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

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Domestic PreparednessaIncidentCommandCommand StaffbPublic InformationOfficerAreaCommandSafety OfficerLiason OfficerIncidentCommand PostIncidentCommand PostOperationsSection ChiefGeneral StaffPlanningSection ChiefLogisticsSection ChiefFinance/AdministrationSection ChiefcState Officials andEmergency OperationsCenterFig. 23-2. Organizational outline for incident managementcommand. The structures address local, field, state andjoint field office national incident response organization. (a)Local responders use the incident command structure. (b)Field-level area command structure. (c) State and emergencyoperations center. (d) Overview of the joint field office andits key componentsReproduced from: US Department of Homeland Security.National Response Framework. Washington, DC: DHS; 2008.Local Officials andEmergency OperationsCenterIncident CommandPostdState Officials andEmergency OperationsCenterPartnershipJoint Field OfficePartnershipPrivate-Sector andNongovernmentalOrganizationsLocal Officials andEmergency OperationsCenterIncident Command PostUnified CommandPrincipalFederalOfficialDOD Representative(Normally DefenseCoordinating Officer)Unified Coordination GroupStateCoordinatingOfficerSenior FederalLaw EnforcementOfficialFederalCoordinatingOfficerOtherSeniorOfficialsJointOperationsCenterJointTaskForceExternal Affairs,Liaisons,and OthersDefenseCoordinatingElementChief of StaffSafety OfficerOperations Planning Logistics Finance/AdminEmergency Support Functions757
Medical Aspects of Chemical WarfareNational Response FrameworkIn 2008 the NRP will be replaced by National ResponseFramework (NRF), which will guide the nationin incident response. The NRF ensures that governmentexecutives and nongovernment organizations,leaders, emergency management personnel, and theprivate segments across the country understand domesticincident response roles.The NRF provides a structure for implementingnational-level policy and operational coordinationfor domestic incident response. The NRF addressesactual or potential emergencies, hazard events (rangingfrom accidents to natural disasters), and actual orpotential terrorist attacks. These incidents could rangefrom modest events that are contained within a singlecommunity to ones that are catastrophic and createnational consequences.The NRF includes a wider incident audience thanthe NRP, including executive leadership, emergencymanagement personnel at all government levels, andprivate community organizations and other nongovernmentalorganizations. It has expanded the focuson partnership, affirming that an effective nationalresponse requires layered and mutually supportingcapabilities. Local communities, tribes, and states areprimarily responsible for the safety and security oftheir citizens. Therefore local leaders will build thefoundation for response and communities will prepareindividuals and families.The NRF has made many changes to the NRP,including updating the planning section and improvingannexes and appendices. It clarifies the roles andresponsibilities of the principal federal official, federalcoordinating officer, senior federal law enforcement official,and the joint task force commander (Figure 23-2).The NRF describes organizational structures that havebeen developed, tested, and refined that are applicableto all support levels. The response structures are basedon the NIMS and they promote on-the-scene initiativeand resource sharing by all levels of government andprivate sectors. At the field level, local responders usethe incident command structure to manage responseoperations (see Figure 23-2a). There may be a need foran area command structure at this level, which maybe established to assess the agency administrator orexecutive in overseeing the management of multipleincidents (see Figure 23-2b). On-scene incident commandand management organizations are located atan incident command post at the tactical level. Stateemergency operations centers are located where multiagencycoordination can occur and they are configuredto expand as needed to manage state-level events (seeFigure 23-2c).The joint field office is the primary federal incidentmanagement field structure and is composedof multiple agencies. It serves as a temporary facilityfor coordinating federal, state, local, tribal, public,and private agencies responsible for response andrecovery. The joint field office is organized in a mannerconsistent with NIMS principles and is led by theunified coordination group (Figure 23-3). It focuses onproviding support to on-the-scene efforts and supportingoperations beyond the incident site. 13Department of defense roles for Domestic Preparedness and ResponseThe Quadrennial Defense Review Report of 2006outlines new challenges facing the DoD. This reportexamines four priority areas of homeland defenseand protection against WMDs. 14 The DoD has uniquecapabilities and resources that can be used to supporta federal response should an incident occur. Withinthe roles and responsibilities of the NRF, the secretaryof defense, as directed by the president, can authorizedefense support for civil authorities (in the form ofan official request for assistance during a domesticincident). 13 Although the secretary of homeland securityis the principal federal agent during an incident ofnational significance, command and control authorityfor military assets remains within military chains ofcommand.The DoD, through the secretary of defense, has tworoles with respect to domestic preparedness. First, theDoD’s mission is to defend US territory and its interests.Its second role is providing military support tocivilian authorities when directed by the president,who can authorize the military to defend nonDoDassets that are designated as critical. The Strategy forHomeland Defense and Civil Support guides DoD actionin each role. 15 This document builds on several others,including the National Defense Strategy of the UnitedStates of America, 16 the National Strategy for HomelandSecurity, 7 and the National Security Strategy of the UnitedStates of America. 