The Joint Task Force National Capital Medicine (JTF Cap Med) recently completed medical support for the 57th Presidential Inauguration, involving hundreds of medical professionals providing health care and preventive services to thousands of military and civilian participants and hundreds of thousands of onlookers. Since the president, key members of government, and Washington DC itself are high profile targets, planners developed a careful intelligence estimate for the event. Military personnel in combat service support roles such as quartermaster, finance, chaplain and medical sometimes do not understand the importance of such estimates. In other cases we do not consider the breadth of threats to military operations such as the Inauguration.
Army Field Manual (FM) 2.0 (March 2010), titled Intelligence, described intelligence as “the product resulting from the collection, processing, integration, evaluation, analysis, and interpretation of available information concerning foreign nations, hostile or potentially hostile forces or elements, or areas of actual or potential operations.” Threat can be globally defined as “the intention to inflict pain, injury, damage or some other hostile action.”
Leaders in every realm must be aware of the world around them, because they must lead their organization in their current environment to accomplish their mission. Medical personnel, attuned to the most subtle changes in their patients, are sometimes surprisingly naïve about changes in their environment, and slow to change their actions as a result. Military medical leaders, just as leaders in other areas, must be aware of the various types of threats and must help defeat them.
1. Cyber Threat – As electronic health records and other media grow more important in the practice of medicine, and as privacy concerns mount, military medical personnel must take personal responsibility for the information security of their staff and patients and the integrity of their part of the information network.
2. Foreign Intelligence and Security Services Threat – Intelligence services from adversaries such as Iran, Russia and China routinely try to gain information from US computer networks. Robert Hanssen was an agent with the Federal Bureau of Investigation but spied for the Soviet Union and Russia from 1979-2001. His treachery resulted in the deaths of many in the USSR. However even intelligence services from friendly nations such as Israel try to gain access to US secrets. Jonathan Pollard worked for US Navy intelligence but clandestinely spied for Israel.
3. Domestic Threat – Americans can be just as dangerous to Americans as foreigners. Timothy McVeigh killed 168 people in the bombing in Oklahoma City in April 1995. In December 2012 Adam Lanza massacred 20 kindergarteners and six staff at the Sandy Hook Elementary School in Connecticut. Army Major Nidal Malik Hasan, an American Islamist radical, killed 13 people in Fort Hood, Texas in 2009.
4. Criminal Threat – Criminal threats and domestic threats such as those mentioned above can overlap markedly, but even lesser criminal threats can cause great mischief. Computers containing patient information have been stolen from the cars of government workers, compromising both the workers and the system as a whole.
5. International Terrorist Threat – Lone actors such as Lanza and Hasan can cause great harm, but organized terrorists such as the Al Qaeda network, infamous for the attacks of 11 September 2001, can cause widespread catastrophes. Groups such as the Kurdistan Workers Party and Hamas are other examples.
6. Medical Threat – Diseases such as influenza comprise a major threat to any military operation. Arguably disease, even more than the actions of armies, has shaped world history. Had the Plague of Justinian (541-750 AD) not destroyed half of the population of the Iberian Peninsula between 707 and 709 AD, the Muslim Arabs may never have been able to conquer it. There is ample historical evidence of the impact of European diseases on Native Americans in the 15th through 18th centuries.
7. Natural Hazards – Earthquakes, floods, hurricanes, and other natural events have changed the course of history as well. Kublai Khan’s Mongol invasions of Japan in 1274 and 1281 were dispersed by typhoons, thus saving the islands and giving rise to the name Kamikaze (“God wind”) of World War II infamy. Many Biblical battles, such as the fall of Jericho, cite natural events in explaining the outcome.
8. Chemical, Biological, Radiological and Nuclear Threats (CBRN) – Chemical weapons have been around since Achilles was killed by poison on a Trojan arrow. Biological agents such as anthrax and smallpox, chemical agents such as Soman and Tabun, and nuclear weapons are capable of vast harm.
9. Lawful Demonstrations – Demonstrations are not necessarily bad; soldiers fight every day for American’s right to peaceful protest, but they can cause harm to people and damage to the military mission. Protests can become violent, and service members, representing the “Establishment”, are too often targets.
Military medical personnel, just like chaplains, lawyers, and other warriors who don’t perceive themselves to be immediately in harm’s way, can often underestimate or even ignore the wide variety of threats that they face. Though an Army doctor with the rank of lieutenant colonel may see himself as a doctor, enemies of the US see him as a high ranking soldier and a high value target. As such, every warrior, no matter what branch, must take intelligence threats seriously. Leaders must do so, and must ensure that those they lead do as well.