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Executive Summary
Since Operation Desert Shield/Desert Storm, Gulf War veterans have
expressed concerns that medical symptoms they have experienced could
have been caused by exposures to hazardous materials or other deployment-
related factors associated with their service during the war. Potential
exposure to a broad range of chemical and/or biological (CB) and other
harmful agents was not unique to Gulf operations but have been a com-
ponent of all military operations in this century. Nevertheless, the Gulf
War deployment focused national attention on the potential, but uncer-
tain, relationship between the presence of CB agents in theater and health
symptoms reported by military personnel. Particular attention has been
given to the potential long-term health effects of low-level exposures to
CB agents.
Since the Gulf War, U.S. forces have been deployed to Haiti, Somalia,
Bosnia, Southwest Asia, and, most recently, Kosovo, where they were
(and are) at risk of exposure to toxic CB threats. The U.S. Department of
Defense (DoD) anticipates that deployments will continue in the foresee-
able future, ranging from peacekeeping missions to full-scale conflicts.
Therefore, the health and preparedness of U.S. military forces, including
their ability to detect and protect themselves against CB attack, are central
elements of overall U.S. military strength. Current doctrine requires that
the military be prepared to engage in two simultaneous major regional
an. . . .. . .. . .
, cat
.
conflicts while concluctmg peace~eepmg operations ancl other assign-
ments around the globe. The diversity of potential missions, as well as of
potential threats, has contributed to the complexity of developing an ef-
fective strategy.
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2
STRATEGES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
BACKGROUND
In the spring of 1996, Deputy Secretary of Defense John White met
with the leadership of the National Academies to discuss the DoD's con-
tinuing efforts to improve protection of military personnel from adverse
health effects during deployments in hostile environments. Although
many lessons learned from previous assessments of Operation Desert
Shield/Desert Storm have been reported, prospective analyses are still
needed: (1) to identify gaps and shortcomings in policy, doctrine, train-
ing, and equipment; and (2) to improve the management of battlefield
health risks in future deployments.
DoD determined that independent, external, unbiased evaluations
focused on four areas would be most useful: (1) health risks during
deployments in hostile environments; (2) technologies and methods for
detecting and tracking exposures to harmful agents; (3) physical protec-
tion and decontamination; and (4) medical protection, health conse-
quences and treatment, and medical record keeping. This report, which
addresses the issues of physical protection and decontamination, is one of
four initial reports that will be submitted in response to that request.
CHARGE
This study, conducted by two principal investigators with the sup-
port of an advisory panel and National Academies staff from the Com-
mission on Engineering and Technical Systems, assessed DoD approaches
and technologies that are, or may be, used for physical protection both
individual and collective against CB agents and for decontamination.
This assessment includes an evaluation of the efficacy and implementa-
tion of current policies, doctrine, and training as they relate to protection
against and decontamination of CB agents during troop deployments and
recommends modifications in strategies to improve protection against
deleterious health effects in future deployments. This report includes re-
views and evaluations of the following topics:
· current protective equipment and protective measures, as well as
those in development
· current and proposed methods for decontaminating personnel and
equipment after exposure to CB agents
· current policies, doctrine, and training for protecting against and
decontaminating personnel and equipment in future deployments
· the effects of using current protective equipment and procedures
on unit effectiveness and other human performance factors
· current and projected military capabilities to provide emergency
response to terrorist CB incidents
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EXECUTIVE SUMMARY
3
THREAT AND RISK ASSESSMENT
Chemical and Biological Battle Space
Chemical agents were first used extensively as military weapons dur-
ing World War I. CB weapons programs continued to flourish during the
1950s and 1960s, led by scientists in the United States and the Soviet
Union, and to a lesser extent, in other countries including Great Britain.
New nerve agents were developed during those years, including the fam-
ily of V agents, which are not only lethal in smaller ingested doses but can
also be absorbed directly through the skin. Natural toxins and biological
pathogens were also investigated as biological warfare agents.
In the post-1950s era, improving the means of dissemination of lethal
agents became a major research objective. Airborne spray tanks, special-
ized artillery shells, CB-capable missile warheads, and an assortment of
other weapons were developed. The United States discontinued its offen-
sive biological and chemical military research programs in 1969 and 1989,
respectively, but continued to expand its defensive programs. However,
CB technologies have continued to proliferate in other countries, and
with advances in bioengineering and molecular biological capabilities,
even small nations or groups now have the potential to develop novel
biological agents. This asymmetrical threat prompted the United States to
extend its CB defense programs, which have increased substantially since
Desert Shield/Desert Storm.
