DTIC ADA445069: DoD Policies on Force Health Protection: Medical Defense Against Biological Warfare Agents (DoD Directives, DoD Instructions)

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Chapter54
DoD POLICIESON FORCE HEALTH PROTECTION: MEDICAL DEFENSE ArticleContents
AGAINST BIOLOGICAL WARFAREAGENTS (DoDDIRECTIVES, DoD
• Introduction
INSTRUCTIONS) • DoDIssuancesforFHPAgainst
BWAgents
FRANKJ.LEBEDA • MedicalCountermeasures
AgainstBWAgents
• Surveillance:RecordKeeping,
Detection,andEpidemiology
• Occupationaland
EnvironmentalHealthRisk
Assessments
• MedicalTraining:Preparingfor
aBWEvent
• Conclusion
• References
Opinions, interpretations, conclusions, and recommenda- intoweaponsandintentionallyusedtocausehumandis-
tions are those of the author and are not necessarily easeorfatalities(DoDDirective6205.3,1993).Drivenby
endorsedbytheU.S.Army. thehealthconcernsafterOperationDesertStormin1991,
newhealthcarepoliciesandplansarecontinuouslybeing
developed and implemented to enhance the protection of
INTRODUCTION
U.S.militarypersonnelagainstdiseasesandenvironmen-
talhazards,includingBWagents(Mazzuchietal.,2002).
The concept of force health protection (FHP) defines
In this effort, the DoD and other agencies were directed
the medical defense approaches to maintain the health
by(Presidential Review Directive, National Science and
of the men and women who serve in the U.S. Armed
Technology Council-5 (PRD/NSTC-5), 1998) to review
Forces, to minimize or eliminate casualties, and to
their existing policies and develop plans to help estab-
provide superior casualty care. Medical defense against
biological warfare (BW) agents, whether encountered lish new FHP programs. Recommendations were made
on a battlefield or as a result of bioterrorism, forms to alter policies and doctrines concerning threat analy-
an important part of this strategy. Summarized here ses, medical countermeasures (vaccines and therapeutic
are directives, instructions, and other policy statements drugs), medical surveillance (record keeping, detection,
published by the U.S. Department of Defense (DoD) andepidemiology),healthriskassessments(occupational
that apply to the medical aspects of FHP against andenvironmental),andpreparednesstraining.
BW threats (Tables1and2). These statements focus on DoD policies can be promulgated as DoD directives
medical countermeasures, medical surveillance, health (DoDDs) that establish or guide activity of the Army,
riskassessment,andpreparednesstraining. Navy, Air Force, Marines, National Guard, Reserve
components, and other DoD organizational units. These
broad policy statements reflect the requirements set
DODISSUANCESFORFHPAGAINSTBWAGENTS
forth by legislation, the President, or the Secretary
of Defense (SECDEF). Senior military and civilian
MedicalpoliciesintheU.S.militarytopreventdiseasecan
DoD officials issue memoranda that can also become
betracedbackto1777,whenGeneralGeorgeWashington
policy statements. Within these directives, missions are
ordered that his troops be variolated (the method of
defined and responsibilities are assigned, while policies,
conferring active immunity that was employed prior to
programs,andorganizationsareestablishedordescribed.
the advent of vaccination) against smallpox. More than
Individuals affected by DoD’s health care policies, in
200years later, this disease is again a focal point of
FHP efforts, as policies and instructions were given in addition to military personnel, can include essential
2002tobeginvaccinatingmilitarypersonnelagainstthis civiliansintheDoDandotherfederaldepartmentswhen
potentialBWthreat.Thissectionwillreviewsomeofthe assigned as part of the U.S. Armed Forces, as well as
more recent DoD medical policy statements and some of beneficiariesofthemilitaryhealthsystem(MHS).
