e. A nuclear detonation may introduce new levels of destruction to the battlefield. There is very little experience with nuclear effects and there is certainly no experience with these weapons on a modern, highly technological battlefield. Therefore, there is little historical data on which to base estimates of personnel injured. Computer simulations are generally used to estimate numbers of personnel injured. Although these estimates may include significant uncertainty, they provide the best estimates to date.
D-4. Medical Planning Considerations
a. For effective mass casualty management, key medical and related considerations must be well planned and practiced. These include on-site triage and emergency care, communications, health service logistics, evacuation by ground and air resources, and personnel training in self-aid/buddy aid. Plans need to be made for requirements that may differ from the usual combat situation. For example, in combat situations, severe burn injuries in large numbers are relatively uncommon. Therefore, no special planning for the care of large numbers of burn patients is required. In a nuclear environment, this may not be true, and consideration must be given to the increased need for medical support that would result from a high incidence of burn patients.
b. Prior to an attack, the data may be used by medical planners to augment the requirements for conventional combat as appropriate for the nuclear situation. The tables can be used to prepare estimates of the number of patients at all echelons.
c. After an attack, the effectiveness and adequacy of the medical support effort during the first 24 hours are critical. Commanders should be informed rapidly of the estimated medical load in order to provide rescue and treatment resources or request assistance from higher headquarters, adjacent units, or allied units. These estimates should be updated postattack based on aerial or ground reconnaissance and survey.
d. In addition to casualties, a nuclear weapon detonation can generate an EMP that may cause catastrophic failures of electronic equipment components and may adversely affect the capability of all units in the area of the detonation. Electromagnetic pulse has no direct effect on personnel and is not further addressed in this publication.
D-5. Triage
Since a nuclear detonation may produce mass casualties, plans for a triage system must be in place. Paragraphs 3.4 through 3.5 of the guide describe patient categories by injury severity and may be used to estimate the number and injury severity of patients for a particular operational scenario. The guide does not, however, provide estimates of the number of patients by triage classification.