,,transcrib]',s ,,note ,italic text is d5ot$ by und]scores4 ,blank space 9 "s sample docum5ts 9 ! text is also d5ot$ by 4 ,bold text is d5ot$ by equal signs4 ,sup]scripts are d5ot$ by eg abc,,tm4 ,subscripts 9 *emical =mulae are d5ot$ by eg ,,co#b4 ,footnotes are all )9 a specific ,table1 includ+ ! ,table ( ,cont5ts4 ,!y are position$ at ! bottom ( t ,table1 z 9 ! orig9al text1 & are d5ot$ by 99 or 99994 ,obvi\s punctuation errors h be5 correct$ aft] c>eful comp>ison ) o!r occurr5ces )9 ! text & consultation ( ext]nal s\rces4 ,m detail c be f\nd at ! end ( ! book4 ,,fm #d-jb4g 7,,fm #h-aj-g7 ,,heal? ,,s]vice ,,support ,,9 ,a ,,nucle>1 ,,biological1 ,,& ,,*emical ,,environm5t ,,tactics1 ,,te*niques1 ,,& ,,proc$ures ,,octob] #bjjb ,,headqu>t]s1 ,,dep>tm5t ,,( ,,! ,,army ,,di/ribution ,,re/riction3 ,approv$ = public release2 di/ribution is unlimit$4 99,,fm #d-jb4g 7,,fm #h-aj-g7 ,,field ,,manual ,,headqu>t]s ,,no4 #d-jb4g 7#h-aj-g7 ,,dep>tm5t ,,( ,,! ,,army ,wa%+ton1 ,,dc1 #a ,octob] #bjjb ,,heal? ,,s]vice ,,support ,,9 ,a ,,nucle>1 ,,biological1 ,,& ,,*emical ,,environm5t ,,tactics1 ,,te*niques ,,& ,,proc$ures ,,table ,,( ,,cont5ts ,page ,preface viii ,,*apt] #a4 ,,nucle>1 ,,biological1 ,,& ,,*emical ,,w>f>e ,,aspect ,,( ,,! ,,m$ical ,,?reat #a-a #a-a4 ,g5]al #a-a #a-b4 ,m$ical ,?reat #a-a #a-c4 ,nucle>1 ,biological1 ,*emical1 & ,radiological ,disp]sal ,device ,?reats--,! ,heal? ,s]vice ,p]spective #a-b ,,*apt] #b4 ,,comm& ,,& ,,control #b-a #b-a4 ,g5]al #b-a #b-b4 ,heal? ,s]vice ,support ,comm& & ,control ,plann+ ,consid]ations #b-a #b-c4 ,heal? ,s]vice ,support ,comm& & ,control ,appraisal ( ! ,support ,mission #b-b #b-d4 ,heal? ,s]vice ,support ,units #b-b #b-e4 ,movem5t_/,managem5t ( ,contam9at$ ,facilities #b-c #b-f4 ,lead]%ip on ! ,contam9at$ ,battlefield #b-e #b-g4 ,homel& ,security #b-f ,,*apt] #c4 ,,levels ,i ,,& ,,ii ,,heal? ,,s]vice ,,support #c-a #c-a4 ,g5]al #c-a #c-b4 ,level ,i ,heal? ,s]vice ,support #c-b #c-c4 ,level ,,ii ,heal? ,s]vice ,support #c-b #c-d4 ,=w>d ,surgical ,team #c-c #c-e4 ,actions ,be=e a ,nucle>1 ,biological1 or ,*emical ,attack #c-c #c-f4 ,actions ,dur+ a ,nucle>1 ,biological1 or ,*emical ,attack #c-d #c-g4 ,actions ,aft] a ,nucle>1 ,biological1 or ,*emical ,attack #c-d #c-h4 ,logi/ical ,consid]ations #c-e #c-i4 ,p]sonnel ,consid]ations #c-e #c-aj4 ,disposition & ,employm5t ( ,treatm5t ,elem5ts #c-f #c-aa4 ,civilian ,casualties #c-f #c-ab4 ,nucle> ,environm5t #c-g #c-ac4 ,m$ical ,triage #c-h #c-ad4 ,biological ,environm5t #c-h #c-ae4 ,*emical ,environm5t #c-i #c-af4 ,op]ations 9 ,extreme ,environm5ts #c-aj #c-ag4 ,m$ical ,evacuation 9 a ,nucle>1 ,biological1 & ,*emical ,environm5t #c-aj ,,*apt] #d4 ,,levels ,,iii ,,& ,,iv ,,hospitalization #d-a #d-a4 ,g5]al #d-a #d-b4 ,protection #d-c #d-c4 ,decontam9ation #d-h #d-d4 ,em]g5cy ,s]vices #d-aj #d-e4 ,g5]al ,m$ical ,s]vices #d-aa #d-f4 ,surgical ,s]vices #d-aa #d-g4 ,nurs+ ,s]vices #d-ab #d-h4 ,conv5tional ,op]ations #d-ac ,,*apt] #e4 ,,o!r ,,heal? ,,s]vice ,,support #e-a ,section ,i4 ,prev5tive ,m$ic9e ,s]vices #e-a #e-a4 ,g5]al #e-a #e-b4 ,disease ,incid5ce ,foll[+ ! ,use ( ,nucle>1 ,biological1 & ,*emical ,weapons #e-a #e-c4 ,prev5tive ,m$ic9e ,section #e-c #e-d4 ,prev5tive ,m$ic9e ,deta*m5t #e-c ,section ,,ii4 ,vet]9>y ,s]vices #e-d #e-e4 ,g5]al #e-d #e-f4 ,food ,protection #e-d #e-g4 ,food ,decontam9ation #e-d #e-h4 ,animal ,c>e #e-e ,section ,,iii4 ,laboratory ,s]vices #e-e #e-i4 ,g5]al #e-e #e-aj4 ,level ,,ii #e-e #e-aa4 ,level ,,iii #e-e #e-ab4 ,level ,,iv #e-f #e-ac4 ,level ,v 7,cont95tal ,unit$ ,/ates7 #e-f #e-ad4 ,field ,samples #e-f ,section ,,iv4 ,d5tal ,s]vices #e-g #e-ae4 ,g5]al #e-g #e-af4 ,mission 9 a ,nucle>1 ,biological1 or ,*emical ,environm5t #e-g #e-ag4 ,d5tal ,treatm5t ,op]ations #e-g #e-ah4 ,pati5t ,treatm5t ,consid]ations #e-g #e-ai4 ,pati5t ,protection #e-h ,section ,v4 ,combat ,op]ational ,/ress ,control #e-i #e-bj4 ,g5]al #e-i #e-ba4 ,lead]%ip ,actions #e-i #e-bb4 ,individual ,responsibilities #e-aj #e-bc4 ,m5tal ,heal? ,p]sonnel ,responsibilities #e-aa ,section ,,vi4 ,heal? ,s]vice ,logi/ics #e-aa #e-bd4 ,g5]al #e-aa #e-be4 ,protect+ ,supplies ,9 ,/orage #e-ab #e-bf4 ,protect+ ,supplies ,dur+ ,%ipm5t #e-ab #e-bg4 ,organizational ,ma9t5ance #e-ab ,section ,,vii4 ,homel& ,security ,response #e-ac #e-bh4 ,*emical1 ,biological1 ,radiological1 ,nucle>1 & ,high-,yield ,explosive ,response #e-ac #e-bi4 ,capabilities ( ,response ,elem5ts #e-ad ,,app5dix ,a4 ,,m$ical ,,effects ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,weapons ,,& ,,toxic ,,indu/rial ,,mat]ial ,a-#a ,a-#a4 ,g5]al ,a-#a ,a-#b4 ,physical ,effects ( ,nucle> ,weapons ,a-#a ,a-#c4 ,physiological ,effects ( ,nucle> ,weapons ,a-#d ,a-#d4 ,biological ,effects ( ,!rmal ,radiation ,a-#g ,a-#e4 ,physiological ,effects ( ,ioniz+ ,radiation ,a-#h ,a-#f4 ,h&l+ & ,manag+ ,radiologically ,contam9at$ ,pati5ts ,a-#aj ,a-#g4 ,radiological ,pati5ts 9 ,/ability ,op]ations & ,support ,op]ations ,a-#ac ,a-#h4 ,effects ( ,biological ,weapons ,a-#ad ,a-#i4 ,behavior ( ,biological ,weapons ,a-#ae ,a-#aj4 ,managem5t ( ,biological ,w>f>e ,pati5ts ,a-#af ,a-#aa4 ,effects ( ,*emical ,weapons ,a-#ag ,a-#ab4 ,behavior ( ,*emical ,weapons ,a-#ag ,a-#ac4 ,*>act]i/ics ( ,*emical ,ag5ts ,a-#ai ,a-#ad4 ,managem5t ( ,*emical ,ag5t ,pati5ts ,a-#bc ,a-#ae4 ,managem5t ( ,toxic ,indu/rial ,mat]ial ,pati5ts ,a-#bc ,,app5dix ,b4 ,,sample_/,,specim5 ,,collection ,,& ,,managem5t ,b-#a ,section ,i4 ,introduction ,b-#a ,b-#a4 ,g5]al ,b-#a ,b-#b4 ,sample_/,specim5 ,backgr\nd ,in=mation ,b-#b ,b-#c4 ,sample_/,specim5 ,collection & ,pres]vation ,b-#c ,b-#d4 ,*a9 ( ,cu/ody ,b-#h ,section ,,ii4 ,sampl+ ,te*niques & ,proc$ures ,b-#i ,b-#e4 ,g5]al ,b-#i ,b-#f4 ,exp5d$ ,mat]ial ,b-#aa ,b-#g4 ,environm5tal ,samples ,b-#aa ,b-#h4 ,collection ( ,air & ,vapors ,b-#ab ,b-#i4 ,collection ( ,wat] ,samples ,b-#ac ,b-#aj4 ,collection ( ,soil ,samples ,b-#ae ,b-#aa4 ,collection ( ,contam9at$ ,vegetation ,b-#af ,b-#ab4 ,m$ical ,specim5s ,b-#af ,b-#ac4 ,collection ( ,m$ical ,specim5s ,b-#ag ,b-#ad4 ,po/ ,mortem ,specim5s ,b-#ai ,b-#ae4 ,report+1 ,packag+1 & ,%ipm5t ,b-#bj ,b-#af4 ,h&l+ & ,packag+ ,mat]ials ,b-#ba ,b-#ag4 ,collection ,report+ ,b-#bc ,b-#ah4 ,sample_/,specim5 ,backgr\nd ,docum5ts ,b-#bg ,,app5dix ,c4 ,,guidel9es ,,= ,,op]ational ,,plann+ ,,= ,,heal? ,,s]vice ,,support ,,9 ,a ,,nucle>1 ,,biological1 ,,& ,,*emical ,,environm5t ,c-#a ,c-#a4 ,g5]al ,c-#a ,c-#b4 ,pr$eploym5t ,c-#a ,c-#c4 ,mobilization ,c-#b ,c-#d4 ,e/abli% a ,m$ical ,treatm5t ,facility ,c-#c ,c-#e4 ,op]ate a ,m$ical ,treatm5t ,facility ,receiv+ ,contam9at$ ,pati5ts4 ,c-#d ,c-#f4 ,prev5tive ,m$ic9e ,s]vices ,c-#e ,c-#g4 ,vet]9>y ,s]vices ,c-#f ,c-#h4 ,d5tal ,s]vices ,c-#f ,c-#i4 ,combat ,op]ational ,/ress ,control ,c-#f ,c-#aj4 ,m$ical ,laboratory ,s]vices ,c-#f ,c-#aa4 ,heal? ,s]vice ,logi/ics ,c-#g ,c-#ab4 ,homel& ,security ,c-#h ,,app5dix ,d4 ,,m$ical ,,plann+ ,,guide ,,= ,,! ,,e/imation ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,battle ,,casualties ,d-#a ,section ,i4 ,introduction ,d-#a ,d-#a4 ,g5]al ,d-#a ,d-#b4 ,m$ical ,plann]s' ,tool ,d-#a ,section ,,ii4 ,m$ical ,plann+ ,guide = ! ,e/imation ( ,nucle>1 ,biological1 & ,*emical ,battle ,casualties 7,nucle>7--,a,med,p-#h7;,a71 ,volume ,i ,d-#a ,d-#c4 ,g5]al ,d-#a ,d-#d4 ,m$ical ,plann+ ,consid]ations ,d-#b ,d-#e4 ,triage ,d-#c ,d-#f4 ,evacuation ,d-#c ,d-#g4 ,9-,unit ,c>e ,d-#c ,d-#h4 ,hospital ,b$ ,requirem5ts ,d-#d ,d-#i4 ,m$ical ,logi/ics ,d-#d ,d-#aj4 ,m$ical ,=ce ,plann+ ,d-#d ,section ,,iii4 ,m$ical ,plann+ ,guide = ! ,e/imation ( ,nucle>1 ,biological1 & ,*emical ,battle ,casualties 7,biological7--,a,med,p-#h7;,a71 ,volume ,,ii ,d-#d ,d-#aa4 ,g5]al ,d-#d ,d-#ab4 ,m$ical ,plann+ ,consid]ations ,d-#f ,d-#ac4 ,triage ,d-#f ,d-#ad4 ,evacuation ,d-#f ,d-#ae4 ,9-,unit ,c>e ,d-#g ,d-#af4 ,pati5t ,b$ ,requirem5ts ,d-#g ,d-#ag4 ,m$ical ,logi/ics ,d-#g ,d-#ah4 ,m$ical ,=ce ,plann+ ,d-#h ,section ,,iv4 ,m$ical ,plann+ ,guide = ! ,e/imation ( ,nucle>1 ,biological1 & ,*emical ,battle ,casualties 7,*emical7--,a,med,p-#h7;,a71 ,volume ,,iii ,d-#h ,d-#ai4 ,g5]al ,d-#h ,d-#bj4 ,m$ical ,plann+ ,consid]ations ,d-#aj ,d-#ba4 ,triage ,d-#aa ,d-#bb4 ,evacuation ,d-#aa ,d-#bc4 ,9-,unit ,c>e ,d-#aa ,d-#bd4 ,pati5t ,b$ ,requirem5ts ,d-#ab ,d-#be4 ,m$ical ,logi/ics ,d-#ab ,d-#bf4 ,m$ical ,=ce ,plann+ ,d-#ab ,,app5dix ,e4 ,,example ,x-1 ,,annex1 ,,to ,,hss ,,plan_/,,op]ation ,,ord]1 ,,m$ical ,,nbc ,,/aff ,,(fic] ,,plann+ ,,= ,,hss ,,9 ,,an ,,nbc ,,environm5t ,e-#a ,,app5dix ,f4 ,,employm5t ,,( ,,*emical ,,& ,,biological ,,collective ,,protection ,,%elt] ,,sy/ems ,,by ,,m$ical ,,units ,f-#a ,section ,i4 ,introduction ,f-#a ,f-#a4 ,g5]al ,f-#a ,f-#b4 ,types ( ,collective ,protection ,%elt] ,sy/ems ,f-#a ,section ,,ii4 ,employm5t ( ! ,*emically & ,biologically ,protect$ ,%elt] ,sy/em ,f-#b ,f-#c4 ,e/abli% a ,battalion ,aid ,/ation 9 a ,*emically ,biologically ,protect$ ,%elt] ,f-#b ,f-#d4 ,division ,cle>+ ,/ation 9 a ,*emically ,biologically ,protect$ ,%elt] ,f-#d ,f-#e4 ,=w>d ,surgical ,team 9 a ,*emically ,biologically ,protect$ ,%elt] ,f-#f ,section ,,iii4 ,employm5t ( ! ,*emically ,protect$ ,deployable ,m$ical ,sy/ems & ,simplifi$ ,collective ,protection ,sy/ems ,f-#h ,f-#f4 ,collective ,protection 9 a ,deployable ,m$ical ,sy/em-,equipp$ ,hospital ,f-#h ,f-#g4 ,*emically_/,biologically ,protect+ ! ,int]national ,organization = ,/&>dization ,%elt] ,f-#aa ,f-#h4 ,*emically_/,biologically ,protect+ ! ,ve/ibules ,f-#ab ,f-#i4 ,*emically_/,biologically ,protect+ ,air ,h&l] ,equipm5t ,f-#ab ,f-#aj4 ,e/abli% ,collective ,protection ,%elt] ,us+ ! ,m#bj ,simplifi$ ,collective ,protection ,sy/em ,f-#ab ,f-#aa4 ,casualty ,decontam9ation ,f-#ab ,section ,,iv4 ,op]ations1 ,entry1 & ,exit ,guidel9es ,f-#ac ,f-#ab4 ,op]ations ,f-#ac ,f-#ac4 ,decontam9ation ( ,entrance ,area ,f-#ac ,f-#ad4 ,proc$ures ,prior to ,entry ,f-#ad ,f-#ae4 ,entry_/,exit = ! ,collective ,protection ,%elt] ,sy/em ,f-#ad ,f-#af4 ,resupply ( ,protect$ ,areas ,f-#ag ,,app5dix ,g4 ,,pati5t ,,decontam9ation ,g-#a ,section ,i4 ,introduction ,g-#a ,g-#a4 ,g5]al ,g-#a ,g-#b4 ,imm$iate ,decontam9ation ,g-#b ,g-#c4 ,pati5t ,decontam9ation & ,?or\gh ,decontam9ation ,collocation ,g-#b ,g-#d4 ,pati5t ,decontam9ation at ! ,battalion ,aid ,/ation 7,level ,i7 ,g-#e ,g-#e4 ,pati5t ,decontam9ation at ! ,m$ical ,company ,cle>+ ,/ation 7,level ,,ii7 ,g-#e ,g-#f4 ,pati5t ,decontam9ation at a ,hospital 7,level ,,iii & ,,iv7 ,g-#e ,g-#g4 ,prep>e ,hypo*lorite ,solutions = ,pati5t ,decontam9ation ,g-#e ,g-#h4 ,classification ( ,pati5ts ,g-#f ,g-#i4 ,pati5t ,treatm5t ,g-#f ,section ,,ii4 ,pati5t ,decontam9ation ,proc$ures ,g-#g ,g-#aj4 ,decontam9ate a ,litt] ,*emical ,ag5t ,pati5t ,g-#g ,g-#aa4 ,decontam9ate an ,ambulatory ,*emical ,ag5t ,pati5t ,g-#ad ,g-#ab4 ,biological ,pati5t ,decontam9ation ,proc$ures ,g-#ah ,g-#ac4 ,decontam9ate a ,litt] ,biological ,ag5t ,pati5t ,g-#ah ,g-#ad4 ,decontam9ate an ,ambulatory ,biological ,ag5t ,pati5t ,g-#ai ,g-#ae4 ,decontam9ate ,nucle>-,contam9at$ ,pati5ts ,g-#bj ,g-#af4 ,decontam9ate a ,litt] ,nucle>-,contam9at$ ,pati5t ,g-#ba ,g-#ag4 ,decontam9ate an ,ambulatory ,nucle>-,contam9at$ ,pati5t ,g-#ba ,,app5dix ,h4 ,,field ,,exp$i5t ,,protective ,,sy/ems ,,aga9/ ,,nucle>1 ,,biological1 ,,& ,,*emical ,,attack ,h-#a ,h-#a4 ,g5]al ,h-#a ,h-#b4 ,protection ,aga9/ ,radiation ,h-#a ,h-#c4 ,exp$i5t ,%elt]s = ,protection ,aga9/ ,radiation ,h-#b ,h-#d4 ,exp$i5t ,%elt]s ,aga9/ ,biological & ,*emical ,ag5ts ,h-#e ,,app5dix ,i4 ,,detection ,,& ,,treatm5t ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,contam9ation ,,9 ,,wat] ,i-#a ,i-#a4 ,g5]al ,i-#a ,i-#b4 ,detection ( ,contam9ation 9 ,wat] ,i-#a ,i-#c4 ,proc$ures on ,discov]y ( ,contam9ation 9 ,wat] ,i-#a ,i-#d4 ,treatm5t ( ,contam9at$ ,wat] ,i-#b ,,app5dix ,j4 ,,food ,,contam9ation ,,& ,,decontam9ation ,j-#a ,j-#a4 ,g5]al ,j-#a ,j-#b4 ,protection ( ,food ,f ,contam9ation ,j-#b ,j-#c4 ,nucle> ,j-#c ,j-#d4 ,biological ,j-#d ,j-#e4 ,*emical ,j-#e ,,gloss>y ,gloss>y-#a ,,ref]5ces ,ref]5ces-#a ,,index ,index-#a ,,di/ribution ,,re/riction3 ,approv$ = public release2 di/ribution is unlimit$4 99 ,?is publication sup]s$es ,,fm #h-aj-g1 #bb ,april #aiic4 ,*ange #a1 #bf ,novemb] #aiif ,,preface ,! purpose ( ?is field manual 7,,fm7 is to provide doctr9e & tactics1 te*niques1 & proc$ures = heal? s]vice support 7,,hss7 units & p]sonnel op]at+ 9 a nucle>1 biological1 & *emical 7,,nbc71 radiological disp]sal device 7,,rdd71 & toxic indu/rial mat]ial 7,,tim7 environm5t4 ,! manual provides in=mation = use by comm&]s1 plann]s1 lead]s1 & individuals 9 provid+ ,,hss "u ^! adv]se conditions4 ,! use ( trade or br& names 9 ?is publication is = illu/rative purposes only4 ,_! use does n con/itute endorsem5t by ! ,dep>tm5t ( ,def5se 7,,dod74 ,! propon5t ( ?is publication is ! ,unit$ ,/ates 7,,u7 ,army ,m$ical ,dep>tm5t ,c5t] & ,s*ool 7,,am$dc,s74 ,s5d comm5ts & recomm5dations directly to ,comm&]1 ,,u ,army ,m$ical ,dep>tm5t ,c5t] & ,s*ool1 ,,attn3 ,,mccs-,,fcd1 #adjj ,ea/ ,grayson ,/reet1 ,=t ,sam ,h\/on1 ,texas #ghbcd-ejeb4 ,! use ( ! t]m level ( c>e 9 ?is publication is synonym\s ) e*elon ( c>e & role ( c>e4 ,! t]m e*elon ( c>e is ! old ,nor? ,atlantic ,treaty ,organization 7,,nato7 t]m4 ,! t]m role ( c>e is ! new ,,nato & ,am]ican1 ,briti%1 ,canadian1 & ,au/ralian 7,,abca7 t]m4 ,! use ( ! t]m ,,tim 9 ?is publication is inclusive ( ,,rdd4 ,! use ( ! t]m ,heal? ,s]vice ,support 9 ?is publication is synonym\s ) ,combat ,heal? ,support z us$ 9 o!r publications4 ,heal? ,s]vice ,support is ! t]m us$ 9 ,jo9t ,publications to describe m$ical support to ,jo9t ,=ces4 ,radiological & *emical detection devices discuss$ 9 ?is publication are curr5tly be+ replac$ ?r\gh mod]nization or new device developm5ts4 ,! us]s %\ld adapt ! application ( doctr9e z describ$ to fit ! new devices :5 issu$_/au?oriz$4 ,unless ?is publication /ates o!rwise1 mascul9e n\ns & pron\ns d n ref] exclusively to m54 ,?is publication implem5ts ,,nato ,/&>dization ,agreem5ts 7,s,t,a,n,a,gs7 #bdge1 ,m$ical ,plann+ ,guide = ! ,e/imation ( ,,nbc ,battle ,casualties 7,nucle>7--,alli$ ,m$ical ,publication 7,a,med,p7 #h7;,a71 ,volume ,i2 #bdgf1 ,m$ical ,plann+ ,guide ( ,,nbc ,battle ,casualties 7,biological7--,a,med,p-#h7;,a71 ,volume ,,ii2 #bdgg1 ,plann+ ,guide = ! ,e/imation ( ,,nbc ,battle ,casualties 7,*emical7--,a,med,p-#h 7,a71 ,volume ,,iii4 ,x is also 9 consonance ) ! foll[+ ,,nato ,s,t,a,n,a,gs & ,,abca ,quadrip>tite ,/&>dization ,agreem5ts 7,q,s,t,a,gs73 ,,title ,,/anag ,,q/ag ,w>n+ ,signs = ! ,m>k+ ( ,contam9at$ or ,dang]\s ,l& ,areas1 ,complete ,equipm5ts1 ,supplies & ,/ores #bjjb #eja ,em]g5cy ,al>ms ( ,haz>d or ,attack 7,,nbc & ,air ,attack ,only7 #bjdg #ahc ,int]op]able ,*emical ,ag5t ,detector ,kits #fjh ,em]g5cy ,w> ,surg]y #bjfh ,comm&]'s ,guide on ,nucle> ,radiation ,exposure ( ,gr\ps #bjhc #hih ,report+ ,nucle> ,detonations1 ,biological & ,*emical ,attacks1 & ,pr$ict+ & ,w>n+ ( ,associat$ ,haz>ds & ,haz>d ,areas--,,atp-#de7;,b7 #bajc #ahg ,fri5dly ,nucle> ,/rike ,w>n+ #bajd #ahi ,nucle>1 ,biological & ,*emical ,reconnaissance #baab ,,nato ,h&book on ! ,m$ical ,aspects ( ,,nbc ,def5sive ,op]ations--,a,med,p-#f7;,b7 #bejj ,concept ( ,op]ations ( ,m$ical ,support 9 ,nucle>1 ,biological1 & ,*emical ,environm5ts--,a,med,p-#g7;,a7 #bhgc ,m$ical ,aspects ( ,,nbc ,def5sive ,op]ations #accj ,pr9ciples ( ,m$ical ,policy 9 ! ,managem5t ( a ,mass ,casualty ,situation #bhgi ,m$ical ,aspects ( ,mass ,casualty ,situations #haf ,guidel9es = ,air & ,gr\nd ,p]sonnel ,us+ ,fix$ & ,transportable ,collective ,protection ,facilities on ,l& #bida #bjjj ,tra9+ ( ,m$ical ,p]sonnel = ,,nbc ,op]ations #bied ,,*apt] #a ,,nucle>1 ,,biological1 ,,& ,,*emical ,,w>f>e ,,aspect ,,( ,,! ,,m$ical ,,?reat #a-a4 ,g5]al a4 ,aft] ,_w ,w> ,,ii1 ! ,soviet ,union repres5t$ ! pr9cipal ?reat to ! national security int]e/s ( ! ,,u4 ,dur+ ?is p]iod1 ! milit>y capability ( ! ,soviet ,arm$ ,=ces grew enorm\sly4 ,/>t+ 9 ! lat] ye>s ( ! #aihjs1 ! int]national security environm5t has und]gone rapid1 fundam5tal1 & revolution>y *anges4 ,) ! collapse ( ,soviet communism1 ! ,soviet ,union dis9tegrat$ z a viable economic & political sy/em4 ,! ,w>saw ,pact dissolv$ z a political & milit>y entity4 ,! c5tral ,soviet gov]nm5t 0 replac$ by ! ,commonweal? ( ,indep5d5t ,/ates 7,,cis71 dom9at$ by ! ,russian ,republic4 ,! cohesion ( ,soviet /rategic milit>y capability has be5 fractur$ by-- ,! dissolution ( c5tral ,soviet control4 ,! =mation ( ! ,,cis4 ,! unpr$ictability associat$ ) unc]ta9 loyalties & l[ morale4 ,! ultimate outcome ( ^! ev5ts 9 t]ms ( ,,u national security int]e/s is uncle>4 ,! milit>y capabilities ( ,,cis l ,russia1 ,ukra9e1 ,kazak/an1 & ,bel>us rema9 =midable4 ,! capabilities include /rategic nucle> & impressive conv5tional1 biological1 & *emical w>fight+ capabilities4 b4 ,f a global p]spective1 ! economic p[] & influ5ce ( develop+ & newly indu/rializ$ nations cont9ue to gr[4 ,c5t]s ( p[] 7global or regional7 _c be measur$ solely 9 milit>y t]ms4 ,nation /ates pursu+ _! own political1 ideological1 & economic int]e/s may become engag$ 9 direct or indirect competition & conflict ) ! ,,u4 ,m nations h acquir$ significant numb]s ( mod]n1 le?al1 combat weapon sy/ems2 develop$ v capable arm$ =ces2 & become m ass]tive 9 int]national affairs4 ,9 ! abs5ce ( a s+le1 cr$ible1 co]cive ?reat1 old rivalries & long repress$ t]ritorial ambitions w resurface1 caus+ increas$ t5sions 9 _m regions4 ,political1 economic1 & social in/ability & religi\s1 cultural1 & economic competition w cont9ue to erode ! influ5ce ( ! ,,u ov] ! re/ ( ! _w4 ,?is erosion w also r$uce ! ,,u influ5ce ( traditional regional p[]s ov] _! neighbors4 ,?is environm5t w enc\rage ! cont9u$ developm5t1 or acquisition1 ( mod]n arm$ =ces & equipm5t by less influ5tial nations2 ?us rais+ ! pot5tial = ! use ( ,,nbc_/,,rdd weapons dur+ int]nal conflict & arm$ confrontations 9 develop+ regions ( ! _w4 c4 ,a ?ird dim5sion to ! ?reat is t]rori/1 rogue gr\ps1 & bellig]5ts employ+ a numb] ( *emical & biological ag5ts & ! possible use ( ,,tim to injure or kill ,,u p]sonnel4 ,! actions may be isolat$ or may be impos$ by gr\ps ( individuals4 ,mo/ w h ! f9ancial back+ ( nations1 l>ge organizations1 or gr\ps t h ! desire to cause h>m & create public di/ru/ 9 our gov]nm5t4 #a-b4 ,m$ical ,?reat ,m$ical ?reat is ! composite ( all ongo+ or pot5tial enemy actions & environm5tal conditions t w r$uce combat effectiv5ess ?r\gh w\nd+1 injur+1 caus+ disease1 &_/or degrad+ p]=mance4 ,soldi]s are ! t>gets ( ^! ?reats4 ,weapons or environm5tal conditions t w g5]ate w\nd$1 injur$1 & sick soldi]s1 beyond ! capability ( ! ,,hss sy/em to provide timely m$ical c>e f available res\rces1 are consid]$ major m$ical ?reats4 ,weapons or environm5tal conditions t produce qualitatively diff]5t w\nd or disease processes are also major m$ical ?reats4 ,add$ to ! combat op]ational & disease & nonbattle injury 7,,dnbi7 m$ical ?reats are adv]s>y use ( ! foll[+ types ( weapons1 ag5ts1 & devices3 ,biological w>f>e ag5ts4 ,*emical w>f>e ag5ts4 ,nucle> weapons4 ,toxic indu/rial mat]ials4 ,radiological disp]sal devices4 ,direct$-en]gy devices_/weapons4 ,*emical1 biological1 radiological1 nucle>1 & high-yield explosives4 #a-c4 ,nucle>1 ,biological1 ,*emical1 & ,radiological ,disp]sal ,device ,?reats--,! ,heal? ,s]vice ,p]spective a4 ,nucle> ,weapons & ,radiological ,disp]sal ,device ,?reats4 ,s9ce ! breakup ( ! ,soviet ,union1 ! numb] ( c\ntries ) kn[n nucle> capable milit>y =ces has almo/ d\bl$4 ,available in=mation sugge/s t a numb] ( c\ntries 9 ! ,middle ,ea/1 ,asia1 & ,africa h or may h nucle> weapons capability )9 ! next decade4 ,table #a-a li/s ^? c\ntries kn[n to h1 suspect$ ( possess+1 or seek+1 nucle> weapons4 ,plann]s c expect1 z a m9imum1 #aj to #bj p]c5t casualties )9 a division-siz$ =ce t has exp]i5c$ a nucle> /rike4 ,9 addition to ! casualties1 a nucle> weapon detonation c g5]ate an electromagnetic pulse 7,,emp7 t w cause cata/rophic failures ( electronic equipm5t compon5ts4 ,radiological disp]sal devices1 compris$ ( an explosive device ) radioactive mat]ial1 c be detonat$ )\t ! ne$ = ! compon5ts ( a nucle> weapon4 ,! ,,rdd c disp]se radioactive mat]ial ov] an area ( ! battlefield caus+ effects f nuisance levels ( radioactive mat]ial to life-?reat5+ levels )\t ! !rmal &1 9 mo/ cases1 ! bla/ effects ( a nucle> detonation4 ,= nucle> weapons effects see ,app5dix ,a4 ,table #a-a4 ,c\ntries ,possess+ or ,suspect$ ( ,possess+ ,nucle> ,weapons ,,kn[n ,,to ,,possess ,,suspect ,,or ,,seek+ ---------------------------------------- ---------------- ,,unit$ ,,/ates ,,( ,,am]ica ,,iraq ,,russia ,,nor? ,,korea ,,ukra9e ,,iran ,,bel>us ,,libya ,,kazak/an ,,alg]ia ,,p',s ,,republic ,,( ,,*9a ,,s\? ,,africa ,,france ,,israel ,,unit$ ,,k+dom ,,paki/an ,,india b4 ,biological ,w>f>e4 7#a7 ,biological w>f>e 7,,bw7 is def9$ by ! ,,u intellig5ce community z ! int5tional use ( disease-caus+ organisms 7pa?og5s71 tox9s1 or o!r ag5ts ( biological orig9 7,,abo7 to incapacitate1 injure1 or kill humans & animals2 to de/roy crops2 to weak5 resi/ance to attack2 & to r$uce ! w to fight4 ,hi/orically1 ,,bw has prim>ily involv$ ! use ( pa?og5s 9 assass9ations or z sabotage ag5ts 9 food & wat] supplies to spread contagi\s disease among t>get populations4 7#b7 ,= purposes ( m$ical ?reat risk assessm5t1 we are int]e/$ only 9 ^? ,,bw ag5ts t incapacitate1 injure1 or kill humans or animals4 7#c7 ,kn[n or suspect ,,bw ag5ts & ,a,b,os c g5]ally be categoriz$ z naturally occurr+1 unmodifi$ infecti\s ag5ts 7pa?og5s72 tox9s1 v5oms1 & _! biologically active fractions2 modifi$ infecti\s ag5ts2 & bioregulators4 ,see ,table #a-b = examples ( kn[n or suspect$ ,,bw ?reat ag5ts4 ,also1 ,table #a-c pres5ts possible developm5tal & future ,,bw ag5ts4 ,table #a-b4 ,examples ( ,kn[n or ,suspect ,biological ,w>f>e ,ag5ts ,,pa?og5s ,,tox9s ---------------------------------------- -------------------- ,,bacillus ,,an?racis 7,,an?rax7 ,,botul9um ,,tox9 ,,francisella ,,tul>5ius 7,,tul>emia7 ,,mycotox9s ,,y]s9ia ,,pe/is 7,,plague7 ,,ent]otox9 ,,brucella ,,species 7,,brucellosis7 ,,ric9 ,,vibrio ,,*ol]ae 7,,*ol]a7 ,,v>iola 7,,smallpox7 ,,viral ,,hemorrhagic ,,fev]s ,table #a-c4 ,! ,future ( ,biological ,w>f>e ,ag5ts ,,curr5t ,,?reat ,,future ---------------------------------------- ------------------------------- ,,pa?og5s ,,modifi$ ,,pa?og5s ,,limit$ ,,numb] ,,( ,,tox9s ,,exp&$ ,,range ,,( ,,tox9s 7,,organo-,,tox9s7 ,,ag5ts ,,( ,,biological ,,orig9 ,,prote9 ,,fractions ,,ag5ts ,,( ,,biological ,,orig9 7#d7 ,_m gov]nm5ts recognize ! indu/rial & economic pot5tial ( advanc$ biote*nology & bio5g9e]+4 ,! same k1 skills1 & me?odologies c be appli$ to ! production ( second & ?ird g5]ation ,,bw ag5ts4 ,naturally occurr+ infecti\s organisms c be made m virul5t & antibiotic resi/ant & manipulat$ to r5d] protective vacc9es ineffective4 ,^! developm5ts complicate ! ability to detect & id5tify ,,bw ag5ts & to op]ate 9 areas contam9at$ by ! ,,bw ag5ts4 ,= biological ag5t *>act]i/ics & effects see ,app5dix ,a4 ,! fir/ indication t a ,,bw ag5t release_/attack has occurr$ may be pati5ts pres5t+ at a m$ical treatm5t facility ) symptoms n fitt+ ! mold = endemic diseases 9 ! area ( op]ations 7,,ao74 ,see ,app5dix ,b = sampl+ requirem5ts1 sampl+ proc$ures1 packag+ & %ipp+1 & *a9 ( cu/ody requirem5ts4 c4 ,*emical ,w>f>e4 7#a7 ,s9ce ,_w ,w> ,i1 mo/ we/]n political & milit>y lead]s h publicly held *emical w>f>e 7,,cw7 9 disrepute4 ,h[ev]1 evid5ce accumulat$ ov] ! la/ #ej ye>s does n support ! position t public condemnation equates to limit+ developm5t or use ( (f5sive ,,cw ag5ts4 ,! report$ use ( *emical ag5ts & biological tox9s 9 ,s\!a/ ,asia by ,vietnamese =ces2 ! confirm$ use ( ,,cw ag5ts by ,egypt aga9/ ,yem52 & lat] by ,iraq aga9/ ,iranian =ces2 & ! probable use ( ,,cw ag5ts by ! ,soviets 9 ,afghani/an indicate a height5$ int]e/ 9 ,,cw z a =ce multipli]4 ,also1 an (f5sive ,,cw capability is develop$ z a det]r5t to ! milit>y advantage ( a pot5tial adv]s>y4 ,= a li/ ( common *emical ag5ts1 _! *>act]i/ics1 behavior1 & effects see ,app5dix ,a4 ,table #a-d li/s ^? c\ntries kn[n or suspect$ ( hav+ (f5sive *emical weapons4 7#b7 ,! ,russian ,republic has ! mo/ ext5sive ,,cw capability 9 ,europe4 ,*emical /rikes c be deliv]$ ) almo/ any type ( conv5tional fire support weapon sy/em 7f mort>s to long-range tactical missiles74 ,ag5ts kn[n to be available 9 ! ,russian inv5tory include n]ve ag5ts 7,o-e?yl me?yl phosphono?iolate ,,vx1 ?ick5$ ,,vx1 ,s>9 ,,gb1 & ?ick5$ ,soman ,,gd72 vesicants 7?ick5$ ,lewisite,l & mu/>d-,lewisite mixture,,hl72 & *ok+ ag5t 7phosg5e74 ,al?\gh n consid]$ ,,cw ag5ts1 riot control ag5ts are also 9 ! ,russian inv5tory4 7#c7 ,! ,,u is 9 ! process ( de/roy+ its /ockpiles ( ,,cw weapons4 ,_m weapons h already be5 de/roy$ & ! /orage facilities h be5 r5d]$ safe ( all ,,cw ag5t residues4 ,table #a-d4 ,nations ,kn[n or ,suspect$ ( ,possess+ ,*emical ,weapons ,,kn[n ,,to ,,possess ,,suspect$ ,,( ,,possess+ ---------------------------------------- -------------------------- ,,unit$ ,,/ates ,,( ,,am]ica ,,p',s ,,republic ,,( ,,*9a ,,russia ,,nor? ,,korea ,,france ,,egypt ,,libya ,,israel ,,iraq99 ,,e?iopia ,,iran ,,taiwan ,,syria ,,burma ---------------------------------------- -------------------------- 99 ,,foll[+ ,,! ,,p]sian ,,gulf ,,w> 7#aiij-ia71 ,,! ,,unit$ ,,nations 7,,un7 ,,began ,,de/roy+ ,,cw ,,munitions ,,discov]$ ,,dur+ ,,inspection ,,visits ,,to ,,iraq ,,by ,,un ,,arms ,,control ,,inspectors4 ,,includ$ ,,among ,,! ,,cw ,,munitions ,,discov]$ ,,7 ,,"s #b1jjj ,,a]ial ,,bombs ,,& #f1bjj ,,artill]y ,,%ells ,,fill$ ,,) ,,mu/>d ,,& ,,sev]al ,,?\s& #abb ,,millimet]s 7mm7 ,,rocket ,,w>heads ,,fill$ ,,) ,,n]ve ,,ag5t 7,,gb74 ,,iraq ,,also ,,decl>$ ,,surface ,,to ,,air ,,missile 7,,scud7 ,,w>heads ,,fill$ ,,) ,,n]ve ,,ag5t 7,,gb ,,& ,,gf74 ,,table #a-e ,,provides ,a ,,li/ ,,( ,,kn[n ,,cw ,,ag5ts4 ,table #a-e4 ,*emical ,w>f>e ,ag5ts ,,n]ve ,,vesicant ,,incapacitat+ ,,*ok+ ,,blood ---------------------------------------- ------------------------------- ,,tabun7,,ga7 ,,sulfur ,,cns ,,depressant7,,bz7 ,,phosg5e 7,,cg7 ,,hydrog5 ,,mu/>d 7,,hd7 ,,cyanide 7,,ac7 ,,gb ,,hl ,,*lor9e 7,,cl7 ,,diphosg5e 7,,dp7 ,,cyanog5 ,,gd ,l ,,*loropicr9 7,,ps7 ,,*loride 7,,ck7 ,,gf ,,phosg5e ,d-,,lys]gic ,,acid ,,oxime 7,,cx7 ,,vx ,,die?ylamide 7,,lsd7 d4 ,toxic ,indu/rial ,mat]ials4 ,toxic indu/rial mat]ials c pres5t a m$ical ?reat = deploy$ =ces4 ,toxic indu/rial mat]ials are compris$ ( toxic indu/rial biologicals 7,,tib71 toxic indu/rial *emicals 7,,tic71 & toxic indu/rial radiological 7,,tir7 mat]ials4 ,^! mat]ials are f\nd ?r\gh\t ! _w & are us$ on a daily basis = comm]cial & private purposes4 ,l>ge /orage facilities1 transportation tank]s 7ov] ! road & railc>s71 z well z small] conta9]s ( mat]ial1 pose a dang] to ! heal? ( p]sonnel4 ,accid5tal spills or releases & t]rori/ actions c all lead to release ( ^! mat]ials into ! environm5t caus+ pot5tial casualty produc+ effects4 ,m$ical treatm5t facilities & nucle> p[] plants use radioactive mat]ials t c pose a heal? haz>d if accid5tally releas$ or us$ by ho/ile =ces1 t]rori/s1 or o!rs to contam9ate an area4 ,biological mat]ials us$ 9 m$ical rese>* & ph>maceutical manufactur+ may be us$ by ho/ile =ces1 t]rori/s1 or o!rs to produce casualties4 ,_m ,t,i,cs produce ! same effects on p]sonnel z ,,cw ag5ts4 ,z a matt] ( fact1 _m ,t,i,cs are ( ! same *emical /ructure z ,,cw ag5ts4 ,h[ev]1 !re is q a diff]5ce 9 _! pot5cy2 9 mo/ ,t,i,cs ! pot5cy is mu* l[]4 ,= example1 *lor9e us$ to treat wat] supplies has also be5 us$ z a ,,cw ag5t2 organophosphate pe/icides c cause ! same effects z "s n]ve ag5ts4 ,ho/ile =ces1 t]rori/s1 or o!rs may use ,r,d,ds to produce casualties z well4 ,= detail$ in=mation on toxic indu/rial mat]ials see ,,fm #h-ejj4 ,,*apt] #b ,,comm& ,,& ,,control #b-a4 ,g5]al ,! ,,u =ces may be attack$ by or expos$ to ,,nbc1 ,,tim1 las]s1 advanc$ electronics1 high explosives1 fuel-air1 !rmob>ic1 & conv5tional weapons2 or a comb9ation ( ^! weapons_/mat]iel4 ,mass casualty situations w be ! rule & n ! exception4 ,mass casualty situations c occur anyplace on ! battlefield4 ,comb9$ ,,nbc & conv5tional weapons injuries may pr$om9ate4 ,comm& & control 7,c#b7 w be ess5tial to prev5t casualties & to provide effective ,,hss4 ,h[ev]1 ,c#b 7to include ,,hss ,c#b7 elem5ts may be prim>y t>gets4 ,effective ,,hss 9 an ,,nbc environm5t c be accompli%$1 b only if necess>y prep>ations to survive & to be mission capable are tak54 ,increas$ ,,hss ,c#b actions are ne$$ to ma9ta9 ,,hss proximity to ! support$ =ce2 to cle> ! battlefield2 to move & resupply ! ,,hss units1 :ile manag+ multiple simultane\s mass casualty incid5ts2 & to rapidly evacuate pati5ts4 ,heal? s]vice support ,c#b units mu/ pu% ,,hss augm5tation to mass casualty sites1 cle> ! site1 evacuate ! pati5ts to ,m$ical ,treatm5t ,facilities 7,m,t,fs7 t c provide ess5tial c>e or out ( ! ,,ao2 decontam9ate & extract m$ical =ces f ,,nbc contam9at$ areas & r$i/ribute or r$eploy ! ,,hss =ces4 ,)9 m$ical units1 ,c#b w be *all5g$ by ! use ( protective clo?