|Translating Medical Chemical Defence Research Into Operational Medical Capabilities Against Chemical Warfare Agent Threats|
|Human Factors and Medicine|
CBRN, Chemical Warfare Defence, Medical Countermeasures
Chemical warfare (CW) agents present a significant threat to NATO forces, inter alia posed by emerging non-state parties. Medical countermeasures (MedCMs) form an important part of the defence planning priority against this threat. Within the previous RTG (HFM 253) gaps within the current MedCMs have been identified for a wide range of chemical agents, and ways of moving forward have been defined. Treatment of chemical casualties across the medical chain, i.e. self and buddy aid to Role 2/3, covers a larger time range than has generally been considered until now. As yet, the focus has mostly been on the treatment in the first few hours after exposure. The medical requirements across the complete medical chain, and the impact with regards to efficacy that can be achieved, vary between agents. International collaboration in the area of medical chemical countermeasures and establishment of medical treatment protocols is crucial, particularly given the requirement to license new pharmaceutical products used in MedCMs when possible, which makes development costly and slow. In this respect, it should also be noted that the development and supply of medical countermeasures is critical, stressing the need for international collaboration. In this context, a better understanding of existing drugs and treatments, including those licensed for other purposes, may help identify more effective ways of using these or new alternatives against a broader range of threats. An additional identified prerequisite for optimizing the efficacy of medical treatment in the field is the availability of reliable and rapid diagnostics. Therefore, emerging technologies for point-of-care diagnostics (in particular those for a ‘trigger to treat’) will also be addressed. Also, diagnostics for broader classes of agents are required to rapidly select the right class of treatment. The same accounts for triage, personal decontamination and medical evacuation procedures.
The proposed RTG will be a logical follow-up of RTG-253 and will move forward from the actions and recommendations defined in that particular RTG. The general objective will be to coordinate and leverage multinational research into Medical Chemical Defence to improve coherence between national programmes. The more specific objectives will be:
• To share experience and insights into development and licensing of MedCM, and its implications for preclinical studies
• To examine challenges within MedCM research and development, and identify mitigation strategies
• To co-ordinate research programmes to fill knowledge and capability gaps to provide enhanced capability
• To identify ways for optimization of medical capabilities in the field/on site, including the use of point-of-care diagnostics, triage, integration of decontamination procedures in the medical chain, and medical evacuation (medevac).
The RTG will begin by surveying a range of possible approaches to improving capability and will then focus on those that are identified as providing the greatest potential for improvements. These may include:
• Identification of critical points in the medical operational chain where scientific innovation could make a difference, e.g. identification of ‘triggers to treat’, triage, clinical diagnostics and monitoring, skin decontamination
• Improving existing treatments, e.g. use of mixtures of oximes, dosing and timing of atropine against nerve agents
• Novel approaches for MedCM development, e.g. ‘orphan drug’ development (for rare diseases)
• Security of supply for MedCMs, e.g. drug manufacture
• Licensing/regulations, including pharmacovigilance, end user attitudes to risk, risk-benefit balance for life-saving immediate therapy, medics’ attitude to off-label use
• Military-civilian collaboration on MedCM, including collaboration with industries, and governmental/non-governmental organizations
• Integrated treatment approaches throughout the medical chain, including interoperability between different countries
• International collaboration, including coordination of national programmes to exploit synergies and maximise benefit.