Section II. SAMPLING TECHNIQUES AND PROCEDURES

B-5. General

The collection of environmental, and background (control) samples/medical specimens is an integral part of investigating allegations pertaining to the first use of chemical or biological agents. The types of samples/specimens taken and the collection methods primarily depend upon the circumstances encountered by the collector. During all chemical and biological sampling operations, the commander establishes the required protective equipment to fit the situation. This appendix includes a recommended list of equipment for use during chemical and biological sampling operations (Table B-2).

Table B-2. Example NBC Collection and Shipping Equipment List

AMOUNTDESCRIPTIONSTOCK NUMBER
20 LABELS, PAPER, PRESSURE SENSITIVE7530-00-577-4376
2GLOVES, 8-8½, EDMONT WILSONTM8415-00-JO2-2902
2GLOVES, 9-9½, EDMONT WILSONTM8415-00-634-4639
1TAPE, ADHESIVE, PRESSURE SENSITIVE, 2 INCH7510-00-159-4450
1PLIERS, #47, 5 INCHES6520-00-543-5330
1SCREWDRIVER, FLAT TIP, ¼ INCH5120-00-596-865
1TONGS, TEFLONTM TIPSAF 15-202-5
2MICROSPATULA, WITH TEFLONTM ENDSAF 21-401-50A
1SCISSORS, UNIVERSAL TYPEAF 08-951-30
1SCOOP, POLYPROPYLENE, 5X2X2ASP S1021-5
2SPOON/SPATULA WITH TEFLONTMAF 14-356-10
1KNIFE, POCKET5110-00-526-8740
5BOTTLES, SAMPLE, POLYETHYLENE, 6 OUNCECP J-6103-50
1PIPET, JUMBO, TRANSFER TYPE (500/PKG)AF 13-711-7
10PIPET, GRADUAL, TRANSFER TYPE (500/PKG)AF 13-711-9A
10BAG, INSULATED, TYPE IAF 01-814-8
10BAG, INSULATED, TYPE 2[*]AF 01-814-10
1BAG, WHIRL/PAK, 6 OUNCE (500/PKG)AF 01-812-6B
1STRIP, pH TESTING, NONBLEEDING, PLASTICSW S-65271
1SEP-PAKTM C18W51910 (50/BOX)
2SYRINGE, HYPODERMIC, 50 OR 60 ml6515-00-168-6913
2STOPCOCK, THREE-WAYASP S8965-2
1TUBING, LABORATORY, R3602 CLEARAF 14-169-3B
1PEN, MARKING, WATERPROOFAF13-381 (12/PKG)
2TUBES, TENAXTMEC ST-023
1BLADE, SURGICAL, CS2L 150S6515-01-009-5297
2PACK, ICECP TR-6345-20
6PAD, NONADHESIVE, 3X4, 100s6510-00-111-0708
4PAD, COOLING, CHEMICAL, 4S6530-00-133-4299
2PIGLETTESSPECIAL ORDER
1TAPE, ANTISEIZE8030-00-889-3535
1AIR SAMPLER, PERSONALLSS G4980
1KIT, METRIC, POCKET BUBBLEGL4981
2METHANOL
1WATER, DISTILLED (5 BOTTLE/PKG)
1MATCHES, WATERPROOF
20RAZOR, SURGICAL PREP6515-00-926-2089
10WATCH, WRIST6645-00-066-4279
2PARAFILM WITH DISPENSER6640-01-185-3289
2FLOOR SWEEP (VERMICULITE)8720-01-026-9419
100SEALS, TAMPER-RESISTANT
1A GAS METER CAPABLE OF PROVIDING ON-STATION ANALYSIS/DETECTION CAPABILITY FOR MULTIPLE GASES TO INCLUDE INDUSTRIAL GASES.
1A COMBUSTIBLE GAS INDICATOR THAT INDICATES PERCENTAGE OF OXYGEN AND EXPLOSIVITY.
1A GAS METER THAT DETECTS VAPOR IN PARTS PER MILLION (PPM) AND INDICATES PRESENCE OF VAPOR AND ITS STRENGTH.
1SWABS, THROAT
2CAN, 6 POUND, METAL
10BAG, MYLAR
1CONTAINER, LEAD SHIELDING (FOR RADIATION SAMPLES)
1CONTAINER, SHIPPING, IATA
1CHEST, ICE
10BAG, PLASTIC, RECLOSABLE
[*] WILL BE REPLACED BY MYLAR BAGS

B-6. Expended Material

The NBC recon units collect samples under various circumstances. For example, a recon unit may collect samples in an area free of hostile forces. The Special Forces NBC Reconnaissance team may collect samples within the enemy area of operations or deep into the enemy's rear area. Samples include toxic agent munitions, chemical products, air, water, soil, and vegetation. In addition, all expended material used to collect the samples should be turned in to the laboratory with the samples. This material includes items such as expended M256A1 kits, M8 and M9 paper. These items should be recovered, packaged, and shipped with the suspected samples for analysis. Different information may be derived from each type of sample; [Table B-3] compares different types of samples.

B-7. Environmental Samples

Control or background samples that are collected from clean samples must be identical to the samples collected from the areas near the attack areas as baseline data. The contaminated samples must be compared to the baseline data (control samples). This is especially true if unknown or nonstandard chemical and/or suspected biological agents were employed. The analysis center uses the control samples to compare with a contaminated one. The recon unit collects control samples of soil, water, and vegetation from areas about 500 meters upwind of an alleged attack area. Control samples generically are the same as those collected in an alleged attack area. For example, if leaves from an apple tree in an attack area were collected as a suspected contaminated sample, the recon team should collect leaves (as a control sample) from an apple tree outside of the contaminated area. If water from a pond in the attack area is collected, the recon unit should collect control samples of water from a pond (not a moving stream) in a nearby clean area. The size of an environmental control sample should be about the same as the suspected contaminated sample collected from the attack area (see [Table B-4], page B-20).