+ & equipm5t1 ! ne$ to move 7ei!r to ! pati5ts or out ( ! contam9at$ area71 & obta9+ additional support4 ,heal? s]vice support advis]s & /aff (fic]s mu/ provide guidance to comm&]s on cont9u$ duty = p]sonnel :o h be5 expos$ to ,,nbc weapons_/ag5ts & ,,tim effects4 ,lead]s mu/ greatly increase coord9at+1 preplann+1 us+ tactical /&+ op]at+ proc$ures 7,t,s,o,ps71 & e/abli%+ multiple ,c#b me*anisms4 ,see ,app5dix ,c = guidel9es on op]ational plann+ = heal? s]vice support 9 an ,,nbc or ,,tim environm5t4 ,see ,app5dix ,d = m$ical plann+ guide on ,,nbc casualties4 ,see ,app5dix ,e = a sample =mat ( a m$ical ,,nbc /aff (fic] app5dix to annex ,q4 #b-b4 ,heal? ,s]vice ,support ,comm& & ,control ,plann+ ,consid]ations a4 ,battle situational und]/&+ is ( great importance on ! ,,nbc battlefield4 ,! numb] ( casualties f ea* ,,nbc attack w ov]:elm any s+le m$ical unit or ,,mtf caus+ ! m$ical comm&]_/lead] to take action4 ,to ! ext5t possible1 ! comm&]_/lead] %\ld be prep>$ = ! requirem5t in/ead ( react+ to x4 ,to ensure responsive ,c#b ! ,,hss plan mu/ consid]3 ,likely t>gets 7,c#b nodes1 ma9 supply r\tes 7,,msr71 supply nodes1 troop conc5trations1 key t]ra9 features1 key =ces1 or o!r high value t>gets74 ,pati5t e/imates 7conv5tional1 ,,nbc1 & ,,tim74 ,availability ( ,,hss res\rces 7pree/abli%$ support plans74 ,availability ( requir$ nonm$ical support 7pati5t decontam9ation teams74 ,ability to ma9ta9 op]ations if ,c#b is lo/ at any ,,hss level4 ,ability to ma9ta9 ,c#b op]ations :5 normal communication sy/ems h be5 disabl$ due to ,,emp effects or o!r sy/em failures4 ,ability to ma9ta9 ,c#b op]ations :ile ! unit is op]at+ 9 mission-ori5t$ protective po/ure 7,,mopp7 ,level #d 7r$uc$ audio & visual acuity74 ,! requirem5ts = immunizations1 pretreatm5ts1 b>ri] creams1 prophylaxis1 insect repell5ts1 & o!r m$ical c\nt]measures to protect ! =ces4 ,! res\rce requirem5ts = treatm5t1 ,,m$evac1 & hospitalization 7includ+ c>e = enemy prison]s ( w> ,,epw74 b4 ,cle>+ ! battlefield w require preplann+ & close coord9ation at all levels4 ,e>ly resuscitation1 /abilization1 & prompt m$ical evacuation 7,,m$evac7 are m&atory = survival ( ! sick & w\nd$4 c4 ,= conv5tional op]ations ,c#b see ,,fm #h-aj4 ,field ,manual #h-ee provides ,,hss plann+ = conv5tional op]ations4 d4 ,provisions = em]g5cy m$ical c>e ( civilians1 consi/5t ) ! milit>y situation4 ,all non-,,dod civilian c>e mu/ be approv$ by ! ,,ao ,comm&] 9 ,*ief_/s5ior (ficial & coord9at$ ) ! civil affairs unit &_/or c\ntry team4 ,= eligibility ( c>e det]m9ations guidance1 see ,,fm #h-aj4 e4 ,= additional in=mation on plann+ op]ations 9 an ,,nbc environm5t see ,f,ms #h-aj1 #d-jb4aj1 #d-jb4d1 #d-jb4f1 #d-jb4bhc1 #h-i1 #h-aj-f1 #h-aj-bf1 #h-bhd1 & #h-bhe4 ,high] headqu>t]s mu/ di/ribute timely plans & directives to subord9ate units to ensure t ! subord9ate unit's ,,hss plan supports _! plan4 #b-c4 ,heal? ,s]vice ,support ,comm& & ,control ,appraisal ( ! ,support ,m9ion ,! ,,hss p]sonnel make an appraisal ( ! support$ mission to det]m9e ! expect$ pati5t load4 ,once ! appraisal has be5 accompli%$1 ,,hss p]sonnel prep>e = ! ,,hss mission by assign+ p]sonnel responsibilities4 ,us+ triage & ,,emt decision matrices = manag+ pati5ts 9 a contam9at$ environm5t improves treatm5t pr(ici5cy4 ,see ,figure #b-a = a sample decision matrix4 ,tra9+ ,,hss p]sonnel 9 ! use ( simple decision matrices %\ld enhance _! effectiv5ess & contribute to a m effici5t battlefield ,,hss process4 ,prior tra9+ = designat$ nonm$ical p]sonnel 9 pati5t decontam9ation proc$ures w enhance _! effectiv5ess 9 ! ov]all pati5t c>e mission4 ,see ,app5dix ,d = plann+ factors on ! e/imation ( ,,nbc casualties4 #b-d4 ,heal? ,s]vice ,support ,units ,heal? s]vice support units mu/ plan1 tra91 & r\t9ely practice mass casualty managem5t4 ,! ,,nbc attack or ,,tim ev5t w likely be 9 conjunction ) enemy conv5tional op]ations4 ,b1 ! ,,tim ev5t may be caus$ by t]rori/ or bellig]5t action4 ,!re w likely be increas$ conv5tional casualties 9 addition to ! ,,nbc_/,,tim relat$ casualties4 ,! supply & transportation units w be us+ ! ,,msr 9 support ( ! combat comm&]'s requirem5ts2 ?us1 impact+ on pati5t ,,m$evac & ,,hss unit resupply4 ,communications w be disrupt$4 ,!re=e1 ,,hss ,c#b mu/ plan & prep>e = conduct+ op]ations ) limit$ or no communications ) o!r ,,hss organizations4 ------------------------------------ ,,ga!r ,,data ,,n]ve ,,ag5t ,,symptoms 7,,visual_/,,tactile--,,v]bal_/,,nonv]ba l7 ----------------------------------- ---------------- ,,*eck ,,mopp ,,ge> ---------------- ---------------------------- ------------- ------------- ,,n ,,intact ,,intact ------------- ------------- ------------- ------------- ,,adm9i/] ,,adm9i/] ,,antidote ,,antidote ------------- ------------- ------------- ----------- ,,secure ,,mopp ,,ge> --------- --------- ------------- ,,individual ,,individual ,,c ,,_c ----------- ,,function ,,function --------- --------- --------- --------- ------- ----------- ,,individual ,,individual ,,rtd ,,*eck ,,= ,,c ,,_c -------- ,,o!r ,,function ,,function ---------------- ,,injuries --------- ---------- ----------- --------- -------------- ,,rtd ---------- ------------ ----------- ,,no ,,injuries ,,injuries ------------ ----------- ------------ ----------- ,,evac ,,provide ------------- ,,emt ----------- ----------- ,,evac ------------ ,figure #b-a4 ,sample triage & em]g5cy m$ical treatm5t decision matrix4 #b-e4 ,movem5t_/,managem5t ( ,contam9at$ ,facilities ,op]ations 9 a contam9at$ area require ! ,,hss comm&]_/lead] to op]ate ) contam9at$ or pot5tially contam9at$ assets4 ,! foll[+ provides guidance 9 det]m9+ h[ to op]ate ) contam9at$ facilities3 a4 ,fulfill ,heal? ,s]vice ,support ,pr9ciples4 ,9 mak+ 8 decision to move or cont9ue to op]ate ) contam9at$ facilities1 ! comm&]_/lead] mu/ apply ! pr9ciples ( con=mity1 proximity1 flexibility1 mobility1 cont9uity1 & control4 ,! unit's op]ation mu/ con=m to ! tactical comm&]'s op]ation plan 7,,oplan74 ,heal? s]vice support mu/ be provid$ to ! tactical unit z f> =w>d z possible2 ?is ensures prompt1 timely c>e4 ,additionally1 ! ,,hss comm&]_/lead] mu/ be flexible2 8 support mu/ be tailor$ to meet ! support$ comm&]'s ,,oplan requirem5ts4 ,!re=e1 ,,hss assets mu/ be z mobile z ! unit !y support4 ,f9ally1 ! ,,hss comm&]_/lead] mu/ control 8 assets4 ,disp]sion on ! integrat$ battlefield may enhance unit survivability2 b ! ,,hss comm&]_/lead] may n be able to ma9ta9 control ( 8 assets1 !y may become compromis$4 b4 ,decision to ,move4 ,! ,,hss comm&]_/lead] 7:5 decid+ to move 8 unit to an uncontam9at$ area or 9 support ( ! tactical comm&]'s plan7 mu/ base 8 decision to move on sev]al factors4 7#a7 ,protection available4 ,:at type ( protection is available 9 ! new area8 ,w he ne$ to e/abli% ! units' collective protection %elt] 7,,cps7 sy/ems1 or are indig5\s %elt]s available 7= example1 build+s1 tunnels1 caves78 ,does ! unit h suffici5t individual protective equipm5t = unit p]sonnel8 7#b7 ,p]si/5cy4 ,if 8 unit has be5 9 a contam9at$ area1 is ! contam9ation p]si/5t or nonp]si/5t8 ,is ! area he w move to contam9at$ or clean8 ,p]si/5cy det]m9es ! ,,mopp level2 ! degree ( ?reat2 & p]=mance decrem5t caus$ by ! protective measures us$4 ,! level ( contam9ation w det]m9e :e!r employm5t ( ,,cps is viable4 ,! ,,mtf may be able to cont9ue to op]ate at ! location by employ+ ,,cps4 ,p]sonnel & pati5t decontam9ation mu/ be accompli%$ be=e process+ into ! ,,cps4 7#c7 ,pati5ts4 ,be=e mov+ ! entire facility1 ! ,,hss comm&]_/lead] mu/ consid] ! numb] & types ( pati5ts at ! ,,mtf2 8 ability to r$irect en r\te pati5ts to ! new ,,mtf location2 & 8 ability to evacuate ! pati5ts curr5tly on h&4 ,all pati5ts %\ld be /abiliz$ be=e movem5t2 b1 ,,m$evac mu/ be cont9u$4 7#d7 ,alt]nate facilities4 ,alt]nate facilities may be us$ 7if ! facility c be configur$ to ensure cont9uity ( c>e or provide a protect$ area = pati5ts7 until ! relocat+ activity is up & op]at+4 ,?is is a viable consid]ation :5 ,,cps is n available or ! curr5t location is contam9at$ ) a p]si/5t ag5t4 ,pati5t decontam9ation _c be p]=m$ 9 an area heavily contam9at$ ) a p]si/5t ag5t4 7#e7 ,m$ical evacuation4 ,consid]ation mu/ always be giv5 to ! pati5t4 ,r\tes ( ,,m$evac mu/ be dissem9at$ to support$ & support+ units4 ,! ability to evacuate pati5ts dur+ ! move mu/ cont9ue4 ,all ,,m$evac consid]ations mu/ be address$ be=e any move4 7#f7 ,mobility4 ,an ,,mtf t is n #ajj p]c5t mobile requires movem5t support4 ,?us1 ! comm&]_/lead] mu/ coord9ate movem5t support requirem5ts ) high] headqu>t]s4 7#g7 ,mission4 ,! prim>y consid]ation is ! support mission ( ! ,,mtf4 ,! tactical comm&] requires cont9u\s ,,hss = 8 p]sonnel2 :5 a move jeop>dizes ! quality ( c>e1 ! move may be delay$4 7#h7 ,su/a9ability4 ,h&-9-h& ) ! mission is su/a9ability 7! ability ( ! unit to cont9ue its support mission74 ,if ! curr5t location ( ! ,,mtf h9d]s ! unit's ability to su/a9 its support mission1 !n ! ,m,t,fs support to ! unit is 9 "q4 ,simil>ly1 if mov+ ! ,,mtf w result 9 a disruption ( support1 !n ! move may n be viable4 7#i7 ,decontam9ation4 ,:5 a nonp]si/5t ag5t haz>d exi/s & a ,,cps is n available1 pati5ts may be direct$ to ano!r ,,mtf until ! haz>d is gone2 or ! ,,mtf c move to a contam9ation free area4 ,c]ta9 facilities may be decontam9at$1 pati5t protection proc$ures appli$1 & ! op]ation cont9u$4 ,h[ev]1 an ,,mtf contam9at$ ) a p]si/5t ag5t requires "t-consum+ & res\rce-int5sive decontam9ation op]ations2 x may include replacem5t ( contam9at$ %elt]s4 c4 ,managem5t ( ,contam9at$ & ,clean ,facilities4 ,facilities contam9at$ ) a p]si/5t ag5t may be too res\rce int5sive to decontam9ate4 ,op]at+ ) a comb9ation ( contam9at$ assets & clean assets may be necess>y4 ,m>k contam9at$ assets ) /&>d w>n+ tags4 ,use ^! assets 9 contam9at$ environm5ts & along contam9at$ r\tes4 ,keep clean assets 9 op]ation 9 clean areas4 ,( prim>y importance is prop] m>k+ & ! avoidance ( cross contam9ation4 d4 ,m$ical ,supplies & ,equipm5t = ,pati5t ,treatm5t4 ,are suffici5t m$ical supplies & equipm5t available to p]=m ! anticipat$ mission8 ,does ! unit h special m$ical equipm5t sets available 7*emical ag5t pati5t decontam9ation & *emical ag5t pati5t treatm5t m$ical equipm5t sets78 #b-f4 ,lead]%ip on ! ,contam9at$ ,battlefield a4 ,op]at+ on a contam9at$ battlefield w /ress lead]%ip4 ,heat /ress f be+ 9 high] levels ( ,,mopp = long p]iods ( "t may lead to dehydration4 ,! comm&]_/lead] mu/ ensure t 8 p]sonnel re/1 dr9k1 & eat suffici5tly to all[ !m to cont9ue ) ! mission4 ,9 ! mid/ ( activity1 re/1 hydration1 & nutrition are (t5 ov]look$2 h[ev]1 a good lead] w ensure t 8 p]sonnel ne$s are met4 ,see ,,fm #ba-aj = "w_/re/ cycles & wat] dr9k+ requirem5ts4 ,individuals may suff] hyp]v5tilation because ( ! enclos$ feel+s4 ,p]sonnel rema9+ 9 ,,mopp ,level #d ar\nd ! clock may suff] f increas$ sleep loss4 ,use ( ,,cps c r$uce ?is problem by all[+ ! p]sonnel to re/ out ( _! ,,mopp ge>4 ,lead]s mu/ %>e lead]%ip responsibilities & delegate responsibilities z mu* z possible s t ea* "o gets suffici5t re/ to ma9ta9 unit effectiv5ess4 ,fur!r1 lead]s %\ld conc5trate on sup]vision or unit mission1 r ?an on g5]ation ( new proc$ures dur+ & aft] an attack4 ,! ,,nbc battlefield w1 !re=e1 require m proactive & d$icat$ lead]s :o c balance ! ne$s ( _! p]sonnel & ! mission4 ,fur!r1 lead]s w be *all5g$ by an additional logi/ics burd5 ( provid+ nontraditional respiratory protection = p]sonnel aga9/ ,t,i,ms4 ,= detail$ in=mation on combat op]ational /ress control 7,,cosc7 see ,,fm #h-ea & ,,fm #bb-ea4 ---------------------------------------- ----------- ,,dang] ,! /&>d ,,nbc protective mask w n protect p]sonnel f mo/ ,t,i,cs4 ---------------------------------------- ----------- b4 ,lead]%ip mu/ plan = & e/abli% proc$ures to ma9ta9 p]sonnel p]=mance dur+ ,,nbc op]ations4 ,p]sonnel p]=mance :ile we>+ ,,mopp is degrad+4 ,at ,,mopp ,level #c or #d1 all b ! mo/ basic pati5t c>e proc$ures may h to be susp5d$ because-- ,we>+ gloves r$uces ! ability to grasp & manipulate small items 7f9e motor skill74 ,,mopp imp$es ! ability to move ab\t 7gross motor skills74 ,! mask r$uces visual fields & acuity 7visual skills74 ,! mask & hood greatly r$uces vocalization & he>+ abilities 7auditory skills74 ,! ,,mopp creates significant heat & m5tal /ress 7/am9a74 ,heat injuries c occur 9 a v %ort p]iod ( "t4 #b-g4 ,homel& ,security ,comm&]s & lead]s mu/ plan = & be prep>$ to support homel& security ef=ts2 especially1 = response to *emical1 biological1 radiological1 nucle>1 & high-yield explosive 7,,cbrne7 ev5ts4 ,dep5d+ ^u ! location ( ! ev5t1 ! response may be to a milit>y in/allation 9 support ( ! weapons ( mass de/ruction--in/allation support team 7,,wmd-,,i/7 or to an ev5t site (f a milit>y in/allation4 ,response to a ,,cbrne ev5t (f a milit>y in/allation w normally require a reque/ = ,dep>tm5t ( ,def5se support to ! ev5t f ! fir/ respond]s to ! ev5t 7usually f ! incid5t comm&] or lead f$]al ag5cy ,f$]al ,bureau ( ,inve/igation or ,f$]al ,em]g5cy ,managem5t ,ag5cy74 ,see ,app5dix ,c = plann+ consid]ations4 ,,*apt] #c ,,levels ,i ,,& ,,ii ,,heal? ,,s]vice ,,support #c-a4 ,g5]al a4 ,! use ( ,,nbc weapons is a condition ( battle & ,,hss p]sonnel mu/ prep>e to op]ate 9 ^! environm5ts4 ,add$ is ! dim5sion ( ,,tim releases_/incid5ts 9 ! op]ational area4 ,! importance ( prev5tive m$ic9e 7,,pvntm$7 measures & fir/ aid 7self-aid1 buddy aid1 & combat lifesav] ,,cls support7 are ev5 m critical4 ,heat & /ress injuries relat$ to ,,mopp we> are issues = ! ,,hss lead]%ip z well z ! =ce he is support+4 ,! /ress load on p]sonnel is increas$ by ! conc]ns ( be+ expos$ to ,,tim releases4 ,consid]+ t /aff+ ( ,,hss units is bas$ ^u ! m9imum requir$ to provide support on a conv5tional battlefield1 !y w be *all5g$ to provide ! same level ( ,,hss 9 ^! environm5ts4 b4 ,! ,,hss lead]%ip mu/ quantify ! ,,hss capability to _! comm&]s4 ,! m$ical /aff mu/ review ,,oplans & make recomm5dations to r$uce ! numb] ( pati5ts4 ,m$ical ,,nbc tra9+ programs mu/ /ress ! ess5tial imp]ative ( imm$iate decontam9ation1 ! ne$ to monitor y\r buddy = ,,nbc & heat or combat_/op]ational /ress injury effects1 & ! prop] use ( ,,nbc def5se prophylaxis1 pretreatm5ts1 insect repell5ts1 b>ri] creams1 & immunizations4 c4 ,ma9ta9+ close proximity to ! support$ =ce has be5 a major t5et ( ,,hss doctr9e & a critical factor 9 r$uc+ ! mortality rate4 ,ma9ta9+ ?is proximity & f9d+ a place clean en\gh to provide necess>y c>e requires int5se coord9ation ) ! support$ =ce4 ,alt]nate casualty collection po9ts1 decontam9ation sites1 m$ical treatm5t sites1 & ,,m$evac r\tes mu/ be e/abli%$1 coord9at$ & communicat$ to ! l[e/ level practical4 ,communication w be mu* m difficult1 b mu/ be ma9ta9$4 ,timely reports ?r\gh ! ,,hss te*nical *annels w all[ an optimal ,,hss response4 ,replacem5ts = ,,hss front l9e losses mu/ be rapidly fill$ aft] ,,nbc weapons are employ$4 d4 ,contam9ation 7,,nbc & ,t,i,ms7 c significantly h9d] ,,hss op]ations4 ,to maximize ! unit's survivability & ,,hss capabilities & to avoid su* contam9ation1 lead]s mu/ use-- ,contam9ation avoidance te*niques4 ,al>ms & detection equipm5t4 ,unit disp]sion te*niques4 ,ov]head %elt]1 %ield+ mat]ial1 protective cov]1 & build+s ( opportunity4 ,h[ev]1 ^! %elt]s may n provide protection f *emical vapor or ,,bw haz>ds4 ,collective protection %elt]s1 if available4 ,see ,app5dix ,f4 ,*emical ag5t resi/ant coat+s on equipm5t4 e4 ,on ! ,,nbc battlefield1 z on ! conv5tional battlefield1 ,,hss is focus$ on keep+ soldi]s 9 ! battle4 ,effective & effici5t ,,pvntm$ measures1 triage1 em]g5cy m$ical treatm5t 7,,emt71 decontam9ation1 advanc$ trauma managem5t 7,,atm71 & contam9ation control 9 ! ,,ao saves lives1 assures judici\s ,,m$evac1 & maximizes ! return to duty 7,,rtd7 rate4 #c-b4 ,level ,i ,heal? ,s]vice ,support a4 ,level ,i 7unit-level7 ,,hss may consi/ ( a combat m$ic section1 a ,,m$evac section1 & a treatm5t squad4 ,! treatm5t squad op]ates ! ,level ,i ,,mtf 7battalion aid /ation ,,bas74 ,level ,i ,,hss is support$ by fir/ aid 9 ! =m ( self-aid_/buddy aid & ! ,,cls4 ,see ,,fm #d-jb4d = detail$ in=mation on conv5tional ,level ,i ,,hss4 b4 ,:5 op]at+ "u an ,,nbc ?reat or :5 ,,nbc attack is imm95t1 ! ,,bas mu/ prep>e = cont9uation ( its mission4 ,%\ld an attack occur or a d[nw9d haz>d exi/1 ! ,,bas mu/ seek out a contam9ation free area to e/abli% a clean treatm5t area1 or mu/ e/abli% collective protection to cont9ue ! mission4 ,"s ,b,a,ss h ,*emically ,biologically ,protect$ ,%elt] 7,,cbps7 ,sy/ems4 ,:5 available1 ^! sy/ems s]ve z ! prim>y %elt] = ! ,,bas2 !y are op]at$ 9 ! full *emical_/biological 7,,cb7 mode :5 attack is imm95t or has occurr$4 ,see ,app5dix ,f = in=mation on e/abli%+ a ,,bas 9 a ,,cbps sy/em4 ,:5 op]at+ 9 ! ,,cb mode only pati5ts requir+ life- or limb-sav+ proc$ures are all[$ entry at ! ,,bas4 ,pati5ts t h m9or injuries t c be manag$ 9 ! contam9at$ ,,emt area ( ! pati5t decontam9ation site w receive treatm5t 9 ?is area4 ,aft] treatm5t1 ^! pati5ts w h ! integrity ( _! ,,mopp re/or$ by tap+ ! damag$ area & return$ to duty4 ,pati5ts ) injuries t require fur!r treatm5t1 b :o c survive evacuation to ! ,level ,,ii ,,mtf w h _! ,,mopp spot decontam9at$1 _! injuries manag$1 ! integrity ( _! ,,mopp re/or$1 & be direct$ to an evacuation po9t to await transport to ! ,level ,,ii ,,mtf 7example1 an individual ) a spl9t$ brok5 arm74 ,:5 pati5ts or p]sonnel are contam9at$ or are pot5tially contam9at$1 !y mu/ be decontam9at$ be=e admission into ! clean treatm5t area 7see ,,fm #c-e = p]sonnel decontam9ation proc$ures & ,app5dix ,g = pati5t decontam9ation proc$ures74 #c-c4 ,level ,,ii ,heal? ,s]vice ,support a4 ,9 ! brigade1 ,level ,,ii ,,hss consi/s (-- ,evacuat+ pati5ts f ! ,,bas & ,,m$evac on an area support basis f )9 ! brigade support area 7,,bsa74 ,provid+ area support ,level ,i m$ical treatm5t4 ,op]at+ ! m$ical company cle>+ /ation 7h]eaft] ref]r$ to z ! division cle>+ /ation ,,dcs71 :i* provides a pati5t hold+ capability = up to #dj pati5ts = #gb h\rs4 ,see ,,fm #d-jb4f & ,,fm #h-aj-bd = detail$ in=mation on ,level ,,ii conv5tional op]ations4 ,provid+ limit$ d5tal s]vice4 ,provid+ limit$ ,,pvntm$ support 9 ! areas ( m$ical surveillance1 occupational & environm5tal heal? surveillance1 food s]vice sanitation1 wat] quality control 7includ+ ,,nbc contam9ation surveillance71 & communicable disease control4 ,provid+ limit$ ,,cosc2 ^! pati5ts are return$ to duty z f> =w>d z _! condition p]mits4 b4 ,9 ! division1 ,,hss is ! same z = ! brigade1 except pati5ts may be evacuat$ f ! ,,bsa ,,dcs1 b n evacuat$ f ! ,,bas4 c4 ,:5 op]at+ "u an ,,nbc ?reat or :5 ,,nbc attack is imm95t1 ! ,,dcs mu/ prep>e = cont9uation ( its mission4 ,%\ld an attack occur or a d[nw9d haz>d exi/ ! ,,dcs mu/ seek out a contam9ation free area1 or mu/ e/abli% collective protection to cont9ue ! mission4 ,! ,,dcs 9 "s m$ical companies h f\r ,,cbps ,sy/ems2 !y are complex$ to provide space = ,,dcs op]ations4 ,^! sy/ems are op]at$ 9 ! ,,cb mode :5 attack is imm95t or has occurr$4 ,see ,app5dix ,f = in=mation on e/abli%+ a ,,dcs 9 ,,cbps ,sy/ems4 ,:5 op]at+ 9 ! ,,cb mode only pati5ts requir+ life- or limb-sav+ proc$ures are all[$ entry4 ,pati5ts ) m9or injuries t c be manag$ 9 ! contam9at$ ,,emt area ( ! pati5t decontam9ation site w receive treatm5t 9 ?is area4 ,aft] treatm5t1 ^! pati5ts w h ! integrity ( _! ,,mopp re/or$ by tap+ ! damag$ area & return$ to duty4 ,pati5ts ) injuries t require fur!r treatm5t1 b :o c survive evacuation to ! ,level ,,iii ,,mtf w h _! ,,mopp spot decontam9at$1 _! injuries manag$1 & be direct$ to an evacuation po9t to await transport to ! ,level ,,iii ,,mtf 7example1 an individual ) a spl9t$ brok5 arm74 ,:5 p]sonnel & pati5ts are contam9at$ or are pot5tially contam9at$1 !y mu/ be decontam9at$ be=e admission into ! clean treatm5t area 7see ,,fm #c-e = p]sonnel decontam9ation proc$ures & ,app5dix ,g = pati5t decontam9ation proc$ures74 #c-d4 ,=w>d ,surgical ,team ,=w>d surgical teams 7,,f/7 are ei!r organic to divisional & nondivisional m$ical units or are =w>d deploy$ 9 support ( divisional or nondivisional m$ical companies to provide a surgical capability4 ,field ,manual #h-aj-be describes ,,f/ op]ations4 ,h[ev]1 :5 =w>d deploy$ & ,,nbc contam9ation is imm95t ! ,,f/ mu/ employ collective protection 9 ord] to cont9ue _! support mission4 ,:5 op]at+ 9 a contam9at$ area ! ,,f/ ,,cbps ,sy/ems mu/ be complex$ ) ! ,,dcs ,,cbps4 ,! ,,f/ _c op]ate 9 an ,,nbc environm5t )\t ! support ( ! ,,dcs4 ,!y d n h ! capability to decontam9ate pati5ts4 ,all pati5ts are decontam9at$ 9 ! ,,dcs pati5t decontam9ation area4 ,!y are !n process$ into ! ,,emt section ( ! ,,dcs2 :]e !y are triag$ & r\t$ to ! ,,f/ = surg]y1 if requir$4 ,see ,app5dix ,f = ,,f/ employm5t ( collective protection proc$ures4 #c-e4 ,actions ,be=e a ,nucle>1 ,biological1 or ,*emical ,attack a4 ,giv5 ! disruption ( transportation1 communications1 & op]ations dur+ & foll[+ an ,,nbc attack1 x %\ld be cle> t prep>ation is ! key to survival & effectively provid+ ,,hss4 ,prep>+ a simple & complete ,,tsop & ,,hss plan t really integrates ,,nbc is ! fir/ /ep4 ,critical tra9+ = m$ical p]sonnel be=e an ,,nbc attack is h[ to-- ,survive ! attack individually & z a unit4 ,op]ate ! ,level ,i or ,level ,,ii ,,mtf 9 ! environm5t4 ,effectively c>e = ,,nbc pati5ts4 b4 ,ev5 m9imal site prep>ation 7nucle> h>d5+ or ,,cb protect+7 may improve survival1 greatly r$uce contam9ation1 & ma9ta9 ! ability to cont9ue to provide ,,hss4 ,see ! discussion bel[ = m in=mation on ea* environm5t4 ,z ) o!r milit>y p]sonnel1 ,,hss p]sonnel mu/ keep _! immunizations curr5t2 use available prophylaxis aga9/ suspect ,,cb ag5ts2 use pretreatm5ts = suspect *emical ag5ts2 use insect repell5ts1 & h antidotes & ess5tial m$ical supplies readily available = kn[n or suspect$ ,,nbc effects4 ,! be/ def5se = ,,hss p]sonnel is to protect !mselves1 _! pati5ts1 m$ical supplies1 & equipm5t by apply+ contam9ation avoidance proc$ures4 ,!y mu/ ensure t /or$ m$ical supplies & equipm5t are 9 protect$ areas or 9 _! /orage conta9]s ) cov]s 9 place4 ,"o me?od ( hav+ supplies & equipm5t protect$ is to keep !m 9 _! %ipp+ conta9]s until actually ne$$4 ,:5 "t p]mits & w>n+s are receiv$ t an ,,nbc attack is imm95t1 or t a d[nw9d haz>d exi/s1 ,,hss p]sonnel %\ld employ _! ,,cps 7see ,app5dix ,f7 or seek protect$ areas 7build+s1 t5ts1 or o!r ,,above gr\nd %elt]s = biological or *emical attack2 culv]ts1 rav9es1 basem5ts1 or o!r %ield$ areas = nucle>7 = !mselves & _! pati5ts4 c4 ,o!r tasks include3 ,v]ify+ ,,nbc def5se ,,hss inv5tories are complete4 ,review+ support$ units ,,nbc plans1 proc$ures1 casualty collection po9ts1 decontam9ation sites1 & res\rces available to support ! ,,hss mission4 ,coord9at+ ) ! ,s#b_/;,g#b1 ,s#c_/;,g#c & ,s#d_/;,g#d ( ! support$ unit to develop ! m$ical c\rses ( action2 to obta9 necess>y mat]iel to support ext5d$ op]ations )\t resupply 7,,msr contam9ation or transportation support n available74 ,coord9at+ ) support$ units = at lea/ eight nonm$ical p]sonnel = pati5t decontam9ation augm5tation at ! ,level ,i & ,,ii ,m,t,fs4 #c-f4 ,actions ,dur+ a ,nucle>1 ,biological1 or ,*emical ,attack ,:ile x is possible t ! ,,nbc attack w be discrete %ort ev5ts1 ! m likely sc5>io is ! enemy w use ,,nbc ?r\gh\t ! conflict4 ,! w>n+ & report+ sy/em w provide z mu* notice z is possible4 ,us+ ! in=mation provid$1 ,,hss p]sonnel w cont9ue _! mission by us+ ! be/ available protect$ areas4 ,if w>n$ ( a nucle> attack1 !y take up positions )9 ! be/ available %elt]2 movem5t out ( ^! positions w be direct$ by lead]%ip :5 x is safe to d s4 #c-g4 ,actions ,aft] a ,nucle>1 ,biological1 or ,*emical ,attack ,all p]sonnel mu/ survey _! equipm5t to det]m9e ! ext5t ( damage & _! capabilities to cont9ue ! mission4 ,initially1 pati5ts f nucle> detonations w be suff]+ !rmal burns or bla/ injuries4 ,also1 expect pati5ts & ,,hss p]sonnel to be disori5t$4 ,nucle> bla/ & !rmal injuries w imm$iately manife/1 mo/ radiation-induc$ injuries w n be obs]v$ = sev]al h\rs to days4 ,*emical ag5t pati5ts w manife/ _! injuries imm$iately ^u exposure to ! ag5t1 except = bli/] ag5ts4 ,biological ag5t pati5ts may n %[ any signs ( illness = h\rs to days aft] exposure1 except = tri*o!c5e 7,t#b7 mycotox9s4 ,all pati5ts arriv+ at ,levels ,i & ,,ii ,m,t,fs mu/ be *eck$ = ,,nbc contam9ation4 ,pati5ts are decontam9at$ be=e treatm5t 7see ,app5dix ,g7 to r$uce ! haz>d to ,,hss p]sonnel1 unless life- or limb-?reat5+ conditions exi/4 ,pati5ts requir+ treatm5t be=e decontam9ation are treat$ 9 ! ,,emt area ( ! pati5t decontam9ation /ation4 ,examples ( pati5t conditions t may require treatm5t at ! contam9at$ treatm5t /ation ( ! pati5t decontam9ation area-- ,massive hemorrhage4 ,respiratory di/ress4 ,sev]e %ock4 #c-h4 ,logi/ical ,consid]ations a4 ,heal? s]vice logi/ics 7,,hsl7 p]sonnel mu/ tra9 & prep>e to op]ate 9 all battlefield situations4 ,op]at+ 9 an ,,nbc environm5t requires ! issue ( *emical pati5t treatm5t m$ical equipm5t set & *emical pati5t decontam9ation m$ical equipm5t set4 ,expect disruption ( ,,msr & communications sy/ems & plan accord+ly4 ,see ,,fm #d-jb4a & ,,fm #h-aj-i = details on ,,hsl op]ations4 b4 ,! m$ical platoon 7,level ,i7 is au?oriz$ two *emical ag5t pati5t treatm5t m$ical equipm5t sets & "o *emical ag5t pati5t decontam9ation m$ical equipm5t set4 ,ea* *emical ag5t pati5t treatm5t m$ical equipm5t set has en\gh supplies to treat #cj pati5ts4 ,ea* *emical ag5t pati5t decontam9ation m$ical equipm5t set has en\gh consumable supplies to decontam9ate #fj pati5ts4 ,,note ,! *lor9e granules 9 ! *emical ag5t pati5t decontam9ation set are us$ to prep>e ! hypo*lorite solutions = use to decontam9ate pati5ts4 c4 ,! brigade1 divisional1 & nondivisional m$ical companies are au?oriz$ five *emical ag5t pati5t treatm5t m$ical equipm5t sets & ?ree *emical ag5t pati5t decontam9ation m$ical equipm5t sets4 ,^! m$ical equipm5t sets are = use at ! ,,dcs pati5t decontam9ation /ation4 #c-i4 ,p]sonnel ,consid]ations ,dur+ ,,nbc actions1 ,,hss p]sonnel requirem5ts increase2 ?us1 ,,hss re9=cem5t or replacem5ts are necess>y4 ,plans = ,,hss 9 a ,,nbc battlefield mu/ include ef=ts to cons]ve available ,,hss p]sonnel & ensure _! be/ use4 ,,hss p]sonnel w be fully active 9 provid+ ,,emt or ,,atm c>e2 !y w provide m def9itive treatm5t z "t & res\rces p]mit4 ,h[ev]1 to provide c>e !y mu/ be able to "w 9 a %irt-sleev$ environm5t1 n 9 ,,mopp ,levels #c or #d4 ,nonm$ical p]sonnel conduct se>* & rescue op]ations = ! injur$ or w\nd$2 !y provide imm$iate fir/ aid & decontam9ation4 ,see ,,fm #c-e1 = detail$ in=mation on p]sonnel & equipm5t decontam9ation op]ations4 ,see ,f,ms #d-jb4bhc1 #h-bhd1 & #h-bhe = detail$ in=mation on treatm5t ( ,,nbc pati5ts4 #c-aj4 ,disposition & ,employm5t ( ,treatm5t ,elem5ts a4 ,select sites = ! ,,bas & ,,dcs t are locat$ away f likely enemy t>get areas4 ,cov] & concealm5t is extremely important2 !y increase protection = op]at+ ! ,,mtf4 b4 ,op]at+ a ,,cbps ,sy/em 9 ! ,,cb mode at ! ,,bas requires at lea/ eight m$ical p]sonnel4 ,! s5ior ,,nco p]=ms pati5t triage & limit$ ,,emt & m9or injury c>e 9 ! pati5t decontam9ation area4 ,"o trauma speciali/ sup]vises pati5t decontam9ation & manages pati5ts dur+ ! decontam9ation process4 ,two trauma speciali/s "w on ! clean side ( ! hot l9e & manage ! pati5ts until !y are plac$ 9 ! clean treatm5t area or are s5t into ! ,,cbps = treatm5t4 ,!y also manage ! pati5ts t are await+ ,,m$evac to ! ,,dcs4 ,! physician1 physician assi/ant1 & two trauma speciali/s provide ,,atm 9 ! clean treatm5t area or inside ! ,,cbps4 ,see ,app5dix ,f = ,,cps entry_/exit proc$ures4 c4 ,:5 ! ,,bas or ,,dcs are receiv+ ,,nbc contam9at$ pati5ts1 !y require at lea/ eight nonm$ical p]sonnel f support$ units to p]=m pati5t decontam9ation proc$ures4 ,^! facilities are only /aff$ to provide pati5t c>e "u conv5tional op]ational conditions4 ,)\t ! augm5tation support1 !y c ei!r provide pati5t decontam9ation or pati5t c>e1 b n bo?4 d4 ,a pati5t decontam9ation /ation is e/abli%$ to h&le contam9at$ pati5ts 7see ,app5dix ,g74 ,! /ation is sep>at$ f ! clean treatm5t area by a hot l9e & is locat$ d[nw9d ( ! clean treatm5t area or ,,cps4 ,p]sonnel on bo? sides ( ! hot l9e assume a ,,mopp level comm5surate ) ! ?reat ag5t employ$ 7normally ,,mopp ,level #d74 ,! pati5t decontam9ation /ation %\ld be e/abli%$ 9 a contam9ation-free area ( ! battlefield4 ,h[ev]1 x may be necess>y to e/abli% a pati5t decontam9ation /ation t is collocat$ ) an ,,mtf t is employ+ a ,,cbps1 9 a *emical vapor haz>d area 9 ord] to decontam9ate pati5ts & cle> ! battlefield be=e mov+ ! ,,mtf to a clean area4 ,:5 ,,cps sy/ems are n available1 ! clean treatm5t area is locat$ upw9d #cj to #ej met]s ( ! contam9at$ "w area4 ,:5 p]sonnel 9 ! clean work+ area are away f ! hot l9e1 !y may r$uce _! ,,mopp level4 ,*emical monitor+ equipm5t mu/ be us$ on ! clean side ( ! hot l9e to detect vapor haz>ds due to slight %ifts 9 w9d curr5ts2 if vapors invade ! clean "w area1 ,,hss p]sonnel mu/ re-mask to prev5t l[-level ,,cw ag5t exposure & m9imize cl9ical effects 7su* z miosis74 #c-aa4 ,civilian ,casualties ,civilian casualties may become a problem 9 populat$ or built-up areas1 z !y are unlikely to h protective equipm5t & tra9+4 ,! ,,bas & ,,dcs may be requir$ to provide assi/ance :5 civilian m$ical res\rces _c h&le ! workload4 ,h[ev]1 aid to civilians w n be und]tak5 )\t comm& approval1 or at ! exp5se ( heal? s]vices provid$ to ,,u p]sonnel4 #c-ab4 ,nucle> ,environm5t a4 ,! ,,hss mission mu/ cont9ue 9 a nucle> environm5t2 protect$ %elt]s are ess5tial to cont9ue ! support role4 ,well-con/ruct$ %elt]s ) ov]head cov] & exp$i5t %elt]s 7re9=c$ concrete /ructures1 basem5ts1 railroad tunnels1 or tr5*es7 provide good protection f nucle> attacks 7see ,app5dix ,h74 ,armor$ vehicles provide "s protection aga9/ bo? ! bla/ & radiation effects ( nucle> weapons4 ,pati5ts g5]at$ 9 a nucle> attack w likely suff] multiple injuries 7comb9ation ( bla/1 !rmal1 & radiation injuries7 t w complicate m$ical c>e4 ,nucle> radiation pati5ts fall into ?ree categories3 ,! irradiat$ pati5t is "o :o has be5 expos$ to ioniz+ radiation1 b is n contam9at$4 ,!y are n radioactive & pose no radiation ?reat to m$ical c>e provid]s4 ,pati5ts :o h suff]$ exposure to initial nucle> radiation w fit into ?is category4 ,! ext]nally contam9at$ pati5t has radioactive du/ & debris on 8 clo?