CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR DEFENSE (CBRND) FUNCTIONAL NEEDS ANALYSIS. FINAL REPORT (2005)

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exposure prophylaxis consists of neutraceuticals, plant isoflavone genistein, and alpha tocopherol (Vitamin E) but are not approved by the FDA for prophylaxis against radiation.

FDA-approved preexposure medical countermeasures are available for anthrax, cholera, HFRS (Haantan), Rift Valley fever, yellow fever, HFRS (Haantan), and smallpox. IND

status vaccines are currently available for Q-fever, tularemia (although use has been placed on hold by the FDA), Botulinum, Junin hemorrhagic fever, and VEE/WEE/EEE.

Antiviral/bacterial medications may be administered and/or issued to provide a level of protection against biological agents. Medical prophylaxes are developed for the military

force. Prophylaxes for MWAs are virtually nonexistent. Prophylaxis for eligible civilians is not addressed. Availability of prophylaxis is questionable for issue and administration

to eligible civilians. The issue and administration of prophylaxis to eligible civilians requires review due to questions regarding applicability to the range of body types, ages, and

physical/medical factors inherent within a potential population, as well as long-term health issues and legal implications.

⁹ Medical screening and preparation of deploying personnel include the administration of immunizations addressing the anticipated threats. Military members tasked to participate

in operations with threat are briefed on the threat agents and associated CBRND measures, including medical prophylaxes. If pre- and/or post-exposure/presymptomatic

prophylaxes are issued, the force is trained on the use of the medication. However, CBRND prophylaxes for MWAs do not exist, and DOTLPF is inadequate for the training of

non-U.S. military personnel for prophylactic treatment of CBRN/TIM agent exposure.

¹⁰ CBRND medical countermeasures are issued/administered to address the threat. Military members tasked to participate in operations with threat are briefed on the threat agents

and associated CBRND measures, including medical prophylaxes. If pre- and/or post-exposure/presymptomatic prophylaxes are issued, the force is trained on the use of the

CBRND medical countermeasures. However, CBRND prophylaxes for MWAs do not exist, and DOTLPF is inadequate for the training of non-U.S. military personnel for

prophylactic treatment of CBRN/TIM agent exposure.

¹¹ Plans for operations with threat incorporate MOPP levels and methodologies are adjustable to meet local operations and threat needs. MOPP levels and methodologies apply to

military personnel and are generally considered to apply to equipped nonmilitary personnel (although doctrine, policy, procedures, and TTPs do not address application to these

personnel). The MOPP methodologies in planning and operations include CBRND COLPRO to mitigate or prevent the effects of CBRN/TIM agents upon critical functions,

activities, and operations. However, preplanning for the conduct of large-scale medical operations within the AO for unanticipated threats/hazards is generally not performed.

Planning and operations addressing events of this nature occur upon determination of need.

¹² Negative-pressure COLPRO with filtered expelled air does not exist within the inventory for the transport and housing of numbers of infectious/contaminated casualties.

Hospital ships are not equipped with COLPRO. All current COLPRO systems in land, air, and sea assets are not designed for the containment and transport of

infectious/contaminated casualties. Casualties must be decontaminated before entry into COLPRO. COLPRO, however, may be applied for the protection of noninfectious/

uncontaminated casualties against exposure/contamination to CBRN/TIM agents. Current mobile COLPRO systems are predominantly integrated into selected combat

vehicles/vessels and do not support transport of exposed/contaminated casualties. The only currently fielded land-based mobile COLPRO is CBPS. The CBPS system is available

on a mobile platform and can provide a limited number of people protection. The CBPS consists of a dedicated M1113 HMMWV with an LMS mounted on the back and provides

a highly mobile, contamination-free, environmentally controlled work area for forward deployed medical units. The CBPS has been fielded to treatment squads, forward surgical

teams, and medical companies. Four personnel are required to operate the CBPS. However, these systems are limited in supply and cannot provide COLPRO during movement.

Selected U.S. Naval combat vessels may be equipped with full COLPRO (CITADEL). However, these systems are generally restricted to critical operations areas of the ships. The

critical areas are contiguous in that they share common bulkheads and movement between areas is not prevented. The application of these COLPRO systems for the treatment and

isolation/quarantine of infectious/contaminated casualties is not operationally acceptable. Naval hospital ships, U.S. Naval auxiliaries, and USCG vessels are not equipped with

COLPRO. None of the identified COLPRO systems provide negative pressure environments with filtered exhausting air exchange.

¹³ Mobile casualty COLPRO does not exist for the transport of infectious/contaminated casualties precluding or mitigating the potential for secondary exposure/contamination of

handling and transport personnel and resources. Handling and transport personnel must wear IPE and the transporting resource is considered contaminated until decontaminated

and verified.

¹⁴ DOTLPF does not adequately address the application of negative-pressure COLPRO for the transport and mass sheltering of infectious/contaminated casualties.

