NOTE
This guideline contains items that are required specifically for HSS operations in an NBC environment. The items are in addition to supplies and equipment required for conventional operations. This guideline is not all inclusive, but is a starting point for HSS units to develop their specific guidelines.
Health service support units and installation medical activities/centers must be prepared to provide support in the event that CBRNE are used on the United States. Medical commanders and leaders should develop plans on how the provision of medical support will be provided to a CBRNE event. The plan should include, but not be limited to—
The primary purpose of the Medical Planning Guide for the Estimation of Nuclear, Biological, and Chemical Battle Casualties—AMedP-8(A), a three-volume publication for NBC, is to assist medical planners, medical logisticians, and medical staff officers in predicting NBC warfare contingency requirements for HSS personnel, medical materiel stockpiles, patient transport or evacuation capabilities, and facilities needed for patient decontamination, triage, treatment, and supportive care. The optional use of these guides is for projecting medical NBC operational estimates at brigade, division, corps, and EAC.
NOTE
The use of "the guide" in this appendix refers to AMedP-8(A), Volume I, II, or III. The AMedP-8(A), Volume I, II, or III, is the text for each of the STANAGs. The contents of this appendix are extracts from Sections 1, 2, and 3 of the guide.
Medical planners' estimates (such as casualty, logistics, evacuation, and personnel cross leveling) must be modified for the NBC environment. Estimates of NBC medical workload can be found in AMedP-8(A). A compact disk containing these documents and an automated version of AMedP-8(A), the Casualty Requirements Estimation Tool (CREST), can be obtained from Headquarters, Department of the Army, ATTN: DASG-HCZ-FD, 5109 Leesburg Pike, Falls Church, VA 22041-3258. The CREST is primarily an Army tool focusing on corps, brigades, and battalions, but also models aerial ports of debarkation, seaports of debarkation, and other units.
This Section Implements STANAG 2475.
a. Volume I of the guide provides estimates of casualties and remaining operational strength after a nuclear detonation in a brigade-sized unit during an out-of-area contingency operation. These estimates include the numbers, injury type (initial nuclear radiation, blast, and thermal injuries), and injury severity of nuclear patients based on several brigade scenarios. The scenarios include three different brigade-sized units, in warned or unwarned posture, which have single detonation of 5, 20, or 50 KT in the unit area.
b. The guide is organized into 10 sections. Section 1 introduces the guide and presents background and medical planning considerations. Section 2 provides information on the methodology used to develop the estimates of fatalities, casualties, and effectiveness of individuals remaining in the unit. Section 3 explores the use of the casualty prediction tables based on combat effectiveness decrements and estimates of the number of casualties categorized by insult level. Sections 4 through 10 contain tables of casualty estimates.
c. A sample of this information is graphically depicted in Tables 1-1 and 1-2 of the guide. The casualty estimates used to prepare these tables are presented in the guide as Tables 6-4 and 10-4 in Sections 6 and 10 respectively. The use of these tables is explained in paragraphs 3.1 through 3.6 of the guide. Paragraphs 3.7 and 3.8 of the guide discuss how to use the guide for situations not explicitly addressed.
d. The effects of residual radiation on personnel are not included in the guide. AMedP-6 and AMedP-7 provide information on planning, operations, and treatment for a residual radiation situation. Also not included is the impact of tumbling; impact of glass shards from windows of vehicles or buildings; crushing deaths from building failure; or COSC casualties; thus causing underestimations on the number of patients. Further, there will be personnel who get radiation doses or burns and do not seek medical care.
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.
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.
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.
a. An efficient and flexible evacuation plan is absolutely essential for the preservation of life and to retain the mobility of forward medical resources. In a potential mass casualty situation, the full range of evacuation assets should be considered.
b. The extended hospital time of nuclear casualties will influence levels of evacuation or hospitalization. In addition, estimates of the different types of casualties can be a consideration in evacuation planning. In planning for evacuation, estimates provided in the guide can be used as a starting point from which to estimate evacuation resources.
a. Some personnel within the military unit may not be classified medically as casualties, but will require some self-aid and buddy aid. A casualty is defined as anyone entering the medical system. Paragraph 2.5 of the guide further describes the basis for casualty calculation.
b. Nuclear detonations will produce a large number of blast, burn, and projectile injuries that initially must be treated by individual soldiers trained in first aid procedures. The physical damage to the surrounding area as a result of a nuclear detonation will increase delays in medical assistance and evacuation. Training in self-aid/buddy aid will improve casualty survival rates and conserve medical resources. The guide can be used to provide a conservative estimate of the numbers of injured that will require first aid. The tables in Sections 4 through 10 of the guide, showing the status of unit personnel by time period, can be used to indicate the numbers of personnel who are injured (but not casualties) who may require first aid.