+1 sk91 or hair4 ,?is radioactive debris c cause burns if n remov$ quickly4 ,?is usually pres5ts a h\sekeep+ problem to ! ,,mtf1 simil> to ! lice-infe/$ pati5t arriv+ at a peacetime ,,mtf4 ,h[ev]1 an accumulation ( radioactive debris1 f sev]al pati5ts admitt$ to ! ,,mtf1 may pres5t a ?reat to o!r p]sonnel4 ,! ext]nally contam9at$ pati5t is decontam9at$ at ! e>lie/ "t consi/5t ) requir$ m$ical c>e4 ,lifesav+ c>e is always r5d]$1 :5 necess>y1 be=e decontam9ation4 ,! int]nally contam9at$ pati5t is "o t has +e/$ or inhal$ radioactive mat]ial1 or radioactive mat]ial has ent]$ ! body ?r\gh an op5 w\nd4 ,! radioactive mat]ial cont9ues to irradiate ! pati5t int]nally until radioactive decay &_/or biological elim9ation removes ! radioactive isotope4 ,att5d+ m$ical p]sonnel are %ield$1 to "s degree1 by ! pati5t's body4 ,inhalation1 +e/ion1 or injection ( quantities ( radioactive mat]ial suffici5t to pres5t a ?reat to heal? c>e provid]s is highly unlikely4 b4 ,m$ical units op]at+ 9 a radiation fall\t environm5t w face ?ree problems3 ,! ,,mtf may be imm]s$ 9 fall\t1 requir+ decontam9ation & relocation ef=ts4 ,pati5ts may cont9ue to be produc$ f cont9u$ radiation exposure4 ,! contam9at$ environm5t h9d]s ,,m$evac4 c4 ,decontam9ation ( mo/ radiological contam9at$ pati5ts & equipm5t c be accompli%$ ) soap & wat]4 ,soap & wat] w n neutralize radioactive mat]ial4 ,h[ev]1 x w remove ! mat]ial f ! sk91 hair or mat]ial surface4 ,see ,app5dix ,g = specific pati5t decontam9ation proc$ures4 ,! wa/e c become a conc5trat$ po9t ( radiation & mu/ be manag$ & monitor$4 d4 ,comm&]s & lead]s mu/ consid] ! radiation exposure levels = !mselves1 _! /affs1 & pati5ts :5 op]at+ 9 or det]m9+ if ! unit w ent] a radiologically contam9at$ area4 ,! comm&] & lead] mu/ e/abli% an op]ational exposure guide = _! unit & p]sonnel4 ,! op]ational exposure guide 7,,oeg7 is e/abli%$ = ei!r battlefield exposures z %[n 9 ,table #c-a or = exposures 9 /ability op]ations & support op]ations z %[n 9 ,table #c-b4 ,! tables pres5t radiation exposure /atus 7,,res7 categories2 h[ev]1 !y c be us$ to e/abli% ,o,e,gs bas$ on ! same exposure crit]ia4 ,table #c-a4 ,radiation ,exposure ,/atus ,categories = ,tactical ,op]ations ,,res-,o ,,! ,,unit ,,has ,,_h ,,no ,,radiation ,,exposure4 ,,res-#a ,,! ,,unit ,,has ,,be5 ,,expos$ ,,to ,,great] ,,?an #j c,gy ,,b ,,less ,,?an ,,or ,,equal ,,to #ge c,gy4 ,,res-#b ,,! ,,unit ,,has ,,be5 ,,expos$ ,,to ,,great] ,,?an #ge c,gy ,,b ,,less ,,?an ,,or ,,equal ,,to #abe c,gy4 ,,res-#c ,,! ,,unit ,,has ,,be5 ,,expos$ ,,to ,,great] ,,?an #abe c,gy4 ,table #c-b4 ,radiation ,exposure ,/atus ,categories ,dur+ ,/ability ,op]ations & ,support ,op]ations ,,res-,o #j4je c,gy ,,res-#a;,a #j4je ,,to #j4e c,gy ,,res-#a;,b #j4e ,,to #e c,gy ,,res-#a;,c #e ,,to #aj c,gy ,,res-#a;,d #aj ,,to #be c,gy ,,res-#a;,e #be ,,to #ge c,gy #c-ac4 ,m$ical ,triage ,m$ical triage is ! classification ( pati5ts accord+ to ! type & s]i\sness ( illness or injury2 ?is a*ieves ! mo/ ord]ly1 timely1 & effici5t use ( ,,hss res\rces4 ,h[ev]1 ! triage process & classification ( nucle> pati5ts diff]s f conv5tional injuries4 ,see ,,fm #d-jb4bhc = nucle> pati5t triage & treatm5t proc$ures4 #c-ad4 ,biological ,environm5t a4 ,a biological attack 7su* z ! enemy use ( bomblets1 rockets1 spray or a]osol disp]sal1 release ( ar?ropod vectors1 & t]rori/ or insurg5t contam9ation ( food & wat]7 may be difficult to recognize4 ,frequ5tly1 x does n h an imm$iate effect on expos$ p]sonnel4 ,all ,,hss p]sonnel mu/ monitor = ,,bw indicators su* z-- ,increases 9 disease incid5ce or fatality rates4 ,sudd5 pres5tation ( an exotic disease4 ,o!r sequ5tial epidemiological ev5ts4 b4 ,passive def5sive measures 7su* z immunizations1 good p]sonal hygi5e1 physical condition+1 us+ ar?ropod repell5ts1 we>+ protective mask1 & practic+ good sanitation7 w mitigate ! effects ( _m biological ag5t intrusions4 c4 ,! ,,hss comm&]s & lead]s mu/ en=ce contam9ation control to prev5t illness or injury to ,,hss p]sonnel & to pres]ve ! facility4 ,incom+ vehicles1 p]sonnel1 & pati5ts mu/ be survey$ = contam9ation4 ,v5tilation sy/ems 9 ,m,t,fs 7)\t ,,cps7 mu/ be turn$ (f if ,,bw exposure is imm95t4 d4 ,decontam9ation ( mo/ ,,bw contam9at$ pati5ts & equipm5t c be accompli%$ ) soap & wat]4 ,soap & wat] w n kill all biological ag5ts2 h[ev]1 x w remove ! ag5t f ! sk9 or equipm5t surface4 ,see ,app5dix ,g = specific pati5t decontam9ation proc$ures4 e4 ,treatm5t ( ,,bw ag5t pati5ts may require obs]v+ & evaluat+ ! individual to det]m9e necess>y m$ications1 isolation1 or managem5t4 ,see ,,fm #h-bhd = specific treatm5t proc$ures = ,,bw ag5t pati5ts4 f4 ,m$ical surveillance is ess5tial4 ,mo/ ,,bw ag5t pati5ts initially pres5t common symptoms su* z l[-grade fev]1 *ills1 heada*e1 malaise1 & c\ghs4 ,m pati5ts ?an normal may be ! fir/ indication ( biological attack4 ,daily m$ical treatm5t summ>ies1 especially ,,dnbi1 ne$ to be prep>$ & analyz$4 ,tr5ds ( increas$ numb]s ( pati5ts pres5t+ ) unusual or ! same symptoms are valuable indicators ( enemy employm5t ( ,,bw ag5ts4 ,daily analysis ( m$ical summ>ies c provide e>ly w>n+s ( ,,bw ag5t use1 ?us enabl+ comm&]s to initiate prev5tive measures e>li] & r$uce ! total numb]s ( troops lo/ due to ! illness4 ,see ,,fm #d-jb4ag = in=mation ( m$ical surveillance proc$ures4 ,see ,,fm #h-bhd = prev5tive1 protective1 & treatm5t proc$ures4 #c-ae4 ,*emical ,environm5t a4 ,consid] t all pati5ts g5]at$ 9 a ,,cw ag5t environm5t are contam9at$4 ,! vapor haz>ds associat$ ) contam9at$ pati5ts may require ,,hss p]sonnel to rema9 at ,,mopp ,level #d = long p]iods4 ,! ,,mtf mu/ be set up 9 clean areas or employ ,,cps4 ,if !re is liquid ag5t contam9ation1 or a cont9u$ vapor haz>d1 ! ,,mtf %\ld be mov$ & be decontam9at$1 mission p]mitt+4 b4 ,initial triage1 ,,emt1 & decontam9ation are accompli%$ on ! dirty side ( ! hot l9e4 ,life-su/a9+ c>e is r5d]$1 z requir$1 )\t reg>d to contam9ation4 ,normally1 ! s5ior heal? c>e s]geant p]=ms initial triage & ,,emt at ! ,,bas4 ,second>y triage1 ,,atm1 & pati5t disposition are accompli%$ on ! clean side ( ! hot l9e4 ,:5 treatm5t mu/ be provid$ 9 a contam9at$ environm5t outside ! ,,cps1 ! level ( c>e may be greatly r$uc$ because m$ical p]sonnel & pati5ts are 9 ,,mopp ,level #c or #d4 ,h[ev]1 lifesav+ proc$ures mu/ be accompli%$4 ,see ,,fm #h-bhe = specific treatm5t ( ,,cw ag5t pati5ts4 c4 ,decontam9ation ( mo/ *emically contam9at$ pati5ts & equipm5t requires ! use ( mat]ials t w remove & neutralize ! ag5t4 ,see ,,fm #c-e = equipm5t decontam9ation proc$ures & ,app5dix ,g = specific pati5t decontam9ation proc$ures4 #c-af4 ,op]ations 9 ,extreme ,environm5ts ,enemy employm5t ( ,,nbc weapons or ,t,i,ms 9 ! extremes ( climate or t]ra9 w>rants additional consid]ation4 ,includ$ are ! peculi>ities ( urban t]ra91 m\nta9s1 sn[ & extreme cold1 jungle1 & des]t op]ations 9 an ,,nbc environm5t ) ! resultant ,,nbc-relat$ effects ^u m$ical treatm5t & ,,m$evac4 ,= a m detail$ discussion on ,,nbc aspects ( urban t]ra91 m\nta91 sn[ & extreme cold1 jungle1 & des]t op]ations1 see ,f,ms #c-jf4aa1 #ca-ga1 #ij-c1 #ij-e1 & #ij-aj4 a4 ,9 m\nta9 op]ations1 passes & gorges may t5d to *annel ! nucle> bla/ & ! movem5t ( *emical & biological ag5ts4 ,ridges & /eep slopes may (f] "s %ield+ f !rmal radiation effects4 ,close t]ra9 may limit conc5trations ( troops & few] t>gets may exi/2 !re=e1 a l[] pati5t load may be anticipat$4 ,h[ev]1 ! t]ra9 w complicate pati5t evacuation & may require pati5ts to be decontam9at$1 treat$1 & held = long] p]iods ?an w\ld be requir$ = o!r op]ational areas4 b4 ,! effects ( extreme cold wea!r comb9$ ) ,,nbc-produc$ injuries h n be5 ext5sively /udi$4 ,h[ev]1 ) traumatic injuries1 cold ha/5s ! progress ( %ock1 provid+ a less favorable prognosis4 ,!rmal effects w t5d to be re9=c$ by reflection ( !rmal radiation f sn[ & ice-cov]$ areas4 ,c>e mu/ be ex]cis$ :5 mov+ *emically contam9at$ pati5ts into a w>m %elt]4 ,a ,,cw ag5t on ! pati5t's clo?+ may n be app>5t4 ,z ! clo?+ w>ms to room temp]ature1 ! ,,cw ag5t w vaporize 7(f-gas71 contam9at+ ! %elt] & expos+ occupants to pot5tially haz>d\s levels ( ! ag5t4 ,a ?ree-t5t sy/em is sugge/$ = process+ pati5ts 9 extreme cold op]ations4 ,! fir/ t5t 7unheat$7 is us$ to /rip (f pot5tially contam9at$ clo?+4 ,! second 7heat$7 is us$ to p]=m decontam9ation1 p]=m ,,emt & detect (f gass+4 ,! ?ird 7heat$7 is us$ to provide ! foll[ on c>e & pati5t hold+4 c4 ,9 ra9 =e/s & o!r jungle environm5ts1 ! ov]head canopy w1 to "s ext5t1 %ield p]sonnel f !rmal radiation4 ,h[ev]1 ! canopy may ignite & create =e/ fires & result 9 burn injuries4 ,by r$uc+ sunlight1 ! canopy may increase ! p]si/5cy effect ( ,,cw ag5ts ne> gr\nd level4 ,! canopy also provides a favorable environm5t = ,,bw ag5t disp]sion & survival4 d4 ,9 des]t op]ations1 troops may be widely disp]s$1 pres5t+ less pr(itable t>gets4 ,h[ev]1 ! lack ( cov] & concealm5t exposes troops to increas$ haz>ds4 ,smoo? s& is a good reflector ( nucle> !rmal & bla/ effects2 g5]at+ increas$ numb]s ( injuries4 ,high temp]atures w increase ! discom=t & debilitat+ effects on p]sonnel we>+ ,,mopp1 especially heat injuries4 #c-ag4 ,m$ical ,evacuation 9 a ,nucle>1 ,biological1 & ,*emical ,environm5t a4 ,an ,,nbc environm5t =ces ! unit lead]%ip to consid] to :at ext5t he w commit ,,m$evac assets to ! contam9at$ area4 ,if ! battalion or task =ce is op]at+ 9 a contam9at$ area1 mo/ or all ( ! organic m$ical platoon ,,m$evac assets w op]ate !re4 ,h[ev]1 ef=ts %\ld be made to keep "s ambulances free ( contam9ation4 ,= conv5tional ,,m$evac op]ations see ,,fm #h-aj-f & ,,fm #h-aj-bf4 b4 ,we h ?ree basic modes ( evacuat+ pati5ts 7p]sonnel litt] be>]s1 gr\nd vehicles1 & aircraft74 ,us+ litt] be>]s to c>ry ! pati5ts involves a great deal ( /ress4 ,cumb]some ,,mopp ge>1 add$ to climate1 increas$ workload1 & ! fatigue ( battle1 w greatly r$uce p]sonnel effectiv5ess4 ,if p]sonnel mu/ ent] a radiologically contam9at$ area1 an ,,oeg mu/ be e/abli%$ 7see ,table #c-a74 ,radiation exposure records are ma9ta9$ by ! ,,nbc ,,nco & made available to ! comm&]1 /aff1 & m$ical lead]4 ,! exposure is ent]$ into ! individual's m$ical record4 ,bas$ on ! ,,oeg1 ! comm&] & lead]s w decide :i* ,,m$evac assets w be s5t into ! contam9at$ area4 ,aga91 e ef=t is made to limit ! numb] ( ,,m$evac assets t are contam9at$4 ,m$ical evacuation consid]ations %\ld include ! foll[+3 7#a7 ,a numb] ( ambulances w become contam9at$ 9 ! c\rse ( battle4 ,optimize ! use ( res\rces2 use ^? already contam9at$ 7m$ical or nonm$ical7 be=e employ+ uncontam9at$ res\rces4 7#b7 ,once a vehicle or aircraft has ent]$ a contam9at$ area1 x is highly unlikely t x c be sp>$ long en\gh to und]go ?or\gh decontam9ation4 ,h[ev]1 op]ational decontam9ation %\ld be p]=m$ to ! greate/ ext5t possible4 ,?is w dep5d ^u ! contam9ant1 ! tempo ( ! battle1 & ! res\rces available to ! ,,m$evac unit4 ,normally1 contam9at$ vehicles 7air & gr\nd7 w be conf9$ to dirty environm5ts4 ,see ,,fm #c-e = details on decontam9ation proc$ures4 7#c7 ,use gr\nd ambulances in/ead ( air ambulances 9 contam9at$ areas2 !y are m pl5tiful1 are easi] to decontam9ate1 & are easi] to replace4 ,h[ev]1 ?is does n preclude ! use ( aircraft4 ,if an air ambulance is deploy$ into a contam9at$ area1 use x = repeat$ ,,m$evac missions r ?an s5d+ o!r clean aircraft into ! area4 7#d7 ,! relative positions ( ! contam9at$ area1 =w>d l9e ( own troops 7,,flot71 & ?reat air def5se sy/ems w det]m9e :]e helicopt]s may be us$ 9 ! ,,m$evac process4 ,"o or m helicopt]s may be re/rict$ to contam9at$ areas2 use gr\nd vehicles to cross ! l9e sep>at+ clean & contam9at$ areas4 ,! gr\nd ambulance proce$s to an ,,mtf ) a pati5t decontam9ation /ation 7,,pds72 ! pati5t is decontam9at$ & treat$4 ,if fur!r ,,m$evac is requir$1 a clean gr\nd or air ambulance is us$4 ,! r\tes us$ by gr\nd vehicles to cross betwe5 contam9at$ & clean areas are consid]$ dirty r\tes & %\ld n be cross$ by clean vehicles1 if mission p]mits4 ,consid] ! effects ( w9d & "t ^u ! contam9ants2 "s ag5ts w rema9 = ext5d$ p]iods ( "t4 7#e7 ,keep ! helicopt] rotor wa% 9 m9d :5 evacuat+ pati5ts1 especially 9 a contam9at$ environm5t4 ,! int5se rotor wa% w di/urb ! contam9ants & fur!r aggravate ! condition4 ,! aircraft mu/ be all[$ to l& & r$uce to flat pit* be=e pati5ts are br\ght ne>4 ,?is w r$uce ! effects ( ! rotor wa%4 ,additionally1 a helicopt] mu/ n l& too close to a decontam9ation /ation 7especially upw9d7 because any trace ( contam9ants 9 ! rotor wa% w compromise ! decontam9ation proc$ure4 c4 ,imm$iate decontam9ation ( rotor w+ aircraft & gr\nd vehicles is accompli%$ to m9imize crew exposure4 ,units include decontam9ation proc$ures 9 _! /&+ op]at+ proc$ures 7,,sop74 ,a sample aircraft decontam9ation /ation t may be tailor$ to a unit's ne$s is provid$ 9 ,,fm #c-e4 d4 ,evacuation ( pati5ts mu/ cont9ue1 ev5 9 an ,,nbc environm5t4 ,! ,,hss lead] mu/ recognize ! con/ra9ts ,,nbc places on op]ations2 !n plan & tra9 to ov]come ^! defici5cies4 e4 ,to m9imize ! spread ( contam9ation inside ! ,,m$evac aircraft1 pla/ic %eet+ %\ld be plac$ "u ! litt] to cat* any contam9ant t drips (f ! pati5t or litt]4 ,! pla/ic %eet+ c be remov$ ) ! pati5t1 remov+ any contam9ation ) x4 ,:5 pla/ic %eet+ is n available1 plac+ a blanket "u ! litt] w r$uce ! am\nt ( ag5t t makes contact ) ! inside ( ! aircraft4 ,,note ,! key to mission success is detail$ preplann+4 ,a ,,hss plan mu/ be prep>$ = ea* support mission4 ,ensure t ! ,,hss plan is 9 conc]t ) ! tactical plan4 ,use ! plan z a />t+ po9t & improve on x :ile provid+ ,,hss4 f4 ,m$ical evacuation by ,unit$ ,/ates ,air ,=ce 7,,usaf7 aircraft w be sev]ely limit$ until runway repairs & decontam9ation has occurr$4 ,a]ial flights f contam9at$ areas into uncontam9at$ airspace & de/9ations may be impossible = ext5d$ p]iods ( "t2 "s nations w n all[ pati5ts f contam9at$ areas to travel ?r\gh or ov] _! c\ntry4 ,!re=e1 pati5t hold+ on-site 7or 9 !at]7 = an ext5d$ p]iod ( "t mu/ be anticipat$4 g4 ,pati5t protection dur+ evacuation mu/ be ma9ta9$4 ,pati5ts t h be5 decontam9at$ at ! ,,pds at an ,,mtf w h _h _! ,,mopp ensemble remov$4 ,! =w>d deploy$ ,m,t,fs w n h replacem5t ,,mopp ensembles = ! pati5ts4 ,^! pati5ts mu/ be plac$ 9 a pati5t protective wrap 7,,ppw7 be=e !y are remov$ f ! clean treatm5t area = evacuation 7see ! ,,ppw in/ruction %eet_/,,ppw label = use ( ! ,,ppw74 ,! ,,ppw provides ! same level ( protection z ! ,,mopp ensemble4 ,! pati5t does n h to we> a protective mask :5 inside ! ,,ppw4 ,! pati5t is plac$ inside ! ,,ppw t is on a litt]4 ,! ,,ppw may also h a batt]y-op]at$ bl[] t c provide a r$uction ( ! body heat load & r$uce ! c>bon dioxide level )9 ! ,,ppw4 ,! ,,ppw w provide protection = ! pati5t = up to #f h\rs & is a "o-"t use item4 ,! bl[] is reusable1 remove x & ! atta*m5t devices f ! us$ ,,ppw & return x to ! pati5t movem5t items inv5tory4 ,see ,,fm #d-jb4a = a discussion on pati5t movem5t items4 ---------------------------------------- ------------------ ,,w>n+ ,,d ,,n place contam9at$ pati5ts 9 ! ,,ppw4 ,x is = use ) uncontam9at$_/decontam9at$ pati5ts only4 ---------------------------------------- ------------------ ,,*apt] #d ,,levels ,,iii ,,& ,,iv ,,hospitalization #d-a4 ,g5]al a4 ,_m factors mu/ be consid]$ :5 plann+ = ,levels ,,iii & ,,iv hospital support on ! integrat$ battlefield4 ,! hospital /aff mu/ be able to def5d aga9/ ?reats by individuals or small gr\ps 7two or ?ree7 ( infiltrators & survive ,,nbc /rikes or ,,tim incid5ts :ile cont9u+ _! mission4 ,?is ?reat may include ! introduction ( ,,nbc or ,,tim 9 ! hospital area1 ! wat] or food supplies2 & ! de/ruction ( equipm5t &_/or supplies4 ,on ! l>g] scale ( surviv+ ,,nbc /rikes & cont9u+ to support ! mission1 op]at+ 9 a contam9at$ environm5t w pres5t _m problems = hospital p]sonnel4 ,! use ( ,,nbc weapons or ,,tim release c compromise bo? ! quality & quantity ( heal? c>e deliv]$ by m$ical p]sonnel due to ! contam9ation at ! ,,mtf2 con/ra9 mobility & evacuation2 & contam9ate ! logi/ical supply base4 ,:ile provid+ hospital support1 consid] ! foll[+ assumptions3 7#a7 ,_! location1 close to o!r support assets1 makes !m vuln]able to ,,nbc /rikes & release_/disp]sion ( ,t,i,ms4 ,comm&1 control1 communications1 comput]s1 & intellig5ce 7,c#d;,i7 infra/ructure1 logi/ical nodes1 & base clu/]s are high value t>gets4 ,mo/ ,,nbc weapons are design$ = wide-area cov]age4 ,*emical & biological ag5ts may pres5t a haz>d "s di/ance d[nw9d f ! area ( attack2 also1 residual radiation may ext5d = hundr$s ( kilomet]s 7km7 f gr\nd z]o4 ,! l>ge signature 7size1 heat1 infr>$7 ( a hospital makes x easy to f9d & t>get 7! assumption is t ! hospital is v ne> ! int5d$ t>gets74 ,hospitals locat$ ne> road networks & airfields = access to evacuation r\tes increase _! exposure to tactical /rikes ( ,,nbc weapons & exposure to ,,tim releases4 ,!re are ev]-increas+ numb]s ( c\ntries & individuals ) ! ability to manufacture & deliv] ,,nbc weapons_/ag5ts4 ,?is activity increases _! use pot5tial at all levels ( conflict4 ,,note ,:5 us+ exi/+ civilian hospitals1 ! mat]ials = an ,,rdd may be at ^! hospitals4 ,explod+ ! mat]ial 9 place is v practical = a small team ( t]rori/s4 7#b7 ,l>ge numb]s ( casualties are produc$ 9 a %ort p]iod ( "t4 ,_m ( ^! casualties may h injuries t are unfamili> to hospital p]sonnel4 ,^! injuries may include-- ,radiation casualties4 ,biological casualties4 ,*emical casualties4 ,toxic indu/rial biological casualties 7release ( mat]ial f biological rese>* facilities74 ,toxic indu/rial *emical casualties4 ,toxic indu/rial radiological casualties4 ,*emical ag5t antidote ov]dose casualties4 ,comb9$ conv5tional & ,,nbc injuries4 ,/ress casualties mimick+ all ! above4 7#c7 ,9 addition to ! w\nd+ effects ( ,,nbc weapons on troops1 _! use w h o!r effects ^u ! pati5t c>e deliv]y sy/em4 ,foll[-on treatm5t may h to be delay$ due to ! ne$ = pati5t & faculty decontam9ation4 ,! arrival ( contam9at$ pati5ts at ! hospital w require hospital p]sonnel to p]=m triage2 adm9i/] ,,emt proc$ures 9 ! pati5t decontam9ation area2 sup]vise augm5tation p]sonnel p]=m+ pati5t decontam9ation2 & con/antly monitor ! hospital = contam9ation4 ,! combat support hospital ,,c% requires at lea/ #bj nonm$ical p]sonnel f units )9 ! geographic area_/base clu/] ( ! hospital to p]=m pati5t decontam9ation "u m$ical sup]vision4 ,see ,app5dix ,g = pati5t decontam9ation proc$ures4 ,pati5ts may h be5 triag$ & decontam9at$ at a ,level ,i or ,level ,,ii ,,mtf4 ,h[ev]1 all pati5ts mu/ be triag$ & *eck$ = contam9ation z !y arrive at ! hospital ambulance drop (f po9t4 ,triage ensures pati5ts receive life- or limb-sav+ c>e 9 a timely mann]4 ,if pati5ts are arriv+ f a suspect$ ,,nbc contam9at$ area1 !y mu/ be decontam9at$ be=e admission into ! clean treatm5t area ( ! hospital4 ,! pati5t decontam9ation area is e/abli%$ on ! d[nw9d side ( ! hospital4 ,:5 ! hospital does n h collective protection1 ! pati5t decontam9ation po9t mu/ be at lea/ #ej y>ds d[nw9d ( ! hospital entry po9t4 ,:5 ! hospital is locat$ inside a base clu/]1 ! pati5t decontam9ation area may h to be e/abli%$ "s di/ance f ! hospital to prev5t contam9ation ( o!r units 9 ! area4 ,%\ld ?is be ! case1 ! pati5ts may h to be transport$ by ambulance or o!r vehicle f ! clean side 7hot l9e7 ( ! pati5t decontam9ation area to ! receiv+ po9t ( ! hospital4 ,conditions may m&ate ! use ( nonm$ical vehicles to transport casualties to ! ,,mtf4 ,! use ( ^! vehicles limits or prohibits en r\te m$ical c>e1 b may be ! only way to cle> ! battlefield & ensure timely c>e ( pati5ts at ! hospital4 7#d7 ,mission-ori5t$ protective po/ure r$uces ! effici5cy ( all p]sonnel4 7#e7 ,)\t ,,cps sy/ems1 hospitals may op]ate = a limit$ "t 9 a nonp]si/5t ag5t environm5t1 b are incapable ( op]at+ 9 a p]si/5t ag5t environm5t4 ,*emical_/biological filt]s = fix$ site hospital v5tilation sy/ems w be a critical item ( supply4 ,controll$ entry & exit po9t ) suffici5t space to p]mit placem5t ( litt] pati5ts &_/or numb]s ( p]sonnel t p]mit purge ( vapors w h to be e/abli%$4 ,all w9d[s1 doors1 & o!r po9ts t may h air leaks w h to be seal$ 7use tape & pla/ic %eet+7 to enable ! facility to h a positive ov]pressure to keep ,,cb ag5ts out4 ,liquid *emical ag5ts c p5etrate ! ,,temp] 9 ab\t #f h\rs or g5]al purpose 7,,gp7 t5tage 9 a %ort] p]iod ( "t4 ,^! ag5ts w p5etrate ! wrapp+s on m$ical supplies & equipm5t2 especially1 /]iliz$ equipm5t & supplies1 pap]-wrapp$ cotton sponges1 & op5 or lightly clos$ m$ications_/solutions4 ,!y c also contam9ate wat]_/food supplies4 ,!re=e1 equipm5t & supplies mu/ be /or$ 9 protect$ areas or "u protective cov]+s4 ,)\t a ,,cps sy/em1 treatm5t proc$ures involv+ op5 w\nds or ! respiratory tract 9 ! pres5ce ( a ,,cb ag5t haz>d is limit$4 ,expos+ op5 w\nds & ! respiratory tract to ! ag5t increases ! effects ( ^! ag5ts on ! pati5t4 ,)\t h>d5$ protection1 ! hospital1 /aff1 & pati5ts are susceptible to ! effects 7bla/1 !rmal1 radiation1 & missil+7 ( nucle> weapons4 ,hospital electrical & electronic m$ical equipm5t is vuln]able to ! effects ( ! ,,emp produc$ by nucle> weapons4 ,! ,,emp is n h>mful to humans1 animals1 or plants1 b is v damag+ to electronic equipm5t4 ,hospital equipm5t is v difficult to decontam9ate4 ,ag+ 7all[+ ! ag5t to (f-gas7 may be ! only means ( decontam9ation4 ,hospitals are n kept 9 res]ve4 ,all p]sonnel & equipm5t losses due to ,,nbc contam9ation or radiation w h to be replac$4 b4 ,!re are curr5tly two =ce mod]nization initiative hospital sy/ems 9 ! =ce /ructure4 ,! ,m$ical ,=ce #bjjj 7,,mf#b,k7 sy/em consi/s ( ! ,,c%1 ! field hospital 7,,fh71 & ! g5]al hospital 7,,gh74 ,! ,m$ical ,re5g9e]+ ,initiative 7,,mri7 consi/s ( only "o hospital sy/em--! ,,c%4 ,! ,,mf#b,k ,,c% is a corps asset1 :]eas1 ! ,,fh & ,,gh are ! e*elon above corps hospital sy/ems4 ,! ,,mri ,,c% w be locat$ 9 ! corps & at e*elons above corps4 ,! ,,mri ,,c% w replace ! ,,fh & ,,gh at e*elons above corps4 ,see ,,fm #d-jb4aj1 ,,fm #h-aj-ad1 & ,,fm #h-aj-ae = detail$ in=mation on ^! hospital sy/ems4 #d-b4 ,protection a4 ,protection ( hospital assets requires int5sive use ( intellig5ce in=mation & c>eful plann+4 ,! limit$ mobility ( hospitals makes _! site selection vital to m9imize collat]al damage f attacks on o!r units4 ,hospitals mu/ be locat$ z close to ! support$ units z possible to provide responsive c>e 9 support ( ! tactical comm&]'s plan4 ,h[ev]1 _! limit$ mobility mu/ be consid]$ :5 select+ _! locations4 ,protective factors 7di/ance f o!r support units & int]pos$ t]ra9 features7 mu/ be balanc$ aga9/ ! op]ational factors 7accessibility & "t requir$ = pati5t transport74 ,dep5d+ on ! weapon sy/ems us$1 local topography1 & meteorological conditions1 relatively l>ge portions ( ! tactical area may rema9 uncontam9at$4 b4 ,_m def5sive measures w ei!r imp$e or preclude p]=mance ( ! hospital mission4 ,successful hospital def5se aga9/ an ,,nbc ?reat is dep5d5t ^u accurate1 timely receipt ( in=mation via ! nucle>1 biological1 & *emical w>n+ & report+ sy/em 7,,nbcwrs74 ,?is in=mation w all[ ! hospital to op]ate long] )\t ! limitations & problems associat$ ) ! use ( ! ,,cps & p]sonnel assum+ ,,mopp ,levels #c & #d4 ,! detail$ in=mation 7provid$ 9 ! ,,nbc #e & #f reports respectively7 on ! areas affect$ & ! types ( ag5ts us$ all[s ! hospital /aff to-- ,project ! numb] & types ( pati5ts to be expect$4 ,e/abli% a pati5t decontam9ation area4 ,reque/ pati5t decontam9ation assi/ance4 7#a7 ,protective proc$ures4 7a7 ,because mo/ hospital sections op]ate 9 %elt]$ areas 7t5tage or h>d-wall$ %elt]71 "s protection is provid$ aga9/ vapor1 liquid1 & p>ticulate 7fall\t7 haz>ds4 ,seal+ all op5+s c increase ! tempor>y protection f su* haz>ds2 all entries & exits mu/ be curtail$ :ile op]at+ 9 ?is mode4 ,liquid ag5ts w ev5tually seep ?r\gh ! t5t fabric & create a vapor haz>d inside ! %elt]4 ,locat+ equipm5t1 su* z trucks1 "u trees or o!r cov] provides simil> effects4 ,sett+ up hospitals 9 exi/+ /ructures 7concrete or /eel build+s7 provides great] protection f haz>ds & elim9ates _m decontam9ation problems4 ,h[ev]1 )\t means to seal op5+s1 *emical ag5t vapors c ent] ! /ructure4 ,! addition ( ,,cb filtration sy/ems ) air locks1 t provide ov]pressure1 c provide maximum protection = occupants4 ,entry & exit proc$ures mu/ be e/abli%$ to prev5t contam9ation be+ introduc$ by p]sonnel & pati5ts ent]+4 ,see ,app5dix ,f = entry_/exit proc$ures :5 ,,cb filt]s & air locks are 9 use4 7b7 ,concealm5t & good op]ations security 7,,opsec7 w help prev5t id5tification ( a unit4 7c7 ,disp]sion is a def5sive measure employ$ by tactical comm&]s2 h[ev]1 hospital op]ations limit ! value ( ?is te*nique4 ,"o te*nique t may be us$ is locat+ sections ( ! hospital1 su* z ! motor pool1 p]sonnel billets1 laundry1 & logi/ical /orage1 a great] di/ance f ! hospital complex ?an normal4 ,?is w increase disp]sion )\t sev]ely compromis+ ! hospital mission4 7d7 ,! ,,mopp ensemble does n protect aga9/ all radiation effects ( nucle> weapons4 ,h[ev]1 x provides "s protection aga9/ alpha & beta radiation burns4 ,by cov]+ all body surfaces1 especially hairy areas1 ,,mopp greatly exp$ites ! decontam9ation process4 7#b7 ,nucle>4 7a7 ,mo/ protective measures = hospitals aga9/ nucle> attack require eng9e] &_/or int5sive logi/ic support4 ,?is support includes plac+ s&bag walls ar\nd t5ts2 digg+ tr5*es = pati5t occupation2 or con/ruct+ e>!n b]ms 7see ,app5dix ,h74 ,occupy+ exi/+ /ructures1 dep5d+ ^u _! /r5g? & pot5tial flammability1 may be ! be/ protection aga9/ ! effects ( a nucle> /rike4 ,! rema9d] ( ?is section pres5ts factors to consid] :5 select+ ! protective po/ure = ! hospital aga9/ a nucle> attack4 ,leav+ equipm5t pack$ & load$ until actually ne$$ = op]ations w help protect mat]iel 9 an ,,nbc environm5t4 ,9 any ev5t ! unit mu/ h e/abli%$ an ,,oeg1 implem5t$ radiation monitor+1 & h cont+5cy plans if ^! radiation levels are approa*$ or exce$$4 7b7 ,p]sonnel & pati5t protection requirem5ts w dep5d ^u ! ?reat 7bla/1 !rmal1 imm$iate radiation1 or fall\t effects74 ,! ,,mopp ensemble w n protect aga9/ int]nal radiation1 b w provide "s protection f ext]nal radiological contam9ation4 ,if ! ?reat is nucle> fall\t1 ! hospital /ructure provides protection2 ! fall\t c be bru%$ or wa%$ (f4 ,?is all[s protection :ile p]mitt+ pati5t c>e to cont9ue virtually un9t]rupt$4 ,a ne$ to relocate ! hospital w dep5d ^u ! degree ( contam9ation2 ! am\nt ( decontam9ation possible2 & ! project$ /ay be=e a normal move 9 support ( op]ations4 ,hospital t5tage alone (f]s little protection aga9/ bla/ & missil+ effects4 ,if ! pati5ts are to rema9 9 ! t5ts1 !y are plac$ on ! floor4 ,place all equipm5t on ! gr\nd or z l[ z possible & secure all loose objects4 ,9 ,,gp t5ts1 s&bags c be pil$ ar\nd ! base ( ! t5t poles to add /ability4 ,! t5t poles & pati5t b$s %\ld keep ! canvas (f ! gr\nd en\gh 7if ! t5t collapses7 to cont9ue m9imal pati5t c>e & evacuation2 h[ev]1 be aw>e ( possible t5t pole breakage4 ,hospital units are v susceptible to ! !rmal effect ( a nucle> detonation4 ,t5ts w n provide protection aga9/ ! !rmal pulse4 ,if ! !rmal effect 7fire7 is an imp5d+ ?reat1 pati5ts & p]sonnel 9 t5tage mu/ move to tr5*es1 bunk]s1 or o!r nonflammable areas4 ,protection factors t c r$uce ! ov]all radiation exposure rate = hospital p]sonnel & pati5ts are-- ,"t4 ,r$uc+ ! exposure "t to ! radiation r$uces ! ov]all exposure proportionally 7cut ! "t ( exposure 9 half & ! ov]all exposure is cut 9 half74 ,,example3 ,an exposure "t ( #fj m9utes to a dose rate ( #ajj c5tigray 7c,gy7 is cut 9 half 7#cj m9utes7 to an exposure rate ( #ej c,gy4 ,di/ance4 ,increas+ ! di/ance f ! radiation s\rce r$uces ! exposure 9 an inv]se squ>e relation%ip 7d\ble ! di/ance factor by #b decreases ! exposure factor by #d74 ,%ield+4 ,plac+ mat]ial betwe5 p]sonnel & pati5t & ! radiation s\rce decreases ! dose 7! r$uction factor is dep5d5t on ! type ( radiation & ! d5sity ( ! %ield+ mat]ial74 ,placem5t ( s&bags 7two feet wide7 ar\nd ! hospital t5ts & %elt]s provides adequate %ield+ = protection f gamma & x-ray radiation2 ! ?ick] ! s&bag /acks ! great] ! protection factor4 ,t5t mat]ial is a good %ield = alpha p>ticles & adequate %ield+ f beta p>ticles4 ,see ,app5dix ,h = field exp$i5t %ield+ te*niques4 7#c7 ,biological4 ,! mo/ likely use ( a biological ag5t 7su* z an?rax7 is releas+ ! ag5t z an a]osol4 ,:ile su* ag5ts may produce l>ge numb]s ( casualties1 initially pati5ts may be se5 at ! ,,mtf 9 small numb]s1 b ! numb] ( pati5ts w rapidly increase )9 a few h\rs to days4 ,:5 a tr5d is id5tifi$1 ! enemy use ( a biological ag5t is suspect$4 ,g5]al protective measures are ! same z = any infecti\s disease2 specific protective measures are us$ once ! vector or me?od ( transmission has be5 id5tifi$4 ,designat+ a s+le hospital to c>e = ^! pati5ts 7f a pati5t c>e or disease transmission /&po9t7 may n be necess>y4 ,h[ev]1 if ! ag5t is communicable1 consolidat+ !m all at "o facility maximizes ! use ( limit$ assets & aids 9 limit+ ! spread ( ! disease4 ,protective measures aga9/ biological attack are ! same z ^? = *emical ag5ts :5 bombs1 sprays1 or gases are us$2 see 7#d7 bel[4 ,! difficulty 9 rapidly id5tify+ biological ag5ts may =ce ! use ( protective measures = long] p]iods ( "t4 ,fac$ ) ?is situation1 a c>eful evaluation ( ! mask-only po/ure is necess>y be=e implem5t+ any level ( ,,mopp4 ,see ,,fm #h-bhd = additional in=mation on prev5tion1 protection1 & treatm5t ( biological casualties4 7#d7 ,*emical4 7a7 ,individual protection4 ,:5 ,,cps sy/ems are n available1 us+ ! correct ,,mopp level is ess5tial 9 hospital mission p]=mance4 ,! level ( ,,mopp assum$ dep5ds ^u ! level ( ?reat4 ,an alt]native approa* = ! hospital comm&] is ! use ( ! mask-only po/ure4 ,?is po/ure is acceptable :5 ! haz>d is f vapor only 7except mu/>d74 ,see ,,fm #c-d = a description ( ea* ,,mopp level & mask-only proc$ures4 ,hospital w>n+ sy/em4 ,! hospital mu/ h a w>n+ sy/em t al]ts all p]sonnel ( imp5d+ or pres5t haz>ds4 ,?is sy/em mu/ include visual & auditory signals2 ! signals mu/ op]ate inside & outside ! hospital complex4 ,!re are num]\s problems associat$ ) w>n+ p]sonnel2 !y include-- ,! wide area cov]$ by ! hospital op]ations4 ,"s p]sonnel w be asleep at all times ( ! day or night 7two or ?ree %ifts74 ,! consid]able noise f me*anical support equipm5t2 su* z ! p[] g5]ation & environm5tal control equipm5t4 ,t5tage & equipm5t int]rupts l9e ( sight4 ,hospital p]sonnel response4 ,:5 ,,nbc al>ms are activat$1 all p]sonnel 7includ+ (f duty p]sonnel7 report to _! duty /ations z soon z !y are 9 ! designat$ ,,mopp level4 ,?is all[s = #ajj p]c5t p]sonnel acc\nt+ & provides additional p]sonnel to secure pati5ts & mat]iel4 ,unprotect$ hospital areas4 ,areas ( ! hospital )\t ,,cps are at _! be/ po/ure ) all op5+s secur$ & ! v5tilation sy/ems turn$ (f4 ,= nonp]si/5t ag5ts 7vapor haz>ds71 p]sonnel & pati5ts /ay at ! designat$ ,,mopp level until ! all cle> signal is giv52 !n normal op]ations are resum$4 ,,note ,pati5ts ) injuries t prev5t _! assum+ a protective po/ure mu/ be plac$ 9 a ,,ppw or imm$iately evacuat$ to a clean ,,mtf4 7b7 ,environm5tal protection4 ,z not$ previ\sly1 hospital complexes )\t ,,cps (f] "s protection aga9/ liquid or fall\t contam9ation1 b little protection aga9/ vapor haz>ds4 ,:5 ,,mopp ,level #a mu/ be assum$1 close & secure all t5t flaps1 v5ts1 & doors to prev5t ! entrance ( liquids or p>ticles4 ,all hospital p]sonnel outside ( %elt]s assume ,,mopp ,level #d4 ,cov] or move all equipm5t & supplies into %elt]s 7t5ts1 h>d-wall$ %ipp+ conta9]s71 if possible4 ,placem5t "u ?ick foliage trees is bett] ?an left out 9 ! op54 ,! be/ policy is to keep all equipm5t & supplies n imm$iately ne$$ cov]$ or 9 clos$ conta9]s4 ,:5 ,,mopp ,level #c or mask-only po/ure is assum$1 %ut d[n ! hospital's v5tilation sy/em to prev5t draw+ vapors or fall\t contam9ation into ! hospital4 ,?is measure also provides "s protection ( ! int]nal environm5t dur+ ! "t requir$ = ! vapor to p5etrate ! t5tage4 7c7 ,pati5t protection4 ,pati5t protection dep5ds ^u prior plann+ & timely w>n+ ( ! *emical ?reat4 ,ea* pati5t's protective mask mu/ be available & s]viceable4 ,if ! pati5t came f a contam9at$ area1 ! mask mu/ be decontam9at$ & ! filt]s *ang$4 ,! mask decontam9ation & filt] *ange may h to be p]=m$ by hospital p]sonnel4 ,if ambulatory pati5ts' m$ical conditions p]mit 7m9imal c>e w>d71 !y may be able to p]=m ?is task4 ,! hospital supply /aff mu/ ensure t mask filt]s are available at ! support+ logi/ics support facility & c be requisition$ to meet ?is requirem5t4 ,*eck all masks = s]viceability z soon z ! mission p]mits1 b always be=e !y are ne$$4 ,d n wait until ! w>n+ has be5 receiv$ to beg9 *eck+ ! mask4 ,ea* area mu/ h an e/abli%$ plan = op]ations 7to include assi/+ pati5ts assum+ ,,mopp or o!r protective po/ure7 9 ! ,,nbc environm5t4 ,app5dix ,f provides additional in=mation on pati5t protection4 ---------------------------------------- ---------------- ,,caution ,rememb]1 p]sonnel mu/ assume ,,mopp ,level #d be=e beg9n+ any decontam9ation process or risk becom+ a casualty !mselves4 ---------------------------------------- ---------------- ,hospital /aff always mask !mselves fir/1 !n assi/ pati5ts 9 mask+4 ,on m9imal c>e w>ds1 mo/ pati5ts c put on _! masks4 ,= ^? :o _c1 o!r pati5ts c assi/ !m aft] putt+ on _! own masks4 ,on ! int]m$iate c>e w>ds1 "s pati5ts w be able to put on _! masks1 b _m w require assi/ance4 ,int5sive c>e & em]g5cy room /aff w h to assi/ _! pati5ts 9 mask+4 ,_m pati5ts ) head & neck w\nds or :o are on life-support devices w be unable to we> _! individual protective masks2 ^! pati5ts mu/ be plac$ 9 a ,,ppw4 ,:ile ! ,,ppw has two ports = intrav5\s or blood infusion l9es1 ! /aff may h to adapt = o!r devices 7,foley ca!t]s1 traction devices1 & c>diac monitor7 by us+ tape & o!r means to seal ! gaps creat$ 9 ! seal ar\nd ! edge ( ! ,,ppw4 ,pati5ts requir+ assi/$ v5tilation are at extreme risk1 unless _! air supply is protect$4 ,! sequ5ce ( protect+ ev]yone is mask y\rself fir/2 assi/ ^? pati5ts :o c we> _! protective masks2 & !n place pati5ts 9 ! ,,ppw4 7d7 ,mat]iel protection4 ,protection ( mat]iel1 especially exp5dable supplies1 requires cov]s & b>ri]s4 ,all mat]iel n requir$ = imm$iate use is kept 9 %ipp+ conta9]s1 m$ical *e/s1 or "u cov] 7t5tage1 pla/ic %eet+1 & t>paul97 = protection aga9/ p>ticulate or liquid haz>d4 ,protection aga9/ vapor haz>d may require multiple b>ri]s ?r\gh :i* ! vapor mu/ p5etrate4 ,= example1 intrav5\s solutions are 9 _! individual pla/ic bags1 9 ! c>dbo>d %ipp+ box1 on a cov]$ pallet1 9 a h>d-wall$ %elt]2 su* z a milit>y-own$ dem\ntable conta9] 7,,milvan74 ,?is pres5ts f\r b>ri]s aga9/ ! vapor haz>d4 ,^! pr9ciples %\ld be us$ to ! maximum ext5t practical4 #d-c4 ,decontam9ation a4 ,decontam9ation ( nucle>-contam9at$ p]sonnel1 equipm5t1 & ! op]ational site is z foll[s3 7#a7 ,monitor+ equipm5t is us$ to detect contam9ation2 ! contam9ation is !n remov$ by bru%+ or scrap+ ) brooms1 bru%es1 or tree bran*es4 ,flu%+ h>d surface contam9at$ areas ) wat] is also effective 9 remov+ nucle> contam9ation4 ,h[ev]1 !re rema9s a problem ( conta9+ & remov+ ! contam9at$ wat]4 ,! be/ me?od ( conta9m5t is to tr5* ! area into a sump = collection ( ! contam9ation4 ,?is w r$uce ! area ( contam9ation2 h[ev]1 ! level ( conc5trat$ radiation may be su* t !re is an increas$ haz>d to p]sonnel4 ,! collection area mu/ be cle>ly m>k$ us+ ! /&>d nucle> haz>d signs4 7#b7 ,nucle> contam9ation ( ! site may require relocat+ ! hospital4 ,scrap+ #a or #b in*es ( topsoil f ! area1 or cov]+ ! area ) #a or #b in*es ( uncontam9at$ dirt w n be practical4 ,a ne$ to relocate ! hospital w dep5d ^u ! degree ( contam9ation2 ! am\nt ( decontam9ation possible & ! project$ /ay be=e a normal move 9 support ( op]ations4 ,if ! hospital is imm]s$ 9 a high level ( radioactivity1 ! be/ option may be to ab&on x = #dh to #gb h\rs4 ,aft] ?is p]iod ! area %\ld be *eck$ & if ! radioactivity has decay$ suffici5tly ! hospital may be reoccupi$ & cont9ue op]ations or mov$ to a clean area4 ,! comm& ,,oeg mu/ be foll[$ if reoccupy+ or mov+ ! facility4 b4 ,suspect biological ag5ts %\ld be remov$ f equipm5t z quickly z possible1 ,9 ! abs5ce ( ag5t-specific guidance1 clean expos$ surfaces us+ a #e p]c5t hypo*lorite solution or copi\s quantities ( soap & wat] 7pref]ably hot74 ,lib]ally apply ! hot1 soapy wat] & scrub all surfaces ) a bru%4 ,!n r9se ! surfaces ) hot wat]4 ,z previ\sly discuss$1 ! soapy wat] us$ is contam9at$ & mu/ be controll$ & remov$ to a safe area4 ,sup]tropical blea* 7,,/b7 & decontam9at+ solution ,numb] #b 7,,ds#b1 ,,u ,army7 are effective aga9/ mo/ kn[n biological ag5ts because ( _! cau/ic nature4 ,if an?rax 7or o!r spore =m]s7 is suspect$1 repeat ! entire decontam9ation process aga9 to remove ! spores4 ,o!r /&>d biological decontam9ation ag5ts are describ$ 9 ,,fm #c-e4 ---------------------------------------- -------------------------- ,,caution #a4 ,keep liquid decontam9ants out ( equipm5t ) electronic or electrical circuits4 ,unplug electrical devices be=e attempt+ to decontam9ate !m2 prev5t electric %ock4 ,"s electronic devices ma9ta9 an electric *>ge1 ev5 aft] be+ unplugg$1 use extreme c>e to prev5t %ock4 #b4 ,soap & wat] only me*anically remove ,,bw ag5ts4 ,! soap & wat] solution mu/ be conta9$ to prev5t spread+ ! ag5t to o!r p]sonnel1 ?us caus+ m casualties4 ---------------------------------------- -------------------------- c4 ,decontam9ation ( *emical contam9ation is z foll[s3 7#a7 ,p]sonnel use _! soldi] skills & _! ,m#bie ,individual ,equipm5t ,decontam9ation ,kit to decontam9ate _! p]sonal equipm5t4 ,! ,m#ac1 decontam9ation app>atus1 portable1 is us$ to decontam9ate vehicles1 trail]s1 & ,int]national ,organization = ,/&>dization 7,,iso7 %elt]s4 ,?is app>atus uses ,,ds#b 7a highly cau/ic1 flammable solution t _c be us$ to decontam9ate t5tage74 ,! ,,ds#b mu/ be wa%$ (f aft] suffici5t "t has pass$ = decontam9ation 7see ,,fm #c-e = details74 ,wat] us$ = ,,nbc decontam9ation purposes becomes contam9at$2 !re=e1 x mu/ be conta9$ 9 sumps4 ,dig %all[ tr5*es to *annel ! wat] into sumps4 ,?is w be difficult 9 hospital areas because relatively flat sites are ne$$ = hospital complex+1 b mu/ be accompli%$ to r$uce ! contam9ation levels 9 ! hospital area4 7#b7 ,:5 hospital t5tage becomes contam9at$1 decontam9ation op]ations mu/ be consid]$ imm$iately4 ,spot decontam9ation may be effective = small areas2 h[ev]1 gross contam9ation ( ,,temp] & ,,gp t5tage is be/ decontam9at$ by ag+4 ,)\t ,,cps & ) p]si/5t ag5t contam9ation t absorbs into ! t5tage & pres5ts a cont9u+ vapor haz>d1 ! hospital /ops receiv+ pati5ts & evacuates all pati5ts z quickly z possible4 ,:5 l>ge portions ( ! hospital are contam9at$1 p]sonnel decontam9ate all equipm5t possible & relocate to a new site1 leav+ ! contam9at$ equipm5t to age or to be decontam9at$ by a specializ$ unit4 ,:5 small portions ( ! hospital are contam9at$1 ! contam9at$ portions are remov$ to ano!r location = decontam9ation2 hospital op]ations are cont9u$1 b at a l[] op]ational level4 ,= detail$ equipm5t decontam9ation proc$ures1 see ,,fm #c-e4 ,,note ,liquid decontam9ation mat]ial mu/ n be us$ on electrical or electronic compon5ts ( equipm5t4 ,liquid decontam9ants c damage ! equipm5t2 ?us mak+ x inop]able & n available = pati5t c>e or transport4 ,! use ( liquids to decontam9ate electronic equipm5t c\ld also pot5tially result 9 injury or electrocution ( p]sonnel4 7#c7 ,ea* ,,u ,army hospital is issu$ five *emical ag5t pati5t treatm5t ,,mes & ?ree *emical ag5t pati5t decontam9ation ,,mes1 ,*emical ,ag5ts ,pati5t ,decontam9ation1 = use 9 decontam9at+ pati5ts4 ,ea* hospital mu/ decontam9ate & treat its own p]sonnel :o become casualties2 *emical casualties f units 9 its g5]al area2 or contam9at$ pati5ts receiv$ f l[] level ,m,t,fs4 ,see ,app5dix ,g = pati5t decontam9ation proc$ures & = e/abli%m5t ( a pati5t decontam9ation & treatm5t /ation4 #d-d4 ,em]g5cy ,s]vices a4 ,provid+ em]g5cy s]vices w be complicat$ by sev]al factors3 ,v>y+ levels ( treatm5t receiv$ prior to arrival at ! hospital4 ,c>+ = comb9$ conv5tional w\nds & ,,nbc ag5t effects4 ,manag+ heat-relat$ complications associat$ ) ,,mopp_/,,ppw use4 ,controll+ psy*ological effects caus$ by biological & *emical ag5ts1 ! impact ( ,,nbc weapons1 or ! isolation ( ,,mopp ge> or ,p,p,ws4 ,hav+ ,,emt p]sonnel work+ at ! arrival po9t1 decontam9ation site1 & 9 ! hospital ,,emt area4 ,conduct+ triage & provid+ pati5t c>e :ile 9 ,,mopp ge>4 ,sup]vis+ support$ units decontam9ation augm5tation p]sonnel4 ,^! p]sonnel w mo/ likely be ( any milit>y occupational specially 7,,mos71 except m$ical4 ,!y w use hospital equipm5t & supplies to decontam9ate pati5ts4 b4 ,contam9at$ pati5ts mu/ be triag$ 9 ! decontam9ation area t is e/abli%$ at ! hospital4 ,contam9at$ pati5ts ,,w ,,n be br\ght into ! clean ,,emt area until decontam9at$4 ,all pati5ts are scre5$ = contam9ation4 ,bas$ on ! f9d+s1 ! pati5t is r\t$ to ! contam9at$ triage /ation1 or to ! clean triage /ation4 ,contam9at$ pati5ts are triag$1 !n r\t$ to ! decontam9ation area1 or to ! contam9at$ treatm5t area4 ,pati5t admission to ! clean treatm5t area may be delay$2 h[ev]1 life- or limb-sav+ c>e is provid$ 9 ! contam9at$ treatm5t area be=e decontam9ation4 #d-e4 ,g5]al ,m$ical ,s]vices ,! provision ( g5]al m$ical s]vices 9 ! hospital w be cont9u$ ) m9imal int]ruptions 9 ! ,,nbc environm5t4 ,! non9vasive nature ( ^! s]vices all[s _! cont9uation at mo/ ,,mopp levels4 ,h[ev]1 "s g5]al m$ical s]vices w be con/ra9$ by ,,mopp ,levels #c & #d & ! mask-only po/ure4 ,^! con/ra9ts may include1 b n be limit$ to-- ,communication limitations4 ,loss ( ! oral r\te = adm9i/]+ m$ications to pati5ts4 ,limit$ ability to accurately evaluate ! eyes1 nose1 & m\? ( pati5ts we>+ a protective mask4 ,r$uc$ ability to p]=m exam9ation_/assessm5t ( pati5ts 9 ,,ppw or ,,mopp ,levels #c & #d4 ,inability to provide oxyg5 !rapy or v5tilator support to a pati5t 9 a vapor haz>d environm5t1 unless a ,,cb filt]-support$ respirator is available4 ,logi/ical con/ra9ts bas$ ^u ! fact t key areas su* z dietetics1 supply1 & laundry are n 9 ! ,,cps4 ,^! s]vices may be r$uc$ or delay$ 9 ! ,,nbc environm5t4 ,see ,app5dix ,f = ,in=mation on pati5t fe$+ "u ,,nbc conditions4 #d-f4 ,surgical ,s]vices a4 ,surgical s]vices w be sev]ely limit$ 9 ! ,,nbc environm5t4 ,at any level above ,,mopp ,level #j1 )\t a ,,cps sy/em surgical s]vices are halt$ except = life- or limb-sav+ exp$i5t proc$ures4 ,surg]y _c be safely p]=m$ outside a ,,cps due to a v>iety ( factors includ+-- ,lack ( protect$ v5tilation = pati5ts dur+ & aft] surg]y4 ,inability to ma9ta9 a /]ile field :ile us+ ,,mopp ge>4 ,direct access = ag5ts ?r\gh op5 w\nds to ! circulatory & respiratory sy/ems4 ,decreas$ dext]ity & vision result+ f ,,mopp ge> use4 ,inability to quickly place ! pati5t 9 a ,,ppw %\ld ! ne$ arise4 b4 ,due to ! relatively high numb] ( trauma cases1 hospital s]vices may be sev]ely con/ra9$ by ,,nbc contam9ation4 ,! hospital location & ! possible ne$ = relocation are two major plann+ consid]ations = ! comm& /aff4 c4 ,pati5t acc\nt+ & m$ical regulat+ are critical factors 9 ! transf] ( pati5ts f a hospital )\t a ,,cps t mu/ move out ( an ,,nbc environm5t4 ,hospitals )\t ,,cps /op receiv+ pati5ts :5 a p]si/5t haz>d is id5tifi$2 pati5ts on h& are protect$ & transf]r$ to a clean ,,mtf4 #d-g4 ,nurs+ ,s]vices ,provid+ nurs+ c>e 9 a hospital )\t ,,cps is influ5c$ by ! am\nt ( protective ge> worn by ! nurs+ /aff & ! pati5ts4 ,! pati5ts may be 9 _! ,,mopp ge>1 9 a ,,ppw1 or we>+ only _! protective mask2 any ( :i* w int]f]e ) c>e4 ,! nurs+ /aff w we> ! same level ( protection z ! pati5ts4 a4 ,direct assessm5t ( a pati5t's vital signs is extremely limit$ at ,,mopp ,levels #c or #d2 h[ev]1 a c>otid art]y pulse c be tak5 by palpat+ ! neck area4 ,! pati5t's respiratory rate & level ( consci\sness may be assess$ visually4 ,palpitation ( ! blood pressure ?r\gh a ,,ppw may be possible if x is relatively /rong1 or at lea/ 9 ! normal range4 ,! pati5t's temp]ature _c be monitor$2 ?is is an area ( conc]n due to ! possibility ( heat /ress4 b4 ,only gross neurological signs c be assess$ ?r\gh ! ,,ppw or :5 ! pati5t is 9 ,,mopp ,levels #c or #d4 ,h[ev]1 ev5 ?is assessm5t is complicat$ by ! pres5ce ( miosis & by ! heal? c>e provid]'s mask4 ,ur9>y output & c>diac monitor+ is cont9u$ un9t]rupt$ = pati5ts we>+ a mask only & = pati5ts 9 ! ,,ppw4 c4 ,oral hygi5e & ba?+ are po/pon$ until a safe environm5t is available 7,,mopp ,level #b or less74 ,all toilet+ w occur )9 ! hospital complex us+ ,,iso conta9$ latr9es1 *emical toilets1 b$pans1 ur9als1 buckets1 or conta9]s ) pla/ic l9]s4 ,wa/e f improvis$ conta9]s mu/ be plac$ 9 conta9]s ) cov]s or 9 pla/ic bags & seal$ to control odors & prev5t spread ( infecti\s mat]ial )9 ! facility4 d4 ,at ,,mopp ,levels #c & #d1 fe$+ mu/ be po/pon$4 ,a nutritional assessm5t is ne$$ to det]m9e h[ long ea* pati5t c tol]ate a fa/+ /ate :5 ,,mopp ,level #c or ,level #d rema9s 9 effect = ov] #bd h\rs4 e4 ,intrav5\s 7,,iv7 m$ications are mix$ 9 a clean area & !n transport$ 9 a protective wrap 7multilay]s ( pla/ic1 m$ical *e/1 or lay]$ c>dbo>d7 to ! us]4 ,h[ev]1 ,,iv solutions1 blood1 & injections c be giv5 to pati5ts on an unprotect$ w>d4 ,normally1 oral m$ications are only giv5 at ,,mopp ,level #b or l[]4 f4 ,treatm5t proc$ures t h ! pot5tial ( contam9at+ ! pati5t's pulmon>y or circulatory sy/ems are conduct$ only at ,,mopp ,level #b or bel[4 ,h[ev]1 ,,emt proc$ures may h to be p]=m$ 9 ! contam9at$ treatm5t area1 or ! pati5t decontam9ation area4 g4 ,cont9u\s oxyg5 !rapy requires a collective protection environm5t or a ,,cb filt] support$ respirator4 h4 ,deliv]y ( nurs+ c>e at ,,mopp ,level #c or ,level #d is limit$ due to ! s5sory re/rictions ( ,,mopp ge>4 ,"t is tak5 to reassure ! pati5ts on a p]sonal basis1 z mu* z possible1 & by r\t9ely monitor+ ! w>d environm5t4 ,communications are difficult & id5tities are mask$4 ,ma9ta9 ! id5tity ( p]sonnel by us+ h&writt5 "n tags = /aff & pati5ts 7includ+ pati5ts 9 ,,ppw74 i4 ,z ) all proc$ures1 ! "t requir$ = record-keep+ rises m>k$ly at ,,mopp ,level #c or ,level #d4 ,contam9at$ pap]work _c be evacuat$ ) ! pati5t4 ,transcribe ess5tial in=mation onto uncontam9at$ docum5ts = evacuation ) ! pati5t4 ,a record ( pati5t exposure "t to a contam9at$ area is prep>$ to assess ! cumulative risk to ! pati5t4 #d-h4 ,conv5tional ,op]ations ,= conv5tional op]ations ( hospitals 9 a field environm5t see ,,fm #d-jb4aj1 ,,fm #h-aj-ad1 & ,,fm #h-aj-ae4 ,,*apt] #e ,,o!r ,,heal? ,,s]vice ,,support ,section ,i4 ,,prev5tive ,,m$ic9e ,,s]vices #e-a4 ,g5]al ,on ! integrat$ battlefield1 ,,pvntm$ s]vices w be 9 great] dem& ?an at any o!r "t1 especially "u ,,bw conditions4 ,prev5tive m$ic9e p]sonnel w be call$ ^u to assi/ ! comm&] 9 det]m9+ ! heal? haz>ds associat$ ) nucle> fall\t2 ! safety ( dr9k+ wat] 9 an ,,nbc environm5t2 z well z det]m9+ :5 to use prophylaxis1 pretreatm5ts1 immunizations1 & o!r ,,pvntm$ measures 7,,pmm7 associat$ ) ,,nbc w>f>e4 ,prev5tive m$ic9e p]sonnel mu/ be aw>e ( ! m$ical ?reat 9 ! ,,ao4 ,!y mu/ cont9ually update _! m$ical surveillance activities to id5tify disease tr5ds 7endemic & epidemic71 pot5tial disease vectors1 & ! susceptibility ( troops to ^! diseases4 ,"u ,,nbc conditions1 diseases may manife/ t exi/ 9 ! area1 b 7 n be+ transmitt$ to p]sonnel4 ,h[ev]1 due to ! r$uc$ heal? /atus ( p]sonnel f exposures to or f /ress-relat$ ,,nbc conditions1 ! troops beg9 to suff] _! effects4 ,! appe>ance ( diseases or ar?ropods n kn[n to exi/ 9 ! ,,ao are indicators t ,,bw ag5ts h be5 us$4 ,= details on ,,pvntm$ op]ations1 see ,,fm #d-jb4ag4 #e-b4 ,disease ,incid5ce ,foll[+ ! ,use ( ,nucle>1 ,biological1 & ,*emical ,weapons a4 ,det]m9+ ,factors4 ,factors ( prime importance 9 det]m9+ ! nature & sev]ity ( ! disease effects are-- ,immunization /atus ( p]sonnel4 ,population d5sity4 ,degree ( indu/rialization 9 ! op]ational area4 ,availability ( food supplies4 ,availability ( wat]4 ,climate4 ,f9ally1 ! mann] & situation 9 :i* nucle> weapons are us$ are ( importance4 ,a s+le weapon detonat$ 9 a socially /able area w h f> less s]i\s effects ?an a detonation 9 an area :]e combat has already disrupt$ ! social /ability4 ,at ,hiro%ima & ,nagasaki1 ,japan 7excell5t examples ( ! fir/ type ( situation71 ! survivors :o c\ld get away 7 able to obta9 food1 %elt]1 & c>e f surr\nd+ intact areas4 ,) prolong$ combat op]ations1 su* intact areas w\ld n be available1 result+ 9 no food1 %elt]1 or c>e = survivors4 ,!re w be a breakd[n 9 social ord] & !re w be a lack ( effective m$ical support2 includ+ ,,pvntm$ functions & facilities4 b4 ,disease ,incid5ce4 ,)\t ,,pvntm$ capabilities1 increas$ incid5ce & morbidity f diseases w foll[4 ,"s diseases w pr$om9ate 9 incid5ce1 dep5d+ ^u ! geographical areas involv$ & ! endemic diseases pres5t4 7#a7 ,9 urban areas 9 temp]ate climates1 sev]al diseases are epidemic ?reats4 ,^! epidemic ?reats may include-- ,dys5t]y 7due to a v>iety ( pa?og5s74 ,rickettsial diseases1 p>ticul>ly typhus & scrub typhus4 ,hepatitis4 ,tub]culosis4 ,sexually transmitt$ diseases4 ,mal>ia & *ol]a 79 _m p>ts ( ! _w74 7#b7 ,!re are sev]al reasons = ! increas$ risk ( disease includ+1 b n limit$ to-- ,cr[d+ ( surviv+ populations ) limit$ sanit>y facilities1 su* z 0 se5 9 ,europe at ! end ( ,_w ,w> ,,ii4 ,a lack ( prophylaxis & immunizations ) resultant increases 9 ! susceptible faction ( a giv5 population4 ,a lack ( pe/ managem5t4 ,! effect ( irradiation on susceptibility to infection4 ,) ! high levels ( fall\t cov]+ wide areas1 a l>ge numb] ( p w su/a9 suble?al :ole-body doses ( irradiation4 ,! int]action ( irradiation ) infections is n cle>2 b x may be ! result ( lat5t infections manife/+ & decreas$ resi/ance to infection4 ,! result is an increas$ incid5ce ( disease4 ,! ecological imbalance & ho/-p>asite relation%ip foll[+ ! use ( nucle> weapons4 ,ea* class & ord] ( animals has m>k$ diff]5ces 9 s5sitivity to irradiation4 ,ar?ropods1 = example1 are mu* m resi/ant ?an are v]tebrates4 ,! normal balance betwe5 ar?ropods & birds t prey ^u !m 9 a giv5 area may be sev]ely upset1 produc+ a m>k$ ov]gr[? ( ! ar?ropods4 ,if ! ar?ropods include vectors ( disease !re w\ld be a s]i\s increase 9 disease haz>ds4 ,if !re is an increase 9 ar?ropods t de/roy vegetation !re w\ld be a s]i\s de/ruction ( food crops4 ,! introduction ( a ,,bw ag5t 9 an ,,ao 9 :i* ! disease organism is endemic or epidemic c increase ! risk level = expos$ p]sonnel4 #e-c4 ,prev5tive ,m$ic9e ,section ,! ,,pvntm$ sections ( ! brigade1 divisional1 & nondivisional m$ical companies p]=m analysis on wat] s\rces & supplies to det]m9e ! pres5ce or abs5ce ( ,,nbc_/,,tim contam9ation2 see ,app5dix ,i = additional in=mation4 ,bas$ ^u _! f9d+s1 ! wat] is releas$ = consumption1 or is re/rict$ f use until x is treat$ 7usually by wat] production p]sonnel us+ ! rev]se osmosis wat] purification unit ,,r[pu74 ,!y also collect wat] samples = suspect biological ag5t contam9ation = support+ m$ical laboratory analysis 7see ,app5dix ,b74 ,!y conduct m$ical surveillance activities1 to include occupational & environm5tal heal? ?reat surveillance4 ,!y conduct limit$ entomological surveys to det]m9e ! exi/5ce ( disease-vector+ ar?ropods 9 ! ,,ao4 ,!y inspect food s]vice facilities to det]m9e ! ext5t1 if any1 ( ,,nbc contam9ation4 ,!y evaluate ! unit's-- ,immunization /atus4 ,use ( prophylaxis = specific diseases 7su* z antimal>ial tablets7 7see ,,fm #d-jb4cc71 = nucle> radiation exposure 7su* z granisetron = nausea & vomit+7 7see ,,fm #d-jb4bhc71 & = ,,bw ag5ts 7su* z ,cipr(loxac9 = po/exposure *emoprophylaxis = ,an?rax7 7see ,,fm #h-bhd74 ,use ( n]ve ag5t pyrido/igm9e pretreatm5t tablets 7see ,,fm #h-bhe71 if w>rant$4 ,application ( p]sonal hygi5e & field sanitation proc$ures 7,,fm #ba-aj_/,,mcrp #d-aa4a;,d74 ,bas$ ^u _! f9d+s1 !y provide recomm5dations = corrective actions to ! comm&]s4 ,!y assi/ 9 tra9+ ,,u ,army unit field sanitation teams 7,,fm #d-be4ab72 !y are n memb]s ( ! unit field sanitation team4 ,!y conduct m$ical surveillance activities = _! comm& 7,,fm #d-jb4ag74 #e-d4 ,prev5tive ,m$ic9e ,deta*m5t ,! ,,pvntm$ deta*m5t provides ,,pvntm$ s]vices on an area support basis to units )9 _! assign$ ,,ao4 ,^! s]vices include1 b are n limit$ to-- ,conduct+ wat] surveillance1 includ+ ,,nbc contam9ation4 ,collect+ wat] samples suspect$ ( ,,nbc_/,,tim contam9ation = analysis by support+ m$ical laboratory 7see ,app5dix ,b74 ,p]=m+ food s]vice sanit>y inspections4 ,conduct+ m$ical surveillance & provid+ epidemiological consultation4 ,conduct+ pe/ 7ar?ropod & rod5t7 surveys & surveillance4 ,conduct+ ar?ropod control op]ations4 ,! a]ial spray+ missions are dep5d5t ^u availability ( helicopt] support4 ,conduct+ occupational & indu/rial hygi5e surveys4 ,advis+ comm&]s on ! application ( ,,pmm4 ,tra9+ ! support$ units' field sanitation teams4 ,section ,,ii4 ,,vet]9>y ,,s]vices #e-e4 ,g5]al ,! ,,u ,army ,vet]9>y ,s]vice is ! ,executive ,ag5t = vet]9>y s]vices to all ,s]vices )9 ! ,,dod4 ,!y ensure t food & bottl$ wat] supplies are safe & provide vet]9>y m$ical & surgical c>e = gov]nm5t-own$ animals ?r\gh\t ! ,,ao4 ,on ! integrat$ battlefield1 _! role is p>ticul>ly important2 ! pot5tial = food supplies becom+ contam9at$ ) ,,nbc ag5ts is high4 ,= detail$ in=mation on provision ( vet]9>y s]vices see ,,fm #h-aj-ah4 #e-f4 ,food ,protection ,food may become contam9at$ f enemy employm5t ( ,,nbc weapons_/ag5ts or f t]rori/ic contam9ation ( food procurem5t facilities & food supplies4 ,! ,,nbc ag5ts may be introduc$ dur+ production or 9 ! /orage area ( ! procurem5t facility2 :ile ! product is 9 transit2 at ! milit>y /orage facility2 or at ! unit food s]vice facility4 ,reg>dless ( :]e ! ag5t is us$1 ! effect is ! same2 p]sonnel w become ill or die if !y consume ! contam9at$ food4 ,to ensure food safety1 vet]9>y p]sonnel inspect & monitor food f its procurem5t until x is issu$ to ! consum]4 ,?r\gh\t ! ,,ao1 all ,s]vices 7,army1 ,navy1 ,m>9e1 & ,air ,=ce7 logi/ics & food s]vice p]sonnel mu/ take precautions to protect subsi/5ce f contam9ation4 #e-g4 ,food ,decontam9ation ,vet]9>y p]sonnel are involv$ 9 ! detection & monitor+ ( ,,nbc contam9at$ rations2 be=e use1 !y mu/ inspect all food suspect$ ( be+ contam9at$ ) ,,nbc ag5ts4 ,app5dix ,j provides guidance on food decontam9ation proc$ures4 ,vet]9>y p]sonnel provide advice on ! decontam9ation ( food to unit p]sonnel own+ ! food1 or p]sonnel p]=m+ ! food decontam9ation4 ,dep5d+ on ! type ( contam9ation & packag+1 ! food may be-- ,consum$ )\t be+ decontam9at$4 ,decontam9at$ & !n consum$4 ,de/roy$4 ,"s items may be held to all[ "t = natural decay ( nucle> or *emical contam9ation be=e consumption4 ,! comm&]1 ) advice f vet]9>y p]sonnel1 makes ! decision on ! disposition ( ! food4 ,h[ev]1 vet]9>y p]sonnel make ! f9al det]m9ation ( food safety4 #e-h4 ,animal ,c>e ,vet]9>y p]sonnel are conc]n$ ) ! protection ( gov]nm5t-own$ animals & animals be+ procur$ = consumption4 ,animals mu/ be protect$ f ,,nbc contam9ation1 :5ev] possible4 ,animals %\ld be mov$ into enclosures to protect !m z mu* z possible f contam9ation4 ,protective equipm5t is n available = milit>y work+ dogs2 h[ev]1 protection ( ! animal's feet & body mu/ be consid]$4 ,:5 milit>y work+ dogs mu/ cross a contam9at$ area1 protect _! feet by us+ butyl rubb] mat]ial to improvise booties4 ,s9ce ,,cps sy/ems are n available1 animal treatm5t facilities mu/ be e/abli%$ 9 contam9ation free areas4 ,vet]9>y treatm5t p]sonnel mu/ rema9 9 ,,mopp ,level #d :5 c>+ = ,,nbc animal casualties until ! animals h be5 decontam9at$4 ,! treatm5t ( milit>y work+ dog ,,nbc casualties is outl9$ 9 ,,fm #h-aj-ah4 ,section ,,iii4 ,,laboratory ,,s]vices #e-i4 ,g5]al ,laboratory s]vices mu/ cont9ue _! support role ev5 "u ,,nbc conditions4 ,= ! provision ( cl9ical & diagno/ic support1 ! facility mu/ be locat$ 9 a contam9ation-free area or be inside collective protection4 ,designat$ laboratories )9 ! !at] w analyze ,,nbc samples_/specim5s 7includ+ 9 !at] field confirmation id5tification ( biological ag5ts by evaluat+ specim5s f symptomatic pati5ts & animals & environm5tal samples collect$ f ! ,,ao74 ,see ,app5dix ,b = proc$ures 9 collect+ biological samples_/specim5s1 h&l+_/packag+1 ma9ta9+ *a9 ( cu/ody1 transport+ samples_/specim5s1 & analysis4 #e-aj4 ,level ,,ii ,laboratory support at ?is level is extremely limit$2 x consi/s ( laboratory proc$ures 9 direct support ( ,,mtf & ,,f/ activities4 ,laboratory p]sonnel prep>e collect$ suspect ,,nbc specim5s = submission to ! support+ laboratory = analysis2 ! specim5s are =w>d$ to support+ m$ical laboratories 7,app5dix ,b74 #e-aa4 ,level ,,iii ,laboratory support 9 a ,,c% is int5d$ = provid+ cl9ical laboratory support & is prim>ily 9 support ( acute surgical cases1 blood s]vices1 & /atim 7,,/at7 s]vices requir$ = int5sive c>e op]ations4 ,only extremely limit$ microbiology s]vices 7p>asitological exams & gram /a9s7 are provid$4 ,9 a mature !at]1 ! microbiology s]vices may be augm5t$ to include limit$ cultures & s5sitivity te/+4 ,pati5ts ) docum5t$ or suspect$ exposure to ,,nbc weapons_/ag5ts w be m$ically evaluat$1 specim5s w be collect$1 packag$1 & h *a9 ( cu/ody e/abli%$4 ,! specim5s w be =w>d$ ?r\gh te*nical *annels to ! support+ m$ical laboratory 7su* z ! !at] ,army m$ical laboratory ,,taml7 = analysis4 ,see ,app5dix ,b = specim5 collection1 packag+1 *a9 ( cu/ody1 & process+ requirem5ts4 #e-ab4 ,level ,,iv a4 ,cl9ical ,laboratories4 ,! cl9ical laboratories 9 ! combat support1 field1 & g5]al hospitals h ! ability to p]=m a g5]al1 b limit$1 array ( analytical proc$ures 9 hematology1 ur9alysis1 *emi/ry1 microbiology1 s]ology1 & blood bank4 ,pati5t specim5s ( suspect$ biological or *emical ag5t exposures are =w>d$ ?r\gh te*nical *annels to ! support+ m$ical laboratory4 ,see ,app5dix ,b = sample_/specim5 collection1 packag+1 *a9 ( cu/ody1 process+1 & transport+ requirem5ts4 b4 ,field ,laboratories4 7#a7 ,!at] ,army ,m$ical ,laboratory4 ,! ,,taml is ! specializ$ e*elons above corps 7,,eac7 laboratory t provides cl9ical & noncl9ical m$ical laboratory support4 ,:5 equipp$ & /aff$1 ! ,,taml provides 9-!at] field confirmation id5tification ( ,,nbc samples or specim5s4 ,us+ sophi/icat$ equipm5t & me?ods1 ! ,,taml has ! capability to detect & id5tify ,,nbc ag5ts 9 a v>iety ( specim5s_/samples 7su* z human1 air1 soil1 wat]1 animals1 vegetation1 & food74 ,direct support f cont95tal ,unit$ ,/ates 7,,conus7-bas$ laboratories aids ! ,,taml ) id5tification ( ,,nbc ag5ts4 ,comm& decision on use ( protective_/prev5tive measures & pati5t c>e may be bas$ on ! ,,taml f9d+s4 ,prop] collection1 packag+1 & rapid %ipm5t ( specim5s by ,m,t,fs & samples f o!r s\rces w ensure effective1 timely1 & accurate laboratory analyses4 7#b7 ,area ,m$ical ,laboratory4 ,! ,area ,m$ical ,laboratory 7,,aml7 is ! specializ$ laboratory )9 ! !at] t provides noncl9ical m$ical laboratory support4 ,! ,,aml c be deploy$ 9 ! corps or to ,,eac = support missions4 ,:5 field$1 ! ,,aml w replace ! ,,taml 9 ! =ce /ructure4 ,! ,,aml provides 9-!at] field confirmation id5tification ( ,,nbc samples or specim5s4 ,us+ sophi/icat$ equipm5t & me?ods1 ! ,,aml has ! capability to detect & id5tify ,,nbc ag5ts 9 a v>iety ( specim5s_/samples 7su* z human1 air1 soil1 wat]1 animals1 vegetation1 & food74 ,direct support f ,,conus-bas$ laboratories aids ! ,,aml ) id5tification ( ,,nbc ag5ts4 ,comm& decision on use ( protective_/prev5tive measures & pati5t c>e may be bas$ on ! ,,aml f9d+s4 ,prop] collection1 packag+1 & rapid %ipm5t ( specim5s by ,m,t,fs & samples f o!r s\rces w ensure effective1 timely1 & accurate laboratory analyses4 #e-ac4 ,level ,v 7,cont95tal ,unit$ ,/ates7 ,designat$ ,level ,v m$ical laboratories p]=m analyses to provide def9itive id5tification ( suspect biological ag5ts = ! ,presid5t & ,secret>y ( ,def5se purposes4 ,! def9itive id5tification ( suspect biological ag5ts also aids comm&]s 9 ! ,,ao 9 ma9ta9+ ! heal? ( _! comm&4 #e-ad4 ,field ,samples ,*emical corps p]sonnel collect environm5tal1 air1 soil1 & vegetation samples4 ,prev5tive m$ic9e p]sonnel collect samples f dr9k+ wat] s\rces & supplies4 ,vet]9>y p]sonnel collect samples f food supplies & m$ical specim5s f animals4 ,all o!r units collect soil1 vegetation1 & small animal samples = laboratory analysis4 ,samples are subject$ to initial scre5+ ) rapid te/ kits & 9-!at] confirmatory id5tification at ! support+ m$ical laboratory4 ,! ,presid5t- & ,secret>y ( ,def5se-requir$ def9itive id5tification is p]=m$ at ! designat$ ,level ,v m$ical laboratory4 ,compreh5sive databases w be ma9ta9$ to provide hi/orical te/+ results & w aid 9 ! ,,ao comm&]'s decisions to conduct op]ations 9 an ,,nbc environm5t4 ,see ,app5dix ,b = specific proc$ures = sample collection1 packag+1 transport+1 ma9ta9+ *a9 ( cu/ody1 & analysis4 ,section ,,iv4 ,,d5tal ,,s]vices #e-ae4 ,g5]al ,d5tal s]vice support is provid$ 9 ! ,,ao at ,levels ,,ii1 ,,iii1 & ,,iv4 ,because ( _! location close to ma9 supply r\tes & o!r support assets1 d5tal units are vuln]able to an ,,nbc /rike4 ,nucle>1 biological1 & *emical op]ations h an impact at all levels2 ?us1 d5tal units mu/ be prep>$ to survive on ! integrat$ battlefield4 ,def5se aga9/ ,,nbc weapons mu/ be includ$ 9 ! d5tal unit's ,,tsop4 ,individual & collective tasks mu/ be int5sely tra9$ on a regul> basis2 survival dep5ds on ! ability ( p]sonnel to use basic survival skills aga9/ an ,,nbc attack4 ,= details on provision ( d5tal s]vices1 see ,,fm #d-jb4ai4 #e-af4 ,mission 9 a ,nucle>1 ,biological1 or ,*emical ,environm5t ,! ov]all mission ( d5tal units to provide d5tal s]vices is greatly affect$ 9 ! aft]ma? ( an ,,nbc attack4 ,fir/1 ! unit mu/ survive ! attack & rapidly recov] f its effects4 ,secondly1 9 ! ev5t ( mass casualties1 ! d5tal pati5t c>e ef=t mu/ be r$irect$ f d5tal treatm5t to ! alt]nate w>time role ( augm5t+ ! adjac5t ,,mtf4 ,d5tal units d n possess ,,cps2 !re=e1 provid+ d5tal s]vices 9 an ,,nbc environm5t w be limit$ to ! treatm5t ( maxill(acial em]g5cies requir+ imm$iate att5tion4 ,?is c>e w be provid$ at an ,,mtf ) a ,,cps4 #e-ag4 ,d5tal ,treatm5t ,op]ations ,z a g5]al rule1 9 ! aft]ma? ( an ,,nbc attack1 d5tal treatm5t op]ations cease until delib]ate decontam9ation ( ! unit & its equipm5t has be5 accompli%$4 ,only maxill(acial injuries ( an imm$iate life-?reat5+ nature %\ld be consid]$ = treatm5t4 ,aft] an attack1 ! res\rces ( ! d5tal treatm5t facility 7,,dtf7 are r$irect$ t[>d support ( any mass casualty situation t may h be5 g5]at$ at an adjac5t ,,mtf1 or t[>d decontam9ation & relocation to a noncontam9at$ area4 #e-ah4 ,pati5t ,treatm5t ,consid]ations ,! only category ( d5tal treatm5t appropriate 9 an ,,nbc environm5t is em]g5cy2 & !n1 only ^? em]g5cies ( an extreme nature :i* dem& imm$iate att5tion4 ,! mo/ likely condition requir+ su* att5tion w\ld be maxill(acial trauma & w\ld mo/ likely be treat$ at an ,,mtf r ?an a ,,dtf4 ,al?