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U 8 ARMY BOOMMMA RIESARCH & DY!WPMENT LASORATORY

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NOTICE

Disclaiemr

The findings in this report are not to be construed as an officialDepartment of the Army position unless designated by other authorizmidooauents.

Disposition

Destroy this report vhen it is no longer needed. Do not return It to theoriginator.

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19. ýUiorophonea incorpo'rated into the cuf Analysis of the state-of -the-art of eachdevice jidiostes that none of the. cre advanced enough to fulf ill all the vsquir4bzta ofthe draft JYoint Services Operational Requirement. 1hree of the devices identified arereooomsaded for further evalutat ion.

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MILITARY ATTICRALF ..................................................... I

3s.itrsor3 ..... .....................................................*~*~**** aMI.T$ OF IMEYKY ... ...................... ...............

DISCUSSION ............................................

TABUL - .WWI4ATY 017 CAX)IDATE3 AILCLAT'E .............................. 3

uCONOzCLU 3 LIM tWCHMATION3 ........... .......................... 10

APPKIDII A -m0rI9T. ........................... .................. 12

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D I S T IR 'T rO I LI SI T . . . . . . . . . . . . . . ... . . . . . , . . . . . . . , . , . . , . 14

forNTi$ rOT•C T& C

BY

Dist 1

ABSTRACT

This report summarizes an assessment of technology available to develop anoninvasive life detector for use on the battlefield. The detectors determineif casualties wearing chemoical •-tective overgarments are alive or deadwithout further exposing either .-, casualties or the aidmen to thecontaminated environment. Seven technology approaches sponsored by the

Department of Defense (comprising 11 devices), four technologies identified ina market survey, and one device described in a Broad Agency Announcement (BAA)proposal were examined as candidate Advanced Life Detectors (ALD). Thetechnologies and instruments surveyed included three transnitter-receivertechnologies, an electrocardiogram teocmology, pacemaker-transmitter/reoeiver,dry electrode heart rate monitor, five nicrowave technologies, flashreflectance oximetry, an ultrasound technology, a streaming potential tech-nology, a dry electrode ECG monitor coupled co a microphone, a statometrictechnique for determining heart rate and blood pressure, and a vital signsmonitor that determines heart rate and blood pressure using blood pressureouff and microphones incorporated into the cuff. Analysis of the otate-of-the.irt of each device indicates that none of them are advanced enough tofulfill all the requirements of the draft Joint Services OperationalRequtrement (JSOR). Three of the devices idantified are recommended forfurtker evaluation.

iv

INTRODUCTION

A Tri-Service Joint Working Group (TSJWG) on Advanced Life Detectors (ALDs)reviewed the status of five exploratory development efforts azd outlinedtechnical requirements for an ALD. The group agreed that a technology surveywas needed to determine the potential for meeting requirements. This surveyincluded (1) review of the five ongoing developmental efforts, (2) review ofother technologies, (3) a market survey of life detectors, and (4) a tech-nology assessment plan (i.e., a test procedure) to select candidate(s) forengineering development.

MILITARY RATIONALE

Employnent of chemical warfare agonts on the modern battlefield by hostileforces has the capability of generating an unprecedented number of casualties,thus information is required to determine if casualties are alive or dead;this would enable the aidman to divote his limited time and resources tocasualties who are salvageable. 2, The ALD is intended to assist in theselection of casualties for treateent and evacuation on the battlefield. Thedevice must be usable when both the aidman and the casualty are wearing NBCprotective ensembles and when the casualty is in chemical warfare agentprotective patient wrap, without copromising protection.

KMWHODS

Technologies and instruments were evaluated on the basis of their conformancewith or potential for mneting the requirements of the draft JSOR: 3

a. The device will be capable of determining heart and respiratory rates.

b. Weight and volume shall be consistent with good engineering practices,and it is desired that dimensions not exceed 31n I 4in X 1/2in.

o. The display will be digital for heart and respiratory ratcs.

d. The display will be instantaneous.

e. The device will be operable in high noise and vibration environments.

f. The device will be capable of operating continuously for a minimum of6 hours on its own power source.

