Section III. MEDICAL PLANNING GUIDE FOR THE ESTIMATION OF NUCLEAR, BIOLOGICAL, AND CHEMICAL BATTLE CASUALTIES (BIOLOGICAL)—AMedP-8(A), VOLUME II
D-11. General
The guide, AMedP-8(A), Volume II, provides estimates of casualties, and remaining operational strength, after single BW attacks on tactically deployed, brigade-sized land force units, offshore naval and marine forces, and selected strategic targets in rear areas. These worst-case casualty estimates are for personnel within both the targeted and the downwind hazard areas of the attacked forces. They assume that all affected personnel will be unsheltered and unwarned. To further estimate worst-case outcomes, the guide assumes that exposed individuals have not been vaccinated against any of the evaluated agents, nor have they undergone any type of medical prophylactic treatment prior to exposure. The tables included in the guide are designed to show numbers of expected casualties; expected fatalities; personnel at different performance levels; and times after exposure. In selected scenarios, the guide provides a method for estimating casualties among collocated civilians based on local population density.
a. The guide presents casualty estimates for all possible combinations of the following conditions:
- Eleven operational scenarios.
- Seven biological agents.
- Four types of delivery systems.
- Three attack intensities.
b. The guide is subject to limitations of extent and content. Since there are many more possible attack variables than those considered, the guide presents a limited number of estimates and provisional guidance for estimating cases not modeled. These estimates are based upon the best available medical data, but such data result in qualified estimates. Therefore, for more authoritative medical descriptions, medical planners and staff personnel should use FM 8-9, NATO Handbook on the Medical Aspects of NBC Defensive Operations, AMedP-6(B), Part II—Biological. Users of the guide must amplify or modify these estimates to meet emergent requirements such as injuries resulting from combined biological and conventional attacks.
c. Computer models that integrate available information have been used to predict the effects of future biological attacks. These resultant estimates may include substantial uncertainties when applied to specific situations. However, they provide the best estimates available to date.
d. The guide is also organized into 10 sections. Section 1 introduces features of the guide, and then presents background and medical planning considerations. Section 2 provides information on the methodology used to develop the estimates. Section 3 describes how to use the tables presented in the guide. Sections 4 through 10 of the guide contain tables of casualty estimates, with one section for each of the seven biological agents.
e. Biological attacks are likely to have a significant impact on the medical system. As detailed elsewhere in the guide, victims may number in the hundreds or even thousands. Demand for medical care may quickly overwhelm available resources; this problem will be exacerbated if medical personnel themselves become victims of the attack. Local civilian populations will be victimized as well, limiting host-nation support and potentially adding to the demands on the military medical system.
f. A variety of medical responses to BW attacks are available, depending on the agent used and whether medical countermeasures are employed prior to attack or after exposure has already occurred. For many agents, immunization or pre-exposure prophylaxis with antibiotics may prevent illness in those subsequently exposed. After exposure, disease can often be prevented or ameliorated via immunization and therapeutic use of antibiotics, antiviral drugs, and hyperimmune gammaglobulins.
D-12. Medical Planning Considerations
a. Effective mass casualty management requires careful planning. The guide is designed to support such planning by providing medical planners and staff personnel with a systematic means for estimating the number of biological casualties. However, casualty management also involves practice of self-aid and buddy aid, on-site triage and emergency care, decontamination, transport to medical facilities, infection control measures, communications, health services, logistics, and evacuation by ground or air transportation.
b. Medical requirements resulting from attacks with biological agents may be substantially different from those resulting from conventional, nuclear, or chemical combat. There would be no indication of the presence of biological agents in most tactical situations. Units downwind from an attack area may be unexpectedly exposed to biological agents. In some cases, there will also be a risk of secondary infection and subsequent epidemics amongst troops and/or the local population. Additionally, use of biological agents may generate reservoirs within the local animal population that may serve as a further source of infection.
c. Often the first indication of an attack with a biological agent will be the development of symptoms in exposed personnel. Diagnosis and treatment are complicated by the fact that many of the agent-induced diseases described in the guide begin with symptoms associated with common illnesses, such as influenza. In such cases, biological agent attacks may generally be distinguished from naturally occurring epidemics by the sudden onset of disease, the large number of personnel presenting with similar symptoms, and the concentration of those personnel in geographically contaminated areas.
