Enhanced Understanding of CBRN Threat, Vulnerability

1
Enhanced Understanding of CBRN Threat,
Vulnerability Capability

• LTC Debra Schnelle
• 24 Apr 02

HQDA (DASG-HCF) 5111 Leesburg Pike Falls Church,
VA 22041 www.nbc-med.org
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QUESTION TO THE BOARD

• Provide recommendations on vaccines
  immunization protocols necessary to enhance
  protection against validated biological warfare
  threat agents.

3
Agenda

• Where were we, when?
• Where are we, now?
• Where do we need to be?
• NATO Biological Medical Advisory Committee
  (BioMedAC) Smallpox Recommendations, 3 May 02

4
Where Were We, When?

• 26 Nov 93 DODD 6205.3, DOD Immunization
  Program for BW Defense
• May 99 AFEB recommends a medical risk
  assessment of BW threat list
• May 00 Joint Staff directs DOD EA to conduct a
  medical risk assessment
• May 01 Medical Risk Assessment product briefed
  to AFEB

5
Medical Risk Assessment Objective

• To develop a methodology that will integrate a
  medical risk assessment and the intelligence
  threat assessment of validated biowarfare agents.
  
• Will be used for making medical defense
  research, development, testing, acquisition and
  stockpiling decisions.

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Overview of OTSG Approach

• Step 1 Convene Oversight Committee
• Step 2 Develop award contract
• Step 3 Convene Military Panel
• Step 4 Scientific Panel
• Step 5 Develop Medical Risk Conclusions for
  Validated Biowarfare Agents

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Study Design

• Military Medical Panel identified and weighted
  significant operational criteria
• These criteria (w/o weights), and the word
  pictures necessary to evaluate the individual BW
  agents, were given to the Scientific Panel
• Results of the two Panels will be brought
  together and applied to the threat list

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Status of Med Risk Assessment Product

• Endorsed by AFEB, Sep 01
• Widely applied received (informally)
• Presented
• NATO NBC/Medical WG, Jan 01
• NATO BioMedical Advisory Committee, Jun 01
• National Defense University, Jul 01
• CANUKUS MOU Mtg, Sep 01

12
Where Are We, Now?

• Summer 01 QDR directs a shift toward
  capability based planning
• 11 Sep 01
• Dec 01
• GAO report recommendation that DOD address the
  gap between the stated CB threat and the current
  level of medical readiness
• DOD response stated that OTSG would perform a
  CBRN hazard analysis by May 02

13
Threat, Vulnerability Capability
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What is the threat???

• Diverse lists, approaches purposes
• Diverse User Requirements
• CBRN scope too broad for conventional threat
  analysis
• Multiple agents infinite scenarios
• Scenario impact largely unknown
• Fails to rule out threats
• Reinforces threat-based thinking

15
Current NBC Threat Lists/Purposes

• Support acquisition
• Chairmans BW Threat List
• System Threat Assessment Report (STAR)
• OTSG Medical Risk Assessment
• Prioritization for Response
• ITF6 Assessment (CANUKUS)
• CDC Critical Biological Agent List

16
User Requirements

• Strategic shape national military strategy
  Operational
• What is the scope of the problems presented by
  the identified threats?
• How will I prepare, plan prioritize?
• Tactical What adaptations to my OPLAN must I be
  prepared to make, if the threat is realized?
• Technical guide RDTE

17
Current Threat Definition

• Threat Enemy Intent Capability, based upon
  assessment of enemy
• Doctrine
• Possession of agents
• Possession of delivery mechanisms
• Vulnerability of Friendly Forces

18
Scope of CBRN Threat

• Multiple Possible Hazards (CBRN)
• Chemical CWA/TIC
• Biological BW/BT
• Nuclear/Radiological weapon/improvised nuclear
  device
• Multiple Delivery Mechanisms
• Homeland Deploying Forces

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SPECTRUM OF NBC THREAT
Natural
Manmade
Weapons
Nuclear Weapons Attack
Background Radiation
Low Level Sources
Nuclear Reactors
Endemic Disease
BW Attack
Resistant Disease
Biochemical Industry
Natural Sources
CW Attack
Environmental Pollution
General Industry
Toxic Industry
20
Weaknesses of Current Lists

• All agents treated as equally dangerous
• Do not differentiate between hazards and
  potential events
• Focus on known threats
• Does not account for unknowns
• Omits agents that were once weaponized
• Ignores non-state users or transfers

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Where Do We Need to BE????
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Objective

• The analysis of CBRN hazards, as they are
  realized along a broad spectrum of possible CBRN
  events, that allows a consistent assessment of
  vulnerability and defines the scope of
  capabilities required for an adequate medical
  response to a CBRN event.