the federal laws mentioned within these issuances that General guidelines for implementing these policies,
dealwiththesehealththreats. outliningprocedures,andassigningmoredetailedrespon-
TheDoDdefinesBWagentsasmicroorganismsorbio- sibilitiesarefoundinDoDinstructions.Detailedtechnical
logically derived poisons (i.e., toxins) that are developed instructions can come in the form of memos from the
EncyclopediaofBioterrorismDefense, EditedbyRichardF.PilchandRaymondA.Zilinskas
ISBN0-471-46717-0 Copyright2005Wiley-Liss
1
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1. REPORT DATE 2. REPORT TYPE 3. DATES COVERED
1 JAN 2005 N/A -
4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER
DoD policies on force health protection: medical defense against
5b. GRANT NUMBER
biological warfare agents (DoD directives, DoD instructions); in Pilch, RF
Zalinskas, RA,Encyclopedia of Bioterrorism Defense, Wiley Liss 5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S) 5d. PROJECT NUMBER
Lebeda FJ
5e. TASK NUMBER
5f. WORK UNIT NUMBER
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION
United States Army Medical Research Institute of Infectious Diseases, REPORT NUMBER
RPP-03-046
Fort Detrick, MD
9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S)
11. SPONSOR/MONITOR’S REPORT
NUMBER(S)
12. DISTRIBUTION/AVAILABILITY STATEMENT
Approved for public release, distribution unlimited
13. SUPPLEMENTARY NOTES
14. ABSTRACT
The concept of force health protection (FHP) defines the medical defense approaches to maintain the
health of the men and women who serve in the U.S. Armed Forces, to minimize or eliminate casualties, and
to provide superior casualty care. Medical defense against biological warfare (BW) agents, whether
encountered on a battlefield or as a result of bioterrorism, forms an important strategy. Summarized here
are directives, instructions, and other policy statements published by the U.S. Department of Defense
(DoD) that apply to the medical aspects of FHP against threats. These statements focus on medical
countermeasures, medical surveillance, health risk assessment, preparedness training.
15. SUBJECT TERMS
biowarfare, biodefense, bioterrorism, DoD policy
16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF 18. NUMBER 19a. NAME OF
ABSTRACT OF PAGES RESPONSIBLE PERSON

a. REPORT b. ABSTRACT c. THIS PAGE SAR 6
unclassified unclassified unclassified
Standard Form 298 (Rev. 8-98)
Prescribed by ANSI Std Z39-18
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2 DoDPOLICIESONFORCEHEALTHPROTECTION:MEDICALDEFENSEAGAINSTBIOLOGICALWARFAREAGENTS
Table1. DoDDirectivesandInstructionsRelatedtoFHPAgainstBWAgentsa
Publication
DoDD/DoDI Numberb Title Date WebAddressc
Directive 5136.1 AssistantSecretaryofDefense December2,1992 http://www.dtic.mil/whs/directives/corres/
forHealthAffairs html/51361.htm
Directive 5160.5 ResponsibilitiesforResearch, May1985 http://www.dtic.mil/whs/directives/corres/
Development,andAcquisition html/51605.htm
ofChemicalWeaponsand
ChemicalandBiological
Defense
Directive 6025.3 ClinicalQualityManagement July20,1995
ProgramintheMilitary
HealthServices
Directive 6200.2 Useofinvestigationalnew August1,2000 http://www.dtic.mil/whs/directives/corres/
drugsforforcehealth html/62002.htm
protection
Directive 6205.2 Immunizationrequirements 1989 http://usmilitary.about.com/library/milinfo/
dodreg/bldodreg6205-2i.htm?terms=6205.2
Directive 6205.3 DoDimmunizationprogramfor 1993 http://www.dtic.mil/whs/directives/corres/
biologicalweaponsdefense html/62053.htm
Directive 6490.2 JointMedicalSurveillance August30,1997 http://www.dtic.mil/whs/directives/corres/
html/64902.htm
Instruction 1322.24 MilitaryMedicalReadiness December20,1995 http://www.dtic.mil/whs/directives/corres/
SkillTraining html/132224.htm
Instruction 6490.3 Implementationand August7,1997 http://www.dtic.mil/whs/directives/corres/
ApplicationofJointMedical ins1.html
SurveillanceforDeployments
aTables1and2weremodifiedfrom(Mazzuchietal.,2002).
bDoDDandDoDInumberedseriesofcategoriesrelevanttoBWdefense.
