ended IMO still little understanding of how FP affects domestic policy in the USA for its citizens and residents.

Thus, my FP link for the week is to what seems the driver for the Republican candidates masked as 1) Regime Change; and 2) R2P-Responsibility to Protect:

http://work.colum.edu/~amiller/wolfowitz1992.htm

Comment by William R. Cumming

February 26, 2016 @ 10:17 am

Other than strategic capability [still driven by MAD?] is the Armed Force of the USA deployed strategically given limited resources even as we send SOCOM [Special Operations Command] forces to Nigeria?

Comment by William R. Cumming

February 26, 2016 @ 10:22 am

Of the remaining candidates here is my listing of their key expertise:

The DEMS:

1. HRC–Self-dealing;

2. Bernie Sanders–Understanding demographics;

The REPUBLICANS:

1. Donald Trump-the role of the federal tax code in real estate development;

2. Marco Rubio- The influence of Cuba on Florida politics;

3. Ted Cruz-Manipulation of the legal system;

4. John Kasich-The Congressional Budget Office;

5. Dr. Carson, M.D.–Pediatric neurosurgery.

Comment by William R. Cumming

February 26, 2016 @ 10:25 am

I have long predicted in comments on this blog that legal and illegal immigration might well be the key to destruction of the Republicans and DEMS. Always remember that in 2008, President Obama stated as a candidate that he would address immigration reform.

He also promised to remove FEMA from DHS through one of his advisers.

What exactly has been promised so far by the candidates?

Comment by William R. Cumming

February 26, 2016 @ 10:28 am

Turning my focus to domestic policy and in particular HS and EM I found it interesting that in last night’s debate John Kasich announced a laundry list that under his version of federalism at least 6 state funded programs would become part of the federal role so that the states would have funds to be the “laboratories of Democracy”!

One on that list was MEDICAID!

Comment by William R. Cumming

February 26, 2016 @ 10:32 am

The so-called Free Clinics in the USA have multiple funding sources. IMO they should be formally related and incorporated into the nation’s first response community. Are there any links to articles, books or studies as to their operation in disasters.

Last night [2/25/2016] Donald Trump announced or agreed that he was not in favor of free health insurance but also that he would not let people die on the street.

Comment by William R. Cumming

February 26, 2016 @ 10:34 am

How many DHS full-time employees have died in the line of duty since DHS opened its doors on 3/1/2003?

Comment by William R. Cumming

February 26, 2016 @ 10:36 am

What is the DHS role in Drug Enforcement? Links?

What is the DHS role in combating ICOs [International Organized Crime]?

Comment by William R. Cumming

February 26, 2016 @ 10:38 am

The FBI Director states that the Apple raised issues are the toughest he has dealt with in his long government service! What do you think?

Comment by William R. Cumming

February 26, 2016 @ 10:43 am

The so-called 30 years WAR lasted from 1618-1648! It was in fact a religious war arising out of the PROTESTANT REFORMATION! Its settlement was opposed by the Papacy. But in trying to limit violence it impacted creation of the modern nation-state system IMO. The Papacy is in fact and law a nation-state! Peerhaps if the Papacy opposes the nation-state system [or fails to recognize it?] in its policies [build bridges not walls e.g.] should it surrender it nation-state status?

Comment by William R. Cumming

February 26, 2016 @ 10:53 am

Chris Tingus has sent me an interesting e-mail describing MORTMAIN statutes and perhaps her could post and comment here after some edits?

All the candidates in the debate last night did not refer to the separation of church and state as part of their future efforts [thanks Mr. Jefferson and others]!

Does church and state separation impact HS and EM? Very definitely yes since FEMA has on program rules long ago UNCONSTITUTIONAL by DoJ/OLC the Emergency food and Shelter Act under the Stewart B. McKinney Act [Title III?] and while non-profits performing communitiy services was added to the Disaster Relief Act of 1974 [Public Law 93-288] they are not required to have formal tax exemption.

