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Philosophy, Doctrine, and Training for Chemical and Biological Warfare PHILOSOPHY DoD has an active CB defense program as well as a passive defense program (DoD, 1996~. The active program involves improving capabili- ties for detecting, tracking, identifying, intercepting, destroying, and neu- tralizing NBC warheads delivered by airborne launch platforms, ballistic missiles, and cruise missiles, while minimizing collateral effects. The pas- sive defense program involves protecting against the effects of CB weap- ons. The passive defense programs includes: (1) contamination avoidance (reconnaissance, detection, and warning); (2) force protection (individual protection, collective protection, and medical support); and (3) decon- tamination. Contamination avoidance includes sensors for joint task forces, mo- bile CB reconnaissance, and systems capable of detecting multiple CB agents and characterizing new agents. Technological advances to support this policy include remote detectors, miniaturization, lower detection lim- its, logistics support, and biological detection capability. In force protection, improved mask systems and advanced protective clothing are being developed under a joint program to reduce the weight, heat stress, and logistics burden of current gear. (See Chapter 4 for a description.) Medical research is directed toward improving prophylaxes, antidotes, treatments, vaccines, and medical casualty management. Other research is focused on lightweight CB protective shelters and collective protection technologies (see Chapter 4~. In decontamination, modular systems are being developed, and new 58

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PHILOSOPHY, DOCTRINE, AND TRAINING Procurement ~ R&D (other than S&T) - includes demonstration/validation, engineering and manufacturing development, and management support Science and Technology base (S&T) - includes basic research, applied research, and advanced technology development, and management support 900 800 700 _% o 600 ~ 500 o 400 300 200 100 O 59 FY96 FY97 FY98 FY99 FYOO FYO1 FY02 FY03 FY04 FY05 FIGURE 3-1 Summary of appropriations for the Chemical and Biological Defense Program. technologies, such as sorbents, catalytic coatings, and the physical re- moval of contaminants, are being developed (DoD, 1996~. RDT&E and procurement budgets for the joint service CB defense program have steadily increased from about $388 million in fiscal year (FY) 1996 to the current level of $645 million in FY 1999 (DoD, 1999~. Figure 3-1 provides a summary of appropriated and requested funding from FY 1996 to FY 2005. As the funding profiles show, funding levels for the science and technology base (i.e., basic research, applied research, and advanced technology development) are relatively stable. Based on these figures and the funds for individual protection, collective protection, and decontamination technologies (see Appendix A for a detailed breakout of the funds), new technologies for physical protection and decontamina- tion are not likely to be developed.

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60 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES DoD established an integrated CB defense program under the over- sight of the Deputy Assistant to the Secretary of Defense for Counter- Proliferation and Chemical/Biological Defense (DATED [CP/CBD]~. This program was created to consolidate, coordinate, and integrate the CB defense requirements of all services into a single program. DoD also es- tablished the Counterproliferation Support Program specifically to ad- dress shortfalls in operational capabilities. The Counterproliferation Sup- port Program supports the following existing programs to accelerate the deployment of essential military counterproliferation technologies and capabilities: (1) a program to accelerate (by up to six years) the fielding of an advanced, long-range, eye-safe, infrared LIDAR (laser detection de- vice) to provide long-range battlefield warning of CB agents; (2) a pro- gram to evaluate the use of ultraviolet multifrequency lasers to detect and characterize biological agents by their fluorescent spectra; (3) a program to develop miniaturized CB extremely sensitive point detectors that can be installed on unmanned aerial vehicles; (4) a program to accelerate (by two years) the procurement of improved PPE and CPE; (5) a program to expand the technology base for decontamination; and (6) a program to improve joint NBC doctrine and training procedures by improving battle- field simulations (DoD, 1996~. Approximately $30 million was budgeted in FY 1996 to support these programs. In addition, the Counterprolifera- tion Support Program supports the activities of the CB defense program and facilitates the collection of information on proliferant states. The Defense Threat Reduction Agency carries out the CB technology development activities (referred to as the "tech base") for the DATSD (CP/CBD) through the Joint Technology Panel for Chemical and Biologi- cal Defense. The CB tech base includes programs for the development of active defenses and a number of passive defenses. The Army's programs also include the operation of Dugway Proving Ground, Utah, as the pri- mary test range for CB defensive equipment. Details on CB testing at Dugway can be found in reports by the Counterproliferation Program Review Committee issued in May 1995 and 1997 (DoD, 1995, 1997a). CHEMICAL/BIOLOGICAL WARFARE DOCTRINE Past Doctrine: "Fight Dirty" Before systems for detecting contaminated areas were available, mili- tary planners developed a doctrine (best described as the "fight dirty" doctrine) that supported operations in contaminated areas. The doctrine involved a combination of individual protective equipment and extensive training to enable individuals and units to fight in contaminated environ- ments. Individual protective equipment (MOPP) consisted of heavy