The estimated CB threat from Soviet forces during the Cold War was
based on the perceptions that a broad range of chemical and biological
weapons had been fielded, that the Soviet Union had the capability of
deploying and supporting those weapons on the battlefield, and that the
Soviets were pursuing an extensive research program. U.S. tactics, train-
ing, and requirements were based on this perceived threat. Today, many
countries possess CB capabilities although intelligence assessments indi-
cate that most of them have limited quantities of agents and limited deliv-
ery systems.
Response to Chemical/Biological Threats
The CB threat to U.S. forces can be defined as the perceived capability
of an opposing force to expose U.S. forces to CB agents. The most obvious
way to minimize the risk of CB exposure is to avoid contact with these
materials. Therefore, the military has developed a doctrinal principle for
protecting deployed forces based on avoiding exposure (i.e., contamina-
tion avoidance). Avoiding contact depends on the capability and avail-
ability of detection equipment; however, because of current lag times in
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4
STRATEGES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
detection capability, a responsive strategy (the so-called "detect to treat"
strategy), rather than a preventive strategy, has been necessary.
The U.S. intelligence community provides data, analyses, and advice
concerning the development of CB capabilities by threat nations. Based
on this information, commanders and the Joint Service Integration Group
(ISIG) evaluate how CB agents could be used against U.S. troops and
develop policy, doctrine, training, and requirements for equipment to
counter the perceived threat. As the threat changes, U.S. approaches to
countering the threat should also change.
As a result of the proliferation of CB capabilities, recent reductions in
U.S. forces, continuing budget constraints, and attempts to minimize du-
plications of effort among the services, operations have become more
integrated and cooperative (i.e., joint service operations). To encourage
the integration of CB research and development (R&D) at all levels, in
1994 Congress enacted Public Law 103-160, the National Defense Autho-
rization Act for Fiscal Year 1994 (Title XVII), establishing a new structure
for the CB defense program.
Finding. Joint structure and joint service processes were developed to
maximize the efficient use of funds and reduce duplications of effort.
Finding. The object of the joint prioritization of system needs (and, there-
fore, research, development, and acquisition [RDA] needs) is to ensure
that fielded systems meet joint service needs. This requires that
commander-in-chief (CINC) priorities and nuclear, biological, chemical
(NBC) community priorities be coordinated.
Finding. The prioritization and selection of RDA projects are often based
on compromises or political trade-offs unrelated to CINC prioritization,
technical capabilities, or bona fide needs and are focused on service-
specific rather than joint service needs.
Recommendation. The Department of Defense should reevaluate and
possibly revise its prioritization process for the development of equip-
ment. The reevaluation should include reassessment of the use of threat
information.
Challenge
The chemical agent challenge established for protective equipment
(lOg/m2 for liquids; 5,000-10,000 mg-min/m3 for vapors) has not been
changed in four decades. Although analyses using relatively sophisti-
cated computer models have shown that under certain conditions,
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EXECUTIVE SUMMARY
5
10 g/m2 levels may be present in localized areas of a battlefield, the aver-
age concentration may be considerably lower. These same models predict
that the areas where levels would be higher than 10 g/m2 would be the
same areas where the shrapnel and projected shell materials would be
more likely to cause injuries or deaths than CB agents. Nevertheless, be-
cause challenge levels determine the requirements for protection, the goals
of the entire CB R&D program are based on the 10 g/m2 level for liquid
agents and 5,000-10,000 mg-min/m3 for vaporous agents.
Finding. The battlefield areas with the highest contamination levels will
also have the highest levels of ballistic fragmentation lethalities. There-
fore, CB protective measures will be ineffective in these areas regardless
of the liquid or vapor challenge levels. The threat from CB weapons rela-
tive to other battlefield threats is unknown.
Finding. System development is sometimes based on outdated and pos-
sibly inaccurate evaluations of threats and challenges.
Recommendation. The Department of Defense should reevaluate the liq-
uid and vapor challenge levels based on the most current threat informa-
tion and use the results in the materiel requirements process and, subse-
quently, in the development of training programs and doctrine.
