WMD Resources

by John Bastin, PA-C

Published in the Winter 2003 edition of the Maine EMS I/C News

Since the tragic events of September 11^th we as a nation have realized just how vulnerable we really are. Our vulnerability exists not only to a conventional terrorist attack but to an attack from a weapon of mass destruction (WMD). A conventional terrorist attack is something that we have a fair amount of experience with and many safeguards have been implemented to prevent and to respond to such an attack. In comparison, little is known about the prevention or even the response to a WMD attack.

Almost every magazine we pick up today, whether a medical journal or publication in the lay press, has an article on the topic of bio-terrorism, and a fair number of self proclaimed “WMD/Bio-terrorism Experts” have published articles or developed web pages on this topic. We as medical professionals have learned to review critically what we read, and should continue this practice when reviewing any information on WMD/bio-terrorism. Not everything we read should be interpreted as policy.

In my role as a Military Disaster Preparedness Officer and an advisor to the Surgeon General for Homeland Security, I have had the opportunity to attend numerous military-sponsored WMD courses and have reviewed a lot of information on the internet and in print. What I would like to do in this article is share with you some of the resources that I that I have found to be beneficial.

United States Army Medical Research Institute of Infectious Diseases (USAMRIID)

Web address: <http://www.usamriid.army.mil/>

USAMRIID is the lead agency within the Department of Defense for all aspects of the research and development into the defense of biological agents. (The anthrax letters were analyzed at USAMRIID.) Much of the research at USAMRIID is being done into the early detection and prevention of a biological warfare agent as well as the development of vaccines against the agents.

USAMRIID is also very active in training and education, and has developed several presentations on the Medical Defense of Chemical and Biological Agents. Videotapes from the November 2001 program “Biological & Chemical Warfare and Terrorism—Medical Issues and Response” can be ordered from this web site. I had the opportunity to view this broadcast in December of 2002 and found it to be very informative.

USAMRIID also offers “The Medical Management of Chemical and Biological Casualties” course, which is an intensive seven-day course taught at USAMRIID in Fort Dietrich, Maryland and Aberdeen Proving Ground, Dahlgren, Maryland. As a graduate of this course, I can say that it was the most informative course I have ever attended. The course is primarily for active duty military and I am not sure what the policy is for civilians to attend. There were two civilian physicians in my class. If you’re interested, I would recommend contacting USAMRIID to see if you can secure a class quota. Contact information can be obtained from the web site.

An excellent reference tool, “The Medical Management of Biological Casualties” handbook can be ordered from this site. More commonly known as the “Blue Book,” this pocket-sized reference contains a wealth of information on biological agents. This text can also be downloaded from the site as well. The downloaded version is not in pocket-size format, but the larger 8.5” x 11” document is suitable to be kept in a binder for easy reference. On the same page you can also order or download the publication, “Defense against Toxin Weapons.” I have not personally reviewed this document but it may be a good source of information.

United States Army Medical Research Institute of Chemical Defense Chemical Casualty Care Division

Web Address: < http://ccc.apgea.army.mil/>

This organization is affiliated with USAMRIID, but where USAMRIDD deals primarily with biological agents, this organization is dedicated to chemical agents. This site contains an enormous amount of information and reference material. The site contains three computer-based training modules that you can complete on-line and for which you can receive CEUs.

§ § “Medical Management of Chemical Casualties Mini-course,” which is very similar to the in-house “Medical Management of Chemical & Biological Casualties Course”

§ § “Medical Management of Nerve Agent Casualties”

§ § “Medical Management of Vesicant Agent Casualties”

The mini-course can be taken on-line or by ordering the Chemical Casualty Care Division’s supplemental training CD-ROM. If done by CD, there are instructor narrations for each slide where the on-line course has a series of PowerPoint slides for each section that you read. The CD can also be used as a reference source for preparing your own lectures and presentations. I have not done the mini-course, only because I attended the in-house course. I have done the Medical Management of Nerve and Vesicant Agent Casualties courses and both are excellent.

