International Task Force-45 Meeting
By Cmdr Dr. Duane C. Caneva (M.D.)

          As part of the CANUKUS Tripartite Agreement between Canada, US and UK, Task Force 45 addresses separate but related issues concerning the emergency response to mass casualties. While its scope focuses on chemical warfare (CW) settings, many of the issues are germane to any mass casualty scenario, be they be on the traditional battlefield or in an urban setting.
          As opposed to the conventional passive NBC defense "Detect to Avoid" paradigm where agent is detected and avoided, this ITF focuses on the issues related to chemical, biological, radiological, nuclear, and high-yield explosives (CBRNE) weapons of mass destruction (WMD) mass casualties and a "Detect to Treat" paradigm, in which the contaminated area is the work environment, and the victims are numerous. This requires validation, revision, or development of new strategies, tactics, techniques, and procedures (TTPs), equipment and work tools, and training. The ITF 45 is hosted at www.disasterhelp.gov on a restricted basis due to the sensitivity of the live model training. For access, register at the site and contact the ITF 45 Chair, CDR Duane C. Caneva at canevadc@cbirf.usmc.mil
          This ITF-45 meeting was held at the USMC Chemical Biological Incident Response Force (CBIRF) headquarters building in Indian Head, MD, USA, on 15-17 Jan 03, co-incident with CBIRF's monthly "Force Training Day" and "Technology Demonstration Day" evolutions held during the 3 day meeting. Members were divided into 4 separate working groups to develop specific deliverables or strategies, and then presented findings in a final plenary session.
          The Training Working Group addressed the issue of developing a CBRNE "Center of Expertise" at DRDC Suffield that would focus on development of an international training center for mass casualty response for civilian and military first responders, homeland security units, and medical care providers. Recommendations were to pursue a multi-pronged approach to seek support for development and funding through the CANUKUS MOU, the ABCA MOU, and individually through the US Marine Corps, and to actively identify other potential partners (e.g., NATO, OTSG, Homeland Security).
          The Prioritization and Triage Working Group addressed the issue of victim prioritization for unresponsive victims in the "hot zone". The START (Simple Triage and Rapid Treatment) is a triage system used for trauma mass casualties. CW mass casualties require a different system, with the most challenging aspect being addressing the unresponsive victim. It was felt that a formal study is required for identification of variables easily determined that can be used to develop criteria for victim prioritization. Such variables might include blood pressure, inspiratory occlusion pressure, active heart motion, or advanced technologies capable of "stand-off" observation and characterization of victim conditions.
          The Casualty Management Working Group addressed the following issues: enhanced decontamination throughput techniques; hasty decontamination in the hot zone; airway management strategies and techniques in mass casualty incidents; and management of concurrent traumatic and toxic injuries. Recommendations include a spectrum of work from formal study designs to basic trials of current response concepts of operation.
          The Respiratory Protection Working Group discussed several groundbreaking issues including the need for Personal Protective Ensemble (PPE) characterization to be based on protection factors versus Levels A-D. Respirator cartridges would be characterized by breakthrough data and related factors, with further studies elucidating characterization criteria. Consideration for the Automated Decision Aid System for Hazardous Incidents (ADASHI) tool under development at Edgewood Chemical Biological Center (ECBC) included further development of a technical approach paper and testing and validation at DRDC Suffield. Combining this with efforts of ITF's 26, 40, 45, commercial vendor data on PPE, Palmtop Emergency Action for Chemicals (PEAC), data from NIOSH/NIST, and other similar tools and sources, all incorporated into the Consequence Management Interoperability Services (CMI-S), should provide incident commanders with slide rule tools to determine best response procedures for a given incident. Also discussed were efforts working on breakthrough sampling techniques using Solid-Phase Microextraction (SPME) fibers interfaced with field portable GC/MS. The group will work directly with the Technical Support Working Group (TSWG) on the PPE/filter characterization issues.
          What has become clear throughout the efforts of the working groups is that the intricacies of a response across the various disciplines involved require a new frame of reference for our response in general to these mass casualty incidents. We cannot continue to constrain ourselves by formal HAZMAT protocols designed for spills and containment, but rather need to develop tools that allow incident commanders to weigh scientifically supported risk management optimized solutions in a lifesaving response. This has to be done across all involved disciplines (emergency services, emergency medical services, NBC, HAZMAT, Security) and has to occur, ultimately, at the level of statutory agency levels.
          "Where great is the enemy of good enough, we need only be good enough."

Editor's Note: Commander Dr. Caneva is the Emergency Medical Officer, Chemical Biological Incident Response Force (CBIRF), 4th Marine Expeditionary Brigade (Anti-terrorism), 101 Strauss Ave., Bldg 901, Indian Head, Maryland 20640. His telephone numbers are: 1-301-744-1025/ 1028 and his e-mail numbers are: canevadc@cbirf.usmc.mil