An ethnographic perspective of CMM, CMO, and NSS interrelated to geography, geopolitics, and globalization

1. Organized Chaos: Civil-Military
Medicine (CMM), Civil-Military
Operations (CMO), and National
Security Strategy (NSS)
University of Central Missouri (UCMO)
Homeland Security Conference March 2010:
Global and Domestic Perspectives
Presentation made for academic purposes only. Originally started with research paper entitled:
“Civil-Military Medicine (CMM), Civil-Military Operations (CMO), and National Security Strategy
(NSS) : An ethnographic study about cosmopolitanism, Geographic Information Science (GIS), and
a lifecycle framework to compare Tactics, Techniques, and Procedures (TTPs)”
By Ralph R. Stanton, Jr.
ACHE, M.A. Emergency & Disaster Management
For questions or comments, contact author at: ralph.stanton@thi-terra.com

2. Agenda: Circa (ca.) 50 Minutes (:50)
Part I (7-10 minutes) Introduction
• References
• Research Questions
• About the author:
– Citizen-Soldier
– Healthcare Consultant
Rod of Aesclepius (top left) and the
– Medical Service Corps (MSC) Officer Caduceus (bottom left) are associated
• Introduction: “Organized Chaos” with some of today’s civilian symbols
(top right) in the vein of Emergency
• Questions and Answers (Q&A) Medical Service (EMS) and military
symbols (bottom right) of Health
Part II (7 minutes) Designing the Solution Service Support (HSS) such as the U.S.
Army Medical Department (AMEDD)
• MASCAL Situation Medical Service Corps (MSC) Officers.
• Moderating Variables
• Output Variables
Part III (3-30 minutes)
• Executive Summary
• Q&A

3. References
Open-Source Intelligence (OSINT) & Public Information
• Author’s Research Paper: • Additional Questions, Contact
Title: “Civil-Military Medicine (CMM), Civil-Military
–
Operations (CMO), and National Security Strategy Author at:
(NSS)”
– Subtitled: “An ethnographic study about
– Ralph.stanton@thi-terra.com
cosmopolitanism, Geographic Information Science – (910) 263-1195
(GIS), and a lifecycle framework to compare Tactics,
Techniques, and Procedures (TTPs)” • Additional References/Suggested
– (Draft): 31 January 2010. Readings:
Author’s Poster Presentation and Research
– “
Paper to United Nations: – Basic Writings of Kant (1781-1794/
– Stanton, R. (2008, August). Project La Mancha. Poster trans. 2001)
session presented at the International Disaster and – Chaos: Making of a New Science
Risk Conference: IDRC Davos 2008.
– Stanton, R. R. (2008). Project La Mancha: Leaders
(James Gleick, 1987)
should incorporate Creative Marginalization into – Collapse (Jared Diamond, 2005)
Emergency and Disaster Management Theory to
bridge the chaos and culture of a postmodern – Take the Risk (Ben Carson, 2008)
community. In W. J. Ammann, M. Poll, E. Häkkinen, & – The Essence of Chaos (Edward
G. Hoffer (Eds.), International Disaster Risk
Conference (IDRC) Davos 2008: Short Abstracts (p. Lorenz, 1993)
344). Davos Dorf, Switzerland: GRF Davos. – The Production of Space (Henri
• This Presentation: Lefevbre 1974/1991 trans. )
– Google Images, MS Clip Art and
– Some works from internet including: – What is a Disaster? New Answers to
http://www.army.mil/-news/2010/01/15/32976-military- Old Questions (ed. Ron W. Perry &
working-feverishly-to-help-haiti/index.html E.L. (Henry) Quarantelli, 2005)
http://media.ft.com/cms/e50cbb40-0027-11df-8626-
00144feabdc0.jpg
http://understandingkatrina.ssrc.org/Quarantelli/

4. Research Questions:
American Geography & Leadership
What is America? (Epistemology) How is geography (faces, paces, places)
Who is an American? (Geography) linked Homeland Security? Leadership?
• American values, vices, virtues: • Face: Personal & Organizational
Relationships (Homeland)
– Economic Factors (Conservative,
• Pace: Emergence of leaders
Liberal) associated with Time (History) &
– Environmental Factors Technology (Security)
– Social Factors – Text
– Trade
• Being American is Geography: – Tools
– face (ethnicity, family, race, etc.) – Travel
– pace (birth, immigration, etc.) • Place: Revolutionary Leadership
– place (North, South, etc.) – Good (Positive Outcome)
– Bad (Negative Outcome)
– Ugly (Uncertain Outcome)

