Medical After Action Report

File: doc04_18.txt
Page: 18
Total Pages: 23
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                    BIOLOGICAL WARFARE DEFENSE

                        MEDICAL GUIDELINES


1.  (U)  DEFINITION:  A Biological Warfare agent is defined by the
North Atlantic Treaty Organization (NATO) as "A microorganism which
causes diseases in man, plants, and animals or causes deterioration
of materials".    By convention toxins of biological origin which
produce disease in man are included.

2.  (U)   HISTORY:  The use of biological agents in warfare dates
to  1346  at Kaffa  (now  Feodossia) where  the bodies    of Tartar
soldiers who succumbed to the plague were catapulted over the walls
of the besieged city.    The Spanish are said to have     introduced
smallpox among the South American Indians by giving them clothing
that had been in contact with smallpox patients.     This may also
have been done in North America in the 18th Century.      In 1940-45
in China and Manchuria the Japanese used plague and anthrax in
experimental  and  operational  trials.   As recently   as  1979 an
accidental   explosion in Sverdlovsk in the USSR was    followed by
pulmonary anthrax in the surrounding population.

         PROBLEMS OF BIOLOGICAL WARFARE DEFENSE

     a.  (U) RECOGNITION OF THE ATTACK:

  The first evidence of a biological warfare attack will probably
be a large number of casualties ill with one or more diseases.
One must first ask if an outbreak is due to a biowarfare attack or
merely an epidemic of a naturally occurring disease.  The following
considerations may help answer these questions:

     - Occurrence of acutely ill military and civilian patients
with the epidemiology of a massive, point-source outbreak.

     - A high attack rate of clinical illness in the potentially
exposed population.

     - The type of illness will reflect an unusual or "impossible"
agent for the geographic area.

     - An unusual tendency for respiratory manifestations that is
the signature of the aerosol route of infection.

     -   An  unusually high  fatality rate  with  large   number of
fulminating and fatal cases.

     - The geographic area of diseaes is very localized.

     - The occurrence of multiple agents in single patients at the
same site,   multiple  epidemics at  a single  site,   and  multiple
epidemics at widely separated sites.