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.