To assist with a catastrophic mass casualty incident in the United States and its territories - at the direction of the President - the Chairman of the Joint Chiefs of Staff or the appropriate Combatant Commander may deploy the CBRNE Consequence Management Response Force (CCMRF). The CCMRF is trained and equipped to provide a rapid response capability following a catastrophic event. Just as with all instances of Defense Support of Civil Authorities (DSCA), military forces respond only when requested. Requests always work their way up from the local level. After a major incident, city leaders will ask for county assistance; county asks for State assistance; the State Governor asks for Federal assistance from the President. If the President agrees, a Presidential Declaration of Disaster is declared. The Secretaries of Homeland Security, Defense, and other cabinet members meet and determine the best course of action. The SecDef may initiate activation of CCMRF units. State National Guard units are usually mobilized under the direction of the Governor and remain State assets, while CCMRF units are usually Title 10 under the direction of NORTHCOM, ARNORTH, and the Joint Task Force (JTF) Commander - or the Defense Coordinating Officer (DCO) if a JTF is not stood up. The CCMRF includes assets such as medical surge, chemical decontamination and biological detection that may be helpful to the victims of a catastrophic event. The CCMRF also includes communications, force protection, transportation, supply and maintenance assets that can be used to establish command and control capabilities to facilitate additional military and civilian resources into the affected area. Joint Doctrine for Civil Support notes, "DOD resources are normally used only when state and local resources are overwhelmed and/or non-DOD resources of the Federal government are insufficient or unable to meet the requirements of local and state civil authorities." This workbook focuses on domestic consequence management under the command of USNORTHCOM. The CCMRF mission is part of a broader Department of Defense (DOD) support package to the Lead Federal Agency (LFA), which is responsible for overall coordination of the response. The primary agency is responsible for overall coordination of the response. In many cases the primary agency is FEMA, but not always. In the case of many other emergencies the state government retains legal and operational leadership. Often, for these incidents, there is no need to establish a Joint Task Force, and the Defense Coordinating Officer remains the single point of contact for DoD. Other Federal agencies may also support the response - for example, the FBI may assist in collecting evidence - but the primary responsibility remains at the State or local level. There is also likely to be significant involvement in emergency response by local authorities, private organizations, and individual citizens. The legal, political, and operational implications can be complex. When the CCMRF is deployed, the event has overwhelmed local resources. If the event is perceived as having terrorist origins, the level of public concern will be especially high. Public concern, legal limitations, and the need to collaborate with a wide range of other players establish a challenging strategic context.

Parents have come to depend on vaccines to protect their children from a variety of diseases. Some evidence suggests, however, that vaccination against pertussis (whooping cough) and rubella (German measles) is, in a small number of cases, associated with increased risk of serious illness. This book examines the controversy over the evidence and offers a comprehensively documented assessment of the risk of illness following immunization with vaccines against pertussis and rubella. Based on extensive review of the evidence from epidemiologic studies, case histories, studies in animals, and other sources of information, the book examines: The relation of pertussis vaccines to a number of serious adverse events, including encephalopathy and other central nervous system disorders, sudden infant death syndrome, autism, Guillain-Barre syndrome, learning disabilities, and Reye syndrome. The relation of rubella vaccines to arthritis, various neuropathies, and thrombocytopenic purpura. The volume, which includes a description of the committee's methods for evaluating evidence and directions for future research, will be important reading for public health officials, pediatricians, researchers, and concerned parents. Table of Contents Front Matter 1 Executive Summary 2 Histories of Pertussis and Rubella Vaccines 3 Methodologic Considerations in Evaluating the Evidence 4 Evidence Concerning Pertussis Vaccines and Central Nervous System Disorders, Including Infantile Spasms, Hypsarrhythmia, Aseptic Meningitis, and Encephalopathy 5 Evidence Concerning Pertussis Vaccinces and Deaths Classified as Sudden Infant Death Syndrome (SIDS) 6 Evidence Concerning Pertussis Vaccines and Other Illnesses and Conditions 7 Evidence Concerning Rubella Vaccines and Arthritis, Radiculoneuritis, and Thrombocytopenic Purpura Afterword on Research Needs Bibliography Glossary of Terms Appendix A: Strategies for Gathering Information: Adverse Effects of Pertussis and Rubella Vaccines Appendix B: Pertussis and Rubella Vaccines: A Brief Chronology Appendix C: Animal Models for the Study of Whooping Cough and the Testing of Vaccine Materials Appendix D: Technical Details of Power Calculations and Meta-Analyses Appendix E: Possible Involvement of Aluminum Salts in Erythema Multiforme, Encephalopathy, or Other Adverse Events After Pertussis Immunization Appendix F: Committee and Staff Biographies Index