¹⁵ The USMC MGPTS with CB Protective Liner System provides a positive-pressure, filtered-air, toxic-free shelter for protection against CBRN agents. However, there are

insufficient quantities to meet all operational requirements for protection from CBRN/TIM effects. The CP-DEPMEDS provides a clean, toxic-free, environmentally controlled,

patient treatment area and the components are designed to integrate as field hospitals. They are packaged as a set for deployment to threat areas for hospital operations. The entire

composite hospital consists of expandable tentage, passageways, environmental control units, and ISO shelters. The CP-DEPMEDS exist in very limited quantities. Although it

could be applied to provide COLPRO to the task identified groups, its designed and primary function is that of medical care. A similar COLPRO is the USAF’s CP-EMEDS,

which is an air-transportable medical facility deployable in various configurations from a single shelter to a 25-bed patient hospital. The CP-EMEDS is in a very limited number

and, like the CP-DEPMEDS, is designed for its primary function of the provision of medical care. The USAF CP-SSS is a small-scale CPS applied for the conduct of C2

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operations, maintenance of critical equipment, force beddown, and the provision of R2 for sortie generators and key leadership. This shelter is in limited supply and unlikely

sufficient quantities would be available to support a group of any size, especially during operations against an adversary. The M20/M20A1 SCPE is a lightweight, modular system

involving a liner designed for inflation within a room or building. The M20A1 serves to bridge the gap between the M20 SCPE and CBPS. These systems are designed for

standard room configurations and, like other COLPRO systems, are in limited number. Fixed-site COLPRO within the United States and its territories is predominantly designed

for nuclear fallout and does not address other CBRN/TIM hazards and threats arising after September 11, 2001. Selected critical key facilities are equipped with CBRN COLPRO,

but are not available to other than designated personnel and are not installed in medical treatment facilities. Fixed-site CBRN COLPRO is installed in facilities housing selected

activities and functions within HTAs. However, these facilities are dedicated to critical operational requirements and restricted to assigned and designated personnel and do not

generally include medical treatment facilities. However, the Guardian Program is reviewing FP protective measures at U.S. installations and facilities will be addressing these

issues. The projected mid-term fielding of JECP may alleviate COLPRO shortages but will likely be insufficient to satisfy all COLPRO requirements. Prior planning and

prioritization of COLPRO allocation is critical. However, none of these systems provide negative pressure environments with filtered exhausting air exchange.

¹⁶ Plans incorporate MOPP levels and methodologies are adjustable to meet local operations and threat needs. MOPP levels and methodologies apply to military personnel and are

generally considered to apply to equipped nonmilitary personnel (although doctrine, policy, procedures, and TTPs do not address application to these personnel). The MOPP

methodologies in planning and operations include CBRND actions, activities, and requirements to mitigate or prevent the effects of CBRN/TIM agents.

¹⁷ Plans incorporate MOPP levels and methodologies are adjustable to meet local operations and threat needs. MOPP levels and methodologies outlined in doctrine, policy,

procedures, and TTPs require levels of protection readiness based upon the threat and/or presence of contaminants. Full protection is required in the presence of CBRN/TIM

agents/contamination. This includes protective measures and the wear of protective equipment when the possibility exists for secondary exposure/contamination to personnel and

equipment, such as the movement of infectious/contaminated casualties. MOPP levels and methodologies are generally considered to apply to equipped nonmilitary personnel.

Plans within HTAs may incorporate this perception. However, doctrine, policy, procedures, and TTPs do not address their application to nonmilitary personnel. Protective

measures and application of medical protective resources are applied by medical practitioners and supporting staff during treatment and quarantine/isolation operations. These

measures and resources generally follow standard medical requirements and guidance for infectious disease control medical practices and are not applicable to MOPP and

CBRND. Standard warfighter individual protection may continue to be applied by medical unit personnel during treatment and management of isolated/quarantined personnel but

is the decision of the conducting medical services unit commander. Nonmedical personnel supporting these operations (e.g., security, transport, administration, etc.), are considered

subject to MOPP methodologies and level requirements. The distinction is not adequately addressed in existing DOTLPF between protection for medical care and supporting

activities.

¹⁸ Plans incorporate MOPP levels and methodologies and are adjustable to meet local operations and threat needs. MOPP levels and methodologies apply to military personnel and

are generally considered to apply to equipped nonmilitary personnel (although doctrine, policy, procedures, and TTPs do not address application to these personnel). The MOPP

methodologies in planning and operations include CBRND medical countermeasures, including vaccination/immunization to mitigate or prevent the effects of CBRN/TIM agents.

¹⁹ Plans incorporate MOPP levels and methodologies are adjustable to meet local operations and threat needs. MOPP levels and methodologies outlined in doctrine, policy,

procedures, and TTPs require levels of protection readiness based upon the threat and/or presence of contaminants. Full protection is required in the presence of CBRN/TIM

agents/contamination. This includes protective measures and the wear of protective equipment when the possibility exists for secondary exposure/contamination to personnel and

equipment, such as the movement of infectious/contaminated casualties. MOPP levels and methodologies are generally considered to apply to equipped nonmilitary personnel.

Plans within HTAs may incorporate this perception. However, doctrine, policy, procedures, and TTPs do not address their application to nonmilitary personnel.

²⁰ DOTLPF is adequately addresses MOPP methodologies and levels for military force members. DOTLPF does not address the application of MOPP to eligible civilians. The

distinction between medical infectious disease control equipment and measures by medical care providers and MOPP application to supporting force members is not identified in

MOPP DOTLPF.