The data provided in the guide can be used to determine immediate additional bed requirements resulting from a nuclear detonation. In addition to the numbers of patients who will need beds, the data provided in the guide can also indicate the increased hospitalization time of nuclear casualties. Long-term bed requirements, greater than 30 days, are not provided. Based on the theater evacuation policy specified for the operation, the hospital bed days may be in theater or in CONUS.
The data provided in the guide can assist in estimating the needed supplies. The supply system must be prepared for increased demands for certain types of medical and general supplies and equipment, kits, dressings, and antibiotics. The treatment of combined injuries will not require any special types of supplies, although demands for certain types of supplies will increase.
The assignment of medical support is normally based upon the total military population and the expected conventional casualty rate. The data provided in the guide may be used to assess the requirement for additional medical units. The planning guidance presented in this document can (and should) be modified to reflect the needs of the anticipated operation, including operational tempo, national/coalition priorities, medical resource allotment, and so forth. When trying to augment personnel, consider that the use of a nuclear weapon in a tactical situation could be an indication of an increased tempo of warfare. Therefore, even though a unit may be targeted with a nuclear detonation, that unit may not be the site where the highest numbers of casualties are being produced, and another unit may have priority of support.
This Section Implements STANAG 2476.
The guide, AMedP-8(A), Volume II, provides estimates of casualties, and remaining operational strength, after single BW attacks on tactically deployed, brigade-sized land force units, offshore naval and marine forces, and selected strategic targets in rear areas. These worst-case casualty estimates are for personnel within both the targeted and the downwind hazard areas of the attacked forces. They assume that all affected personnel will be unsheltered and unwarned. To further estimate worst-case outcomes, the guide assumes that exposed individuals have not been vaccinated against any of the evaluated agents, nor have they undergone any type of medical prophylactic treatment prior to exposure. The tables included in the guide are designed to show numbers of expected casualties; expected fatalities; personnel at different performance levels; and times after exposure. In selected scenarios, the guide provides a method for estimating casualties among collocated civilians based on local population density.
a. The guide presents casualty estimates for all possible combinations of the following conditions:
b. The guide is subject to limitations of extent and content. Since there are many more possible attack variables than those considered, the guide presents a limited number of estimates and provisional guidance for estimating cases not modeled. These estimates are based upon the best available medical data, but such data result in qualified estimates. Therefore, for more authoritative medical descriptions, medical planners and staff personnel should use FM 8-9, NATO Handbook on the Medical Aspects of NBC Defensive Operations, AMedP-6(B), Part II—Biological. Users of the guide must amplify or modify these estimates to meet emergent requirements such as injuries resulting from combined biological and conventional attacks.
c. Computer models that integrate available information have been used to predict the effects of future biological attacks. These resultant estimates may include substantial uncertainties when applied to specific situations. However, they provide the best estimates available to date.
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.
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.
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.
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.
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.
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.
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.
a. The assignment of medical support is normally based upon the total military population and the expected conventional casually rate. The guide may be used to assess requirements for additional medical units.
b. Although a specific unit may be the target of a biological attack, more casualties could be suffered by other units downwind. Accordingly, a unit other than the targeted one may have priority for support. The tables presented in the guide can be used in planning for either situation. Some tables show estimated maximum numbers of personnel by illness severity category. Such estimates should be combined with a comprehensive array of other available information to increase the effectiveness of medical force planning.
This Section Implements STANAG 2477.
a. The primary purpose of Volume III is to assist medical planners, logisticians, and staff officers in predicting CW contingency requirements. Requirements include medical personnel, medical materiel stockpiles, patient transport or evacuation capabilities, and facilities needed for patient decontamination, triage, treatment, and supportive care. An optional purpose is to support medical operational estimates.