Finding. Little or no new funding is being provided for basic research on
new technologies for physical protection or decontamination.
Recommendation. The Department of Defense should reprogram funds
to alleviate the shortfall in basic research on new technologies for physical
protection and decontamination.
PHILOSOPHY, DOCTRINE, AND TRAINING
The CB defense program involves (1) contamination avoidance (re-
connaissance, detection, and warning); (2) force protection (individual
and collective protection and medical support); and (3) decontamination.
Before systems for detecting contaminated areas were available, military
planners developed a doctrine (best described as the "fight dirty" doc-
trine) that was based on conducting operations in contaminated areas.
Implementing the doctrine involved providing a combination of indi-
vidual protective equipment and extensive training on fighting in con-
taminated environments. As technology has advanced, especially detec-
tion technologies, and as new detection equipment has been fielded, the
doctrine has shifted to "contamination avoidance." Stated simply, this
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STRATEGES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
doctrine provides that U.S. forces will engage an enemy while avoiding
casualties from contamination by CB agents.
Once the doctrine of contamination avoidance (with concomitant de-
tection and protective equipment) was adopted, training was naturally
modified to carry out the new doctrine. A critical requirement for deter-
ring the use of CB agents (and for successful operations if deterrence fails)
is that forces be fully trained to respond to the full spectrum of CB threats.
Operational requirements must balance the risk factors from all sources
and determine trade-offs between protecting the individual and main-
taining the combat effectiveness of the force.
Finding. The current doctrine is based on the concept of contamination
avoidance, although U.S. CB detection systems do not, as a rule, provide
sufficient advance warning to prevent exposures.
Finding. Unit commanders receive little training related to assessing CB
risks to their units, especially in determining when, whether, and how
much protective gear is necessary.
Recommendation. The Department of Defense should develop com-
mander training protocols and/or simulations to assist unit leaders in
making appropriate chemical and biological risk-based decisions.
INDIVIDUAL PROTECTION
The military conceptual approach to individual protection, called
mission-oriented protective posture (MOPP), is an ensemble comprised
of protective garments, boots, masks, and gloves. MOPP levels proceed
(i.e., adding parts of the ensemble) from the MOPP-ready level to the
MOPP 4 level, increasing the level of protection in response to the hazard.
Because design requirements for personal protective equipment (PPE)
include the ability to withstand the established threat and risk levels, PPE
has severely limited individual (and unit) performance. Problems include
difficulties in speech and communications, impairment in hearing,
reduced vision, thermal stress, occasional adverse reactions to materials,
and overall reductions in operational effectiveness.
Some improvements in PPE have been made, however. For example,
the joint service lightweight integrated suit technology (JSLIST) affords
better CB protection, reduces the physiological heat burden, and inter-
feres less with weapons systems than previous technologies. The RELIST
preplanned product improvement (P3I) should provide even better pro-
tection. Because the human respiratory system is extremely vulnerable to
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EXECUTIVE SUMMARY
the highly toxic and rapidly acting agents to which deployed forces may
be exposed, respiratory protection is a major factor in contamination
avoidance. Respirators of various types have been developed and used
both in military and civilian operations. The newest mask the joint ser-
vice general purpose mask (ISGPM) allows better peripheral vision, is
reasonably comfortable to wear, and has a somewhat flexible design to
meet service-specific requirements.
The hands have traditionally been protected by impermeable gloves;
however, recent research has also focused on multilaminate technologies
and barrier creams designed to prevent or reduce the penetration and
absorption of hazardous materials by the skin, thus preventing skin le-
sions and/or other toxic effects. Effective barrier creams might also be
used to protect skin adjacent to areas where the garments are known to
provide less than optimal protection (e.g., under seams, around closures).
Finding. Current challenges used to evaluate protective equipment do
not reflect changes in threat levels.
Recommendation. The Department of Defense should reevaluate its re-
quirements for materiel development to protect against liquid and vapor
threats and revise design requirements, if appropriate.
Finding. PPE modules (e.g., masks, garments, gloves) were designed as
independent items and then "retrofitted" to create an ensemble. They
were also developed without adequate attention to various human fac-
tors issues, such as the integration of PPE with weapon systems.
