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

Domestic Preparednesstreatment, and decontamination of chemical casualtiesat the site. 23The Hospital Management of CBRNE IncidentsCourse is conducted jointly by USAMRICD, USAM-RIID, and the Armed Forces Radiobiology ResearchInstitute. The course is designed for hospital-basedmedical professionals, including healthcare professionals,hospital administrators, medical planners, and otherswho plan, conduct, or are responsible for hospitalmanagement of mass-casualty incidents or terrorismpreparedness. The course consists of classroom instruction,scenarios, and tabletop exercises with militaryand civilian hospital-based medical and managementprofessionals with skills, knowledge, and informationresources to carry out the full spectrum of healthcarefacility responsibilities required by a CBRNE event.Nonmedical NBC and CBRNE courses offered tothe military include leadership courses in homelandsecurity, antiterrorism and force protection, andconsequence management, in addition to the ongoingdevelopmental courses available to both enlistedservice members and officers (eg, officer and noncommissionedofficer basic and advanced courses). Opportunitiesalso exist for certain individuals in CBRNEdefense specialist training from the US Army ChemicalSchool and the Defense Threat Reduction AgencyDefense Nuclear Weapons School. Other professionalmilitary, nonmedical education includes the US ArmyCBRN Defense Professional Training at Fort LeonardWood, Missouri. 23In addition to specialized, credentialed medicaltraining, there are other opportunities for civilian andmilitary individuals to obtain further education ingeneral homeland security training. After September11, 2001, courses on homeland security, preparedness,consequence management, and response were offeredat colleges and universities across the nation. Coursesrange from introductory levels and information awarenessto full-credit courses. These courses introducestudents to topics including policy, legislation, security,management, operations, and planning.Online distance learning and educational informationare also easily accessible. The Web sites of theDHS, the CDC, and the DHHS have several valuablelinks that can be used to find resources for planningpreparedness operations, online courses for accreditation,and reference materials for responders and medicalpersonnel. FEMA offers an online course coveringthe incident command system, starting with a basiccourse and advancing through the NIMS and the NRP.Students are entered into a national database as trainedindividuals upon graduation. 47 In addition, the DHSand other federal agencies offer several assistanceprograms, grants and training courses to states andlocalities on terrorism preparedness and healthcareemergency services. 48–50Finally, there are several informational resourcesworth noting. The CDC, for example, has numerousreferences on topics related to chemicals and chemicalemergencies. Its emergency preparedness andresponse Web site has a wide variety of informationfor both healthcare professionals and the general public.50 Another valuable source of information from theDHHS is the Agency for Toxic Substances and DiseaseRegistry. 19 This is a health registry of the DHHS andCDC that is available to the public and provides valuableinformation on toxic profiles of potentially hazardoussubstances and their health effects, if known.The substances are ranked according to their potentialrisk for exposure. The information is easy to read andunderstand and is updated by peer review. Currentlythere are 289 toxicological profiles that can be used byemergency responders. 19The Agency for Toxic Substances and Disease Registryis capable of assisting local, state, and federalagencies in responding to chemical terrorist acts byanalyzing biological and environmental samples. Theregistry offers an emergency hotline service, maintainsa Web site, and provides training, exercises, and qualificationcertification to improve laboratories. 19,50ExercisesExercises are the best test of the effectiveness of preparednessplans, policies, and training. These practicesmeasure agency and interagency abilities to respondto incidents and are critical tools that can be used toenhance coordination. Exercises also provide a wayto initiate policy change, review lessons learned, andgive quantifiable performance measurements that canbe used for certification purposes and improvement.Exercises can be conducted at many levels, from localto national.The first step in conducting an exercise is to trainthe trainers, and that process usually begins withtabletop exercises that are conducted with representativesfrom participating agencies. Local, state, andfederal systems are tested addressing local and stateresponse and how well that response integrates withfederal support. The final step in practical exerciseis usually a full-scale exercise, such as a mock event,that includes first responders, private individuals,businesses, and local, state, and federal agencies.The goal of training should be to provide immediatefeedback to participants, reinforce training, andevaluate a particular method’s effectiveness. An additionalgoal is to learn from the exercise to improvethe preparedness plan for the next exercise or real769