And gathering INTELLIGENCE domestically from religious institutions not subject to any formal policy announcements by DHS or doctrinal documentation.

Comment by William R. Cumming

February 26, 2016 @ 10:54 am

After the 10th comment this blog automatically starts a new thread on each post.

Comment by William R. Cumming

February 26, 2016 @ 10:55 am

If you click on comments you can find the first 10 comments!

Comment by Tom Russo

February 27, 2016 @ 12:26 pm

WCR wrote:

“The so-called Free Clinics, in the USA have multiple funding sources. IMO they should be formally related and incorporated into the nation’s first response community. Are there any links to articles, books or studies as to their operation in disasters.”

Your point is well made…over 2,000 are federally funded free clinics or FQHCs Today free clinics are referred to as Federally Qualified Health Centers (FQHCs). Federally Qualified Health Center (FQHC) are federally funded nonprofit health centers or clinics that serve medically underserved areas and populations. Federally qualified health centers provide primary care services regardless of ability to pay. Services are provided on a sliding scale fee based on ability to pay per http://www.HealthCare.gov. In the past they have been called Community Health Centers, Rural Health Centers, Migrant Health Centers, and Primary Care Centers. Under ACA, they all become FQHCs.

I would have to do a search to find articles but I think I can provide a brief overview and some links. In the past, the impetus for adopting a response orientation among FQHCs would come from either the traditional “free clinic” funding source (s) or the DHHS Hospital Preparedness Program (HPP). Traditional funding sources include Medicare, Medicaid and now ACA.

With the traditional federal funding source, there is little incentive among clinic managers to adopt emergency response capabilities…they are primary care centers. They would have neither the personnel, skill set nor supplies to support those EM capabilities. Unless the traditional federal funding sources to those community health clinics has changed and incorporates preparedness carrots, then they have yet to adopt an emergency response orientation. Training, personnel and supplies cost extra bucks…for which I am sure is not among the funded priorities.

States (or large metro jurisdictions) direct DHHS HPP funded healthcare coalitions and work to coordinate those health and medical capabilities. In the past, hospital take the position that HPP funds are intended for hospital preparedness and marginally supportive of directing those funds to non-hospital healthcare facility entities. Afterall, EMS units direct emergency response to hospitals ERs…it’s up to the ERs to configure for surge medical capacities.

Better positioned for the role for emergency response orientation are the private sector Urgent Care Centers (UCC). There are more of them, strategically located and they have the skill set to respond to mass casualty incidents where emergency care skills are required. They also know how to triage and direct patients with traumatic injuries to hospital ERs.

One model for the position you advocate is of the H1N1 2009 pandemic in which federally funded clinics in concert with selected physician practices, in collaboration with state public health agencies served as vaccination clinics.
The contrast here is primary care services versus those of emergency care services. Physicians with frontline MASH experiences gravitate to urgent care centers…I go there in an emergency.

Out of curiosity, I Googled healthcare centers and came up with CHCs in Alaska. This is interesting as they describe themselves as private, non-profit and one would get the impression this is a private sector healthcare facility. Read on and it becomes clear the CHC is a FQHC. This brief shows the traditional CHC role but integrated into today’s federally funded FQHC with the mission…primary care! If you can find a role of emergency response…do let us know!
http://dhss.alaska.gov/dph/HealthPlanning/Pages/primarycare/chc330.aspx

Probably the best emergency response scenario in which both private and public sectors clinics would work in concert with state and federal agencies for response are those where an emerging infectious disease is a threat to population centers or demographic targets (pregnant moms), such as the 2009 H1N1 pandemic. The skill set required is one of needle sticks…the paperwork, privacy, permissions, liability limitations would be more overwhelming than the stick.

