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OCR for page 151
7
Assessment of Military Capabilities to
Provide Emergency Response
In a sense, the subject of military emergency response capabilities in
civil situations is beyond the scope of this study, which is focused on
deployed forces. However, because the agencies responsible for the pro-
tection of our forces also have certain responsibilities during domestic CB
terrorist incidents, this subject is treated briefly.
Because of recent concerns about possible CB terrorist incidents in the
United States, various initiatives have been implemented and numerous
studies undertaken to assess emergency response capabilities (e.g., GAO,
1999; IOM, l999b). Many of these initiatives define the role of the U.S.
military in coordination with other federal (e.g., the Federal Bureau of
Investigation, the Federal Emergency Management Agency, the U.S. De-
partment of Energy), state, and local agencies.
For example, the Domestic Preparedness Initiative, established in the
FY 1997 Defense Authorization Bill (Public Law 104-201), commonly re-
ferred to as the Nunn-Lugar-Domenici legislation, provides funding for
DoD to enhance the capabilities of federal, state, and local emergency
responders in incidents involving NBC terrorism. In response, SBCCOM
has set up a hot line to provide emergency responders and emergency
planners with immediate access to information during a CB terrorist inci-
dent. SBCCOM also provides training to improve existing metropolitan
response capabilities to CB incidents.
The Army has formed specialty response teams to complement the
military medical response in the event of a local, national, or international
CB attack. The two teams, which are required to be capable of deploying
within 18 to 24 hours of notification, are the Special Medical Augmentation
151
OCR for page 152
52
STRATEGES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
Response Team-Preventative Medicine (SMART-PM) and the Special Medi-
cal Augmentation Response Team-Chemical/Biological (SMART-CB). The
mission of the SMART-PM team is to provide initial assessments of dis-
ease and environmental health threats either prior to or in the initial
stages of a contingency operation or during the early or continuing stages
of a disaster.
The SMART-CB includes the National Medical Chemical-Biological
Advisory Team (MCBAT) and the Regional Medical Command CB Spe-
cialty Response Teams (CB-SRTs). SMART CB components, which are
elements of the DoD Chemical Biological Rapid Response Team, are re-
quired to be ready to deploy worldwide within four hours of receiving
their orders. The responsibilities of the National MCBAT and the regional
CB-SRT include: (1) providing medical advice to commanders or local
authorities (a) on protecting first responders and other health care per-
sonnel, (b) on casualty decontamination procedures, and (c) on first aid
and initial medical treatment; and (2) aiding in handling casualties.
USAMRICD has developed a Chemical Casualty Site Team with the
capability of rapid deployment in support of DoD, the Foreign Emer-
gency Response Team, or the Domestic Emergency Response Team. The
personnel available for deployment can provide information on the medi-
cal effects of specific chemical warfare agents, identify chemical agents or
their metabolites in biological samples, determine blood cholinesterase
levels, provide technical and biomedical means to protect personnel re-
sponding to chemical incidents or to decontaminate personnel and casu-
alties, and assist with mission planning. Military units can also provide
training, advice, and assistance in bomb disposal and decontamination
operations.
A 350-member Marine Corps unit, the Chemical Biological Incident
Response Force (CBIRF), assists with evacuation, decontamination, and
medical stabilization of victims. CBIRF is required to be able to have an
advance party airborne within four hours of notification; however, given
its limitations, this unit is likely to play a major role only when deployed
to a site in advance (e.g., the 1996 Olympics in Atlanta) (IOM, l999b).
Recently, the Army published a regulation stating that U.S. Army
medical treatment facilities and clinics will provide assistance to civilian
first responders in the event of a CB terrorist act and emergency room
and in-patient treatment for both DoD beneficiaries and civilian casual-
ties (U.S. Army, 1998~. Requirements of the Surgeon General include:
coordinating emergency medical CB response capabilities worldwide
with other DoD, joint service, federal, state, local, and host nation agen-
cies; maintaining medical CB response teams to address emerging infec-
tious diseases and chemical accidentsfincidents worldwide; and estab-
lishing policy and guidelines for managing and treating conventional
and CB casualties.
OCR for page 153
ASSESSMENT OF MILITARY CAPABILITIES
153
The National Guard has established rapid assessment and initial de-
tection (RAID) teams in 10 areas around the country (designated by the
Federal Emergency Management Agency) to respond to terrorist attacks
in the United States that involve CB agents. These teams are designated to
be the first military responders sent to help civilian authorities detect and
assess CB agents. They are also prepared to train local authorities in CB
weapons detection, defense, and decontamination; assist in casualty treat-
ment and evacuation; quarantine affected areas and people; and assist in
restoration of infrastructure and services.
Many recommendations have recently been made to improve U.S.
readiness to respond (e.g., GAO, 1999; IOM, l999b), and initial efforts
have been made to implement some of them. For example, to protect
civilian emergency responders in the event of a CB warfare incident, the
National Institute for Occupational Safety and Health (NIOSH), the
SBCCOM, and the Occupational Safety and Health Administration are
working together to provide respiratory protection for emergency re-
sponders. Currently, respiratory protection that is certified by NIOSH for
use against CB agents is not available.
Much less attention, however, has been given to responding to CB
attacks against U.S. facilities on foreign soil. Although many safeguards
have been put in place since the attacks on the U.S. embassies in Kenya
and Tanzania in October 1998, others have been identified and have been,
or are in the process of being, added. In general, the U.S. Department of
State and the Federal Bureau of Investigation are primarily responsible
for dealing with these types of incidents; however, the host nation often
provides medical treatment and works with the United States in response
to the attack. Documentation obtained during the course of this study did
not include the role of the military in these types of attacks.
Based on a presentation about the proposed NATO Long-Term Scien-
tific Study on Chemical and Biological Defense (Medema, 1999), there are
significant deficiencies in doctrine and guidance for emergency responses
in allied countries. No provisions are being made to ensure that host
nation forces are equipped with CB protective equipment compatible with
the equipment used by U.S. forces. Nor are there provisions for training
foreign nationals engaged in mission-critical activities on U.S. bases in
host nations that might be targets for CB attack.
FINDINGS AND RECOMMENDATIONS
Finding. Because numerous agencies will respond to a domestic CB inci-
dent, close cooperation will be necessary for the response to be efficient
and effective. Unless civilians (e.g., first responders, employees of rel-
evant state and local agencies, etc.) who respond to domestic CB incidents
OCR for page 154
54
STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
are equipped with protective and decontamination equipment that is com-
patible with equipment used by the military, coordination will be difficult
if not impossible.
Recommendation. The Department of Defense, in collaboration with ci-
vilian agencies, should provide compatible equipment and training to
civilians (e.g., first responders, employees of relevant state and local agen-
cies, etc.) who respond to domestic chemical and/or biological incidents
to ensure that their activities can be coordinated with the activities of
military units. Doctrine and guidance should be developed on an inter-
agency basis.
Finding. Doctrine and training are not well developed for mission-critical
civilians working at military installations that might become targets of
chemical and/or biological attacks.
Recommendation. Coordinated doctrine, training, and guidance on in-
dividual protective equipment, collective protective equipment, and de-
contamination for civilians working at military installations should be
established on a joint service, interagency and coalition basis.
Representative terms from entire chapter:
emergency responders