b. The guide provides medical worst-case estimates of casualties and remaining operational strength after a single CW attack on a tactically deployed, brigade-sized land force units, with protection available and protection unavailable. These worst-case casually estimates are for personnel located within both the targeted and the downwind hazard areas of the brigade. It is assumed that all targeted personnel will be unsheltered and without medical pre-exposure prophylactic treatment. Tables in the guide are designed to show total numbers of—
c. The guide presents estimates of personnel status at specific time points. These range from 1 to 3 hours to 7 to 30 days after an attack, depending on the type of agent considered. Such estimates are projected from all possible combinations of the following conditions:
d. An index to essential information and four sample problems to illustrate use of this information are at the end of the guide (see Section 11). Section 11 provides a planning guide overview, describes applications, and presents a brief explanation of modeling methods used to prepare estimates.
e. The guide is subject to limitations of extent and content. Since there are many more possible attack variables than those considered, the guide presents a limited number of estimates. These estimates are based upon the best available toxicological values, but such values are qualified estimates. Therefore, medical planners and staff personnel should use FM 8-9, NATO Handbook on the Medical Aspects of NBC Defensive Operations, AMedP-6 (B), Part III—Chemical, for more authoritative medical descriptions and information on effects of longer duration.
f. The guide is most value to the user who needs to know what kinds of casualties to expect, relative numbers of each, and the time frames in which they are likely to appear. To assist the user, who lacks experience in actual CW, the guide describes types of injury, relevant factors, general magnitudes of effects, and effects of time courses on chemical casualty numbers. The casualty estimates are appropriate for training exercises. However, this initial attempt to provide complex estimates has limitations for battlefield use. The limitations are described as follows:
a. The guide provides medical planners and staff personnel with a systematic means for estimating chemical casualties in various-sized units, without regard to composition. This document provides more accurate and detailed estimates and is based upon detailed operational scenarios for brigade-sized units. Both chemical planning guides support estimates of combat performance from individuals remaining in the unit.
b. 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, type, and time-related status of chemical casualties.
NOTE
Each user is advised to consult any available national military NBC defense doctrinal publications of similar nature.
c. Medical requirements during CW may be substantially different from those for the usual combat situation. There may be no indication of the presence of chemical agents in some tactical situations. Unprotected units downwind from an attack area, or those entering contaminated areas in an unprotected posture, may be unexpectedly exposed to chemical agents. However, casualty management also involves practice of self-aid and buddy aid, on-site medical triage and emergency care, transport to medical facilities, communications, health services, logistics, and evacuation by ground or air transportation.
d. The signs and symptoms of chemical agent exposure may be sudden and intense, or delayed and subtle, depending on the agent used and the level of exposure. Individuals may not reach the first level of care for 15 to 60 minutes after the onset of effects. Decontamination may delay medical treatment. Stabilization should occur before casualties leave emergency care areas, but contamination of these areas may delay the stabilization process. However, effects of decontamination or secondary contamination on estimated doses and effects are not considered in the guide. For medical planning, users of the guide need to consider the various qualifications of its casualty estimates, as discussed in paragraphs 3.4 and 3.4.2 of the guide.
e. A chemical burn caused by HD can require more care than a same-sized burn induced by conventional munitions. Therefore, the initial prognosis may require revision after treatment is underway, and estimates of percent capable by performance band may require adjustment.
Since a chemical attack may produce mass casualties, preparations for a triage system should be in place before the attack. Paragraph 2.5.1 of the guide describes patient categories by injury severity. For a particular described operational scenario, this information may be used to estimate the number of patients with specified levels of injury. The guide does not provide estimates of the number of patients by triage classification or usual medical and toxicological descriptions.
a. An efficient and flexible evacuation plan is essential for adequate casualty treatment and to retain mobility of forward medical resources. For assessment of a potential mass casualty situation, the full range of evacuation assets, limitations, and obstacles should be considered by the medical planner. After an attack, the medical staff may need to estimate the number of casualties that require evacuation resources at given postexposure times.
b. Evacuation requirements will vary with the type of chemical agent used. Nerve agent casualties may not be evacuated because the time course of severe effects is relatively short. Depending upon exposure conditions, HD casualties may or may not require evacuation to a facility where they can receive care for several days, or possibly 6 to 9 months. Estimates provided in the guide can be used as a starting point from which to plan for evacuation resources.
The casualty estimates in the guide are presented with no allowance for in-unit care such as self-aid or buddy aid. Soldiers trained in first aid procedures may be the first to see chemical injuries. The guide can provide an estimate of the numbers of injured personnel who will require first aid. However, there may be need for rapid augmentation, support, or other intervention. Delays in obtaining medical care may occur because of physical damage or contamination of the surrounding area. The tables described in paragraphs 3.3.2 and 3.3.3 of the guide give the time courses of effects that may apply to estimation of in-unit and delayed medical requirements.