Finding. The most serious risk from most CB agents appears to be from
inhalation. Current doctrine allows for Mask-Only protection, but the
mask seal could be broken while advancing from Mask-Only to MOPP 4
status.
Recommendation. A total systems analysis, including human factors en-
gineering evaluations, should be part of the development process of the
personal protective equipment system to ensure that the equipment can
be used with weapon systems and other military equipment. These evalu-
ations should include:
· the performance of individuals and units on different tasks in vari-
ous realistic scenarios
· the interface of the mask and garments and potential leakage dur-
ing an "advance" from Mask-Only to MOPP 4 status
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STRATEGES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
Finding. Although researchers have good data from human factors test-
ing that identified serious performance (cognitive and physical) limita-
tions as a result of wearing PPE, they have been unable to adequately
relate these deficiencies to performance on the battlefield.
Recommendation. The Department of Defense should place greater em-
phasis on testing in macroenvironments and controlled field tests rather
than relying mostly on systems evaluations for personal protective
equipment.
Finding. Although the seal of the mask is much improved over previous
mask models, seal leakage continues to be a critical problem. The leakage
can be attributed to (1) problems with the interface between the seal and
the face, and (2) improper fit.
Recommendation. Additional research is needed on mask seals and mask
fit. The research program should focus on seals, fit, and sealants (adhe-
sives). The duration/severity of leaks, if any, during transitions in protec-
tive posture from one MOPP level to another should also be investigated.
These data would be useful for future studies on long-term health effects
of low-level exposures. In addition, training to fit masks properly should
be conducted for all deployed forces equipped with mission-oriented pro-
tective posture equipment.
Finding. Although mask fit testing has been shown to improve protec-
tion factors 100-fold, the Air Force and Army have only recently begun
deploying mask fit testing equipment and providing appropriate training
protocols and supportive doctrine.
Recommendation. Doctrine, training, and equipment for mask fit testing
should be incorporated into current joint service operations. The Depart-
ment of Defense should deploy the M41 Mask Fit Test kit more widely.
Finding. Leakage around closures in personal protective equipment re-
mains a problem.
Recommendation. The Department of Defense should continue to invest
in research on new technologies to eliminate problems associated with
leakage around closures. This research could include the development of
a one-piece garment, the use of barrier creams on skin adjacent to closure
areas, and other technologies still in the early stages of development.
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EXECUTIVE SUMMARY
Finding. Current gloves reduce tactile sensitivity and impair dexterity.
9
Recommendation. The Department of Defense should evaluate using a
combination of barrier creams and lightweight gloves for protection in a
chemical and/or biological environment. Multilaminate gloves should
also be further explored.
Finding. An impermeable garment system is believed to provide the most
comprehensive protection against CB agents. But impermeable barriers
cause serious heat stress because they trap bodily moisture vapor inside
the system. Permeable systems, which breathe and allow moisture vapor
to escape, cannot fully protect against aerosol and liquid agents.
An incremental improvement could be achieved by using a semiper-
meable barrier backed with a sorptive layer. This system would allow the
moisture vapor from the body to escape and air to penetrate to aid in
cooling. The multilayer system would have some disadvantages, how-
ever. It would be bulky and heavy. The sorptive layer is an interstitial
space where biological agents could continue to grow because human
sweat provides nutrients for biological agents, which could prolong the
period of active hazards. Countermeasures should be investigated to miti-
gate these problems.
Recommendation. The Department of Defense should investigate a
selectively permeable barrier system that would be multifunctional,
consisting of new carbon-free barrier materials, a reactive system, and
residual-protection indicators.
The carbon-free barrier materials could consist of: (1) smart gel coat-
ings that would allow moisture/vapor transport and would swell up and
close the interstices when in contact with liquid; (2) selectively permeable
membranes that would allow moisture/vapor transport even in the pres-
ence of agents; (3) electrically polarizable materials whose permeability
and repellence could be electronically controlled.
The reactive material could be smart, carbon-free clothing with gated
membranes capable of self-decontamination. A reactive coating could also
be applied to the skin in the form of a detoxifying agent (e.g., agent
reactive dendrimers, enzymes, or catalysts capable of self-regeneration).
A residual-protection indicator would eliminate the premature dis-
posal of serviceable garments and might also be able to identify the type
of contamination. Conductive polymers could be used with fiber-optic
sensors to construct the device.
