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Operations Progress Report: Disaster Activities in Connection with Hurricane 'Betsy' (Final Report)
"This report is submitted pursuant to instruction by OCE in letter ENGCW-OE dated 13 June 1967, subject: 'Operations Progress Report on Disaster Activities in Connection with Hurricane Betsy- Mobile District.' It covers emergency repair work to public facilities in Mississippi coastal areas, as directed by the Office of Emergency Planning, under general authority of Public Law 875, 81st Congress."
United States. Department of the Army
1967-07-28
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Health Service Support in a Nuclear, Biological, and Chemical Environment: Tactics, Techniques, and Procedures (October 2002)
"The purpose of this field manual (FM) is to provide doctrine and tactics, techniques, and procedures for health service support (HSS) units and personnel operating in a nuclear, biological, and chemical (NBC), radiological dispersal device (RDD), and toxic industrial material (TIM) environment. The manual provides information for use by commanders, planners, leaders, and individuals in providing HSS under these adverse conditions"
United States. Department of the Army
2002-10-01
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NBC Decontamination Operations
"This publication may be used by the US Army and US Marine Corps during training, exercises, and contingency operations."
United States. Department of the Army
2002-01-31
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[Hurricane Andrew: Potable Water]
This report discusses the availability of potable water during and after Hurricane Andrew and contains information on the program to distribute water. It also includes a brief After-Action Report.
United States. Department of the Army
1992-12-22
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After Action Report: Hurricane Mitch Relief - Joint Task Force Eagle
"The purpose of this document is to give the reader the opportunity to review the Detachment's mission in El Salvador. This will also give the reader a clear understanding of the need to continue follow up preventive medicine (PM) operations in El Salvador and the Central America region."
United States. Department of the Army
1999-03-06
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Mortuary Affairs Operations
This manual serves as a planning and operations guide for all personnel involved in mortuary affairs within a theater of operations. This manual will assist in determining operational capabilities and limitations and help guide the allocation of resources to successfully complete the mission. This publication applies to the Active Army, Army National Guard/Army National Guard of the United States, and United States Army Reserve unless otherwise stated.
United States. Department of the Army
2007-01-09
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'Eyes of the Army': U.S. Army Roadmap for Unmanned Systems, 2010-2035
"The purpose of 'The US Army UAS [Unmanned Aircraft Systems] Roadmap (2010-2035)' is to provide a broad vision for how the Army will develop, organize, and employ UAS across the full spectrum of operations. The major ideas that emerge will provide a common foundation for continued learning and analysis. We will evaluate ideas and challenge assumptions to develop a full range of UAS capabilities. The roadmap will inform warfighting functional concepts, contribute to capabilities-based assessments, and assist in the development of resource informed decisions on new technologies that will be evaluated through comprehensive experimentation and testing. Ultimately, our roadmap will frame an answer to the question, 'What UAS capabilities do we need for the Army in the future?' […] The road map provides the basis for an evolutionary approach to developing and integrating UAS capabilities into our formations. The road map is divided into three time periods: near (2010-2015), mid (2016-2025), and far (2026-2035). The near-term focus addresses gaps in today's UAS capabilities while emphasizing the rapid integration of existing technologies to meet current demands of t he Warfighter on the ground. The mid-term focus is on integrating additional multipurpose UAS into all aspects of Army operations ranging from 'Network' support to 'Cargo' capable. The more distant future is focused on increasing capability while reducing size, power, and weight requirements. We will review the roadmap every 2 years to remain relevant wit h operational needs, lessons learned, and emerging technology."
United States. Department of the Army
2010-04-09
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Combined Arms Countering Weapons of Mass Destruction
"ATP [Army Techniques Publication] 3-90.40 provides doctrine on how to conduct the countering weapons of mass destruction (CWMD) mission as combined arms teams. It is primarily oriented on the brigade combat team (BCT) and below. This manual provides tactical-level commanders, staff, and key agencies with a primary reference for planning, synchronizing, integrating, and executing combined arms CWMD."
