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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.
Calculations for biochemical medications were based on dosage information that NHRC developed to calculate the required amount of medications for the Marine Corps Surgical Company’s nuclear, biological, and chemical warfare supply block, which underwent an NHRC SME review in 2002 (Hill, Galarneau, Pang, & Konoske, 2003). The requirements for atropine, pralidoxime chloride, and diazepam were calculated on a worst-case maximum dosage of 12 mg of atropine per person. The per-person dosage for pralidoxime chloride was calculated on the basis of 600 mg per 2 mg of atropine. Diazepam dosage was calculated at a rate of 10 mg per 6 mg of atropine. These doses were based on military rule-of-thumb suggestions for field treatment of nerve agent poison (USAMRICD, 2000; Battlebook Project Team, 2000). In reality, some victims would require less while others would require more, depending on their exposure.
Due to cyanide’s fast-acting effect, CBIRF probably would not deploy in time to provide medical treatment to victims. Therefore, cyanide treatment kits were provided only for members of the CBIRF initial entry team, those 10 members who would be working the closest to the hot zone in the event of a cyanide attack. In the event of a biological incident, CBIRF’s medical section would probably not provide more than force health protection for CBIRF Marines. Therefore, antibiotics for biological attacks were limited to amounts needed to provide prophylactic treatment to CBIRF’s 250-member response force.
Radiological Response. Recommended emergency field treatment for radiological casualties—whether from nuclear detonation fallout, nuclear accident, or dispersal from a radiation dispersal device or “dirty bomb”—is limited to decontamination, treatment of trauma and/or burns, and pain medication and anti-emetics as needed (DeLorenzo & Porter, 2000). However, some medications may be of value in treating radiation victims in the field. These medications, if administered quickly after exposure, aid in eliminating some radioactive elements from the body, thus limiting exposure effects (American College of Radiology, 2002; Battlebook Project Team, 2002; DeGarmo, 2003). A list of recommended medications for radioactive agents can be seen in Table 5. In addition, antacids and laxatives can be useful in preventing absorption and assisting the elimination of radioactive elements from the body (DeGarmo, 2003).
The NHRC review of existing CBIRF AMALs found little ability to treat radiation exposure. The proposed CBIRF radiological response module included all of the medications listed above except for zinc and trisodium calcium diethylenetriaminepentaacetate, which at the time were investigational drugs in the United States. In addition, aluminum hydroxide antacid, calcium carbonate antacid, and magnesium citrate oral laxative solution were included. In all cases, oral medications were chosen to simplify distribution, and amounts were calculated to treat 500 patients, plus force protection for 250 CBIRF members.
Additional Supplies. CBIRF’s expanded mission role could find it responding to extreme climates throughout the world. However, its original medical inventory provided little or no capability for treating the type of environmentally related medical conditions that can be found in weather extremes. To correct this, two supplemental modules—one for hot weather, another for cold—were created, allowing CBIRF to carry only those supplies dictated by need. The hot-cold weather supplies are based on the existing Marine Corps Surgical Company environmental supply block originally devised using NHRC’s modeling method, this time scaled down to CBIRF needs. Though primarily focused on force protection (population at risk = 250 personnel), these supplies can also be used to treat victims of terror attacks if harsh weather produces environment-related medical complications.
As previously stated, the SME panel selected the standard battalion sick-call supply block to provide a sick-call capability for CBIRF during prolonged deployments. This will allow CBIRF to respond with this supplemental capability only when deemed necessary, such as during an overseas deployment lasting for weeks. Using a standard sick-call supply block will also provide convenient resupply, if needed.
Conclusion
CBIRF’s evolving mission, growing from biochemical response to include the full range of CBRNE responses, outstripped its original medical inventory. This study afforded the first opportunity to analyze clinical supply needs of the unit’s medical section in light of its increased responsibilities. In doing so, the study was able to identify weaknesses in CBIRF medical capabilities due to deficiencies in its authorized medical blocks, particularly in the areas of radiological response, the treatment of crush syndrome, sick call for prolonged deployments, and medical conditions that might be encountered in extreme environmental conditions.
As a result of this study, these “capability gaps” were closed. In doing so, the study showed that NHRC’s method of analyzing and modeling battlefield medical requirements can also be utilized to determine the medical supply requirements for field medical units responding to terrorist attacks. Such modeling can be useful in ensuring disaster responders have not only the equipment that is correct and necessary to respond to WMD attacks, but also have it in adequate amounts.
References
American College of Radiology. (2002). Disaster preparedness for radiology professionals: Response to radiological terrorism. Retrieved October 10, 2003, from http://www.acr.org/s_acr/index.asp
The Battlebook Project Team (2000). The medical NBC battlebook (USACHPPM Tech. Guide 244). Aberdeen Proving Ground, MD: U.S. Army Center for Health Promotion and Preventive Medicine.