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STRATEGES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
COLLECTIVE PROTECTION
Collective protective structures (e.g., shelters and positive pressure
vehicles) provide relatively unencumbered safe environments where ac-
tivities such as eating, recovery, command and control, and medical treat-
ment can take place. Collective protective equipment is based on filtering
and overpressurization technologies. Advanced filters and absorbents are
critical components in these systems. Improvements in protection will
depend on the availability of advanced filtration and adsorbent capa-
bilities.
Finding. The Department of Defense does not have enough collective
protection units to meet the needs of deployed forces.
Recommendation. The Department of Defense should assess the needs
of deployed forces for collective protection units in light of changing
threats and the development of new personal protective equipment and
provide adequate supplies of such equipment to deployed forces.
DECONTAMINATION
Decontamination is the process of neutralizing or removing chemical
or biological agents from people, equipment, and the environment. For
military purposes, decontamination must restore the combat effective-
ness of equipment and personnel as rapidly as possible. Most current
decontamination systems are labor intensive and resource intensive, re-
quire excessive amounts of water, are corrosive and/or toxic, and are not
considered environmentally safe. Current R&D is focused on the devel-
opment of decontamination systems to overcome these limitations and
effectively decontaminate a broad spectrum of CB agents from all sur-
faces and materials. Because of the vastly different characteristics of per-
sonnel, personal equipment, interior equipment, exterior equipment, and
large outdoor areas, situation-specific decontamination systems must be
developed.
DoD has developed doctrine and training for decontamination but
has not established levels of acceptable risk. Therefore, detection capabili-
ties are not designed to verify acceptable decontamination levels.
Finding. lust as only a few benchmarks for the removal of MOPP gear
have been established (because detection technology is inadequate), few
benchmarks of decontamination levels have been established. Therefore,
it is difficult to know when it is safe to return equipment to operational
status and impossible to "certify" that previously contaminated equipment
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EXECUTIVE SUMMARY
11
can be transported to a new location, especially a location in the United
States.
Recommendation. The Department of Defense should initiate a joint
service, interagency, and international cooperative effort to establish de-
contamination standards. Standards should be based on the best science
available and may require the development of new models for setting
benchmarks, especially for highly toxic or pathogenic agents.
If residual decontamination levels are based on ultraconservative tox-
icity and morbidity estimates, returning contaminated equipment be-
comes impractical. Benchmarks for decontamination should be based on
highly accurate, reliable, up-to-date toxicity data.
Finding. Although significant progress is being made with limited re-
sources in exploring decontamination technologies that may be effective,
no organized, integrated research program has been developed to meet
the new challenges and objectives that have been posed (i.e., environmen-
tally acceptable decontamination). Various agencies are actively pursuing
many projects, but they are not well coordinated and do not have clear
priorities for fixed-site programs, casualty management, and sensitive
equipment programs.
Recommendation. The Department of Defense (DoD) should coordinate
and prioritize the chemical/biological research and development (R&D)
defense program, focusing on the protection of deployed forces and the
development of environmentally acceptable decontamination methods.
DoD should also establish the relative R&D priority of decontamination
in the chemical/biological defense program.
Finding. Recent developments in catalytic/oxidative decontamination
(enzymes, gels, foams, and nanoparticles) appear promising for decon-
taminating a wide range of CB agents.
Recommendation. Research on enzyme systems for battlefield decon-
tamination (especially for small forces) should be given high priority
because they could be used to decontaminate both personnel and
equipment and would not require large volumes of water or complicated
equipment.
Recommendation. The Department of Defense should continue to de-
velop other catalytic/oxidative systems for larger scale decontamination.
If possible, these systems should be less corrosive and more environmen-
tally acceptable than current methods.
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STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
Finding. Low-power plasma technology has been shown to be effective
for decontaminating sensitive equipment and has the potential of incor-
porating contaminant-sensing capabilities.
Recommendation. The Department of Defense should continue to de-
velop plasma technology and other radiation methods for decontaminat-
ing equipment.
TESTING AND EVALUATION
Testing and evaluation of equipment, methodologies, and the toxico-
logical effects of chemical agents are critical for the development of ap-
propriate defensive strategies. Adherence to the principles of the non-
proliferation agreements entered into by the United States prohibits most
tests using live agents, as well as studies with human volunteers (except
with surrogate agents). Most human and animal tests are, therefore, con-
ducted using simulants, although it is not entirely clear that these
simulants are adequate surrogates.
