DEPARTMENT OF THE ARMY

Washington, DC, 1 October 2002

HEALTH SERVICE SUPPORT IN A NUCLEAR, BIOLOGICAL, AND CHEMICAL ENVIRONMENT
TACTICS, TECHNIQUES AND PROCEDURES

TABLE OF CONTENTS

Page
Preface[viii]
CHAPTER1.NUCLEAR, BIOLOGICAL, AND CHEMICAL WARFARE ASPECT OF THE MEDICAL THREAT[1-1]
1-1. General[1-1]
1-2. Medical Threat[1-1]
1-3. Nuclear, Biological, Chemical, and Radiological Dispersal Device Threats—The Health Service Perspective[1-2]
CHAPTER2.COMMAND AND CONTROL[2-1]
2-1. General[2-1]
2-2. Health Service Support Command and Control Planning Considerations[2-1]
2-3. Health Service Support Command and Control Appraisal of the Support Mission[2-2]
2-4. Health Service Support Units[2-2]
2-5. Movement/Management of Contaminated Facilities[2-3]
2-6. Leadership on the Contaminated Battlefield[2-5]
2-7. Homeland Security[2-6]
CHAPTER3.LEVELS I AND II HEALTH SERVICE SUPPORT[3-1]
3-1. General[3-1]
3-2. Level I Health Service Support[3-2]
3-3. Level II Health Service Support[3-2]
3-4. Forward Surgical Team[3-3]
3-5. Actions Before a Nuclear, Biological, or Chemical Attack[3-3]
3-6. Actions During a Nuclear, Biological, or Chemical Attack[3-4]
3-7. Actions After a Nuclear, Biological, or Chemical Attack[3-4]
3-8. Logistical Considerations[3-5]
3-9. Personnel Considerations[3-5]
3-10. Disposition and Employment of Treatment Elements[3-6]
3-11. Civilian Casualties[3-6]
3-12. Nuclear Environment[3-7]
3-13. Medical Triage[3-8]
3-14. Biological Environment[3-8]
3-15. Chemical Environment[3-9]
3-16. Operations in Extreme Environments[3-10]
3-17. Medical Evacuation in a Nuclear, Biological, and Chemical Environment[3-10]
CHAPTER4.LEVELS III AND IV HOSPITALIZATION[4-1]
4-1. General[4-1]
4-2. Protection[4-3]
4-3. Decontamination[4-8]
4-4. Emergency Services[4-10]
4-5. General Medical Services[4-11]
4-6. Surgical Services[4-11]
4-7. Nursing Services[4-12]
4-8. Conventional Operations[4-13]
CHAPTER5.OTHER HEALTH SERVICE SUPPORT[5-1]
SectionI.Preventive Medicine Services[5-1]
5-1. General[5-1]
5-2. Disease Incidence Following the Use of Nuclear, Biological, and Chemical Weapons[5-1]
5-3. Preventive Medicine Section[5-3]
5-4. Preventive Medicine Detachment[5-3]
SectionII.Veterinary Services[5-4]
5-5. General[5-4]
5-6. Food Protection[5-4]
5-7. Food Decontamination[5-4]
5-8. Animal Care[5-5]
SectionIII.Laboratory Services[5-5]
5-9. General[5-5]
5-10. Level II[5-5]
5-11. Level III[5-5]
5-12. Level IV[5-6]
5-13. Level V (Continental United States)[5-6]
5-14. Field Samples[5-6]
SectionIV.Dental Services[5-7]
5-15. General[5-7]
5-16. Mission in a Nuclear, Biological, or Chemical Environment[5-7]
5-17. Dental Treatment Operations[5-7]
5-18. Patient Treatment Considerations[5-7]
5-19. Patient Protection[5-8]
SectionV.Combat Operational Stress Control[5-9]
5-20. General[5-9]
5-21. Leadership Actions[5-9]
5-22. Individual Responsibilities[5-10]
5-23. Mental Health Personnel Responsibilities[5-11]
SectionVI.Health Service Logistics[5-11]
5-24. General[5-11]
5-25. Protecting Supplies In Storage[5-12]
5-26. Protecting Supplies During Shipment[5-12]
5-27. Organizational Maintenance[5-12]
SectionVII.Homeland Security Response[5-13]
5-28. Chemical, Biological, Radiological, Nuclear, and High-Yield Explosive Response[5-13]
5-29. Capabilities of Response Elements[5-14]
APPENDIXA.MEDICAL EFFECTS OF NUCLEAR, BIOLOGICAL, AND CHEMICAL WEAPONS AND TOXIC INDUSTRIAL MATERIAL[A-1]
A-1. General[A-1]
A-2. Physical Effects of Nuclear Weapons[A-1]
