a. Given the disruption of transportation, communications, and operations during and following an NBC attack, it should be clear that preparation is the key to survival and effectively providing HSS. Preparing a simple and complete TSOP and HSS plan that really integrates NBC is the first step. Critical training for medical personnel before an NBC attack is how to—

b. Even minimal site preparation (nuclear hardening or CB protecting) may improve survival, greatly reduce contamination, and maintain the ability to continue to provide HSS. See the discussion below for more information on each environment. As with other military personnel, HSS personnel must keep their immunizations current; use available prophylaxis against suspect CB agents; use pretreatments for suspect chemical agents; use insect repellents, and have antidotes and essential medical supplies readily available for known or suspected NBC effects. The best defense for HSS personnel is to protect themselves, their patients, medical supplies, and equipment by applying contamination avoidance procedures. They must ensure that stored medical supplies and equipment are in protected areas or in their storage containers with covers in place. One method of having supplies and equipment protected is to keep them in their shipping containers until actually needed. When time permits and warnings are received that an NBC attack is imminent, or that a downwind hazard exists, HSS personnel should employ their CPS (see [Appendix F]) or seek protected areas (buildings, tents, or other ABOVE ground shelters for biological or chemical attack; culverts, ravines, basements, or other shielded areas for nuclear) for themselves and their patients.

c. Other tasks include:

3-6. Actions During a Nuclear, Biological, or Chemical Attack

While it is possible that the NBC attack will be discrete short events, the more likely scenario is the enemy will use NBC throughout the conflict. The warning and reporting system will provide as much notice as is possible. Using the information provided, HSS personnel will continue their mission by using the best available protected areas. If warned of a nuclear attack, they take up positions within the best available shelter; movement out of these positions will be directed by leadership when it is safe to do so.

3-7. Actions After a Nuclear, Biological, or Chemical Attack

All personnel must survey their equipment to determine the extent of damage and their capabilities to continue the mission. Initially, patients from nuclear detonations will be suffering thermal burns or blast injuries. Also, expect patients and HSS personnel to be disoriented. Nuclear blast and thermal injuries will immediately manifest, most radiation-induced injuries will not be observed for several hours to days. Chemical agent patients will manifest their injuries immediately upon exposure to the agent, except for blister agents. Biological agent patients may not show any signs of illness for hours to days after exposure, except for trichothecene (T2) mycotoxins. All patients arriving at Levels I and II MTFs must be checked for NBC contamination. Patients are decontaminated before treatment (see [Appendix G]) to reduce the hazard to HSS personnel, unless life- or limb-threatening conditions exist. Patients requiring treatment before decontamination are treated in the EMT area of the patient decontamination station. Examples of patient conditions that may require treatment at the contaminated treatment station of the patient decontamination area—