Table B-3. Comparison of Sample Types

SAMPLE STABILITY ANALYSIS
SAMPLE TYPEINFO VALUETO COLLECTTIME REQUIREDRELIABILITY
AIRGOODGOOD20 MINHIGH
WATERGOODGOOD5 MINHIGH
SOILFAIRFAIR5 MINMODERATE
VEGETATIONFAIRPOOR10 MINLOW
TISSUEEXCELLENTFAIR30 MINHIGH
BLOODGOODFAIR10 MINHIGH
URINEGOODFAIR10 MINHIGH
MUNITION FRAGMENTSFAIRFAIR10 MINFAIR
PACKING MATERIALSFAIRFAIR10 MINFAIR

B-8. Collection of Air and Vapor Samples

a. Air is a good sample matrix since it is a well-mixed medium. Air from a sample site contains a static concentration of contaminants. The concentration of contaminants depends upon the flow rate of the contaminant into the environment, the wind speed, and the physical state of the contaminant, the terrain contours, and temperature as a variable. The sample should be taken within 102 meters of a contaminated surface and at the downwind edge of a contaminated area. The method should consist of pumping a given volume of air, by hand or electric pump, through sample tubes.

b. To avoid contamination, persons conducting air sampling should not use cologne, perfume, insect repellent, medical creams, or strong soaps before taking a sample. The fragrances from these products are volatile organic compounds that may be absorbed on the filter and skew analytical results. Smoke also severely interferes with air sampling, therefore, avoid tobacco and vehicle exhaust smoke.

c. The primary method for collecting air samples is with the PAS 1000 automatic air sampler in conjunction with a TenaxTM tube for a total of three to four minutes when possible. Upon completion of sampling, place the TenaxTM tube in a 2¼-inch piglette. Seal the piglette around the cap with either pressure-sensitive or TeflonTM tape. Once sealed, place the piglette into a Mylar or reclosable bag. Fold the bag around the piglette in a circular motion, then apply another bag and fold again. Once the bag is folded around the piglette, use any type tape to secure the bag around the piglette. Place the piglette into a refrigerator or cooler until the sample is transported to its destination.

d. When chemicals are permitted into the atmosphere from a facility, the best places to obtain samples are close to the emission source where the concentration of the chemical is not diluted. The further from the original point of release, the more diluted the sample becomes from mixing with air, water, or environmental pollutants.

e. Natural and man-made terrain features such as hills, valleys, and rows of buildings, sometimes aid the collector by channeling emissions. When these features are associated with a particular facility, their downwind side is a suitable place to collect a sample because the emission remains more concentrated further from the release point.

f. For collection in a possibly contaminated location, and if the situation permits, initially use a detection kit such as the M18A2/M256AI to determine if a possible vapor hazard exists from known chemical agents. Also, use the kit when personnel are required to examine possible toxic agent munitions. In any case, collect air samples with the white-band tubes and save for identification and analysis.

g. Small air samplers also enable the collector to obtain vapor samples from alleged toxic agent munitions at a safe distance while explosive ordnance disposal (EOD) operations are performed. If EOD personnel are not on the scene, the air sampler can be activated, and the collector can stand at a safe distance while the sampler is operating.

h. Perform sampling operations as soon as possible when directed by a higher headquarters or after suspected chemical or biological contamination is encountered.

B-9. Collection of Water Samples

a. Water sampling is a matter of collecting enough water to get acceptable information about the contaminants. The collector should provide the analysis center with one C18 and one silica cartridge when using the Sep-PakTM technique or 100 ml in a sterile bottle when Sep-PakTM is not available.

b. General guidelines: If it is believed that the threat has used standard chemical agents during an attack, use the M272 chemical agent water test kit for initial screening and sampling.

c. When collecting water samples using the Sep-PakTM C18 cartridge, the following items are required:

d. Prior to collecting each sample, prime the Sep-PakTM system in the following manner:

e. After priming the Sep-PakTM, assemble the components in the following configuration:

f. Use the following procedures to collect samples with Sep-PakTM:

NOTE

You should take a minimum of four samples: three samples of the suspected contamination and one control sample from a nearby unaffected (none contaminated) area for reference.

g. For samples to be representative of the overall contaminated area, the collection point should be carefully selected. Collect samples from—

NOTE

If an oil film, globules of organic materials, or an unnatural appearing powder-like material is visible on the water's surface, collect a surface sample of the material. If not, collect the sample from near the bottom of the water source (stream, lake, pond, water container). The upper layers of water may have lesser amounts of contaminants, due to higher temperatures that promote decomposition. Since most chemicals of interest are more dense than water, contaminants usually sink to the bottom of the water source.

h. Collect the sample without the Sep-PakTM by immersing a capped or stoppered container to the desired depth, removing the cap or stopper, letting the container fill, and then capping the container. An alternate method for deeper water is to use a plastic, pump-operated siphon to pump water from a specific depth.

i. The best time to collect a sample of water from a location is when intelligence or local reports indicate that a process of possible interest is ongoing. In the absence of reliable reporting, this may be indicated by increased activity, higher than normal amounts of security, or increased flow from facility chimneys or water discharge pipes. In field areas where a toxic agent has been sprayed or disseminated over a land area, the best time to collect water samples is just after the start of a rainstorm when runoff is beginning. Natural surface drainage will concentrate any remnants of toxic compounds in depressions, streams, or ditches.