²¹ Command staff plans include predeployment medical screening and the stockpiling, allocation, and distribution of CBRND protective resources. Unit plans address medical

activities by referring to appropriate JTF and medical plans, policies, and procedures. Medical Service unit staff plan and develop associated plans and policies addressing medical

activities and procedures to support force operations within the AO. The invocation of quarantine and enforcement of medical isolation are within the purview of medical

authorities. The command staff provides support as defined in the coordinated and appropriate medical (AO and JOA) and JTF plans. DOTLPF is inadequate to address large-scale

medical CBRN/TIM operations, particularly sustained operations within a CBRN/TIM environment and/or command staff and Medical Services action associated with large-scale

medical operations involving non-U.S. personnel (e.g., indigenous civilians, third-party nations, etc.).

²² Existing medical facilities within an HTA exercise the reception and treatment of contaminated/infectious casualties. Voluntary institutional training for the treatment

contaminated/infectious casualties is available through AMEDD. Periodic exercises are performed with medical activities, but on a limited basis, to provide training opportunities

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and to assess capabilities. Treatment of casualties is currently performed following completion of casualty decontamination. AMEDD institutional training for the treatment of

contaminated/infectious casualties is not mandatory for medical practitioners identified for deployment or assignment where there exists a CBRN/TIM threat. The ability of the

command staff to ensure medical capabilities for CBRND is limited by routine medical operations and requirements prior to deployment. Generally, casualty care, until completion

of decontamination, is performed by medical corpsmen and not medical practitioners. Isolation of large-scale numbers of contaminated/infectious casualties is not adequately

addressed in DOTLPF and current medical operations are limited in their isolation abilities.

²³ Force protection using medical prophylaxis is dependent upon identification of the threat, preplanning for the threat, positioning of stocks for issue and administration, timing of

notification to administer/issue prophylaxis, availability of medical personnel to perform administration (if required), ongoing operational requirements, and the available quantity

of sufficient medical prophylaxis to meet requirements. Vaccination to achieve acquired immunity by force personnel prior to entry into the theater or completion of an adequate

level of acquired immunity prior to adversary biological agent employment is a function of the preplanning and deployment operations. The command staff directs the

implementation of these measures when and as appropriate based upon established plans and JTF/Medical Services guidance. Medical prophylaxis does not exist for all threat

biological agents. Current prophylaxis and supporting doctrine, policy, and procedures do not address presymptomatic medical CBRND protective countermeasures by other than

U.S. forces, excluding MWAs and eligible civilians. Additionally, the efficacy of existing prophylaxis, particularly vaccines, widely varies. The application of medical prophylaxis

is not adequately addressed for eligible civilians and MWAs within the force.

²⁴ JTF and unit plans include the medical review of personnel identified against deployment taskings. Screenings of deployable personnel are periodically performed for potential

limitations. Often, these are associated with annual medical physicals. The routine rotation and movement of personnel to and from units require the application of screenings to

ensure personnel are qualified for deployment. The unit and Medical Services staff plans attempt to provide for early (prior to deployment notice) and continued medical screening

of the force. Plans also include provisions for the conduct of predeployment screenings by medical personnel upon notification of deployment. Often, a record review is conducted

of the period following the physical for indications of issues precluding deployment. Predeployment medical screenings do not consider prior presymptomatic low-dose

CBRN/TIM exposures, associated potential cumulative long-term effects, and the potential threat. Timing of notice of deployment and the availability of medical personnel impact

the conduct of predeployment screenings. Short-notice operations and reallocated taskings may also impact the conduct of predeployment medical screenings. However, annual

physicals, when used to meet deployment screening requirements, may be conducted several months before a deployment.

²⁵ Automated systems to track medical treatment and the movement of casualties exist at Echelon 3 and higher levels of care. Unit reporting includes CBRND readiness. Reliance

is placed upon the individual’s vaccination and health records (both manual records) to reflect the most recent status of the individual. Current medical systems are stovepiped and

require manual intervention to share information. Medical treatment recording below Echelon 3 is limited and not linked to higher-echelon systems. Outpatient care is not

generally recorded and aggregate information is reported. Unit reporting is not linked to medical information systems. Individual manual vaccination and health records are not

always available or complete.

²⁶ Medical prophylaxis is issued/administered for identified CBRN/TIM threats to the military force. The administration and issuance of prophylaxis is addressed by the command

and Medical Services staffs during the planning and support for operations. Prophylaxis for MWAs is virtually nonexistent. Prophylaxis for eligible civilians is not adequately

addressed in current doctrine, policy, and procedures.

²⁷ Existing standards and procedures provide adequate protection of handling and transporting personnel against secondary exposure/contamination and require the application of

protective equipment and measures if the potential exists for contamination/exposure. Casualties able to wear standard IPE are required to apply the equipment outside of CPSs.

Medical policy is the patient’s unit is responsible for providing the equipment to the medical unit for use by the patient. Unit-level training is limited to the movement of casualties

to the medical facility/station and is predominantly reliant upon tactical ground transport. Air transport (tactical rotary-wing) is a last resort due to concerns about asset

contamination. Tactical and strategic fixed-wing air transport is not considered an acceptable means of transport. Air and sea transport resources are inadequately equipped and

prepared to transport exposed and contaminated human and MWA casualties. Exposed and contaminated casualties (human and MWA) unable to wear IPE are not adequately

addressed in doctrine, policy, and standards. Protective equipment is not available for these casualties. However, medical units are not provided stocks of standard IPE for use by

patients. Operationally involved units may be delayed, at best, in providing the equipment. Large-scale medical activities and actions are not adequately addressed in DOTLPF,

especially those involving large numbers of non-U.S. personnel (e.g., indigenous civilians, third-party nationals, etc.).

