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

Domestic Preparednessdiation and recovery exercises and Army-mandated,quarterly chemical accident or incident response andassistance exercises. 37 All exercises are evaluated andanalyzed to assess performance. The evaluationscompare performance based on criteria from ArmyRegulation 50-6 37,38 and the applicable portions of theCode of Federal Regulations.Emergency procedures are in place in the communitiessurrounding chemical stockpiles and the proceduresare published. Through the CSEPP program,the communities work with FEMA and the Army toenhance their preparedness and will continue to do sountil the stockpiles no longer exist. CSEPP’s successeshave been nationally recognized. The community riskhas been significantly reduced in Aberdeen, Anniston,and Tooele, demonstrating to other communities thatapplying the lessons learned is beneficial. 39 Some lessonslearned that have contributed to decreased riskinclude advances in building and improving publicwarning systems, increasing public awareness, andadding more trained medical personnel and responders.Another valuable chemical countermeasure resourceis the Chemical Security Analysis Center. Thecenter provides threat awareness and assessment on avariety of chemical-related threats (eg, chemical warfareagents, toxic industrial chemicals) through a forumfor subject matter experts. It supports informationmanagement, reach-back capability, and threat characterization.A similar project was developed in 2004for the center’s biological counterpart, the NationalBio-Defense Analysis and Countermeasure Center.Currently the Chemical Security Analysis Center isplanned for a central location and is to provide easyaccess to the database. These efforts aim to prevent andmitigate the consequences of chemical or biologicalthreats by preparing ahead.Training and educationTraining and education are an integral part of anycommunity response to an emergency, including anact of terrorism. The ability to respond safely andeffectively to incidents of chemical, biological, or radiologicalterrorism resulting in large numbers of casualtiesrequires disaster education and preparednesstraining. This unique training, required for militaryresponse teams and healthcare providers (particularlythose involved in CBRNE), has been a valuable assetin domestic preparedness. Increasing awareness andtraining in CBRNE will continue be important. Bybuilding on knowledge, increasing awareness, trainingin CBRNE, and applying lessons learned, military andcivilian medical providers and first responders willbecome more proactive in preventing and deterringattacks and minimizing the effects of a human-madeor natural disaster. In 2001 the Joint Commission onAccreditation of Healthcare Organizations challengedhealthcare providers to obtain the proper training andeducation to decrease vulnerabilities of a catastrophicincident and improve communications between agenciesfor a more efficient and rapid response throughemergency planning and training exercises. 40CBRNE training for the DoD is multiservice andsingle-service oriented. Although each service mayhave its own defense CBRNE doctrine, all US militaryservices support the joint doctrine. The goals ofthese efforts are to ensure publications are up todate, coordinated across services, and relevant. Forexample several of the Army’s field manuals 41,42 arepart of multiservice doctrines. These Army manualshave Air Force, Navy, and Marine counterpart manualsthat are service-specific, but that all support jointpublications that are currently available or underdevelopment. 23,42,43Across the services, initial entry training forCBRNE events on the battlefield begins with first aid,self aid, and buddy aid. This training is augmentedwith rigorous instruction on employing the variousmission-oriented protective posture levels and conductingpersonnel and equipment decontamination.Equipping service members with mission-orientedprotective posture gear, pyridostigmine bromidepretreatment tablets, atropine and 2-pralidoxime chlorideautoinjectors, diazepam, decontamination kits,chemical agent detection paper, and training on theuse of these supplies is the foundation from which tobuild. Operationally, US Army Medical Department,US Army Chemical Corps, and US Army OrdinanceCorps personnel with specialized training in CBRNEare a valued training resource. Effective training isessential for handling mass casualty situations, treatingfield casualties expediently, and managing uniqueaspects related to treating CBRNE casualties. Thechallenge of decreasing vulnerabilities and improvingpreparedness becomes one of improving communicationbetween agencies for a more efficient and rapidresponse so that the right materials and individualsare present at the right time and place.There have been many changes in disaster preparednesssince the attacks on the World Trade Center andthe Pentagon in 2001. Above all, the military healthcaresystem has improved medical readiness. The positionof assistant secretary of defense for acquisition,767