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: The fifteen National Planning Scenarios depict the broad range of natural and man-made threats facing our nation. Several of which, would significantly exceed our ability to respond. In any large scale disaster, key components of the already stressed civilian healthcare system will be overwhelmed. As occurs during battlefield mass casualty events; patient evacuation, emergency, surgical and critical care assets are most rapidly and frequently overwhelmed. American hospitals and emergency medical services have, by fiscal necessity, eliminated almost all excess capacity in the system. In the event of a large, no notice disaster the ability to rapidly respond with critical medical capabilities will save lives and reduce human suffering. As America's resident "911" military response force, the National Guard will surely respond to the call for assistance. The National Guard has undergone a significant change over the past several years. The Guard has moved from the strategic to an operational reserve of the Department of Defense. Although the Guard has long history of responding to domestic disasters of all types, events of the past decade have made clear that our efforts must be more coordinated and synchronized. Under the guiding principles of the National Response Framework, the local, state and federal response must be well integrated both horizontally and vertically. It is well understood in response planning that the local, state and immediate regional capabilities will bear the full burden of a disaster for the first 48 to 72 hours before federal assets begin to arrive in significant strength. It is therefore necessary that the NG response be rapid, robust and be structured to serve as the nucleus upon which to build follow on military medical assets. To accomplish this, the National Guard must organize and employ its medical capabilities using more current and efficient doctrinal techniques.

Integration of National Guard Medical Capabilities During Domestic Disasters: Developing the Synergies