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Threat, Vulnerability Capability

• Aspects of Capability
• Aggregate of facilities expertise, personnel
  resources
• Competency - judgment necessary for OODA
• That allows execution of a specified COA.

Counter
Develop

• Aspects of Vulnerability
• - Damage disruption of normal combat operations
  includes increased morbidity mortality
• Impact severity extent of damage.

• Aspects of Threat
• Enemy Intent Capability.
• Risk of CBRN hazards becoming events.

Creates
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Approach

• Consider diverse sources
• OTSG Medical Risk Assessment
• NDU/CCR effort
• Env Risk Assessment methodologies
• Disaster Emergency Medicine tenets
• Develop a framework that clarifies terms
  concepts
• Threat, vulnerability capability
• Enemy intent capability
• Hazard, event damage
• Capability medical response

25
Approach

• Use current mod-sim tools analytical methods to
  reveal subtle connections between concepts.
• NBC CREST
• NATO Publication Medical Planning Guide for NBC
  Battle Casualties

26
What is Threat?

• Enemy intent capability
• CBRN hazard realized as a CBRN event
• Hazard condition with the potential to cause
  injury, illness or death of personnel damage to
  or loss of equipment or property or mission
  degradation.
• Risk probability of a particular hazard
  becoming realized as an event
• Event an occurrence negatively influencing
  living beings and/or their environment

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What is Vulnerability???

• Damage disruption of normal combat operations
• Impact severity extent of disruption, in
  terms of combat effectiveness

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What is Capability?

• The aggregate of facilities, expertise, personnel
  resources
• Encompasses competency
• Know how to do the right procedures
• Possess the judgment on when, what, where, who
  how
• For a specified course of action.

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Hazard Characteristics

• Persistence
• Communicability
• Infectivity/Effectivity/LD50/Activity
• Based upon work of Medical Risk Assessment
  Project

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Event Characteristics

• Specified event scenario includes
• Delivery Mechanism
• Distribution System (as applicable)
• Target Vulnerability
• Characteristics (WADEM)
• Onset (sudden gradual slow)
• Duration (short or long)
• Scope (amplitude intensity magnitude)

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Damage Characteristics

• Defined elements of disruption to normal
  operations
• Increased morbidity mortality
• Compromised functions of
• Facilities, Communication, Transportation
• Food Water Supplies
• Power Industrial Production

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Medical NBC Capabilities

• Hazard Analysis
• Early Detection/Monitoring Warning
• Protection
• Medical Countermeasures
• Treatment
• Competency

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Medical Response

• The application of medical CBRN capabilities to
  prevent or mitigate the damage from a CBRN event.
  Includes
• Planning
• Preventive Actions
• Mitigating Actions
• Recovery Actions

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Initial Products from Hazard Analysis
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Evaluation of BW Hazards
36
Prioritization of CBRN Events

• BW Events
• Destruction of Toxic Industrial Facilities
• Destruction of US Army Chemical Warfare Agent
  Stockpiles
• Use of Chemical Warfare Agents
• PENDING nuclear/radiological covert use of
  TICs contagious BW

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Damage from BW Events(Increased Morbidity)
38
Damage from BW Events(Increased Morbidity/day)
500000
450000
400000
350000
300000
Number of Casualties
250000
200000
150000
100000
50000
0
2
3
4
5
6
7
8
9
10
11
50437
188756
166254
79549
22273
6840
2673
1581
0
0
ANTHRAX Point
8653
276180
453141
272414
107020
31832
10177
4708
0
0
ANTHRAX Ground
Day (Attack occurs at beginning of Day 1)
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Damage from BW Events(Increased Morbidity/day)
40000
35000
30000
25000
Number of Casualties
20000
15000
10000
5000
0
2
3
4
5
6
7
8
9
10
11
583
3164
2580
2810
2510
1467
1308
689
318
53
BOT TOX Point
2459
21000
35704
34130
24122
14877
7180
4082
1574
0
BOT TOX Ground
Day (Attack occurs at beginning of Day 1)
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Prediction of Magnitude of Damage on First
Day(Increased Morbidity)
Casualties on Day 1
ANT
BOT
PLG
SMP
TUL
VEE
-
-
-
-
lt1000
Bin 3
Bin 3 or 4
-
-
-
-
1000 to 3000
Bin 4
Bin 4 or 5
-
-
-
-
3000 to 10,000
Bin 5
Bin 5 or 6
-
-
-
-
10,000 to 25,000
Bin 6
Bin 5
-
-
25,000 to 50,000
Bin 5 or 6
Bin 7
Bin 6
Bin 6
-
-
-
gt50,000
Bin 7
Bin 7
Bin 7
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BW Event Damage Medical Resources (Personnel
Beds)
Bin
Base Casualty Range
Resource Type
Req Day 2
Add Req Day 3
Add Req Day 4
Add Req Day 5
Add Req Day 6
Total Req
3
5,000 - 25,000
Med Spec ( people)
490
3,959
10,035
10,140
0
24,624
Physicians ( people)
315
1,512
630
0
0
2,457
Beds (number)
619
3,380
3,395
1,943
0
9,337
4
25,000 - 150,000
Med Spec ( people)
2,650
27,780
33,088
101,858
56,289
221,664
Physicians ( people)
1,474
14,958
6,146
19,059
3,548
45,185
Beds (number)
1,438
15,947
23,861
29,350
17,121
87,716
5
150,000 - 500,000
Med Spec ( people)
20,118
116,454
38,390
110,513
89,528
375,002
Physicians ( people)
12,816
66,899
9,024
47,365
27,143
163,246
Beds (number)
16,979
90,461
95,763
80,805
32,933
316,940
6
500,000 - 1,000,000
Med Spec ( people)
28,308
167,264
76,441
41,202
38,694
351,910
Physicians ( people)
18,195
105,696
36,382
6,111
6,711
173,095
Beds (number)
36,501
253,454
262,956
57,368
0
610,279
7
gt 1,000,000
Med Spec ( people)
59,325
405,322
241,511
76,887
99,644
882,689
Physicians ( people)
38,038
268,309
158,714
35,047
29,649
529,757
Beds (number)
57,345
490,147
690,690
355,281
0
1,593,461
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CB Event Damage Medical Supplies
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Emerging Insights Onset Duration

