Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Aspects of Chemical WarfareProjections for the Future of Chemical Casualty managementThe historical key to the success of managingchemical casualties has unfortunately been hands-onexperience. Today’s military medical community hasno residency or specialty training in disaster or terrormedicine other than that offered at the US Army MedicalResearch Institute of Chemical Defense. LieutenantColonel Edward Vedder’s “course for medical officers”has evolved into comprehensive training for all facetsof the US government and allied countries as well.Modern audiovisual technologies now bring trainingto the battlefield. When communication elementssupport it, an organizational interface with medicaland chemical experts in personnel, intelligence, operations,research, and logistics can provide “reach-back”capabilities for combat decision-makers and their staffs(Figure 3-19). The potential for a trained and confidentchemical casualty manager exists if command is willingto engage.As demand for specialty training increases, the medicalcommunity must modify its organization to encompasschemical casualty managers. Educational communitiesmust consider providing residency in specialtiesincluding disaster or terror medicine and subspecialtiesthat address the spectrum of chemical casualty management.As long as soldiers are unprepared to managechemical casualties, sources with the capability to usechemical weapons will engage those capabilities to theirbest strategic and tactical advantage.SUMMARYCombatants respond to a current war in the mannerin which they conducted the previous one. In termsof employing medical assets on a chemical battlefield,World War I saw units on both sides of the battlefieldperforming reactively rather than proactively. After allthe lessons learned in World War I, the chemical casualtiesof the Bari disaster found themselves medicallymanaged by physicians who were still unable to meetthe minimum standard of care for chemical casualties.After World War II, the fate of the chemical casualtyfell into the hands of medical personnel untrained inthe appropriate medical management. This disconnectamong experts in chemical warfare, military medicine,and military personnel must be addressed so thatcasualties on the chemical battlefield have the servicesupport system that yields the greatest chance for success.Today, when terrorists are sufficiently organizedto bring chemicals to the home front, base hospitals,military medical centers, and other medical treatmentfacilities must be competently prepared for chemicalcasualties.Lieutenant Colonel Vedder studied with medicalhistorian Richard Shryock, who suggested that allsciences must pass through stages of development.Vedder said of Shryock:Fig. 3-19. This poster from World War I was designed toencourage enthusiasm for quality assurance among womenwho manufactured protective masks.Reproduced from: Pictorial History, Gas Defense Division,Chemical Warfare Service. Vol 5. Edgewood Historical Files.Located at: Chemical and Biological Defense CommandHistorical Research and Response Team, Aberdeen ProvingGround, Md.In his landmark work, The Development of ModernMedicine, Shryock postulates that all sciences, includingmedicine, must pass through four stages ofdevelopment. The first is a period of minimal observationand maximal theoretical synthesis. The secondis an early attempt at objectivity and measurement.The third stage sees a partial lapse of quantitativeprocedures due to unforeseen difficulties, while thefourth is a revival of such procedures with “a finalvictory for modern technology.”108