B-10. Collection of Soil Samples

Soil is a suitable medium to collect as samples for toxic organic compounds. A critical point, however, is that the precise site of the agent deposition must be sampled for best results. Contamination may be recognized by discoloration or apparent deposition of material on the soil's surface. If discoloration or deposits of material are evident, only collect the discolored soil or deposited materials, if possible. Dead, malformed, and wilted foliage is an indicator of contamination. Soil samples should be collected from open areas, along the drip line tents, stationary equipment, bottom of ditches and terrain depressions.

a. Collect the soil samples by using a knife, spoon, spatula, or similar item to scrape a square of topsoil (2×5×1 centimeters) from areas that appear to have been contaminated in to a collection container. If chunks or clods of earth are collected, select those that are no larger than 10×5×1 centimeters (see [Table B-4]). Also, collect a control sample of soil of the same type and texture from a nearby uncontaminated area.

b. Use a glass bottle, jar, or TeflonTM jar as the container when available. When these containers are not available, Mylar bags may be used. When using a glass bottle, jar, or TeflonTM jar, seal the cap with either pressure-sensitive or TeflonTM tape, and mark for identification. When using Mylar bags, place each sample in a separate bag, push excess air out, and seal by folding the open end over two to three times and wrapping the bag with tape. Insert the first bag into a second bag, seal, tape, and mark for identification. If possible, place the samples in a piglette.

CAUTION

Avoid direct contact with the sample to prevent exposing yourself to the suspect agent (MOPP 4 is required).

c. Collect samples as soon as possible when directed, upon detection of a suspect substance, or after the alleged incident.

B-11. Collection of Contaminated Vegetation

As with soil samples, vegetation is also a suitable medium to collect as samples for toxic organic compounds.

a. Collect samples of vegetation that appear to be different from normal. Select leaves that have wilted or appear to have been chemically burned. Collect samples of vegetation that appear to have liquid or solid substances deposited on their surfaces (this may be noticed as a shiny or moist area).

b. Collect samples of vegetation at several locations within the suspected contaminated area. Using a cutting tool or any sharp object, cut several affected leaves and/or a handful of grass whenever possible. Do not crush the sample. Place the sample into a Mylar or reclosable bag. Squeeze excess air out of the bag and seal it. Fold the open end of the Mylar bag over two to three times, and wrap it with tape. The minimum size for a sample is three leaves or three handsful of grass. One leaf is of little value, but is better than nothing. Bark is acceptable but not preferred. Mark the bag for identification. Take a control sample of similar material from an unaffected (uncontaminated) area. Fold, seal, tape, and mark the control sample in the same manner as the actual sample.

c. When it is possible to determine a probable center of attack in an area, collect vegetation samples near the center of the area, about 100 meters upwind of the area, and in several 100-meter increments downwind of the area. If the collector can discern a contamination pattern in the area, this should be reported.

B-12. Medical Specimens

a. Just as blood and urine specimens are taken from humans who were allegedly exposed in an attack, also collect specimens from individuals who claim not to be affected by a toxic agent and are from the same group as exposed personnel. The purpose is the same as collecting environmental control specimens; that is, to determine if a toxic substance is present in the individuals' natural environment or if it has been artificially introduced.

b. Selection of humans for control sampling is somewhat more complicated than selection of environmental control samples. This is because ethnic diets, racial differences, physiological makeup, and actual living conditions of persons who are outwardly similar may introduce potentially large deviations. Each of these factors must be accurately considered before selecting subjects as controls.

c. Consideration of ethnic diets is important because of unique foods or methods of food preparation that may exist. As an example, individuals in settled areas may purchase beer that has been carefully filtered and sterilized, while individuals in a nearby unsettled area may ferment their own beer by burying home crafted jugs in the ground and extracting the product little by little over several months.

d. Racial differences can account for differences in mortality and morbidity rates in specific populations. One example of this could be the high rate of hemophilia in a population versus the rarity of the disease in another.

e. Physiological makeup is critical because of the differences in hormone balance and tissue composition in males, females, adults, and juveniles. For this reason, medical control specimens should be drawn from individuals of the same gender and approximate age as specimens from exposed personnel, if possible.

f. Differences in the actual living conditions of people also require a close look. The point here is that conditions in remote, semicivilized camps are seldom the same as those in a well-established camp that has access to modern amenities.

g. The bottom line in selecting subjects for medical control sampling is that they be as similar in all aspects as possible.

B-13. Collection of Medical Specimens

a. Trained medical technicians or physicians should collect medical specimens (human or animal); however, Special Forces NBC Reconnaissance team personnel are trained to do this procedure. Remember, the collector must have express permission (authority) to collect medical specimens from the dead, because of religious beliefs in many cultures. To obtain such specimens without permission may result in unnecessary mission complications. Ensure all personnel handling or collecting medical specimens have received proper immunizations for their own protection. They must be inoculated IAW The Surgeon General's guidance.

b. Medical specimens collected during an investigation include blood, urine, sputum, nasal swabs, and tissue specimens from living victims and blood and urine specimens from unexposed persons (background control specimens).

c. Collect blood specimens using either a standard 10 cc disposable syringe with a 1- to 1½-inch needle (20 to 22 gauge), or by using a VacutainerTM system. When using a VacutainerTM system, ensure that multiple specimen needles and "red top" vacuum tubes are used. Ten cc of blood is sufficient for analytical testing. Do not take more than 5 cc from small, malnourished children. After blood is collected, it should be transferred to a polypropylene-type container and sealed with parafilm before transporting. All body fluids should be collected without violating antiseptic techniques. Also, prior to transporting specimens, collectors need to check specimen containers for paper labels IAW guidelines for labeling medical specimens. Collect blood specimens using the following materials equipment:

NOTE

Gloves should be worn whenever handling medical specimens. Do not freeze liquid blood and urine specimens (ideal cooling temperature is between 35° and 40°F [2° to 4°C].)

d. Collect urine specimens using either a standard urine cup or by a urine catheter and urine cup. When collecting the specimen directly into a urine cup, the person must urinate into the cup until sufficient fluid is collected (40 cc of urine is preferable, although 10 cc can support analytical testing). When the person is unable to urinate, the catheterization technique is preferable. The catheterization technique is best performed in a clinical environment. As with other body fluids collected, urine must be kept cold. Do not freeze.