Boodram, B., Torian, L., Thomas, P., Wilt, S., Pollock, D., Bell, M., et al. (2002). Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center-New York City, September 11, 2001. CDC Morbidity and Mortality Weekly Report, 51(1), 1-5.
Chemical Biological Incident Response Force (CBIRF). (2003). Retrieved August 4, 2003, from the Global Security.org website: www.globalsecurity.org/military/agency/usmc/cbirf.htm
DeGarmo, B. (2003). Radiological terrorism: Primary care preparedness. Retrieved November 15, 2003, from http://www.bioterrorism.slu.edu/bt/products/ahec_rad.htm
DeLorenzo, R. A., & Porter, R. S. (2000). Weapons of mass destruction emergency care. Upper Saddle River, NJ: Brady.
Dickson, J. R. (1998). Crush injury (Disaster Medical Assistance Team training document). Washington, DC: U.S. Department of Homeland Security National Disaster Medical System.
Gonzalez, M. S. (2002). The impact of mass casualties on the health care delivery system—conventional injuries. Retrieved October 14, 2003, from www.vch.state.va.us
Hill, M., Galarneau, M., Pang, G., & Konoske, P. (2003). Marine Corps NBC warfare: Determining clinical supply requirements for treatment of battlefield casualties from chemical and biological warfare (NHRC Tech. Rep. No. 03-13). San Diego, CA: Naval Health Research Center.
Pennsylvania Emergency Management Agency (PEMA). (2003). Medical aspects of urban search and rescue. Retrieved August 4, 2003, from http://www.pema.state.pa.us/pema/
Temerlin, S. (2003). CBIRF medical concept of employment (CBIRF report). Indian Head, MD: U.S. Marine Corps Chemical Biological Incident Response Force.
U.S. Army Medical Research Institute of Chemical Defense (2000). Medical management of chemical casualties handbook (3rd ed.). Aberdeen Proving Ground, MD: USAMRICD.
U.S. Department of Defense. (2001). CONPLAN: United States Government interagency domestic terrorism concept of operations plan (Joint Agency Rep. No. A583783). Washington, DC: U.S. DoD.
U.S. General Accounting Office. (1999). Combating terrorism: Chemical and biological medical supplies are poorly managed (Rep. No. GAO/HEHS/AIMD-00-36). Washington, DC: U.S. GAO.
U.S. General Accounting Office. (2001). Combating terrorism: Accountability over medical supplies needs further improvement (Rep. No. GAO-01-463). Washington, DC: U.S. GAO.
About the Authors
Martin Hill is a research analyst with the Naval Health Research Center in San Diego, CA, specializing in operational field medicine for the Marine Corps. Mr. Hill has 16 years of military experience in Navy counter-insurgency operations, and in Coast Guard search-and-rescue and maritime law enforcement operations, including counter-narcotics and homeland security operations. He has served as a tactical and rescue medical specialist with the San Diego County Sheriff’s Department Search and Rescue detail and is a medic and security specialist with a federal Disaster Medical Assistance Team. He is Certified in Homeland Security at Level III (CHS-III) by the American Board for Certification in Homeland Security.
Michael Galarneau, MA, a research psychologist, has been involved in the research and development of medical information systems, health care products, and modeling simulations for the U.S. Navy Fleet Marine Force since the mid-1990s. He has received a patent for his work at the Naval Health Research Center (United States patent 5,995,077, November 1999). He currently oversees the Navy-Marine Corps Combat Trauma Registry at NHRC. Mr. Galarneau is a Nationally Registered Emergency Medical Technician-Basic.
Gerry Pang, MA, is a computer specialist whose responsibilities at the Naval Health Research Center include both hardware and software support for research and development of medical information systems, health care products, and modeling simulations for the U.S. Navy Fleet Marine Force. Mr. Pang designs, develops, debugs, evaluates, analyzes, and implements new medical software and provides database and programming support for research projects.
Paula Konoske, PhD, received her doctorate in social psychology from Wayne State University, Detroit, MI. Prior to coming to the Naval Health Research Center in 1994, she was a research psychologist at the Navy Personnel Research and Development Center, San Diego. Her research experience includes the design of interactive technical training, survey design and development, program evaluation, Total Quality Leadership implementation, and the application of statistical process control. Dr. Konoske is currently the Program Manager for the Modeling and Simulation Group. Dr. Konoske has authored numerous technical reports and journal publications and has presented research results at professional meetings and conferences.
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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.
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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:
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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:
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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.
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