In the know: medical intelligence in CBRN health security threats


Alexander Languimir was the father of modern field epidemiology, and in 1951, established the Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS), primarily due to the threat of biological warfare against the United States.

During World War II, the U.S.Army Medical Intelligence Office (under the Army Surgeon General) was responsible for medical intelligence for the U.S. military. In 1963, the Defense Intelligence Agency (DIA) Medical Intelligence Division assumed the mission. In 1973, the DIA underwent a significant reduction in force; the Medical Intelligence Division was abolished and the US Army Surgeon General then assumed the entire medical intelligence mission.

During the Vietnam War, US Army Special Forces medical personnel and advisors provided a plethora of useful medical intelligence pertaining to the endemic diseases and injury mechanisms of the guerilla warfare battle space, such as the ubiquitous “punji stake”, sharpened and sometimes fecally contaminated bamboo shoots capable of causing lethal and sublethal injuries accompanied by raging infections.


In the 1991 Persian Gulf War, active medical intelligence activities were vital in defining and countering the multifactorial battle and non-battle related illness and injury matrix associated with the most toxic battlefield to have ever been encountered by America and Allied troops, including exposures to neurotoxic warfare agents, toxic combustion-by products, depleted uranium (DU), endemic infectious diseases, toxic pesticides and a variety of other etiologic agents and conditions.

In 1982, the Armed Forces Medical Intelligence Center (AFMIC) was officially established as a tri-service intelligence activity. The Army Surgeon General was designated as Executive Agent. In 1992, AFMIC became a “DIA Field Production Activity”.On 2 July 2008, recognizing the pressing need for optimal intelligence information-sharing and military-civilian stakeholder cooperation post-9/11, the DIAs AFMIC was formally redesignated as the National Center for Medical Intelligence (NCMI) in a ceremony at Fort Derrick, Maryland.

The NCMI was, until recently, under the leadership of Colonel Anthony Rizzi, who strived to achieve the production and dissemination of high quality medical intelligence products that not only would be useful in the military’s Global War on Terror, and recent involvement in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF), but to a variety of other stakeholders in the intelligence, homeland security and public health communities.
Generally, the NCMI mission is to monitor, track and assess a full range of global health events that could negatively impact the health of US military and civilian populations.

In the strictest sense, medical intelligence can be defined as that category of intelligence resulting from collection, evaluation, analysis, and interpretation of foreign biomedical, environmental, epidemiological and health care infrastructure data which can be applied to strategic Health and Force Protection activities and to conduct military medical planning and operations relevant to foreign theatres of operations during wartime or conflicts, complex humanitarian emergency missions, covert operations and other military activities to protect US and Allied war-fighters and civilian friendlies.

Collection of medical intelligence may include both classified and open sources. Evaluation may involve preexisting publications or ongoing public health surveillance, and it may also include analysis and/or interpretation of of well-established or newly gained data. Characterizations may include situational awareness of current events, eg. use of improvised chemical devices and chemical agents in Syria, increased incidences of suicide bombings, theft or diversion of toxic industrial chemicals/materials or radionuclides.

Forensic_Toxicology_Research_LaboratoryMedical intelligence gathering and its applications can run the gamut from assessing and exploiting an adversary’s medical-healthcare infrastructure and capabilities such as hospitals, clinics, support services, emergency medical transport capabilities to identification and analysis of hazardous materials and chemical precursor, storage, transport and disposal production that could be pose serious chemical warfare or environmental health threats to war-fighters, contractors and civilians.Such was the case in the highly industrialized area of Kosovo where US and UN troops were exposed to abandoned and uncontrolled industrial waste sites and other contaminated areas, as well as the supposition that incapacitating chemical agents, such as BZ may have been deployed against resistance forces.

Medical intelligence includes pre-deployment and on-going medical threat assessments that are critical to the Force Health Protection and preventive medical efforts of the military forces.Such assessments must include a comprehensive epidemiological profile which addresses naturally occuring endemic infectious diseases, as well as emerging infectious diseases affecting the region involved in a military operation or operations other than war (OOTW) mission.

The existence of endemic or emerging infectious threats must be identified, catalogued and analyzed and used to form an epidemiological “mapping” of the region. The possibility that endemic and emerging biothreats may be (or have been) weaponized as biological warfare agents (BWAs), and that a BW capability exists in a nation-state; becomes part of the strategic and medical intelligence products generated for Force Health Protection and military operations.

Assessing a nation-state’s or region’s life sciences and biotechnological capacities and capabilities can provide key intelligence related to foreign basic and applied biomedical and biotechnological developments of military (and civilian) medical and public health importance including research and development of advanced bioweapons utilizing recombinant bioengineering and production techniques. The scrutiny of both offensive and defensive R&D programs are of paramount importance for military and civilian biodefense efforts.

bio detection

Based upon this data analysis, protective and biomedical countermeasures can be deployed and an operational plan can be implemented which integrates relevant medical intelligence.
Medical intelligence related to specifically to the terrorist threat has obvious applicability to both military and civilian environments.
On a civilian tactical level, such as in a tactical law enforcement setting, tactical emergency medical service (TEMS) personnel responsibilities include generating a medical threat assessment for the tactical team, including foreseeing and preparing to decontaminate, triage, treat and transport (DT3) team members and civilian casualties in the aftermath of a CBRN event.

Medical intelligence sections and personnel have been integrated in several of our multiagency intelligence fusion centers created to share early, credible, consistent and reliable intelligence and incident information about terrorist activities which may impact jurisdictions. This evolves into an enhanced methodology and system of situational readiness and situational awareness to effectively and efficiently thwart, counter and interdict threats.

The utilization of well versed, multi-skilled individual(s) as medical-public health intelligence officers in a fusion center or any intelligence setting is critically important to address the broad spectrum of threats that can affect public health and safety.
The military and its civilian counterparts have been better able to integrate and share their medical intelligence efforts in the post-9/11, post-mail-borne anthrax attacks of 2001, however, much more needs to be accomplished and refined in this age of expanding and complex threats.

Our military, national and homeland security challenges continue to rise, especially in the face of novel disease outbreaks and bolder acts of terrorism and political violence threatening global stability and security, as well as global public health.
Planning, preparedness, mitigation and response tactics and strategies utilizing accurate medical & public health intelligence, will do much to reduce morbidity and mortality among war-fighters and civilians when confronted by either natural or human-generated emerging health threats or acts of tactical ultraviolence and CBRNe terrorism.

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Frank G. Rando possesses over 30 years of real world experience as a public safety professional,clinician, educator ,emergency and crisis manager ,author and consultant in the areas of tactical ,disaster and operational medicine, weapons and tactics, law enforcement /criminal investigations ,counterterrorism, hazardous materials management and emergency response ,toxicology, environmental safety and health,and health care and public health emergency management .