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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 noted, NHRC research found few studies identifying the specific types of traumatic injuries incurred in terrorist attacks. A study of survivors who received medical treatment after the collapse of the World Trade Center reported generic categories of injuries, but not interventions (Boodram et al., 2002). A study of the impact of the Oklahoma City bombing on local medical facilities showed similar injury categories, but also provided a list of the types and numbers of field and emergency room medical interventions performed on survivors (see Table 3; Gonzalez, 2002). The SME panel agreed that using these interventions and their percentages on a casualty stream of 100 patients was appropriate.
These interventions were mapped to the DMSB/NHRC clinical tasks identified by the SME panel. In doing so, one intervention in the Oklahoma City list might become two or more tasks in the SME panel list. This was due to breaking down some DMSB/NHRC interventions into smaller steps than those identified in the Oklahoma City bombing. In some cases, the percentage of patients receiving a task was reduced to reflect the belief that a particular task would not be performed as often as others would in the same grouping. Examples of the intervention/task mapping can be seen in Table 4.
Quantities of mannitol and sodium bicarbonate injection-medications commonly used in the treatment of crush syndrome as seen in building collapses like those created by high-yield explosions were calculated for the CBIRF mission using data provided by the Federal Emergency Management Agency (FEMA). FEMA estimates disaster crush casualties at between 5% and 40%, depending on the cause of the disaster, with 20% as the average (Dickson, 1998; Pennsylvania Emergency Management Agency, 2003). Therefore, the amounts of these medications were calculated on the assumption that crush syndrome injuries would occur in 20% of the casualties encountered by CBIRF.
Next, task profiles were created linking each task to the supplies and equipment required to perform it, plus the amount of each supply needed to perform the task, as well as the percentage of patients who would likely receive the procedure. Once the profiles were complete, the amount of each supply was calculated using the NHRC modeling method, then totaled.
This study also attempted to identify new technology and products that would enhance CBIRF medical capabilities yet remain within unit weight and cube restrictions. As previously noted, a decision was made to use an oxygen generator instead of carrying a large number of oxygen tanks. The added portable oxygen generation system (POGS 10) provides 10 liters per minute of oxygen through two patient outlets, weighs 70 pounds, and comes in its own wheeled case. Also added were portable ultrasound equipment to detect unseen internal injuries; automated external defibrillators; QuikClot (Wallingford, CT), a thermogenic powder pioneered by the Marine Corps to control hemorrhage; and the introduction of the pelvic sling to replace the use of military antishock trousers for stabilizing pelvic fractures.
Another addition was the use of prepacked medical “roll-down” bags in the Patient Stabilization area. These bags, made by Iron Duck (Chicopee, MA), are long, hanging multipocket bags packed with medical supplies. Designed to speed the setup of field medical facilities, they are similar to the prepackaged bags used so successfully in the Marine Corps Forward Resuscitative Surgery System (FRSS), a sort of one-bed trauma center on wheels that has been widely used in the war in Iraq. Also adapted from the FRSS is the Base-X tentage system (Base-X, Inc., Lexington, VA), which includes built-in lighting and a portable electric generator to give the CBIRF medical section operating capability in various lighting and climate extremes that it did not previously have.
Biochemical Response. Medical supplies for injuries caused by pulmonary agents or vesicants are largely the same as those trauma supplies used for respiratory distress and burns and, therefore, were not calculated separately (U.S. Army Medical Research Institute of Chemical Defense [USAMRICD], 2000; Battlebook Project Team, 2000). CBIRF’s major concern in the area of chemical attack is the potential use of nerve agents such as sarin. CBIRF medical officers estimate they can decontaminate and treat up to 500 nonambulatory nerve agent patients in a 10-hour period, the maximum amount of time CBIRF team members can operate in full Level-A protective gear before requiring relief. Therefore, calculations for nerve agent antidotes were based on the requirements for treating 500 patients, plus force protection for up to 250 CBIRF members. (The latter included Mark I personal nerve agent kits to be carried by all CBIRF members in the cargo pockets of their pants, or in thigh rigs duct-taped to their chemical suits.)
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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