NOTE

For correct procedures on catheterization refer to STP 8-91W15-SM-TG.

e. Collect tissue specimens using sterile scissors and forceps or as directed by the attending physician.

(1) When casualties have unidentified skin lesions, photographs of the lesion(s) and overall photos of the extent of the lesion(s) should be taken, using color film before biopsy. A specimen of the lesion should be obtained. This is done by surgically removing a portion of the skin with a sterile pair of scissors and forceps.

(2) Place tissue specimens in a TeflonTM container filled ¼ inch from the bottom with a preservative, (formalin 10%) for preservation of the specimen until it reaches its proper destination. Seal the container and lid with parafilm. As with any other medical specimens, tissue specimens are refrigerated prior to shipment; but do not freeze tissue specimens.

f. Collect nasal swabs by using a cotton-tipped swab. Place the swab with collected specimen in a TeflonTM container filled ¼ inch from the bottom with a preservative for preservation of the specimen until it reaches its destination. Seal the container and lid with parafilm. Refrigerate the specimen for shipment, but do not freeze.

g. Collect sputum by having the patient discharge the sputum into a small, sterile screw-top jar or urine specimen cup. Seal the container and refrigerate the specimen for shipment, but do not freeze.

B-14. Post mortem Specimens

Post mortem specimens should be collected by individuals trained in forensics. When forensics-trained individuals are not available, the most qualified medical person should collect human specimens. Specimens from animals should be collected by veterinary personnel. In either case, the following specimens are collected:

NOTE

Before attempting any of the above procedures, collector must be certified by a qualified person (medical doctor) on the correct procedures to collect specimens from cadavers.

Table B-4. Standard Sizes of CB Samples/Specimens to be Collected

TYPESIZENOTES
CHEMICAL WARFARE SAMPLES
SOIL(10 CM X 5 CM X 1 CM)CIGARETTE-PACK SIZE OR LARGER AREA IS MORE USEFUL THAN GREATER DEPTH
DILUTE AGENT10 ML
WATER500 ML (MAXIMUM)
C18 SEP-PAKTM200 ML
VEGETATION(EQUIVALENT TO 3 LEAVES OR 3 HANDSFUL OF GRASS)DEPENDS ON AMOUNT OF CONTAMINATION. BEST SAMPLES WILL BE FOUND NEAR THE RELEASE POINT
BIOLOGICAL WARFARE SAMPLES
SOIL(10 CM X 5 CM X 1 CM)CIGARETTE-PACK SIZE OR LARGER AREA IS MORE USEFUL THAN GREATER DEPTH
LIQUID25 TO 50 MLDO NOT USE C18 SEP-PAKTM WITH MEDICAL SPECIMENS
VEGETATIONSIZE OF SOFT DRINK CANBEST SAMPLES DEPEND ON THE AMOUNT OF CONTAMINATION FOUND NEAR THE RELEASE POINT
MEDICAL SPECIMENS
URINE20 TO 50 MLMUST OBTAIN CONSENT TO COLLECT SPECIMENS FROM OTHER THAN US CASUALTIES
WHOLE BLOOD OR SERUM5 MLMUST OBTAIN CONSENT TO COLLECT SPECIMENS FROM OTHER THAN US CASUALTIES
CEREBRAL SPINAL FLUID2 MLMUST OBTAIN CONSENT TO COLLECT SPECIMENS FROM OTHER THAN US CASUALTIES
ORGAN TISSUE30 G (MINIMUM)
MEDIASTINAL LYMPH NODES2SHOULD BE REMOVED BY A SURGEON DURING AN AUTOPSY

B-15. Reporting, Packaging, and Shipment

Although a sample/specimen collected from an alleged attack area can be significant, it can become useless if proper steps are not taken to record critical information about its collection or if it is improperly packed and breaks during shipment to an analysis center. This section discusses the information needed when acquiring samples/specimens and the preferred methods for handling and packing samples/specimens for shipment.

a. A complete background information history of the circumstances about each sample's/specimen's acquisition must be provided to the agency analyzing the sample/specimen.

b. Critical background information includes—

c. Provide information on the agent effects on vegetation for soil or environmental samples. A description of the general area (jungle, mountain, grassland) and changes in the vegetation after agent deposition (such as color change, wilting, drying, dead) in the main attack and fringe areas.

d. Provide information on the agent effects on humans for medical specimens. Describe how the agent affected personnel in the main attack area versus fringe areas; the duration of agent effects; peculiar odors that may have been noticed in the area prior to, during, and/or after an attack; measures taken that alleviated or deteriorated the effects; and the approximate number of victims and survivors, to include their ages and genders.

e. Describe the agent effects on animals. Provide information on the types of animals that were or were not affected by an attack and of how they were affected.