United States. Department of the Army
2017-06-29
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Army Science and Technology Master Plan, Volume II
From the Defense Technical Information Center (DTIC) abstract: "This volume 2 includes the following annexes: (A) Science and Technology Objectives (STOs); (B) Advanced Technology Demonstrations (ATDs); (C) Interaction with TRADOC [ U.S. Army Training and Doctrine Command]; (D) Space, Strategic, and Theater Missile Defense Technologies; (E) International Armaments Strategy and Near-Term Foreign Opportunities; (F) U.S. Special Operations Command Technology Overview."
United States. Department of the Army
1996-12
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Department of the Army Polygraph Activities
From the Document: "This regulation contains policies, responsibilities, and procedures for use of polygraph in the Department of the Army. [...] This regulation applies to the Active Army, the Army National Guard, and the U.S. Army Reserve. It also applies to Department of Defense and Army contractors when they are subject to authorized polygraph examinations."
United States. Department of the Army
1995-09-29
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Multi-Service Tactics, Techniques, and Procedures for Treatment of Biological Warfare Agent Casualties
From the Introduction: "ATP [Army techniques publication] 4-02.84/MCRP [Marine Corps reference publication] 3-40A.3/NTRP [Navy tactical reference publication] 4-02.23/AFMAN [Air Force manual] 44-156_IP [integrated policy] describes the classification and description of biological warfare agents associated with military operations; provides procedures for collecting, handling and labeling, shipping, and identifying potential biological warfare agents; describes procedures for medical diagnosis, treatment, and management of biological warfare casualties; and describes medical management and treatment in biological warfare operations. This revision reduces redundancies with principal operations process doctrinal publications and reflects recent changes in guidance, methodology, and terminology. The material in this publication is applicable to the full range of military operations to include major operations and campaigns (including combating terrorism; homeland defense; and chemical, biological, radiological, and nuclear response). It also incorporates changes in the capabilities within each of the Services."
United States. Department of the Army
2019-11-21
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Open-Source Intelligence
"Since before the advent of the satellite and other advanced technological means of gathering information, military professionals have planned, prepared, collected, and produced intelligence from publicly available information and open sources to gain knowledge and understanding of foreign lands, peoples, potential threats, and armies. Open sources possess much of the information needed to understand the physical and human factors of the operational environment of unified land operations. Physical and human factors of a given operational environment can be addressed utilizing publicly available information to satisfy information and intelligence requirements and provide increased situational awareness interrelated with the application of technical or classified resources. The world is being reinvented by open sources. Publicly available information can be used by a variety of individuals to expand a broad spectrum of objectives. The significance and relevance of open-source intelligence (OSINT) serve as an economy of force, provide an additional leverage capability, and cue technical or classified assets to refine and validate both information and intelligence. As an intelligence discipline, OSINT is judged by its contribution to the intelligence warfighting function in support of other warfighting functions and unified land operations."
United States. Department of the Army
2012-07
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Force Health Protection (FHP): Occupational and Environmental Health (OEH) Threats (June 27, 2001; Expires July 27, 2003)
"This letter prescribes policy concerning the goals and responsibilities of the Department of the Army regarding occupational and environmental health threats during deployments. These threats must be considered as part of the commander's Force Health Protection Program. The information in this policy will be incorporated into the next changes of all pertinent Army regulations and manuals, including those cited in appendix A."