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PHILOSOPHY, DOCTRINE, AND TRAINING 6 carbon-impregnated materials, ill-fitting restrictive masks, and heavy pro- tective gloves and boots. The protective masks required special filters to absorb airborne agents and protect the lungs and eyes. The other compo- nents protected against agent contact with the skin in solid, liquid, or vapor form. Impermeable overboots and butyl rubber gloves provided a solid barrier to liquid agents. Overgarments and hoods were designed to permit some passage of air and moisture, allowing perspiration to evapo- rate, but they were impractical for most combat functions because the rapid buildup of body heat and moisture quickly rendered soldiers non- functional. Garments were designed with two layers, an outer layer that limited liquid absorption or redistributed it to reduce concentration and an inner layer (constructed of charcoal-impregnated foam) that filtered the air and adsorbed any vapor that penetrated the outer layer. Because detection and warning systems were (and still are) inad- equate (see NRC, l999b), MOPP 4 has been consistently overused in train- ing exercises (Williams, 1998~. Anecdotal reports indicate that the same was true in Desert Shield/Desert Storm (NRC, l999d), which resulted in significant decrements in unit effectiveness because of heat load, restricted vision, and loss of tactile sensitivity. Current Doctrine: Contamination Avoidance As technologies have advanced, especially detection technologies, and as new, more capable detection equipment has been fielded (e.g., the automatic chemical agent detection alarm), the doctrine has shifted to "contamination avoidance." The basis of this doctrine is that U.S. forces can now engage an enemy while avoiding casualties from contamination by CB agents. Avoiding contamination requires rapid and accurate detec- tion, identification, warning, and reporting systems for the presence of threat agents. Protective equipment and decontamination systems are still necessary, however, in situations where avoidance of contamination is impossible (e.g., fixed sites) or for missions that require operations in a contaminated environment. CHEMICAL/BIOLOGICAL WARFARE TRAINING Once the new doctrine of contamination avoidance (with concomi- tant detection and chemical protective equipment) was adopted, training was naturally modified to implement it. 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. At the most basic level, CB training includes learning how to don boots, gloves, masks, and overgarments and how to conduct battlefield