The requirements for reliability, availability, maintainability, aysts6,safety, preplanned product improvement, manprint, etc. were not evaluated.

RESULTS OF REVIEW

The devices surveyed and the results of the evaluation are outlined below:

a. PERSONAL MONITOR AND COMMUNICATOR (PMC) SYSTEM (ARMYrrACKER). TheALD version of the PMC system is derived from an earlier device, developedat Purdue University Biomedical Engineering Center, thaý locates distantcasualties by triangulation and interprets vital signs. The PMC system isa two-unit device, one (wrist unit) to be worn by each cccbatant in the NBCtheater under his protective clothing and the other (interrogator) to becarried by the aidman. The wrist unit resembles an over-size wristwatch; fourdry electrodes in the wristband detect tissue volume changes by impedancemeasurements. The unito basically measures pulse, but other vital signs, suchas respiratory rate, can be derived in principle. As presently configured,the wrist unit transmits pulse to the aidman's interrogator using a 440.6 MHzsignal. The ALD version, which is presently being developed at Purdue, willhave a muah shorter range, probably no more than a few feet. The aidman'sunit (i.e., the receiver) was not completed at the time of inspection (August1987); it was simulated on a personal computer. The pulse signal appeared tobe picked up satisfactorily during normal arm movementi, and it is claimedthat the system functions while the wearer is jogging. The present contractcovers development of the ALD interrogator and miniaturization of the wristunit.

Prognosis: The preaent contract calls for delivery of the prototype ALDversion of the PMC on 1 September 1988. This schedule should be met, but theprecise configuration of the unit is uncertain. The device should satisfy therequirements of the draft JSOR, although it is not certain at this time thatthe wrist unit can be made small enough to be practical for issue to allcombatants.

b.. MICROWAVE SYSTEM (NAVY/SIEGEL). A heart and respiratory rate monitorhas been developed under Navy contract by the Michigan State UniversityElectrical Engineering and Systems Science Division. The demonstration unitwas observed in August 1987. It is a single box about twice the size of ahand calculator and employs a 10 GHz microwave source with a pulsed dopplerdetector and digital readout. It is designed to operate at 1-2 feet or lessfrom the subject. Even though the highly sophisticated algorithms of speechprocessing are used, normal variability in heart ratI complicates separationof the heart rate signal from extraneous vibrations. The first-generationdevice was demonstrated by mans of a mechanical heart simulator rather thana live subject; both detector and heart simulator were firmly anchored on abench. The second-generation device, which uses more advanced signalprocessing, will discriminate more effectively; but the fielded device inall probability will still need rieid support to provide stability.

Prognosis: It is underegood that sufficient funding exists to complete thesecong-generation device which could be ready for evaluation by the summer of1988. It is unlikely that the first-generation device ca" satisfy the JSORwith respect to noise and vibration, although other requirements should bemet.

2

o. MICROWAVE SYSTEM (AIR FORCE/SEALS). A heart and respiratory rot.monitor has been developed under Air Force contriot by the Georgia TechnicalResearch Institute Biomedical Research Division. A preprototype (brasaboard)device was observed in operation at Brooks Air Force Base during August 1987and discussed with the contractor. The device, roughly the size and appear-ance of an old-fashioned wall telephone, was developed in both 3 GHz and10 OHz versions and is capable of remote detection up to about 10 meters.It is described as a dual-channel microwave phase detector. The microwavegeneration *nd detection are more sophisticated than tho3e of the Navy/Siegelsystem, but it lacks the latter's advanced (igital signal processing; in fact,the signal is presented on an oscilloscope, which is useful for diagnosticinformation, but not suitable as a life detector. (The device is intended asa vital signs monitor.) As with other microwave systems, a steady platform isrequired; but this requirement may be eliminated with better signalprocessing. No further development is projected at this time.

