One Science for CBRN Mitigation
A.L. Sobel, M.D., M.S.
Assistant to the Provost and VP
University of Missouri
Overview
In an age of terrorism, targeting of civilians and critical infrastructure has become all too commonplace.
The threat environment has emerged as a setting that merges the complexities of tactical and strategic actions. Across the spectrum of operations, the field of management of CBRN operations spans the principles of complex emergencies, security, stability, transition, post-incident recovery/reconstruction, mass care, and psychosocial dynamics. There are many insertion points for technologies in the gap areas, specifically in the area of mobile adaptive communications and sensor fusion that may assist in the conduct of operations and organization of the public.
Immediate objectives are for threat verification as the driver for ensuing operations and best measurable outcome. Although an “All Hazards” response is viewed as the optimal approach in the setting of high uncertainty, the diverse issues affecting the optimal management of unconventional threats are many. This paper will specifically focus on chemical and biological threats and some of the gaps that must be addressed.
Threat Detection and Identification
Threat verification may be challenging due to compromise many factors, such as: the operational environment, confounding sensor data and information, time delay, inadequate sampling, lack of recognition of the event, lack of training and other human factors and technical issues. However, let us assume that sampling is adequate with minimal time delay and contamination of evidence, and the presence of coexisting observables that may assist in threat location and mechanism of action.
Protection of Responders
Protection of responders must be one of the initial priorities in response to CBRN attacks. The rationale for such actions is two-fold: (1) protection of critical personnel and (2) mitigation of the effects of such an attack. All hazard response algorithms allow for the most flexible personnel protective posture while optimizing responder and victim survivability.
Decontamination
Routine protocols exist for chemical decontamination, particularly of nerve and other traditional military agents. However, protocols are variable in efficacy and availability for novel agents and other next generation agents. A similar case exists for radiological agents, given the routes of contamination are through primarily skin, respiratory and gastrointestinal routes. In the case of infectious biological agents, however, decontamination is not the standard of care. Surface disinfection may have variable effectiveness, although respiratory containment of threat agents is the first priority of consideration.
Medical Management
Medical management of CBRN events must be adaptive. An initial comprehensive assessment of the extent of contamination and/or infectious or toxin dose and routes of dissemination must be determined. Agent identification, population and individual susceptibility must be rapidly assessed. The most critical aspect of medical management is timely, accurate information management and characterization of the attack.
Information Dissemination
Information management is probably among the most ineffectively managed aspects of emergency and disaster response. A disaster of any scale requires pre-emptive information flow to minimize public fear and mobilize leadership and confidence in public services.
Levels of uncertainty should be minimized and specific actions encouraged through clear communications across all levels of responders, the general public, decision-makers, and relevant agencies.
Cooperation between media, authorized subject matter experts, and public safety and other government communications is required for seamless information flow. These communities of interest must not operate in “silos” rather, they must routinely work to achieve value-added through collaboration. Routine interagency and transnational cooperation minimizes misinformation and enables recruitment of the public as a partner in emergency response and security. Additionally, the public seeks direction and clear guidelines during emergencies, and emerges as a force-multiplier in a response. In summary, although public behavior may not be fully anticipated during a WMD event, clear, expert guidelines enable fear to be channeled into action and positive behavior.
Command, Control and Communication
Command and control (C2) is one of the highest priorities of emergency management of CBRN operations. The most important aspect of command is delineation of clear-cut lines of responsibility. Typically, the first on-scene responder leadership is traditionally in charge. Once again, this approach must be adaptive. Specifically, if specialty areas of expertise and capability are required, the personnel most trained, equipped, and knowledgeable must be considered as the most reliable first-echelon decision-making authority. Of course, this does not imply overall C2, rather, situation-specific control and information source. Typically, as a response progresses and phases of the operation unfold, so does the nature of the information and knowledge required to successfully contain the threat and minimize collateral damage.
International Collaboration
Collaboration is the cornerstone to containment of a WMD event, from measurable geopolitical effects, casualty and terror generation, and critical infrastructure destruction/disruption. The greatest enabler of international collaboration is sharing of time-sensitive, validated, actionable, and relevant information dissemination. Collaboration ensures consistency of information, shared situation awareness, and input to policy and action.
International collaboration is especially valued for ability to pre-empt or disrupt future WMD events and maximize the efficiency and surge capacity of a response.