Medical CBRN Defence in the Australian Defence Force
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Original Article Medical CBRN Defence in the Australian Defence Force Major David J Heslop, Commander Neil Westphalen Introduction were catapulted into the city of Caffa (now Feodosia in Crimea) by besieging Mongols� Even so, it was This article focuses on a specialist area of military not until the mid-19th century that investigators, medicine, following a series of recently published such as Louis Pasteur in France and Robert Koch in papers regarding occupational and environmental Germany, demonstrated that microorganisms could medicine in the ADF�1 They assert that high rates cause disease, while research into the industrialised of preventable workplace illness and injury indicate weaponising of potential biological agents only began the need to improve the management of occupational during World War I (WWI)�3 and environmental hazards associated with ADF workplaces, with better emphasis on prevention Lethal chemical weapons were first used in 1915 by rather than treatment� the Germans near Ypres on the Western Front�4 The century since has seen many nations develop, and These papers advocate that, rather than replicating sometimes utilise, a chemical weapons capability�5 the treatment services used for Australian civilians, Although nuclear weapons were used twice in 1945,6 the ADF’s health services should be premised on an other radiological weapons have so far not been occupational and environmental health paradigm� employed on a mass scale�7,8,9 For this to occur, the health capability gaps in the current ADF health service delivery model demand Since the end of the Cold War, most CBRN events have reassessment of the fundamental inputs to (health) usually entailed the use of chemical and biological capability, for both Joint Health Command (JHC) weapons by non-state terrorist organisations�10 and Defence’s Work Health and Safety Branch� Examples include the 1995 attack on the Tokyo subway by the Aum Shinrikyo cult using sarin,11 and Such a reassessment, with implementation of the 2001 attack on the US Senate and two media necessary changes, could lead to a holistic and outlets by unknown perpetrators using anthrax�12 sustainable workforce-based ADF health service delivery model by 2030� This timeframe is based The development, production, stockpiling and use on the current state of the ADF’s occupational of chemical weapons is prohibited by the 1997 and environmental health services, and the Chemical Weapons Convention,13 while the 1975 small number of civilian specialist practitioners Biological Weapons Convention likewise prohibits within the Australasian Faculty of Occupational that for biological weapons�14 Nuclear weapons are and Environmental Medicine (AFOEM)� These presently subject to the 1963 Partial Nuclear Test considerations suggest that a mature health delivery Ban Treaty15 and the 1970 Nuclear Non-Proliferation model would take 10–15 years’ sustained effort, Treaty�16,17 with respect to occupational and environmental However, several nations have not signed or ratified physicians alone�2 some or any of these treaties� In addition, North This article expands on the previous papers, with Korea withdrew from the Nuclear Non-Proliferation respect to how such a paradigm is essential to Treaty in 2003,18 and has recently threatened several the ADF’s defensive medical Chemical, Biological, regional neighbours, including Australia, with Radiological and Nuclear (CBRN) capabilities� nuclear weapons�19 Moreover, these treaties lack relevance with respect to compliance by non-state Global CBRN Threats non-signatories, such as terrorist organisations� CBRN weapons therefore, remain an important Hunter-gatherer communities have used biological global threat� weapons such as poisoned-tipped spears and arrows since prehistoric times� However, the first Furthermore, the goals and actions of non-state documented use of a biological agent for warlike terrorists in recent years have made the use of CBRN purposes was in 1346, when plague-infected corpses weapons more likely, while technological advances Page 66 Journal of Military and Veterans’ Health Original Article have made their use more feasible�20 Given the Japanese�29 Australia then provided three sites victims of a CBRN attack may vary from individuals and about 15,000 personnel for 12 British nuclear to whole populations – which may include military weapons tests between 1952 and 1957�30 personnel as well as civilians21 – defending against these weapons has become an important public More recently, the Australian deployments before health issue�22 and during the 1990-91 Gulf War were conducted in what was assessed as a high-threat chemical and Many nations including Australia have therefore biological warfare environment�31 Australians then focused their defensive CBRN measures against participated in a series of United Nations CBRN the public health threat posed to their civilian weapons inspections in Iraq�32 populations by terrorist organisations, particularly after the 2001 World Trade Center terrorist The ability of ADF personnel at sea, on land and in the attacks�23 This approach predicates managing health air to maintain operational capability before, during responses to deliberate CBRN terrorist attacks that and after a CBRN attack remains fundamental to are intended to cause harm, on comparable terms as defending Australian interests� To this end, all ADF for accidental hazardous material incidents�24 personnel undergo basic CBRN defensive training on entry and periodically thereafter (typically every five This article therefore, contends that occupational and years)� It usually takes only one day and is generally environmental medicine has an important role with limited to describing the various types of CBRN respect to commanders applying a risk management hazards and practical demonstrations of respirators approach to the prevention and treatment of CBRN and other CBRN equipment� Navy incorporates casualties, while maintaining ADF operational this training into its non-CBRN shipboard damage capability� control courses�33 Civilian CBRN Defence in Australia Additional training is provided for the relevant instructors and for specific deployments that are Within Australia, the primary responsibility for assessed as posing a greater CBRN threat� protecting life, property and the environment lies with the states and territories� Each of these have ADF health support in CBRN environments is based their own plans and arrangements to respond on self- and buddy-aid, which are time-critical and to, and recover from, natural and human-caused complicated by the risk of further contamination� emergencies� To this end, some state and territory After decontamination, casualties require further health departments have dedicated disaster specialist CBRN treatment, perhaps concurrently management units�25 with resuscitation for other life-threatening injuries� To complement their efforts in responding to Current ADF operational doctrine for CBRN defence emergencies, the Australian Government can also is therefore predicated on five pillars – Detection, provide physical and financial assistance� This is Identification and Monitoring (DIM); Warning and an Attorney-General’s Department responsibility Reporting (W&R); Physical Protection; Hazard through Emergency Management Australia (EMA)�26 Management and Medical Countermeasures (MCM); and Medical Support� Although the medical Australia’s civilian CBRN defensive measures are contributions are predominantly centred on the final generally incorporated into a unified ‘All Hazards’ pillar, they still include all the others, which can be approach, for a range of different emergencies� Local summarised as: authorities initially respond to these emergencies, followed by a series of escalatory stages� In addition, CBRN occupational screening. This ensures that EMA has specific health guidance for dealing with at-risk personnel meet the appropriate physical, CBRN hazards�27 medical and psychological standards� This particularly refers to personal protective equipment ADF CBRN Defence suitability, fitting and kitting� The standards are difficult to justify, and are often subsumed within For a medium-sized power, Australia’s involvement broader medical standards, where their justification with CBRN issues has been surprisingly intimate� can be lost� This began in WWI, where 323 Australian Imperial Force (AIF) personnel died and 16,426 were wounded CBRN medical preparation. This includes physical by gas on the Western Front�28 Although they were conditioning activities, vaccinations, providing not used, Australia stockpiled its own chemical personal medical countermeasures and CBRN first weapons during WWII, as a deterrent against the aid items� Apart from high readiness elements, this is Volume 27 Number 1; January 2019 Page 67 Original Article usually conducted ‘just-in-time’� It is also contingent personnel is to conserve fighting strength, continue on sufficient quantities of in-date vaccinations and providing non-CBRN health services and support CBRN medications being available when required, to the maximum extent possible, protect health typically when other nations are competing for the personnel from CBRN injuries, minimise CBRN same items simultaneously� morbidity and mortality, avoid the spread of contamination into health vehicles and facilities, and CBRN medical training� This refers to the medical provide command advice� theory and recognition of CBRN agents, how to use personal medical countermeasures, protocols