2000—InternationalandForeignAffairs.
3000—PlansandOperations,ResearchandDevelopment,Intelligence,andComputerLanguage.
5000—AcquisitionandAdministrativeManagement,OrganizationalCharters,Security,andPublicandLegislativeAffairs.
6000—Health.
(fromhttp://www.fas.org/irp/doddir/dod/index.html)
cAllwebsiteswereaccessibleinMarch2003.
seniorleadership,suchasthe2002memofromtheAssis- multinational forces, and civilians who provide essential
tant Secretary of Defense for Health Affairs (ASD(HA)) support(JointPublication3–11,2000).
thatestablished policyforreinstating theadministration Policymakers are supplied with feedback regard-
ofsmallpoxvaccine.Mostoftheseissuancesarecurrently ing FHP plans and their implementations from DoD-
generatedreports,analysesbyothergovernmentagencies,
available on the worldwide web (see Tables1and2 for
and by nongovernment groups. Implementations of med-
moreinformation).
ical policy are summarized in congressionally mandated
As described in DoDD 5136.1 (1992), the ASD(HA)
reports.Forexample,annualDoDreportsontheChemical
assists the SECDEF in DoD-related health policy issues
and Biological Defense Program, in accordance with P.L.
and oversees the MHS, including all aspects concerning
103–160Sec.1523, are presented to Congress describ-
the delivery of health care services. The fundamental
ing the overall organization of research and its progress
missionsoftheMHSaretosupportmilitaryreadinessand
towardprotectingthehealthofmilitaryservicemembers.
• peacetimehealthcare,bothofwhichincludeFHP(•Baily,
Q1
1999). FHP in turn involves three strategic programs:
surveillance and casualty prevention programs designed MEDICALCOUNTERMEASURESAGAINSTBWAGENTS
to protect against endemic diseases and environmental
Themorerecent DoDbiodefensehealthpoliciesbeganin
hazards(includingBWagents),andclinicalprogramsthat
1976withDoDD5160.5,whichassignedresponsibilityfor
providecasualtycareandmanagement(JointPublication
chemical and biological defense research, development,
4-02,2001).
testing, and evaluation. Revised in 1985 to update pro-
Public Law 105-85 established the requirements of
ceduresforbudgeting,programming,andoperations,this
maintaining records of all health care services, including
directive also assigns responsibilities for DoD research,
vaccinations, in a centralized location; conducting and
development, and the acquisition of countermeasures
recordingpre-andpostdeploymentmedicalexaminations; against chemical and biological agents. An example of
and recording changes in a service member’s medical aresultingimplementationfromDoDD5160.5istheJoint
condition during deployment. FHP policy by the Joint Medical Biological Defense Research Program. This pro-
ChiefsofStaffalsotakesintoconsiderationhostcountries, gram integrates DoD-supported internal and extramural
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DoDPOLICIESONFORCEHEALTHPROTECTION:MEDICALDEFENSEAGAINSTBIOLOGICALWARFAREAGENTS 3
Table2. DoD-issuedPolicyStatementsRelatedtoFHPAgainstBWAgents
DoDIssuances Publication
&Memoranda Number Title Date WebAddressa
ASD(HA) HAPolicy01–017 Updatedpolicyforpre-and October25, http://chppm-