Prognosis: Since it lacks a suitable display for life stiis and is unable tosatisfy the noise and vibration requirement, this device Is not a candidatefor comparative evaluation as an ALD within the requirements of the JSOR.

d. MICROWAVE SYSTEM (NAVY/S•ALS). A heart and respiratory rate monitorwith distant sensing capability has been developed under Navy contract byGeorgia Technical Research Institute Biomedical Research Division. Thisdevice, similar in function to the one above developed for the Air Force, isdesigned to detect vital signs at distances of 100 meters and is intended topermit life detection without risk to the aidaan. At this time, readout isby oscilloscope. It requires a very steady platform and an optical sight.The device exhibits the shortcomings of all microwave systems in its inabilityto discriminate between life signs and strong returns in the sam froquencyrange; a recent report from the contractor s§ggesta that distant microwavedetectoro are not practical for outdoor u&e. The brassboard device inspectedduring August 6 1987 was not in operation. No further development is projectedat this time.

Pr2o.!is.: Lacking a suitable life signs display, with inability to satisfythe noise and vibration requirement and perhaps inability to met the sizelimitation as well, this device is not a candidate for comparative evaluationas an ALD within the requirements of the JSOR.

e. MICROMAVE SYSTDI (NAVY/CHEN). A heart and respiration rate detectorwith remote/distant capability has been developed under Navy contract by theHichiganAtate University Departaent of Electrical Engineering and SystemsScience. This systea, capable of detecting life signs behind a concreteblock wall at a distance of 3 meters, was conceived an a means for locatingvictims buried in rubble. Signal presentation is by oscilloscope. The devicehas not been fully developed and was not inspected.

Promosis: A suitable device is not available for comparative evaluation.

__

f. MICROWAVE SYSTEM (AM4Y/NCWOGRODZKI). A noncitact heart rate monito'was developed by RCA Corporation under Army contract. A prototype devicewas delivered, but it was 'extremely sensitte to alight aensor movementswhich produce frequent erroneous reading.s.0 Further development was notundertaken.

Proj•*g13: A suitable device is not available for comparative evaluation.

S. ULTRASONIC SYSTEM (ARKY/CHANG). A noncontact heart rate monitor wasdeveloped by IBS Corporation under Army contract. The device is an ultrasonictransceiver which is based on th¶3Doppler effect to detect movement of theheart wall or aortic blood flow. Ultrasonic systems usually use a gel/skincontact since ultrasound is strngly attenuated by air, even the small amountof air in a layer of clothing; but it is claimed that heart rate could bemeasured 1 ith the subject wearing normal clothing, as well as a protectivegamrsnt. 1 2 A prototype was delivered, but it was 'extremely sensitive tomotion.' Further development was not undertaken.

Proa01: A suitable device is not available for comparative e6vluation.

h. STREAMING POTENTIAL (AHMY/SHAFER). A noncontact heart rate monitorwas developed by Titan Systems Incorporated under Army contract. This deviceis based on the disputed concept that a field, the "streaming poten iae,' isgenerated by the body when blood is forced through the capillaries." Aprototype was delivered, but *the sensor only works len used on a braohial orcarotid artery and is extremely location sensitive.* Further developmentwas not undertaken.

Eogasi: A suitable device is not available for comparative evaluation.

i. VITAL SIGNS DETECTOR (AIR FORCE/LESSARD). Two devices for deteotingheart aid respiratory rate of casualties in protective Garments have beendeveloped by Texas A&M University under Air Force contract. Both brasaboarddevices were inspected at Brooks Air Force Base in August 1987. Both arenoninvasive, but both require direct skin contact; the hood of the NBCprotective mask would have to be raised to provide sacess to the throat area.In both, sensors and digital indicators are separate units. The moresuccessful one has a yoke-shaped sensor that fits the threat of the casualty,with four electrocardiogram dry electrodes mounted on the sensor arms of theyoke to detect heart beat and a oentrally-monntod microphone for respiration..ate. This device save a reasonably good heart rate indication when testedon a human subject; the readout was voice stable, but not very stable tomechanical vibration. Readout of resuiration rate was less satisfactory.The second device (roughly, a 6-inch tube) uses a mingle microphone probeto pick up heart and respiratory &ounds; neither indication wak usable.

h• devinea are reported to,ýave worked well at the breadboard stage withan oscilloscop, as detector. -

4

Promnosis: Iteither device meets JSOR criteria for an ALD for NBC battlefieldsse long as direct skin contact is required. While it is conceivable thateither device could be given noncontact or remote capability (sinilar to thePMC), no such development is contemplated.