The most comprehensive test program, the Man-in-Simulant Test
(MIST) Program, which tests complete and partial protective ensembles
under controlled conditions, is a valuable program, although it has many
shortcomings. Simulants are commonly used for testing protective and
decontaminating equipment to determine the effectiveness of the protec-
tive equipment. However, the simulants have not been systematically
validated to determine how closely their behavior mimics the behavior of
actual agents. Therefore, the United States may not have the ability to
determine whether or not a specific piece of equipment actually meets its
performance requirements.
Finding. Testing of dermatological threat agents has not been consistent.
The available quantitative data are not sufficiently precise to make an
accurate evaluation of potential percutaneous threats from agents other
than blister agents or irritants.
Recommendation. Tests of dermatological threat agents should be con-
ducted to establish the level of protection necessary to provide adequate
margins of safety and to establish quantitative criteria for evaluating the
performance of protective equipment, such as gloves, undergarments,
and overgarments.
Finding. Mask testing under the MIST program was unreliable because
the passive dosimeters did not function satisfactorily in the mask envi
ronment.
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EXECUTIVE SUMMARY
13
Recommendation. Active samplers or improved passive samplers for
mask testing using simulants should be developed and made available
for tests of the joint service lightweight integrated suit technology (ISLIST)
ensemble.
ASSESSMENT OF MILITARY CAPABILITIES TO
PROVIDE EMERGENCY RESPONSE
Various initiatives have been implemented and numerous studies
undertaken to determine the role and assess the capability of the U.S.
military in providing emergency response capabilities in coordination
with other federal, state, and local agencies. Examples of military pro-
grams to support emergency response include the DoD Chemical Biologi-
cal Rapid Response Team, the U.S. Army Medical Research Institute of
Chemical Defense Chemical Casualty Site Team, the Marine Corps Chemi-
cal Biological Incident Response Force, and the National Guard Rapid
Assessment and Initial Detection Program.
Finding. Because numerous agencies will respond to a domestic CB inci-
dent, close coordination 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
are equipped with protective and decontamination equipment that is com-
patible with the 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 must 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 should be established on a joint service, interagency, and
coalition basis for civilians working at military installations.
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STRATEGES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES
SUMMARY AND GENERAL RECOMMENDATIONS
The health of military personnel who served in the Gulf War, and of
personnel who will serve in future deployments, is a matter of great con-
cern to veterans, the public, Congress, and DoD. Based on the many les-
sons that have been learned from the Gulf War and subsequent deploy-
ments, as well as on information from other sources, a great deal can be
done to minimize potential adverse health effects from exposure to CB
agents and to increase protection levels against them.
Recommendation. Threat projections and risk perceptions should be
reevaluated in terms of realistic or credible battlefield risks. The require-
ments for protective equipment should then be adjusted to respond to
those threats and challenges.
Characterizing a "low-level" contaminated environment is still an
open question. Answering this question has become an urgent priority
since post-Gulf War medically unexplained symptoms have become a
serious issue. Information on the effects of extended exposures to low
levels of CB agents is incomplete, but recent studies have suggested that
low-level exposures may have some long-term consequences.
Recommendation. Research on the toxicology of low-level, long-term ex-
posures to chemical and biological agents and other potentially harmful
agents (e.g., environmental and occupational contaminants and toxic in-
dustrial chemicals) should be continued and expanded.
Unfortunately, modeling and simulation can only partly compensate
for the lack of data based on actual experiments. Evidence has shown that
modeling and simulation of the performance of CB protective equipment
have not been very effective.
Recommendation. The use of simulants, data from animal models, and
data on human exposure should be reevaluated as part of the develop-
ment of a coherent research program to determine the physiological ef-
fects of both high-level and low-level long-term exposures to chemical
and biological agents. The data should then be used to determine risks
and challenges.
Training for CB operations has been very inconsistent, both within
and among the services.
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EXECUTIVE SUMMARY
15
Recommendation. Required levels of training (with the appropriate level
of funding for training devices and simultants) should be established and
monitored for effective unit performance throughout the services. Objec-
tive criteria should be established for determining whether current
service-specific training requirements are being met.
Representative terms from entire chapter:
joint service
