D-14. Evacuation
a. An efficient and flexible evacuation plan is essential for adequate casualty treatment and to retain mobility of forward medical resources. For an assessment of a potential mass casualty situation, the medical planner should consider the full range of evacuation assets, limitations, and obstacles. After an attack, the medical staff may need to estimate the number of casualties that could require evacuation at given postexposure times.
b. Evacuation requirements will vary with the type of biological agent used. Casualties resulting from some agents may not be evacuated because the time course of effects is relatively short. For others, like botulinum toxin, casualties may require evacuation to a facility where they can receive care for weeks or even months. Estimates provided in the guide can be used as a starting point from which to plan for evacuation resources, including those required for decontamination of personnel and transportation assets.
D-15. In-Unit Care
The casualty estimates in the guide are presented without allowance for in-unit care. However, there may be need for rapid intervention. Delays in obtaining medical care may occur because of physical damage or contamination of the surrounding area. Soldiers trained in first aid procedures may be the first to provide aid to biological agent casualties. The guide provides a conservative estimate of the numbers of exposed personnel who will require first aid. The tables described in paragraphs 3.3.2 through 3.3.4 of the guide give the time courses of effects that may apply to estimation of in-unit care and delayed medical requirements.
D-16. Patient Bed Requirements
Bed requirements can be estimated using the tables described in paragraphs 3.3.2 through 3.3.4 of the guide. The latter type of table is useful after an attack since it shows gains and losses of casualties over time. The type of table described in paragraph 3.3.5 of the guide may be more useful for long-range planning. It shows maximum numbers of personnel by illness severity category. The tables in the guide only provide estimates for the first 35 days after attack. Based on the theater evacuation policy specified for the operation, hospital days may be in theater or in the national area.
D-17. Medical Logistics
a. The estimates provided in the guide are intended to support projections of medical materiel and logistical requirements. Increased demands may occur for certain types of medical and general supplies, including equipment, kits, antibiotics, disinfectants, and other critical medical materiel. Demands may also increase for items unique to the prevention and treatment of biological agent casualties, such as vaccines, antibiotics, and antisera, as well as items adapted to contaminated environments. Tables showing maximum numbers of personnel by illness severity category can provide useful input for logistical planning.
b. 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 diseases.