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By Martin Hill, BA, CHS-III; Mike Galarneau, MA; Gerry Pang, MA; & Paula Konoske, PhD
The Marine Corps Chemical Biological Incident Response Force (CBIRF) was established in 1996 in response to Presidential Decision Directive 39 to outline the nation’s plan for responding to terrorist acts at home and abroad. CBIRF’s mission subsequently expanded from biochemical response to the full scope of chemical, biological, radiological, nuclear, and explosive responses. The objective of this study was to determine the medical supply requirements for CBIRF’s expanded mission.
In November 2003, preliminary research on injury types and medical interventions seen at previous terrorist incidents was presented by the Naval Health Research Center (NHRC) to a subject-matter-expert (SME) panel consisting of military medical and logistical experts. The SME panel identified the clinical tasks that CBIRF needed the capability to perform. NHRC’s method of modeling supply requirements was then applied to those tasks, establishing the clinical requirements for CBIRF’s Authorized Medical Allowance Lists (AMAL). This study was able to identify weaknesses in the existing CBIRF AMALs and strengthen the unit’s field medical capabilities with the addition of new technologies and modularization that allows greater flexibility in responding to terrorist disasters.
As part of this change, a new medical concept of operation (CONOPS) was written. Each of the two IRFs have a medical contingent consisting of 11 Navy medical personnel, including one physician, one nurse or physician’s assistant (PA), one hospital independent duty corpsman (IDC), and eight regular corpsmen. Fewer would respond if deploying to a nearby incident by helicopter (Temerlin, 2003). The duties of the medical unit include casualty collection and stabilization, spot decontamination, and emergency medical intervention.
The new medical CONOPS establishes a generic method of deployment for the CBIRF medical section in the event of deployment. The medical section of each IRF will be deployed in three sections: the Casualty Collection Point, with four corpsmen and the senior-most clinician to perform triage; the Nonambulatory Decontamination Line, with two corpsmen to oversee victims as they undergo decontamination, if necessary; and Patient Stabilization, with either a nurse or PA and two corpsmen. An IDC will be stationed at the incident command post as a liaison with the mission commander. This concept of deployment can be collapsed, as needed, according to the type of terrorist incident to which CBIRF responds.
Due to CBIRF’s quick establishment and evolving mission, its medical inventory never received a formal review and analysis, leading to questions of whether its series of six medical supply blocks, called Authorized Medical Allowance Lists (AMALs) in the Navy and Marine Corps, were adequate for the unit’s expanded CBRNE mission (U.S. General Accounting Office [GAO], 2001; U.S. GAO, 1999). Marine Corps Systems Command tasked the Naval Health Research Center (NHRC) with reviewing CBIRF AMALs with the intent of developing an inventory based on appropriate research. It was the objective of this study to conduct a systematic assessment of the clinical requirements needed to support CBIRF’s missions.
Method
The existing CBIRF medical supply inventory was divided among 6 separate allowance lists: AMAL 8400, Casualty Search; AMAL 8401, Casualty Clearing; AMAL 8402, Airway Management; AMAL 8403, Casualty Evacuation; AMAL 8404, Force Protection; and AMAL 8405, Organic Support (C. E. Puckett, personal communication, December 11, 2000). CBIRF officials stated early in the study that this arrangement was unsatisfactory. Despite the indicated use for each AMAL, they did not correspond to any medical function within CBIRF. The six separate AMALs also made both routine maintenance of the inventory and its deployment in the field difficult. Prior to training and actual deployments, CBIRF medical personnel had to pull individual supply items from the various AMALs to put together the inventory with which they actually deployed (W. B. Cogar, personal communication, August 21, 2003).
For the purpose of this study, the six CBIRF AMALs were consolidated on paper and the supply amounts aggregated. An early NHRC analysis showed weaknesses in the area of medications for biological and radiological response, crush syndrome, and medical conditions that might be encountered in extreme environmental conditions.
Recommendations for filling these gaps were submitted for review by a SME panel that convened November 18-20, 2003, at CBIRF headquarters in Indian Head, Maryland. The panel consisted of 15 military and civilian experts in military medicine, medical logistics, and the treatment of WMD victims, including medical officers from two National Guard WMD Civil Support Teams. At the conclusion of the SME panel, the following assumptions were agreed upon for the development of the new CBIRF medical inventory:
• CBIRF will have only one AMAL with individual modules for flexibility in responding to various disaster scenarios.
• Each IRF will have 1 CBIRF AMAL. A third will be kept at CBIRF headquarters for quick resupply.
• The CBIRF medical section will provide basic emergent care according to Advance Trauma Life Support protocols to stabilize patients prior to transport to more definitive care. Facilities will include a patient stabilization tent with four treatment stations.
• Patient holding will be limited to 12 hours for a domestic response, 24 hours for outside the United States.