²⁸ Operational warfighter unit plans address medical activities by referring to appropriate medical plans, policies, and procedures. The staff of the Medical Services unit plans and

develops associated policies addressing medical activities and procedures to support force operations. The invocation of quarantine and enforcement of medical isolation are within

the purview of medical authorities. The operational warfighter unit provides support as defined in the coordinated and appropriate medical plans. The Medical Services unit staff

coordinates with the operational warfighter unit command and JTF staffs for Medical Services support requirements and associated tasking and their inclusion in force planning.

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DOTLPF is inadequate to address force actions associated with medical quarantine and/or enforcement of medical isolation involving large numbers of non-U.S. personnel (e.g.,

indigenous civilians, third-party nations, etc.

²⁹ Operational warfighter unit plans address medical activities by referring to appropriate medical plans, policies, and procedures. The staff of the Medical Services unit plans and

develops associated policies addressing medical activities and procedures to support force operations. The implementation and operation of large-scale quarantine sheltering and

treatment operations are in the purview of medical authorities. The operational warfighter command staff provides support and resources as defined in the coordinated and

appropriate medical plans and as adjusted and requested by appropriate medical authorities, with JTF concurrence, to meet specific circumstances. Large-scale medical activities

and actions are not adequately addressed in DOTLPF, especially those involving large numbers of non-U.S. personnel (e.g., indigenous civilians, third-party nationals, etc.).

³⁰ The unit staff, in coordination with the JTF and Medical Services staffs, conduct coordinated planning for operations for the potential threat. Equipping the force and Medical

Services elements are an integral part of planning preparation. The combination of established force and Medical Services element organic assets, material acquisitions,

prepositioned material, and movement of identified CBRND resources from unit designated stockpiles and reallocation activities are pursued by the command staff with the JTF

and Medical Services staff to prepare and support the force as outlined by the appropriate plan. Mass medical operations may not be possible until the theater matures or additional

resources are allocated to force. Additionally, deploying eligible civilians and MWAs (particularly MWDs) are not equipped and trained to survive a CBRN/TIM environment. The

force staff does not possess clear guidance for planning and providing CBRN/TIM protection training and CBRND protection resources to deploying eligible civilians and MWAs.

Current doctrine and policy does not adequately address sustained operations within a CBRN/TIM environment. Large-scale medical activities and actions are not adequately

addressed in DOTLPF, especially those involving large numbers of non-U.S. personnel (e.g., indigenous civilians, third-party nationals, etc.).

³¹ Legacy systems will remain in the inventory throughout the mid term. These systems will be gradually replaced by new joint systems of respiratory/ocular protection as they are

fielded. The JSAM replaces the Service-specific systems. When incorporated with anti-G protection of high-performance aircraft aviators, the JSAM will provide simultaneous

CBRN and anti-G protection. The JSAM is compatible with existing and programmed CBRN IPE, provides flame and thermal protection, and reduces the heat stress associated

with existing systems of ocular/respiratory protection. Further, the JSAM may be donned and doffed during flight. The JSGPM also replaces current Service-specific

ocular/respiratory protection. The system provides respiratory and ocular protection from CBRN agents and selected TIMs. The field-of-vision is improved and encumbrances

associated with legacy systems are reduced. The JSGPM incorporates state of the art technology and is designed to integrate with future warfighter CBRND IPE and function

equipment/assets. The JCESM is a COTS one-time use, one-size-fits-all, respiratory/ocular protective system affording 2 hours of protection and is lightweight and disposable. The

system is designed to provide low-level CBRN vapor, aerosol, and particulate protection to the wearer for egressing the contaminated environment. The JCESM is projected for

use when standard respiratory/ocular protection is not practical. The JCESM is not programmed for general dissemination. The Guardian Program is projected to review, assess,

and implement protection for critical members of the installation/facility populace during the mid term. This will predominantly be COTS-based assets for respiratory/ocular

protection. However, the Guardian Program is not expected to address eligible civilian protection within the AO for other than existing U.S. military installations and facilities.

MWA respiratory/ocular protection is not programmed or forecasted.

³² Legacy systems will remain in the inventory throughout the mid term. These systems will be gradually replaced by new joint systems of percutaneous protection as they are

fielded. The JSLIST NBC Protective Garment is a two-piece, risk-taking, overgarment with integrated hood affording protection against CBRN agents and selected TIMs. The

garment reduces the physiological and psychological encumbrances associated with legacy systems. The JSLIST is under evaluation by NIOSH for application to OSHA

protection requirements. The JPACE replaces the Service-specific systems. The JPACE provides aircrew members with equivalent protection to the JSLIST ensemble. The JPACE

is designed to not interfere with emergency ejection from a combat aircraft and continues to provide CBRN percutaneous protection following ejection and during escape and

evasion operations. The ensemble is both flame-retardant and self-extinguishing to permit emergency egress from a burning aircraft. Further, the ensemble provides CBRN

protection when subject to rotor, propeller, and jet wash. Joint Service glove upgrades are provided under the Joint Block 1 and 2 Glove Upgrade Program (JB1/2GU) in the near

