4-1. General
a. Many factors must be considered when planning for Levels III and IV hospital support on the integrated battlefield. The hospital staff must be able to defend against threats by individuals or small groups (two or three) of infiltrators and survive NBC strikes or TIM incidents while continuing their mission. This threat may include the introduction of NBC or TIM in the hospital area, the water or food supplies; and the destruction of equipment and/or supplies. On the larger scale of surviving NBC strikes and continuing to support the mission, operating in a contaminated environment will present many problems for hospital personnel. The use of NBC weapons or TIM release can compromise both the quality and quantity of health care delivered by medical personnel due to the contamination at the MTF; constrain mobility and evacuation; and contaminate the logistical supply base. While providing hospital support, consider the following assumptions:
(1) Their location, close to other support assets, makes them vulnerable to NBC strikes and release/dispersion of TIMs.
- Command, control, communications, computers, and intelligence (C4I) infrastructure, logistical nodes, and base clusters are high value targets.
- Most NBC weapons are designed for wide-area coverage. Chemical and biological agents may present a hazard some distance downwind from the area of attack; also, residual radiation may extend for hundreds of kilometers (km) from ground zero.
- The large signature (size, heat, infrared) of a hospital makes it easy to find and target (the assumption is that the hospital is very near the intended targets).
- Hospitals located near road networks and airfields for access to evacuation routes increase their exposure to tactical strikes of NBC weapons and exposure to TIM releases.
- There are ever-increasing numbers of countries and individuals with the ability to manufacture and deliver NBC weapons/agents. This activity increases their use potential at all levels of conflict.
NOTE
When using existing civilian hospitals, the materials for an RDD may be at these hospitals. Exploding the material in place is very practical for a small team of terrorists.
(2) Large numbers of casualties are produced in a short period of time. Many of these casualties may have injuries that are unfamiliar to hospital personnel. These injuries may include—
- Radiation casualties.
- Biological casualties.
- Chemical casualties.
- Toxic industrial biological casualties (release of material from biological research facilities).
- Toxic industrial chemical casualties.
- Toxic industrial radiological casualties.
- Chemical agent antidote overdose casualties.
- Combined conventional and NBC injuries.
- Stress casualties mimicking all the above.
(3) In addition to the wounding effects of NBC weapons on troops, their use will have other effects upon the patient care delivery system.
- Follow-on treatment may have to be delayed due to the need for patient and faculty decontamination.
- The arrival of contaminated patients at the hospital will require hospital personnel to perform triage; administer EMT procedures in the patient decontamination area; supervise augmentation personnel performing patient decontamination; and constantly monitor the hospital for contamination. The combat support hospital [CSH] requires at least 20 nonmedical personnel from units within the geographic area/base cluster of the hospital to perform patient decontamination under medical supervision. See [Appendix G] for patient decontamination procedures.
- Patients may have been triaged and decontaminated at a Level I or Level II MTF. However, all patients must be triaged and checked for contamination as they arrive at the hospital ambulance drop off point. Triage ensures patients receive life- or limb-saving care in a timely manner. If patients are arriving from a suspected NBC contaminated area, they must be decontaminated before admission into the clean treatment area of the hospital. The patient decontamination area is established on the downwind side of the hospital. When the hospital does not have collective protection, the patient decontamination point must be at least 50 yards downwind of the hospital entry point. When the hospital is located inside a base cluster, the patient decontamination area may have to be established some distance from the hospital to prevent contamination of other units in the area. Should this be the case, the patients may have to be transported by ambulance or other vehicle from the clean side (hot line) of the patient decontamination area to the receiving point of the hospital.
- Conditions may mandate the use of nonmedical vehicles to transport casualties to the MTF. The use of these vehicles limits or prohibits en route medical care, but may be the only way to clear the battlefield and ensure timely care of patients at the hospital.