B-16. Handling and Packaging Materials

Materials used for packaging samples/specimens primarily consist of Mylar collection bags, TeflonTM specimen jars and tubes, pigs and piglettes, ice chests, sealing materials, and wrapping and cushioning supplies.

a. Collection Bag. Use the Mylar bag as the initial container for such samples as protective masks and filter canisters, individual antidote and decon kits, munition fragments, and other items too large to place in a specimen jar. Use it also to package sample/specimen containers to ensure a vapor barrier in case the container is broken in transit. The bag acts as an initial or secondary vapor barrier to prevent air from leaking inward and toxic material outward. Follow the procedures below when using the bag.

b. Glass Specimen Jars and Polypropylene Tubes. Use glass containers to hold small environmental samples, water samples, and medical and post mortem specimens. Use polypropylene containers to hold medical specimens such as blood or urine. Polypropylene containers may be used for post mortem specimens if required; however, glass containers are preferred. The use of glass rather than plastic containers is preferred for environmental samples because toxic agents may leach chemicals from plastics into a sample, introducing contamination and confusing the analysis efforts.

c. Six-Pound Metal Can. Use metal cans as the external container for packaging small items that have been sealed in Mylar bags, specimen jars, and polypropylene tubes containing medical specimens. The metal can helps absorb shock from rough handling during shipment and eliminates the spread of contamination if a specimen container is broken. The six-pound metal can is capable of holding more than one sample/specimen (depending upon size of samples/specimens).

d. Ice Chest. Standard polyethylene or metal ice chests are the most easily procured items used for transworld shipment of CB samples/specimens. The most easily used size is about 24 inches long by 18 inches high by 15 inches deep. This size permits the sender to ship two or three 6-pound metal cans in each chest with sufficient dry ice to maintain freezing temperatures for about four days. Also, each chest remains at a weight that one individual can handle.

e. Transport Container. When the samples/specimens must be transported on commercial aircraft, an IATA-approved sample transport container must be used for shipment/delivery to the CONUS laboratory.

f. Coolants. Samples/specimens submitted for laboratory analysis must be properly packaged, labeled, and shipped to ensure they arrive in an analytically acceptable condition. All samples should be maintained at a temperature of 1° to 4°C during transport. Ideally, samples/specimens should arrive at the in-theater laboratory within 6 hours of collection. The samples/specimens should be delivered to the CONUS laboratory within 24 to 48 hours. If the samples/specimens cannot be delivered to the CONUS laboratory within this time, then they should be flash frozen to -165°C, if capabilities are available. If available, dry ice should be used when flash freezing cannot be accomplished. If the samples/specimens cannot be delivered to the CONUS laboratory within 24 hours, the supporting laboratory should subculture the samples/specimens and send the subculture with the samples/specimens to the CONUS laboratory. The subculturing date should also be provided.

g. Internal Insulation. While a commercial ice chest provides good insulation of both the samples/specimens and the coolant, it is best to place extra insulation and cushioning around the metal cans inside the chest. Newspapers, plastic bubble wrap, and foam rubber may all be used with almost equally good results except newspapers and standard ice do not mix well.

B-17. Collection Reporting

a. The collector must provide a formatted message for transmission as soon as possible to report acquisition and shipment of samples/specimens. During special operations in a theater in which a Special Forces Group (SFG) is deployed, the message is transmitted by the fastest means through the fewest channels to the NBC control (NBCC) center. If a NBCC center has not been deployed to the area of operations, as in low-sample/specimen volume peacetime NBC sampling operation, the message is transmitted by the fastest means through the fewest channels to the message addressees below. In addition, a written report accompanies each sample/specimen or batch of samples/specimens. The collector ensures that the acquisition message has been properly classified.

b. The collection report includes at least the following addressees:

SECSTATE WASHDC
SECDEF WASHDCHOSD-ISA/OUS-DREH
JCS WASHDC//J-3/J-5H
CIA WASHDCHOSWR-STD-LSBNIC-NIO(STP)H
DIA WASHDC//DT-3B/DT-5A//
DIR AFMIC FT DETRICK MD//AFMIC-CR/AFMIC-SA//
DA WASHDC//DAMI-FIT/DAMO-SWC//
CMDT USACMLS FT LEONARD WOOD MO//ATSN-CM-CO//
CDR SBCCOM APG
MDHSMCCR-OPF/SMCTE-OPE-RA-ID2H
CDR FSTC CHARLOTTESVILLE VA//AIAST-RA-ID2H
CDR USAMRIID FT DETRICK MD (For suspect biological samples/specimens only.)

c. A collection message contains the following information:

d. Ship all samples/specimens by the fastest, safest means, preferably by a technical escort unit (TEU) to the theater Chemical-Biological Sampling Control Element (CBSCE) or to a location the CBSCE designates. If there is no CBSCE in the theater, send the samples/specimens IAW preplanned instructions from the Chemical-Biological Sampling Control Center (CBSCC) at CBDA, Aberdeen, Maryland. The CBSCC uses the following criteria to determine the final destination of each sample:

(1) In any case, the NBCC center must be notified in advance of shipment of the sample so additional instructions or deviations from standard instructions can be given. [Figure B-l] shows an example of a shipping notification message. The NBCC center will direct, in advance, that samples be sent to one or more of the following locations, depending on the category of the samples. Prior to shipment of samples/specimens, contact must be made with—

Commander
Technical Escort Unit
ATTN: SMCTE-OPE
Aberdeen Proving Ground, MD 21010
DSN: 584-4381 (Duty hours) DSN: 584-2773 (After duty hours)

(2) This unit controls the transport of samples/specimens to their final destination(s). Do not ship suspected toxic samples/specimens or munition systems to CONUS technical centers or intelligence agencies without coordination and prior approval by the recipient.