and mid term. The JB1GU responds to an urgent need by designated elements of the force for increased tactility/durability supporting mission requirements. The JFIRE addresses

protection of military firefighters within a CBRN/TIM environment conducting firefighting operations involving structural and crash/firefighting/rescue. The JFIRE incorporates

the JSLIST into firefighter bunker gear. The JB1GU is expected to meet most of the requirements within the JSLIST ORD and is viewed as an evolutionary approach in the

development of the JB2GU. Versions under consideration include a protective inner glove worn under existing warfighter gloves, a replacement glove for existing hand wear, or a

combination of glove shell and liner affording CBRN protection of the legacy gloves they are projected to replace. The MULO is projected to replace legacy footwear covers. The

ability of the MULO to provide adequate antislip protection for USN personnel asea is under review. The Guardian Program is projected to review, assess, and implement

protection for critical members of the installation/facility populace during the mid term. This will predominantly be COTS-based assets for percutaneous protection. However, the

Guardian Program is not expected to address eligible civilian protection within the AO for other than existing U.S. military installations and facilities. MWA percutaneous

protection is not programmed or forecasted.

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³³ Cell Culture Derived Vaccinia is projected for production during the near-term. Clostridium Botulinum Toxin Medical Defense System is projected for availability during the

mid term for Serotypes A, B, C, E, and F. The SERPACWA Active TSP is also projected for production during the late mid term.

³⁴ Fielding of the P3I upgraded CBPS for heavy/airborne use is projected for the mid term.

³⁵ The projected initial fielding of JECP within the mid term provides additional capabilities for the COLPRO protection of casualties within CBRN/TIM contaminated areas.

JECP includes COLPRO adaptive inserts for buildings/rooms and legacy tentage and stand-alone COLPRO sheltering for small units. The projected mid-term fielding of JECP

may alleviate COLPRO shortages but will likely be insufficient to satisfy all COLPRO requirements. Quantities to be fielded of these systems have not been determined. JTCOPS

Block I is projected for initial fielding during the mid term. Prior planning and prioritization of COLPRO allocation is critical.

³⁶ The next-generation series of nonaviator respiratory/ocular protective assets is in R&D. The capabilities and fielding of these assets are not as yet determined.

³⁷ The next-generation series of nonaviator percutaneous protective assets is in R&D. The capabilities and fielding of these assets are not as yet determined.

³⁸ Active TSPs are projected for replacement of SERPACWA TSP and SERPACWA Active TSP in the far term. The Chemical Agent Prophylaxis and Cyanide Pretreatment are

also projected for the far term. The Multivalent VEE Vaccine is projected to begin production in FY2013. The Next-Generation Anthrax Vaccine, Tularemia Vaccine, and Plague

Vaccine are projected for production beginning in FY2010. Serotypes A and B are addressed in the Recombinant Bivalent Botulinum Vaccine projected for production in FY2012.

A number of R&D efforts are under way for the development of pre- and post-exposure prophylaxes. Potentially, these efforts may produce viable prophylaxes within the mid and

far term resulting in fielded material. However, possible resulting prophylaxes cannot be predicted at this time.

³⁹ A decision on the inclusion of COLPRO in the LHA(R) is expected in the mid term.

⁴⁰ JTCOPS Block II is projected for the far term. Continued fielding of JECP.

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13.12.3

Functional Solution Analysis

13.12.3.1

DOTLPF Assessment Summary

This section addresses the deficiencies and suggests potential non-materiel solutions. If there are

no non-materiel solutions, or they are only partial solutions, the remaining non-materiel need is

then stated. Materiel needs are assessed in the IMA section.

Deficiency: DOTLPF for Protective Posture Protocols is inadequate or nonexistent

addressing CBRND of eligible civilians.

Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures addressing

eligible civilian personnel for CBRND. Organization: Identify organization services and

activities necessary to support survivability of eligible civilian personnel within a

CBRN/TIM environment. Training: Establish CBRND training, exercise, and evaluation

criteria and programs for eligible civilians; and conduct CBRND training, exercises, and

evaluations. Leadership: Implement and manage CBRND training, equipping, and protection

of eligible civilian personnel.

Deficiency: DOTLPF for Protective Posture Protocols is inadequate or nonexistent

addressing CBRND of MWAs.

Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures addressing

MWAs, particularly MWDs, for CBRND. Organization: Identify organization services and

activities necessary to support survivability of MWDs within a CBRN/TIM environment.

Training: Establish CBRND training, exercise, and evaluation criteria and programs for

MWDs and conduct CBRND training, exercises, and evaluations. Leadership: Implement

and manage CBRND training, equipping, and protection of MWDs.

Deficiency: Expelled air from an exposed/contaminated casualty equipped with standard

ocular/respiratory protection is not filtered and may present a potential secondary hazard or

contamination source or handling and transporting personnel and resources.

Partial Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures

addressing the safe management of potentially hazardous expelled air by exposed/

contaminated casualties wearing standard ocular/respiratory protection to preclude the

potential for secondary exposure/contamination of handling/transporting personnel and

resources. Training: Establish institutional, recurring, and unit training, exercise, and

evaluation criteria and programs addressing potentially hazardous expelled air by

exposed/contaminated casualties wearing standard ocular/respiratory protection.