Requirements for patient beds and hospitalization time may be greater after chemical exposures than after a conventional attack. Such increases are particularly important for agents, such as HD, that produce injuries followed by a long recovery period. Bed requirements can be estimated using the tables described in paragraphs 3.3.2 and 3.3.3 of the guide. Casualties Occurring by Time Period tables (see paragraph 3.3.3) in the guide are useful after an attack since they show gains and losses of casualties over time. Personnel by Injury Category tables (as described in paragraph 3.3.4) in the guide may be more useful in long-range planning. They show maximum numbers of personnel by injury severity category. The tables in the guide only provide estimates for the first 30 days after attack. Depending upon the theater evacuation policy specified for the operation, hospital days may be either in theater or in the national area.
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. These may include specific equipment, kits, dressings, antibiotics, and other critical medical materiel. Demands may also increase for items unique to the chemical battlefield (such as nerve agent antidote autoinjectors), as well as items adapted to chemical environments (including IV systems and special self-contained intensive care units). Tables showing maximum numbers of personnel by injury severity category (see paragraph 3.3.4 in the guide) can provide useful input for logistical planning.
a. The assignment of medical support is normally based upon the total military population and the expected conventional casualty rate. The guide may be used to assess requirements for additional medical units. The use of chemical weapons in tactical situations could be one indication of an increased tempo of warfare and need for additional personnel.
b. Although a unit may be targeted for chemical attack, that unit might not be located where the highest number of casualties could occur (as in a downwind hazard area). Accordingly, another unit might have priority for support. The tables presented in the guide can be used in planning for either situation. Some tables (see paragraph 3.3.4 in the guide) show estimated maximum numbers of personnel by injury severity category. Such estimates should be combined with a comprehensive array of other available information to increase the effectiveness of medical force planning.
c. The guide is organized into 11 sections. Section 1 introduces the guide and presents background and medical planning considerations. Section 2 provides information on the methodology used to develop the estimates of fatalities, casualties, and effectiveness of individuals remaining in the unit. Section 3 explores the use of the casualty prediction tables based on combat effectiveness decrements and estimates of the number of casualties categorized by insult level. Sections 4 through 10 contain tables of casualty estimates. Section 11 is a tutorial on use of the tool.
d. These medical worst-case casualty estimates (see paragraph 2.1.2 through 2.1.7 in the guide) are for personnel in the chemical-targeted and downwind hazard areas of the brigade sector. The actual areas presenting chemical agent hazards to personnel are relatively small and localized when compared to the entire brigade sector. These estimates are not valid for acute effects from repeated exposures, possible delayed effects of low dosage exposures, operational worst-case targeting, targets with different numbers or distributions of exposed personnel, or attacks involving different conditions (of meteorology, terrain, protective status, and so forth) than are modeled. Although the guide is primarily designed to support medical force planning for future CW defense, it may be used to anticipate short-term requirements. For example, delayed requirements of HD victims for care or evacuation resources may be predicted from tables that give estimates of casually numbers by injury type at given times after a CW attack (see paragraphs 3.3.2 and 3.3.3 in the guide).
1. PURPOSE. Establish standardized procedures for medical NBC staff officers planning, preparing for, detecting, reporting, and providing preventive/protective measures for NBC/TIM hazards. Establish planning procedures for conducting HSS in NBC/TIM environments. Also, establish procedures for providing technical guidance/support to leadership before, during, and after an NBC/TIM event.
2. PROCEDURES
a. Medical NBC staff officers prepare list of equipment and procedural guidelines for HSS operations under NBC/TIM conditions. (Provide a list of radiological detection devices, chemical agent detection/identification kits/devices, components of biological sample/specimen collection, and shipping containers. Provide guidelines/references for operating detection/identification devices.)
b. Planning actions for use before an NBC/TIM event. (Provide preventive/protective measures that the leadership can employ to reduce the health effects of a NBC/TIM event. Also, provide preventive/protective measures that leadership can employ to reduce the health effects of existing NBC/TIM hazards/contamination in an AO. Provide HSS leadership with procedures that can be employed to protect their unit and patients.)
c. Planning action for use during an NBC/TIM event. (Provide preventive/protective measures that the leadership can employ to reduce the health effects of a NBC/TIM event. Provide HSS leadership with procedures that can be employed to protect their unit and patients.)
