Implications drawn from a military bioterror exercise in Israel.

Orange Flame is an Israeli preparedness build-up project, conducted by the Ministry of Health, that is aimed at improving national readiness and preparedness for unusual biological events. The project is intended for both medical and nonmedical organizations, and, since 2011, the exercise has also included operational units outside the medical corps. This has provided valuable insights into the consequences of bioterror or naturally occurring outbreaks for operative functionality and for the unique medical, logistical, and administrative efforts required from the armed forces in such an event. The 2-day drill reported on here executed a notional scenario in which category A bioterror agents were dispersed, causing civil and military casualties. Military personnel observed and assessed the performances of all participating organizations and observed the employment of emergency protocols during the drill. Military sustainment and operative capabilities were significantly affected by the occurrence of an unusual biological event. Comprehensive actions to be executed during such a scenario included quarantining military bases, considering postponement of military operations, and transferring on-call missions to other bases. Logistic consequences included the need for manpower and equipment reinforcement, as well as food and water supplies in cases of suspected source contamination. The project unveiled many operational and logistic quandaries and exposed various potential effects of a bioterror attack in the military. Lessons learned were used to revise preevent national and military doctrine for unusual biological events.