Memorandum post-deploymenthealth 2001 www.apgea.army.mil/deployment/
assessmentsandblood #DODandArmyPolicies
samples
ASD(HA) Noneavailable ClinicalpolicyfortheDoD November26, http://www.smallpox.army.mil/resource/
Memorandum smallpoxvaccinationprogram 2002 policies.asp
Joint 3-11 JointDoctrineforOperationsin July11,2000 http://www.dtic.mil/doctrine/jpoperations-
Publication Nuclear,Biological,and seriespubs.htm
ChemicalEnvironments
Joint 4-02 DoctrineforHealthService July30,2001 http://www.dtic.mil/doctrine/jplogistics-
Publication SupportinJointOperations seriespubs.htm
Joint 5.00–2 JointTaskForcePlanning April13,1999 http://www.dtic.mil/doctrine/jpplanning-
Publication GuidanceandProcedures seriespubs.htm
CJCSMemo- MCM-251-98 DeploymentHealth December4, Notcurrentlyavailable
randum SurveillanceandReadiness 1998
CJCSMemo- MCM-0006-02 UpdatedProceduresfor February1, http://www.dtic.mil/doctrine/
randum DeploymentHealth 2002 other directives.htm
SurveillanceandReadiness
Joint AFJI48-110; Immunizationsand November1, http://afpubs.hq.af.mil/pubfiles
Instruction AR40-562; Chemoprophylaxis 1995
BUMEDINST
6230.15;
CGCOMDTINST
M6230.4E
Army 525-13 AntiterrorismForceProtection: September10, Notcurrentlyavailable
Regulation SecurityofPersonnel, 1998
Information,andCritical
ResourcesfromAsymmetric
Attacks
ArmyMedical MEDCOM525-4 EmergencyPreparedness December11, http://chppm-
Command 2000 www.apgea.army.mil/smallpox/
Regulation
aAllwebsiteswereaccessibleinMarch2003.
basic research efforts leading to the development of vac- DoDD 6200.2 also incorporates the mandates of Title
cines, therapeutic drugs, and diagnostic tools to protect 10USC1107,ExecutiveOrder13139(1999),andtheFDA
againstandtodetertheuseofBWagents(Lebeda,1997; interim final rule 21 CFR 50.23.The SECDEF, under
DoD,2002).
10.1107,mustnotifyservicepersonnelinwritingthatthe
Vaccinationpoliciesforallmembersofthearmedforces,
specified drug they are to receive is an IND or a drug
civilianemployeesoftheDoD,andeligiblebeneficiariesof
whose use, under the circumstances, is not approved by
theMHSarestatedinDoDD6205.2(1989).Programsare
theFDA.Notificationmustalsobegivenfortherationale
outlinedfordiseasesthatcanbepreventedbyvaccination.
for administering the drug, possible adverse reactions
Specified civilian personnel, for example at risk DoD
laboratoryworkerswhomaybecomeexposedtopathogenic producedbythedrug,andanyotherinformationrequired
organisms,mayalsoneedtousevaccinesotherthanthose bytheSecretaryoftheDepartmentofHealthandHuman
thatareroutinelyadministered. Services. Title 10 USC 1107 also allows the president to
ThemainDoDpoliciesthatarespecificforvaccinating waive the prior consent requirement for administering
the armed forces against known or potential BW agents INDs to service personnel. The policy in E.O. 13139
are summarized in DoDD 6205.3 (1993). The policies outlines procedures for informed consent requirements
involve ‘‘research, development, testing, acquisition, and
and waiver provisions. The FDA’s interim rule 21 CFR
stockpiling’’ of vaccines to be used for biological defense.