d. Planning actions for use after an NBC/TIM event. (Provide preventive/protective measures that line leadership can employ to reduce/mitigate the health effects of an NBC/TIM event on the force. Provide HSS leadership with procedure that can be employed to mitigate the effects on their unit and patients.)
e. Planning actions for preventive medicine support for NBC/TIM events. (Provide types and numbers of PVNTMED units/personnel required to perform PVNTMED missions during such events. Describe mission requirements for units/personnel preparing for and reacting to the event. Describe types of samples required and how samples must be collected, preserved, packaged, and shipped to supporting medical laboratory for analysis. Describe detection/monitoring equipment required for the event; such as AN/PDR77, AN/VDR2 radiac meter, chemical agent monitor (CAM), and M272 water test kit.)
f. Planning actions for veterinary support for NBC/TIM events. (Provide types and numbers of veterinary units/personnel required to perform the veterinary service missions during such events. Describe mission requirements for units/personnel preparing for and reacting to the event. Describe types of samples/specimens required and how samples/specimens must be collected, preserved, packaged, and shipped to supporting medical laboratory for analysis. Describe food contamination and decontamination procedures. Describe detection/monitoring equipment required for the event; such as AN/PDR77, AN/VDR2 radiac meter, and CAM.)
g. Planning actions for medical laboratory support for NBC/TIM events. (Provide requirements for medical laboratory support for an NBC/TIM event. Describe types of laboratory test/procedures required to provide command verification on the use of an NBC device/weapon. Provide medical laboratory reporting requirements; example: provide report to command surgeon; Joint Task Force/theater commander; senior commander in affected operational area.)
h. Planning actions for combat health logistics support for NBC/TIM events. (Provide requirements for combat health logistics support units and personnel. Describe types of Class VIII supplies required to support HSS response to an event. Examples: Numbers of chemical agent patient decontamination MESs, chemical agent patient treatment sets, number of packets of chemical agent pretreatment tablets required, and chemoprophylaxis required for personnel exposed to a biological agent.)
i. Planning actions for combat stress control/mental health support for NBC/TIM events. (Provide requirements for COSC/mental health support units/personnel. Describe where and how COSC/mental health personnel will provide their support in response to the event.)
j. Planning for medical treatment of NBC/TIM event casualties. (Provide requirements for medical evacuation and treatment (including emergency dental care) support units/personnel. Provide requirements for nonmedical personnel to perform patient decontamination at the MTF. Describe where and how evacuation and treatment personnel will provide their support in response to include supervision of patient decontamination procedures.)
3. COORDINATION REQUIREMENTS. (Provide requirements for support such as who should transport/escort samples/specimens from unit of origin to support medical laboratory and on to the CONUS gold standard laboratory. Example: The Technical Escort Unit normally provides transportation and escort for suspect NBC samples, in their absence describe who will provide this service. Provide requirements for numbers of personnel required to perform patient decontamination at supporting MTFs. Describe decontamination support requirements for medical units; especially hospitals and major combat health logistics facilities.)
4. REPORTS. (Describe types of reports required and frequency of reporting on HSS aspects of NBC/TIM events. Reports should provide, at a minimum, aspects of event and recommended preventive/protective actions needed to prevent or minimize casualties.)
To continue the HSS mission under CB conditions, MTFs must search out contamination free areas or employ CPS systems. Levels I and II MTFs may be able to locate contamination free areas; however, due to the mobility limitations of hospitals, they must always be prepared to operate under CB conditions if the area is under attack. Systems that can be employed as an MTF (Levels I, II, III, and IV) are described in this appendix.
a. The CBPS system is employed at the BAS, DCS, and FST. The CBPS is attached to the hard-walled box on the rear of a high mobility multi-purpose wheeled vehicle (HMMWV). The BAS will have one CBPS system per treatment team; the DCS will have four CBPS systems; the FST will have three CBPS systems. Also, systems will be issued to other selected medical treatment teams. When employed at the DCS, the patient holding team will also require GP tents to hold their required number of patients (see Chapter 4). Patients held inside the CBPS will be those that have been decontaminated and admitted into the system for treatment and are recovering from the treatment procedures and are awaiting evacuation. Any patients held in the GP tent must remain in MOPP Level 4 (the GP tent will not have collective protection); these patients are those that are expected to RTD within 72 hours.