J. VITAL SIGNS !OLUTOR (AMiT/SAMARAS). A noncontact vital signsmonitor has been developed in prototype by 3S1 Engineering Corporation underArmy contract. This device uses an arm cuff to pick up heart rate and bloodpressure, and an anemometrlo transducer tc measure respiratory rates andvolumes. The device can be used with the nasualty in the chemical protectiveensemble or protective patient wrap. It is functional in high noise andvibration environamnts, such as the M113 armored persGnnel carrier. This isa diagnostic instrument, and not an ALD as such; it was evaluated to determinewhether it could meet requirements as an ALD.

Pr.ognosis: The device is too large &nd heavy to reet the size and weightrequirement, and the cuff is too uumbersome to permit rapid indication of lifesigns on a battlefisld.

k. VITAL SIGNS MONITOR (ARMY, AIR FORCE/ALLING). A noncontaot vitalsiEPs monitor has been developse in prototype by Arthur D. Little, Inc., underjoint Army and Air Force funding. The device was not inspected, but it isunderstood to be s;jilar in function and capabilities to the device describedimmediately above. A competitivcoparison of t1.a two units was scheduledby the Air Force for October 1987.

Prognosis: It appears that this device will be too large, heavy, andcumbersome to meet the requirements of an ALD.

1. FLASH REFLECTANCE OXIMETER (SAMARAS). A device described in a B&Aproposal from GMS Engineering Corporation is based on oximtry, a techniquefor determining arterial hemoglobin oxygen saturation. An alive-or-deadindication is giuen in less than one second, and the device is not motion-sensitive. Because an oximeter measures integrated cardiopulnonary function,it indirectly meets the requirement for heart and respiration rote. In itspresent oonfiguration, it indicates the absence of heart beat as well ashemoglobin saturation; the offeror states that it could be readily recon-figured to prcvide a heart rate indication in less t~an 10 seconds. Theprojeoted size and weight of the prototype are 27 in and 1.5 lb.,respectively.

Pmognosis: No suitable device exists for evaluation; however, this isthe only system of which we are aware that meets the basic requirement fora small device that provides a rapid, reliable, alive-or-dead indicationwithout support aquipment attached to the casualty.

5

MARKET SURVEY RESULTS

A market survey was conducted, and six approaches rep,-esentirg fourdevelopmntal units (tw already described above) and twc nondevelopmentalunits we-e identified."

a. Nondevelopmental Systems:

(1) BIOSIG INSTRUMENTS, INC. The system is similar in function tothe PMC under development at Purdue. A miniature transmitter is mounted onan elasticized chest belt containing ECG electrodes. The heart-rate signalis transmitted to a wrist unit or other small receiver; each transmitter hasa discrete frequency (up to 80 channels). The manufacturer claims that thesystem on be used to monitor the pulse of athletes which may relate to thesuitability and reliability of the system in the field.

Projiosis: The device apparently qualifies for technology assessment.

(2) BUFFINGTON CLINICAL SYSTEMS. The Buffington cuff system ismore nearly a vital signs monitor than advanced life detector. It resemblesan ordinary blood pressure cuff, but the output is a pressure change relatedto pulse rolume; when connected to a MicroCor ECO monitor, it provides adigital diepla7 of pulse rate and a wave display of pulse amplitude. It isclaimed that the cuff will function through several layers of heavy clothing,although it would certainly be unsuitable for use with the protective patientwrap. The monitor is the size of a pocket calculator.

