Chapter 1

NUCLEAR, BIOLOGICAL, AND CHEMICAL WARFARE ASPECT OF THE MEDICAL THREAT

1-1. General

_a._ After World War II, the Soviet Union represented the principal threat to the national security interests of the US. During this period, the military capability of the Soviet Armed Forces grew enormously. Starting in the later years of the 1980s, the international security environment has undergone rapid, fundamental, and revolutionary changes. With the collapse of Soviet communism, the Soviet Union disintegrated as a viable economic and political system. The Warsaw Pact dissolved as a political and military entity. The central Soviet government was replaced by the Commonwealth of Independent States (CIS), dominated by the Russian Republic. The cohesion of Soviet strategic military capability has been fractured by--

· The dissolution of central Soviet control.

· The formation of the CIS.

· The unpredictability associated with uncertain loyalties and
low morale.

The ultimate outcome of these events in terms of US national security interests is unclear. The military capabilities of CIS like Russia, Ukraine, Kazakstan, and Belarus remain formidable. The capabilities include strategic nuclear and impressive conventional, biological, and chemical warfighting capabilities.

_b._ From a global perspective, the economic power and influence of developing and newly industrialized nations continue to grow. Centers of power (global or regional) cannot be measured solely in military terms. Nation states pursuing their own political, ideological, and economic interests may become engaged in direct or indirect competition and conflict with the US. More nations have acquired significant numbers of modern, lethal, combat weapon systems; developed very capable armed forces; and become more assertive in international affairs. In the absence of a single, credible, coercive threat, old rivalries and long repressed territorial ambitions will resurface, causing increased tensions in many regions. Political, economic, and social instability and religious, cultural, and economic competition will continue to erode the influence of the US over the rest of the world. This erosion will also reduce the US influence of traditional regional powers over their neighbors. This environment will encourage the continued development, or acquisition, of modern armed forces and equipment by less influential nations; thus raising the potential for the use of NBC/RDD weapons during internal conflict and armed confrontations in developing regions of the world.

_c._ A third dimension to the threat is terrorist, rogue groups, and belligerents employing a number of chemical and biological agents and the possible use of TIM to injure or kill US personnel. The actions may be isolated or may be imposed by groups of individuals. Most will have the financial backing of nations, large organizations, or groups that have the desire to cause harm and create public distrust in our government.

1-2. Medical Threat

Medical threat is the composite of all ongoing or potential enemy actions and environmental conditions that will reduce combat effectiveness through wounding, injuring, causing disease, and/or degrading performance. Soldiers are the targets of these threats. Weapons or environmental conditions that will generate wounded, injured, and sick soldiers, beyond the capability of the HSS system to provide timely medical care from available resources, are considered major medical threats. Weapons or environmental conditions that produce qualitatively different wound or disease processes are also major medical threats. Added to the combat operational and disease and nonbattle injury (DNBI) medical threats are adversary use of the following types of weapons, agents, and devices:

· Biological warfare agents.

· Chemical warfare agents.

· Nuclear weapons.

· Toxic industrial materials.

· Radiological dispersal devices.

· Directed-energy devices/weapons.

· Chemical, biological, radiological, nuclear, and high-yield
explosives.

1-3. Nuclear, Biological, Chemical, and Radiological Dispersal Device Threats--The Health Service Perspective

_a._ _Nuclear Weapons and Radiological Dispersal Device Threats._ Since the breakup of the Soviet Union, the number of countries with known nuclear capable military forces has almost doubled. Available information suggests that a number of countries in the Middle East, Asia, and Africa have or may have nuclear weapons capability within the next decade. Table 1-1 lists those countries known to have, suspected of possessing, or seeking, nuclear weapons. Planners can expect, as a minimum, 10 to 20 percent casualties within a division-sized force that has experienced a nuclear strike. In addition to the casualties, a nuclear weapon detonation can generate an electromagnetic pulse (EMP) that will cause catastrophic failures of electronic equipment components. Radiological dispersal devices, comprised of an explosive device with radioactive material, can be detonated without the need for the components of a nuclear weapon. The RDD can disperse radioactive material over an area of the battlefield causing effects from nuisance levels of radioactive material to life-threatening levels without the thermal and, in most cases, the blast effects of a nuclear detonation. For nuclear weapons effects see Appendix A.