A-3. Physiological Effects of Nuclear Weapons[A-4]
A-4. Biological Effects of Thermal Radiation[A-7]
A-5. Physiological Effects of Ionizing Radiation[A-8]
A-6. Handling and Managing Radiologically Contaminated Patients[A-10]
A-7. Radiological Patients in Stability Operations and Support Operations[A-13]
A-8. Effects of Biological Weapons[A-14]
A-9. Behavior of Biological Weapons[A-15]
A-10. Management of Biological Warfare Patients[A-16]
A-11. Effects of Chemical Weapons[A-17]
A-12. Behavior of Chemical Weapons[A-17]
A-13. Characteristics of Chemical Agents[A-19]
A-14. Management of Chemical Agent Patients[A-23]
A-15. Management of Toxic Industrial Material Patients[A-23]
APPENDIXB.SAMPLE/SPECIMEN COLLECTION AND MANAGEMENT[B-1]
SectionI.Introduction[B-1]
B-1. General[B-1]
B-2. Sample/Specimen Background Information[B-2]
B-3. Sample/Specimen Collection and Preservation[B-3]
B-4. Chain of Custody[B-8]
SectionII.Sampling Techniques and Procedures[B-9]
B-5. General[B-9]
B-6. Expended Material[B-11]
B-7. Environmental Samples[B-11]
B-8. Collection of Air and Vapors[B-12]
B-9. Collection of Water Samples[B-13]
B-10. Collection of Soil Samples[B-15]
B-11. Collection of Contaminated Vegetation[B-16]
B-12. Medical Specimens[B-16]
B-13. Collection of Medical Specimens[B-17]
B-14. Post Mortem Specimens[B-19]
B-15. Reporting, Packaging, and Shipment[B-20]
B-16. Handling and Packaging Materials[B-21]
B-17. Collection Reporting[B-23]
B-18. Sample/Specimen Background Documents[B-27]
APPENDIXC.GUIDELINES FOR OPERATIONAL PLANNING FOR HEALTH SERVICE SUPPORT IN A NUCLEAR, BIOLOGICAL, AND CHEMICAL ENVIRONMENT[C-1]
C-1. General[C-1]
C-2. Predeployment[C-1]
C-3. Mobilization[C-2]
C-4. Establish a Medical Treatment Facility[C-3]
C-5. Operate a Medical Treatment Facility Receiving Contaminated Patients.[C-4]
C-6. Preventive Medicine Services[C-5]
C-7. Veterinary Services[C-6]
C-8. Dental Services[C-6]
C-9. Combat Operational Stress Control[C-6]
C-10. Medical Laboratory Services[C-6]
C-11. Health Service Logistics[C-7]
C-12. Homeland Security[C-8]
APPENDIXD.MEDICAL PLANNING GUIDE FOR THE ESTIMATION OF NUCLEAR, BIOLOGICAL, AND CHEMICAL BATTLE CASUALTIES[D-1]
SectionI.Introduction[D-1]
D-1. General[D-1]
D-2. Medical Planners' Tool[D-1]
SectionII.Medical Planning Guide for the Estimation of Nuclear, Biological, and Chemical Battle Casualties (Nuclear)—AMedP-8(A), Volume I[D-1]
D-3. General[D-1]
D-4. Medical Planning Considerations[D-2]
D-5. Triage[D-3]
D-6. Evacuation[D-3]
D-7. In-Unit Care[D-3]
D-8. Hospital Bed Requirements[D-4]
D-9. Medical Logistics[D-4]
D-10. Medical Force Planning[D-4]
SectionIII.Medical Planning Guide for the Estimation of Nuclear, Biological, and Chemical Battle Casualties (Biological)—AMedP-8(A), Volume II[D-4]
D-11. General[D-4]
D-12. Medical Planning Considerations[D-6]
D-13. Triage[D-6]
D-14. Evacuation[D-6]
D-15. In-Unit Care[D-7]
D-16. Patient Bed Requirements[D-7]
D-17. Medical Logistics[D-7]
D-18. Medical Force Planning[D-8]
SectionIV.Medical Planning Guide for the Estimation of Nuclear, Biological, and Chemical Battle Casualties (Chemical)—AMedP-8(A), Volume III[D-8]
D-19. General[D-8]
D-20. Medical Planning Considerations[D-10]
D-21. Triage[D-11]
D-22. Evacuation[D-11]
D-23. In-Unit Care[D-11]
D-24. Patient Bed Requirements[D-12]
D-25. Medical Logistics[D-12]
D-26. Medical Force Planning[D-12]
APPENDIXE.EXAMPLE X-__, ANNEX__, TO HSS PLAN/OPERATION ORDER__, MEDICAL NBC STAFF OFFICER PLANNING FOR HSS IN AN NBC ENVIRONMENT[E-1]