NOTE

Suspect CB samples/specimens are first delivered to the supporting medical laboratory in the AO for in-theater analysis before they are transported out of the AO. The supporting laboratory will withdraw an aliquot of selected samples/specimens for analysis. The supporting medical laboratory is responsible for providing the AO commander confirmatory identification within the AO. The CONUS-based reference laboratory is responsible for providing confirmatory identification for President and Secretary of Defense purposes.

FM AMEMBASSY DDTTTTZ JAN 02
TO CDR TEU APG MD//SMCTE-OPE//
SECSTATE WASHDC
SECDEF WASHDC//OSD-ISA/OUS-DRE//
INFO CIA WASHDC//OSWR-STD-LSB/NIC-NIO(STP)//
JCS WASHDC//J-3/J-5//
DIA WASHDC//DT-3B/DT-5A//
DIR NSA FT MEADE MD
DIR AFMIC FT DETRICK MD//AFMIC-CR/AFMIC-SA//
DA WASHDC/DAMI-FIT/DAMO-SWC//
CDR FSTC CHARLOTTESVILLE VA//AIAST-RA-ID2//
CDR CBDA APG MD//SMCCR-OPF//
CDR USACMLS FT MCCLELLAN//ATZN-CM-CU//

CLASSIFICATION

SECSTATE FOR...
SECDEF FOR...
CIA FOR...
JCS FOR J-3/J-5 FOR...
DA FOR DAMO-SWC FOR...
AFMIC FOR...
CBDA FOR FIO...
FSTC FOR AMXST-FW...
USACMLS FOR THREAT MGR...
E.0.12356: DECL: OADR (Note: This is included if the message is classified.)
TAGS: ...
Subject: Shipment of CB Samples/Specimens
REF(S): TEU MSG #, (DTG DDTTTT [time zone] JAN 02)

1. (W) SHIPPING INFORMATION:

2. SPECIAL HANDLING REQUIREMENTS: DRY ICE ENCLOSED AS COOLANT.

3. SHIPMENT CONSISTS OF TWO ICE CHESTS (1 FOR CRDEC AND 1 FOR AFMIC) CONTAINING SIX SAMPLES/SPECIMENS. ALL LIQUID SAMPLES/SPECIMENS ARE IN POLYPROPYLENE TUBES AND HAVE BEEN CAREFULLY PACKED TO AVOID BREAKAGE. THE FOLLOWING SAMPLES ARE INCLUDED IN THE SHIPMENT:

SAMPLE/SPECIMEN NUMBERMESSAGE REFERENCE
TH-850102-001AG THRU TH-850102-005AGBANGKOK DDTTTTZ JAN 02

4. USDAO HAS STATED THAT THIS SHIPMENT IS PARTIAL FULFILLMENT OF CIR.

Figure B-l. Sample shipping notification message.

B-18. Sample/Specimen Background Documents

The sample/specimen background document allows a collector to note the most relevant details associated with pre- and post-sample/specimen collection conditions. Do not consider the report to be all-inclusive. The information collected should include at least the items listed in [Figure B-2]. Interviews should be conducted with individuals exposed to the CB agent as well as individuals not exposed (see [Figure B-3]).

1. ID NUMBER___________

2. COLLECTION (DATE/TIME):______________________

3. COLLECTOR/UNIT:_______________________________

4. TYPE: ENVIRONMENTAL___ BIOMEDICAL___ SINGLE___ MULTIPLE___

5. PURPOSE: ATTACK___ CHEM/BIO ALARM___ CHEM DETECT___ RECON ILLNESS/DEATH___ OTHER___

6. POSTEXPOSURE: HOURS___ DAYS___ WEEKS___ UNKNOWN___

7. LOCATION: TOWN_________________ COORDINATES____________________________

A. TERRAIN: FLAT___ HILLS___ MOUNTAIN___ DESERT___ JUNGLE___ SPARSE TREES___ GRASS___ BODY OF WATER/TYPE___

B. WEATHER: CLEAR___ CLOUDY___ RAIN___ FOG___ SNOW___ DUST___

C. WIND: LIGHT___ HEAVY___ GUSTY___ NONE___

D. ODOR: SWEET___ FRUITY___ PEPPER___ FLOWER___ IRRITATING___ CHANGING___ NONE___ OTHER_____

E. TEMPERATURE AT TIME OF ATTACK:_____ TEMPERATURE AT TIME OF SAMPLE COLLECTION:_____

8. COMMENTS: _____________________________________________________________ _____________________________________________________________

9. ATTACK: DATE/TIME________ METHOD: ARTILLERY___ ROCKET___ AIRCRAFT___ MORTAR___ RPG/GRENADE___ OTHER, DESCRIBE:______________________________

A. EXPLOSION: AIR_________ (HEIGHT)_________ GROUND___________ SIZE_______ DISTANCE_________ DESCRIBE:____________________

B. CONSISTENCY: SMOKE___ MIST___ DUST___ RAIN___ GEL___ INVISIBLE, DESCRIBE:_______

10. ENVIRONMENTAL SAMPLE: SOIL___ WATER___ VEGETATION___ AIR___ OTHER___

11. BIOMED SPECIMEN: ACUTE___ CONVALESCENT___ EXPOSED___ NOT ILL___ POSTMORTEM___ CONTROL, EXPLAIN:___________________ BLOOD___ LIVER___ LUNG___ SPLEEN___ BRAIN___ SKIN___ KIDNEY___ URINE___ OTHER, DESCRIBE:_________________________

12. COMMENTS: _________________________________________________________

13. CASUALTY: SSN_______________ UNIT_______________________ SEX______

14. SIGNS/SYMPTOMS: ONSET__ DURATION__

A. HEAD: FEVER___ CHILLS___ HEADACHE___ FLUSHED___ DIZZINESS___ UNCONSCIOUSNESS___ COMA___ HALLUCINATIONS___

B. EYES: SUNLIGHT SENSITIVE___ PAINFUL___ BURNING___ DROOPY EYELIDS___ DOUBLE VISION___ BLURRED VISION___ LARGE PUPILS___ PINPOINT PUPILS___