United States. Department of the Army
2001-06-27
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Crisis of Trust and Cultural Incompatibility: A Red Team Study of Mutual Perceptions of Afghan National Security Force Personnel and U.S. Soldiers in Understanding and Mitigating the Phenomena of ANSF-Committed Fratricide-Murders
"Since May, 2007 there have been at least 26 murder/attempted murder incidents by ANSF [Afghan National Security Forces] or ASG [Afghan Security Guard] members against ISAF/UNAMA [International Security Assistance Force/United Nations Assistance Mission in Afghanistan] members, resulting in the killings of at least 58 Western personnel Most of these incidents have occurred since Oct. 2009, representing 6% of all hostile deaths by ISAF during this period. Such fratricide-murder incidents are no longer isolated; they reflect a growing systemic threat. They are also provoking a crisis of confidence and trust among Westerners training and working with ANSFs. Rather than just a result of insurgent infiltration into ANSF, indicators exist that many of these fratricide incidents resulted from personal clashes. Therefore, a field study was undertaken to assess ANSF members' and US. Soldiers' perceptions of each other; specifically, to identify those behaviors that upset them or cause anger. Sixty-eight focus groups were conducted on 613 ANSF personnel throughout three provinces at 19 locations. Their reported negative views, experiences and observations of US. Soldiers' social behaviors were recorded. ANSF members identified numerous social, cultural and operational grievances they have with US. Soldiers. Factors that created animosity were reviewed through a content analysis that measured frequency and intensity of the perceived grievances."
United States. Department of the Army
Bordin, Jeffrey
2011-05-12
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North Korea Tactics
From the Preface: "Army Training Publication (ATP) 7-100.2 describes North Korean tactics for use in Army training, professional education, and leader development. This document is part of the ATP 7-100 series that addresses a nation-state's military doctrine with a focus on army ground forces and tactical operations in offense, defense, and related mission sets. Other foundational topics include task organization, capabilities, and limitations related to military mission and support functions. ATP 7-100.2 serves as a foundation for understanding how North Korean ground forces think and act in tactical operations. This publication presents multiple examples of functional tactics in dynamic operational environment conditions. The tactics in this ATP are descriptive, and provide an orientation to tactics gathered from North Korean doctrine, translated literature, and observations from recent historical events."
United States. Department of the Army
2020-07
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FM 7-0: Training
This June 2021 Field Manual 7-0 (FM 7-0) supersedes FM 7-0, dated 5 October 2016. From the Preface: "FM 7-0 prepares the Army to compete, respond to crisis, win in conflict, and consolidate gains during large-scale ground combat in a multi-domain environment. It provides the foundational procedures Army leaders use to train Soldiers and units. The principal audience for FM 7-0 is all members of the profession of arms. Commanders and staffs of Army headquarters serving as joint task force or multinational headquarters should also refer to applicable joint or multinational doctrine concerning the range of military operations and joint or multinational forces. Trainers and educators throughout the Army will also use this publication."
United States. Department of the Army
2021-06-14
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Army Multi-Domain Transformation: 'Ready to Win in Competition and Conflict'
From the Introduction: "In competition, the Army provides the Department of Defense (DoD) with foundational capabilities and capacity to shape the environment. Army forces pursue relative positional and capability advantage to support Joint and political objectives. The former is gained primarily through expanding the Global Landpower Network, in conjunction with Allies and partners. The latter is gained through the development of capabilities, force structure, doctrine and training to support multi-domain operations (MDO) at the speed of innovation. Demonstrations of joint assured power projection enhance the credibility of military deterrence, enabling policy makers to employ the right mix of diplomatic, economic, and information levers to prevent a conflict before it starts. 'Army Multi-Domain Transformation' describes why and how the U.S. Army must transform to enhance our core competencies and become a multi-domain force, with the right capabilities in the right place to enable the Joint Force to win, from competition through conflict. It further describes the application of the Multi-Domain Operations Concept, first published in 2018, across competition, crisis response, and conflict to support Joint All Domain Operations."
United States. Department of the Army
2021-03-16
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Army in Military Competition: Chief of Staff Paper #2
From the Executive Summary: "Military competition encompasses the range of activities and operations employed to achieve political objectives and to deny adversaries the ability to achieve objectives prejudicial to the United States. Armed conflict is one element of what is termed the 'competition continuum' in joint doctrine. The focus of this publication is the set of activities that occur outside of armed conflict. These might be taken to directly achieve objectives without fighting or they might be part of preparations for armed conflict meant to both deter adversaries and to ensure the Joint Force begins a conflict on the most favorable terms. In all instances, the Joint Force competes as part of a national strategy that integrates all instruments of power to accomplish U.S. objectives. The Army contributes to military competition by building and employing land force capability and capacity to support a broad range of policy choices."
