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

Domestic Preparednessmost likely be required to respond and may be asked toprovide its unique capabilities to assist other agencies.For emergencies involving chemical or biologicalweapons that overwhelm the capabilities of local,state, or other federal agencies, the DoD directly supportsand assists in the areas of monitoring, identifying,containing, decontaminating, and disposing ofthe weapon. Specific NRP incidence annexes outlinecontingency plans for response to incidents involvingbiological, radiological, or chemical agents and toxicindustrial chemicals and materials. 12 Although the coordinatingagency may not be the DoD, the departmentis involved in these incidents because of its specializedtraining and capabilities. These unique DoD capabilities,specifically in the areas of programs and assets,are the focus of the remainder of this chapter.the Department of defense’s Support to Civil AuthoritiesThe events of the 1995 sarin gas attack in the Tokyosubway, as well as threats against the United Statesand its allies, substantiated the need for planning tomitigate a chemical attack on the United States. Thisneed became more evident with the continued threatand possible use of chemical weapons by Iraq and theformer Soviet Union. The potential for exposure existsbecause many countries still maintain access to, orstockpiles of, chemical warfare agents. The continuedthreat of accidental or intentional incidents resultingfrom human-made disasters following the release oftoxic industrial chemicals or materials has necessitatedefforts to develop streamlined, rapid responses tochemical events. In an effort to provide informationto the public, other agencies, and authorities, theCenters for Disease Control and Prevention (CDC) hascomplied a comprehensive and extensive list of toxicchemicals and chemical agents, chemical characteristics,and medical first aid and antidote treatment. 19The anthrax attacks of 2001 and the potential use ofbiological weapons make emergency planning necessary.Multiagency planning is also required to preparefor potential nuclear incidents.The DoD is uniquely capable of responding to theseevents because of wartime experience, continued researchto counteract WMDs, and ongoing training inprotective measures. Since the use of chemical weaponsin World War I and the establishment of a chemicalwarfare service in 1918, the DoD has continued to beinvolved in developing countermeasures (antidotes,protective equipment, etc) through research, training,and initiating new programs, resources, and centersof authority. 20 Today challenges for the DoD includeincorporating these capabilities into homeland securityand coordinating these efforts with other agencies andthe civilian incident commands.The National Response Framework ESF 8 (“Healthand Medical Services”) outlines coordination guidelinesfor the DHHS, the lead agency during a domesticincident, as well as all signatory supporting agencies,including the DoD. 4,13 The NRF states that the DHHSand the US Department of Agriculture are the coordinatingagencies for the food and agriculture incidentannex. In this capacity, the military contributes only asupporting role to civilian authority. The DoD military12,13, 16,21operations that have priority over disaster reliefare also defined in ESF 8 (Figure 23-5).Defense support in a domestic incident can involvefederal military forces and DoD civilians and contractors,as well as other DoD components. The executiveauthority for military support is through the secretaryof defense, who can authorize defense support of civilauthorities. The secretary of defense retains the commandof military forces throughout operations. 16,21 Thesecretary of defense also designates the secretary of theArmy as the DoD executive agent for military supportto civil authorities, and the point of contact for the DoDexecutive agent is the defense coordinating officer. Thisindividual is the DoD’s representative at the joint fieldoffice. For a domestic incident in which DoD assistanceis needed, the defense coordinating officer forwards arequest for assistance to the US Army Northern Command,which passes the request to the US Army MedicalCommand (MEDCOM) and the commander of theUS Army Forces Command. If the disaster exceeds thedefense coordinating officer’s command and control,a supporting military commander-in-chief establishesa joint task force or response task force to control DoDassets and resources (including personnel). 21The DoD’s role in supporting emergency responseoperations depends on well-trained, readily available,fully qualified personnel. These personnel are oftenfrom different commands and services within the DoD.In addition, active, reserve, and National Guard componentscan be made available for domestic support,depending on the extent and nature of the incident andthe forces’ current deployment missions throughoutother regions of the world.The capabilities of the DoD and the military to reactto a CBRNE event are described in terms of “detectionand response” and “reach-back response.” 15 Thedetection and response capability provides teamstrained in detection, initial response, and medicalresponse. The initial response to a domestic incidentis often the most crucial step and sets the stage for awell-executed and effective overall response. These761