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

Domestic Preparedness17 corpsmen. All elements train and certify in theirrespective areas. They are required to attend uniquetraining, such as the Medical Management of Chemicaland Biological Casualties Course or the ContaminatedCasualty Decontamination Course given through theUS Army Medical Research Institute of ChemicalDefense (USAMRICD) in conjunction with US ArmyMedical Institute of Infectious Disease (USAMRIID).CBIRF members are also NBC-qualified by the USMarine Corps Forces, NBC School in Atlanta, Georgia.The CBIRF can provide expert advice to an incidentcommander by means of a reach-back capability tomilitary and civilian scientific experts. 22–24 This meansthat through networking and communication, CBIRFelements “reach back” to other DoD assets or consultingexperts on specific information related to chemicalor biological threats. This reach-back capability resultsin rapid and coordinated effort. 22–24The National Guard’s role in a domestic CBRNEevent is to support state governors and fully integratewithin CBRNE operations. 15 The Army National Guardis currently composed of over 360,000 individuals,while the Air National Guard has approximately109,000. The National Guard, organized by the DoD,also coordinates its efforts across many other federalagencies. 25 When called up by the state governor, theguard provides initial security and response for up to24 hours, after which WMD civil support teams mobilize.The National Guard has at least 55 WMD civilsupport teams that are equipped and trained to detectCBRNE agents. These teams are early entry forcesequipped with diagnostic equipment for detectingCBRNE weapons, they are trained and equipped fordecontamination, and they can provide emergencymedical treatment. Depending on the mission, theycan also assist other early responders and advise theincident commander. 22,25In March 2004 the joint chiefs of staff and the commanderof the US Army Northern Command supportedforming National Guard CBRNE-enhancedresponse force packages for CBRNE missions. Thepackages use existing capabilities combined with specializedtraining and equipment and are designed tosupport domestic missions for state governors, but arealso able to support joint expeditionary capabilities. 23,25The future vision for these integrated CBRNE forcesis for them to work closely with other agents withinthe DoD, including the chemical corps, NorthernCommand, and other state and federal agencies. TheNational Guard is committed to supporting civilauthorities in homeland security missions as well asserving as a first-line military capability to supporthomeland defense. 25The 20th Support Command was initiated in October2004 and is structured out of the forces commandunder the US Joint Forces Command. The 20th supportsa wide spectrum of CBRNE operations with fullytrained forces. It is capable of exercising command andcontrol in these operations. The 20th Support Commandincludes personnel from the chemical corps,technical escort unit, and the explosive ordnancedisposal. Within this command structure, supportcontinues to come from and go to MEDCOM. 26,27There is currently an ongoing effort within the DoD toexpand the 20th Support Command to serve as a jointtask force capable of immediate deployment on WMDelimination and exploitation missions. 14The US Army’s First and Ninth area medical laboratories(AMLs) also support forces’ command missions.These two units, based out of Aberdeen ProvingGround, Maryland, are capable of deploying anywherein the world on short notice to conduct health-hazardsurveillance. The units draw on the scientific expertiseof surrounding organizations in many areas, such asthe US Army Center for Health Promotion and PreventiveMedicine (USACHPPM), USAMRICD, andUSAMRIID.The AMLs conduct health-hazard surveillance forbiological, chemical, nuclear, radiological, occupationaland environmental health, and endemic diseasethreats at the theater level to protect and sustain thehealth of forces throughout military and domesticsupport operations. Using sophisticated analyticalinstruments combined with health risk assessment bymedical and scientific professionals, the AMLs confirmenvironmental exposures in the field associated withthe contemporary operating environment. The executionof this mission provides combat commanderswith critical information that can assist in mitigatingor eliminating health threats during the operationalrisk management process.The AMLs are composed of personnel with militaryoccupational specialties from the areas of occupationaland environmental health, NBC exposure, andendemic disease. 27,28 The AMLs were structured fromthe original 520th Theater Army Medical Laboratoryand maintain a chain of command through the 44thMEDCOM. This structure enables the units to providecomprehensive health hazard surveillance typicallyassociated with MEDCOM-fixed facilities. 26,28The occupational and environmental health sectionof the AML provides comprehensive environmentalhealth threat assessments by conducting air, water,soil, entomological, epidemiological, and radiologicalsurveillance and laboratory analyses. In support of thismission, the occupational and environmental healthsection conducts analysis in four areas: environmentalhealth, industrial hygiene, radiological assessment,763