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

Medical Aspects of Chemical WarfareIntroductionMajor emergencies like the terrorist attacks of September11, 2001, and the following anthrax mailings, aswell as the devastating effects of Hurricane Katrina andthe emerging threat of avian influenza are currentlyfresh in Americans’ memories. Military healthcareproviders have a role in responding to national events,whether terrorist attacks, natural disasters, or emergingdiseases. This chapter outlines the organizationalframework within which military healthcare providerswill operate. The following pages will discuss howmilitary healthcare providers are expected to interactwith local, state, and federal agencies while remainingin a military chain of command when reacting tonational emergencies. The strategy and primary goalof federal and civilian counterterrorism agencies is todeter attacks. Natural catastrophes and human-madeaccidents require diligence in awareness and preparednessactivities to coordinate operations, prevent andsafeguard lives, and protect economic interests andcommodities.This is an introduction to national measures andpolicies as well as to medical resources, training, andexercises available to military healthcare providers.Effective information flow is crucial to the success ofa proper and well-organized emergency response forchemical, biological, radiological, nuclear, or explosive(CBRNE) incidents. Learning about the militaryhealthcare provider’s role in preparing for such anevent and becoming familiar with the organizationalframework and expectations of disaster preparednessresults in a healthcare force that is prepared to assistin the biomedical arena of national defense.National Civilian Preparedness (1990–2001)The fundamental tenet of disaster response in theUnited States is that disasters are local. As a result,local authorities are primarily responsible for respondingto incidents, whether natural or human-made.However, state and regional authorities and assetscan assist upon request from the local governing bodyand federal assets can assist upon request of the stategovernor. Most states authorize either a city council,board of supervisors, or other authority sanctionedby a local ordinance to request help should a localgovernment be unable to handle a disaster. This localgoverning body, or “incident command system,” canrequest state aid. Prior to 2001 domestic preparednessefforts at local, state, and federal levels were oftenpoorly coordinated and disruptive because of disputesover authority, particularly when legal and recoverypriorities clashed. Existing federal legislation andpolicy was comprehensive but inconsistent and didnot adequately address the full range of antiterrorismand counterterrorism actions necessary to deal withthe risk of, or recovery from, a major terrorist actionusing chemical, biological, or nuclear weapons of massdestruction (WMDs). Disasters and terrorist attacks cantake on many forms and preparedness plans requiremeasuring risk against the potential for damage.Incidents such as the bombings of the World TradeCenter in 1993, Oklahoma City’s Murrah FederalBuilding in 1995, and Atlanta’s Olympic CentennialPark in 1996 and the Tokyo sarin attack in 1995 allhighlighted inadequacies in capability and readiness toavert and manage large-scale terrorist events. Reviewof the events resulted in agencies understanding theimportance of a coordinated response and the impactof proper communication on positive outcomes. Theabove experiences led to a series of policies designedto ensure interagency coordination and communication.However, these policies are complicated, whichmay partially explain the degraded state of coordinationand communication between agencies when theSeptember 11, 2001, attacks occurred.After the sarin gas attacks in Tokyo and the OklahomaCity bombing, President Bill Clinton signedpresidential decision directives 39 and 62. 1,2 Thesedirectives outline policy for deterring and respondingto terrorism through detecting, preventing, and managingWMD incidents. Presidential Decision Directive39 also defines domestic and international threats andseparates the nation’s response to these events intowhat are called “crisis responses” and “consequencemanagement responses.” Crisis responses involveproactive, preventative operations intended to avertincidents and support post-event law enforcementactivities for legal action against the perpetrators.Consequence management refers to operations focusedon post-incident activities intended to assist in damagerecovery. This phase of recovery includes tasks such asrestoring public services, safeguarding public health,offering emergency relief, providing security to protectcasualties, staffing response agencies, and guaranteeinginformation flow and infrastructure stability.In Public Law 104-201 (the National DefenseAuthorization Act for Fiscal Year 1997, Title XIV,“Defense against Weapons of Mass Destruction,”commonly referred to as the “Nunn-Lugar-Domenicilegislation”), Congress implemented presidentialdecision directives 39 and 62, which directed and supportedan enhanced federal effort toward preventingand responding to terrorist incidents. 3 One of these754