United States. Department of the Army
2021-03-01
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Chapter 35: Medical Challenges in Chemical and Biological Defense for the 21st Century
The future requires that we carefully and continually assess the evolving threat from chemical and biological weapons. This can be predicted with certainty: the threat will change with time. As stronger countermeasures are developed by the United States and its allies, the employment of certain agents may become less appealing to adversaries on the battlefield. From that standpoint, medical countermeasures may be an effective deterrent. Biotechnology itself may be the threat of the future, and not specific agents, as adversaries may attempt to evade effective preventive measures with bioengineering. The employment of multiple chemical and biological agents is a very likely scenario of the future, thereby challenging the medical community to be much more proactive in its development of appropriate countermeasures. The missions of the United States military are changing, and deployments will require a capability to address potential chemical and biological incidents on the domestic and international fronts. Military medical personnel must, therefore, be continually prepared to deal with such contingencies as we become an even more important asset to this nation's defense and healthcare structures.
United States. Department of the Army. Office of the Surgeon General
Johnson-Winegar, Anna; Takafuji, Ernest T.; Zajtchuk, Russ
1997
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Chapter 2: History of Chemical and Biological Warfare: An American Perspective
"Webster's Ninth New Collegiate Dictionary" defines the term "chemical warfare," first used in 1917, as "tactical warfare using incendiary mixtures, smokes, or irritant, burning, poisonous, or asphyxiating gases." A working definition of a chemical agent is "a chemical which is intended for use in military operations to kill, seriously injure, or incapacitate man because of its physiological effects. Excluded from consideration are riot control agents, chemical herbicides and smoke and flame materials." Chemical agents were usually divided into five categories: nerve agents, vesicants, choking agents, blood agents, and incapacitates. This chapter focuses primarily on the development of chemical and biological weapons and countermeasures to them, thus setting the stage for Chapter 3, Historical Aspects of Medical Defense Against Chemical Warfare, which concentrates on medical aspects of chemical warfare. To avoid excessive duplication of material, protective equipment of the modern era is illustrated in Chapter 16, Chemical Defense Equipment.
United States. Department of the Army. Office of the Surgeon General
Smart, Jeffrey K.
1997
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Chapter 5: Nerve Agents
Nerve agents are extremely toxic chemicals that were first developed in secrecy before and during World War II primarily for military use. Related substances are used in medicine, in pharmacology, and for other purposes, such as insecticides, but they lack the potency of the military agents. Much of the basic knowledge about the clinical effects of nerve agents comes from research performed in the decades immediately following World War II. The military stockpiles of several major powers are known to include nerve agents, and the armamentaria of other countries are thought to contain them as well (see Chapter 4, The Chemical Warfare Threat and the Military Healthcare Provider). Because of the possibility of nerve agent use in future conflicts, military medical personnel should have some knowledge of these agents, their effects, and the proper therapy for treating casualties. Therapy is based on the administration of atropine, which interferes with receptor binding of acetylcholine at muscarinic but not nicotinic receptors, and the oxime 2-PAM Cl, which breaks the agent-enzyme bond formed by most agents. Assisted ventilation and other supportive measures are also required in severe poisoning.
United States. Department of the Army. Office of the Surgeon General
Sidell, Frederick R.