D-13. Triage
a. Since a biological attack may produce mass casualties, preparations for a triage system should be in place before the attack. Paragraph 3.3.8 of the guide describes patient categories by illness severity. For a particular described operational scenario, this information may be used to estimate the number of patients with specified levels of illness. The guide does not provide estimates of the number of patients by triage classification or usual medical descriptions.
b. Decontamination of patients must be considered before further evacuation.
D-14. Evacuation
a. An efficient and flexible evacuation plan is essential for adequate casualty treatment and to retain mobility of forward medical resources. For an assessment of a potential mass casualty situation, the medical planner should consider the full range of evacuation assets, limitations, and obstacles. After an attack, the medical staff may need to estimate the number of casualties that could require evacuation at given postexposure times.
b. Evacuation requirements will vary with the type of biological agent used. Casualties resulting from some agents may not be evacuated because the time course of effects is relatively short. For others, like botulinum toxin, casualties may require evacuation to a facility where they can receive care for weeks or even months. Estimates provided in the guide can be used as a starting point from which to plan for evacuation resources, including those required for decontamination of personnel and transportation assets.
D-15. In-Unit Care
The casualty estimates in the guide are presented without allowance for in-unit care. However, there may be need for rapid intervention. Delays in obtaining medical care may occur because of physical damage or contamination of the surrounding area. Soldiers trained in first aid procedures may be the first to provide aid to biological agent casualties. The guide provides a conservative estimate of the numbers of exposed personnel who will require first aid. The tables described in paragraphs 3.3.2 through 3.3.4 of the guide give the time courses of effects that may apply to estimation of in-unit care and delayed medical requirements.
D-16. Patient Bed Requirements
Bed requirements can be estimated using the tables described in paragraphs 3.3.2 through 3.3.4 of the guide. The latter type of table is useful after an attack since it shows gains and losses of casualties over time. The type of table described in paragraph 3.3.5 of the guide may be more useful for long-range planning. It shows maximum numbers of personnel by illness severity category. The tables in the guide only provide estimates for the first 35 days after attack. Based on the theater evacuation policy specified for the operation, hospital days may be in theater or in the national area.
D-17. Medical Logistics
a. The estimates provided in the guide are intended to support projections of medical materiel and logistical requirements. Increased demands may occur for certain types of medical and general supplies, including equipment, kits, antibiotics, disinfectants, and other critical medical materiel. Demands may also increase for items unique to the prevention and treatment of biological agent casualties, such as vaccines, antibiotics, and antisera, as well as items adapted to contaminated environments. Tables showing maximum numbers of personnel by illness severity category can provide useful input for logistical planning.
b. Often the first indication of an attack with a biological agent will be the development of symptoms in exposed personnel. Diagnosis and treatment are complicated by the fact that many of the agent-induced diseases described in the guide begin with symptoms associated with common illnesses, such as influenza. In such cases, biological agent attacks may generally be distinguished from naturally occurring diseases.
D-18. Medical Force Planning
a. The assignment of medical support is normally based upon the total military population and the expected conventional casually rate. The guide may be used to assess requirements for additional medical units.
b. Although a specific unit may be the target of a biological attack, more casualties could be suffered by other units downwind. Accordingly, a unit other than the targeted one may have priority for support. The tables presented in the guide can be used in planning for either situation. Some tables show estimated maximum numbers of personnel by illness severity category. Such estimates should be combined with a comprehensive array of other available information to increase the effectiveness of medical force planning.
This Section Implements STANAG 2477.