Health Service Support in a Nuclear, Biological, and Chemical Environment / Tactics, Techniques, and Procedures

by United States. Department of the Army

Section II. MEDICAL PLANNING GUIDE FOR THE ESTIMATION OF NUCLEAR, BIOLOGICAL, AND CHEMICAL BATTLE CASUALTIES (NUCLEAR)—AMedP-8(A), VOLUME I

D-3. General

a. Volume I of the guide provides estimates of casualties and remaining operational strength after a nuclear detonation in a brigade-sized unit during an out-of-area contingency operation. These estimates include the numbers, injury type (initial nuclear radiation, blast, and thermal injuries), and injury severity of nuclear patients based on several brigade scenarios. The scenarios include three different brigade-sized units, in warned or unwarned posture, which have single detonation of 5, 20, or 50 KT in the unit area.

b. The guide is organized into 10 sections. Section 1 introduces the guide and presents background and medical planning considerations. Section 2 provides information on the methodology used to develop the estimates of fatalities, casualties, and effectiveness of individuals remaining in the unit. Section 3 explores the use of the casualty prediction tables based on combat effectiveness decrements and estimates of the number of casualties categorized by insult level. Sections 4 through 10 contain tables of casualty estimates.

c. A sample of this information is graphically depicted in Tables 1-1 and 1-2 of the guide. The casualty estimates used to prepare these tables are presented in the guide as Tables 6-4 and 10-4 in Sections 6 and 10 respectively. The use of these tables is explained in paragraphs 3.1 through 3.6 of the guide. Paragraphs 3.7 and 3.8 of the guide discuss how to use the guide for situations not explicitly addressed.

d. The effects of residual radiation on personnel are not included in the guide. AMedP-6 and AMedP-7 provide information on planning, operations, and treatment for a residual radiation situation. Also not included is the impact of tumbling; impact of glass shards from windows of vehicles or buildings; crushing deaths from building failure; or COSC casualties; thus causing underestimations on the number of patients. Further, there will be personnel who get radiation doses or burns and do not seek medical care.

e. A nuclear detonation may introduce new levels of destruction to the battlefield. There is very little experience with nuclear effects and there is certainly no experience with these weapons on a modern, highly technological battlefield. Therefore, there is little historical data on which to base estimates of personnel injured. Computer simulations are generally used to estimate numbers of personnel injured. Although these estimates may include significant uncertainty, they provide the best estimates to date.

D-4. Medical Planning Considerations

a. For effective mass casualty management, key medical and related considerations must be well planned and practiced. These include on-site triage and emergency care, communications, health service logistics, evacuation by ground and air resources, and personnel training in self-aid/buddy aid. Plans need to be made for requirements that may differ from the usual combat situation. For example, in combat situations, severe burn injuries in large numbers are relatively uncommon. Therefore, no special planning for the care of large numbers of burn patients is required. In a nuclear environment, this may not be true, and consideration must be given to the increased need for medical support that would result from a high incidence of burn patients.

b. Prior to an attack, the data may be used by medical planners to augment the requirements for conventional combat as appropriate for the nuclear situation. The tables can be used to prepare estimates of the number of patients at all echelons.

c. After an attack, the effectiveness and adequacy of the medical support effort during the first 24 hours are critical. Commanders should be informed rapidly of the estimated medical load in order to provide rescue and treatment resources or request assistance from higher headquarters, adjacent units, or allied units. These estimates should be updated postattack based on aerial or ground reconnaissance and survey.

d. In addition to casualties, a nuclear weapon detonation can generate an EMP that may cause catastrophic failures of electronic equipment components and may adversely affect the capability of all units in the area of the detonation. Electromagnetic pulse has no direct effect on personnel and is not further addressed in this publication.

D-5. Triage

Since a nuclear detonation may produce mass casualties, plans for a triage system must be in place. Paragraphs 3.4 through 3.5 of the guide describe patient categories by injury severity and may be used to estimate the number and injury severity of patients for a particular operational scenario. The guide does not, however, provide estimates of the number of patients by triage classification.

D-6. Evacuation

a. An efficient and flexible evacuation plan is absolutely essential for the preservation of life and to retain the mobility of forward medical resources. In a potential mass casualty situation, the full range of evacuation assets should be considered.

b. The extended hospital time of nuclear casualties will influence levels of evacuation or hospitalization. In addition, estimates of the different types of casualties can be a consideration in evacuation planning. In planning for evacuation, estimates provided in the guide can be used as a starting point from which to estimate evacuation resources.

D-7. In-Unit Care

a. Some personnel within the military unit may not be classified medically as casualties, but will require some self-aid and buddy aid. A casualty is defined as anyone entering the medical system. Paragraph 2.5 of the guide further describes the basis for casualty calculation.

b. Nuclear detonations will produce a large number of blast, burn, and projectile injuries that initially must be treated by individual soldiers trained in first aid procedures. The physical damage to the surrounding area as a result of a nuclear detonation will increase delays in medical assistance and evacuation. Training in self-aid/buddy aid will improve casualty survival rates and conserve medical resources. The guide can be used to provide a conservative estimate of the numbers of injured that will require first aid. The tables in Sections 4 through 10 of the guide, showing the status of unit personnel by time period, can be used to indicate the numbers of personnel who are injured (but not casualties) who may require first aid.

D-8. Hospital Bed Requirements

The data provided in the guide can be used to determine immediate additional bed requirements resulting from a nuclear detonation. In addition to the numbers of patients who will need beds, the data provided in the guide can also indicate the increased hospitalization time of nuclear casualties. Long-term bed requirements, greater than 30 days, are not provided. Based on the theater evacuation policy specified for the operation, the hospital bed days may be in theater or in CONUS.

D-9. Medical Logistics

The data provided in the guide can assist in estimating the needed supplies. The supply system must be prepared for increased demands for certain types of medical and general supplies and equipment, kits, dressings, and antibiotics. The treatment of combined injuries will not require any special types of supplies, although demands for certain types of supplies will increase.

D-10. Medical Force Planning

The assignment of medical support is normally based upon the total military population and the expected conventional casualty rate. The data provided in the guide may be used to assess the requirement for additional medical units. The planning guidance presented in this document can (and should) be modified to reflect the needs of the anticipated operation, including operational tempo, national/coalition priorities, medical resource allotment, and so forth. When trying to augment personnel, consider that the use of a nuclear weapon in a tactical situation could be an indication of an increased tempo of warfare. Therefore, even though a unit may be targeted with a nuclear detonation, that unit may not be the site where the highest numbers of casualties are being produced, and another unit may have priority of support.

This Section Implements STANAG 2476.