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62 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES operations in a CB environment using protective equipment. Training requires repetition and commitment on the part of unit commanders and is relatively straightforward in execution. Discussions (at Fort Benning and at NRC workshop) with individual soldiers who have undergone this training in the last several years revealed that the commitment to CB training is left to the unit commander's discretion and that training has been inconsistent, both within and across services. Thus, some equipment shortfalls may have been exacerbated by inadequate training and could be mitigated by more consistent and more stringent training (including training with coalition forces). Although shortcomings in the training of individuals can be easily overcome, training commanders at all levels to react to a potential CB environment is quite difficult. Commanders must be taught to determine when protective gear is necessary, what levels of protection are necessary, and the timing and methods of removing MOPP gear safely. An audit conducted by the DoD Office of the Inspector General assessing unit train- ing in chemical and biological defense revealed that commanders were not fully integrating CB defense into their unit training (DoD, 1998a). As a result, "commanders could not adequately assess unit readiness to suc- cessfully complete wartime missions under chemical and biological con- ditions" (DoD, 1998a, pit). Both commanders and individual soldiers must have a realistic idea of the risk in a given situation (see section "Under- standing the Risk" below). The current state of CB training has been reviewed in numerous docu- ments (e.g., DoD, 1998a, 1999; Joseph, 1996), and DoD has acknowledged that the integration of safe, realistic CB defense, including defense against aerosol agents, into training simulations is essential. Models and simula- tions could be used to enable both units and commanders to understand an adversary's intent and CB capabilities and to enable trainees to visual- ize how CB capabilities might affect the battle space, defensive responses, and planned operations. Models and simulations would also enable com- manders to apply CB defense training doctrine and leader-development training strategies in preparing their forces to maintain operational conti- nuity and fulfill their missions in a CB environment. Currently, several engineering-level models represent the dynamics of CB contamination, but only a few robust representations of chemical effects (and almost none for biological effects) have been fully implemented in war games; and few analytical models have been used for training (DoD, 1999; Joseph, 1996~. There is inadequate guidance within the services or from operational chains of command that defines tasks, conditions, or standards for more complex CBW activities such as operational planning to minimize the potential effects of enemy NBC use...the commanders of units

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PHILOSOPHY, DOCTRINE, AND TRAINING undergoing training essentially determine the scope and nature of play, if any, to be included in the scenarios by CTC [Combat Training Center] controllers and opposing forces Joseph, 1996, p. 78~. UNDERSTANDING THE RISK 63 Commanders are much better able to assess the hazards posed by the familiar risks from ballistic weapons than from CB weapons. The lack of information concerning how CB agents affect health and at what concen- trations they are dangerous has skewed the overall perception of risk and has led to DoD adopting the goal of complete CB protection with no, or minimal, casualties. Thus, the level of protection from CB threats is higher (100 percent) than the level of protection from ballistic threats. The 100-percent protection level has resulted in overly conservative choices for protection against unrealistically high challenge levels. Protec- tive equipment has been designed to meet CB challenges that are far greater than realistic battlefield threats. For example, many countries be- lieved to possess CB capabilities may not have suitable delivery systems to create a sustainable threat of the magnitude against which the United States is currently defending (see Table 3-1 for service-specific require- ments for liquid and vapor contamination levels) (Institute for Defense Analyses, 1999~. Even though some enemies could contaminate a given target to this level, the requirement for percutaneous protection should not be deter- mined on this basis. The requirement should balance inherent risk factors and trade-offs between the protection of the individual and the combat effectiveness of the force. The implicit assumption of maximum CB pro- tection is that it will minimize casualties. In fact, the opposite may be true because a protective system that significantly encumbers the soldier will degrade the overall combat effectiveness of the unit (see Chapter 4~. This TABLE 3-1 Service Requirements for ISLIST Navy- Air Force Challenge Levels Army Sea Ground Marines Liquid protection (g/m2) Vapor protection (mg*min/m3) 10 5 5 10 10,000a/5,000b 5,000 7,500 no standard .s .s aFor Army aviators and all CB undergarments bOvergarment Source: Barrett, 1998.

