In the war with Iraq, it is the White House and the Pentagon that are holding center stage. But in the background, the Department of Veterans Affairs also has been preparing for armed conflict and its aftermath.
By the nature of its mission, the VA is not on the front lines. But the agency's sprawling health care system serves as the primary backup for the health care system run by the Defense Department and the military services. VA officials hope they will not be needed to help, but if the number of casualties returning from the Persian Gulf begins to put too much strain on military hospitals, VA facilities would be the first to take up the slack.
"You could see us make as many as 7,000 beds available," VA Deputy Secretary Leo Mackay said in an interview before the war began.
The VA is also the lead government agency in overseeing the National Disaster Medical System, a network of about 2,000 civilian hospitals across the country that have volunteered to help if a disaster overwhelmed the health care capacity of a local community. It could also be activated to care for war casualties if needed.
Kristi L. Koenig, director of the VA's emergency management strategic health care group, said the agency is doing more frequent monitoring of the civilian system so that it knows what resources are available in addition to VA hospitals.
"DOD doesn't give us a number and say be prepared to take so many casualties," she said. "We tell them how many we can take."
Speaking in an interview before the war was launched with Iraq, Koenig said the military services and the VA take a regional approach in deciding where military personnel returning from a war zone should be treated, attempting to place them in hospitals close to where their units are based.
If the military hospitals in a region became overwhelmed, VA hospitals in the region could take the overflow. And if both military and VA facilities become swamped, the civilian hospitals in that region that are part of the National Disaster Medical System become the third line of defense, she said.
U.S. casualties in the Persian Gulf War in 1991 were light, and there was no need to call on the VA for medical help. But unlike in 1991, the VA and other agencies are now also preparing for the possibility that this war will be brought home in more ways than the return of the wounded from the front lines.
"One of the things that's different is we have an increased concern for retaliatory strikes and are preparing for other roles such as terrorist attacks in the U.S.," Koenig said. This has led to "intense training" for VA personnel in some new areas, she said, including decontamination methods, the use of personal protection equipment, and testing and safeguarding of communications systems.
The VA has also tried to learn from the experience of the Gulf War and its aftermath. Numerous veterans of that conflict were later afflicted with a variety of ailments that, collectively, became known as Gulf War Syndrome, the cause of which has never been determined.
In the last two years, the VA has established two centers, in Washington and East Orange, N.J., to conduct research on war-related illnesses. Mackay said this was a direct outgrowth of the Gulf War.
The VA and the Pentagon are also trying to do a better of job of developing information on the health of service personnel before and after a deployment to a combat area such as the Persian Gulf region.
Mackay said the Defense Department has been doing a pre-deployment health screening and questionnaire before troops ship out to the Gulf and will do the same when they return, sharing the information with the VA because that agency will inherit the long-term health care responsibility for the veterans.
"There is a real commitment to do it differently this time," he said.
One great unknown still is whether Iraq will unleash chemical or biological weapons on U.S. forces. VA officials would not discuss this aspect of their planning in any detail, but Mackay said they are in "constant communications" with the Pentagon "about what kind of casualties that may occur and that includes talk about chemical and biological injuries."