Deficiency: Existing DOTLPF is inadequate, or nonexistent, for eligible civilians.

Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures addressing

eligible civilian personnel for CBRND. Organization: Identify organization services and

activities necessary to support survivability of eligible civilian personnel within a

CBRN/TIM environment. Training: Establish CBRND training, exercise, and evaluation

criteria and programs for eligible civilians; and conduct CBRND training, exercises, and

evaluations. Leadership: Implement and manage CBRND training, equipping, and protection

of eligible civilian personnel.

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Deficiency: Existing DOTLPF is inadequate, or nonexistent, for MWAs.

Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures addressing

MWAs, particularly MWDs, for CBRND. Organization: Identify organization services and

activities necessary to support survivability of MWAs within a CBRN/TIM environment.

Training: Establish CBRND training, exercise, and evaluation criteria and programs for

MWAs and conduct CBRND training, exercises, and evaluations. Leadership: Implement

and manage CBRND training, equipping, and protection of MWAs.

Deficiency: Medical units are not equipped with additional protective material for existing

patients and replacement assets for casualties.

Non-Materiel Solutions: Doctrine: Adjust joint doctrine to require force planning of IPE

support and resupply of Medical Services for patients and casualties. Disconnect requirement

with operational unit. Organization: Develop organizational structures, resources, staffing,

and stock management capabilities to support IPE requirements for patients and casualties.

Deficiency: Casualties unable to wear respiratory/ocular protection are not addressed.

Partial Non-Materiel Solutions: Doctrine: Establish alternative procedures and processes

within doctrine, policy, and procedures for casualties unable to wear respiratory/ocular

protection and who must be moved within or through a CBRN/TIM contaminated zone.

Organization: Develop organizational structures, resources, staffing, and stock management

capabilities to support casualties unable to wear respiratory/ocular protection. Training:

Implement institutional, recurring, and unit training on established procedures and processes

(see Doctrine) for the protection of casualties unable to wear respiratory/ocular protection.

Deficiency: Distinction between MOPP and medical protection requirements not adequately

addressed in existing DOTLPF.

Non-Materiel Solution: Doctrine: Clarify in doctrine, policy, and procedures the distinction

between MOPP and medical protection requirements as relates to this task.

Deficiency: CBRND protective equipment and measures do not protect against all

CBRN/TIM agents.

Partial Non-Materiel Solutions: Doctrine: Requirement for development of CBRND

protective equipment and measures to protect against all CBRN/TIM agents, particularly

high-risk/high-threat agents. Leadership: Enforce compliance with established standards (see

Doctrine) for prophylactic CBRND protection.

10. Deficiency: Medical prophylaxis does not exist for all threat CBRN/TIM and TIM agents.

Partial Non-Materiel Solutions: Doctrine: Establish in doctrine, policy, and procedures the

application of standards for prophylactic CBRND protection against all threat agents.

Training: Train, exercise, and evaluate personnel (military and eligible civilians) on the use

of prophylactic CBRND protection against threat agents. Leadership: Enforce compliance

with established standards (see Doctrine) for prophylactic CBRND protection. Implement

and ensure training is adequate and conduct exercises and evaluations to ensure readiness.

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11. Deficiency: Current doctrine, the UJTL, and operational planning do not adequately address

sustained operations within a CBRN/TIM environment.

Non-Materiel Solutions: Doctrine: Include in doctrine, policy, procedures, and UJTL

sustained operations within a CBRN/TIM environment. Training: Train, exercise, and

evaluate the force for sustained operations within a CBRN/TIM environment. Leadership:

Recognize criticality of readiness of the force for potential sustained operations within a

CBRN/TIM environment, training providing the skills to manage the force in these

circumstances, and willingness and ability to implement necessary changes and activities to

prepare and appropriately apply the force.

12. Deficiency: Prophylaxes against most high-threat TIMs are not currently available due to the

relatively recent consideration of these agents as a potential threat.

Partial Non-Materiel Solutions: Doctrine: Establish in doctrine, policy, and procedures the

application of metrics for standards and criteria for protection against all high-threat TIM

agents. Training: Train, exercise, and evaluate personnel (military and eligible civilians) on

the use of prophylactic CBRND protection against threat agents. Leadership: Enforce

compliance with established metrics for standards and criteria. Implement and ensure training

is adequate and conduct exercises and evaluations to ensure readiness.

13. Deficiency: Efficacy of existing prophylaxes varies widely.

Non-Materiel Solutions: Doctrine: Establish overarching single common standard for

prophylaxes efficacy.

14. Deficiency: Not all prophylaxes are FDA approved.

Non-Materiel Solutions: Doctrine: Require FDA approval of all prophylaxes, including

medications potentially applied as prophylaxes. The latter requires specific approval as

prophylactic treatment.

15. Deficiency: Prophylaxis for eligible civilians is not addressed.

Non-Materiel Solutions: Doctrine: Establish in doctrine, policy, and procedures

requirement to address the administration, provision, and application of medical CBRND

protective countermeasures by other than U.S. forces (e.g., civilians, non-U.S. forces, etc.).