USAMRIID, in conjunction with the Chemical Casualty Care Division, is presenting “Advanced Topics on Medical Defense against Biological and Chemical Agents” throughout the first part of this year. This is a series of six two-hour satellite broadcasts on various topics. The first presentation was on smallpox, this month’s topic was on nerve and vesicant agents. The next presentation will be in March and the topic will be vaccinations. When you register for the program you will be given a list of numerous sites throughout Maine where you can go to view the broadcast. I viewed the second broadcast today at Central Maine Technical College in Auburn, and there are other sites throughout the state. The broadcast is free and you receive two CEUs/CMEs for each broadcast by filling out an online critique after viewing the program.

Videotapes of previous year’s broadcasts can also be ordered from this site. I have access to tapes of last year’s broadcast, and anyone may contact me if interested in obtaining a copy.

Reference books can also be requested from this site.

§ § The Medical Aspects of Chemical and Biological Warfare. This is a hard cover text that is a very comprehensive reference on all aspects of chemical and biological warfare. The text can be viewed on-line or ordered.

§ § Field Management and the Medical Management of Chemical Casualties. These texts are similar to the biological handbook that can be ordered from USAMRIID. (Actually the biological handbook can also be ordered from this site as well.) Both are pocket-size and contain extensive information regarding chemical casualties. The texts can be ordered or downloaded in a larger version.

Three other texts that are new to the web site that I have not had the opportunity to review are:

§ § NATO Handbook on the Medical Aspects of NBC Defensive Operations

§ § The Medical NBC Battle Book

§ § Treatment of Biological Warfare Agent Casualties—Field Manual

The site is very user-friendly and easy to navigate. Both this site and the USAMRIID site have extensive links to other civilian and military resources.

U.S. Army Solider and Biological Chemical Command

Web address: <http://www.apgea.army.mil/>

This site does not have much in the way of CME/CEUs, but it is an excellent site for reference material. Clicking on the picture in the center of the home page will take you to the Homeland Defense web site. Again, this site has a lot of very good information on procedures and equipment, as well as other related sites.

Armed Forces Radiobiology Research Institute (AFFRI)

Web address: <http://www.afrri.usuhs.mil/>

This site contains information pertaining to a radiological threat. There is a lot of scientific information that is not really useful to first responders, but it does contain a couple of good resources. The first is the Medical Management of Radiological Casualties handbook. Similar to the biological and chemical handbooks previously mentioned, it is a good reference for radiation injuries. AFFRI has been out of the book for sometime now; the last time I checked they expected to receive more after the first of the year. You can download a full text copy. Also available to download is the “Pocket Guide for Responders to Ionizing Radiation Terrorism.” This is a two-page reference tool that pertains to the recognition and treatment of radiation casualties.

AFFRI also offers a two-hour course entitled, “The Medical Effects of Ionizing Radiation,” which deals with the medical management of radiation casualties. I attended the course last month and it was pretty informative, but also dry at times. This course is actually taught all over the U.S. and the world. I cannot speak for AFFRI’s policy on civilians attending the course, but if you’re interested in attending there is a contact person listed on the web site.

Federal Emergency Management Agency (FEMA)

Web site: <http://www.fema.gov/>

The FEMA web site offers 36 distance learning courses that you can enroll in from the web site. You can either request the course materials be mailed to you or you can do the course on line. Access to the course page is somewhat confusing, so here is the quickest way to get to the course listing:

§ § From the FEMA home page click on “Education and Training”

§ § On the next page under the heading “Information and courses for emergency personnel” click on “Emergency Management Institute”

§ § Under “Courses” click on “Independent Study”

§ § Scroll down and to the end of the page and click and “See our list of available courses.” The next page will list the available courses.

I hope this information has been helpful. Contact me through Jacky at <jacky_vaniotis@onf.com> if I can be of any further assistance. I would be more than happy to come out and give a talk to your classes or your services on any of these topics. Remember to read a lot but be critical of what you read.

John Bastin, PA-C, MS, NREMT-B