5. About the Author: Citizen-Soldier
Healthcare Consultant & Director of Logistics
TerraHealth, Inc. (THI) 228th US Army Reserve (USAR)
“Your Global Solutions Partner” Combat Support Hospital (CSH)
Education: M.A. Emergency & Disaster Management, B.A. Geography & Spanish, CPT, MS, USAR
Erudition: Self-studies from family & friends, eclectic book club in TX, anthropological (African,
Asian, European, Latin American, and Middle Eastern) studies associated with world travels
Experience: Born in Panama Canal Zone (patría); Hometown: Fayetteville/Fort Bragg, NC (país); and
presented to members of the UN (United Nations) at the Davos 2008 Global Risk Forum (GRF)

6. My highlights as a Medical
Service Corps (MSC) Officer:
• 82nd Airborne Division, Paratrooper and Platoon Leader (2000-2);
• European Regional Medical Command, Healthcare Executive (2002-4);
• Civil Affairs (CA) Operations for reconstruction efforts in Baghdad, Iraq (2006-7);
• Director (S-4) Medical Logistics of USAR Combat Support Hospital (2009-Present)

7. For instance, the 82nd Airborne (left) was called when catastrophe struck Haiti (right).
Previously, the United Nations (UN) was performing a peacekeeping mission after a
bloody rebellion. This earthquake trapped peacekeepers and more military intervention
was required to improve survival rates of the local national (LN) population. Today, Haiti
is still in a state of chaos; albeit a little more organized.
These photographs (fotos) taken from (foto left): http://www.army.mil/-news/2010/01/15/32976-military-working-feverishly-to-help-haiti/index.html
And (foto right): http://media.ft.com/cms/e50cbb40-0027-11df-8626-00144feabdc0.jpg

8. Introduction: Organized Chaos
Input Variables: Organized Chaos Output Variables includes:
• Cosmopolitanism (dualism) to raise • Civil-Military Medicine (CMM)
consciousness of Geography – Citizen-Soldier, ACHE, M.A., B.A.
– Faces (personal & population) – Healthcare Consultant
– Paces (time & technology) – Medical Service Corps (MSC) Officer
– Places (institutional & physical) • Civil-Military Operations (CMO),
• Geographic Information Science 38A, Civil Affairs (CA) trained in:
(GIS) to assess (geopolitics, hazards, – Populace and Resource Control (PRC)
and risks) associated with ASCOPE: – Foreign Humanitarian Assistance
– Area, Structures (FHA)
– Capabilities, Organizations – Civil Information Management (CIM)
– Persons, Events – Nation Assistance (NA)
• Lifecycle framework to evaluate the – Support to Civil Administration (SCA)
the effects of Globalization • National Security Strategy (NSS)
interrelated to: – Military Tactics, Techniques,
– Economic Factors Procedures (TTPs)
– Environmental Factors – National Response Framework (NRF)
– Social Factors – Various Scenarios, Stakeholders, and
Systems associated with Civil
Defense, Emergency Management,
and Homeland Security

9. “Organized Chaos”: Definition
Between art and science; substance is form and content
“Organized” Dualism of individual and “Chaos” is the third period (time)
group relationships (psychosocial) linked to a when a behavior (act) increases the
Triad (geospatial) of Formal, Informal, and parameter (flow) into systemic instability
Technical (FIT) Communications (Culture) (uncertainty)
Metamorphosis of Narcissus (1937) Salvador Dalí presented this surreal work of art to Sigmund Freud, demonstrating his understanding of
psychoanalysis. Similarly, individual reflection may be a detrimental transformation towards “CHAOS” (right, 2007) if the behavior is a vain reflection of
individual acts that flows into various economic, environmental, or social factors.