50.23 permits the waiver of prior consent if personnel
Thesevaccinesare(orwillbe)eitherlicensedorclassified
are already involved in a military operation in which
as Investigational New Drugs (INDs) by the Food and
exposurestoNBCthreatsorotherenvironmentalhazards
DrugAdministration(FDA).DoDD6200.2(2000)provides
are imminent and likely to be lethal or cause serious
further policy and guidance forthe use of INDs for FHP.
illness. Just before Operation Desert Shield, this rule
This document identifies at-risk armed forces personnel
and DoD-related civilians who need to be protected wasinvokedtoallowtheuseoftwoINDs,pyridostigmine
fromnuclear, biological,andchemical(NBC)threatsand bromideandbotulinumtoxoidvaccine,tocounterchemical
endemicdiseases. andbiologicalthreats,respectively.
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4 DoDPOLICIESONFORCEHEALTHPROTECTION:MEDICALDEFENSEAGAINSTBIOLOGICALWARFAREAGENTS
Thejointinstructionpublishedin1995forvaccinations standardsystemtohelpdeliverandtrackclinicalpreven-
and chemoprophylaxis outlines implementation require- tiveservices.
ments under the Armed Forces Immunizations Program
for protecting individuals from endemic diseases and
OCCUPATIONALANDENVIRONMENTALHEALTHRISK
potentialBWthreats.Alsoprovidedarerequirementsfor
ASSESSMENTS
tracking vaccinations for an individual’s health record.
These vaccinations are intended for service personnel
Relevant to BW agents, guidance for joint medical
andselectedcivilians(federalemployeesandMHS-eligible
surveillance on nuclear, biological, or chemical battle or
familymembers).
operational environments contaminated by other factors,
such as toxic industrial chemicals, was provided in
1997 by DoDD 6490.2 and DoDI 6490.3.Both documents
SURVEILLANCE:RECORDKEEPING,DETECTION,AND
emphasize the need for accurate communication about
EPIDEMIOLOGY
potential environmental and health risks to service
members. ‘‘Environmental risk assessments’’ predict the
Medical (health) surveillance programs are designed frequency of disease occurrence, based on environmental
to warn of and to reduce the incidence of illness. A exposures,inapopulation,whilepredictionsfrom‘‘health
memorandumbytheChairmanoftheJointChiefsofStaff hazardassessments’’arebasedonoccupationalexposures.
(CJCS)(MCM-251-98,1998)initiallyoutlinedaFHPplan The CJCS memo (MCM-0006-002; 2002) outlines the
thatfeaturedhealthsurveillanceasakeycomponent.For process of occupational and environmental health (OEH)
joint operations, DoD Instruction (DoDI) 6490.3 (1997), risk assessment in such environments. A part of this
bydefininghealthsurveillancerequirements,implements assessment is an Environmental Baseline Survey (EBS)
policy, outlines procedures, and assigns responsibilities at the site of deployment, which identifies occupational
set forth in DoDI 6490.2 (1997). Medical surveillance is and environmental health and safety hazards and
mandated for all members of the military services and estimatestheirseverity.Technicalguidanceinconducting
reserve components before, during, and after military this survey is in Field Manual FM 3–100.4 (2000).
deployments. The main goals are to identify potential As part of the FHP program, the EBS documents
threats to health, which may include exposure to BW these hazards. Commanders are instructed to use
agents;tocollecthealthdatafrommultiplelocationsinthe these surveillance measures to determine appropriate
deploymentarea;andtocommunicatequicklytherelevant responsesandcommunicatetheseriskswiththeirforces.
dataforstorage,integration,andfurtherassessment.The Commanderscan thenmakeinformedchoices and weigh
significant health risks are to be identified by the CJCS missionrequirementsduringoperationalplanningagainst
in coordination with the ASD(HA). In this Instruction, occupationalandenvironmentalhealthhazards.