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64 STRATEGES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES degradation affects all units that don protective gear, regardless of whether or not their location has actually been targeted. The decrease in combat effectiveness across the larger force may result in more overall casualties than may have resulted from a lesser protective posture with less of an effect on combat performance. Contamination is not usually uniform in a target area. Contamination levels are likely to be significantly higher than the challenge against which the United States currently defends in some areas but significantly lower elsewhere. In fact, the areas with the highest contamination densities will be closest to the burst of the munitions. Consequently, ballistic fragmen- tation effects are also likely to be highest in these same areas. Some analy- ses have suggested that the ballistics effects of bursting chemical multiple launch rocket system (MLRS) rounds may have as much as 30 percent of the ballistics effects of a comparable high-explosive MLRS round (Battelle Memorial Institute and Charles Williams, Inc., 1999~. This means that significant portions of those areas with 10 g/m2 or greater liquid agent contamination densities would also be subject to lethal shell-fragment effects (Institute for Defense Analyses, 1999~. Thus, chemical protective suits would be ineffective in these areas, regardless of the level of con- tamination. Striking a balance between protection and performance will require that many factors be considered. Specifically, the intelligence community must assess the enemy's overall ability to deliver a CB agent on target. Planners need to know how many and what types of targets might be contaminated to the level against which the United States currently pro- tects (Table 3-1), the delivery systems that might be used, and the enemy's resupply capabilities before the appropriate assessments can be made. As the number of U.S. forces and resources continue to decline, U.S. intelli- gence will have to provide these types of assessments so that the current totally risk-averse position can be adjusted to a realistic risk management strategy. Current appraisals of the threat and current toxicological information are inadequate for proper evaluations of the health consequences of expo- sure, even with soldiers in MOPP 4 status. Evaluations of the protection afforded by various MOPP levels are based on estimates of the CB dose that can be delivered to an individual. Although some simulant studies have been conducted, they may not be universally applicable to all CB agents, especially aerosol agents (NRC, 1997b). The existing toxicological data on real agents are sparse. In recent reports, previous studies on the toxicity of chemical agents in humans and animals have been reevaluated to determine reference doses (NRC, 1997a, l999e). However, these data are not reliable enough for the purposes of modeling and simulation for the following reasons: (1) not enough data have been collected; (2) the

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PHILOSOPHY, DOCTRINE, AND TRAINING 65 assays used to collect these data are not as sensitive as advanced methods; and (3) they do not show subtle effects. Therefore, modelers have deter- mined that they do not have sufficient information on toxicokinetic fac- tors, such as the uptake, metabolism, and excretion of CB agents, to pre- dict risks and hazards accurately. These circumstances have led to an exaggerated perception of risk and a design for overprotection. According to information presented at briefings and in a previous NRC report (e.g., Institute for Defense Analyses, 1999; NRC, 1985; U.S. Army SBCCOM, 1998), little evidence supports the hypothesis that low- level exposures to CB agents have long-term deleterious health effects. However, because of a lack of data, substantial doubts have been raised, and illnesses that cannot be medically diagnosed or attributed to conven- tional causes may be attributed to CB exposures (NRC, l999b). Since FY 1996, DoD has dedicated $5 million to evaluating the chronic effects of low-level exposures to chemical agents (DoD, 1999~. Studies have been under way since the first quarter of 1997 to develop highly specific and sensitive assay equipment that can be used in forward areas to detect and potentially quantify low-level exposures to chemical agents. According to the Executive Summary of the Persian Gulf Veterans Coordinating Board Action Plan with Respect to the Findings and Recommendations of the Presidential Advisory Committee (1997, p. 2), Federal research requests for proposals include the possible long-term health effects of chemical and other hazards (including subclinical expo- sure to CW [chemical warfare] nerve agents)...tand there is] develop- ment of a strategic plan for research into the potential health conse- quences of exposure to chemical or other hazards, including low levels of chemical agents. In May 1999, the U.S. Army Center for Health Promotion and Pre- ventive Medicine published Technical Guide (TG) 230A, Short Term Chemical Exposure Guidelines for Deployed Military Personnel, to address the health risks that may be experienced by deployed military personnel following temporary or short-term exposure to a number of toxic chemi- cals (U.S. Army CHPPM, 1999~. These guidelines are based on a variety of effects, ranging from mild signs or symptoms and long-term delayed effects from low-level exposures, to more severe effects, such as death, from temporary high-level exposures. Commanders must be trained and evaluated on the appropriate use of these new guidelines. A second tech- nical guidance document (TG 230B), which will address the risks associ- ated with longer-term exposures (i.e., from 14 days to one year), is under development.

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66 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES FINDINGS AND RECOMMENDATIONS 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. Recommendation. The Department of Defense should reevaluate liquid and vapor challenge levels based on the most current threat information 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 and decontamination. Recommendation. The Department of Defense should reprogram funds to alleviate the shortfall in basic research on new technologies for physical protection and decontamination. Finding. Unit commanders receive little training related to assessing CB risks to their units, especially in determinating 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.