10. Organized Chaos: Communication
Good, Bad, Ugly of Chaos: Communication Crisis Response
Convergence, Divergence, Emergence Improvisation (Factors)
Economic Factors (Geography)
• Communication: Crisis (3) •Epidemiology (Geography): Faces, Paces, Places
•Epistemology (Knowledge): Nature and Philosophy
Convergence (1): Organized
to understand Good, Bad, and Ugly of Geography
• •Etiology (Values): Qualitative and Quantitative
Measures between variance of vices and virtues
Divergence (2): Split to Chaos
• Products, Projects, Purposes, Services, Teams
•
• Emergence (4): Systemic Environmental Factors (Geopolitics)
• Chaos: Disruption (Positive/Negative Outcomes),
• Improvisation: Variance Instability, and Uncertainty (variance)
• Civil Considerations of ASCOPE (Areas, Structures,
Capabilities, Organizations, Persons, and Events)
(Factors) • Hazards and Risks linked to Anthropogenic Factors:
Climate Change, Commerce, Competition (Conflict),
Consumption (Convenience), Crisis (Culture)
Social Factors (Globalization) is the
multifaceted complexity of various:
• Scenarios (Organizational and Personal)
• Stakeholders (Non-profit, Private, Public Sectors)
• Systems associated with ASCOPE and phases of
mitigation, preparedness, response, and recovery
that includes: Civil Defense, Emergency
Management, and Homeland Security

11. Organized Chaos: Critical Thinking
Developing a chaotic framework for Macro (Catastrophe) and
Micro (Crisis) Levels of Preparedness and Scenario-planning
• A catastrophe is different than a
disaster (military intervention, press
conferences, social media, etc.)
• Disaster recovery requires a multi-
organizational response (i.e. National
Response Framework replaced NRP)
• Emergency management is linked to
several scenarios, stakeholders, and
systems in a local community
• Crisis planning occurs at the
individual and organizational levels
(convergence, divergence, and
emergence still applies)
Refer to Works of E.L. (Henry) Quarantelli and
other scholars in What is a Disaster? (2005)
http://understandingkatrina.ssrc.org/Quarantelli/

12. Organized Chaos:
Thoughts to compare a “Catastrophe” with a “Crisis”
Catastrophe (Think Haiti) Crisis (Think Toyota)
• Communications (Civil Defense) • Communications (Crisis)
– Mass Casualty (MASCAL) > 900K affected? – <100 isolated deaths & injuries?
– Dealing with Media (Mass) – Dealing with Media (Social)
– Stakeholders: Internal (Intelligence) / – Stakeholders: Internal (Key Messages)/
External (Information) / Global GOs, NGOs External (PR)/ International (Private)
– Common Q: Who’s in charge? (Haiti is a – Common Q: Who’s on first? (press
sovereign nation; UN, DoS, DoD, etc.) conference, TV commercials, etc.)
– A: Everyone & no one; hence catastrophe. – A: Spokespersons (actors, CEO, VPs, etc.)
• Crisis (Emergency Management) • Crisis (Product Recall)
– Hazards and risks are interrelated to – Hazards and risks are directly related to
geography, geopolitics, and globalization the organizational relationships
– Locals required military intervention – Gaps in products and services (P&S)
– Global logistics converged into domain – Major and minor changes to P&S Lifecycle
• Critical Thinking (Homeland Security) • Critical Thinking (Cosmopolitanism)
– Civil-Military Medicine (CMM) – Toyota had World Citizenship?
– Civil-Military Operations (CMO) – GIS technology for product recall?
– National Security Strategy (NSS) – Lifecycle framework of P&S revised?

13. Organized Chaos: MASCAL
(Mass Casualty) Situation
How do you define MASCAL? Geography: Faces, Paces, Places
• Epidemiology: Art and Science • MASCAL (Mass casualty) Scenario:
• Faces: Cohorts, Population,
• Epistemology: What is a Stakeholders (Internal/External)
catastrophe? Disaster? • Paces: TTPs & Strategy
Emergency? Crisis? – Tactics (Force structure)
• Etiology (Causes, Survival): – Techniques (Improvisation)
– Procedures (Prescribed steps)
– Convergence: Crisis response
– Strategy (Knowledge, Wisdom)
DART (domain, activity,
resources, and tasks) • System (JP 1-02, p.534):
– “A functionally, physically, and/or
– Divergence: Creativity, critical behaviorally related group of
thinking, and improvisation – regularly interacting or interdependent
– Emergence: New scenarios, elements;
stakeholders, and systems – that group of elements forming a
unified whole.”

14. Organized Chaos:
MASCAL Scenario, Stakeholders, and Systems
Convergence (DART), Divergence (Split), Emergence
Organizational
TTPs
Econ. Env. Soc.
Personal Econ. Env. Soc.
Improvisation
(Laypersons*)
Casualty — Any person who is lost to the organization by having been declared dead, duty status – whereabouts unknown, missing, ill, or injured (JP 1-02, 2001, p. 79).
*Layperson: First responders that are non-clinical (by credentials, occupation, or professional requirements). For instance, bystander (non-EMT) caring for/evacuating casualty
Mass casualty (MASCAL) — Any large number of casualties produced in a relatively short period of time, usually as the result of a single incident such as a military aircraft
accident, hurricane, flood, earthquake, or armed attack that exceeds local logistic support capabilities (JP 1-02, 2001, p. 333).