\gh ! likelihood ( a requirem5t to treat d5tal pati5ts 9 an ,,nbc environm5t is extremely l[1 ,d,t,fs mu/ h a plan 9 ! ev5t t su* pati5ts d pres5t4 a4 ,pati5t ,decontam9ation4 ,decontam9ation ( pati5ts1 d5tal pati5ts includ$1 is an absolute requirem5t be=e admission into a clean ,,mtf4 ,contam9at$ pati5ts are triag$ & decontam9at$ be=e treatm5t 7except = life- or limb-sav+ c>e74 ,bo? triage & decontam9ation %\ld be accompli%$ z f> =w>d z possible4 ,specific details on pati5t decontam9ation are 9 ,app5dix ,g4 ,x is important to note t normally pati5t decontam9ation is n p]=m$ by m$ical or d5tal p]sonnel4 ,initial decontam9ation at ! basic skill level is accompli%$ at ! casualty's unit4 ,detail$ pati5t decontam9ation is accompli%$ by ! pati5t decontam9ation teams 7made up ( nonm$ical p]sonnel f ! support$ units7 t are sup]vis$ by m$ical p]sonnel at ! ,,mtf4 b4 ,pati5t ,decontam9ation at ,d5tal ,treatm5t ,facilities4 ,nei!r d5tal units nor _! ,d,t,fs are equipp$ = pati5t decontam9ation4 ,any contam9at$ pati5ts arriv+ at a ,,dtf requir+ urg5t att5tion mu/ be direct$ or evacuat$ to ! ne>e/ ,,mtf ) a pati5t decontam9ation capability4 #e-ai4 ,pati5t ,protection ,d5tal treatm5t facilities mu/ also consid] ! ne$ to protect pati5ts 9 _! c>e 9 ! ev5t ( an ,,nbc attack1 or :5 ! ?reat ( an attack is high4 ,special consid]ation mu/ be made = maxill(acial pati5ts ^: condition prev5ts !m f we>+ _! protective mask4 a4 ,imm$iate ,response4 ,9 ! ev5t ( an attack or :5 ! al>m s\nds1 d5tal treatm5t provid]s imm$iately cease "w & mask4 ,! pati5ts %\ld d likewise4 ,only aft] putt+ on _! own masks1 d ! d5tal treatm5t provid]s assi/ ! pati5t1 if necess>y1 by remov+ mat]ials t imp$e ! pati5t's mask+4 ,only ^? mat]ials t imp$e mask+ or may compromise ! airway 7su* z rubb] dam frames or impressions7 are remov$1 ! re/ are left 9 place until ! all cle> is s\nd$4 ,special att5tion mu/ be giv5 to pati5ts :o may h be5 m$icat$ into a less ?an fully consci\s /ate1 or are o!rwise incapacitat$4 b4 ,mission-,ori5t$ ,protective ,po/ure ,consid]ations4 ,! ,,mopp level %\ld be tak5 into acc\nt :5 det]m9+ ! category & ext5t ( d5tal treatm5t to be provid$4 ,pati5ts1 includ+ ^? seat$ 9 ! d5tal *air1 %\ld be at ! ,,mopp level prescrib$ = ! ,,dtf by its p>5t headqu>t]s4 ,d5tal treatm5t at ,,mopp ,levels #c & #d is1 ( c\rse1 impossible because ( ! requirem5t to we> ! protective mask2 h[ev]1 treatm5t is /ill possible at ,,mopp ,levels #j1 #a1 & #b4 ,treatm5t at ,,mopp ,level #b %\ld be limit$ only to em]g5cy c>e requir+ urg5t att5tion4 ,at ,,mopp ,level #a1 mo/ types ( d5tal em]g5cies c be accommodat$2 h[ev]1 only m9imal ess5tial treatm5t %\ld be und]tak5 9 ord] to r$uce risk ( ! pati5t be+ caught 9 a compromis$ /ate4 ,at ,,mopp ,level #j1 ! provision ( d5tal treatm5t g5]ally is n limit$4 ,h[ev]1 ! degree ( ! ,,nbc ?reat =eca/ = ! area %\ld be consid]$ be=e und]tak+ ext5sive treatm5t4 c4 ,maxill(acial ,injuries4 ,pati5ts ) maxill(acial injuries t prev5t prop] fit & seal ( ! individual protective mask mu/ be plac$ 9 a ,,ppw4 ,?\gh pati5ts ) ^! types ( injuries are mo/ likely to be f\nd only 9 ,,mtf *annels1 ,d,t,fs %\ld nev]!less be prep>$ 9 ! ev5t a pati5t pres5ts to ! ,,dtf4 ,s9ce ! ,,dtf does n h any ,p,p,ws2 ^! pati5ts %\ld be imm$iately evacuat$ to ! adjac5t ,,mtf = treatm5t4 ,section ,v4 ,,combat ,,op]ational ,,/ress ,,control #e-bj4 ,g5]al ,:5 op]at+ "u ! ?reat ( or "u actual ,,nbc conditions1 soldi]s w be at a high risk ( suff]+ combat op]ational /ress-relat$ conditions4 ,! invisible1 p]vasive nature ( ^! weapons creates a high] degree ( unc]ta9ty & ambiguity1 pres5t+ f]tile opportunities = false al>ms1 mass panic1 & o!r maladaptive /ress reactions4 ,!re=e1 comm&]s & lead]s mu/ take actions to prev5t & r$uce ! numb]s ( combat op]ational /ress cases 9 ?is environm5t4 ,! symptoms & physical signs caus$ by excessive /ress are simil> to "s signs ( true ,,nbc ag5t injury4 ,9 ,_w ,w> ,i1 inexp]i5c$ units initially evacuat$ two /ress cases = e "o true *emical casualty4 ,"s m9or *emical casualties also _h major /ress symptoms4 ,!re=e1 f> =w>d triage is ess5tial to prev5t ov] evacuation & loss ( ! individual to ! unit4 ,= details on provision ( ,,cosc see ,,fm #h-ea & ,,fm #bb-ea4 #e-ba4 ,lead]%ip ,actions a4 ,keep ,p]sonnel ,in=m$ ( ! ,situation4 ,keep in=mation fl[+1 dispel my?s1 & control rumors by-- ,discuss+ ! situation & its possible long-t]m implications hone/ly4 ,ma9ta9+ ! p]spective t ! be/ *ance = mission accompli%m5t is assur$ :5 ! unit & ! ,army /ays mission focus$4 b4 ,tra9 ,soldi]s to ,survive4 ,use tra9+ proc$ures t-- ,tell ! lessons ( hi/ory on ,,nbc weapons employm5t4 ,%[ t ! enemy's use ( ,,nbc weapons_/ag5ts w n give him en\gh advantage to ju/ify ! risk to 8 =ces4 ,increase ! *ance ( surviv+ & w9n+ %\ld ! enemy use ,,nbc weapons_/ag5ts4 ,emphasize ! buddy sy/em z a means ( keep+ wat* = ea* o!r4 ,p]sonnel mu/ always seek buddy aid be=e tak+ additional antidotes4 ,?is w r$uce ! numb]s ( individuals us+ _! antidotes :5 n ne$$2 & prev5t ! increas$ heat /ress caus$ by ! effects ( atrop9e on ! body's cool+ capabilities4 c4 ,put ,nucle>1 ,biological1 & ,*emical ,def5se 9 ,reali/ic ,p]spective4 ,cont9u\sly /rive to ma9ta9 a reali/ic p]spective 9 ! unit by-- ,comp>+ ! risks ( ! ?reat ) ! increas$ risk ( fac+ ! conv5tional ?reat 9 v>y+ levels ( ,,mopp4 ,! decision to initiate a ,,mopp level %\ld be l decid+ h[ mu* cov] is ne$$ to protect a unit f conv5tional weapons4 ,*oos+ ! l[e/ ,,mopp level t protects ! unit1 yet p]mits accompli%m5t ( ! mission4 ,d n try to be #ajj p]c5t safe f *emical attack if x means t !re is-- ,only a small *ance ( mission accompli%m5t4 ,a high probability ( be+ kill$ by ! enemy4 ,a high p]sonnel loss due to heat injury4 d4 ,tra9 9 ! ,protective ,mask4 ,tra9 9 ! protective mask (t54 ,x takes repeat$ we> & "t to acclimate & get ov] ! clau/rophobic feel+ ( we>+ ! mask4 ,! tra9+ c be conduct$ dur+ a v>iety ( activities4 ,h p]sonnel we> ! mask (t5 9 g>rison or dur+ lulls 9 o!r activities1 ev5 at desk jobs4 ,if on av]age1 "o p]son 9 five we>s ! mask1 on a rotational basis1 at any giv5 "t1 ev]yone w quickly become accu/om$ to we>+ x4 ,p]iodic prolong$ we> 7#h h\rs or m7 helps soldi]s ga9 confid5ce & realize t !y c tol]ate ! discom=t4 ,h p]sonnel we> ! mask :ile p]=m+ combat-relat$ 7mission ess5tial7 tasks4 e4 ,tra9 9 ,mission-,ori5t$ ,protective ,po/ure ,level #d4 ,tra9+ 9 ,,mopp ,level #d 7or simulat$ ,,mopp #d1 :i* is to ov]dress :ile we>+ ! protective mask1 ov]boots1 & gloves7 w increase p]sonnel confid5ce 9 _! ability to we> ! ensemble4 f4 ,ensure ,sleep ,plans are ,safely ,practic$4 ,h ev]yone practice we>+ ! mask :ile sleep+4 ,ensure p]sonnel only sleep 9 safe places2 d n all[ p]sonnel to sleep "u or ne> vehicles or o!r motoriz$ ma*9]y4 ,require gr\nd guides = all vehicles 9 ! unit biv\ac area4 ,ensure t ea* individual get at lea/ #d h\rs ( un9t]rupt$ sleep dur+ e #bd-;h\r p]iod1 mission p]mitt+ 7,see ,,fm #ba-aj74 #e-bb4 ,individual ,responsibilities a4 ,foll[ ,ord]s4 ,by foll[+ ord]s1 individuals c increase _! ability to cope ) & prev5t combat op]ational /ress-relat$ conditions4 ,cop+ ) ! /resses ( an ,,nbc environm5t requires extra individual action4 ,conc5trate on ! positive aspects ( survival1 n ! negatives ( illness or dea?4 b4 ,tra94 ,use e opportunity to we> ! protective mask or ! entire ,,mopp ensemble dur+ tra9+1 :5 p]mitt$4 ,y build self-confid5ce & endurance by frequ5tly tra9+ ) y\r protective mask1 or at ,,mopp ,level #d4 ,p]=m refre%] tra9+ 9 basic ,,nbc survival skills4 c4 ,use ,buddy ,sy/em4 ,use ! buddy sy/em to increase y\r ability to survive4 ,s]vice memb]s look+ out = ea* o!r give a s5se ( security t relieves /ress4 ,look+ out = ea* o!r improves e individual's ability to p]=m 8 duties4 #e-bc4 ,m5tal ,heal? ,p]sonnel ,responsibilities a4 ,/aff+ = ,combat ,op]ational ,/ress ,control4 ,combat op]ational /ress control is provid$ by ! foll[+ activities or units3 ,brigade m5tal heal? section4 ,division m5tal heal? section4 ,area support m$ical battalion m5tal heal? section4 ,neuropsy*iatric w>d & consultation s]vice ( ea* ,,c%1 field hospital1 & g5]al hospital4 ,m$ical deta*m5t1 ,,cosc4 ,m$ical company1 ,,cosc4 b4 ,conduct ,prev5tive ,activities4 ,9 an ,,nbc environm5t1 prev5tion is ! mo/ economical means ( controll+ combat op]ational /ress reactions4 ,m5tal heal? p]sonnel mu/ beg9 consultation s]vices be=e ,,nbc weapons_/ag5ts h be5 employ$4 c4 ,control ,/ress ,reactions4 ,individuals ) combat op]ational /ress reactions require prompt int]v5tion4 ,! evaluation ( ov]-/ress$ p]sonnel is difficult b n impossible :5 bo? ! soldi] & ! evaluator are 9 ,,mopp4 ,! prim>y me?od ( m5tal heal? evaluation is ! int]view & m5tal /atus exam9ation4 ,= details on controll+ /ress reactions1 see ,,fm #h-ea4 ,section ,,vi4 ,,heal? ,,s]vice ,,logi/ics #e-bd4 ,g5]al ,z 9 all combat situations1 ! protection ( m$ical supplies & equipm5t on ! integrat$ battlefield is a mu/4 ,)\t m$ical supplies & equipm5t1 ,,hss w be greatly dim9i%$4 ,?us1 ! fl[ ( supplies mu/ cont9ue to =w>d units z !y are reque/$1 includ+ dur+ ,,nbc op]ations4 ,= detail$ in=mation on provid+ heal? s]vice logi/ics see ,,fm #d-jb4a & ,,fm #h-aj-i4 #e-be4 ,protect+ ,supplies 9 ,/orage ,protect+ supplies c be accompli%$ by plac+ !m "u t5ts1 us+ pla/ic wraps1 or provid+ /orage w>eh\ses ) ,,cb filt]$-condition$ 7heat$ or cool$7 air sy/ems4 ,wrapp+ supplies 9 two lay]s ( pla/ic mat]ial provides protection f mo/ ag5ts = a %ort p]iod ( "t2 ! ?ick] ! pla/ic mat]ial1 ! long] ! protection4 ,effectiv5ess ( protective proc$ures c be *eck$ by plac+ ,m#i tape on supplies & betwe5 lay]s ( ! cov]+4 ,protection f ! !rmal & bla/ effects ( nucle> detonations requires mu* m elaborate measures4 ,plac+ ! supplies 9 tr5*es1 inside e>!n b]ms1 beh9d /onewalls1 or 9 o!r field exp$i5t facilities w enhance ! protective po/ure ( supplies f ! nucle> effects4 ,ev5 :5 tak+ ^! protective measures1 a quantity ( supplies w become contam9at$ & mu/ be replac$4 ,plans %\ld be 9 place = replacem5t ( lo/ items4 #e-bf4 ,protect+ ,supplies ,dur+ ,%ipm5t ,dur+ %ipm5t1 supplies are protect$ by placem5t inside ,m,i,l,v,a,ns1 9 cov]$ enclos$ vehicles1 or by wrapp+ !m 9 sev]al lay]s ( pla/ic1 9 t>paul9s1 or 9 o!r protective mat]ial4 ,to monitor exposure ( supplies to *emical ag5ts dur+ %ipm5t1 place ,m#i detector pap] betwe5 ! wrapp+s4 ,if exposure is limit$ to ! out] lay]1 simple removal ( ?is lay] may be all t is requir$ to elim9ate ! contam9ation4 ,decontam9ation is mu* easi] :5 ! supplies & equipm5t h be5 protect$ by multilay]s ( ov]-wraps4 #e-bg4 ,organizational ,ma9t5ance ,ma9t5ance on vehicles1 equipm5t1 & m$ical equipm5t w become mu* m complex "u ,,nbc conditions4 ,mo/ *emical ag5ts are soluble 9 organic solv5ts su* z gasol9e1 motor oils1 & lubricants4 ,! ag5t may be remov$ f ! equipm5t by ^! solv5ts1 b exposure to ! contam9at$ solv5ts w produce ! same effects z exposure to ! ag5t on ! equipm5t4 ,! ag5ts may seep d[n ar\nd ! ?reads ( bolts1 9 cracks & crevices ( ! equipm5t1 & inside ! cab9ets or enclosures ( equipm5t4 ,^! pot5tial contam9ation s\rces produce an increas$ haz>d to ma9t5ance p]sonnel4 ,decontam9ation ( "s items1 especially m$ical equipm5t1 may be a problem = ma9t5ance p]sonnel4 ,! use ( /&>d decontam9ation ag5ts w cause damage beyond repair to mo/ m$ical equipm5t & electronic equipm5t4 ,9 "s in/ances1 removal ( *emical ag5ts w require ag+ 7(f-gass+7 ( ! ag5t4 ,turn+ ! equipm5t on & runn+ x1 or j expos+ ! equipm5t to w>m air w spe$ ! (f-gass+ process4 ,ma9t5ance p]sonnel mu/ p]=m all proc$ures 9 ,,mopp ,level #d until decontam9ation is complet$4 ,radiation w p5etrate ! metal /ructures ( vehicles & o!r equipm5t2 radioactive mat]ial w be absorb$ into ! lubricants & fuels4 ,decontam9ation ( ?is type ( contam9ation is v difficult1 if n impossible4 ,p]sonnel mu/ use radiation detection equipm5t to det]m9e ! ext5t ( contam9ation & decontam9ate ! items z mu* z possible4 ,du/+ or wa%+ ) wat] c remove any fall\t on ! surface ( vehicles & nonelectrical_/electronic compon5ts ( equipm5t4 ,removal ( radioactivity absorb$ into metals or mix$ 9 lubricants & fuels is beyond ! capabilities ( unit p]sonnel4 ,see ,,fm #c-e = decontam9ation proc$ures4 ,section ,,vii4 ,,homel& ,,security ,,response #e-bh4 ,*emical1 ,biological1 ,radiological1 ,nucle>1 & ,high-,yield ,explosive ,response ,al?\gh1 homel& security is n a specific milit>y mission1 comm&]s mu/ plan = & be prep>$ to support a lead f$]al ag5cy 7su* z ! ,f$]al ,bureau ( ,inve/igation or ,f$]al ,em]g5cy ,managem5t ,ag5cy7 9 response to ,,cbrne ev5t4 ,:5 ! ,,cbrne ev5t occurs on a milit>y in/allation1 ! ,weapons ( ,mass ,de/ruction--,incid5t ,support ,team 7,,wmd-,,i/7 is ! lead f$]al ag5cy 9 *>ge ( respond+ & e/abli%es an incid5t comm& c5t] 7,,icc74 ,! in/allation m$ical au?ority 7,,ima7 provides ! ,,hss initial response to ! ev5t site4 ,reque/ = assi/ance f deployable ,,hss organizations & /affs are initiat$ by ! ,,ima ?r\gh milit>y *annels4 ,! incid5t comm&] w submit a reque/ = ,,hss assi/ance to a ,,cbrne ev5t (f ! milit>y in/allation ?r\gh ! appropriate f$]al *annels4 ,! ,presid5t w direct any ,,dod response 9 support ( a lead f$]al ag5cy to a ,,cbrne ev5t4 ,! ,presid5tial direction to assi/ w be pass$ d[n ?r\gh milit>y *annels to ! appropriate ,,hss organization = response4 ,! ,,hss response may be 9 ! =m ( special m$ical augm5tation teams 7,,sm>t7 support f ,,u ,army ,m$ical ,comm& res\rces or ,,hss 7table ( organization & equipm5t ,,toe7 units may be direct$ to respond4 ,normally1 respond+ ,,toe units w provide ,,hss to nonm$ical milit>y respond]s4 ,h[ev]1 ! ,,hss mission may be to provide support to ! lead f$]al ag5cy or civilian public heal? organizations1 em]g5cy m$ical s]vices 7ambulance crews71 or hospitals4 ,! ,,hss response w include1 b n be limit$ to-- ,provid+ m$ical c>e to casualties at ! incid5t casualty decontam9ation site & sup]vis+ ! casualty decontam9ation process to ensure t no fur!r injury is caus$ to ! casualty4 ,provid+ en r\te c>e = casualties f ! incid5t site to an ,,mtf or designat$ location = fur!r c>e4 ,normally1 ,,toe ,,m$evac assets are n us$1 b ,,hss p]sonnel provide ! en r\te c>e on locally provid$ transport vehicles4 ,provid+ guidance to local respond]s 9 ! managem5t ( ,,cbrne casualties4 ,! guidance may be on ! correct use ( antidotes1 *emoprophylaxis1 prev5tion ( contam9ation spread 9 ! ,,mtf1 pati5t decontam9ation at ! ,,mtf1 & o!r relat$ m$ical managem5t proc$ures4 ,id5tify+ suspect *emical1 biological1 or radiological mat]ials us$ 9 ! ev5t4 ,provid+ guidance on application ( /&>d precautions = ,,cbrne1 especially prev5tive measures to prev5t spread ( contagi\s ag5ts4 ,manag+1 triag+1 & treat+ mass casualties4 #e-bi4 ,capabilities ( ,response ,elem5ts ,= detail$ ,in=mation on capabilities ( ,s,m,a,r,ts see ,,fm #d-jb & ,,fm #h-db4 ,= detail$ in=mation on capabilities & functions ( ,,toe ,,hss units see ,,fm #d-jb- & #h-s]ies publications4 ,,app5dix ,a ,,m$ical ,,effects ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,weapons ,,& ,,toxic ,,indu/rial ,,mat]ial ,a-#a4 ,g5]al ,biological & *emical weapons_/ag5ts may be employ$ by assass9s1 t]rori/s1 rebels1 & insurg5ts1 z well z well-=m$ battle organizations1 across ! cont9uum ( op]ations4 ,9 addition1 nucle> weapons w rema9 a ?reat on ! future battlefield4 ,ano!r weapon t may be us$ is ! ,,rdd4 ,! ,,rdd c cause significant damage & pres5t heal? haz>ds to fight+ =ces by expos+ !m to radiation )\t ! !rmal & full bla/ effects ( nucle> weapons4 ,! ,,rdd c disp]se radioactive mat]ial ov] an area ( ! battlefield2 ! area cov]$ is dep5d5t ^u ! am\nt ( radioactive & explosive mat]ial us$4 ,9 ord] to detonate a nucle> weapon1 an adv]s>y mu/ fir/ obta9 access to ! appropriate weapons-grade mat]ial4 ,h[ev]1 an ,,rdd c be produc$ & us$ by anyone ) access to indu/rial or m$ical radioisotopes & explosives4 ,biological ag5ts are easy to disp]se on ! battlefield )\t imm$iate detection2 h[ev]1 _! effects on expos$ troops c *ange ! c\rse ( ! battle4 ,"s nations consid] *emical weapons z a compon5t ( _! munitions = ! battlefield4 ,z m nations ent] ! ar5a ( develop+ biological & *emical weapons1 _! pot5tial effects on our troops w increase4 ,! enemy's use ( ,t,i,ms z weapons or collat]al damage to ,,tim /orage faculties c sev]ely affect ! unit p]sonnel's ability to cont9ue ! mission4 ,! signs & symptoms ( "s ,,tim exposure c be ! same z ^? pres5t$ f exposure to ,,nbc weapons4 ,consid]ations ( bo? ! physical & biological effects ( ^! weapons are requir$ = ,,hss op]ations4 ,field ,manual #d-jb4bhc provides additional in=mation on nucle> & radiological effects2 ,,fm #h-bhd provides additional in=mation on biological ag5t effects2 ,,fm #h-bhe provides additional in=mation on ,,cw effects2 ,,fm #h-ejj provides detail$ in=mation on haz>d\s mat]ial 7,,tim7 effects4 ,a-#b4 ,physical ,effects ( ,nucle> ,weapons a4 ,! pr9cipal physical effects ( nucle> weapons are bla/1 !rmal radiation 7heat71 & nucle> radiation4 ,^! effects are dep5d5t ^u ! yield 7or size7 ( ! weapon express$ 9 kilotons 7,,kt71 ! physical design ( ! weapon 7su* z conv5tional & enhanc$71 & ! me?od ( employm5t4 ,! di/ribution ( en]gy 7,figure ,a-#a7 f ! detonation ( a mod]ate-siz$ 7#c to #aj ,,kt7 weapon is z foll[s3 7#a7 ,fifty p]c5t z bla/4 7#b7 ,?irty-five p]c5t z !rmal radiation2 made up ( a wide spectrum ( electromagnetic radiation1 includ+ infr>$1 visible1 & ultraviolet light & "s s(t x-ray radiation4 7#c7 ,f\rte5 p]c5t z nucle> radiation1 #d p]c5t z initial ioniz+ radiation compos$ ( neutrons & gamma rays emitt$ )9 ! fir/ m9ute aft] detonation1 & #aj p]c5t z residual nucle> radiation 7fall\t74 7#d7 ,"o p]c5t z ,,emp4 b4 ,l>g] weapons are m de/ructive ?an small] weapons1 b ! de/ructive effect is n l9e>4 ,table ,a-#a pres5ts a comp>ison ( ?ree aspects ( nucle> weapons effects ) yield4 ,illu/ration3 ,figure ,a-#a4 ,di/ribution ( en]gy4 c4 ,! altitude at :i* ! weapon is detonat$ det]m9es ! bla/1 !rmal1 & nucle> radiation effects4 ,nucle> bla/s are classifi$ z air1 surface1 or subsurface bur/s4 7#a7 ,an airbur/ is a detonation 9 air at an altitude bel[ #cj1jjj met]s1 b high en\gh t ! fireball does n t\* ! l& or wat] surface4 ,! altitude is v>i$ to obta9 ! desir$ tactical effects4 ,initial radiation w be a significant haz>d1 b !re is ess5tially no local fall\t4 ,h[ev]1 ! gr\nd imm$iately bel[ ! airbur/ may h a small area ( neutron-induc$ radioactivity4 ,?is may pose a haz>d to troops pass+ ?r\gh ! area4 7#b7 ,a surface bur/ is a detonation 9 :i* ! fireball actually t\*es & vaporizes ! l& or wat] surface4 ,9 ?is case1 ! area affect$ by bla/1 !rmal radiation1 & initial nucle> radiation w be small] ?an = an airbur/ ( comp>able yield4 ,h[ev]1 9 ! region ar\nd gr\nd z]o1 ! de/ruction w be mu* great] & a crat] is (t5 produc$4 ,additionally1 all ! mat]ial t 0 )9 ! fireball becomes fall\t & w be a haz>d d[nw9d4 ,a surface bur/ is ! mo/ likely type ( t]rori/ detonation4 7#c7 ,a subsurface bur/ is an explosion 9 :i* ! detonation is bel[ ! surface ( l& or wat]4 ,crat]+ usually results4 ,if ! bur/ does n p5etrate ! surface1 ! only haz>d is f ! gr\nd or wat] %ock4 ,if ! bur/ p5etrates ! surface1 bla/1 !rmal1 & initial nucle> radiation w be pres5t1 ?\gh less ?an = a surface bur/ ( comp>able yield4 ,local fall\t w be heavy ov] a small area4 7#d7 ,a high altitude bur/ occurs above #cj1jjj met]s4 ,radiation & physical effects d n rea* ! gr\nd & !re is no local fall\t4 ,?is is ! only detonation :]e ! effects ( ! ,,emp are significant4 ,nonh>d5$ electronic equipm5t includ+ _m m$ical devices may become inop]ative4 ,! ,,emp damage is a moot po9t ) o!r types ( detonations1 z its range is prim>ily limit$ to ! area ( int5se physical de/ruction4 ,table ,a-#a4 ,comp>ison ( ,weapons ,effects 7,radii ( ,effects 9 ,kilomet]s--,airbur/7 #a ,,kt #bj ,,kt #ajj ,,kt #a ,,mt #aj ,,mt ---------------------------------------- ---------------------- ,,nucle> ,,radiation #j4ga #a4c #a4f #b4c #c4g 7#a1jjj c,gy7 ---------------------------------------- ---------------------- ,,bla/ 7#ej ,,incid5ce ,,( ,,translation ,,) ,,subsequ5t ,,impact #j4bh #a4j #a4d #c4h #aa4g ,,) ,a ,,non-,,yield+ ,,surface7 ---------------------------------------- ---------------------- ,,!rmal 7#ej ,,incid5ce ,,( #b,,nd-,,degree ,,burns ,,to #j4gg #a4h #c4b #d4h #ad4e ,,b>e ,,sk91 #aj ,,km ,,visibility7 ,a-#c4 ,physiological ,effects ( ,nucle> ,weapons ,! physiological effects ( nucle> weapons are ! result ( exposure to ! bla/2 !rmal radiation2 ioniz+ radiation 7initial or residual7 effects2 or a comb9ation ( ^!4 ,= small] weapons 7less ?an #aj ,,kt71 ioniz+ radiation is ! prim>y creator ( casualties requir+ m$ical c>e1 :ile = l>g] weapons 7great] ?an #aj ,,kt71 !rmal radiation is ! prim>y creator ( casualties4 a4 ,! rapid compression & decompression ( bla/ waves on ! human body results 9 transmission ( pressure waves ?r\gh ! tissues4 ,result+ damage is prim>ily at junctions betwe5 tissues ( diff]5t d5sities 7bone & muscle71 or at ! int]face betwe5 tissue & airspace4 ,lung tissue & ! ga/ro9te/9al sy/em 7bo? conta9 air7 are p>ticul>ly susceptible to injury4 ,! tissue disruptions c lead to sev]e hemorrhage or to an air embolism2 ei!r c be rapidly fatal4 ,direct ov]pressure effects d n ext5d out z f> f ! po9t ( detonation z ! drag =ce & are (t5 mask$ by ! drag =ce effects4 ,a typical range ( probability ( le?ality1 ) v>iations 9 ov]pressure = a #a ,,kt weapon1 is %[n 9 ,table ,a-#b4 ,table ,a-#b4 ,range ( ,le?ality ( ,peak ,ov]pressure ,,le?ality ,,peak ,,ov]pressure ,,di/ance ,,f 7,,approximate 7 7,,atmosph]es7 ,,gr\nd ,,z]o2 ,,met]s ---------------------------------------- ---------------------- #a #b4c-b4i #aej #ej #b4i-d4a #abc #ajj #d4a #aaj 7#a7 ,! significance ( ! data is t ! human body is relatively resi/ant to /atic ov]pressure comp>$ to rigid /ructures su* z build+s4 ,= example1 an unre9=c$ c9d] block panel w %att] at #j4a to #j4b atmosph]es4 7#b7 ,ov]pressure l[] ?an ^? 9 ,table ,a-#b c cause nonle?al injuries su* z lung damage & e>drum rupture4 ,lung damage is a relatively s]i\s injury1 usually requir+ hospitalization1 ev5 if n fatal2 :]eas e>drum rupture is a m9or injury1 (t5 requir+ no treatm5t at all4 7a7 ,! ?re%old level ( ov]pressure = an unre9=c$ unreflect$ bla/ wave t c cause lung-damage is ab\t #a4j atmosph]e4 7b7 ,! ?re%old level = e>drum rupture is ar\nd #j4b atmosph]es2 ! ov]pressure associat$ ) a #ej p]c5t probability ( e>drum rupture is ab\t #a4a atmosph]es4 7#c7 ,casualties requir+ m$ical treatm5t f direct bla/ effects are produc$ by ov]pressure betwe5 #a4j & #c4e atmosph]es4 ,h[ev]1 o!r effects 7su* z indirect bla/ injuries & !rmal injuries7 are s pr$om9ate t pati5ts ) only direct bla/ injuries make up a small "p ( ! pati5t workload4 b4 ,! drag =ces 7indirect bla/7 ( ! bla/ w9ds are proportional to ! velocities & duration ( ! w9ds4 ,! w9ds are relatively %ort 9 duration1 b c rea* velocities ( sev]al hundr$ km p] h\r4 ,injury c result f missiles impact+ on ! body or f ! physical displacem5t ( ! body aga9/ objects & /ructures4 7#a7 ,! di/ance f ! po9t ( detonation at :i* sev]e indirect injury occurs is great] ?an t = equally s]i\s direct bla/ injuries4 ,a high probability ( s]i\s indirect injury c occur :5 ! peak ov]pressure is ab\t #j4b atmosph]es4 ,?is range w increase ) ! increas$ size ( ! weapon2 = a #a ,,kt weapon1 ! range is #j4bb km1 :]eas = a #bj ,,kt weapon1 ! range is #j4gf km4 ,at great] ranges injuries w occur & casualties w be g5]at$1 b n consi/5tly4 7#b7 ,! drag =ces ( ! bla/ w9ds produc$ by a nucle> detonation are s great t almo/ any =m ( vegetation or /ructure w be brok5 up or fragm5t$ into missiles4 ,?us1 multiple1 v>i$ missile injuries w be common1 increas+ _! ov]all sev]ity & significance4 ,table ,a-#c li/s ranges at :i* significant missile injuries c be expect$4 ,table ,a-#c4 ,ranges = ,probabilities ( ,s]i\s ,injury f ,small ,missiles ,,ranges 7km7 ---------------------------------------- ------------------------- ,,yield #a ,,probability ,,( #ej ,,probability ,,( #ii ,,probability ,,( 7,,kt7 ,,s]i\s ,,injury ,,s]i\s ,,injury ,,s]i\s ,,injury ---------------------------------------- ------------------------- #a #j4bh #j4bb #j4ag #aj #j4gc #j4eg #j4dd #bj #j4ih #j4gf #j4eh #ej #a4d #a4a #j4hd #ajj #a4i #a4e #a4a #bjj #b4e #a4i #a4e #ejj #c4f #b4g #b4a #a1jjj #d4h #c4f #b4g ---------------------------------------- ------------------------- #a ,,incid5ce ,,( ,,injury ,,bas$ ,,on ,,sk9 ,,& ,,tissue ,,p]=ation4 #b ,,missiles ,,us$ ,,7 #aj ,,gram 7gm7 ,,9 ,,weight4 7#c7 ,! velocity to :i* missiles are accel]at$ is ! major factor 9 caus+ injury4 ,! probability ( a p5etration injury increases ) increas+ velocity1 p>ticul>ly = small1 %>p missiles su* z glass fragm5ts4 ,small1 light objects are accel]at$ to spe$s approa*+ ! maximum 7w9d7 velocity4 ,table ,a-#d %[s data = probability ( p5etration relat$ to size & velocity ( glass fragm5ts4 ,table ,a-#d4 ,probability ( ,glass ,fragm5ts ,p5etrat+ ! ,abdom9al ,cavity ,,mass ,,( ,,glass #a #ej #ii ,,fragm5ts 7gm7 ,,impact ,,velocity 7,,met]s ,,p] ,,second7 ---------------------------------------- --------------- #j4a #gh #acf #bdc #j4f #ec #ia #afa #a4j #df #hb #adc #aj4j #ch #fj #aah 7#d7 ,heavy1 blunt missiles may n p5etrate1 b c result 9 significant injury1 p>ticul>ly fractures4 ,! ?re%old velocity = skull fractures f a #d4e milligram 7mg7 missile is ab\t #d4f met]s p] second 7m_/sec74 7#e7 ,! drag =ces ( ! bla/ w9ds are /rong en\gh to displace l>ge objects 7su* z vehicles71 or cause l>ge /ructures to collapse 7su* z build+s7 result+ 9 s]i\s cru%+ injuries4 ,man himself c become a missile result+ 9 injuries 7call$ translational injuries74 ,! velocity at :i* ! body is displac$ w det]m9e ! probability & ! sev]ity ( injury4 ,assum+ a displacem5t ( #c4j met]s1 ! impact velocity associat$ ) v>i\s degrees ( injury is %[n 9 ,table ,a-#e4 ,! velocities 9 ,table ,a-#e c be correlat$ aga9/ yield4 ,! ranges at :i* su* velocities c occur & ! probability ( injury are giv5 9 ,table ,a-#f4 ,table ,a-#e4 ,translational ,injuries ,a4 ,,blunt ,,injuries ,,& ,,fractures ,,probability ,,( ,,injury ,,velocity 7m_/sec7 ---------------------------------------- -------- #a #b4f #ej #f4f #ii #af4e ---------------------------------------- -------- ,b4 ,,fatal ,,injuries ,,probability ,,( ,,fatality ,,velocity 7m_/sec7 ---------------------------------------- -------- #a #f4f #ej #ag4j #ii #ci4g ,table ,a-#f4 ,ranges = ,select$ ,impact ,velocities ( a #gj-,kilogram ,human ,body ,displac$ by ,bla/ ,w9d ,drag ,=ces = ,diff]5t ,yield ,weapons ,,weapon ,,yield ,,velocities 7m_/sec7 7,,kt7 #b4f #f4f #ag4j ---------------------------------------- ------ ,,ranges 7km7 ---------------------------------------- ------ #a #j4ch #j4bg #j4ai #aj #a4j #j4ge #j4ec #bj #a4c #j4ii #j4ga #ej #a4i #a4d #a4j #ajj #b4e #a4i #a4d #bjj #c4b #b4e #a4i #ejj #d4f #c4f #b4g #a1jjj #e4i #d4h #c4f ,a-#d4 ,biological ,effects ( ,!rmal ,radiation ,! !rmal radiation emitt$ by a nucle> detonation causes burns 9 two ways--by direct absorption ( ! !rmal en]gy ?r\gh expos$ surfaces 7fla% burns72 or by ! indirect action ( fires 9 ! environm5t 7flame burns74 ,indirect flame burns c easily outnumb] all o!r types ( injury4 a4 ,!rmal radiation travels outw>d f ! fireball 9 a /raight l9e2 !re=e1 ! am\nt ( en]gy available to cause fla% burns decreases rapidly ) di/ance4 ,close to ! fireball all objects w be inc9]at$4 ,! range = #ajj p]c5t le?ality w v>y ) yield1 height ( bur/1 wea!r1 environm5t1 & imm$iacy ( treatm5t4 ,! critical factors det]m9+ ! degree ( burn injury are ! flux 7calories p] squ>e c5timet]_/second cal_/cm#b_/sec7 & ! duration ( ! !rmal pulse4 ,! total am\nt ( !rmal radiation ne$$ to cause a fla% p>tial ?ickness burn on expos$ sk9 w v>y ) ! yield ( ! weapon & ! nature ( ! pulse 7,table ,a-#g74 ,mo/ burn pati5ts w come f ! zones :]e p>tial ?ickness burns occur4 ,9 areas :]e radiation1 bla/1 & !rmal int5sity are highe/1 burn victims surviv+ long en\gh to rea* m$ical c>e w be r>e4 ,,note ,! battle dress uni=m 7,,bdu71 ,,mopp ge>1 or any o!r clo?