1997
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Chapter 3: Historical Aspects of Medical Defense Against Chemical Warfare
In discussing the history of the use of any new weapon and the medical response to it, one must also describe the context of the weapon: its scientific, social, and political aspects. For chemical warfare, there is the particular idea that chemical weapons are inhumane and immoral. Medical people, who treat the wounded, may well believe that all weapons are inhumane. Nevertheless, even the terms are relative--consider Pope Innocent II, who, in 1139, forbade the use of the relatively new crossbow as "Hateful to God and unfit for Christian Use." His prohibition was cheerfully ignored; the crossbow was used for over 300 years. In this essay, the author will return to the issue of the moral use of the chemical weapon, but he will begin with the early history of chemical warfare itself. The chemical weapon has a long and ancient history, especially in its presentation as flame and smoke. Modern chemistry made possible the use of chemical agents in a logistically and tactically feasible way in World War I. Most of what was known--and is still understood by the public--is based on the gas warfare of 1915-1918. Since then, "poison gas" has usually aroused public repugnance at its use as a weapon. Modest use in the 1930s against tribes and its lack of employment in World War II suggested that "gas warfare" had ended. The discovery of the German nerve gases after World War II, the Cold War, and the utility of tear gas in Vietnam maintained a military interest in the chemical weapon. The use of gas by Iraq against Iranian troops and the threat of Iraqi use in the Persian Gulf War clearly document that chemical warfare remains possible.
United States. Department of the Army. Office of the Surgeon General
Joy, Robert J. T.
1997
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Chapter 8: Long-Term Health Effects of Nerve Agents and Mustard
Although the acute effects of the nerve agents and of mustard agent are well known, the longterm effects after a single exposure or multiple exposures are less well recognized. The nerve agents are the subject of Chapter 5, Nerve Agents, and mustard is a subject of Chapter 7, Vesicants, but this chapter focuses on the long-term effects. Available information implicates the nerve agents and mustard as the cause or probable cause of several long-term health effects. Polyneuropathy, the major neuromuscular manifestation seen after exposure to organophosphate pesticides, has not been reported in humans after exposure to nerve agents. Other long-term consequences of exposure to organophosphate pesticides are neuropsychiatric effects and possible EEG changes. The many studies of English and Japanese mustard factory workers establish repeated symptomatic exposures to mustard over a period of years as a causal factor in an increased incidence of airway cancer. The association between a single exposure to mustard and airway cancer is not as well established. The association between one-time mustard exposure and other chronic airway problems, such as chronic bronchitis, which is based on World War I data, seems more clearly established. Several eye diseases, such as chronic conjunctivitis, appear after an acute, usually severe, insult to the eye. In particular, delayed keratitis has appeared more than 25 years after the acute, severe lesion. The production of nonairway cancer by mustard has been demonstrated in animals, but scant evidence exists to implicate mustard as a causative factor in nonairway cancer in humans. Mustard causes chromosomal breakage and induces sister chromatid exchanges in man and has been classed as a mutagen. No data that implicate mustard as a reproductive toxin in man seem to be available, despite the many thousands of people exposed to mustard in the past 80 years.
United States. Department of the Army. Office of the Surgeon General
Sidell, Frederick R.; Hurst, Charles G.
1997
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Chapter 4: The Chemical Warfare Threat and the Military Healthcare Provider
The military healthcare provider should be prepared to be the first to recognize military or civilian casualties of chemical warfare attack. This requires an informed understanding of the likelihood of chemical warfare agent use or threat, and it requires the ability to clearly recognize agent-exposure symptoms against a varying background of unrelated injury and stress behaviors. The healthcare provider should be informed, to the fullest extent possible, when to anticipate chemical warfare attack by hostile forces or terrorist activities. This requires consideration of an adversary with regard to political factors and motivation, chemical agent possession or access, chemical warfare offensive and defensive capabilities, and the strategic advantage to be realized through agent use. When individuals suspected to have been exposed to chemical warfare agents are encountered, initial recognition of the type of agent used may be facilitated through an understanding of tactical agent use, modes of agent dissemination, likely routes of casualty exposure to agent, and physical agent properties and other factors determining the persistence of these toxicants in the operating environment. Finally, to protect both the injured and medical personnel, casualty care must take place within a framework of decontamination both in the field and in forward medical support facilities.
United States. Department of the Army. Office of the Surgeon General
Takafuji, Ernest T.; Kok, Allart B.