15. Questions and Answers (Q&A)?
Answers: Art, Math, & Science
Topological Detachment of Europe–Homage to
Questions? René Thom (1983) from Salvador Dalí’s final
series of paintings: “The Swallow’s Tail – Series
on Catastrophes”

16. Designing a Solution
Input Variables: Cosmopolitanism, GIS, and
Lifecycle Framework
• Cosmopolitanism is a concept of world
citizenship by raising consciousness of geography
(Faces, Paces, Places)
• Geographic Information Science (GIS) is a tool to
assess the economic, environmental, and social
factors of geopolitics (ASCOPE)
• Lifecycle Framework evaluates the economic,
environmental, and social factors associated with
globalization (products, projects, services, teams)

17. Designing a Solution:
Moderating Variables of Geography, Geopolitics,
Globalization
• Geography (Faces, Paces, Places) is not mapmaking (cartography).
• Geopolitics is usually defined by historians, political scientists, and
other pundits instead of the local people affected by foreign policy.
• Globalization is the good, bad, and ugly of technology (advances in
text, trade, tools, and travel).
• For instance:
– Geospatial technology (social media) helps to produce imagery (maps)
about geography; but
– Geopolitics (geography, history, politics) is hard to define in 144
characters or less; especially when
– Economic, environmental, and social factors are linked to
globalization; and
– Globalization is impacted by a triad of formal, informal, and technical
(FIT) communications associated with institutional technology

18. Designing a Solution:
Output Variables: Local Improvisation (Strategy and
TTPs) may require Military Intervention (CMM, CMO, NSS)
when catastrophe or crisis produces casualties
Local Improvisation linked to: Military Intervention includes:
• Strategy- A prudent idea or set • Civil-Military Medicine (CMM)
Medical Emergency Preparedness & Response
of ideas (knowledge) –
– Pandemic Influenza Preparedness
• Tactics-The employment and – Homeland Defense & Civil Support
– Coalition & Non-DoD Beneficiary Health Care
ordered arrangement of forces
• Civil-Military Operations (CMO)
in relation to each other – Populace and Resource Control (PRC)
• Techniques-Non-prescriptive –
–
Foreign Humanitarian Assistance (FHA)
Civil Information Management (CIM)
ways or methods used to – Nation Assistance (NA)
perform missions, functions, – Support to Civil Administration (SCA)
or tasks • National Security Strategy (NSS) and
U.S. Code (USC) Title 10 - Armed
• Procedures-Standard, detailed Forces defines military intervention
steps that prescribe how to – Civil Defense
Emergency Management
perform specific tasks. –
– Homeland Security

19. Definitions: Cosmopolitanism
Raising consciousness of Geography, Geopolitics,
Globalization, Hazards, and Risks with:
• Education (Form) of Geography (Faces, Paces,
Places) to raise consciousness of World
Citizenship (Where will you sit?)
• Facilitation of Hazards and Risks via a
discussion of organizational and personal:
– Economic Factors
– Environmental Factors
– Social Factors
• Reflection of Geopolitics to introduce
Geographic Information Science (GIS) associated
with ASCOPE:
– Area
– Structures
– Capabilities
– Organizations
– Persons
– Events
• Transformation Globalization & Lifecycle
Framework towards World Citizenship

20. Desired Outcome #1:
Cosmopolitanism to understand Hazards, Risks and
Spatial Relationships: Geography’s Faces, Paces, Places?
“Geography is the mother-load of sciences.”
-Kenneth C. Davis, author of Don’t‘ Know
Much about Geography (1992)
“Imagination is more important than knowledge.”
Albert Einstein, Ph.D., Physics
“Your brain can take in 2 million bits of information per
second.” – Ben Carson, M.D., Dir. Pediatric Neurosurgery
Brain Surgeon & Author of: Take the Risk (2008)

21. Desired Outcome #2
Develop Geographic Information Science (GIS) technology for:
Civil Defense, Emergency Management, & Homeland Security
GIS 2008: Earthquake in China GIS 2004: OIF, Baghdad, Iraq