APPENDIXF.EMPLOYMENT OF CHEMICAL AND BIOLOGICAL COLLECTIVE PROTECTION SHELTER SYSTEMS BY MEDICAL UNITS[F-1]
SectionI.Introduction[F-1]
F-1. General[F-1]
F-2. Types of Collective Protection Shelter Systems[F-1]
SectionII.Employment of the Chemically and Biologically Protected Shelter System[F-2]
F-3. Establish a Battalion Aid Station in a Chemically Biologically Protected Shelter[F-2]
F-4. Division Clearing Station in a Chemically Biologically Protected Shelter[F-4]
F-5. Forward Surgical Team in a Chemically Biologically Protected Shelter[F-6]
SectionIII.Employment of the Chemically Protected Deployable Medical Systems and Simplified Collective Protection Systems[F-8]
F-6. Collective Protection in a Deployable Medical System-Equipped Hospital[F-8]
F-7. Chemically/Biologically Protecting the International Organization for Standardization Shelter[F-11]
F-8. Chemically/Biologically Protecting the Vestibules[F-12]
F-9. Chemically/Biologically Protecting Air Handler Equipment[F-12]
F-10. Establish Collective Protection Shelter Using the M20 Simplified Collective Protection System[F-12]
F-11. Casualty Decontamination[F-12]
SectionIV.Operations, Entry, and Exit Guidelines[F-13]
F-12. Operations[F-13]
F-13. Decontamination of Entrance Area[F-13]
F-14. Procedures Prior to Entry[F-14]
F-15. Entry/Exit for the Collective Protection Shelter System[F-14]
F-16. Resupply of Protected Areas[F-17]
APPENDIXG.PATIENT DECONTAMINATION[G-1]
SectionI.Introduction[G-1]
G-1. General[G-1]
G-2. Immediate Decontamination[G-2]
G-3. Patient Decontamination and Thorough Decontamination Collocation[G-2]
G-4. Patient Decontamination at the Battalion Aid Station (Level I)[G-5]
G-5. Patient Decontamination at the Medical Company Clearing Station (Level II)[G-5]
G-6. Patient Decontamination at a Hospital (Level III and IV)[G-5]
G-7. Prepare Hypochlorite Solutions for Patient Decontamination[G-5]
G-8. Classification of Patients[G-6]
G-9. Patient Treatment[G-6]
SectionII.Patient Decontamination Procedures[G-7]
G-10. Decontaminate a Litter Chemical Agent Patient[G-7]
G-11. Decontaminate an Ambulatory Chemical Agent Patient[G-14]
G-12. Biological Patient Decontamination Procedures[G-18]
G-13. Decontaminate a Litter Biological Agent Patient[G-18]
G-14. Decontaminate an Ambulatory Biological Agent Patient[G-19]
G-15. Decontaminate Nuclear-Contaminated Patients[G-20]
G-16. Decontaminate a Litter Nuclear-Contaminated Patient[G-21]
G-17. Decontaminate an Ambulatory Nuclear-Contaminated Patient[G-21]
APPENDIXH.FIELD EXPEDIENT PROTECTIVE SYSTEMS AGAINST NUCLEAR, BIOLOGICAL, AND CHEMICAL ATTACK[H-1]
H-1. General[H-1]
H-2. Protection Against Radiation[H-1]
H-3. Expedient Shelters for Protection Against Radiation[H-2]
H-4. Expedient Shelters Against Biological and Chemical Agents[H-5]
APPENDIXI.DETECTION AND TREATMENT OF NUCLEAR, BIOLOGICAL, AND CHEMICAL CONTAMINATION IN WATER[I-1]
I-1. General[I-1]
I-2. Detection of Contamination in Water[I-1]
I-3. Procedures on Discovery of Contamination in Water[I-1]
I-4. Treatment of Contaminated Water[I-2]
APPENDIXJ.FOOD CONTAMINATION AND DECONTAMINATION[J-1]
J-1. General[J-1]
J-2. Protection of Food From Contamination[J-2]
J-3. Nuclear[J-3]
J-4. Biological[J-4]
J-5. Chemical[J-5]
GLOSSARY[Glossary-1]
REFERENCES[References-1]
INDEX[Index-1]

DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

[*] This publication supersedes FM 8-10-7, 22 April 1993. Change 1, 26 November 1996

[PREFACE]