Joint Deployment

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Joint Deployment Environmental Health Research
Protecting the Fighting Force
2
Department Of Defense

• Defense Medical Programming Guidance for
  FY2000- 2005 directed that Component POM
  submissions support Force Health Protection
  program/mission on
• Environmental Surveillance - Program resources
  to develop and maintain units/teams,
  equipment, and systems to monitor and report
  environmental exposures during deployments.
• OSD Guidance for FY2002-2007 CBD POM. The
  medical CBD technology base needs to conduct
  medical research to understand the effects of
  low-level chemical toxicity on the human body
  and to develop medical countermeasures to
  minimize those effects.

3
POM Funding
Theres a Problem! Were in charge! Give us the
Money!
Theres a problem! Whos in charge? Wheres the
money?
Wrong way!
96
00
98
02
05
07
FY

• Theres a Threat!
• How do we mitigate it?
• What is our plan?
• How much is it going
• to cost to field the solution?

Funding Wedge



96
00
98
02
05
07
FY
4
Army Leadership
GEN Shinsekis Vision12 Oct 99
The Army will roll up its shirt sleeves and
start changing now to develop a force that is
strategically responsive and dominant across the
spectrum of operations.

• 100 self-contained, fully mobile, 100 air
  deployable (C130)
• Entire brigade deployed within 96 hours
• Self-sustained operations for 72 hours
• Capable of sustained operations within a 100 x
  100 km area
• Survive selected levels of NBC

5
Initial Brigade Combat TeamBrigade Support
Medical CompanyPreventive Medicine Section

• Performs sanitary inspections of food service
  field sites, latrines, and other activities
• Coordinates pre-deployment, deployment, and
  post-deployment medical surveillance
• Conducts disease/injury trend analysis and
  advises on strategies to reduce loss of
  productive time
• Monitors field water supplies
• Collects samples to evaluate potential
  NBC/toxic industrial contamination hazards
• Facilitates information flow and data transfer
  between the IBCT, theater, and national medical
  surveillance organizations

PM SECTION
2
1/0/1
Para 2
PERSONNEL O2 - ENV SCI OFF (1) E4 -
PM SPC (1)
COMMUNICATIONS FBCB2 (1) VRC-90F (1) EPLRS
(1) GPS (1) BCIS-NS (1)
MAJOR EQUIPMENT HMMWV (1) TRL, HMMWV (1)
MC4 TYPE IIIA (1)
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Initial Brigade Combat TeamArea Medical
Laboratory (-)

• In-Theater NBC Sample ID and Confirmation of use
• 100 Mobile Functional Team
• Capability per day - 10 Environmental specimens,
  240 Serum specimens, and 10 CW specimens

Plug that is METT-T Dependent
PERSONNEL (10)
MAJOR EQUIPMENT HMMWV (1) PCR (1) TRL, HMMWV
(1) ELISA (1) MTV (4) GC/MS (1) ISO (2) TRL,
WATER (1)
COMMUNICATIONS TA 1042 (1) AN/PSC-5 (1) VRC-90F
(1) GPS (1)
MC4 TYPE II (1) TYPE IIIB (1)
7

Initial Brigade Combat TeamAdditional Army Corps
Augmentation

• The following additional CHS capabilities may be
  deployed in support of the I-BCT dependent on
  METT-T
• Area Laboratory Support
• Veterinary Services to include Food Surveillance
  and Procurement
• Preventive Medicine Services
• Combat Stress Control Services
• Medical C4I Headquarter Elements
• Area Support Medical Companies/Detachment
• Class VIII and Blood Management and Biomedical
  Maintenance Support
• Hospitalization
• Ground and Air Evacuation
• Dental Services

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Rapid Analysis of Food and Water for
Environmental Contaminants
9
Future Requirements and Capabilities

• Military Microbiological Standards (under
  consideration)
• Coliform - 1 cfu/100ml
• Virus - 1 iu/100ml
• Spores/cysts - 1 iu/100ml

• Rapid Water Microbiological Test Kit
• No larger than current Water Testing Kit,
  Bacteriological
• Capable of detecting coliforms (E.coli) and
  other enteric organisms to standards in 4 hours
  (desirable 1 hour)
• Field deployable using PM detachment assets.