C. NOSE: RUNNY___ BLEEDING___

D. THROAT: SORE___ DRY___ SALIVATING___ BLOODY SPUTUM___ HOARSENESS___ DIFFICULTY SPEAKING___

E. RESPIRATION: DIFFICULTY BREATHING___ CHEST/PAIN DISCOMFORT___ WHEEZING (IN/OUT)___ COUGHING___ LABORED BREATHING___

F. HEART POUNDING OR RUNNING___ IRREGULAR HEARTBEAT___

G. GI: LOSS OF APPETITE___ NAUSEA___ FREQUENT VOMITING___ FREQUENT DIARRHEA___ VOMITING BLOOD___ DIARRHEA WITH BLOOD___

H. URINARY: BLOODY URINE___ UNABLE TO URINATE___

I. MUSCULOSKELETAL: NECK PAIN____ MUSCLE TENDERNESS___ MUSCLE TREMBLING/ TWITCHING___ WEAKNESS___ PARALYSIS, DESCRIBE:_____________________ CONVULSIONS___ TREMORS___ MUSCLE ACHES___ BACK PAIN___ JOINT PAIN___

J. SKIN: RASH___ REDDENING___ ITCHING___ BLISTERS___ PAIN___ NUMBNESS___ PROFUSE PERSPIRATION___

15. COMMENTS:
_____________________________________________________________

16. ANIMALS AFFECTED: YES___ NO___ DESCRIBE:_________________

17. RELATED SPECIMENS_________________________________________
ID NUMBER_____________________________________
DESCRIPTION__________________________________

18. COLLECTOR
SIGNATURE____________________________
NAME___________________________
PHONE NUMBER______________________
E-MAIL________________________

19. REVIEWER
SIGNATURE
NAME
PHONE NUMBER_________________
E-MAIL_________________

Figure B-2. Sample/specimen background document.

CB INCIDENT INTERVIEW

DATE:_____________________ INTERVIEWER: _____________________________
SUBJECT'S NAME: _____________________________________________________
ALIAS #1_____________________________ #2_____________________________
AGE:____________ SEX: ____ M ____F YEAR OF BIRTH:_________
NATIONALITY:______________________________________________
SUBJECT'S ADDRESS:_________________________________________
IDENTITY CARD #:___________________________________________
DELIVERY METHODS:
TYPE:____UNKNOWN _____GROUND ____AIR _____ARTILLERY/ROCKET ____MINE
OTHER, DESCRIBE:_______________________________
HEIGHT: ______(M)
SIZE:_____________ (AFFECTED AREA IN METERS)
DISTANCE:__________(M)
AGENT CHARACTERISTICS
ODOR: _____NONE _____SWEET _____FRUITY _____IRRITATING _____PEPPER _____FLOWER _____CHANGING _____
OTHER, DESCRIBE:___________________________
COMMENTS:____________________________________________________
_____________________________________________________________
CONSISTENCY:
______SMOKE ______MIST _____DUST _____RAIN ______GEL ______DRY ____VISIBLE ____INVISIBLE ____OTHER, DESCRIBE:_______________________
COLOR:_____________ DESCRIBE DEVELOPMENT OF COLOR:___________________
AREA COVERAGE:______________________________________________
PHYSICAL DISSEMINATION/COVERAGE (i.e., DROPLET SIZE AND DISTRIBUTION):
WRITE OR DRAW______________________________________________
SYMPTOMS:__________________________________________________
_____________________________________________________________
INDIVIDUAL'S ACTIONS:
DURING ATTACK:_____________________________________________
___________________________________________________________
AFTER ATTACK:______________________________________________
___________________________________________________________
PROTECTIVE MEASURES:_______________________________________
TREATMENT RECEIVED:________________________________________
___________________________________________________________
ENVIRONMENTAL EFFECTS: VEGETATION CHANGE? ___YES ___NO
DESCRIBE:__________________________________________________
___________________________________________________________
ANIMALS AFFECTED? ___YES ___NO
DESCRIBE:__________________________________________________
OTHERS AFFECTED:
NAME AGE SYMPTOMS RESOLUTION
___________________________________________________________
___________________________________________________________
___________________________________________________________

Figure B-3. Chemical/biological incident interview.

FM AMEMBASSY DDTTTTZ JAN 02

1.00
SHIPPING

TO CDR TEU APG MD/SMCTE-OPEI/
SECSTATE WASHDC
SECDEF WASHDC//OSD-ISA/OUS-DRE//
INFO CIA WASHDC//OSWR-STD-LSB/NIC-NIO(STP)//
JCS WASHDC//J-3/J-5//
DIA WASHDC//DT-3B/DT-5A//
DIR NSA FT MEADE MD
DIR AFMIC FT DETRICK MD//AFMIC- CR/AFMIC-SA//DA WASHDC//DAMI-FIT/DAMO-SWC//
CDR FSTC CHARLOTTESVILLE VA//AIAST-RA-ID2//
CDR CRDEC APG MD//SMCCR-OPE//
CDR USACMLS FT LEONARD WOOD MO//ATSN-CM-CO//
CDR USAMRIID FT DETRICK MD// (FOR SUSPECT BIOLOGICAL SAMPLES/SPECIMENS ONLY)

