Koenig Kristi L
Emergency Management Strategic Healthcare Group, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA.
Prehosp Disaster Med. 2003 Oct-Dec;18(4):327-33. doi: 10.1017/s1049023x0000128x.
The terrorist attacks of 11 September 2001 led to the largest US Government transformation since the formation of the Department of Defense following World War II. More than 22 different agencies, in whole or in part, and >170,000 employees were reorganized to form a new Cabinet-level Department of Homeland Security (DHS), with the primary mission to protect the American homeland. Legislation enacted in November 2002 transferred the entire Federal Emergency Management Agency and several Department of Health and Human Services (HHS) assets to DHS, including the Office of Emergency Response, and oversight for the National Disaster Medical System, Strategic National Stockpile, and Metropolitan Medical Response System. This created a potential separation of "health" and "medical" assets between the DHS and HHS. A subsequent presidential directive mandated the development of a National Incident Management System and an all-hazard National Response Plan. While no Department of Veterans Affairs (VA) assets were targeted for transfer, the VA remains the largest integrated healthcare system in the nation with important support roles in homeland security that complement its primary mission to provide care to veterans. The Emergency Management Strategic Healthcare Group (EMSHG) within the VA's medical component, the Veteran Health Administration (VHA), is the executive agent for the VA's Fourth Mission, emergency management. In addition to providing comprehensive emergency management services to the VA, the EMSHG coordinates medical back-up to the Department of Defense, and assists the public via the National Disaster Medical System and the National Response Plan. This article describes the VA's role in homeland security and disasters, and provides an overview of the ongoing organizational and operational changes introduced by the formation of the new DHS. Challenges and opportunities for public health are highlighted.
2001年9月11日的恐怖袭击导致了自第二次世界大战后国防部成立以来美国政府最大规模的变革。超过22个不同机构，全部或部分，以及超过170,000名员工进行了重组，以组建一个新的内阁级国土安全部（DHS），其主要任务是保护美国本土。2002年11月颁布的立法将整个联邦紧急事务管理局以及卫生与公众服务部（HHS）的若干资产转移至国土安全部，包括应急响应办公室，以及对国家灾难医疗系统、国家战略储备和大都市医疗响应系统的监管权。这造成了国土安全部与卫生与公众服务部之间“健康”和“医疗”资产的潜在分离。随后的一项总统指令要求制定国家 incident 管理系统和全灾害国家响应计划。虽然退伍军人事务部（VA）的资产没有被列为转移对象，但退伍军人事务部仍然是美国最大的综合医疗系统，在国土安全中发挥着重要的支持作用，这补充了其为退伍军人提供护理的主要任务。退伍军人事务部医疗组成部分退伍军人健康管理局（VHA）内的应急管理战略医疗小组（EMSHG）是退伍军人事务部第四项任务——应急管理的执行机构。除了为退伍军人事务部提供全面的应急管理服务外，应急管理战略医疗小组还协调向国防部提供医疗后援，并通过国家灾难医疗系统和国家响应计划协助公众。本文描述了退伍军人事务部在国土安全和灾害中的作用，并概述了新成立的国土安全部所带来的持续组织和运营变革。强调了公共卫生面临的挑战和机遇。