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Approaches to Monitoring for Microbial
Contaminants
Problems

• Application of US Standards to the Field
  Environment

• Signal to Noise Ratio
• Viable vs Dead
• Broad Range of Pathogens (viruses to protozoa,
  metazoan parasites)
• Biological Warfare Agents

• Users Expectation

• Small, Fast, Good and Cheap!
• One Size Fits All

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Modified Coliform Assay
Incubator
Unfiltered Water
Sensitivity 30 E.coli n 2-3 h
LED
Detector
Oxygen-sensitive Dye on Membrane Filter
Computer

• Advantages
• Exploits current field technique (cheap and
  good)
• May be able to decrease time to detection
• Disadvantages
• Only works with bacteria

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Spectrofluorometry
Analysis of 117 Surface Water Samples Sensitivit
y 0.88 Specificity 0.65 PPV
0.65 NPV 0.87
320 - 340 nm
Spectral Analysis based on fuzzy K-nearest
neighbor (FKNN) algorithm and learning sets
400 - 500nm
Detector

• Advantages
• Cheap with minimal logistics
• Fast and easy
• Disadvantages
• No single positive or negative spectral pattern
• May only indicate fecal bacteria contamination

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Nucleic Acid Sequence Based Amplification NASBA
(RTPCR)
Sample Preparation
Gene Amplification
Detection

• Cryptosporidium Assay
• Detect live only
• Sensitive at 5-10 oocysts
• Did not cross react with
• other microbes

• Advantages
• Sensitive and specific
• Can be applied to most microorganisms
• May be able to test for multiple pathogens
  simultaneously
• Disadvantages
• Complex assay
• Expensive with logistics considerations

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Deployment Toxicology and the Bigger Picture
Environmental Challenges
Metabolic Demands

• President Clinton (Nov 97)
• I am directing the departments of Defense
  and Veterans Affairs to create a new Force
  Health Protection Program. Every soldier,
  sailor, airman, and marine will have a
  comprehensive, life-long medical record of
  all illnesses and injuries they suffer, the
  care and inoculations they receive, and their
  exposure to different hazards.

Exercise/Work
Cold
Energy/Metabolism
Weightlessness
Dehydration
Hypoxia
Heat
Sleep Loss
Toxic Chemicals
Fatigue
Jolt
OOTW Role Conflicts
RFR
Technical Complexity
G Forces
Vibration
Blast
Chronic Anxiety
Laser
Materiel Hazards
Neuropsychiatric
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Model for Individual Monitoring

• Monitoring does not protect, it only warns.
• Warning must be timely (immediate).
• Warning must be credible.

Risk Assessment
Toxic Exposure
Physio Based Exposure Assessment
Deployment Toxicology Sentinel
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Current Parts, Future Needs

• Toxic Chemical Sensor Badge

• Electroactive polymers sensitive to
• ACHE Inhibitors
• Choking Agents
• Caustics
• Solvents

• War Fighter Physiologic Status Monitor

• Headband EEG and oximetry
• Voice stress
• EKG
• Core and Skin Temperature
• Actigraph
• Transcutaneous monitoring

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Goals for the Next Millennium
Put Ourselves Out of Business!!

• Develop a comprehensive understanding of the
  physical and biochemical effects of chemicals
  and chemical mixtures on humans as defined by
  their genotype or expressed as their phenotype
  given extenuating influences such as stress,
  temperature extremes, etc.
• Field a complete protective ensemble that warns
  and protects against potentially lethal or
  debilitating environmental factors as well as
  weapons of war.

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The Soldier
What matters more when facing a risk, the facts
as we see them or the subjective belief in what
lies hidden in the void of time. (Peter
Bernstein, Against the Gods, The Remarkable Story
of Risk)
Leadership
Performance
Survival
Equipment
Well Being
Support
Long Term Health
Medical
Soldier Perception
Soldier Perception