Prog'nosis: Additional information is required to assess this syster. Theprincipal question concerns the time needed to get a life sign indication.In its present configuration, the device fails to meet the requirement toprovide .a life sign indication through the protective patient wrap.

b. Developmental Systems:

(1) MEDICAL MONITORING SYSTEMS, INC. (MMS). This device representsanother variation on the detector-transmitter-receiver system exemplifiedby the PMC. A BAA preproposal was submitted earlier this year by MMS andrevirwed by USABRDL. The preproposal is technically inadequate; untildetailed information is provided, evaluation of the suizability of thedevice is not possible.

Prognosia: No suitable device exists for evaluation.

(2) THOUGHT TECHNOLOGY LTD. This device is claimed to be a passiveheart rate and temperature monitor based on pacemaker technology. The passivesensor (undefined) attaches to the ahest with a stick-on strip and iselectrically activated when the monitor is placed over the chest. Apparently,a prototype of sorts exists; it is claimed to meet rtze limitations but mayhave problems relating to motion and noise.

NI Prognosis: Although a thorough evaluation of this oystem is not possible atthis tme, the concept and approach appear promising.

Compliance with critical requirements is summarized in Table 1 fcr all devicessurveyed.

N

DISCUSSION

Methods for life signs detection have been reviewed by Lesbard and WongIand are represented by the devices inspected. Most of them are based ontraditional measurements, such as heart rate, respiration rate, pulse, andblood pressure. Innovative concepts, such as oximetry, are only beginning toreach the research and developmcnt stage. Aft er reviewing the current systemsdesigned to detect vital signs, it is apparent that few if any of them aresufficiently Ldvanced to fulfill the requirements of the JSOR, and thedevelopment of a test plan for the proposed tri-service evaluation of devicesis premature. However, the following check list is proposed as a guide:

a. Vital Sign. The vital sign employed must be (within reason) areliable life/death indicator and should not be limited to traditionalmeasurements of heart and resp~iratory rates.

b. Weight and Size. The limitation of 3in. x 4in. by 1/2 in. is probablyunattainable in a single unit at this tile. The developer should strive for adevice not exceeding approximately 20 in and 1 lb. in the finalconfiguration.

o. Display. Whether digital or analog, the data should be displayed interms of the life sign indicated, for example a digital heart rate indicator,or a go/no-lo display.

AId. Speed. A life/death indication should be made within 30 seconds with

both casualty and aidman in NBC protective ensemb]es. (An instantaneousindication is highly unlikely, e.pecially if the parameters measured are heartand respiratory rates.)

e. Noise and Vibration. The level of noise, vibration, or other movementthe device will encounter is a matter dictated by where the device is used;however, as a minimum, it is suggested that the device must give reliable,repeatable life sign indications when hand-held by the aidman.

f. Battery Life. The device should function for at least 6 hours on anintegral power source, based on a 30-second requirement for each alive-or-deadmeasurement. (Battery life is probably an inappropriate requirement sincethere will be large variations in power draw for different devices; it wouldbe better to specify the number of measurements per recharge.)

7

TABLE 1. SU4MARY OF CANDIDATES EVALUATRD

REQUIREMENT

Candidate NBCb Vital Weightd Prese- Speed f Noisesign & size tatione & vibrg

PMC + ? +

Microwave

USI/Siegel + + + ?

USN/Seals - -+

USAF/Seals +- -

USX/Chein + #

USA/RCA +

Ultrasound -

Strseaming Pot. +

Yoke Probe (USAF) - + ?

Tube Probe (USAF) - - ?

VSt/GMS •?

VSI/ADL # # I # #

Biosig ECG + + • ?

Buftington Cuff - •? ?

MMS Deioe ? ? ? ? ?

Thought Technol. •? ? ? ?

Oximter/GlS * • • •

S

a. *: The device moets the requirement or can reasonably

be expected to do so after normal development.

-: The device fails.

?: Success is uncertain.