17 The Strategy for Homeland Defenseand Civil Support has several objectives. These includeinterdicting and defeating threats at a safe distance,providing mission assurance, supporting civil authoritiesin CBRNE attacks, and improving capabilitiesfor homeland defense and security. 15 Overall, policyguidance and supervision to homeland defense activitiesare the responsibility of the assistant secretary ofdefense for homeland defense.In the case of an emergency of national significance,the NRP outlines federal department or agencysupport to state or local governments. 12 The actionsof federal agencies are dictated by the Stafford Act758
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The Coat of Arms1818Medical Departm
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Textbooks of Military MedicinePubli
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MEDICAL ASPECTS o fCHEMICAL WARFARE
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ContentsContributorsForeword by The
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ContributorsMICHAEL ADLER, PhDResea
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DONALD M. MAXWELL, MSResearch Chemi
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ForewordThe US military has been co
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PrefaceA significant concern for th
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PrologueThe original edition of Med
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xxii
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Medical Aspects of Chemical Warfare
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Nerve AgentsChapter 5NERVE AGENTSFR
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Nerve AgentsAbout 10,000 to 30,000
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Nerve Agentsphorofluoridate (DFP) w
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Nerve AgentsFig. 5-2. This schemati
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Nerve AgentsExhibit 5-1 continuedis
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Nerve Agentsactivity but only 15% t
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Nerve AgentsTABLE 5-3CHEMICAL, PHYS
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Nerve AgentsTABLE 5-4EFFECTS OF EXP
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Nerve Agentsaffecting the other eye
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Nerve Agentsmay cause severe rhinor
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Nerve Agentsof jerks and tremor.Cen
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Nerve Agentsand they were decreased
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Nerve Agentsnerve agent toxicity on
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Nerve Agentspatient. Decontaminatio
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Nerve AgentsFig. 5-5. The Mark I ki
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Nerve Agentsadministered intramuscu
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Nerve Agentsthat hydroxamine reacti
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Nerve AgentsOral administration may
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Nerve AgentsTABLE 5-7RECOMMENDED TH
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Nerve Agentsimpairment such as whee
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Nerve Agentssuboptimal, manner. The
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Nerve Agentsthan those who did not.
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Nerve Agentssible for binding nerve
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Nerve Agentsfor comparison was not
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Nerve AgentsTABLE 5-11EFFECTS OF PY
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Nerve Agentstivity of smooth muscle
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Nerve Agents38. Grob D, Lilienthal
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Nerve Agents77. McDonough JH, Shih
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Nerve Agents117. McLeod CG Jr, Sing
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Nerve Agents154. Tryphonas l, Veino
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Nerve Agents193. Funckes AJ. Treatm
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Nerve Agents235. Suzuki T, Morita H
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Nerve Agents274. Pellegrini JE, Bak
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PROCESSMedical Aspects of Chemical
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Triage of Chemical CasualtiesChapte
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Triage of Chemical Casualtiesreceiv
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Triage of Chemical Casualtiescatego
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Triage of Chemical CasualtiesIn a f
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Triage of Chemical Casualtiesnose)
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Triage of Chemical CasualtiesWith n
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Triage of Chemical Casualties14. Sa
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Decontamination of Chemical Casualt
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