theSecretaryoftheArmyisresponsiblefortheoperation
and maintenance by the U.S. Army Center for Health
MEDICALTRAINING:PREPARINGFORABWEVENT
Promotion and Preventive Medicine of a DoD Serum
Repository that stores specimens for exclusive use in the
TheDoDhasdevelopedprogramsthatprovideandmonitor
diagnosis, prevention, and treatment of health problems
military medical skills training in accordance with DoDI
associated with such deployments. Some of these FHP
1322.24 (1995). Knowledge of BW threats and medical
procedures are also referred to in joint doctrine (Joint
consequence responses to BW exposure are provided by
Publication 5.00-2, 1999), while recent policies regarding
the U.S. Army Medical Department. Courses have been
health assessments before and after deployments are
developed in the joint medical management of biological
found in a memorandum by the ASD(HA) (HA Policy
casualties. Three reference texts that accompany some
01–017,2001).TheDefenseMedicalSurveillanceSystem
of these courses are cited in the Further Reading and
is responsible for maintaining these assessment data,
Web Resources section below. The U.S. Army Medical
whichincludebothphysicalandpsychologicalevaluations.
Command,inresponsetoMEDCOMRegulation525-4,is
Instructions for assessing health readiness and con-
preparing a pamphlet on emergency preparedness that
ductinghealthsurveillanceinsupportofjointandunified
provides guidance on responses to emergencies including
commanddeploymentsweredeliveredinamemorandum
those involving the use of NBC weapons. Health- care
fromtheCJCS(MCM-251-98,1998).Amorerecentmemo-
providers within the military must also be certified
randum(MCM-0006-02,2002)instructsthatstandardized
when assigned to military operations (DoDD 6025.3,
health readiness assessments and health surveillances
1995). The certification process includes training in BW
be conducted. This memo also places responsibility on
defensemeasures.
the combatant command to decide which specific med-
ical countermeasures, such as vaccines, antibiotics, or
other drugs, are needed(Embrey, 2002). Epidemiology CONCLUSION
data are required to be analyzed and archived to report
and track adversereactions andillnessesthatmayoccur Thesedirectives,instructions,andotherpolicystatements
afterrequiredvaccinations(DoDI6205.2,1986).Although aredesignedtoenhanceFHPandthepreparednessofthe
each military service currently has its own vaccination- U.S. Armed Forces. It is expected that some of these
trackingprogram,thePreventiveHealthCareApplication health-related policies developed by the DoD after 1990
(PHCA) that is being developed will become the single for military personnel will have civilian applications in
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DoDPOLICIESONFORCEHEALTHPROTECTION:MEDICALDEFENSEAGAINSTBIOLOGICALWARFAREAGENTS 5
thepost-September11era.Itisalsoreasonabletoexpect Public Law 104–201, National Defense Authorization Act for
that some of the implementations resulting from these Fiscal Year 1997, Title XIV: Defense Against Weapons of
DoD policies will help in the continuing struggle by the MassDestruction(WMD),SubtitleA:DomesticPreparedness,
September23,1996.
civilianpublichealthsectortoprotectagainstcurrentand
emerginginfectiousdiseases. PublicLaw105-85,NationalDefenseAuthorizationActforFiscal
Year1998.
Report 106–945, Conference Report to Accompany H.R. 4205,
REFERENCES Enactment of Provisions of H.R. 5408, The Floyd D. Spence
NationalDefenseAuthorizationActForFiscalYear2001.
Bailey,S.,MilitaryHealthSystemOverviewStatement,Submit-
ted to the Personnel Subcommittee, Committee on Armed FURTHERREADINGANDWEBRESOURCES
Services,USSenate,FirstSession,106thCongress,March11,
Eitzen,E., Pavlin,J., Cieslak,T., Christopher,G., and Culpep-
1999.
per,R., Eds., Medical Management of Biological Casualties
Code of Federal Regulations (21 CFR 50.23), Title 21 Food
Handbook, 4th ed., US Army Medical Research Institute
and Drugs, Part50 Protection of Human Subjects, Subpart
of Infectious Diseases, Fort Detrick, MD, February 2001,
BInformedConsentofHumanSubjects,Sec.50.23Exception
http://www.usamriid.army.mil/education/instruct.html.