1997
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Chapter 6: Pretreatment for Nerve Agent Exposure
The inadequacy of postexposure therapy for nerve agent casualties, particularly those with potentially lethal exposures to soman, has been of great concern. Development of pyridostigmine, a peripherally active carbamate compound, as a nerve agent pretreatment adjunct has substantially improved the ability of the U.S. military to protect its soldiers from the lethal effects of nerve agents. A major deficiency of this pretreatment program --that it does not protect the CNS against nerve agent-induced injury--may be overcome by postexposure administration of anticonvulsants. While centrally acting pretreatments offer more effective protection than does pyridostigmine, their development is limited because of their potential for impairing soldier performance. New research may provide a revolutionary advance in protection against nerve agents with biotechnologically derived pretreatments that bind or inactivate nerve agents in the circulation.
United States. Department of the Army. Office of the Surgeon General
Sidell, Frederick R.; Dunn, Michael A.; Hackley, Brennie E., Jr.
1997
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Chapter 1: Overview: Defense against the Effects of Chemical and Biological Warfare Agents
"Gas! Gas!" This warning cry, so common in World War I, almost became real to U.S. forces again as they prepared to liberate Kuwait in late 1990. The threat of chemical, and even biological, warfare was foremost in the minds of U.S. military personnel during Operation Desert Shield, the preparation for the Persian Gulf War. Iraq was known to have a large stockpile of chemical weapons and had demonstrated during its conflict with Iran that it would use them. It was not until after the Persian Gulf War that the U.N. Special Commission on Iraq confirmed that Saddam Hussein also had biological agents loaded in weapons. The chemical and biological threats were major concerns to those in the military medical departments who would be called on to care for poisoned or infected casualties, possibly in a chemically contaminated environment. Fortunately the ground war of the Persian Gulf War (Operation Desert Storm) was brief, and even more fortunately, our adversary did not employ these weapons. Two lessons were learned from this conflict, lessons that should never be forgotten by those in the military. The first was that there are countries that have chemical and biological weapons, and there are other countries that might obtain or produce them. The second was that the U.S. military medical departments must be prepared at all times to treat both types of casualties. As long as potential adversaries exist, the U.S. military might face a chemical or biological battlefield. The breakup of the Soviet Union, and the consequent glut of biowarfare experts on the world employment market, may have actually increased the threat of biological proliferation. In addition to the recent experience in the Persian Gulf, a review of other events of the past 2 decades bears out this conclusion.
United States. Department of the Army. Office of the Surgeon General
Sidell, Frederick R.; Franz, David R.
1997
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Chapter 34: Trichothecene Mycotoxins
Trichothecene mycotoxins are noted for their marked stability under different environmental conditions. On a weight-for-weight basis, they are less toxic than other toxins such as ricin, botulinum, and staphylococcal enterotoxin B, but trichothecene mycotoxins are proven lethal agents in warfare. Symptoms include vomiting, pain, weakness, dizziness, ataxia, anorexia, diarrhea, bleeding, skin redness, blistering, and gangrene, as well as shock and rapid death. Sensitive immunoassays and chemical procedures are available for the identification of trichothecene mycotoxins in biological samples, but no detection kits have been fielded. Prevention of exposure is the only current defense, with a protective mask and clothing worn when under attack. Previous successful lethal attacks have always occurred against unprotected civilians and soldiers. Skin decontamination with water and soap can be used effectively up to 6 hours after exposure. Experimental treatments for systemic toxicity are being investigated, but no therapy is available for humans.
United States. Department of the Army. Office of the Surgeon General
Wannemacher, Robert W., Jr.; Wiener, Stanley L.
1997
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Chapter 30: Defense Against Toxin Weapons
Protecting soldiers on the battlefield from toxins --and replicating agents--is possible if we use our combined resources effectively. Physical countermeasures such as the protective mask, protective clothing, and decontamination capabilities exist and are effective. As we improve our battlefield detection systems, early warning of our soldiers may become a reality, at least in subpopulations within our forces. These assets, unlike most medical countermeasures, are generally generic and protect against most or all of the agents. Among the medical countermeasures, vaccines are available and effective for some of the most important agents, and therapies exist for others. Because of limited resources available to develop vaccines, diagnostic methodologies, and therapies, we can field specific medical countermeasures only to a relatively small group of threat agents. Our efforts in this area must be carefully focused. A third and complementary element of our defensive program must be good intelligence. Only through knowledge of specific threat agents, delivery systems, and national capabilities can we assure the effective development and use of our physical and medical countermeasures. Finally, our renewed understanding of the real strengths and weaknesses of toxins as weapons allows us to put them in perspective in educating our soldiers, removing much of the mystique--and associated fear--surrounding toxins. Knowledge of the threat thus reduces the threat to our soldiers.
