Thursday, December 25, 2014

Probability Assessments for Bio-Defence Drug Research, Development and Delivery

For battlefield trauma, the concept of  the 'golden hour' where the patient must be treated within 60 minutes of multiple traumas, was identified in data gathered by the French during the First World War. In order to achieve rapid treatment, trauma therapies must be administered directly by the combatants themselves (or their colleagues), trained military medical officers or by a Mobile Army Surgical Hospital (MASH) unit located close to the combat zone. J.D. Smart, Drug Delivery Systems and their Potential for use in Battlefield Situations. 

Battlefield exposure to micro-organisms and what I view, based on the current number of offensive biological warfare programs, and several emerging programs in states of concern, as an increasing risk to the war-fighter from such exposure, will require different types of medical countermeasures. Future bio-warfare or even exposure to endemic disease during conflict (think of UNIFIL forces in Lebanon and Syria's WPV1 outbreak), make it imperative we think beyond prophylactic treatments, although this too is an essential first barrier of physical defence for the war-fighter. As the operational nature of warfare changes with increasing emphasis placed on small units conducting highly specialized warfare, so too does the required range of medical counter measures and delivery technology needs.

A Polish special operation forces medical soldier  performs first aid on a detained  opposing forces player as U.S. special operations forces soldier, left, looks on as part of the Jackal Stone 10 exercise
What will the battlefield medical counter measure requirements be ten years from now? In a study conducted by the US Naval Health Research Center Medical Modeling and Simulation Department,   entitled: Using Modeling to Predict Medical Requirements for Special Operations Missions (see: ADA492838.pdf) , the authors contend: "Special Operations Forces (SOF) have become the “tip of the spear” in the global war on terrorism. From Iraq to Afghanistan and in many small, mostly unheard of conflicts in between, commandos from the joint U.S. Special Operations Command (USSOCOM) are engaged in unconventional operations to prevent extremists from gaining footholds in countries where they can build and operational base, as Al Qaeda did in Afghanistan in the 1990s. Special operations missions fall into nine categories. Direction action missions are short duration, small scale offensive actions in hostile or politically sensitive areas. Special reconnaissance missions involve covert reconnaissance or surveillance operations. Foreign internal defence missions involve training a friendly country's military or security forces. Unconventional warfare missions involve a broad spectrum of military and paramilitary operations and are usually of long duration. Counter terrorism missions include offensive actions taken to prevent, deter, preempt or respond to terrorism. Weapons of Mass Destruction (WMDs) counter-proliferation missions are taken to localize, seize, destroy, reder safe, capture, or recover WMDs. Civil affairs operations are aimed at winning 'hearts and minds' in foreign territory. Psychological operations involve actions to manipulate the behavior of a population, government, or military force. Information operations involve adversely effecting the information systems of an adversary." (See:ADA492838.pdf) 

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While a couple of these missions types would not require significant shift in current practice, others will. The future of bio-defence drug research and development, and particularly the delivery of such medical counter measures, in keeping pace with current and future BW threats will need to undergo rapid and considerable change. Battlefield drug delivery, which includes, implants, trans-dermal patches and depot injections coupled with possible bio-printing, nanotechnologies and advanced vaccine and medical counter measures is highly likely to be the battlefield medical counter measure and bio-defence landscape of the future. 


Trans-dermal 4D patches could well become as compulsory as a current military vaccination schedule. Bio-printing coupled with depot injections could well rapidly protect against and in some instances counter, a contaminated environment or exposed individual. A depot injection covering a range of possible agents could preempt certain operational issues in contaminated theaters.  Drug development for operations of the future, must move beyond the current approach of survival and treatment and look more toward drug development to sustain operations in a contaminated environment. Protective clothing should be viewed as the new analogy for bio-defence drug development. It is not merely life saving, treatment, survival but maintaining long term operational capability.

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