In an article written for HSAJ, a new model was proposed for mass vaccination and distribution when a public health threat existed and the mitigation strategy required mass vaccination. I had conducted extensive research in the wake of the 2009 H1N1 pandemic to identify a model for mass vaccination that built upon both private sector (UCCs) and what we refer to as the FQHCs as well as the numerous big-box and pharmacy-based flu clinics. This model was the outcome.
See https://www.hsaj.org/articles/207

I guess my point is there are limitations to what FQHCs can do in an emergency role…yet those roles should be planned, trained and exercised. However, I doubt that occurs sufficiently that FQHCs are readied for emergency response.

In the past we (we being state-level MCI planners) explored post-nuclear attack preparedness medical surge models that called on the very medical centers your initial query sought to incorporate…those free clinics. But now a new literature and scheme has evolved around mass casualty incident response and referred to as medical surge. Thinking today departs from the old models and best captured around the public health emergency planning section of DHHS. This is a model that looks to state and regional medical assistance teams to support federal medical response rather than an impractical approach to depend upon FHQCs. The assets become CDC push packs, Federal Medical Stations, DMATs, public health service corps teams in concert with state RMATs that have 10k square foot and 30k square foot mobile shelter assets that can be configured for all sorts of response requirements. These are the type of medical assets we have seen deployed in disasters such as Joplin and coastal post-hurricane landfall response. A federal medical station (CDC push pack) can be deployed in 12 hours in bed units of 250 beds with required supplies. A 100,000 convention center can be converted to a 750-bed hospital in 24 hours and just require wrap around amenities…wrap arounds are restrooms, kitchen facilities, etc.
See http://www.phe.gov/Preparedness/planning/mscc/handbook/chapter1/Pages/whatismedicalsurge.aspx
Or http://www.hunt4cleanair.net/Articles/allhazardscoop.pdf
Hope that helps!

Comment by Tom Russo

February 28, 2016 @ 6:09 am

Apology for the second, lengthy post…something goofy here with viewing posts.

Comment by A Concerned Citizen

February 29, 2016 @ 1:31 pm

What a pity to see our beloved Republic fail at the hands of those willing to lie and to prostitute America by utilizing personal server and those on both sides of the aisle failing to stand forthright for our Constitution….War looms ahead! God Bless America!

Comment by William R. Cumming

February 29, 2016 @ 3:28 pm

If Bernie campaign fails will Trump be the winner?

Comment by William R. Cumming

February 29, 2016 @ 3:31 pm

Thanks Tom for very informative comments. Scuttlebutt has it that the Zika Virus spreading fast as we head to summer months!

Comment by William R. Cumming

March 1, 2016 @ 7:48 am

Making and destroying civilizations!

Could you rank for me what the natural hazards are that might destroy a civilization?

My first choice would be drought and related desertification!

Comment by William R. Cumming

March 2, 2016 @ 6:11 am

Correction:By accident posted this comment on an unrelated post.

so added here:

In a move I missed Sam Clovis became a national Campaign Co-Chair for Donald Trump! This comment is not a political recommendation but if you don’t know Sam you should know and read what I believe is the Most Outstanding Article yet published on HS and federalism since 9/11/01! See link below:

https://www.hsaj.org/articles/163

Comment by William R. Cumming

March 2, 2016 @ 6:45 am

As many know I like to announce where I stand on a variety of policies and issues and yesterday voted for Senator Sanders in the Virginia Primary and He lost to HRC!

IMO he is NOT a Fabian Socialist!

Comment by William R. Cumming

March 2, 2016 @ 12:45 pm

Thanks to FEMA and Claire Rubin pointing it out this site great for researchers:

https://training.fema.gov/hiedu/highref.aspx

Comment by William R. Cumming

March 4, 2016 @ 5:18 am

Attention Researcher:

FEMA/EMI develped this link:

https://training.fema.gov/hiedu/highref.aspx

Comment by Vicki Campbell

March 4, 2016 @ 2:16 pm

okay, this is just a test to see if this post magically makes all the comments past 10 magically show up….

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