22. Designing “Civil Defense”
JP 1-02 (amended Aug 2009)
Foto (right) taken by Ruth Fremson, NY Times:
“Haiti’s Poverty Stirs Nostalgia for Old Ghosts”
By Marc Lacey, March 23, 2008
http://www.nytimes.com/2008/03/23/world/americas/23haiti.html
History of Homeland Security
commenced with: “Civil Defense”
and this includes all those
activities and measures designed
or undertaken to:
– a. minimize the effects upon the
civilian population caused or
which would be caused by an • Civil Affairs (CA)
enemy attack on the United
States; • Civil Affairs (CA) Activities
– b. deal with the immediate • Civil-Military Medicine (CMM)
emergency conditions that would
be created by any such attack; • Civil-Military Operations (CMO)
and • Civil Support
– c. effectuate emergency repairs • Humanitarian and civic assistance (HCA)
to, or the emergency restoration
of, vital utilities and facilities • Humanitarian Assistance (HA)
destroyed or damaged by any • National Security Strategy (NSS)
such attack.

23. Designing Emergency Management
Mitigation, Preparedness, Response, Recovery
5 Disciplines of Emergency
Management:
• Communication
• Mitigation
Faces
• Preparedness
• Response Places
Paces
• Recovery

24. Designing Homeland Security
Global (Emergency Management) and Domestic
(National Response Framework) Perspectives

25. Desired Outcome #3
Lifecycle Framework to discuss performance of products,
projects, services, and teams before crisis strikes

26. Designing the Solution:
Four Steps to World Citizenship
1. Americans unite to reduce migration, standardize mitigation
(landscape sustainability and reduction of CO2 emissions) by
creating infrastructure projects throughout the Western
Hemisphere (North, Central, and South America)
2. Civil-Military Medicine (CMM) supports transnational security
relative to geographical outbreaks of manmade and natural
hazards associated with civil support and emergency management
3. Civil-Military Operations (CMO) protects a Transparent Democracy
of Regional Homeland Security by evaluating economic,
environmental, and social factors with Geographic Information
Science (GIS) to prioritize urban development initiatives
4. National Security Strategy (NSS) transforms Organization of
American States (OAS) closer to World Citizenship to equally
protect life and property with a functional legal, medical, and
trade system to protect international tourism and reduce effects
of geopolitics and globalization

27. Designing the Solution:
GIS and a Lifecycle Framework are tools to improve
geographic education linked to global and domestic activity
Operation Iraqi Freedom (OIF) Emergency Management

28. Executive Summary (Paper)
Conclusion (144 characters or less): Military Health System needs cosmopolitanism, GIS, and a
lifecycle framework to improve the outcomes of civil support and emergency management.
• Author’s Preface, Abstract, and Additional • Problem:
Information (p.1-3): – Essentially, when a catastrophe strikes
– A reader should not expect this paper to be a – civil support requires military intervention
and cultural awareness;
simple text, or an all-encompassing TWEET!
– but there is an existential difference between
– It is only a glimpse of reality. effective and efficient TTPs.
• Hypothesis: • Research Questions:
– Cosmopolitanism, GIS, and a Lifecycle – How does the MASCAL scenario help to
explore the essential and existential problems
Framework (independent variables) will of emergency management?
improve – Who are the stakeholders when catastrophe
– CMM, CMO, and NSS (dependent variables) strikes?
associated – Why do we need cosmopolitanism, GIS, and a
lifecycle framework to improve TTPs?
– with geography, geopolitics, and globalization
• Review of Professional Literature:
(confounding variables)
– I. Introduction: An ethnographic perspective
– when TTPs (Tactics, Techniques, Procedures) (observer/participant) to define the problem
are linked to emergency management. – II. Cosmopolitanism, Civil-Military Medicine
• Null Hypothesis: (CMM), Geography
– III. Geographic Information Science (GIS),
– Civil support (domestic) and international Civil-Military Operations (CMO), Geopolitics
emergency management Triumphs (successful – IV. Lifecycle Framework, National Security
outcomes) and Strategy (NSS), and Globalization
– Disasters (unsuccessful outcomes) are not – V. Summary: Various outcomes between
effected by MHS (Military Health System). Triumphs and Disasters

29. Executive Summary (Presentation):
Live, Love, Learn, Leave a Legacy . . .
With: Education, Facilitation, Reflection, and
Transformation.

30. Questions and Answers (Q&A)?
Answers: Art, Math, & Science
Topological Detachment of Europe–Homage to
Questions? René Thom (1983) from Salvador Dalí’s final
series of paintings: “The Swallow’s Tail – Series
on Catastrophes”