Organization: Address organizational issues (e.g., who provides the equipment, support

forces to train and equip, etc.) related to the provision of CBRN/TIM protection to eligible

civilians and non-U.S. forces. Training: Include eligible civilians in CBRND training,

exercises, and evaluations. Identify training requirements and responsibilities for non-U.S.

forces. Leadership: Ensure leadership awareness of criticality of resources and increased

dependence of military operations upon civilians. Personnel: Require eligible civilians

supporting the mission to meet minimum standards for safe use of CBRND resources.

16. Deficiency: Prophylaxis for MWAs is not addressed.

Non-Materiel Solutions: Doctrine: Establish in doctrine, policy, and procedures

requirement to address the administration, provision, and application of medical CBRND

protective countermeasures for MWAs, particularly MWDs. Organization: Address

organizational issues (e.g., who provides the equipment, support forces to train and equip,

etc.) related to the provision of CBRN/TIM protection to MWAs. Training: Include MWA

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handlers in CBRND training, exercises, and evaluations. Leadership: Ensure leadership

awareness of criticality of MWA resources.

17. Deficiency: The issue and administration of prophylaxis to eligible civilians requires review

due to questions regarding applicability to the range of body types, ages, and physical/

medical factors inherent within a potential population, as well as possible long-term health

issues and legal implications.

Non-Materiel Solutions: Doctrine: Establish in doctrine, policy, and procedures the

application of standards and measures for protection of eligible civilians addressing the

variation within the potential protected population. Leadership: Establish CBRND training,

exercise, and evaluation criteria and programs for eligible civilians and conduct CBRN/TIM

training, exercises, and evaluations.

18. Deficiency: Prophylaxis for MWAs is virtually nonexistent.

Partial Non-Materiel Solutions: Doctrine: Establish doctrine, policy, and procedures

CBRND protection of MWAs, particularly MWDs, and training for CBRN/TIM environment

survival. Organization: Ensure organizational consideration for maintenance and support of

MWA CBRND protective equipment, measures, and activities. Training: Establish

institutional and unit training of handlers and MWAs for CBRND measures and activities.

Leadership: Ensure awareness and planning for CBRND measures and requirements for

MWA survivability. Facilities: Develop supporting infrastructure for MWA CBRND (e.g.,

logistics, veterinary surveillance, etc.).

19. Deficiency: Negative-pressure COLPRO with filtered expelled air does not exit within the

inventory for the transport and sheltering of numbers of exposed, infectious, and/or

contaminated casualties.

Partial Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures

addressing negative-pressure COLPRO and the safe management of potentially hazardous

exhausted air to preclude the potential for secondary exposure/contamination of

uncontaminated/unexposed personnel and resources. Training: Establish institutional,

recurring, and unit training, exercise, and evaluation criteria and programs addressing the

operation and application of negative-pressure COLPRO and management of potentially

hazardous exhaust air.

20. Deficiency: Mobile COLPRO that operates and provides protection while moving is not

available for the protection of casualties.

Partial Non-Materiel Solutions: Doctrine: Establish in doctrine methods and processes

enabling the transport of multiple casualties safely and without risk of secondary

exposure/contamination by transporting personnel and resources (if casualties are

contaminated) or exposure/contamination of casualties (if casualties are uncontaminated).

Training: Implement institutional, recurring, and unit training of the safe transport (see

Doctrine) of multiple casualties.

21. Deficiency: DOTLPF for Protective Posture Protocols is inadequate or nonexistent

addressing CBRND of eligible civilians.

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Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures addressing

eligible civilian personnel for CBRND. Organization: Identify organization services and

activities necessary to support survivability eligible civilian personnel within a CBRN/TIM

environment. Training: Establish CBRND training, exercise, and evaluation criteria and

programs for eligible civilians and conduct CBRND training, exercises, and evaluations.

Leadership: Implement and manage CBRND training, equipping, and protection of eligible

civilian personnel.

22. Deficiency: DOTLPF for Protective Posture Protocols is inadequate or nonexistent

addressing CBRND of MWAs.

Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures addressing

MWAs, particularly MWDs, for CBRND. Organization: Identify organization services and

activities necessary to support survivability of MWAs within a CBRN/TIM environment.

Training: Establish CBRND training, exercise, and evaluation criteria and programs for

MWAs and conduct CBRND training, exercises, and evaluations. Leadership: Implement

and manage CBRND training, equipping, and protection of MWAs.

23. Deficiency: DOTLPF is inadequate to address large-scale medical CBRN/TIM operations,

particularly sustained operations within a CBRN/TIM environment and/or command staff

and Medical Services action associated with large-scale medical operations involving non-

U.S. personnel (e.g., indigenous civilians, third-party nationals, etc.).

Non-Materiel Solutions: Doctrine: Include in doctrine, policy, procedures, and UJTL

sustained operations (medical and nonmedical) within a CBRN/TIM environment. Include

command and Medical Services activities associated with the planning, coordination,

implementation, operation, and termination of large-scale medical operations involving non-

U.S. personnel (e.g., indigenous civilians, third-party civilians, third-party nationals,

displaced persons, detained persons, etc.). Organization: Ensure resources, taskings, and staff

are in place or available to plan and perform sustained operations (medical and nonmedical)

within a CBRN/TIM environment and/or operations addressing command and Medical

Services actions associated with the planning, coordination, implementation, operation,

support, and termination of large-scale medical operations involving non-U.S. personnel

