Naval Forces' Defense Capabilities Against Chemical and Biological Warfare Threats (2004) / Chapter Skim
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5 Medical Chemical and Biological Countermeasures: Specific Findings and Recommendations
5 Medical Chemical and Biological Countermeasures: Specific Findings and Recommendations
Pages 105-133
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From page 105... ...
Biological warfare defense is clearly the most challenging from a medical perspective, and, not surprisingly, the committee found the greatest gaps between that threat and our capacity to manage the consequences of an attack. Medical defense for naval forces must be viewed holistically and should recognize the importance of individual service members, corpsmen, and health care providers as the main elements of the medical defense equation.
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From page 106... ...
. This kind of analysis and 1Due to their expanded scope of chemical and biological defense associated with the war on terrorism, the Department of Homeland Security and the Department of Health and Human Services, especially in the area of vaccines, may impact the Joint CBD Program.
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From page 107... ...
Embedded in the acquisition programs of DOD and the Joint CBD Program for both vaccines and laboratory diagnostics is the requirement for Food and Drug Administration (FDA) certification of drugs, devices, and vaccines.
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From page 108... ...
Medical Chemical and Biological Countermeasures Finding: Navy Deficiencies in Chemical and Biological Medical Defense Training While specific medical training needs vary, overall the Navy is severely deficient in many areas of chemical and biological medical defense training. Several changes will be needed to rectify the problems.
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From page 109... ...
Available Chemical and Biological Medical Defense Courses The Navy does not have a comprehensive chemical or biological casualty management training program, although there is ample opportunity for the training of Navy Medical Corps officers and health care providers through other organizations. The Army has the most extensive set of such training programs of any of the Services.
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From page 110... ...
However, within this framework, the chemical and biological medical defense training requirement to support medical readiness is inadequately defined. The Navy does require that personnel deploying to field hospitals learn decontamination procedures, but little else in the way of chemical and biological medical defense training is mandatory for physicians, physician's assistants, nurses, medics, or corpsmen.
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From page 111... ...
From the same data, only a small percentage of Navy active duty officers have taken this course in comparison to a much larger percentage of the Army active duty officers.3 Reporting There is no centralized internal training and competency database for the Navy analogous to the one maintained by the Joint Commission on Accreditation of Health Care Organizations for civilian medical care. Consequently, there are no available accurate data on medical personnel trained in chemical and biological defense to support the development of compilations of medical skill availability for war planning and ship staffing.
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From page 112... ...
A capably trained and proficient health care provider will save lives. The Navy should develop a program to track chemical and biological medical defense training and proficiency to allow medical personnel and skills to be adequately accounted for in war planning and ship staffing.
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From page 113... ...
BOX 5.1 Current Medical Treatments for Chemical Warfare Agents Nerve Agents The treatment for nerve agent poisoning recommended by the U.S. military involves the use of three therapeutic drugs: atropine, pralidoxime, and diazepam.
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From page 114... ...
Treatments Under Development Two new medical products are currently in advanced stages of development in the Joint Service Medical Chemical Defense Science and Technology Program: a topical skin protectant and a multichambered autoinjector. The topical skin protectant is a barrier ointment that will significantly delay the penetration of
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From page 115... ...
Also within the Joint Service Medical Chemical Defense Science and Technology Program technology base are programs to develop broad-spectrum enzyme scavengers that will provide pre-exposure protection against CW agents. These scavengers are forms of human cholinesterases and will require the administration of a non-self-generated protein or gene therapy to develop levels that are protective.
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From page 116... ...
However, because of the current age of these stocks, these vaccines cannot be used under an IND protocol until they are retested and pass standard FDA quality-testing requirements. A limited discussion of the current status of approved medical countermeasures is presented in Box 5.2.
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From page 117... ...
The federal government has initiated a program to vac cinate key public health and emergency medical personnel throughout the country with these stores, although suspected cardiac complications in some cases have slowed progress. In the meantime, the JVAP has given the go-ahead to its prime contractor, DynPort Vaccine Company, to initiate clinical trials on its new smallpox vaccine for DOD.
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From page 118... ...
JVAP also manages and monitors progress on vaccine development efforts that are in the Joint Service Medical Biological Defense Science and Technology Program technology base. Vaccine candidates that are mature enough for small-scale production and testing under FDA guidelines are transitioned to DynPort Vaccine Company for advanced development, regulatory compliance, testing, production, and fielding.
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From page 119... ...
