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

Occupational Health and the Chemical Surety Mission• recognition of hazards involved in the operation;• recognition of signs and symptoms of agentexposure;• administration of first aid and self/buddy aid,including CPR;• knowledge of personnel decontaminatingprocedures;• execution of emergency procedures; and• donning and doffing of protective clothingand equipment (such as self-contained breathingapparatus).Refresher training should be conducted at leastannually, and the IMA must review and approve thecourses’ contents and the training personnel.Training programs may focus on chemical warfareagents, but they should also address any additionalphysical and chemical hazards. One example of thesehazards is heat stress caused by wearing butyl protectivegear, as discussed earlier in this chapter. The levelof training should be commensurate with employees’job functions and responsibilities. When feasible, thetraining program should consist of both classroominstruction and hands-on practice. Dry runs of operationaland emergency procedures are often an effectivetraining tool.During training, emphasis must be given to thefirst rule of protection—to protect oneself from injury.Workers should also know the procedure for requestingmedical assistance and should be aware of anypredetermined format for reporting emergencies thatwill expedite the report and response time. Teachingemployees a logical system in which to present thisinformation is extremely helpful. Their reports shouldinclude the nature of the accident or incident as well aswhat has been done for the victims (for example, thenumber of Mark I kits [Meridian Medical TechnologiesInc, Bristol, Tenn] administered). Support personnelcan request additional information as the situationprogresses. The installation will greatly benefit fromactive involvement of the IMA and clinic staff in thistraining.MEDICAL SUPPORT OF THE CHEMICAL PERSONNEL RELIABILITY PROGRAMThe CPRP is a management tool used within theArmy to identify chemical surety duty positions andto manage the personnel assigned to these positions, asdiscussed earlier. It also provides a way to assess the reliabilityand acceptability of employees who are beingconsidered for or assigned to chemical duty positions.The program was established to ensure that personnelassigned to positions involving access to, orresponsibility for, the security of chemical surety materialare emotionally stable, loyal to the United States,trustworthy, and physically fit to perform assignedduties. The certifying official is the commander’srepresentative for the CPRP and is ultimately responsiblefor its administration. This official, with inputfrom the personnel officer and medical personnel,decides whether to qualify or disqualify personnelfor CPRP duties. He or she must also help determinethe appropriate medical surveillance category for eachworker (see above) based on the worker’s potentialfor exposure.During each part of the screening process, evaluatorslook for evidence of potentially disqualifyingfactors that may affect personnel reliability or suitabilityfor CPRP duties. Disqualifying factors of medicalrelevance include alcohol abuse, drug abuse, inabilityto wear protective clothing and equipment requiredby the assigned position, or any significant physicalor mental condition that might be prejudicial to thereliable performance of CPRP duties.The examining physician must notify the certifyingofficial orally and in writing of any medical conditions,including the use of any prescribed medications, thatmay detract from an individual’s ability to performassigned chemical surety duties. In addition, thephysician must provide a recommendation on the employee’ssuitability to continue CPRP duties. Informationthat may affect reliability is referred to as potentialdisqualifying information. These communicationsshould be documented on Standard Form 600. As in allhealthcare, documentation is extremely important and,in this case, subject to examination during a chemicalsurety inspection (Exhibit 18-3).Simply supplying a diagnosis or excerpt from themedical record is not enough to enable the certifyingofficial to make an informed decision; the competentmedical authority must provide a sound medical interpretationand recommendation. The recommendationand supporting documents must be succinct anddecisive, and should also note any lack of potentialdisqualifying information. The recommendationshould state one of the following: (a) no restriction,(b) restrictions or limitations on duties, (c) temporarydisqualification, or (d) permanent disqualification. Potentiallydisqualifying information must be providedin a sealed envelope marked “EXCLUSIVE FOR” thecertifying official. Temporarily disqualified personnelremain in the CPRP, and their medical records mustbe treated in the same manner as the medical recordsof other employees in the program.A chemical-duty position roster lists all individuals605