Chemical and Biological Defense: DOD Should Clarify Expectations 
for Medical Readiness (07-NOV-01, GAO-02-219T). 		 
								 
As the war on terrorism proceeds, attention to medical		 
preparations for chemical and biological defense has become more 
urgent. In June 1995, a Presidential Decision Directive declared 
that the United States would give the highest priority to	 
developing effective capabilities to detect, prevent, defeat, and
manage the consequences of terrorists' use of nuclear,		 
biological, or chemical materials or weapons. In addition, the	 
former Secretary of Defense emphasized, at his confirmation	 
hearing in January 1997, that U.S. forces abroad face the threat 
of chemical and biological weapons. The Office of the Secretary  
of Defense, the joint staff, and the armed services play distinct
but interrelated roles in ensuring medical readiness. Defense	 
planning is led by the Office of the Secretary of Defense whose  
office sets policy and develops defense planning guidance. Based 
on this guidance, the Joint Chiefs issue a biannual Joint	 
Strategic Capabilities Plan for the nation's unified combat	 
commands. These commands are responsible for fighting and winning
the nation's wars within a particular area, usually defined by	 
geographical boundaries. The commanders-in-chief develop war	 
plans and requirements that specify the combat troops and support
that will be needed to meet the threat and mission assigned by	 
the Capabilities Plan. The services, in turn, train and equip the
forces, including medical personnel, to meet the needs of the	 
commanders-in-chief. To Date, neither DOD nor the services have  
systematically examined the current distribution of medical	 
personnel across specialties for adequacy in chemical and	 
biological defense. This testimony summarized an October report  
(GAO-02-38).							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-02-219T					        
    ACCNO:   A02435						        
  TITLE:     Chemical and Biological Defense: DOD Should Clarify      
Expectations for Medical Readiness				 
     DATE:   11/07/2001 
  SUBJECT:   Biological warfare 				 
	     Education or training				 
	     Chemical warfare					 
	     Defense capabilities				 
	     Defense contingency planning			 
	     Emergency medical services 			 
	     Emergency preparedness				 
	     Terrorism						 
	     DOD Joint Strategic Capabilities Plan		 
	     DOD Defense Planning Guidance			 
	     Army Medic 2000 Study				 

******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO Testimony.                                               **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
******************************************************************
GAO-02-219T
     
Testimony Before the Subcommittee on National Security, Veterans? Affairs,
and International Relations, Committee on Government Reform, House of
Representatives

United States General Accounting Office

GAO For Release on Delivery Expected at 10: 00 a. m. EDT Wednesday, November
7, 2001 CHEMICAL AND

BIOLOGICAL DEFENSE DOD Should Clarify Expectations for Medical Readiness

Statement of Nancy Kingsbury, Managing Director, Applied Research and
Methods

GAO- 02- 219T

Page 1 GAO- 02- 219T Chemical and Biological Defense

Mr. Chairman and Members of the Subcommittee: We are pleased to be here
today to contribute to your hearing on medical preparations for chemical and
biological defense. As the war on terrorism proceeds at home and abroad, the
need for attention to these matters has become more urgent. My testimony
today is based on our report on DOD?s preparations for medical support for
chemical and biological casualties. 1 In the report, which is being released
today, we responded to your request that we determine how DOD had adapted
its medical personnel to emerging chemical and biological threats.
Specifically, we looked at how DOD and the services had addressed chemical
and biological threats in the distribution of medical personnel across
specialties. We also looked at the extent of training for medical personnel
in the treatment of chemical and biological casualties.

In June 1995, a Presidential Decision Directive declared that the United
States would give the highest priority to developing effective capabilities
to detect, prevent, defeat, and manage the consequences of terrorists? use
of nuclear, biological, or chemical materials or weapons. In addition, the
former Secretary of Defense emphasized, at his confirmation hearing in
January 1997, that U. S. forces abroad face the threat of chemical and
biological weapons. According to both DOD officials and U. S. government
reports, chemical and biological warfare must be considered a potential
threat in future conflicts.