fromgeneralrequirements,Vol.1,RevisedasofApril1,2002,
•Q2 pp.288–290•. Franz,D., Defense Against Toxin Weapons, US Army Medical
Research and Materiel Command, Fort Detrick, MD, 1997,
Code of Federal Regulations (21 CFR 312.21) Title 21 Food
http://www.usamriid.army.mil/education/toxdefbook.doc.
and Drugs, Part312 Investigational New Drug Application,
HeadquartersDepartmentoftheArmy,EnvironmentalConsider-
Sec.312.21 Phases of an investigation, Vol.5, pp. 61–62,
ationsInMilitaryOperations,(FieldManual3–100.4,Marine
RevisedasofApril1,2002.
Corps Reference Publication, MCRP4-11B), Headquarters
Department of Defense, Chemical and Biological Defense
UnitedStatesMarineCorps,Washington,DC,June15,2000,
Program,Vol.1,AnnualReporttoCongress,April2002.
http://www.adtdl.army.mil/cgi-bin/atdl.dll/fm/3-100.4/toc.htm.
Department of Defense, Chemical and Biological Defense
Sidell,F.R., Takafuji,E.T., and Franz,D.R., ‘‘Medical Aspects
Program, Annual Report to Congress and Performance Plan,
of Chemical and Biological Warfare,’’ in R.Zajtchuk, Ed.,
July2001.
Textbook of Military Medicine, Office of The Surgeon Gen-
Embrey,E., Deputy Assistant Secretary of Defense for Force eral,TMMPublications;BordenInstitute,WalterReedArmy
Health Protection and Readiness, Department of Defense, Medical Center, Washington, DC, •1997, http://www.nbc- •Q4
Statement to the House Committee on Veterans Affairs med.org/SiteContent/HomePage/WhatsNew/MedAspects/
SubcommitteeonHealth,February27,2002. contents.html.
Lebeda,F.J.,Mil.Med.,162,156–161(1997). Treatment Of Biological Warfare Agent Casualties (Field
Mazzuchi,J.F., Trump,D.H., Riddle,J., Hyanms,K.C., and Manual No. 8–284 NAVMED P-5042, Air Force Manual
Balough,B.,Mil.Med.,167,179–185(2002). (Interservice) No. 44–156, Marine Corps MCRP 4–11.1C).
PresidentialReviewDirective,NationalScienceandTechnology Headquarters Departments of The Army, The Navy, and
Council-5, A National Obligation: Improving the Health of The Air Force and The Commandant, Marine Corps,
Our Military, Veterans, and Their Families, Executive Office Washington, DC, July 17, 2000 (incorporates Change 1,
of the President, Office of Science and Technology Policy, 8 July 2002), http://www.adtdl.army.mil/cgi-bin/atdl.dll/fm/8-
August1998. 284/fm8-284.htm.
Public Law 103–160, National Defense Authorization Act for
FiscalYear1994,Title50USC,Sec.1522,Conductofchemical SeealsoDEPARTMENTOFDEFENSE;DETECTIONOFBIOTERRORIST
and biological defense program, Sec.1523, Annual report on AGENTS;RISKASSESSMENTINBIOTERRORISM;andSYNDROMIC
•Q3 chemicalandbiologicalwarfare•defense. SURVEILLANCE.
Queriesinebd054
Q1. Pleaseclarifyifthisnameshouldbe‘Baily’or‘Bailey.’
Q2. ‘Code of Federal Regulations (21 CFR 50.23), 2002’,
‘CodeofFederalRegulations(21CFR312.21),2002’,
‘DoD,2001’,‘PublicLaw103–160,2002’,‘PublicLaw
104–201,1996’,‘PublicLaw105-85,1998(cid:1)and‘Report
106–945,2001(cid:1)havenotbeencitedinthetext.Please
providetheplaceofcitation.
Q3. Please provide the year of publication for this
reference.
Q4. Pleaseprovidethepagerangeforthisreference.