#: Neither the device nor data sheets have been examined.

b. The device can be used with both aidman and casualty in protectiveensebles or with the casualty in protective patient wrap without compromisingNBC protection.

c. The vital sign is heart rate and/or some other suitable parameter.

d. WNight and size can be expected not to exceed approximetely 1 lb. and20 in in final configuration.

e. The presentation is digital or analog. (Conversion from an oscilloscopereadout is not considered * normal. development.0)

f. A life sign indication is presented in 30 seconds or less.

g. A reproducible life sign is possible with both aidman and casualtyundergoing moderate movement.

9

CONCLUSIONS ANY RECOMMENDATION

1. At this time there are three completed or nearly aompleted devices knownto USABRDL that might serve as life detectoi's within the scope of the draftJSOR. These are the PMC, under development at Purdue University; the second-generation microwave system, under development at Michigan State University;and the Biosig ECG device, which is a commercial item. The earliest date fortesting developmental items will be September 1988.

2. In consideration of the above, it is recommended that the three systemdescribed be considered for evaluation according to the proposed test plan InOctober 1988.

3. The Joint Services should continue to seek more satisfactory solutions.

a. Development of the flash reflectance oximeter, nuch as that proposedby GMS Engineering Corporation, should be pursued vigorously.

b. The Buffington Clinical Systems cuff should be evaluated.

c. A demonstration of the principle underlying the Thought Technology LTDheart rate and temperature monitor should be sought.

REFERENCES

(1) Memorandum, SGRD-UMA, 20 May 87, subject: Minutes for Tri-Service JointWorking Group (TSJWG) on Advanced Life Detector.

(2) Letter, HSHA-CDM, 21 Jan 83, subject: Letter of Agreement (LOA) for anNBC Casualty Noninvasive (Heart Rate) Survival Monitor.

(3) Memorandum, HSHA-CDM, 27 Jul 87, subject: Draft Joint ServicesOperational Requirement (JSOR) for the Advanced Life Detector (ALD).

(4) Tacker, W.A., Jr., J.T. Jones and K.S. Foster. 1986. The PersonalMonitor and Communicator. Final Report, DAMD17-85-G-5012. U.S. Army MedicalResearch and Development Command, Ft. Detrick, Frederick, MD.

(5) Dr. Marvin Siegel, Michigan State University, personal oamunication,

August 1967.

(6) Cdr R. Wolf, USN, personal communication, July 1987.

(7) Seals, J., S.R. Crowgey and S.M. Sharpe. 1986. Electromagnetic VitalSigns Monitor. Final Report, Air Force Contract No. F33615-83-D-0601. USAFSchool of Aeiospace Medicine, Brooks AFB, TX.

(8) Dr. David N. Erwin, USAF School of Aerospace Medicine, personalcommunication, August 1987.

10

(9) Paoela, A.F., ed. 1987. Microwave Bee Monitors Bumn Victim' VitalSigns. Rioned. Technol., 14015), 170.

(10) Chen, K-H., D. Misra, H. Wang, H-R. Chuang and S. Postow. 1986. AnI-Band Microwave Life-Detection System. Trans. Biomed. Eng., BME-33 (7),697-701.

(11) Mawhinneyp D.D. 1983. Noninvasive Heart Rate Monitor. Final Report,Phase I, DAMDI7-83-C-3018. U.S. Army Medical Research and DevelopmentCommand, Ft. Detrick, Frederick, MD.

(12) Memorandum, SGRD-UBB-9, 27 Doec 19849 subject: Meeting with Contractorsfor Heart Rate and Vital Signs Monitors.

(13) Chang, K.V. and S.Y. Chang. 1983. Moninvasive Heart Rate Monitor.rinal Report, Phase I, DAMD17-83-C-3019. U.S. Army Medical Research andDevelopment Command, Ft. Detrick, Frederick, MD.

(14) Leasird, C.S. and W.C. Wong. 1984. Evaluation of NonizvaaiveMeasurement Methods and Systems for Application in Vital Signs Detection:Part 1. Literature Review. USAFSAM-TR-85-44-Pt-1. USA? Scobol of AerospaceMedicine, Brooks Air Force Base, TX.