• Sudden, Short (SEB) WILL overwhelm medical
  response
• Slow Short (Tularemia, Anthrax, Plague)
  initial window for medical response is 7 days
• Delayed Long (Smallpox) global mixing
  assumption ROM may not be effective in limiting
  spread

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Scale of CBRN Events
Casualties(X1,000) Event
Economic lt1 Agro-Terrorism Anthrax Letters, 01 Aum Shinrikyo-Matsumoto, 94 Chernobyl Accident, 86
1-5 BW/CW Best Case Aum Shinrikyo-Tokyo, 95
5-lt25 BW/CW Intermediate
25-lt150 TIC Best Case Iran-Iraq Gulf War, 80-88 Bhopal TIC Accident, 84
150-lt500 CW Worst Case
500-lt1,000 BW/TIC Average Case
gt1,000 BW/TIC Worst Case
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CBRN Events, Medical Capabilities Medical
Response Strategies
CATEGORY LOCAL / REGIONAL NATIONAL
AGRO-TERRORISM ANTHRAX LETTERS CURRENT MEDICAL ASSETS AUGMENTATION
CW RELEASE (5-150K) SURGE EMT HASTY DECON AT HOME CARE
TICS (25-1000K) HASTY DECON EVAC/ SHELTER IN PLACE AT HOME CARE
SEB (25-1000K) PUBLIC EDUCATION MASS CARE FACILITIES
PLAGUE (150-1000K) EPIDEMIOLOGY AGENT ID PROPHYLAXIS ISOLATION COMFORT FOR DYING
ANTHRAX (150-1000K) BOT TOX (5K) EPIDEMIOLOGY AGENT ID PROPHYLAXIS MASS CARE FACILITY
VEE(150-1000K) TULAREMIA (gt500K) EPIDEMIOLOGY AGENT ID PROPHYLAXIS (TUL) AT HOME CARE
SMALLPOX (25-1000K) EPIDEMIOLOGY AGENT ID AT HOME CARE ISOLATION MASS Vx
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Competency Medical Surveillance Medical
Countermeasures
Trigger / Decision Points
Medical Surveillance Alert
Clinical Diagnosis
Exposure
Issue Antibiotics Day 0, Exposure Avoid 100 of
Casualties
100
100
80
Day 3, Med Surveillance Alerts Avoid 71 of
Casualties
71
PERCENT CASUALTIES AVOIDED (AVERAGE)
60
Day 4, Avoid 29 of Casualties
40
29
Day 5, Clinical Diagnosis Confirmed Avoid 12 of
Casualties
20
12
0
D0
D2
D3
D4
D5
D6
D7
D9
D12
D14
D18
D21
D1
DAY ANTIBIOTICS INITIATED
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In Summary.

• Evaluate BW agents as hazards
• Define broad range of potential BW events
• Assess prioritize damage from BW event spectrum

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BioMedAC, May 02

• Statement 1 Potential for terrorist use
  implies military planning must be integrated with
  civil defense planning.
• Statement 2
• Appearance of smallpox case most likely the
  result of an illegal (hostile) act
• Most likely scenario large number of index
  cases in many different locations
• BioMedAC recommends that all NATO allies have the
  capability for immediate, widespread smallpox
  vaccination at the first appearance of a
  confirmed smallpox case