+ w provide additional protection aga9/ fla% burns4 ,! airspace betwe5 ! clo?+ significantly imp$es heat transf] & may prev5t or r$uce ! sev]ity ( burns1 dep5d+ on ! magnitude ( ! !rmal flux4 ,table ,a-#g4 ,factors = ,det]m9+ ! ,probability ( ,p>tial ,?ickness ,burns ,,yield ,,( ,,weapon #a ,,kt #aj ,,kt #ajj ,,kt #a ,,mt #aj ,,mt ---------------------------------------- -------------------------- ,,range 7km7 ,,= ,,production ,,( ,,p>tial ,,?ickness ,,burns #j4gh #b4a #d4h #i4a #ad4e ,,on ,,expos$ ,,sk9 ---------------------------------------- -------------------------- ,,duration ,,( ,,!rmal ,,pulse ,,9 ,,seconds #j4ab #j4cb #j4i #b4d #f4d ---------------------------------------- -------------------------- ,cal_/cm#b_/sec ,,requir$ ,,to ,,produce ,,p>tial ,,?ickness #d4j #d4e #e4c #f4c #g4j ,,burns ,,on ,,expos$ ,,sk9 b4 ,indirect 7flame7 burns result f exposure to fires caus$ by ! !rmal effects 9 ! environm5t1 p>ticul>ly f ignition ( clo?+4 ,! l>g]-yield weapons are m likely to cause fire/orms ov] ext5sive areas4 ,!re are too _m v>iables 9 ! environm5t to pr$ict ei!r incid5ce or sev]ity ( casualties4 ,expect ! burns to be f> less uni=m 79 degree7 & n limit$ to expos$ surfaces4 ,= example1 ! respiratory sy/em may be expos$ to ! effects ( hot gases produc$ by ext5sive fires4 ,respiratory sy/em burns cause high morbidity & high mortality rates4 c4 ,! initial pulse ( radiation 9 ! optical & !rmal b&s c cause injuries 9 ! =ms ( fla% bl9dness & ret9al sc>r+4 ,! initial brilliant fla% ( light produc$ by ! nucle> detonation causes fla% bl9dness4 ,?is fla% swamps ! ret9a1 blea*+ out ! visual pigm5ts & produc+ tempor>y bl9dness4 ,dur+ daylight h\rs1 ?is tempor>y effect may la/ = ab\t #b m9utes4 ,at night1 ) ! pupil dilat$ = d>k adaptation1 fla% bl9dness w affect p]sonnel at great] ranges & = great] durations4 ,p>tial recov]y c be expect$ 9 #c to #aj m9utes1 ?\gh x may require #ae to #ce m9utes = full night adaptation recov]y4 ,ret9al sc>r+ is ! p]man5t damage f a ret9al burn4 ,x w occur only :5 ! fireball is actually 9 ! individual's field ( view & %\ld be a relatively uncommon injury4 ,! location ( ! sc> w det]m9e ! degree ( int]f]5ce ) vision4 ,because night vision app>atus electronically amplifies an image1 x _c transmit ! fla% int5sity & w n cause eye injury4 ,a-#e4 ,physiological ,effects ( ,ioniz+ ,radiation ,a nucle> bur/ results 9 f\r types ( ioniz+ radiation3 neutrons1 gamma rays1 beta1 & alpha radiation4 ,! initial bur/ is *>act]iz$ by neutrons & gamma rays :ile ! residual radiation is prim>ily alpha1 beta1 & gamma rays4 ,! effect ( radiation on a liv+ organism v>ies greatly by ! type ( radiation to :i* ! organism is expos$4 ,see ,table ,a-#h = *>act]i/ics ( nucle> radiation4 a4 ,alpha p>ticles are extremely massive1 *>g$ p>ticles 7f\r times ! mass ( a neutron72 !y are a fall\t haz>d4 ,because ( _! size1 alpha p>ticles _c travel f> & are fully /opp$ by ! dead lay]s ( ! sk9 or by ! uni=m4 ,alpha p>ticles are a negligible ext]nal haz>d1 b if inhal$ or +e/$1 c cause significant int]nal damage4 ,illu/ration3 ,figure ,a-#b4 ,?re%old di/ance = m9imal *orioret9al burn & fla% bl9dness v]sus yield 7airbur/7 at night4 ,table ,a-#h4 ,*>act]i/ics ( ,nucle> ,radiation ,"p #a ---------------------------------------- ------------------------ ,,"n ,,& ,,:at ,,is ,,x ,,s\rce ,,en]gy ,,& ,,symbol ,,spe$ ---------------------------------------- ------------------------ ,,en]gy ,,v>ies3 ,,helium ,,decay ,,( ,,uranium ,,spe$ ,,v>ies ,,alpha ,,nucleus ,,& ,,plutonium ,,f #a_/bj ,,to #a_/aj ,,p>ticle ,,spe$ ,,( ,,light ---------------------------------------- ------------------------ ,,high-,,spe$ ,,decay ,,( ,,fission ,,beta ,,spe$ ,,products ,,& ,,v>ies ,,p>ticle ,,electron ,,neutron ,,induc$ ,,elem5ts ---------------------------------------- ------------------------ ,,electromagnetic ,,decay ,,( ,,fission ,,en]gy ,,v>ies3 ,,gamma ,,en]gy ,,products ,,& ,,travels ,,at ,,! ,,ray ,,neutron ,,induc$ ,,spe$ ,,( ,,light ,,elem5ts ---------------------------------------- ------------------------ ,,un*>g$ ,,fission ,,& ,,p>ticle ,,fusion ,,reactions ,,v>ies ,,neutron ---------------------------------------- ------------------------ ,"p #b ---------------------------------------- ------------------------ ,,"n ,,& ,,range ,,9 ,,range ,,9 ,,%ield+ ,,biological ,,symbol ,,air ,,tissue ,,requir$ ,,haz>d ---------------------------------------- ------------------------ ,,none1 ,,unless #e cm ,,_c ,,none ,,+e/$ ,,or ,,alpha ,,p5etrate ,,inhal$ ,,9 ,,p>ticle ,,! ,,epid]mis ,,suffici5t ,,quantities ---------------------------------------- ------------------------ ,,sev]al ,,/opp$ ,,by ,,beta #e ,,met]s ,,lay]s ,a ,,few cm ,,( ,al ,,sup]ficial ,,p>ticle ,,( ,,sk9 ,,or ,,mod]ate ,,sk9 ,,injury ,,clo?+ ---------------------------------------- ------------------------ ,,up ,,to #ejj ,,v ,,d5se ,,:ole ,,body ,,gamma ,,met]s1 ,,b ,,p5etrat+1 ,,mat]ial1 ,,su* ,,injury1 ,,_m ,,ray ,,is ,,en]gy ,,b ,,is ,,en]gy ,,z ,,concrete1 ,,casualties ,,dep5d5t ,,dep5d5t ,,/eel ,,plate1 ,,possible ,,e>? ---------------------------------------- ------------------------ ,,less ,,?an ,,v ,,hydrog5\s ,,:ole ,,body ,,gamma1 ,,b ,,p5etrat+1 ,,mat]ials1 ,,injury1 ,,_m ,,neutron ,,is ,,en]gy ,,b ,,is ,,en]gy ,,su* ,,z ,,casualties ,,dep5d5t ,,dep5d5t ,,wat] ,,or ,,possible ,,damp ,,e>? ---------------------------------------- ------------------------ b4 ,beta p>ticles are v light1 *>g$ p>ticles t are f\nd prim>ily 9 fall\t radiation4 ,^! p>ticles c travel a %ort di/ance 9 tissue2 if l>ge quantities are involv$1 !y c produce damage to ! basal /ratum ( ! sk94 ,! lesion produc$ is simil> to a !rmal burn 7call$ a beta burn74 c4 ,gamma rays1 emitt$ dur+ ! nucle> detonation & 9 fall\t1 are un*>g$ radiation simil> to ,x rays4 ,!y are highly en]getic & pass ?r\gh matt] easily4 ,because ( its high p5etrability1 radiation c be di/ribut$ ?r\gh\t ! body1 result+ 9 :ole body exposure4 d4 ,neutrons1 l gamma rays1 are un*>g$1 are only emitt$ dur+ ! nucle> detonation1 & are n a fall\t haz>d4 ,h[ev]1 neutrons h significant mass & int]act ) ! nuclei ( atoms1 sev]ely disrupt+ atomic /ructures4 ,comp>$ to gamma rays1 !y c cause #bj times m damage to tissue4 e4 ,:5 radiation int]acts ) atoms1 en]gy is deposit$ result+ 9 ionization 7electron excitation74 ,?is ionization may involve c]ta9 critical molecules or /ructures 9 a cell1 produc+ its *>act]i/ic damage4 ,two modes ( action 9 ! cell are direct & indirect action4 ,! radiation may directly hit a p>ticul>ly s5sitive atom or molecule 9 ! cell4 ,! damage f ?is is irrep>able2 ! cell ei!r dies or is caus$ to malfunction4 ,! radiation c also damage a cell indirectly by int]act+ ) wat] molecules 9 ! body4 ,! en]gy deposit$ 9 ! wat] leads to ! creation ( toxic molecules2 ! damage is transf]r$ to & affects s5sitive molecules ?r\gh ?is toxicity4 f4 ,! mo/ radios5sitive organ sy/ems 9 ! body are ! male reproductive1 ! hematopoietic1 & ! ga/ro9te/9al sy/ems4 ,! relative s5sitivity ( an organ to direct radiation injury dep5ds ^u its compon5t tissue s5sitivities4 ,cellul> effects ( radiation1 :e!r due to direct or indirect damage1 are basically ! same = ! diff]5t k9ds & doses ( radiation4 ,! simple/ effect is cell dea?4 ,) ?is effect1 ! cell is no long] pres5t to reproduce & p]=m its prim>y function4 ,*anges 9 cellul> function c occur at l[] radiation doses ?an ^? t cause cell dea?4 ,*anges c include delays 9 phases ( ! mitotic cycle1 disrupt$ cell gr[?1 p]meability *anges1 & *anges 9 motility4 ,9 g5]al1 actively divid+ cells are mo/ s5sitive to radiation4 ,additionally1 radios5sitivity t5ds to v>y inv]sely ) ! degree ( diff]5tiation ( ! cell4 g4 ,pr$ict+ radiation effects is difficult because (t5 x is unkn[n :i* organs 7 expos$4 ,?us1 mo/ pr$ictions are bas$ on :ole body irradiation4 ,p>tial body & specific organ irradiation w occur due to %ield+ by equipm5t1 f fall\t p>ticles1 or f int]nal deposition4 ,dep5d+ ^u ! organ sy/em1 ! irradiation c be sev]e4 ,! sev]e radiation sickness result+ f ext]nal1 :ole body irradiation & its consequ5t organ effects is a prim>y m$ical conc]n4 ,! m$ian le?al dose 7,,ld7 ( radiation t w kill #ej p]c5t ( ! expos$ p]sons )9 a p]iod ( #fj days 7designat$ z ,,ld#ej_/fj7 is e/imat$ to be approximately #d4e gray 7,gy7 if appropriate m$ical c>e is n provid$ to ! casualties4 ,m$ical int]v5tion %\ld raise ?is figure to approximately #aj ,gy4 ,?is l>g] figure includes mo/ ( ! casualties :o w\ld be actually capable ( rea*+ m$ical c>e foll[+ a nucle> detonation1 & ne>ly all ^? :o c\ld be expos$ to a ,,rdd4 ,= acute effects ( s+le high dose rate exposures ( :ole-body irradiation to heal?y adults see ,table ,a-#i4 h4 ,recov]y ( a p>ticul> cell sy/em w occur if a suffici5t fraction ( a giv5 /em cell population rema9s aft] radiation injury & appropriate /imulation & protection are receiv$4 ,complete recov]y may appe> to occur2 h[ev]1 ! immune sy/em may repair incompletely ) consequ5t great] susceptibility to future insult f a v>iety ( ag5ts4 ,x is possible = late somatic effects to h a high] probability ( occurr+ because ( ! radiation damage4 ,efficacy ( bo? prior & future immunization 9 ?is gr\p is n adequately und]/ood4 i4 ,int]actions betwe5 radiological injury & *emical or biological ag5ts appe> to be syn]gi/ic4 ,insult by ^! ag5ts 9 radiologically injur$ p]sonnel1 ev5 9 individually subcl9ical dosages1 may result 9 significant cl9ical illness4 ,a-#f4 ,h&l+ & ,manag+ ,radiologically ,contam9at$ ,pati5ts a4 ,radiologically ,contam9at$ ,pati5ts4 ,p]sonnel f contam9at$ areas may h fall\t on _! sk9 & clo?+4 ,al?\gh ! individual w n be radioactive1 he may suff] radiation injury f ! contam9ation4 ,removal ( ! contam9ation %\ld be accompli%$ z soon z possible2 def9itely be=e admission into a clean treatm5t area4 ,! di/9ction mu/ be made betwe5 a radiation-injur$ soldi] & "o :o is radiologically contam9at$4 ,al?\gh p]sonnel may h receiv$ sub/antial radiation exposure1 ?is exposure alone does n result 9 ! individual be+ contam9at$4 ,contam9at$ p]sonnel d n pose a %ort-t]m haz>d to ! m$ical /aff1 r ! contam9ation is a haz>d to ! individuals' heal?4 ,h[ev]1 )\t pati5t decontam9ation1 m$ical p]sonnel may receive suffici5t exposure to create beta burns1 especially ) ext5d$ exposure4 b4 ,h&l+ ,radiologically ,contam9at$ ,pati5ts4 ,to prop]ly h&le radiologically contam9at$ p]sonnel1 m$ical p]sonnel mu/ fir/ detect ! contam9ation4 ,detectors t may be us$ are ! ,,an_/,,pdr#bg & ,,an_/,,vdr#b to monitor pati5ts = contam9ation4 ,g5]ally1 a read+ on ! met] twice ! curr5t backgr\nd read+ indicates t ! pati5t is contam9at$4 ,monitor+ is conduct$ :5 pot5tially contam9at$ p]sonnel arrive at ! ,,mtf4 ,?is monitor+ is conduct$ at ! ,,mtf's receiv+ po9t be=e admitt+ ! pati5t4 ,contam9at$ pati5ts mu/ be decontam9at$ be=e admission4 ,removal ( radiological contam9ation is less important ?an imm$iate lifesav+ treatm5t & provid+ ! be/ possible m$ical c>e4 ,lifesav+ c>e be=e decontam9ation is provid$ outside ! ,,mtf4 c4 ,decontam9ation4 ,remov+ all out] clo?+ & a brief wa%+ or bru%+ ( expos$ sk9 w r$uce #ie p]c5t ( contam9ation2 vigor\s ba?+ or %[]+ is unnecess>y4 ,see ,app5dix ,g = pati5t decontam9ation proc$ures4 d4 ,int]nal ,contam9ation4 ,int]nalization ( radioactive isotopes w prim>ily occur via inhalation1 +e/ion1 & contam9at$ w\nds4 ,ext5sive int]nal decontam9ation %\ld only be und]tak5 :5 individual dose e/imates indicate t ! individual w b5efit f ! proc$ures4 ,soldi]s :o we> _! protective mask w be adequately protect$ f inhalation & +e/ion ( radioactive p>ticulate matt]4 ,int]nal contam9ation is consid]$ a delay$ problem & does n influ5ce triage categories1 z does irradiation injury4 e4 ,treatm5t4 ,treatm5t proc$ures = radiation injuries are describ$ 9 ,,fm #d-jb4bhc1 ,,fm #h-i1 & ! ,,nato ,h&book1 ,em]g5cy ,w> ,surg]y4 ,appropriate m$ical int]v5tion & bone m>r[ resuscitation w prev5t mo/ dea?s second>y to irradiation & infection4 ,table ,a-#i4 ,acute ,cl9ical ,effects ( ,s+le ,high ,dose ,rate ,exposures ( ,:ole-body ,irradiation ( ,heal?y ,adults ,"p #a ---------------------------------------- ------ #j-ajj c,gy #ajj-ajjj c,gy ,,dose 7,,range7 7,,sub- 7,,suble?al ,,cl9ical ,,range7 ,,range7 ------------ #ajj-bjj c,gy ---------------------------------------- ----- ,,incid5ce ,,( ,,nausea ,,none #e-ej ,,vomit+ ----------------------------------- ,,"t ,,( ---- ,,approx ,,initial ,,onset #c-f ,,hrs ,,phase ----------------------------------- ,,duration ---- ,,less ,,?an #bd ,,hrs ----------------------------------- ,,combat ,,effect- #ajj #ajj ,,iv5ess ---------------------------------------- ----- ,,lat5t ,,duration ---- ,,m ,,?an ,,phase #b ,,weeks ---------------------------------------- ----- ,,signs ,,mod]ate ,,symptoms ,,none ,,leukop5ia ----------------------------------- ,,"t ,,( ,,onset ,,po/ ---- #b ,,weeks ,,or ,,second>y ,,exposure ,,m ,,phase ----------------------------------- ,,critical ,,p]iod ,,po/ ---- ,,none ,,exposure ----------------------------------- ,,organ ,,sy/em ,,none ,,responsible ---------------------------------------- ----- ,,hospital- ,,p]c5tage ,,none ,,less ,,?an #e ,,ization ----------------------------------- ,,duration ---- #de-fj ,,days ---------------------------------------- ------ ,,incid5ce ,,( ,,dea? ,,none ,,none ---------------------------------------- ------ ,,av]age ,,"t ,,( ,,dea? ---- ---- ---------------------------------------- ------ ,,reassurance ,,!rapy ,,none ,,hematologic ,,surveillance ---------------------------------------- ------ ,"p #b ---------------------------------------- ----------------------------- #ajj-ajjj c,gy 7,,suble?al ,,range7 ,,dose 7,,range7 ---------------------------------------- ------ #bjj-fjj c,gy #fjj-ajjj c,gy ---------------------------------------- ---------------------------- ,,incid5ce ,,( ,,nausea #ej-ajj #ge-ajj ,,vomit+ ---------------------------------------- ------------------ ,,"t ,,( ,,approx #b-d ,,hrs ,,approx #a-b ,,hrs ,,initial ,,onset ,,phase ---------------------------------------- ------------------ ,,duration ,,less ,,?an #bd ,,hrs ,,less ,,?an #dh ,,hrs ---------------------------------------- ------------------ ,,c ,,p]=m ,,r\t9e ,,c ,,p]=m ,,only ,,simple ,,combat ,,tasks4 ,,su/a9$ ,,r\t9e ,,tasks4 ,,significant ,,effect- ,,combat ,,or ,,comp>abl ,,incapacitation ,,9 ,,upp] ,,iv5ess ,,activities ,,hamp]$ ,,"p ,,( ,,range4 ,,la/s ,,m ,,= #f-bj ,,hrs4 ,,?an #bd ,,hrs4 ---------------------------------------- ---------------------------- ,,lat5t ,,duration ,,approx #g-ae ,,days ,,none ,,to ,,approx #g ,,days ,,phase ---------------------------------------- ---------------------------- ,,signs ,,sev]e ,,leukop5ia2 ,,purpura1 ,,hemorrhage2 ,,symptoms ,,infection2 ,,epilation ,,ab\t #cjj c,gy4 ---------------------------------------- ------------------ ,,"t ,,( ,,onset ,,po/ ,,sev]al ,,days ,,to #b ,,weeks ,,second>y ,,exposure ,,phase ---------------------------------------- ------------------- ,,critical ,,p]iod ,,po/ #d-f ,,weeks ,,exposure ---------------------------------------- ------------------- ,,organ ,,sy/em ,,hematopoietic ,,tissue ,,responsible ---------------------------------------- ---------------------------- ,,hospital- ,,p]c5tage #ij #ajj ,,ization ---------------------------------------- ------------------ ,,duration #fj-ij ,,days #ij-abj ,,days ---------------------------------------- ---------------------------- ,,incid5ce ,,( ,,dea? #j-hj #ij-ajj ---------------------------------------- ----------------------------- ,,av]age ,,"t ,,( ,,dea? #c ,,weeks ,,to #b ,,mon?s ---------------------------------------- ------------------------------ ,,!rapy ,,blood ,,transfusion1 ,,antibiotics ---------------------------------------- ------------------------------ ,"p #c ---------------------------------------- ----------------------------- ,,ov] #ajjj c,gy 7,,le?al ,,range7 ,,dose 7,,range7 ---------------------------------------- ------ #ajjj-cjjj c,gy ,,ov] #cjjj c,gy ---------------------------------------- ---------------------------- ,,incid5ce ,,( ,,nausea #ajj ,,vomit+ ---------------------------------------- ------------------- ,,"t ,,( ,,less ,,?an #a ,,hr ,,initial ,,onset ,,phase ---------------------------------------- ------------------ ,,duration ,,less ,,?an #dh ,,hrs ,,approx #dh ,,hrs ---------------------------------------- ------------------- ,,progressive ,,incapaci- ,,progressive ,,incapaci- ,,combat ,,tation ,,foll[+ ,,an ,,tation ,,foll[+ ,,an ,,effect- ,,e>ly ,,capability ,,= ,,e>ly ,,capability ,,= ,,iv5ess ,,int]mitt5t ,,h]oic ,,int]mitt5t ,,h]oic ,,response4 ,,response4 ---------------------------------------- ---------------------------- ,,lat5t ,,duration ,,none ,,to ,,approx #b ,,days ,,none ,,phase ---------------------------------------- ---------------------------- ,,signs ,,di>rhea2 ,,fev]2 ,,di/ur-,,convulsions2 ,,tremor ,,symptoms ,,bance ,,( ,,electrolyte ,,ataxia2 ,,le?>gy4 ,,balance4 ---------------------------------------- ------------------ ,,"t ,,( ,,onset ,,po/ #b-c ,,days ,,second>y ,,exposure ,,phase ---------------------------------------- ------------------ ,,critical ,,p]iod ,,po/ #e-ad ,,days #a-dh ,,hr ,,exposure ---------------------------------------- ------------------ ,,organ ,,sy/em ,,ga/ro9te/9al ,,tract ,,c5tral ,,n]v\s ,,sy/em ,,responsible ---------------------------------------- ---------------------------- ,,hospital- ,,p]c5tage #ajj #ajj ,,ization ---------------------------------------- ------------------ ,,duration #b ,,weeks #b ,,days ---------------------------------------- ---------------------------- ,,incid5ce ,,( ,,dea? #ij-ajj ---------------------------------------- ----------------------------- ,,av]age ,,"t ,,( ,,dea? #a-b ,,weeks #b ,,days ---------------------------------------- ----------------------------- ,,ma9t5ance ,,( ,,!rapy ,,electrolyte ,,balance ,,s$atives ---------------------------------------- ----------------------------- ,a-#g4 ,radiological ,pati5ts 9 ,/ability ,op]ations & ,support ,op]ations ,9 /ability op]ations & support op]ations1 high levels ( environm5tal contam9ation & ! use ( ,,rdd c cause radiological injury to p]sonnel at levels bel[ t necess>y to produce p]=mance decrem5t & traditional casualty /atus4 ,treatm5t & evacuation guidel9es w be 9 accordance ) comm& guidance4 ,individual physical dosimetry is ! mo/ exp$i5t measurem5t te*nique = ?is exposure 7see ,table ,a-#aj74 ,^! radiation injuries & effects may also be se5 9 w>2 especially1 f ho/ile =ces employm5t ( ,r,d,ds4 ,table ,a-#aj4 ,/ability ,op]ations & ,support ,op]ations3 ,radiation ,injuries & ,effects ( ,radiation ,exposure ( ,p]sonnel ,,radiation ,,total ,,/o*a/ic ,,risk ,,exposure ,,cumulative ,,long-,,t]m ,,m$ical ,,note ,,m$ical ,,actions ,,/atus ,,dose ,,heal? ,,effects ---------------------------------------- -------------------------------- #j #j4je c,gy ,,normal ,,risk4 ,,u ,,basel9e #bj ,,record ,,9 ,,exposure ,,lifetime ,,risk ,,( ,,record ,,if ,,normally ,,fatal ,,canc]4 ,,monitor$ ,,p]sonnel4 ---------------------------------------- -------------------------------- #a;,a #j4je ,,to ,,up ,,to #j4jd ,,none 7#j4jja ,sv ,,u ,,record ,,z ,,hi/ory ,,9 #j4e c,gy ,,increas$ ,,annual ,,g54 ,,pop4 ,,m$ical ,,record-- ,,risk ,,lifetime ,,exposure ,,limit47 ,,tactical ,,op]ation ,,fatal ,,canc]4 ,,exposure4 ---------------------------------------- -------------------------------- #a;,b #j4e ,,to #e c,gy ,,u ,,radiation ,,reassurance ,,record ,,9 ,,m$ical ,,occupational 7#j4je ,sv ,,u ,,record-- ,,risk4 ,,annual ,,tactical ,,op]ation #j4jd-j4d ,,occupational ,,exposure4 ,,increas$ ,,risk ,,limit47 ,,lifetime ,,canc]4 ---------------------------------------- -------------------------------- #a;,c #e ,,to #aj c,gy #j4d-j4h ,,c\nsel ,,reg>d+ ,,record ,,9 ,,m$ical ,,increas$ ,,risk ,,increas$ ,,long- ,,record-- ,,lifetime ,,fatal ,,t]m ,,risk4 ,,tactical ,,op]ation ,,canc]4 ,,no ,,live ,,virus ,,exposure4 ,,vacc9es ,x #c ,,mon?s4 ---------------------------------------- -------------------------------- #a;,d #aj ,,to #be c,gy #j4h-b ,,pot5tial ,,= ,,inc- ,,record ,,9 ,,m$ical ,,increas$ ,,risk ,,reas$ ,,morbidity ,,record-- ,,lifetime ,,fatal ,,( ,,o!r ,,injuries ,,tactical ,,op]ation ,,canc]4 ,,or ,,incid5tal ,,exposure4 ,,consid] ,,disease4 #b ,,r\t9e ,,evacuation ,,increas$ ,,lifetime ,,f ,,!at] ,,iaw ,,risk ,,( ,,fatal ,,comm&]',s ,,op]- ,,canc]4 ,,ational ,,guidance4 ---------------------------------------- -------------------------------- #a;,e #be ,,to #ge c,gy #b-e4f ,,increas$ ,,morbidity ,,record ,,9 ,,m$ical ,,increas$ ,,risk ,,( ,,o!r ,,injuries ,,record-- ,,lifetime ,,fatal ,,or ,,incid5tal ,,tactical ,,op]ation ,,canc]4 ,,disease4 #f ,,exposure4 ,,consid] ,,increas$ ,,lifetime ,,exp$it$ ,,evacu- ,,risk ,,( ,,fatal ,,ation ,,f ,,!at] ,,canc]4 ,,iaw ,,comm&]',s ,,op]ational ,,guidance4 ,a-#h4 ,effects ( ,biological ,weapons ,biological w>f>e is ! int5tional use1 by an enemy1 ( live ag5ts or tox9s to cause dea? & disease among p]sonnel1 animals1 & plants1 or to det]iorate mat]iel4 a4 ,live ,ag5ts4 7#a7 ,live ag5ts are liv+ organisms l viruses1 bact]ia1 & fungi4 ,!y c be deliv]$ directly 7artill]y or aircraft spray71 or ?r\gh a vector su* z a flea or tick4 ,advances 9 mod]n weaponiz+ ( biological ag5ts h become easi]4 7#b7 ,= "s ag5ts1 only a few organisms are ne$$ to cause infection4 ,live ag5ts are small & light2 !y c be spread great di/ances by ! w9d & contam9ate unfilt]$ or nonairtight places4 7#c7 ,a]osoliz$ p>ticles ( #a to #e micron 77 size c>ry+ live ag5ts are small & light4 ,!y require "t aft] !y are +e/$ to multiply en\gh to ov]come ! body's def5ses4 ,?is incubation p]iod may v>y f h\rs to days or weeks dep5d+ on ! type ( organism4 ,?us1 to be effective1 a live ag5t attack w\ld ne$ to be laun*$ well 9 advance ( a tactical assault4 7#d7 ,^! ag5ts are s5sitive to environm5tal conditions 7= example humidity & sunlight74 ,_m bact]ial ag5ts w n survive outside ! ho/ organism 7human & animals74 7#e7 ,live ag5ts are n detectable by any ( ! five physical s5ses2 usually ! fir/ indication ( a biological attack is ! ill p]sonnel4 ,! diseases caus$ by live ag5ts may be difficult to control :5 ! a]osol attack is direct$ aga9/ a l>ge population4 ,"s diseases may be transmitt$ f p]son-to-p]son aft] ! initial attack2 examples include plague1 smallpox1 & "s viral hemorrhagic fev]s4 7#f7 ,because ( _! incubation p]iod & life cycle1 likely areas = live ag5t use are 9 ! combat s]vice support 7,,css7 area2 b attacks 9 =w>d areas _c be rul$ out4 b4 ,spore ,=m+ ,biological ,ag5ts4 ,spore =m]s su* z an?rax c survive = an ext5d$ "t1 ev5 "u v adv]se environm5tal conditions 7dry1 extremes ( temp]atures1 & flood+74 ,once inhal$1 +e/$1 or inject$ into ! human body1 ! spores g]m9ate & produce ! illness4 c4 ,tox9s4 7#a7 ,tox9s are by-products 7poisons7 produc$ by plants1 animals1 or microorganisms4 ,x is ! poisons t h>m man1 n ! organisms t make ! tox9s4 ,9 ! pa/1 ! only way to deliv] tox9s on a l>ge scale 0 by us+ ! organism4 ,) today's te*nology l>ge quantities ( _m tox9s c be produc$2 ?us1 !y c be deliv]$ )\t ! accompany+ organism4 7#b7 ,tox9s h sev]al desirable traits4 ,!y are poison\s comp\nds t d n gr[1 reproduce1 or die aft] !y h be5 disp]s$2 !y are m easily controll$ ?an live organisms4 ,field monitors capable ( provid+ prompt w>n+ ( a tox9 attack are n available2 !re=e1 p]sonnel mu/ le>n to quickly recognize signs ( attack1 su* z obs]v+ unexpla9$ symptoms ( victims4 ,tox9s produce effects simil> to ^? caus$ by *emical ag5ts2 h[ev]1 ! victims w n respond to ! fir/-aid measures t "w aga9/ *emical ag5ts4 ,unlike live ag5ts1 mycotox9s 7,t#b7 c p5etrate intact sk92 o!r tox9s _c4 ,because ! effects on ! body are direct1 ! symptoms ( an attack may appe> v rapidly4 ,! pot5cy ( mo/ tox9s is su* t v small doses w cause injuries &_/or dea?4 ,?us1 _! use by an enemy may be an alt]native to *emical ag5ts because x all[s ! use ( few] res\rces to cov] ! same or a l>g] area4 ,slight exposure at ! edges ( an attack area may produce sev]e symptoms or dea? f exposure to tox9s because ( _! extreme toxicity4 ,le?al or injury d[nw9d haz>d zones = tox9s may be f> great] ?an ^? ( ,,cw ag5ts4 ,a-#i4 ,behavior ( ,biological ,weapons ,biological ag5ts c be dissem9at$ 9 a spectrum ( physical /ates4 ,!y may be liv+ microorganisms or spore =ms ( ! organism4 ,see ,table ,a-#aa = /ability ( v>i\s biological ag5ts4 ,!y may be spread by-- ,ar?ropods4 ,contact ) infect$ animals4 ,contam9ation ( food & wat]4 ,a]osol1 liquid1 or solid disp]sion4 ,! only requirem5t is t !y mu/ be /able en\gh to survive transport & dissem9ation4 ,! toxicity ( biological ag5ts is n ! same = ev]yone2 ea* individual does n react exactly ! same way to ! same am\nt ( an ag5t4 ,"s are m resi/ive ?an o!rs because ( race1 sex1 age1 or o!r factors4 ,! dose is ! quantity ( a biological ag5t receiv$ by ! subject4 ,! p5etration ( ag5ts by v>i\s r\tes ne$ n be accompani$ by irritation or damage to ! absorb5t surface4 ,!re are (t5 unique signs & id5tify+ symptoms dep5d+ on entry r\te 7inhalation1 +e/ion1 or d]mal74 a4 ,biological ag5ts disp]s$ by spray (t5 ent] ! body ?r\gh ! respiratory tract 7inhalation injury74 ,! ag5t may be absorb$ by any "p ( ! respiratory tract f ! mucosa ( ! nose & m\? to ! alveoli ( ! lungs4 b4 ,liquid droplets & 7less commonly7 solids may be absorb$ f ! surface ( ! sk91 dige/ive tract1 & muc\s membranes4 ,ag5ts p5etrat+ ! sk9 may =m tempor>y res]voirs "u ! sk94 c4 ,contam9at$ food & wat] c produce casualties :5 +e/$4 ,table ,a-#aa4 ,types & ,*>act]i/ics ( ,"s ,biological ,ag5ts ,,entrance ,,type ,,( ,,ag5t ,,/ability ,,incubation ,,"t ,,a]osol ,,nona]osol ---------------------------------------- --------------------------------- ,,an?rax ,,high ,,h\rs ,,to #g ,,days ,,inhalation ,,sk91 ,,m\? ---------------------------------------- --------------------------------- ,,botul9um ,,tox9 ,,high #bd ,,to #cf ,,h\rs ,,inhalation ,,m\?1 ,,w\nd ---------------------------------------- --------------------------------- ,,brucellosis ,,high ,,9 #a ,,to #d ,,weeks ,,inhalation ,,m\?1 ,,sk91 ,,wet ,,env- ,,eyes ,,ironm5t ---------------------------------------- --------------------------------- ,,*ol]a ,,mod]ate ,,h\rs ,,to #e ,,days ,,m\? ---------------------------------------- --------------------------------- ,,plague7,,pneumonic7 ,,l[ #b ,,to #d ,,days ,,inhalation ---------------------------------------- --------------------------------- ,,plague 7,,bubonic7 ,,mod]ate #b ,,to #aj ,,days ,,bite ,,( ,,vector ---------------------------------------- --------------------------------- ,,ric9 ,,high #cf ,,h\rs ,,inhalation ,,m\? ---------------------------------------- --------------------------------- ,,smallpox ,,high #g ,,to #ag ,,days ,,inhalation ,,lesion ,,contact ---------------------------------------- --------------------------------- ,,/aphylococcal ,,high #a ,,to #f ,,h\rs ,,inhalation ,,m\? ,,ent]otox9 ,b ---------------------------------------- --------------------------------- ,,tri*o!c5e ,,high ,,m9utes ,,to ,,h\rs ,,inhalation ,,m\?1 ,,sk9 ,,mycotox9 ---------------------------------------- --------------------------------- ,,tul>emia ,,l[ #b ,,to #aj ,,days ,,inhalation ,,m\?1 ,,sk91 ,,bite ,,( ,,vector ---------------------------------------- --------------------------------- ,,v5ezuelan ,,equ9e ,,mod]ate #a ,,to #f ,,days ,,inhalation ,,bite ,,( ,,vectors ,,encephalitis ---------------------------------------- --------------------------------- ,,viral ,,hemorrhagic ,,l[ ,,days ,,to ,,mon?s ,,inhalation ,,bite ,,( ,,vectors ,,fev]s ,a-#aj4 ,managem5t ( ,biological ,w>f>e ,pati5ts a4 ,managem5t4 ,managem5t ( pati5ts suff]+ f ! effects ( ,,bw ag5ts may include ! ne$ = isolation4 ,b>ri] nurs+ = pati5ts suspect$ ( suff]+ f exposure to ,,bw ag5ts w r$uce ! possibility ( spread+ ! disease to heal? c>e provid]s & o!r pati5ts4 ,specim5s mu/ be collect$ & submitt$ to ! designat$ support+ laboratory = id5tification4 ,= details on hospital infection control aspects ( manag+ ,,bw casualties1 see ,,fm #h-bhd4 b4 ,mass ,casualty4 ,a ,,bw ag5t attack c produce a mass casualty situation at all levels ( ,,hss4 ,a major problem ) a ,,bw mass casualty situation is t ,,hss p]sonnel are m susceptible to becom+ a casualty to ,,bw ag5ts4 ,also1 ! ill pati5t may be ! fir/ indicator t a ,,bw ag5t has be5 disp]s$4 c4 ,decontam9ation4 ,decontam9ation is an individual & unit responsibility4 ,h[ev]1 "s individuals may arrive at ! ,,mtf t h n be5 decontam9at$ or t become contam9at$ en r\te to ! ,,mtf4 ,^! individuals mu/ be decontam9at$ at ! ,,mtf be=e !y are admitt$ to prev5t contam9ation ( ! ,,mtf & exposure ( m$ical p]sonnel to ! biological ag5t4 ,see ,app5dix ,g = details on pati5t decontam9ation4 d4 ,treatm5t4 ,specific treatm5t is dep5d5t ^u ! ,,bw ag5t us$4 ,pati5ts are treat$ = symptomatic pres5tation unless ! ,,bw ag5t id5tity is kn[n4 ,field ,manuals #h-i & #h-bhd provide detail$ in=mation on m$ical managem5t & treatm5t4 ,a-#aa4 ,effects ( ,*emical ,weapons a4 ,a *emical ag5t is a *emical t is us$ to kill1 s]i\sly injure1 or incapacitate man because ( its physiological effects4 ,!y c be dissem9at$ by artill]y1 aircraft1 rocket1 or by nonconv5tional means us$ by t]rori/s4 ,:5 fir/ employ$ 9 combat dur+ ,_w ,w> ,i1 ! *emical weapon 7*lor9e7 0 s effective t ! attack+ ,g]mans 7 n prep>$ to exploit ! success4 b4 ,*emical ag5ts are v effective weapons aga9/ poorly tra9$ & equipp$ =ces2 h[ev]1 !y are less effective aga9/ well-tra9$ =ces4 ,a-#ab4 ,behavior ( ,*emical ,weapons ,*emical ag5ts c be dissem9at$ z a gas1 vapor1 or a]osol "u ambi5t conditions4 ,!y h a range ( odors v>y+ f none to highly pung5t *>act]i/ics4 ,_! /ability is dep5d5t ^u ! environm5tal conditions 9 ! area ( employm5t4 ,see ,table ,a-#aa = p]si/5cy ( v>i\s *emical ag5ts4 a4 ,! toxicity ( a *emical ag5t is n ! same = ev]yone2 ea* individual does n react exactly ! same way to ! same am\nt ( an ag5t4 ,"s are m resi/ant ?an o!rs because ( physiological factors4 ,! dose is ! quantity ( a *emical receiv$ by ! individual = p]cutane\s or oral doses & z a "t-weight$ conc5tration1 milligrams-m9ute 7m#c71 = inhalation4 ,x is usually express$ z milligrams ( ag5t p] kilogram ( subject body weight 7mg_/kg74 ,! ,,ld#ej is ! dose t kills #ej p]c5t ( ! expos$ population4 ,! incapacitation dose #ej 7,,id#ej7 is ! incapacitation dose = #ej p]c5t ( ! expos$ subjects4 ,! p5etration ( ag5ts by v>i\s r\tes ne$ n be accompani$ by irritation or delay$ sup]ficial damage to ! absorb5t surface1 b !re are (t5 unique signs & symptoms id5tifiable by ! r\te ( entry4 7#a7 ,gase\s1 vapor1 & a]osol *emical ag5ts (t5 ent] ! body ?r\gh ! respiratory tract 7inhalation injury74 ,! ag5t may be absorb$ by any "p ( ! respiratory tract f ! mucosa ( ! nose & m\? to ! alveoli ( ! lungs4 ,a]osol p>ticles l>g] ?an #e t5d to be reta9$ 9 ! upp] respiratory tract2 p>ticles 9 ! #a to #e range are reta9$ 9 ! deep volume ( ! lungs2 :ile ^? bel[ #a t5d to be brea!d 9 & out aga92 al?