(15) Decision Science, Inc. 1984. Proposal for Evaluating the Heart RateMonitor Sensor as a Vital Sipns Monitor. Titan Systems, Inc. La Jolla, CA.

(16) .ILT William Raundolph, UISAF School of Aerospece Medicine, personalcomunication, August 1987.

(17) Gordon Alling, Arthur D. Little, Inc., personal communicationi, September1987.

(18) CPT William Marley, USAF School of Aerospace Medicine, personalacomunication, August 1987.

(19) ERR Systems. 19)87. Market Survey Investigation for Advanced LifeDetectors. Draft final report, Contract No. DAMD17-8JI-C4261, Task Order No.U02-A-7-2095, U.S. Army Medical Research and Development Commnd, Ft.Detrick, Frederick, MD.

11111 1 3 1 1 1 1 1 1 11 1

APfPSIX A

DEFINITIONS

An advanced litf detector (ALD) is a device to be used by an aidm•n todetermine if a battlefield casualty is alive or dead. For the purpose ofthis report, noninvasive maons that the device does not penetrate the akin(although radiation from the device my); noncontact means that the devicecan masuwe through heavy clothing; rr3t mews that the device need nottouch the body at all; and glj w mans that the device can operate atdistances of 10 voters or more.

12

APPENDIX B

GLOSSARY

ALD Idvenced Life DetectorBAA Broad Agency AnnounoementECO ElectrocardiogramJSOR Jotnt Services Operational RequirementNBC Nuclear, Biological and ChemoalPHC Personal Monitor and CommuaicatorTSJWG Tri-Service Joint Working GroupUSA U.S. ArmyUSABRDL U.S. Army Biomodical Research and Development LaboratoryOSAF U.S. Air ForceUSX U.S. NavyVSM Vital Signs Monitor

13

D13TJIIBUTI N LIST

No. ofCo~ies

ComanderU.S. Army Medical Research and Development CoutmandATTN: SGRD-ZAFort Detrick, Frederick, MD 21701-5012

5 Commander13.3. Army Medi.,al Research and Development CommandATTN: SORD-RMSFort Detrick, Frederick, HD 21701-5012

3 CommanderU.S. Army Medical Research and Development CommandATTN: SGRD-PLBFurt Detrick, Frederick:, MD 21701-5012

CommanderU.S. Army Medical Researah and Development CommandATTN: SGRD-PLBFort Detriok, Frederick, MD 21701-5012

12 Defense Technical Information Center (DTIC)ATTN: DTIC-DDACameron StationAlexandria, VA 22314

1 CommanderU.S. Army Biomedical Research and Development Laboratoov'ATTN: SGRD-UBZ-ALFort Detrick, Frederick, MD 21701-5010

1 CommanderU.S. Army Medical Materiel AgencyATTN: SCG*1A-IU4PFort Detrick, Frederick, MD 21701-5001

4 CommanderU.S. Army Medical Materiel Development ActivityATTN: SGRD-UMZFort Detriok, Frederick, HD 21701-5009

1 CommanderU.S. Army Medical Materiel Development Activ:,'.tyATTN: SGRD-UMA (COL Leone)Fort Detrick, Frederick, MD 21701-5009

144

2 CommandantAoademy of Health Sciences, U.S. ArmyATTN: BSHA--CDHFort San Houston, TX 76234-6000

1 CcinanderU.S. Army Aercmedical Research LaboratoryATTN: 3GRD-UAC-DFort Rucker, AL 36362-5292

I Naval Medical Researoh A Development CuaandCode 407ATTI: Cdr Volfbthes4a, MD 20814-5044

1 Chief of Naval OperationsOP 933D4ATTN: Cdr CarterWashington, DC 20350-2000

1 USAFSAM/RZPATTN: Dr. ErvinBrooks AFB, TU 782r)3-5301

1 USAFSAM/VWCBrooks AB, TX 78235-5301

I HSD/APBrooks AFB, TX 78235

1 HQ USAF/SGPTBolling AFB, VA 20332-6188

15

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