• Sick call for 250 persons (200 CBIRF personnel and a 50-Marine security detachment) for a deployment lasting up to 3 weeks would be provided by a standard Marine Corps battalion aid station sick-call block (AMAL 699) issued to each IRF, with a third in reserve. In addition, hot-cold climate modules will be added to the CBIRF AMAL for responding to areas with weather extremes.
• Medical supplies are needed for a maximum of 100 nonambulatory trauma patients—the extreme upper range of what repeated training showed CBIRF could treat in a 1- to 2-day period.
• Nerve agent antidotes should be included for 500 patients, plus personal protection for up to 250 CBIRF members.
• Medications for treatment of exposure or ingestion of radiological isotopes would be included for 500 patients, plus force protection for 250 CBIRF members. Oral medications are preferred. No chelating agents will be used.
• Cyanide treatment kits would be provided only for the unit’s search-and-rescue entry team, totaling 10 members. Due to the poison’s fast-acting effect, CBIRF would probably not deploy in time to provide medical treatment to victims.
• In the event of a biological incident, CBIRF’s medical section will probably not provide more than force protection. Therefore, medications such as antibiotics for biological attacks are limited to force health protection.
• To conserve deployment weight, oxygen use will be limited. An oxygen generator will be deployed instead of a large number of tanks.
In addition to these assumptions, CBIRF’s new medical concept of employment required that all supplies and equipment be capable of being moved and set up by as few as six corpsmen and be capable of being loaded, unloaded, and set up with minimal effort and delay. The SME panel decided that the CBIRF AMAL should be modularized as much as possible to allow the greatest flexibility and speed in responses. Table 1 lists the various treatment modules as identified by NHRC and approved by the SME panel.
What does the CFN program do for me?
The Certified Forensic Nurse (CFN) title can demonstrate to your colleagues, patients, clients, employers, and the healthcare community that you have extensive knowledge and education, personal experience, and that you are committed to furthering your education in the forensic nursing profession. CFN also helps to contribute to the weight and relevance of your testimony and how applicable the evidence is that you must present to a court of law.
Forensic nursing is an exciting and rapidly growing specialty field that offers great opportunities and rewarding career options for nursing professionals. However, it can be challenging to set yourself apart from your peers to get the recognition and respect you deserve, both in the medical community and the legal arena.
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Want to know more about the American College of Forensic Examiners? Read the definitive history of the world's foremost association for foresnic experts, mental health professionals, and homeland security experts. If you want to understand the rise of ACFEI, this is the only book you'll ever need.
You can access United for Truth here.
Aside from our many strategic alliances and accreditations, here are some more things to keep in mind before choosing a credentialing program, and why the American College of Forensic Examiners Institute and its sister associations are a good choice to make:
For more information about credentials, the associations, or our journals, please visit us:
The American College of Forensic Examiners Institute: www.acfei.com
The American Psychotherapy Association: www.americanpsychotherapy.com
The American Association of Integrative Medicine: www.aaimedicine.com
The American Board for Certification in Homeland Security: www.abchs.com
Membership. Some of The American College of Forensic Examiners’ well-known members and Board members include; Dr. Henry Lee, Dr. Greg Vecchi, Dr. Zhaoming Chen, Dr. Marc Rabinoff, Congressmen Billy Long and Steven King, and Governor Tom Ridge. These individuals, as well as many other not listed here, have helped mold and guide ACFEI to be the prestigious, online, interactive, multimedia publisher that it is today. They have contributed their knowledge and expertise to ACFEI’s online credentialing programs such as the Certified Forensic Physician®, CFP program; the Registered Investigator®, RI®, program; and the Certified Forensic Consultant, CFC® program; to name a few.
ACFEI and all of its associations are continually seeking further validations, alliances, and accreditations in order to offer maximum continuing education benefits to its thousands of members. Sometimes it is our very members who foster these relationships; we encourage you to get involved and share your ideas for future alliances! This is a group of associations that recognize themselves as yours. We invite you to add your expertise to the pool and make it even greater.
Call (800) 423-9737 for more information, or visit acfei.com.
ACFEI is also an approved provider of training by the following professional organizations:
The outside bodies listed above, as well as the many other attest to the fact that the ACFEI has met or exceeded their regulations and standards to be approved providers of training. Organizations that represent medical doctors, accountants, psychologists, attorneys, law enforcement officers, dentists, military personnel, and numerous other professions and specialties would never approve an lesser, unregulated institution to provide training to these important persons.
Please contact either the American College of Forensic Examiners International, The American Board for Certifcation in Homeland Security, The American Association of Integrative Medicine, or the American Psychotherapy Association for more information about their respective programs, accrediting organizations, and educational opportunities:
www.acfei.com; (800) 423-9737
www.abchs.com; (877) 219-2519
www.aaimedicine.com; (877) 718-3053
www.americanpsycotherapy.com; (800) 205-9165
As the editor in chief of The Forensic Examiner, Annals of the American Psychotherapy Association, and Inside Homeland Security (all peer-reviewed and available on newsstands); and for the associations themselves (The American College of Forensic Examiners International, The American Board for Certification in Homeland Security, the American Psychotherapy Association, and the American Association of Integrative Medicine), I have the privilege of working not only with individuals with remarkable talent, credentials, experience, and professionalism here at the ACFEI Headquarters, but also with the thousands of members who renew their memberships year after year to learn, network, and even teach one another.