\gh a few are reta9$ 9 ! deep volume ( ! lungs4 7#b7 ,vapors & droplets ( liquids c be absorb$ f ! surface ( ! sk9 & muc\s membranes4 ,toxic comp\nds t are h>mful to ! sk9 c produce _! effects 9 liquid or solid /ate4 ,ag5ts p5etrat+ ! sk9 may =m tempor>y res]voirs "u ! sk92 ! vapors ( "s volatile liquids c p5etrate ! sk9 & cause intoxication4 ,additionally1 w\nds & abrasions may pres5t areas t are m p]meable ?an intact sk94 b4 ,*emical ag5ts may be divid$ into two ma9 categories 7p]si/5t & nonp]si/5t7 t describe h[ long !y are capable ( produc+ casualties4 ,table ,a-#ab li/s ! common *emical ag5ts1 _! effects & "t ( effectiv5ess4 ,table ,a-#ac li/s ! types & *>act]i/ics ( common *emical ag5ts4 7#a7 ,p]si/5t ag5ts cont9ue to pres5t a haz>d = consid]able p]iods 7days7 aft] deliv]y by rema9+ z a contact haz>d1 or by sl[ly vaporiz+ to produce a haz>d by inhalation4 7#b7 ,nonp]si/5t ag5ts disp]se rapidly aft] release & pres5t an imm$iate1 %ort duration 7h\rs7 haz>d4 ,!y are releas$ z airborne p>ticles1 a]osols1 & gases4 ,table ,a-#ab4 ,common ,*emical ,w>f>e ,ag5ts ,,common ,,"n ,,effect ,,"t ,,to ,,effect ---------------------------------------- --------------------------------- ,,tabun 7,,ga7 ,,inhalation3 ,,seconds ,,to ,,m9utes ,,s>9 7,,gb7 ,,le?al ,,n]ve ,,ag5ts ,,topical3 ,,m9utes ,,soman 7,,gd7 ,,+e/ion3 ,,m9utes ,,to ,,h\rs ,v-,,ag5ts ---------------------------------------- --------------------------------- ,,hydrog5 ,,cyanide ,,le?al ,,blood ,,ag5t ,,m9utes ---------------------------------------- --------------------------------- ,,mu/>d ,,bli/] ,,ag5ts #a ,,to #ab ,,m9utes ,,lewisite ,,m9utes ---------------------------------------- --------------------------------- ,,lsd ,,& ,,bz ,,incapacitat+ ,,ag5ts #ae ,,to #fj ,,m9utes ---------------------------------------- --------------------------------- ,,phosg5e ,,lung-,,damag+ 7,,*ok+7 ,,m9utes ,,*lor9e ,,seconds ,,to ,,m9utes ,table ,a-#ac4 ,types & ,*>act]i/ics ( ,*emical ,ag5ts ,"p #a ,,type ,,( ,,p]si/5ce ,,rate ,,( ,,ag5t ,,symbol ,,summ] ,,w9t] ,,action ---------------------------------------- ------------------------ ,,ga1 ,,gb1 ,,gd #aj ,,m9-#bd ,,hr #b ,,hr-#c ,,days ,,v ,,quick ,,n]ve ---------------------------------------- --------------- ,,vx #b ,,days-#a ,,wk #b ,,days-,,weeks ,,quick ---------------------------------------- ------------------------ ,,*ok+ ,,cg1 ,,dp #a-aj ,,m9 #aj ,,m9-#a ,,hr ,,imm$iate ---------------------------------------- ------------------------ ,,hd1 ,,hn #c ,,days-#a ,,wk ,,weeks ,,sl[ ---------------------------------------- -------------- ,,bli/] ,l1 ,,hl #a-c ,,days ,,weeks ,,quick ---------------------------------------- -------------- ,,cx ,,days ,,days ,,v ,,quick ---------------------------------------- ------------------------ ,,blood ,,ac1 ,,ck #a-aj ,,m9 #aj ,,m9-#a ,,hr ,,v ,,quick ,"p #b ,,type ,,( ,,entrance ,,ag5t ,,symbol ,,vapor_/,,a]osol ,,liquid ---------------------------------------- ------------------------ ,,ga1 ,,gb1 ,,gd ,,eyes1 ,,lungs ,,eyes1 ,,sk91 ,,m\? ,,n]ve ---------------------------------------- --------------- ,,vx ,,eyes1 ,,lungs ,,eyes1 ,,sk91 ,,m\? ---------------------------------------- ------------------------ ,,*ok+ ,,cg1 ,,dp ,,lungs ,,eyes ---------------------------------------- ------------------------ ,,hd1 ,,hn ,,eyes1 ,,sk91 ,,lungs ,,eyes1 ,,sk9 ---------------------------------------- -------------- ,,bli/] ,l1 ,,hl ,,eyes1 ,,sk91 ,,lungs ,,eyes1 ,,sk91 ,,m\? ---------------------------------------- -------------- ,,cx ,,eyes1 ,,lungs1 ,,sk9 ,,eyes1 ,,sk91 ,,m\? ---------------------------------------- ------------------------ ,,blood ,,ac1 ,,ck ,,eyes1 ,,lungs ,,eyes1 ,,m\?1 ,,injur$ ,,sk9 ,a-#ac4 ,*>act]i/ics ( ,*emical ,ag5ts ,! effectiv5ess ( a *emical ag5t is a measure ( h[ mu* ag5t is requir$ to produce ! desir$ effect4 ,?us1 an ag5t t is toxic at a l[] dose ?an ano!r simil> ag5t is m effective4 ,besides dose requir$ = a giv5 effect1 p]si/5cy may be us$ to measure effectiv5ess4 ,p]si/5cy dep5ds on ! ag5t's physical *>act]i/ics1 ! am\nt ( ag5t deliv]$1 its physical /ate1 weapons sy/em us$1 ! t]ra91 & wea!r 9 ! t>get area4 ,! desir$ effects w det]m9e ! physical1 *emical1 & toxicological prop]ties ( ! *emical ag5t employ$4 a4 ,n]ve ag5ts are prim>ily organophosphorus e/]s simil> to insecticides4 ,^? ( milit>y importance are comb9$ "u ?is t]m4 ,al?\gh "s h be5 giv5 names1 !y are usually kn[n by _! code lett]s3 ,,ga2 ,,gb2 ,,gd2 & ,,vx4 ,!y are all liquids1 v>y+ 9 volatility t is 9 a range betwe5 gasol9e & heavy lubricat+ oil4 ,_! freez+ po9ts are -#dj degrees ,celsius or l[]4 7#a7 ,liquid n]ve ag5ts are pale yell[ to colorless & are almo/ odorless4 ,!y are mod]ately soluble 9 wat] & highly soluble 9 lipids 7oil74 ,!y are rapidly de/roy$ by /rong alkalies & *lor9at+ comp\nds4 ,normal clo?+ is readily p5etrat$ by liquid or vapor ag5ts4 ,butyl rubb] & syn!tic mat]ial are m resi/ant ?an natural fib]s4 ,ag5ts c p5etrate into nonabsorb5t mat]ial su* z web belts & c cont9ue to pres5t a haz>d by desorption 7(f-gass+7 ( ! vapor4 ,al?\gh local sweat+ & twit*+ may occur1 usually !re is no local irritant *ange aft] cutane\s exposure4 ,toxicity dep5ds ^u ! r\te ( entry & physical *>act]i/ics4 7#b7 ,n]ve ag5ts /rongly inhibit ! *ol9e/]ase enzymes4 ,:5 acetyl*ol9e is releas$ by ! n]ve junction1 x is hydrolyz$ by ! enzyme4 ,acetyl*ol9e is ! *emical m$iator = transmission ( ! n]ve impulses 9 num]\s synapses ( ! c5tral n]v\s sy/em 7,,cns7 & ! autonomic n]v\s sy/em & at ! end+s ( ! *ol9]gic n]ves 7= example3 affect+ ! smoo? muscles ( ! iris1 cili>y1 bron*ial tree1 & ga/ro9te/9al tract74 ,! inhibition ( *ol9e/]ase by n]ve ag5ts is almo/ irrev]sible1 s ! effects are prolong$4 ,until ! *ol9e/]ase level is re/or$ to normal1 !re is an increas$ susceptibility to n]ve ag5t exposure4 ,dur+ ?is "t1 ! effects ( repeat$ exposure are cumulative & ! pati5t may feel subp> 7= example3 tir$1 fatigue easily1 poor appetite1 impair$ conc5tration7 until recov]y is complete4 7#c7 ,n]ve ag5t poison+ is easily id5tifi$ by ! *>act]i/ic signs & symptoms z foll[s3 7a7 ,,mild symptoms 7self-aid74 ,casualties ) ,,mild symptoms may exp]i5ce mo/ or all ( ! foll[+3 ,unexpla9$ runny nose4 ,unexpla9$ sudd5 heada*e4 ,sudd5 drool+4 ,difficulty 9 see+ 7dimness ( vision7 7miosis74 ,tightness 9 ! *e/ or difficulty 9 brea?+4 ,localiz$ sweat+ & muscul> twit*+ 9 ! contam9at$ area4 ,/oma* cramps4 ,nausea4 7b7 ,casualties ) ,,mod]ate symptoms 7buddy aid7 w exp]i5ce an increase 9 ! sev]ity ( mo/ or all ( ! ,,mild symptoms4 ,especially prom95t w be an increase 9 fatigue1 weakness1 & muscle fasciculations4 ,! progress ( symptoms f ,,mild to ,,mod]ate indicates ei!r inadequate atrop9e treatm5t or cont9u+ exposure to ag5t4 7c7 ,,sev]e symptoms 7buddy aid74 ,casualties ) ,,sev]e symptoms may exp]i5ce mo/ or all ( ! ,,mild symptoms1 plus mo/ or all ( ! foll[+3 ,/range or confus$ behavior4 ,:eez+1 dyspnea 7sev]e difficulty 9 brea?+71 & c\gh+4 ,sev]ely p9po9t$ pupils4 ,r$ eyes ) te>+4 ,vomit+4 ,sev]e muscul> twit*+ & g5]al weakness4 ,involunt>y ur9ation & defecation4 ,convulsions4 ,unconsci\sness4 ,respiratory failure4 b4 ,!re are ?ree major families ( bli/] ag5ts 7vesicants72 ,,hd & ,,hn1 ,l1 & ,,cx4 ,mo/ vesicants 7except ,,cx7 are relatively p]si/5t4 ,mu/>ds c modify ! /ructure ( nucleic acids1 cellul> membranes1 & prote9s by comb9+ ) c]ta9 functional gr\ps 7p>ticul>ly ! sulfhydryl-conta9+ enzymes7 = :i* !y h an aff9ity4 7#a7 ,! cutane\s syndrome is divid$ into f\r phases3 lat5t1 ery!ma1 vesication1 & necrosis4 ,vesicants c p5etrate ! sk9 by contact ) ei!r liquid or vapor4 ,! lat5t p]iod is *>act]i/ic ( ! ag5t4 ,= mu/>ds x is usually sev]al h\rs1 = ,l x is %ort1 & = ,,cx x is negligible4 ,! lat5t p]iod is also affect$ by ! dose1 temp]ature1 & humidity4 ,! symptoms ( ! ery!ma phase are r$1 pa9ful it*+ foll[$ by pa9ful necrosis t heals sl[ly4 7#b7 ,9 ! eyes1 vesicants produce int5se pa9 & photophobia4 ,bli/]+ ( ! eyelids & muc\s membranes c result 9 tempor>y bl9dness4 ,ev5 aft] recov]y1 sc>s on ! cornea c r$uce visual acuity4 7#c7 ,9 ! respiratory tract1 ^! ag5ts attack ! muc\s membranes irritat+ !m4 ,!y c p>alyze vocal *ords & c lead to *emical pneumonitis1 or possibly dea?4 7#d7 ,al?\gh bli/] ag5ts c affect o!r organs & produce delet]i\s effects1 ! sk91 eyes1 & respiratory tract are ! pr9ciple organs effect$4 c4 ,*emical ag5ts t attack lung tissue 7*ok+ ag5ts7 & cause pulmon>y edema are class$ z lung damag+ ag5ts4 ,*ok+ ag5ts consi/ ( ,,cg & ,,dp1 ,,cl1 & ,,ps4 ,phosg5e is typical ( ! lung-damag+ ag5ts2 x is us$ z ! example "h4 7#a7 ,phosg5e is a colorless gas t has an odor resembl+ new m[n hay4 ,al?\gh effects are prim>ily conf9$ to ! lungs1 phosg5e may also cause mild irritation ( ! eyes & upp] respiratory tract4 ,phosg5e causes a %ift 9 ! membrane pot5tial ( ! alveoli all[+ ! passage ( fluid into ! alveoli1 result+ 9 massive pulmon>y edema & sev]ely impair+ ! ex*ange ( oxyg5 7,o#b7 & c>bon dioxide 7,,co#b7 betwe5 ! capill>y blood & ! alveol> air4 7#b7 ,initially hypoxemia occurs & is foll[$ %ortly by hyp]v5tilation :5 ! fro?y edema fluid fills ! bron*ioli & ,,co#b expiration /ops4 7#c7 ,signs & symptoms dur+ & imm$iately foll[+ exposure are c\gh+1 tightness ( *e/1 nausea1 occasionally vomit+1 heada*e1 & lacrimation 7te>+74 d4 ,blood ag5ts consi/ ( ,,ac & ,,ck2 bo? are readily absorb$ by ! muc\s membranes & ! intact sk94 ,! odor ( ,,ac resembles bitt] almonds1 b _m p _c detect x4 ,detect+ ! odor ( ,,ck is difficult because ( its irritat+ & lacrimatory effects4 ,x is also poorly absorb$ by ! metallic salt-impregnat$ *>coal filt]s 9 ! protective mask4 ,^! ag5ts inhibit c]ta9 enzymes 7p>ticul>ly cyto*rome oxidase7 t are important = oxidation-r$uction 9 ! cells2 !re=e1 cell respiration is inhibit$ & oxyg5 c>ri$ by ! hemoglob9 is n consum$ caus+ ! v5\s blood to rema9 bright r$4 ,initial symptoms are *>act]iz$ by viol5t convulsions1 increas$ deep respiratory movem5ts1 foll[$ by cessation ( respiration )9 "o m9ute1 sl[+ ( he>t rate to dea?4 ,high conc5trations ex]t _! effects rapidly2 h[ev]1 if ! pati5t is /ill alive aft] ! cl\d has pass$1 he w probably recov] spontane\sly4 e4 ,incapacitat+ ag5ts are *emicals t produce a tempor>y disabl+ condition t p]si/s = h\rs to days aft] exposure to ! ag5t has ceas$ 7unlike t produc$ by riot control ag5ts74 ,:ile n requir$1 m$ical treatm5t produces a m rapid recov]y4 ,*>act]i/ics ( ^! ag5ts are t !y-- ,are highly pot5t & logi/ically feasible4 ,produce _! effects ma9ly by alt]+ or disrupt+ ! high] regulatory activity ( ! ,,cns4 ,produce effects t la/ = h\rs or days r ?an mom5t>y or fleet+4 ,d n s]i\sly endang] life1 except 9 exce$+ly high doses4 ,produce no p]man5t injury4 ,! two types likely to be enc\nt]$ are ,,cns depressants & ,,cns /imulants4 7#a7 ,c5tral n]v\s sy/em depressants are comp\nds t h a pr$om9ant effect ( depress+ or block+ ! activity ( ! ,,cns2 (t5 by int]f]+ ) ! transmission ( in=mation across synapses4 ,an example ( ?is type ( ag5t is ,,bz4 ,! action ( acetyl*ol9e1 bo? p]iph]ally & c5trally1 appe>s to be block$ by ,,bz4 ,l[ doses disrupt high] integrative functions ( memory1 problem solv+1 att5tion1 & compreh5sion4 ,high doses produce toxic delirium t de/roys ! ability to p]=m any milit>y task4 ,)9 ! ,,cns1 ,,bz seems to produce its effects 9 ! same way z atrop9e4 ,small doses cause sleep9ess & decreas$ al]tness ) elevat$ he>t rate1 dry sk9 & eyelids1 dr[s9ess1 increas$ pupil size1 & elevat$ sk9 temp]atures4 ,progressive intoxication is m>k$ by an inability to respond effectively to ! environm5t 7#d to #ab h\rs71 foll[$ by increas+ activity & r&om_/unpr$ictable behavior 7#ab to #if h\rs74 ,because ! pati5t _c sweat1 heat /ress becomes a problem4 7#b7 ,c5tral n]v\s sy/em /imulants are ag5ts t cause excessive n]v\s activity1 (t5 by boo/+ or facilitat+ transmission ( impulses across synapses4 ,! effect is to flood ! cortex & o!r high] regulatory c5t]s ) too mu* in=mation1 mak+ conc5tration difficult & caus+ indecisiv5ess & an inability to act4 ,^! include ,,lsd1 psilocyb91 & mescal9e4 ,intoxication %[s sympa!tic /imulation 7rapid he>t rate1 sweaty palms1 pupill> enl>gem5t1 & cold extremities7 & m5tal excitation 7n]v\sness1 trembl+1 anxiety1 & inability to relax or sleep72 feel+s ( t5sion1 exhil>ation1 height5$ aw>5ess1 p>anoid ideas1 & pr(\nd /ates ( t]ror may also occur4 ,a-#ad4 ,managem5t ( ,*emical ,ag5t ,pati5ts a4 ,managem5t4 ,movem5t ( *emical ag5t casualties c spread ! contam9ation to clean areas4 ,all casualties are decontam9at$ z f> =w>d z ! situation p]mits4 ,all pati5ts mu/ be decontam9at$ be=e !y are admitt$ into a clean ,,mtf4 ,! admission ( "o contam9at$ pati5t into an ,,mtf w contam9ate ! facility2 !reby r$uc+ its treatm5t capabilities4 b4 ,mass ,casualty4 ,a mass casualty situation is pres5t$ :5 *emical ag5ts are employ$4 ,additional ,,hss p]sonnel & equipm5t mu/ be provid$ 9 a %ort p]iod ( "t if ! level ( c>e is to be ma9ta9$4 ,treatm5t at f> =w>d ,m,t,fs is limit$ to life- or limb-sav+ c>e4 ,pati5ts t c survive evacuation to ! next level ( c>e are n treat$ at ! =w>d facility4 ,?is provides "t = treat+ ^? pati5ts t _c survive ! evacuation "t4 c4 ,decontam9ation4 ,decontam9ation is an individual & unit responsibility4 ,h[ev]1 "s individuals may arrive at ! ,,mtf t h n be5 decontam9at$ or t become contam9at$ en r\te to ! ,,mtf4 ,^! individuals mu/ be decontam9at$ at ! ,,mtf be=e !y are admitt$ to prev5t contam9ation ( ! ,,mtf & exposure ( m$ical p]sonnel to ! *emical4 ,see ,app5dix ,g = detail$ in=mation on pati5t decontam9ation proc$ures4 d4 ,treatm5t4 ,field ,manuals #h-i & #h-bhe provide treatm5t proc$ures = *emical ag5t pati5ts4 ,a-#ae4 ,managem5t ( ,toxic ,indu/rial ,mat]ial ,pati5ts a4 ,managem5t4 ,movem5t ( ,,tim casualties c spread ! contam9ation to clean areas4 ,all casualties are decontam9at$ z close to ! incid5t site z possible4 ,all pati5ts mu/ be decontam9at$ be=e !y are admitt$ into a clean ,,mtf4 ,! admission ( "o contam9at$ pati5t into an ,,mtf may contam9ate ! facility2 !reby r$uc+ its treatm5t capabilities4 b4 ,mass ,casualty4 ,a mass casualty situation is pres5t$ :5 ! numb] ( casualties exce$s ! capabilities ( m$ical p]sonnel at ! location to provide ne$$ c>e at ! incid5t site4 ,treatm5t at ! incid5t site is limit$ to life- or limb-sav+ c>e4 ,pati5ts t c survive are evacuat$ to ! ne>e/ ,,mtf ) a pati5t decontam9ation capability4 c4 ,decontam9ation4 ,decontam9ation is an individual & fir/ respond] responsibility4 ,h[ev]1 "s individuals t self evacuat$ or 7 evacuat$ due to ! mass casualty situation arrive at ! ,,mtf t h n be5 decontam9at$4 ,^! individuals mu/ be decontam9at$ at ! ,,mtf be=e !y are admitt$ to prev5t contam9ation ( ! ,,mtf & exposure ( unprotect$ m$ical p]sonnel & o!r pati5ts to ! ,,tim4 ,see ,,fm #h-ejj = detail$ in=mation on decontam9ation proc$ures = ,,tim contam9at$ casualties4 d4 ,treatm5t4 ,field ,manual #h-ejj provides treatm5t proc$ures = "s ,,tim casualties4 ,treatm5t = _m ,,tim casualties is ag5t specific & receiv+ ,m,t,fs mu/ be prep>$ = ^! ev5ts4 ,,example3 ,treatm5t = a casualty expos$ to toxic levels ( an inorganic phosphate pe/icide w\ld be treat$ 9 ! same mann] z a n]ve ag5t casualty except ! am\nt ( antidote = ! pe/icide poison$ casualty w be _m times great] ?an = ! n]ve ag5t casualty4 ,,app5dix ,b ,,sample_/,,specim5 ,,collection ,,& ,,managem5t ,section ,i4 ,,introduction ,b-#a4 ,g5]al a4 ,critical elem5ts = accuracy 9 analysis ( ,,nbc samples & physiological specim5s are correct collect+1 packag+1 h&l+1 & transport+ te*niques4 ,! quality ( any analytical evaluation is directly relat$ to ! quality ( ! sample_/specim5 & ! degree ( po/collection degradation t occurs prior to te/+4 ,heal? s]vice support p]sonnel collect & submit specim5s = suspect ,,nbc haz>ds_/ag5ts involv+ humans & animals4 ,*emical corps & o!r nonm$ical units collect & submit environm5tal 7air1 plant1 & soil7 samples = suspect ,,nbc haz>ds_/ag5ts4 ,prev5tive m$ic9e p]sonnel collect & submit wat] & ice samples = suspect ,,nbc haz>ds_/ag5ts4 ,vet]9>y p]sonnel collect & submit food samples1 su* z fruits & vegetables1 & specim5s f animals = suspect ,,nbc haz>ds_/ag5ts4 ,specim5s collect$ f pati5ts t are suspect ( be+ expos$ to a biological ag5t are =w>d$ to ! support+ m$ical laboratory 7su* z ! ,,taml1 ,,aml or ,,u ,navy ,=w>d ,deploy$ ,,pvntm$ ,unit7 = analysis4 b4 ,ess5tially all milit>y op]ations f w> to /ability op]ations & support op]ations may g5]ate m$ical laboratory te/+ requirem5ts4 ,ea* sc5>io1 geographical region1 population base1 & suspect ag5t w impact on ! type & am\nt ( samples_/specim5s requir$ & ! collection process4 ,dur+ all op]ations1 express p]mission is requir$ be=e collect+ specim5s f civilians because ( religi\s or sociological beliefs 9 _m cultures4 ,to obta9 su* specim5s )\t p]mission c\ld result 9 unnecess>y mission complications4 ,,notes #a4 ,! t]m sample ref]s to nonhuman & nonanimal orig94 ,! t]m specim5 ref]s to human & animal orig94 #b4 ,always consid] t *emical ag5ts may h be5 employ$4 ,*eck = *emical ag5ts be=e collect+ a biological sample_/specim54 ,*emical ag5ts c damage or de/roy biological ag5ts4 ,also1 *emical ag5ts n id5tifi$ 9 ! sample_/specim5 c pose a haz>d to receiv+ laboratory p]sonnel4 ,m>k all samples t are pot5tially contam9at$ ) *emical ag5ts z su*4 #c4 ,precautions %\ld be tak5 to protect ! sample_/specim5 collector f pot5tial ,,bw ag5ts2 at a m9imum1 respiratory protection & rubb] gloves mu/ be worn4 ,additional c>e mu/ be tak5 :5 collect+ samples_/specim5s to prev5t cross-contam9ation4 ,gloves mu/ be *ang$ or decontam9at$ betwe5 sample_/specim5 collections4 #d4 ,samples w n be deliv]$ to ! cl9ical laboratory ( an ,,mtf = analysis4 ,!y mu/ be deliv]$ to ! designat$ support+ m$ical laboratory = process+4 ,?is w prev5t accid5tally spread+ a biological ag5t 9 ! ,,mtf4 c4 ,coord9ation = foll[-on te/+ is absolutely critical to ! sample_/specim5 collection process4 d4 ,coord9ation ) ! receiv+ laboratory %\ld be made to e/abli% sample requirem5ts1 pref]r$ collection te*niques1 me?ods ( pres]vation1 & transportation conditions1 :5 ! tactical situation &_/or mission p]mits4 e4 ,! numb] ( m$ical specim5s t ne$ to be collect$ v>ies ) ! type ( analysis p]=m$ & ! impact ( ! values det]m9$4 ,! numb] & types ( control samples_/specim5s requir$ to validate te/ in=mation is det]m9$ by ! support+ m$ical laboratory p]sonnel4 ,r&om sampl+1 mat*$ ) control populations1 or o!r te*niques w be employ$ z ! requirem5ts are id5tifi$4 ,b-#b4 ,sample_/,specim5 ,backgr\nd ,in=mation a4 ,a complete hi/ory ( ! circum/ances ab\t ea* sample's_/specim5's acquisition mu/ be provid$ to ! ag5cy conduct+ ! analysis4 b4 ,critical in=mation includes1 b is n limit$ to-- ,meteorological conditions4 ,describe :at ! meteorological conditions 7 at ! "t ( ! alleg$ attack & at ! "t ( ! sampl+4 ,attack to collection "t4 ,/ate ! l5g? ( "t aft] alleg$ attack :5 sample_/specim5 0 tak54 ,circum/ances ( acquisition4 ,describe h[ ! sample_/specim5 0 obta9$ & ! s\rce ( ! sample_/specim54 ,physical description4 ,describe ! physical /ate ( ! sample_/specim5 7solid1 liquid1 p[d]1 app>5t viscosity71 color1 approximate size1 id5tity ( ! sample_/specim5 7t is1 dirt1 leaves1 blood1 tissue71 & dose rate 7if radiologically contam9at$74 ,circum/ances ( ! ag5t deposition4 ,describe ! type ( deliv]y sy/em1 a description ( h[ ! weapon function$1 h[ ! ag5t act$ on release1 s\nds he>d dur+ dissem9ation1 a description ( any crat]s or %rapnel f\nd associat$ ) ! bur/1 & colors ( smoke1 flames1 or mi/s t may be associat$ ) ! attack4 ,ag5t effects on vegetation4 ,describe ! g5]al area 7jungle1 m\nta91 grassl&7 & *anges 9 ! vegetation aft] ! ag5t deposition 7t is1 color *ange1 wilt+1 dry+1 dead7 9 ! ma9 attack & fr+e areas4 ,ag5t effects on humans4 ,h[ ! ag5t affect$ p]sonnel 9 ! ma9 attack area v]sus fr+e areas2 ! duration ( ag5t effects2 peculi> odors t may h be5 notic$ 9 ! area be=e1 dur+1 or aft] an attack2 measures tak5 t alleviat$ or wors5$ ! effects2 & ! approximate numb] ( victims & survivors 7include age & g5d]74 ,ag5t effects on animals4 ,describe h[ !y are affect$4 ,grid coord9ates or o!r descriptive in=mation on sample collection location4 ,b-#c4 ,sample_/,specim5 ,collection & ,pres]vation a4 ,ante mortem ,specim5s4 ,physiological specim5s f liv+ human or animal pati5ts c include j ab\t any conceivable body s\rce or excret$ by-product4 ,x mu/ be not$ t specim5 types are seldom int]*angeable2 ! exact type & am\nt ( specim5 requir$ = a specific assay mu/ be kn[n be=e a collection proc$ure is initiat$ 7see ,table ,b-#a74 ,pati5ts se5 9 an ,,mtf may be ! fir/ & 9 "s cases ! only s\rce = sampl+ = suspect biological ag5t release4 ,! prim>y m$ical c>e provid] w det]m9e ! level ( treatm5t = ^! pati5ts & ! specim5s requir$ = laboratory diagnosis4 ,! ,,mtf laboratory is n equipp$ to h&le biological ag5ts &1 !re=e1 specim5s g5]at$ w be =w>d$ to ! support+ m$ical laboratory = analysis4 ,pati5t disposition w be bas$ on evacuation policies1 exposure1 suspect ag5t1 cl9ical symptoms1 & requir$ treatm5t_/isolation4 ,blood specim5s repres5t ! mo/ common analytical sample4 ,c]ta9 te*niques & special c>e mu/ be ex]cis$ to ensure an acceptable specim5 is collect$ & to m9imize an adv]se affect to ! pati5t or specim5 collector4 ,9 g5]al1 phlebotomy requires ! use ( a #bj to #bb-;gauge ne$le to m9imize me*anical hemolysis dur+ aspiration us+ a syr+e or ,vacuta9],,tm tube collection sy/em4 ,blood collect$ ) a syr+e & ne$le %\ld be transf]r$ to an appropriate ,vacuta9],,tm tube imm$iately aft] collection4 ,! type ( tube1 type ( anticoagulant or pres]vative1 & am\nt ( blood collect$ w v>y ) ! specific assay reque/$4 ,unless "s special sample prep>ation /ep is requir$1 ! blood is be/ left 9 ! orig9al rubb]-/opp] tube = transport4 ,ur9e specim5s are be/ collect$ us+ a clean-cat* 7mid/ream1 if possible7 te*nique 9 a /]ile ur9e cup4 ,! volume ( sample requir$ w v>y dep5d+ on ! specific assay reque/$2 h[ev]1 #be to #ej ml is suffici5t = mo/ te/s4 ,tissue specim5s c orig9ate f any body s\rce accessible by scrap+1 swabb+1 or m9or excision4 ,tissue specim5s are collect$ only by m$ical tra9$ p]sonnel4 ,specific te*niques = collect+ ^! specim5s are n provid$ 9 ?is app5dix4 ,sputum specim5s are be/ collect$ us+ a /]ile cup4 ,! volume ( specim5 w normally be v small4 ,h[ev]1 a suffici5t quantity mu/ be collect$ to provide = 9-!at] te/+ & to provide = ,,conus laboratory te/+4 ,nasal swabs %\ld be collect$ us+ /]ile cotton-tipp$ swabs4 ,! swabs ) specim5 f ea* p]son %\ld be plac$ 9 a sep>ate /]ile conta9] to prev5t cross-contam9ation4 ,,note ,9 cases :]e ! support+ laboratory _c be contact$1 z a m9imum ! foll[+ specim5s %\ld be collect$3 ,ur9e--#be to #ej ml 9 a /]ile conta9]4 ,blood--two #g to #aj ml tubes )\t anticoagulant 7r$-/opp] ,vacuta9],,tm72 two #g to #aj ml tubes ) potassium or sodium e?yl5$iam9etetraacetate 7,,edta7 7lav5d]-/opp] ,vacuta9],,tm74 ,all specim5s 7reg>dless ( physiological s\rce7 mu/ be label$ to positively id5tify ! individual or animal f :om x 0 collect$2 at a m9imum1 ! individual's full "n1 unique p]sonal id5tification numb] 7social security numb]1 :5 possible71 milit>y unit & location1 & date & "t ( collection %\ld be writt5 on ! label ( ! specim5 conta9]4 ,all specim5s are collect$ us+ aseptic te*niques4 ,all specim5s are packag$1 h&l$1 & transport$ 9 a mann] t ensures !y arrive at ! f9al de/9ation laboratory 9 a te/able condition4 ,p]sonal protection guidel9es mu/ be adh]$ to :5 collect+ or process+ specim5s2 at a m9imum1 ?is includes gloves & a mask4 ,9 ! laboratory1 a g[n or o!r protective items may also ne$ to be us$4 ,9 ! field1 "u suspect ,,nbc conditions1 collectors %\ld be 9 ,,mopp ,level #d or inside ,,nbc-protect$ vehicles4 ,common s5se & ! cl9ical &_/or tactical situation w det]m9e ! ext5t ( p]sonal protection necess>y4 ,pres]vation ( specim5s1 ei!r *emically or me*anically 7cool+71 w be necess>y to m9imize ! am\nt ( analyte degradation t occurs aft] remov+ ! specim5 f its physiological micro5vironm5t4 ,! optimal pres]vation te*nique w v>y ) diff]5t laboratory te/s & mu/ be confirm$ = ea* reque/$ assay4 ,:ile freez+ may pres]ve "s s]um con/itu5ts1 freeze-?aw+ cycles may d5ature o!rs4 ,freez+ may also completely de/roy c]ta9 microorganisms4 ,?is caution also applies to tissue specim5s s9ce fix+ tissue ) a /&>d #aj p]c5t =mal9 solution w pres]ve tissue = special /a9+ te*niques2 h[ev]1 x r5d]s ! specim5s completely useless = microbiological culture4 ,always v]ify specim5 pres]vation requirem5ts = /orage & transport ) ! support+ m$ical laboratory be=e process+ ! specim54 ,ideally1 confirmation ( ! correct h&l+ conditions %\ld be coord9at$ be=e collection4 ,! importance ( coord9at+ sample_/specim5 collection ) ! support+ laboratory facility _c be ov]/at$4 ,contact ! receiv+ laboratory = in/ructions :5 d\bt exi/s ab\t ! appropriate s\rce1 collection te*nique1 /orage & pres]vation conditions 7su* z1 a]obic or ana]obic environm5t71 & transportation requirem5ts = samples_/specim5s4 ,extremely small volumes ( samples_/specim5s1 prop]ly collect$ & h&l$1 c yield a trem5d\s am\nt ( in=mation to assi/ 9 mak+ m$ical1 tactical1 & /rategic decisions4 ,conv]sely1 v l>ge quantities ( poorly collect$ & insuffici5tly pres]v$ samples_/specim5s are ess5tially wor?less = mo/ analytical te*niques4 ,analysis beyond intra!at] capabilities w be coord9at$ by ! support+ laboratory1 :5 deploy$1 or ?r\gh m$ical *annels 9 ! abs5ce ( an 9-!at] support+ laboratory4 b4 ,po/ mortem & ,=5sic ,specim5s4 ,! analysis ( specim5s f deceas$ humans & animals c provide valuable in=mation ab\t ! disease1 organisms1 injuries1 or environm5tal conditions at ! "t ( dea?4 ,?is in=mation c greatly enhance ! treatm5t ( o!rs affect$ by ! same1 or physiologically simil>1 process4 ,specim5 collection = po/ mortem or =5sic exam9ation is v important2 ! te*niques involv$ reflect a significant degree ( tra9+1 exp]i5ce1 & skill4 ,mo/ specim5s w be ( ! same type & size z = ante mortem specim5s1 b types & am\nts ( specim5s w be det]m9$ by ! collector4 7#a7 ,! collection ( specim5s f rema9s %\ld be conduct$ exclusively by a pa?ologi/1 or o!r p]sonnel specifically tra9$ 9 =5sic collection te*niques4 ,an exception is :5 ,special ,op]ations ,=ces 7,,s(7 p]sonnel are op]at+ "u radio sil5ce conditions2 ! mo/ qualifi$ m$ical p]son ) ! op]ation collects1 pres]ves1 & transports or coord9ates transport ( specim5s = evaluation4 ,! same *a9 ( cu/ody requirem5ts applies to specim5s collect$ by ,,s( p]sonnel1 z ) all o!r specim5s4 7#b7 ,a l>ge am\nt ( support in=mation c be ga9$ by analyz+ ! site ( injury & subsequ5t dea?4 ,?is site sc5e inve/igation requires a trem5d\s att5tion to detail & a tra9$ obs]v]4 ,if =5sic p]sonnel _c be contact$1 or w be unduly delay$ 9 arriv+ at ! sc5e1 !n photographs ( ! victim & ! imm$iate surr\nd+s %\ld be made4 ,! scope & ext5t ( ! photographs %\ld be compos$ to reflect z mu* detail z possible to assi/ =5sic p]sonnel 9 review+ ! sc5e retrospectively4 ,9 ! ev5t t photography is n feasible1 detail$ sket*es ( ! sc5e %\ld be made