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

Medical Aspects of Chemical Warfaretechnology, and logistics was established by DoD Directive2000.12 on August 18, 2003, to direct CBRNEreadiness for military medical education and training.Military education and training ensures that medicalservices and personnel can perform optimally in alltypes of disaster environments. The Office of TheSurgeon General oversees and integrates the medicalaspects of CBRNE programs, including materiel development,testing, evaluation, and medical oversight ofnonmedical programs for all Army medical personnel.However, whoever commands and oversees theseprograms today could change tomorrow, so militarymedical personnel need to be ready for the next catastrophicevent.In their domestic preparedness roles, today’s DoDhealthcare providers must be capable of managingmilitary casualties and may also be required to workwith civilian healthcare agencies and providers aswell as other civilian first responders and supportpersonnel. Training for catastrophic chemical incidentshas become a joint effort as well as an exchangeof knowledge and emergency medical training. TheUS Army Medical Department has addressed thetraining and education of healthcare providers in themedical management of CBRNE illness or injuries inArmy Regulation 40-68. 43 This regulation states thatfor clinical privileges or staff appointment approval,providers must be educated in the medical diagnosesand appropriate management of CBRNE casualties.In 2003 the Force Health Protection Council endorsedstandards of proficiency training as a requirement forall medical personnel throughout the DoD. 44The Defense Medical Readiness Training Institute inSan Antonio, Texas, was tasked to conduct a CBRNEtraining gap analysis by the assistant secretary ofhealth affairs in 2004. In 2002 the joint staff and thedeputy assistant secretary of affairs for force healthprotection and readiness tasked the defense medicalreadiness training institute to develop a tri-serviceCBRNE training program. This is a distance learningtraining program for all DoD employees. The programwas developed with core competencies for clinical,medical, and specialty areas for all DoD medical employees.The program consists of a basic course, anoperators’ and responders’ course, a clinical course,and an executive and commander course. Course levelsinclude initial, sustainment, and advanced. 45Training for CBRNE and medical force health protectionis conducted at the Army Medical DepartmentCenter and School, USAMRICD, USAMRIID, theArmed Forces Radiobiology Research Institute, andUSACHPPM. The Web sites of the DHS, FEMA, theNavy, the Air Force, and the Army also offer trainingcourses. The Uniformed Services University of theHealth Sciences conducts a chemical warfare andconsequence management course that brings togetherleading chemical warfare authorities from the DoD andfederal, state, and local governments. The course addressessome potentially controversial topics that maybe faced when making policy decisions.In 2001 the US General Accounting Office statedin its report to the chairman of the Subcommitteeon National Security, Veterans Affairs, and InternationalRelations, Committee on Government Reform,House of Representatives, that the “gold standard”programs for medical training and education werethe Medical Management of Chemical and BiologicalCasualties Course, the Field Management of Chemicaland Biological Casualties Course, 46 and the HospitalManagement of CBRNE Incidents Course developedsoon after. 23The Medical Management of Chemical and BiologicalCasualties Course is conducted by USAMRICDand USAMRIID. The course is designed for US ArmyMedical Corps, Nurse Corps, and Medical ServiceCorps officers, physician assistants, and other selectedmedical professionals. Classroom instructionand laboratory and field exercises prepare studentsto effectively manage the casualties of chemical andbiological agent exposure. Classroom discussionincludes the history and current threat of chemicaland biological agent use, the characteristics of threatagents, the pathophysiology and treatment of agentexposure, and the principles of field management ofthreat agent casualties. In the field, attendees practicethe principles of personal protection, triage, treatment,and decontamination of chemical casualties.During this exercise, attendees learn the capabilitiesand limitations of mission-oriented protective posturewhen treating casualties in a simulated contaminatedenvironment. Continuing medical education creditsare available for this training. 23The Field Management of Chemical and BiologicalCasualties Course is conducted by USAMRICD atAberdeen Proving Ground, Maryland. The course isdesigned for Medical Service Corps officers, ChemicalCorps officers, and noncommissioned officers inmedical or chemical specialties. Classroom instructionand laboratory and field exercises prepare studentsto become trainers in the first echelon managementof chemical and biological agent casualties. Thereare small-group computer and briefing exercises thatreinforce casualty management principles. Duringthe 2 days of field training, attendees establish a casualtydecontamination site and use the site duringscenario-based exercises to manage litter and ambulatorycasualties. Attendees practice the principles ofpersonal protection, agent detection, triage, emergency768