I am proud to work with the courses and articles conceived and written by dedicated professionals who have made it their living to help heal, defend, serve, protect, and save their fellow citizens from terrorism, criminals, mental illness, disease, and so many other world problems and pandemics. I have reviewed dozens of resumes and curriculum vitae for my peer reviewers and course authors. Their degrees, credentials, and experience speak for themselves of the excellence embraced and exuded by the associations.
Under the umbrella of the American College of Forensic Examiners International, I have reviewed and edited articles that discuss cutting-edge research written with government agents I interviewed in person at Quantico; I have met forensic legends Dr. Cyril Wecht and Dr. Henry Lee (both long-time ACFEI members); and I get to see to completion the modules and coursework that are born of the passion of many prominent individuals from an array of important fields. I know for a fact that the continuing education curricula individuals like these and others help create are forged from impeccable research, training, and consultation. These people are far too intelligent, prestigious, and philanthropic to waste their time with lesser organizations; Dr. Robert O’Block’s ACFEI stands only for legitimacy and professionalism.
What is it that draws so many—nurses, physicians, soldiers, investigators, government employees, psychologists, psychiatrists, social workers, and a sheer multitude of other honorable professions—into the American College of Forensic Examiners Institute fold? Decide for yourself, as thousands wisely did before you:
www.acfei.com
www.abchs.com
www.americanpsychotherapy.com
www.aaimedicine.com
The American College of Forensic Examiners Institute began in 1992; it is still here. Most membership associations rise and fall in less than a decade, but the passion of ACFEI’s founder, Dr. Robert O’Block, and the thousands of reputable people his associations help each year, has fueled continued growth since ACFEI’s inception nearly two decades ago.
As we continually improve our continuing education coursework, Web presence, and printed publications, that growth is bound to continue. The fields in which our members work, study, and fight—homeland security, all areas of forensics, integrative medicine, and psychotherapy—are not going anywhere anytime soon, and are dynamic and ever evolving. When you join the American Board for Certification in Homeland Security, the American Association for Integrative Medicine, the American Psychotherapy Association, or the tried-and-true American College of Forensic Examiners Institute, you will see that we rise above the competition in offering continuing education excellence. Dr. Robert O’Block has created a unique opportunity for you to meet like-minded professionals to network, learn, and teach one another and the world at large.
To learn more about each of these associations, please come see us:
The American College of Forensic Examiners: www.acfei.com
The American Board for Certification in Homeland Security: www.abchs.com
The American Association of Integrative Medicine: www.aaim.com
The American Psychotherapy Association: www.americanpsychotherapy.com
The American College of Forensic Examiners International began in 1992; it is still here. Most membership associations rise and fall in less than a decade, but the passion of ACFEI’s founder, Dr. Robert O’Block, and the thousands of reputable people his associations help each year, has fueled continued growth since ACFEI’s inception nearly two decades ago.
As we continually improve our continuing education coursework, Web presence, and printed publications, that growth is bound to continue. The fields in which our members work, study, and fight are not going anywhere anytime soon, and are dynamic and ever evolving. When you join the American Board for Certification in Homeland Security, the American Association for Integrative Medicine, the American Psychotherapy Association, or the tried-and-true American College of Forensic Examiners Institute, you will see that we rise above the competition in offering continuing education excellence. Dr. Robert O’Block has created a unique opportunity for you to meet like-minded professionals to network, learn, and teach one another and the world at large.
To learn more, please visit www.acfei.com.
What is it that draws so many—nurses, physicians, soldiers, investigators, government employees, psychologists, psychiatrists, social workers, forensic examiners, and a sheer multitude of other honorable professions—into the American College of Forensic Examiners Institute fold? Let me share with you just a few of the numerous reasons so you can better decide for yourself, as thousands wisely did before you:
Accreditation. The American College of Forensic Examiners Institute is an approved provider of continuing education by the following:
Continuing education alignments. In addition to the several accreditations above, we are also proud to inform you that:
To learn more, visit www.acfei.com
By Leann Long, BS
A Tragedy Unfolds
On the morning of February 2, 2002, the parents of Danielle van Dam were forced to face their worst nightmare when they discovered the empty bed of their 7-year-old daughter. Danielle was last seen the night before when Damon van Dam put his beautiful blue-eyed daughter to bed. The distraught parents immediately reported Danielle as missing, and an extensive search involving hundreds of volunteers began. Authorities assumed that the innocent young child was abducted from her bed while she slept on the night of February 1, 2002.
Copyright ©2009
ABFE,
ACFEI,
and ABCHS. All rights reserved. Dr. Robert O'Block, Founder, CEO, and Publisher.
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