(e.g., indigenous civilians, third-party civilians, third-party nationals, displaced persons,

detained persons, etc.). Training: Train, exercise, and evaluate the force for sustained

operations (medical and nonmedical) within a CBRN/TIM environment and/or operations

addressing command and Medical Services actions associated with the planning,

coordination, implementation, operation, support, and termination of large-scale medical

operations involving non-U.S. personnel (e.g., indigenous civilians, third-party civilians,

third-party nationals, displaced persons, detained persons, etc.). Leadership: Recognize

criticality of readiness of the force for potential sustained operations (medical and

nonmedical) within a CBRN/TIM environment, training providing the skills to manage the

force in these circumstances, and willingness and ability to implement necessary changes and

activities to prepare the force and appropriately support large-scale medical operations

involving non-U.S. personnel (e.g., indigenous civilians, third-party civilians, third-party

nationals, displaced persons, detained persons, etc.). Personnel: Eligible civilian personnel

and operations supporting the mission/military operations (medical and nonmedical) are

qualified in CBRND and capable of performing their responsibilities in a CBRN/TIM

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environment. Facilities: Develop supporting infrastructure for sustained operations within a

CBRN/TIM environment and operations associated with large-scale medical operations

involving non-U.S. personnel (e.g., indigenous civilians, third-party civilians, third-party

nationals, displaced persons, detained persons, etc.).

24. Deficiency: Timing of notice of deployment and the availability of medical personnel impact

the conduct of predeployment screenings.

Non-Materiel Solutions: Doctrine: Establish in doctrine, policy, and procedures

requirements for ongoing automated and manual medical screenings to ensure baseline

standards are maintained in support of potential deployment taskings. Leadership: Enforce

compliance with established requirements for predeployment medical screenings.

25. Deficiency: Short-notice operations and reallocated taskings may also impact the conduct of

predeployment medical screenings.

Non-Materiel Solutions: Doctrine: Enforce doctrinal requirements for alternative planning

and unit readiness for potential deployment taskings. Leadership: Enforce compliance with

established requirements for planning for predeployment medical screenings.

26. Deficiency: Annual physicals, when used to meet deployment screening requirements, may

be conducted several months before a deployment.

Non-Materiel Solutions: Doctrine: Establish in doctrine, policy, and procedures

requirements for ongoing automated and manual medical screenings to ensure baseline

standards are maintained in support of potential deployment taskings. Leadership: Enforce

compliance with established requirements for predeployment medical screenings.

27. Deficiency: Current medical systems are stovepiped and require manual intervention to share

information.

Non-Materiel Solutions: Doctrine: Enforce doctrine, policy, and procedures for integrated

automated systems and application of data systems standards.

28. Deficiency: Medical treatment recording below Echelon 3 is limited and not linked to higher

echelon systems.

Non-Materiel Solutions: Doctrine: Enforce doctrine, policy, and procedures for integrated

automated systems and application of data systems standards.

29. Deficiency: Outpatient care is not generally recorded and aggregate information is reported.

Non-Materiel Solutions: Doctrine: Enforce doctrine, policy, and procedures for integrated

automated systems, application of data systems standards, and the timely and accurate

reporting of medical treatment information.

30. Deficiency: Unit reporting is not linked to medical information systems.

Non-Materiel Solutions: Doctrine: Enforce doctrine, policy, and procedures for integrated

automated systems and application of data systems standards.

31. Deficiency: Individual manual vaccination and health records are not always available or

complete.

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Non-Materiel Solutions: Doctrine: Enforce doctrine, policy, and procedures for integrated

automated systems, application of data systems standards, and the timely and accurate

reporting of medical treatment information.

32. Deficiency: The AMEDD training for the treatment of contaminated/exposed casualties is

not mandatory for medical practitioners identified for deployment or assignment where there

exists a CBRN/TIM threat.

Non-Materiel Solutions: Doctrine: Promulgate doctrine, policy, and procedures the

application of institutional and unit training standards for the handling of exposed and

contaminated casualties/MWAs. Training: Establish training, exercise, and evaluation

standards for the safe handling of exposed and contaminated casualties/MWAs. Leadership:

Implement and manage training and equipping of functions and activities handling exposed

and contaminated casualties/MWAs.

33. Deficiency: The ability of the command and Medical Services staff to ensure medical

capabilities for CBRND is limited by routine medical operations and requirements.

Non-Materiel Solutions: Doctrine: Incorporate the safe handling, transport, protective

measures, medical reception and triage, and treatment of contaminated casualties into

doctrine, policy and procedures and requires specific exercising and evaluation for these

operations and activities that includes all activities and functions conducting these functions

including nonmedical activities and functions. Organization: Ensure resources, taskings, and

trained personnel are in place or available to support the handling, transport, protective

measures, medical reception and triage, and treatment of contaminated casualties by all

activities and functions conducting these functions including nonmedical activities and

functions. Training: Train, exercise, and evaluate the handling, transport, protective

measures, medical reception and triage, and treatment of contaminated casualties by all

activities and functions conducting these functions including nonmedical activities and

functions, including the prevention of secondary exposure/contamination. Leadership:

Implement and manage training, equipping, protective measures, and exercising for the safe

handling, transport, medical reception and triage, and treatment of contaminated casualties by

all activities and functions conducting these functions including nonmedical activities and

functions.

34. Deficiency: Generally, casualty care, until completion of decontamination, is performed by

medical corpsmen, not medical practitioners.