CLASSIFICATION

SECSTATE FOR...
SECDEF FOR
CIA FOR
JCS FOR J-3/J-5 FOR
DA FOR DAMO-SWC FOR
AFMIC FOR
CRDEC FOR FIO
FSTC FOR AMXST-FM
USACMLS FOR THREAT MGR
E.O. 12356: DECL: OADR (NOTE: This is included if the message is classified.)
TAGS:
SUBJECT: SHIPMENT OF CB SAMPLES
REF(S): TEU MSG, #______. (DTG DDTTTT [time zone] Jan 02)

1. INFORMATION:

2. SPECIAL HANDLING REQUIREMENTS: DRY ICE ENCLOSED AS COOLANT.

3. SHIPMENT CONSISTS OF TWO ICE CHESTS (1 FOR CRDEC AND 1 FOR AFMICO) CONTAINING SIX SAMPLES/SPECIMENS. ALL LIQUID SAMPLES/SPECIMENS ARE IN POLYPROPYLENE TUBES AND HAVE BEEN CAREFULLY PACKED TO AVOID BREAKAGE. THE FOLLOWING SAMPLES/SPECIMENS ARE INCLUDED IN THE SHIPMENT:

SAMPLE/SPECIMEN NUMBERMESSAGE REFERENCE TH-8501
1AG THRU TH-850102-005AGBANGKOK DDTTTTZ JAN 0202-00

4. USDAO HAS STATED THAT THIS SHIPMENT IS PARTIAL FULFILLMENT OF CIR.

Figure B-4. Sample/specimen shipping report.

[APPENDIX C]
GUIDELINES FOR OPERATIONAL PLANNING FOR HEALTH SERVICE SUPPORT IN A NUCLEAR, BIOLOGICAL, AND CHEMICAL ENVIRONMENT

C-1. General

As the HSS unit prepares for its support role, NBC, TIM, and CBRNE considerations must be included. This appendix provides guidelines for HSS planning, preparing for, and conducting operations in an NBC environment and responding to a homeland defense CBRNE event.

C-2. Predeployment

When preparing the unit's mobilization plan and TSOP, include the supplies and equipment that will be required for the unit to operate in an NBC environment. DO NOT wait until ordered to mobilize to begin preparation for the mission. A well-prepared and trained unit stands a much better chance of surviving and accomplishing their assigned mission. At a minimum include the following:

C-3. Mobilization

During mobilization the unit must ensure that all supplies and equipment are on hand and are serviceable. Commanders and leaders must also ensure that—

C-4. Establish a Medical Treatment Facility

Plans for establishing a BAS, DCS, or FST for operating in a NBC environment must include employment of CBPS systems. When establishing a hospital using Deployable Medical Systems (DEPMEDS), the chemically protected (CP) DEPMEDS must be set up as the conventional shelters are being set up. Once the conventional shelter has been set up and is operational, CP DEPMEDS cannot be established without first taking down the existing shelter. Follow the technical manual provided with the CP DEPMEDS system issued to your unit. Plans for operating a DEPMEDS equipped hospital in the NBC environment should include, but not be limited to—

C-5. Operate a Medical Treatment Facility Receiving Contaminated Patients

Individuals should have decontaminated themselves or have been decontaminated by unit personnel; however, an MTF must plan for and be prepared to receive contaminated patients. The patients may not have been decontaminated at the unit, or they may have become contaminated en route to the MTF. Selected CSHs may be designated as the primary NBC MTF and be augmented with additional supplies and medical staff. When designated as such, plans must be prepared designating the location of the CSH that can best support the forward deployed MTFs. All actions listed in paragraph C-4 must be taken. During operations, actions that must be taken are—

C-6. Preventive Medicine Services

Plans for providing preventive medicine services must include monitoring water supplies for contamination. To perform this mission, equipment and supplies must be available and operational. Essential equipment and supplies include—

C-7. Veterinary Services

Plans for veterinary services must include provisioning for treatment to government-owned animals and quality control of food supplies. To perform their mission, essential supplies and equipment include—

C-8. Dental Services

Most dental services at the dental treatment facilities will have to be suspended in NBC contaminated areas due to a lack of CPS. Plans must include for emergency dental services to be provided in a clean area or in an MTF with a CPS. Essential supplies and equipment include—

C-9. Combat Operational Stress Control

Although specific supplies and equipment are not required for COSC, plans must be prepared to provide these services under NBC conditions. The COSC staff must locate clean areas to conduct COSC activities or manage the COSC patients in a MOPP level commensurate with the command MOPP guidance.

C-10. Medical Laboratory Services

Planning for medical laboratory support must include plans for conducting analysis on suspect NBC samples/specimens. Designated supporting medical laboratories must be prepared to analyze and provide confirmation/identification on specimens/samples of suspect NBC agents from humans, water sources, food supplies, and the environment (air and soil). The samples/specimens may be collected by MTF personnel, chemical corps personnel, PVNTMED personnel, veterinary personnel, or other services personnel. To perform this mission, supplies and equipment should include—

C-11. Health Service Logistics

Plans must include health service logistics support to continue under NBC conditions. To continue this role, all supplies must be protected from contamination. Materials required include—

NOTE

This guideline contains items that are required specifically for HSS operations in an NBC environment. The items are in addition to supplies and equipment required for conventional operations. This guideline is not all inclusive, but is a starting point for HSS units to develop their specific guidelines.

C-12. Homeland Security

Health service support units and installation medical activities/centers must be prepared to provide support in the event that CBRNE are used on the United States. Medical commanders and leaders should develop plans on how the provision of medical support will be provided to a CBRNE event. The plan should include, but not be limited to—

[APPENDIX D]
MEDICAL PLANNING GUIDE FOR THE ESTIMATION OF NUCLEAR, BIOLOGICAL, AND CHEMICAL BATTLE CASUALTIES