_Table 1-1. Countries Possessing or Suspected of Possessing Nuclear Weapons_

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KNOWN TO POSSESS SUSPECT OR SEEKING
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UNITED STATES OF AMERICA IRAQ
RUSSIA NORTH KOREA
UKRAINE IRAN
BELARUS LIBYA
KAZAKSTAN ALGERIA
PEOPLE'S REPUBLIC OF CHINA SOUTH AFRICA
FRANCE ISRAEL
UNITED KINGDOM
PAKISTAN
INDIA
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_b._ _Biological Warfare._

(1) Biological warfare (BW) is defined by the US intelligence
community as the intentional use of disease-causing organisms
(pathogens), toxins, or other agents of biological origin (ABO) to
incapacitate, injure, or kill humans and animals; to destroy crops;
to weaken resistance to attack; and to reduce the will to fight.
Historically, BW has primarily involved the use of pathogens in
assassinations or as sabotage agents in food and water supplies to
spread contagious disease among target populations.

(2) For purposes of medical threat risk assessment, we are
interested only in those BW agents that incapacitate, injure, or
kill humans or animals.

(3) Known or suspect BW agents and ABOs can generally be
categorized as naturally occurring, unmodified infectious agents
(pathogens); toxins, venoms, and their biologically active
fractions; modified infectious agents; and bioregulators. See Table
1-2 for examples of known or suspected BW threat agents. Also,
Table 1-3 presents possible developmental and future BW agents.

_Table 1-2. Examples of Known or Suspect Biological Warfare Agents_

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PATHOGENS TOXINS
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_BACILLUS ANTHRACIS_ (ANTHRAX) BOTULINUM TOXIN
_FRANCISELLA TULARENIUS_ (TULAREMIA) MYCOTOXINS
_YERSINIA PESTIS_ (PLAGUE) ENTEROTOXIN
_BRUCELLA SPECIES_ (BRUCELLOSIS) RICIN
_VIBRIO CHOLERAE_ (CHOLERA)
_VARIOLA_ (SMALLPOX)
_VIRAL HEMORRHAGIC FEVERS_
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_Table 1-3. The Future of Biological Warfare Agents_

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CURRENT THREAT FUTURE
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PATHOGENS MODIFIED PATHOGENS
LIMITED NUMBER OF TOXINS EXPANDED RANGE OF TOXINS (ORGANO-TOXINS)
AGENTS OF BIOLOGICAL ORIGIN PROTEIN FRACTIONS
AGENTS OF BIOLOGICAL ORIGIN
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(4) Many governments recognize the industrial and economic
potential of advanced biotechnology and bioengineering. The
same knowledge, skills, and methodologies can be applied to the
production of second and third generation BW agents. Naturally
occurring infectious organisms can be made more virulent and
antibiotic resistant and manipulated to render protective vaccines
ineffective. These developments complicate the ability to detect
and identify BW agents and to operate in areas contaminated by the
BW agents. For biological agent characteristics and effects see
Appendix A. The first indication that a BW agent release/attack has
occurred may be patients presenting at a medical treatment facility
with symptoms not fitting the mold for endemic diseases in the
area of operations (AO). See Appendix B for sampling requirements,
sampling procedures, packaging and shipping, and chain of custody
requirements.

_c._ Chemical Warfare.

(1) Since World War I, most western political and military leaders
have publicly held chemical warfare (CW) in disrepute. However,
evidence accumulated over the last 50 years does not support the
position that public condemnation equates to limiting development
or use of offensive CW agents. The reported use of chemical agents
and biological toxins in Southeast Asia by Vietnamese forces; the
confirmed use of CW agents by Egypt against Yemen; and later by
Iraq against Iranian forces; and the probable use of CW agents by
the Soviets in Afghanistan indicate a heightened interest in CW as
a force multiplier. Also, an offensive CW capability is developed
as a deterrent to the military advantage of a potential adversary.
For a list of common chemical agents, their characteristics,
behavior, and effects see Appendix A. Table 1-4 lists those
countries known or suspected of having offensive chemical weapons.