The Office of the Secretary of Defense, the joint staff, and the armed
services play distinct but interrelated roles in ensuring medical readiness.
Defense planning is led by the Office of the Secretary of Defense. This
office sets policy and develops Defense Planning Guidance. Based on this
formal guidance, the Joint Chiefs issue a biannual Joint Strategic
Capabilities Plan (JSCAP) that gives missions to the nation?s unified combat
commands. These commands have operational control of U. S. combat forces and
are responsible for fighting and winning the nation?s wars within a
particular area of responsibility, usually defined by geographical
boundaries. The commanders- in- chief develop war plans and requirements
that specify the combat troops and support that will be needed to meet the
threat and mission assigned by the Capabilities Plan.

1 Chemical and Biological Defense: DOD Needs to Clarify Expectations for
Medical Readiness (GAO- 02- 38, Oct. 19, 2001). Background

Page 2 GAO- 02- 219T Chemical and Biological Defense

The services, in turn, train and equip the forces, including medical
personnel, necessary to meet the needs of the commanders- in- chief. The
tools available to the services for this purpose include various types of
training and exercises.

We found that neither DOD nor the services had systematically examined the
current distribution of medical personnel across specialties with respect to
adequacy for chemical and biological defense. This was so despite public
assessments by defense officials that have emphasized the seriousness of the
military threat from chemical and biological weapons. Although the services
had begun to review the staffing of deployable medical units for chemical
warfare scenarios, they had not done so for biological warfare scenarios. In
general, DOD has not successfully adapted its conventional medical planning
to chemical and biological warfare. For example, in medical planning, DOD
has used software, evaluations, and review processes that address
conventional threats, but that have not fully incorporated chemical and
biological threats. In addition, medical planners have lacked the
information on casualty rates or qualified medical personnel required to
address the appropriateness of the current distribution of medical personnel
across specialties. As recommended by DOD studies, joint protocols for
treating chemical and biological casualties have recently been completed.
But agreement has not been reached among the services on which medical
personnel are appropriate to provide treatment for different casualties
caused by chemical or biological agents.

DOD officials attributed the lack of systematic efforts to several factors.
These included failure to establish chemical and biological readiness as a
medical priority in Defense Planning Guidance (particularly for biological
warfare), complex assumptions required to predict casualties, poor
availability of data on the effects of particular agents, disagreements
among the services about how quickly troops could actually be evacuated, and
pessimism that medical personnel could effectively treat substantial numbers
of chemical and biological casualties. Medical planners for the joint staff,
unified commands, and the services- who are charged with addressing these
issues- all expressed frustration with inaction on the part of others. For
example, citing lack of input from the services, the medical planners for
the unified commands had reluctantly, they said, adopted a rough method of
estimating the medical support required for chemical and biological
scenarios. Specifically, they had simply multiplied the medical support
required for conventional scenarios by a fixed factor. DOD and the Services?

Efforts to Incorporate CB Threats in Medical Personnel Planning Not
Systematic

Page 3 GAO- 02- 219T Chemical and Biological Defense

This method presumes that the individual medical units currently possess the
appropriate distribution of medical personnel across specialties.

Following the Gulf War, both GAO and the DOD inspector general identified a
number of shortcomings in DOD?s capacity to provide medical treatment for
the numbers of chemical and biological casualties that were predicted. In
1996, GAO observed that many of the problems identified in these reports
persisted. In the review we report on today, we found that the extent of
training, as well as testing and exercises, for medical management of
chemical and biological casualties remains limited. Rather than adjusting
the distribution of medical specialists, the services officials for medical
planning maintain that specialized training in the military is the
appropriate way to address any need for additional medical skills. However,
while progress has been made since the Gulf War in increasing the
availability of such specialized training, these courses are essentially
voluntary. While training requirements for medical personnel generally
incorporate instruction in such matters as donning chemical protective gear,
only the Army includes an introduction to chemical and biological casualty
management in training required of medical personnel. On the basis of the
number of students who have taken the various specialized courses, we found
that no more than a fifth of uniformed medical personnel had completed any
specialized military medical training for chemical and biological
casualties. Even medical personnel who had been trained could not be readily
identified in the event of an emergency. This is because either the tracking
systems do not exist or are not currently functioning. Except for the Army?s
Medic 2000 study- which found that the lowest proficiency scores among
medics were for nuclear, biological, and chemical skills- the services have
not defined standards for treatment of chemical and biological casualties
nor tested the proficiency of medical personnel. The Army study and other
indirect evidence indicate that the likelihood of chemical and biological
casualties receiving proficient medical care remains low, due in part to
weak or absent requirements for training, as well as testing and
certification, of medical staff.