Medical Chemical and Biological Countermeasures Recommendation: Needed Practices and Reforms for Adequate Protection At a minimum, the Navy should ensure that all deployments include adequate stores of current chemical and biological medical defense countermeasures. It should also push the JVAP into a more aggressive development path for new and more effective vaccines and drugs.
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From page 120... ...
Because chemical warfare casualties have a short lag time between exposure and the onset of symptoms and since the distinction between different warfare agents is fairly straightforward, the committee focused on the diagnosis of biological warfarerelated disease, which can be easily confused with naturally occurring ("background") infections.
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From page 121... ...
FDA certifies both the reagents and the laboratory technology used to manage the care of humans. Medical Chemical and Biological Countermeasures Finding: Both Operational and Technical Shortfalls in Laboratory Diagnostics Operational Capabilities The committee's review of a limited number of operational-readiness directives (specifically, instructions from the Commander, Naval Air Force, U.S.
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From page 122... ...
It is the sense of this committee that these laboratories have not been fully exploited as platforms for experimentation in training, doctrine, equipment, and disease surveillance. Technical Directions The Joint CBD Program's development plans for laboratory diagnostics are too narrowly focused on ELISA and PCR sciences.
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From page 123... ...
Medical Chemical and Biological Countermeasures Recommendation: Operational Diagnostic Improvements at Hand Implement existing instructions and make use of environmental and preventive medicine units for introducing new equipment. The Chief of Naval Operations should require that fleet commanders review relevant instructions governing the medical readiness of ships with regard to biological warfare diagnostics.
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From page 124... ...
More specifically: · The Chief of Naval Operations should direct a review of Joint Chemical and Biological Defense Program and Department of Defense lead agent investments in existing technologies and modify, as necessary, Navy operational requirements documents to serve the needs of the fleet and naval station end users. As is apparent from other parts of this report, there is a downside in assuming that joint systems will result in robust Service capabilities.
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From page 125... ...
The point to be made is that traditional clinical diagnosis, unless modified and advanced to a set of early, fundamental indicators of incipient disease, is likely to be "too little, too late" to prevent casualties and loss of life from biological warfare attacks. Medical Chemical and Biological Countermeasures Finding: The Lack of Practice of Clinical Diagnosis Training programs are available through the Department of the Army for both physicians and paramedical personnel in the diagnosis and management of CW and BW casualties.
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From page 126... ...
It is recommended that such an officer with sufficient fleet experience and training in infectious diseases be selected by the Bureau of Medicine and Surgery so that he or she can provide the nexus for concept generation and experimentation. Medical Chemical and Biological Countermeasures Finding: Consequences and Impact of Exposure A serious and generally overlooked issue is that of long-term consequences for the health care system of victims exposed to chemical or biological weapons.
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From page 127... ...
Indications were that the larger the ship and hence the more sophisticated the medical capability, the more likely that the medical contingent functioned relatively independently of the ship captain unless an emergent situation developed. Many medical facilities ashore participate in local community disease reporting systems, but this too is not uniform practice.
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From page 128... ...
Ideally, the Navy system would then communicate the data and analysis to a single national registry, which would correlate developments from the military and civilian communities. Medical Chemical and Biological Countermeasures Finding: Successful Reporting Systems There are examples of successful military and civilian initiatives to identify fundamental warnings and indicators, collect the data, and analyze and merge them into systems capable of assessing the significance of seemingly random clinical observations.
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From page 129... ...
(See also footnote 29 in Chapter 2.) Medical Chemical and Biological Countermeasures Recommendation: Standards for Disease Reporting Build a routine disease reporting system based on the Air Force prototype and adopt "best practices" from the commercial world.
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From page 130... ...
Medical Chemical and Biological Countermeasures Recommendation: Shore Installations and Bases Ensure that all shore installations and bases are included in the disease reporting system. The disease reporting and analysis system outlined above should be mirrored in the ports, at shore installations, and at bases.
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From page 131... ...
It should therefore be the responsibility of the base commander to assure that the base and civilian response to a biological or chemical attack is maximally coordinated. In the case of disease reporting, information should be shared when the first report is made to the base commander and regularly thereafter, until the crisis has passed.
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From page 132... ...
to prioritize and enlist key support organizations, both within the Navy and in the Joint CBD Program, for implementation. BOX 5.3 Summary of Findings and Recommendations on Medical Chemical and Biological Countermeasures Drugs and Vaccines Findings · There are five fielded products for medical chemical warfare (CW)
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From page 133... ...
-- Undertake fundamental research in developing the basis for pre-symp tomatic diagnosis. · Develop gaming and operational concepts, coupled with clinical diagnosis, for biological warfare attacks.
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