(2) The Russian Republic has the most extensive CW capability in
Europe. Chemical strikes can be delivered with almost any type of
conventional fire support weapon system (from mortars to long-range
tactical missiles). Agents known to be available in the Russian
inventory include nerve agents (O-ethyl methyl phosphonothiolate
[VX], thickened VX, Sarin [GB], and thickened Soman [GD]);
vesicants (thickened Lewisite[L] and mustard-Lewisite mixture[HL]);
and choking agent (phosgene). Although not considered CW agents,
riot control agents are also in the Russian inventory.

(3) The US is in the process of destroying its stockpiles of CW
weapons. Many weapons have already been destroyed and the storage
facilities have been rendered safe of all CW agent residues.

_Table 1-4. Nations Known or Suspected of Possessing Chemical Weapons_

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KNOWN TO POSSESS SUSPECTED OF POSSESSING
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UNITED STATES OF AMERICA PEOPLE'S REPUBLIC OF CHINA
RUSSIA NORTH KOREA
FRANCE EGYPT
LIBYA ISRAEL
IRAQ[*] ETHIOPIA
IRAN TAIWAN
SYRIA BURMA
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[*] FOLLOWING THE PERSIAN GULF WAR (1990-91), THE UNITED NATIONS
(UN) BEGAN DESTROYING CW MUNITIONS DISCOVERED DURING INSPECTION
VISITS TO IRAQ BY UN ARMS CONTROL INSPECTORS. INCLUDED AMONG THE
CW MUNITIONS DISCOVERED WERE SOME 2,000 AERIAL BOMBS AND 6,200
ARTILLERY SHELLS FILLED WITH MUSTARD AND SEVERAL THOUSAND 122
MILLIMETERS (mm) ROCKET WARHEADS FILLED WITH NERVE AGENT (GB). IRAQ
ALSO DECLARED SURFACE TO AIR MISSILE (SCUD) WARHEADS FILLED WITH
NERVE AGENT (GB AND GF). TABLE 1-5 PROVIDES A LIST OF KNOWN CW
AGENTS.
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_Table 1-5. Chemical Warfare Agents_

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NERVE VESICANT INCAPACITATING CHOKING BLOOD
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TABUN(GA) SULFUR CNS DEPRESSANT(BZ) PHOSGENE (CG) HYDROGEN
MUSTARD (HD) CYANIDE (AC)
GB HL CHLORINE (CL) DIPHOSGENE (DP) CYANOGEN
GD L CHLOROPICRIN (PS) CHLORIDE (CK)
GF PHOSGENE D-LYSERGIC ACID
OXIME (CX)
VX DIETHYLAMIDE (LSD)
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_d. Toxic Industrial Materials._

Toxic industrial materials can present a medical threat for deployed forces. Toxic industrial materials are comprised of toxic industrial biologicals (TIB), toxic industrial chemicals (TIC), and toxic industrial radiological (TIR) materials. These materials are found throughout the world and are used on a daily basis for commercial and private purposes. Large storage facilities, transportation tankers (over the road and railcars), as well as smaller containers of material, pose a danger to the health of personnel. Accidental spills or releases and terrorist actions can all lead to release of these materials into the environment causing potential casualty producing effects. Medical treatment facilities and nuclear power plants use radioactive materials that can pose a health hazard if accidentally released or used by hostile forces, terrorists, or others to contaminate an area. Biological materials used in medical research and pharmaceutical manufacturing may be used by hostile forces, terrorists, or others to produce casualties. Many TICs produce the same effects on personnel as CW agents. As a matter of fact, many TICs are of the same chemical structure as CW agents. However, there is quite a difference in their potency; in most TICs the potency is much lower. For example, chlorine used to treat water supplies has also been used as a CW agent; organophosphate pesticides can cause the same effects as some nerve agents. Hostile forces, terrorists, or others may use RDDs to produce casualties as well. For detailed information on toxic industrial materials see FM 8-500.