Comments and suggestions are solicited and should be addressed to:

Operational Medicine Division
Attn: Mr. Paul Porreca
U.S. Army Medical Research
Institute of Infectious Diseases
Fort Detrick, Maryland 21702-5011

The purpose of this Handbook is to provide concise supplemental reading material to assist in education of biological casualty management. Every effort has been made to make the information in this handbook consistent with official policy and doctrine. The information contained in this handbook is not official Department of the Army policy or doctrine, and it should not be construed as such.

ACKNOWLEDGMENTS

This handbook would not be possible without the generous assistance and support of COL David Franz, COL Gerald Parker, LTC Gerald Jennings, SGM Raymond Alston, COL James Arthur, COL W. Russell Byrne, LTC Les Caudle, Dr. John Ezzell, COL Arthur Friedlander, Mr. Darren Gerlach, SGT Kevin Gianunzio, Dr. Robert Hawley, LTC Erik Henchal, COL(ret) Ted Hussey, Dr. Peter Jahrling, LTC Ross LeClaire, Dr. George Ludwig, Mr. William Patrick, Dr. Mark Poli, Mr. Paul Porreca, Dr. Fred Sidell, Dr. Jonathon Smith, Mr. Richard Stevens, COL Stanley Wiener, Mr. Benjamin Wilson and others too numerous to mention. The exclusion of anyone on this page is purely accidental and in no way lessens the gratitude we feel for contributions received.

INTRODUCTION

Medical defense against biological warfare is an area of study for military health care providers which does not apply readily to the day to day mission of caring for patients in peacetime. However, during Operations Desert Shield/Desert Storm, it became obvious that the threat of biological attacks against our soldiers was real, and that we could do more to educate our medical professionals about how to prevent and treat biological warfare casualties. Many of our medical personnel who deployed for the Gulf War had less than an optimal understanding of the biological threat and of the medical means available to counter it. Since Desert Storm, there has been a renewed emphasis placed on making sure that our health care professionals gain the necessary background in this important area of military medicine.

In fact, our training efforts have significantly intensified over the past eighteen months following increased incidents and threats of domestic terrorism (e.g., New York City World Trade Center bombing, Tokyo subway sarin release, Oklahoma City federal building bombing, Atlanta Centennial Park bombing). Additionally, the recent escalation of tensions in Iraq and subsequent deployment of military troops to the Persian Gulf region underscored the importance of force protection from biological threats. The Secretary of Defense announced in November 1997 that all U.S. military troops will be immunized against anthrax. Finally, the disclosure of a sophisticated offensive biological warfare program in the Former Soviet Union (FSU) and subsequent media attention has reinforced the need for increased training and education.

The Medical Management of Chemical and Biological Casualties Course taught at both USAMRIID and USAMRICD was revised in March 1998 by doubling its class capacity providing education in both biological and chemical medical defense to over 560 military medical professionals per calendar year. Also, the highly successful 3-day USAMRIID satellite course on the Medical Management of Biological Casualties presented in September 1997 reached over 5600 military and other government health care professionals throughout the United States.

Through this handbook and the training courses noted above, military medical professionals will learn that effective medical countermeasures are available against many of the bacteria, viruses, and toxins which might be used as biological weapons against our military forces. The importance of this education cannot be overemphasized and it is hoped that our physicians, nurses, and allied medical professionals will develop a solid understanding of the biological threats we face and the medical armamentarium for defending against these threats.

The global biological warfare threat is taken seriously by our leaders. The United States was willing to return to war against Iraq in February 1998 to preserve the integrity and the independence of the UNSCOM inspectors such that they would have unconditional, unfettered and unrestricted access to all suspected sites in Iraq in their search for weapons of mass destruction. The threat is indeed serious, and the potential for devastating casualties is high for certain biological agents. However, with appropriate use of medical countermeasures either already developed or under development, many casualties can be prevented or minimized, and the fighting strength of our forces can be maintained.

The purpose for this handbook is to serve as a small and concise manual for medical personnel to carry in their BDU pocket as a guide to medical prophylaxis and management of biological casualties. It is designed as a quick reference and overview, and is not intended as a definitive text on the medical management of biological casualties.