Medical planners from each of the five regional unified commands told us
that, to their knowledge, no realistic field exercise of chemical or
biological defense had been conducted. But the surgeons general from the
services have begun integrating chemical and a few biological scenarios into
their medical exercises. Additional data provided by DOD show that only two
joint military exercises planned since 1993 had included both medical
support activities and chemical or biological warfare. Similarly, key
evaluations used to advise the President on readiness to implement Extent of
Medical

Personnel Training Limited for the Treatment of CB Casualties

Page 4 GAO- 02- 219T Chemical and Biological Defense

the national security strategy had never set a scenario for the unified
commanders requiring medical personnel to respond to the effects of weapons
of mass destruction. Officials told us that exercises involving medical
support for chemical and biological casualties were rare because of
conflicting priorities encountered by both warfighters and medical personnel
and because of difficulty and expense.

In the years since Desert Storm, DOD and the services have not fully
addressed weaknesses and gaps in planning, training, tracking systems, or
tests of proficiency for the treatment of chemical and biological
casualties. The resulting organization of medical personnel has not been
rigorously tested for the capacity to deliver the required support. As a
consequence, medical readiness for chemical and biological scenarios cannot
be ensured.

Although we found efforts to plan and train for these threats, there is a
wide and longstanding gap between DOD?s appraisal of chemical and biological
threats and DOD?s medical preparedness to meet them.

We recommend that the Secretary of Defense address the gap between the
stated chemical and biological threat and the current level of medical
readiness by, first, clarifying DOD?s expectations concerning medical
preparation for chemical and biological contingencies and, second, as
appropriate, incorporating biological medical readiness in Defense Planning
Guidance. To the degree that DOD views chemical or biological contingencies
as a serious threat and expects medical personnel to prepare for them, we
also recommend additional actions:

First, the services and joint staff should conclude an agreement about which
medical personnel are qualified to provide specific treatments. Without such
an agreement, each service?s medical model will continue to be based on
different assumptions concerning which personnel are qualified to administer
treatments. The results will therefore be neither comparable among the
services nor readily defensible. This database should eventually be
validated by proficiency testing of the identified personnel to help further
refine requirements for training and distribution of medical personnel
across specialties.

Second, the services should develop medical training requirements for
chemical and biological contingencies, assess the effectiveness of the
training with rigorous proficiency standards and tests, and track individual
training and proficiency. Conclusions and

Recommendations

Page 5 GAO- 02- 219T Chemical and Biological Defense

Third, the joint staff, commanders- in- chief, and the services should
increase chemical and biological exercises involving medical personnel to an
extent commensurate with current chemical and biological threat assessments.
Given the threat of mass casualties, exercises should explore the extent of
medical capabilities and the full consequences of scenarios that overwhelm
them.

An additional recommendation and further information are included in our
report.

Mr. Chairman, this concludes my statement. I will be happy to answer any
questions you or Members of this Subcommittee may have.

For further questions about this testimony, please contact Nancy Kingsbury,
at (202) 512- 2700. Other individuals making key contributions to this
testimony include Betty Ward- Zukerman, Daniel Rodriguez, and Laurel Rabin.
Contacts and

Acknowledgments

(460517)
*** End of document. ***