United States. Department of the Army. Office of the Surgeon General
Franz, David R.
1997
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Chapter 33: Botulinum Toxins
The seven serotypes of botulinum toxin produced by Clostridium botulinum are the most toxic substances known. They are associated with lethal food poisoning after the consumption of canned foods. This family of toxins was evaluated by the United States as a potential biological weapon in the 1960s and is believed to be an agent that could be used against our troops. Unlike other threat toxins, botulinum neurotoxin appears to cause the same disease after inhalation, oral ingestion, or injection. Death results from skeletal muscle paralysis and resultant ventilatory failure. Because of its extreme toxicity, the toxin typically cannot be identified in body fluids, other than nasal secretions, after inhalation of a lethal dose. The best diagnostic sample for immunologic identification of the toxin is from swabs taken from the nasal mucosa within 24 hours after inhalational exposure. Because of the small quantity of toxin protein needed to kill, botulinum toxin exposure does not typically induce an antibody response after exposure. Prophylactic administration of a licensed pentavalent vaccine fully protects laboratory animals from all routes of challenge. Passive immunotherapy with investigational hyperimmune plasma also prevents illness if it is administered before the onset of clinical intoxication.
United States. Department of the Army. Office of the Surgeon General
Franz, David R.; Middlebrook, John L.
1997
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Chapter 29: Viral Hemorrhagic Fevers
The VHF agents are a taxonomically diverse group of RNA viruses that cause serious diseases with high morbidity and mortality. Their existence as endemic disease threats or their use in biological warfare could have a formidable impact on unit readiness. Significant human pathogens include the arenaviruses (Lassa, Junin, and Machupo viruses, the agents of Lassa fever and Argentinean and Bolivian hemorrhagic fevers, respectively). Bunyavirus pathogens include RVF virus, the agent of Rift Valley fever; C-CHF virus, the agent of Crimean- Congo hemorrhagic fever; and the hantaviruses. Filovirus pathogens include Marburg and Ebola viruses. The flaviviruses are arthropod-borne viruses and include the agents of yellow fever, dengue, Kyasanur Forest disease, and Omsk hemorrhagic fever. A viral hemorrhagic fever should be suspected in any patient who presents with a severe febrile illness and evidence of vascular involvement (subnormal blood pressure, postural hypotension, petechiae, easy bleeding, flushing of the face and chest, nondependent edema), and who has traveled to an area where the virus is known to occur, or where intelligence suggests a biological warfare threat. Patients with viral hemorrhagic fevers generally benefit from rapid, nontraumatic hospitalization to prevent unnecessary damage to the fragile capillary bed. Aspirin and other antiplatelet or anticlottingfactor drugs should be avoided. Secondary and concomitant infections including malaria should be sought and aggressively treated. The management of bleeding includes administration of fresh frozen plasma, clotting factor concentrates and platelets, and early use of heparin to control DIC. Fluids should be given cautiously, and asanguineous colloid or crystalloid solutions should be used. Multiple organ system support may be required. Ribavirin is an antiviral drug with efficacy for treatment of the arenaviruses and bunyaviruses. Passively administered antibody is also effective in therapy of some viral hemorrhagic fevers. The only licensed vaccine available for VHF agents is for yellow fever. Experimental vaccines exist for Junin, RVF, hantaan, and dengue viruses, but these will not be licensed in the near future.
United States. Department of the Army. Office of the Surgeon General
Jahrling, Peter B.
1997