to assi/ ! =5sic inve/igation4 7#c7 ,te*niques su* z c>diac or bladd] puncture1 ne$le biopsy ( organs1 sp9al tap1 or exploratory lap>otomy w n be p]=m$ by untra9$ p]sonnel unless specifically reque/$ & direct$ by =5sic inve/igators4 ,table ,b-#a4 ,specim5 ,collection = ,suspect ,biological ,w>f>e ,ag5ts ,,e>ly ,,po/exposure ,,cl9ical ,,convalesc5t_/,,t]m9al_/,,po/mortem ---------------------------------------- -------------------------------- ,,an?rax #j ,,to #bd ,,h\rs4 #bd ,,to #gb ,,h\rs4 ,,nasal ,,& ,,?roat ,,swabs1 ,,& ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,tox9 ,,assays4 ,,induc$ ,,respiratory ,,secretions ,,blood 7,e1 ,c1 ,h7 ,,= ,,pcr4 ,,= ,,culture1 ,,fa1 ,,& ,,pcr4 ,,blood 7,,bc ,,or ,c7 ,,= ,,cultures4 #c ,,to #aj ,,days4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,tox9 ,,assays4 ,,blood 7,,bc ,,or ,c7 ,,= ,,culture4 ,,pa?ology ,,specim5s4 ---------------------------------------- -------------------------------- ,,plague #j ,,to #bd ,,h\rs4 #bd ,,to #gb ,,h\rs4 ,,nasal ,,swabs1 ,,sputum1 ,,& ,,blood 7,,bc ,,& ,c7 ,,= ,,culture ,,& ,,induc$ ,,respiratory ,,secretions ,,bloody ,,sputum 7,c7 ,,= ,,fa4 ,,s]um ,,= ,,culture1 ,,fa1 7,,tt ,,or ,,rt7 ,,= ,f-#a ,,antig5 ,,assays4 ,,& ,,pcr4 ,,blood 7,e1 ,c1 ,,or ,h7 ,,= ,,pcr4 #f ,,days4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,ig,m1 ,,lat] ,,= ,ig,g4 ,,pa?ology ,,specim5s4 ---------------------------------------- -------------------------------- ,,tul>emia #j ,,to #bd ,,h\rs4 #bd ,,to #gb ,,h\rs4 ,,nasal ,,swabs1 ,,sputum1 ,,& ,,blood 7,,bc ,,or ,c7 ,,= ,,culture4 ,,induc$ ,,respiratory ,,blood 7,e1 ,c1 ,,or ,h7 ,,= ,,pcr4 ,,secretions ,,= ,,culture1 ,,fa1 ,,sputum ,,= ,,fa ,,& ,,pcr4 ,,& ,,pcr4 #f ,,days4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,ig,m ,,& ,,lat] ,ig,g1 ,,agglut9ation ,,tit]s4 ,,pa?ology ,,specim5s4 ---------------------------------------- -------------------------------- ,,melioidosis_/,,gl&]s #j ,,to #bd ,,h\rs4 #bd ,,to #gb ,,h\rs4 ,,nasal ,,swabs1 ,,sputum1 ,,& ,,blood 7,,bc ,,or ,c7 ,,= ,,culture4 ,,induc$ ,,respiratory ,,blood 7,e1 ,c1 ,,or ,h7 ,,= ,,pcr4 ,,secretions ,,= ,,culture ,,& ,,sputum ,,& ,,dra9age ,,f ,,sk9 ,,pcr4 ,,lesions ,,= ,,pcr ,,& ,,culture4 #f ,,days4 ,,blood 7,,bc ,,or ,c7 ,,& ,,tissue ,,= ,,culture4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,immunoassays4 ,,pa?ology ,,specim5s4 ---------------------------------------- -------------------------------- ,,brucellosis #j ,,to #bd ,,h\rs4 #bd ,,to #gb ,,h\rs4 ,,nasal ,,swabs1 ,,sputum1 ,,& ,,blood 7,,bc ,,or ,c7 ,,= ,,culture4 ,,induc$ ,,respiratory ,,blood 7,e1 ,c1 ,,& ,h7 ,,= ,,pcr4 ,,secretions ,,= ,,culture ,,& #f ,,days4 ,,pcr4 ,,blood 7,,bc ,,or ,c7 ,,& ,,tissue ,,= ,,culture4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,immunoassays4 ,,pa?ology ,,specim5s4 ---------------------------------------- -------------------------------- ,q ,,fev] #j ,,to #bd ,,h\rs4 #b ,,to #e ,,days4 ,,nasal ,,swabs1 ,,sputum1 ,,& ,,blood 7,,bc ,,or ,c7 ,,= ,,culture ,,9 ,,eggs ,,induc$ ,,respiratory ,,or ,,m\se ,,inoculation4 ,,secretions ,,= ,,culture ,,& ,,blood 7,e1 ,c1 ,,& ,h7 ,,= ,,pcr4 ,,pcr4 #f ,,days4 ,,blood 7,,bc ,,or ,c7 ,,= ,,culture ,,9 ,,eggs ,,or ,,m\se ,,inoculation4 ,,pa?ology ,,specim5s4 ---------------------------------------- -------------------------------- ,,botulism #j ,,to #bd ,,h\rs4 #bd ,,to #gb ,,h\rs4 ,,nasal ,,swabs ,,& ,,induc$ ,,nasal ,,swabs ,,& ,,respiratory ,,respiratory ,,secretions ,,= ,,secretions ,,= ,,pcr 7,,contam9at+ ,,pcr 7,,contam9at+ ,,bact]ial ,,dna7 ,,& ,,tox9 ,,assays4 ,,bact]ial ,,dna7 ,,& ,,tox9 #f ,,days4 ,,assays4 ,,usually ,,no ,ig,m ,,or ,ig,g4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,tox9 ,,pa?ology ,,specim5s 7,,liv] ,,& ,,assays4 ,,sple5 ,,= ,,tox9 ,,detection74 ---------------------------------------- -------------------------------- ,,ric9 ,,intoxication #j ,,to #bd ,,h\rs4 #cf ,,to #dh ,,h\rs4 ,,nasal ,,swabs ,,& ,,induc$ ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,tox9 ,,respiratory ,,secretions ,,= ,,assay4 ,,pcr 7,,contam9at+ ,,ca/or ,,tissue ,,= ,,immunohi/ological ,,bean ,,dna7 ,,& ,,tox9 ,,assays4 ,,/a9+4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,tox9 ,,pa?ology ,,specim5s4 ,,assays4 #f ,,days4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,ig,m ,,& ,ig,g ,,9 ,,survivors4 ---------------------------------------- -------------------------------- ,,/aph ,,ent]otoxicosis #j ,,to #c ,,h\rs4 #b ,,to #f ,,h\rs4 ,,nasal ,,swabs ,,& ,,induc$ ,,ur9e ,,= ,,immunoassays4 ,,respiratory ,,secretions ,,= ,,nasal ,,swabs ,,& ,,induc$ ,,pcr 7,,contam9at+ ,,bact]ial ,,respiratory ,,secretions ,,= ,,dna7 ,,& ,,tox9 ,,assays4 ,,pcr 7,,contam9at+ ,,bact]ial ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,tox9 ,,dna7 ,,& ,,tox9 ,,assays4 ,,assays4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,tox9 ,,assays4 #f ,,days4 ,,s]um ,,= ,ig,m ,,& ,ig,g4 ---------------------------------------- -------------------------------- ,t-#b ,,toxicosis #j ,,to #bd ,,h\rs ,,po/exposure #a ,,to #e ,,days4 ,,nasal ,,& ,,?roat ,,swabs ,,& ,,s]um 7,,tt ,,or ,,rt7 ,,& ,,tissue ,,= ,,induc$ ,,respiratory ,,tox9 ,,detection4 ,,secretions ,,= ,,immunoassays1 #f ,,days ,,po/exposure4 ,,hplc_/,,mass ,,spectrometry4 ,,ur9e ,,= ,,detection ,,( ,,tox9 ,,metabolites4 ---------------------------------------- -------------------------------- ,,equ9e ,,encephalomyelitis 7,,vee1 ,,eee1 ,,& ,,wee ,,viruses7 #bd ,,to #gb ,,h\rs4 #j ,,to #bd ,,h\rs4 ,,s]um 7,,tt ,,or ,,rt7 ,,& ,,?roat ,,= ,,nasal ,,swabs ,,& ,,induc$ ,,culture4 ,,respiratory ,,secretions ,,= ,,s]um 7,e1 ,c1 ,h1 ,,tt1 ,,or ,,rt7 ,,= ,,rt-,,pcr ,,& ,,viral ,,culture4 ,,rt-,,pcr4 ,,?roat ,,swabs ,,up ,,to #e ,,days ,,= ,,culture ,,!n ,,csf4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,antig5 ,,elisa4 #f ,,days4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,ig,m4 ,,pa?ology ,,specim5s ,,plus ,,bra94 ---------------------------------------- -------------------------------- ,,pox 7,,smallpox ,,& ,,monkeypox7 #b ,,to #e ,,days4 #j ,,to #bd ,,h\rs4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,viral ,,nasal ,,swabs ,,& ,,induc$ ,,culture ,,respiratory ,,secretions ,,= #f ,,days4 ,,pcr ,,& ,,viral ,,culture4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,viral ,,culture ,,dra9age ,,f ,,sk9 ,,lesions_/ ,,scrap+s ,,= ,,microscopy1 ,,em1 ,,viral ,,culture1 ,,& ,,pcr4 ,,pa?ology ,,specim5s4 ---------------------------------------- -------------------------------- ,,ebola #j ,,to #bd ,,h\rs4 #b ,,to #e ,,days4 ,,nasal ,,swabs ,,& ,,induc$ ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,viral ,,respiratory ,,secretions ,,= ,,culture4 ,,rt-,,pcr ,,& ,,viral ,,culture4 #f ,,days4 ,,s]um 7,,tt ,,or ,,rt7 ,,= ,,viral ,,culture ,,pa?ology ,,specim5s ,,plus ,,adr5al ,,gl&4 ---------------------------------------- -------------------------------- ,,leg5d3 ,,bc ,blood culture ,c ,citrat$ blood ,,csf c]ebrosp9al fluid ,,dna deoxyribonucleic acid ,e ,,edta ,,eee ea/]n equ9e encephalitis ,,elisa enzyme-l9k$ immunosorb5t assay ,,em electron microscopy ,f-#a fraction-#a ,,fa fluoresc5t antibody ,h ,hep>9 ,,hplc high-pressure liquid *romatography ,ig,g immunoglobul9 class ,g ,ig,m immunoglobul9 class ,m ,,pcr polym]ase *a9 reaction ,,rt ,r$ ,top1 if ,,tt is n available ,,rt-,,pcr rev]se transcriptase_/polym]ase *a9 reaction ,,tt ,tig] top ,,vee ,v5ezuelan equ9e encephalitis ,,wee we/]n equ9e encephalitis c4 ,wat] ,sample ,collection4 7#a7 ,wat] samples = id5tification or v]ification ( biological ag5t contam9ation are collect$ by ,,pvntm$ p]sonnel4 ,! support+ laboratory %\ld provide guidance on sampl+ proc$ures & collect+ kits = use 9 collect+ ! samples4 ,9 ! abs5ce ( guidance1 a te*nique = use ( ! ,sep-,pak,,tm is describ$ 9 ,,fm #c-ai4 7#b7 ,:5 sampl+ kits are n available1 samples may be collect$ 9 o!r available /]ile conta9]s4 ,! be/ conta9]s = use are ! #ajj-ml glass bottles us$ = collect+ r\t9e wat] samples4 ,all wat] samples mu/ be collect$ & plac$ 9 a cool] or refrig]ator until ! sample is transport$ to its de/9ation4 ,dur+ transportation ! samples mu/ be ma9ta9$ at a temp]ature betwe5 #a;,c & #d;,c4 d4 ,food ,samples4 ,vet]9>y p]sonnel mu/ collect suspect biologically contam9at$ food samples = submission to ! support+ laboratory = 9-!at] v]ification ( contam9ation4 ,all food samples mu/ be collect$ & plac$ 9 /]ile conta9]s4 ,place ! samples 9 a cool] or refrig]ator until ! sample is transport$ to its de/9ation4 ,dur+ transportation ! samples mu/ be ma9ta9$ at a temp]ature betwe5 #a;,c & #d;,c4 e4 ,animal ,specim5s4 ,vet]9>y p]sonnel collect specim5s f suspect biologically contam9at$_/diseas$ animals4 ,! same types & am\nts ( specim5s are prep>$ & %ipp$ 9 ! same mann] z are human specim5s4 f4 ,environm5tal ,samples4 ,environm5tal samples are collect$ z direct$ 9 ! op]ators' manual or o!r publications = op]at+ collection sy/ems4 ,example3 ,! ,biological ,integrat$ ,detection ,sy/em 7,,bids7 collects an environm5tal sample us+ a s+le liquid sample collector4 ,! collector is a high-volume a]osol sampl+ & collection device4 ,on dem& x samples ambi5t air ?r\gh a two-/age virtual impactor t conc5trates a]osol p>ticles 9 ! #b to #aj micromet] diamet]-size range4 ,! conc5trate p>ticle /ream is direct$ ?r\gh a wet collector conta9+ a buff] solution &1 ov] a #de-m9ute p]iod1 a #dj to #ej ml sample is collect$4 ,on ord] or :5 te/ results indicate a suspect$ ag5t1 ! sample & associat$ docum5tation are packag$ & transport$ ,,iaw ,,fm #c-aja-d4 ,b-#d4 ,*a9 ( ,cu/ody a4 ,a /rict *a9 ( cu/ody mu/ be ma9ta9$ = e sample_/specim5 collect$4 ,use ,,dd ,=m #aiaa 7,mat]ial ,c\ri] ,receipt71 or o!r docum5t 7su* z ,,da ,=m #dacg ,evid5ce_/,prop]ty ,cu/ody ,docum5t7 z direct$ = ea* sample_/specim5 collect$4 ,! *a9 ( cu/ody docum5t mu/ accompany ! sample_/specim5 dur+ transport f ! po9t ( collection to ! f9al receiv+ laboratory4 ,ea* "t ! sample_/specim5 is transf]r$ to ano!r individual1 ! receiv+ p]son mu/ sign ! docum5t to %[ t !y receiv$ ! sample_/specim5 & /ate :at happ5$ to ! sample_/specim5 :ile 9 _! cu/ody4 ,! docum5t w provide ! answ] to ! foll[+ que/ions3 ,:5 0 ! sample_/specim5 collect$8 ,:o has ma9ta9$ cu/ody ( ! sample_/specim58 ,:at has be5 done ) ! sample_/specim5 at ea* *ange ( cu/ody8 b4 ,! samples_/specim5s mu/ be appropriately packag$1 label$1 & evacuat$ to ! designat$ m$ical laboratory = confirmation ( a biological attack4 ,! /&>d *a9 ( cu/ody = ! evacuation w\ld be z foll[s3 ,sampl+ unit4 ,unit ,s#b_/security (fice or m$ical op]ations (fic]4 ,te*nical escort unit or o!r comm&-designat$ escort p]sonnel4 ,9-!at] support+ m$ical laboratory4 ,designat$ ,,conus laboratory4 ,section ,,ii4 ,,sampl+ ,,te*niques ,,& ,,proc$ures ,b-#e4 ,g5]al ,! collection ( environm5tal1 & backgr\nd 7control7 samples_/m$ical specim5s is an integral "p ( inve/igat+ allegations p]ta9+ to ! fir/ use ( *emical or biological ag5ts4 ,! types ( samples_/specim5s tak5 & ! collection me?ods prim>ily dep5d ^u ! circum/ances enc\nt]$ by ! collector4 ,dur+ all *emical & biological sampl+ op]ations1 ! comm&] e/abli%es ! requir$ protective equipm5t to fit ! situation4 ,?is app5dix includes a recomm5d$ li/ ( equipm5t = use dur+ *emical & biological sampl+ op]ations 7,table ,b-#b74 ,table ,b-#b4 ,example ,,nbc ,collection & ,%ipp+ ,equipm5t ,li/ ,,am\nt ,,description ,,/ock ,,numb] ---------------------------------------- ------------------------------ #bj ,,labels1 ,,pap]1 ,,pressure ,,s5sitive #gecj-jj-egg-dcgf #b ,,gloves1 #h-h1 ,,edmont ,,wilson,,tm #hdae-jj-;,,jo#b-bijb #b ,,gloves1 #i-i1 ,,edmont ,,wilson,,tm #hdae-jj-fcd-dfci #a ,,tape1 ,,adhesive1 ,,pressure ,,s5sitive1 #b ,,in* #geaj-jj-aei-ddej #a ,,pli]s1 #dg1 #e ,,in*es #febj-jj-edc-eccj #a ,,screwdriv]1 ,,flat ,,tip1 ,,in* #eabj-jj-eif-hfe #a ,,tongs1 ,,teflon,,tm ,,tips ,,af #ae-bjb-e #b ,,microspatula1 ,,) ,,teflon,,tm ,,ends ,,af #ba-dja-ej;,a #a ,,scissors1 ,,univ]sal ,,type ,,af #jh-iea-cj #a ,,scoop1 ,,polypropyl5e1 #e,x#b,x#b ,,asp ,s#ajba-e #b ,,spoon_/,,spatula ,,) ,,teflon,,tm ,,af #ad-cef-aj #a ,,knife1 ,,pocket #eaaj-jj-ebf-hgdj #e ,,bottles1 ,,sample1 ,,polye?yl5e1 #f ,,ounce ,,cp ,j-#fajc-ej #a ,,pipet1 ,,jumbo1 ,,transf] ,,type 7#ejj_/,,pkg7 ,,af #ac-gaa-g #aj ,,pipet1 ,,gradual1 ,,transf] ,,type 7#ejj_/,,pkg7 ,,af #ac-gaa-i;,a #aj ,,bag1 ,,insulat$1 ,,type ,i ,,af #ja-had-h #aj ,,bag1 ,,insulat$1 ,,type #b99 ,,af #ja-had-aj #a ,,bag1 ,,:irl_/,,pak1 #f ,,ounce 7#ejj_/,,pkg7 ,,af #ja-hab-f;,b #a ,,/rip1 p,h ,,te/+1 ,,nonble$+1 ,,pla/ic ,,sw ,s-#febga #a ,,sep-,,pak,,tm ,c#ah ,w#eaiaj 7#ej_/;,,box7 #b ,,syr+e1 ,,hypod]mic1 #ej ,,or #fj ml #feae-jj-afh-fiac #b ,,/opcock1 ,,?ree-,,way ,,asp ,s#hife-b #a ,,tub+1 ,,laboratory1 ,r#cfjb ,,cle> ,,af #ad-afi-c;,b #a ,,p51 ,,m>k+1 ,,wat]pro( ,,af#ac-cha 7#ab_/,,pkg7 #b ,,tubes1 ,,t5ax,,tm ,,ec ,,/-#jbc #a ,,blade1 ,,surgical1 ,,cs#b,l #aej,s #feae-ja-jji-ebig #b ,,pack1 ,,ice ,,cp ,,tr-#fcde-bj #f ,,pad1 ,,nonadhesive1 #c,x#d1 #ajjs #feaj-jj-aaa-jgjh #d ,,pad1 ,,cool+1 ,,*emical1 #d,s #fecj-jj-acc-dbii #b ,,piglettes ,,special ,,ord] #a ,,tape1 ,,antiseize #hjcj-jj-hhi-cece #a ,,air ,,sampl]1 ,,p]sonal ,,lss ,g#dihj #a ,,kit1 ,,metric1 ,,pocket ,,bubble ,,gl#diha #b ,,me?anol #a ,,wat]1 ,,di/ill$ 7#e ,,bottle_/,,pkg7 #a ,,mat*es1 ,,wat]pro( #bj ,,razor1 ,,surgical ,,prep #feae-jj-ibf-bjhi #aj ,,wat*1 ,,wri/ #ffde-jj-jff-dbgi #b ,,p>afilm ,,) ,,disp5s] #ffdj-ja-ahe-cbhi #b ,,floor ,,sweep 7,,v]miculite7 #hgbj-ja-jbf-idai #ajj ,,seals1 ,,tamp]-,,resi/ant #a ,a ,,gas ,,met] ,,capable ,,( ,,provid+ ,,on-,,/ation ,,analysis_/,,detection ,,capability ,,= ,,multiple ,,gases ,,to ,,include ,,indu/rial ,,gases4 #a ,a ,,combu/ible ,,gas ,,indicator ,,t ,,indicates ,,p]c5tage ,,( ,,oxyg5 ,,& ,,explosivity4 #a ,a ,,gas ,,met] ,,t ,,detects ,,vapor ,,9 ,,p>ts ,,p] ,,million 7,,ppm7 ,,& ,,indicates ,,pres5ce ,,( ,,vapor ,,& ,,its ,,/r5g?4 #a ,,swabs1 ,,?roat #b ,,c1 #f ,,p\nd1 ,,metal #aj ,,bag1 ,,myl> #a ,,conta9]1 ,,lead ,,%ield+ 7,,= ,,radiation ,,samples7 #a ,,conta9]1 ,,%ipp+1 ,,iata #a ,,*e/1 ,,ice #aj ,,bag1 ,,pla/ic1 ,,reclosable 99 ,,w ,,be ,,replac$ ,,by ,,myl> ,,bags ,b-#f4 ,exp5d$ ,mat]ial ,! ,,nbc recon units collect samples "u v>i\s circum/ances4 ,= example1 a recon unit may collect samples 9 an area free ( ho/ile =ces4 ,! ,special ,=ces ,,nbc ,reconnaissance team may collect samples )9 ! enemy area ( op]ations or deep into ! enemy's re> area4 ,samples include toxic ag5t munitions1 *emical products1 air1 wat]1 soil1 & vegetation4 ,9 addition1 all exp5d$ mat]ial us$ to collect ! samples %\ld be turn$ 9 to ! laboratory ) ! samples4 ,?is mat]ial includes items su* z exp5d$ ,m#bef;,a#a kits1 ,m#h & ,m#i pap]4 ,^! items %\ld be recov]$1 packag$1 & %ipp$ ) ! suspect$ samples = analysis4 ,diff]5t in=mation may be d]iv$ f ea* type ( sample2 ,table ,b-#c comp>es diff]5t types ( samples4 ,b-#g4 ,environm5tal ,samples ,control or backgr\nd samples t are collect$ f clean samples mu/ be id5tical to ! samples collect$ f ! areas ne> ! attack areas z basel9e data4 ,! contam9at$ samples mu/ be comp>$ to ! basel9e data 7control samples74 ,?is is especially true if unkn[n or non/&>d *emical &_/or suspect$ biological ag5ts 7 employ$4 ,! analysis c5t] uses ! control samples to comp>e ) a contam9at$ "o4 ,! recon unit collects control samples ( soil1 wat]1 & vegetation f areas ab\t #ejj met]s upw9d ( an alleg$ attack area4 ,control samples g5]ically are ! same z ^? collect$ 9 an alleg$ attack area4 ,= example1 if leaves f an apple tree 9 an attack area 7 collect$ z a suspect$ contam9at$ sample1 ! recon team %\ld collect leaves 7z a control sample7 f an apple tree outside ( ! contam9at$ area4 ,if wat] f a pond 9 ! attack area is collect$1 ! recon unit %\ld collect control samples ( wat] f a pond 7n a mov+ /ream7 9 a ne>by clean area4 ,! size ( an environm5tal control sample %\ld be ab\t ! same z ! suspect$ contam9at$ sample collect$ f ! attack area 7see ,table ,b-#d1 page ,b-#bj74 ,table ,b-#c4 ,comp>ison ( ,sample ,types ,,sample ,,/ability ,,analysis ,,sample ,,type ,,info ,,value ,,to ,,collect ,,"t ,,requir$ ,,reliability ---------------------------------------- ------------------------------ ,,air ,,good ,,good #bj ,,m9 ,,high ,,wat] ,,good ,,good #e ,,m9 ,,high ,,soil ,,fair ,,fair #e ,,m9 ,,mod]ate ,,vegetation ,,fair ,,poor #aj ,,m9 ,,l[ ,,tissue ,,excell5t ,,fair #cj ,,m9 ,,high ,,blood ,,good ,,fair #aj ,,m9 ,,high ,,ur9e ,,good ,,fair #aj ,,m9 ,,high ,,munition ,,fragm5ts ,,fair ,,fair #aj ,,m9 ,,fair ,,pack+ ,,mat]ials ,,fair ,,fair #aj ,,m9 ,,fair ,b-#h4 ,collection ( ,air & ,vapor ,samples a4 ,air is a good sample matrix s9ce x is a well-mix$ m$ium4 ,air f a sample site conta9s a /atic conc5tration ( contam9ants4 ,! conc5tration ( contam9ants dep5ds ^u ! fl[ rate ( ! contam9ant into ! environm5t1 ! w9d spe$1 & ! physical /ate ( ! contam9ant1 ! t]ra9 cont\rs1 & temp]ature z a v>iable4 ,! sample %\ld be tak5 )9 #ajb met]s ( a contam9at$ surface & at ! d[nw9d edge ( a contam9at$ area4 ,! me?od %\ld consi/ ( pump+ a giv5 volume ( air1 by h& or electric pump1 ?r\gh sample tubes4 b4 ,to avoid contam9ation1 p]sons conduct+ air sampl+ %\ld n use cologne1 p]fume1 insect repell5t1 m$ical creams1 or /rong soaps be=e tak+ a sample4 ,! fragrances f ^! products are volatile organic comp\nds t may be absorb$ on ! filt] & skew analytical results4 ,smoke also sev]ely int]f]es ) air sampl+1 !re=e1 avoid tobacco & vehicle exhau/ smoke4 c4 ,! prim>y me?od = collect+ air samples is ) ! ,,pas #ajjj automatic air sampl] 9 conjunction ) a ,t5ax,,tm tube = a total ( ?ree to f\r m9utes :5 possible4 ,^u completion ( sampl+1 place ! ,t5ax,,tm tube 9 a #b-;in* piglette4 ,seal ! piglette ar\nd ! cap ) ei!r pressure-s5sitive or ,teflon,,tm tape4 ,once seal$1 place ! piglette into a ,myl> or reclosable bag4 ,fold ! bag ar\nd ! piglette 9 a circul> motion1 !n apply ano!r bag & fold aga94 ,once ! bag is fold$ ar\nd ! piglette1 use any type tape to secure ! bag ar\nd ! piglette4 ,place ! piglette into a refrig]ator or cool] until ! sample is transport$ to its de/9ation4 d4 ,:5 *emicals are p]mitt$ into ! atmosph]e f a facility1 ! be/ places to obta9 samples are close to ! emission s\rce :]e ! conc5tration ( ! *emical is n dilut$4 ,! fur!r f ! orig9al po9t ( release1 ! m dilut$ ! sample becomes f mix+ ) air1 wat]1 or environm5tal pollutants4 e4 ,natural & man-made t]ra9 features su* z hills1 valleys1 & r[s ( build+s1 sometimes aid ! collector by *annel+ emissions4 ,:5 ^! features are associat$ ) a p>ticul> facility1 _! d[nw9d side is a suitable place to collect a sample because ! emission rema9s m conc5trat$ fur!r f ! release po9t4 f4 ,= collection 9 a possibly contam9at$ location1 & if ! situation p]mits1 initially use a detection kit su* z ! ,m#ah;,a#b_/,m#bef;,,ai to det]m9e if a possible vapor haz>d exi/s f kn[n *emical ag5ts4 ,also1 use ! kit :5 p]sonnel are requir$ to exam9e possible toxic ag5t munitions4 ,9 any case1 collect air samples ) ! :ite-b& tubes & save = id5tification & analysis4 g4 ,small air sampl]s also enable ! collector to obta9 vapor samples f alleg$ toxic ag5t munitions at a safe di/ance :ile explosive ordnance disposal 7,,eod7 op]ations are p]=m$4 ,if ,,eod p]sonnel are n on ! sc5e1 ! air sampl] c be activat$1 & ! collector c /& at a safe di/ance :ile ! sampl] is op]at+4 h4 ,p]=m sampl+ op]ations z soon z possible :5 direct$ by a high] headqu>t]s or aft] suspect$ *emical or biological contam9ation is enc\nt]$4 ,b-#i4 ,collection ( ,wat] ,samples a4 ,wat] sampl+ is a matt] ( collect+ en\gh wat] to get acceptable in=mation ab\t ! contam9ants4 ,! collector %\ld provide ! analysis c5t] ) "o ,c#ah & "o silica c>tridge :5 us+ ! ,sep-,pak,,tm te*nique or #ajj ml 9 a /]ile bottle :5 ,sep-,pak,,tm is n available4 b4 ,g5]al guidel9es3 ,if x is believ$ t ! ?reat has us$ /&>d *emical ag5ts dur+ an attack1 use ! ,m#bgb *emical ag5t wat] te/ kit = initial scre5+ & sampl+4 c4 ,:5 collect+ wat] samples us+ ! ,sep-,pak,,tm ,c#ah c>tridge1 ! foll[+ items are requir$3 ,"o #fj cc syr+e )\t ne$le4 ,"o #c-way /]ile1 pla/ic1 /opcock ) protective cov]s4 ,"o piece ( pla/ic tub+ 7#c_/af inn] diamet] #f long m9imum74 ,/]ile wat] or me?anol4 ,"o clean conta9]1 su* z a ,teflon,,tm cup or glass j>4 d4 ,prior to collect+ ea* sample1 prime ! ,sep-,pak,,tm sy/em 9 ! foll[+ mann]3 ,/ep #a4 ,atta* ,sep-,pak,,tm directly to #fj cc syr+e4 ,/ep #b4 ,p\r small am\nt ( /]ile wat] or me?anol into conta9]4 ,/ep #c4 ,ins]t tip ( ,sep-,pak,,tm into conta9]4 ,/ep #d4 ,)draw at lea/ #dj cc ( solution4 ,/ep #e4 ,deta* ,sep-,pak,,tm f syr+e & disc>d solution f syr+e4 ,/ep #f4 ,repeat /eps #c ?r\gh #e us+ ! same syr+e4 e4 ,aft] prim+ ! ,sep-,pak,,tm1 assemble ! compon5ts 9 ! foll[+ configuration3 ,atta* ! #c-way /opcock to a #fj cc syr+e4 ,atta* ! ,sep-,pak,,tm to ! opposite end ( /opcock4 ,atta* ! pla/ic tub+ to ! op5 end ( ! ,sep-,pak,,tm4 f4 ,use ! foll[+ proc$ures to collect samples ) ,sep-,pak,,tm3 ,/ep #a4 ,ensure t ! lev] on ! /opcock is turn$ sideways ) ! (f arr[ po9t$ t[>d ! l>ge outlet port4 ,/ep #b4 ,place ! op5 end ( ! pla/ic tub+ into ! wat] ne> ! bottom1 )\t t\*+ ! bottom or sides ( ! body ( wat]4 ,/ep #c4 ,draw #fj cc ( wat] into ! syr+e4 ,/ep #d4 ,turn ! /opcock lev] to ! (f position by position+ ! lev] to po9t t[>d ! /opcock4 ,/ep #e4 ,pu% ! plung] all ! way 91 dis*>g+ ! wat] f ! syr+e ?r\gh ! outlet port4 ,/ep #f4 ,repeat /eps #a ?r\gh #e4 ,/ep #g4 ,deta* a pla/ic tub+ f ! ,sep-,pak,,tm1 & disc>d x z contam9at$ wa/e4 ,/ep #h4 ,deta* ,sep-,pak,,tm f #c-way /opcock2 place into sample conta9]2 seal ) pressure-s5sitive tape2 & m>k = ,id5tification4 ,,note ,y %\ld take a m9imum ( f\r samples3 ?ree samples ( ! suspect$ contam9ation & "o control sample f a ne>by unaffect$ 7none contam9at$7 area = ref]5ce4 ,/ep #i4 ,dispose ( ! syr+e & /opcock z contam9at$ wa/e4 ,/ep #aj4 ,ins]t ! sample conta9] 9 a cool] or refrig]ator until ! sample is transport$ to its de/9ation4 g4 ,= samples to be repres5tative ( ! ov]all contam9at$ area1 ! collection po9t %\ld be c>efully select$4 ,collect samples f-- ,dra9s & sl[-mov+ /reams1 s9ce contam9ation & dilution f o!r s\rces are m9imiz$4 ,/agnant pools ( wat] if ! pools ( wat] are "p ( *emical wa/e areas1 su* z a l&fill or *emical disposal area4 ,*emicals may p]colate into /agnant pools or sumps close to ! site4 ,,note ,if an oil film1 globules ( organic mat]ials1 or an unnatural appe>+ p[d]-l mat]ial is visible on ! wat]'s surface1 collect a surface sample ( ! mat]ial4 ,if n1 collect ! sample f ne> ! bottom ( ! wat] s\rce 7/ream1 lake1 pond1 wat] conta9]74 ,! upp] lay]s ( wat] may h less] am\nts ( contam9ants1 due to high] temp]atures t promote decomposition4 ,s9ce mo/ *emicals ( int]e/ are m d5se ?an wat]1 contam9ants usually s9k to ! bottom ( ! wat] s\rce4 h4 ,collect ! sample )\t ! ,sep-,pak,,tm by imm]s+ a capp$ or /opp]$ conta9] to ! desir$ dep?1 remov+ ! cap or /opp]1 lett+ ! conta9] fill1 & !n capp+ ! conta9]4 ,an alt]nate me?od = deep] wat] is to use a pla/ic1 pump-op]at$ siphon to pump wat] f a specific dep?4 i4 ,! be/ "t to collect a sample ( wat] f a location is :5 intellig5ce or local reports indicate t a process ( possible int]e/ is ongo+4 ,9 ! abs5ce ( reliable report+1 ?is may be indicat$ by increas$ activity1 high] ?an normal am\nts ( security1 or increas$ fl[ f facility *imneys or wat] dis*>ge pipes4 ,9 field areas :]e a toxic ag5t has be5 spray$ or dissem9at$ ov] a l& area1 ! be/ "t to collect wat] samples is j aft] ! />t ( a ra9/orm :5 run(f is beg9n+4 ,natural surface dra9age w conc5trate any remnants ( toxic comp\nds 9 depressions1 /reams1 or dit*es4 ,b-#aj4 ,collection ( ,soil ,samples ,soil is a suitable m$ium to collect z samples = toxic organic comp\nds4 ,a critical po9t1 h[ev]1 is t ! precise site ( ! ag5t deposition mu/ be sampl$ = be/ results4 ,contam9ation may be recogniz$ by discoloration or app>5t deposition ( mat]ial on ! soil's surface4 ,if discoloration or deposits ( mat]ial are evid5t1 only collect ! discolor$ soil or deposit$ mat]ials1 if possible4 ,dead1 mal=m$1 & wilt$ foliage is an indicator ( contam9ation4 ,soil samples %\ld be collect$ f op5 areas1 along ! drip l9e t5ts1 /ation>y equipm5t1 bottom ( dit*es & t]ra9 depressions4 a4 ,collect ! soil samples by us+ a knife1 spoon1 spatula1 or simil> item to scrape a squ>e ( topsoil 7#bea c5timet]s7 f areas t appe> to h be5 contam9at$ 9 to a collection conta9]4 ,if *unks or clods ( e>? are collect$1 select ^? t are no l>g] ?an #ajea c5timet]s 7see ,table ,b-#d74 ,also1 collect a control sample ( soil ( ! same type & texture f a ne>by uncontam9at$ area4 b4 ,use a glass bottle1 j>1 or ,teflon,,tm j> z ! conta9] :5 available4 ,:5 ^! conta9]s are n available1 ,myl> bags may be us$4 ,:5 us+ a glass bottle1 j>1 or ,teflon,,tm j>1 seal ! cap ) ei!r pressure-s5sitive or ,teflon,,tm tape1 & m>k = id5tification4 ,:5 us+ ,myl> bags1 place ea* sample 9 a sep>ate bag1 pu% excess air out1 & seal by fold+ ! op5 end ov] two to ?ree times & wrapp+ ! bag ) tape4 ,ins]t ! fir/ bag into a second bag1 seal1 tape1 & m>k = id5tification4 ,if possible1 place ! samples 9 a piglette4 ---------------------------------------- ------------------- ,,caution ,avoid direct contact ) ! sample to prev5t expos+ y\rself to ! suspect ag5t 7,,mopp #d is requir$74 ---------------------------------------- ------------------- c4 ,collect samples z soon z possible :5 direct$1 ^u detection ( a suspect sub/ance1 or aft] ! alleg$ incid5t4 ,b-#aa4 ,collection ( ,contam9at$ ,vegetation ,z ) soil samples1 vegetation is also a suitable m$ium to collect z samples = toxic organic comp\nds4 a4 ,collect samples ( vegetation t appe> to be diff]5t f normal4 ,select leaves t h wilt$ or appe> to h be5 *emically burn$4 ,collect samples ( vegetation t appe> to h liquid or solid sub/ances deposit$ on _! surfaces 7?is may be notic$ z a %9y or moi/ area74 b4 ,collect samples ( vegetation at sev]al locations )9 ! suspect$ contam9at$ area4 ,us+ a cutt+ tool or any %>p object1 cut sev]al affect$ leaves &_/or a h&ful ( grass :5ev] possible4 ,d n cru% ! sample4 ,place ! sample into a ,myl> or reclosable bag4 ,squeeze excess air out ( ! bag & seal x4 ,fold ! op5 end ( ! ,myl> bag ov] two to ?ree times1 & wrap x ) tape4 ,! m9imum size = a sample is ?ree leaves or ?ree h&sful ( grass4 ,"o leaf is ( little value1 b is bett] ?an no?+4 ,b>k is acceptable b n pref]r$4 ,m>k ! bag = id5tification4 ,take a control sample ( simil> mat]ial f an unaffect$ 7uncontam9at$7 area4 ,fold1 seal1 tape1 & m>k ! control sample 9 ! same mann] z ! actual sample4 c4 ,:5 x is possible to det]m9e a probable c5t] ( attack 9 an area1 collect vegetation samples ne> ! c5t] ( ! area1 ab\t #ajj met]s upw9d ( ! area1 & 9 sev]al #ajj-met] increm5ts d[nw9d ( ! area4 ,if ! collector c disc]n a contam9ation patt]n 9 ! area1 ?is %\ld be report$4 ,b-#ab4 ,m$ical ,specim5s a4 ,j z blood & ur9e specim5s are tak5 f humans :o 7 alleg$ly expos$ 9 an attack1 also collect specim5s f individuals :o claim n to be affect$ by a toxic ag5t & are f ! same gr\p z expos$ p]sonnel4 ,! purpose is ! same z collect+ environm5tal control specim5s2 t is1 to det]m9e if a toxic sub/ance is pres5t 9 ! individuals' natural environm5t or if x has be5 artificially introduc$4 b4 ,selection ( humans = control sampl+ is some:at m complicat$ ?an selection ( environm5tal control samples4 ,?is is because e?nic diets1 racial diff]5ces1 physiological makeup1 & actual liv+ conditions ( p]sons :o are outw>dly simil> may introduce pot5tially l>ge deviations4 ,ea* ( ^! factors mu/ be accurately consid]$ be=e select+ subjects z controls4 c4 ,consid]ation ( e?nic diets is important because ( unique foods or me?ods ( food prep>ation t may exi/4 ,z an example1 individuals 9 settl$ areas may pur*ase be] t has be5 c>efully filt]$ & /]iliz$1 :ile individuals 9 a ne>by unsettl$ area may f]m5t _! own be] by bury+ home craft$ jugs 9 ! gr\nd & extract+ ! product little by little ov] sev]al mon?s4 d4 ,racial diff]5ces c acc\nt = diff]5ces 9 mortality & morbidity rates 9 specific populations4 ,"o example ( ?is c\ld be ! high rate ( hemophilia 9 a population v]sus ! r>ity ( ! disease 9 ano!r4 e4 ,physiological makeup is critical because ( ! diff]5ces 9 hormone balance & tissue composition 9 males1 females1 adults1 & juv5iles4 ,= ?is reason1 m$ical control specim5s %\ld be drawn f individuals ( ! same g5d] & approximate age z specim5s f expos$ p]sonnel1 if possible4 f4 ,diff]5ces 9 ! actual liv+ conditions ( p also require a close look4 ,! po9t "h is t conditions 9 remote1 semiciviliz$ camps are seldom ! same z ^? 9 a well-e/abli%$ camp t has access to mod]n am5ities4 g4 ,! bottom l9e 9 select+ subjects = m$ical control sampl+ is t !y be z simil> 9 all aspects z possible4 ,b-#ac4 ,collection ( ,m$ical ,specim5s a4 ,tra9$ m$ical te*nicians or physicians %\ld collect m$ical specim5s 7human or animal72 h[ev]1 ,special ,=ces ,,nbc ,reconnaissance team p]sonnel are tra9$ to d ?is proc$ure4 ,rememb]1 ! collector mu/ h express p]mission 7au?ority7 to collect m$ical specim5s f ! dead1 because ( religi\s beliefs 9 _m cultures4 ,to obta9 su* specim5s )\t p]mission may result 9 unnecess>y mission complications4 ,ensure all p]sonnel h&l+ or collect+ m$ical specim5s h receiv$ prop] immunizations = _! own protection4 ,!y mu/ be inoculat$ ,,iaw ,! ,surgeon ,g5]al's guidance4 b4 ,m$ical specim5s collect$ dur+ an inve/igation include blood1 ur9e1 sputum1 nasal swabs1 & tissue specim5s f liv+ victims & blood & ur9e specim5s f unexpos$ p]sons 7backgr\nd control specim5s74 c4 ,collect blood specim5s us+ ei!r a /&>d #aj cc disposable syr+e ) a #a- to #a-;in* ne$le 7#bj to #bb gauge71 or by us+ a ,vacuta9],,tm sy/em4 ,:5 us+ a ,vacuta9],,tm sy/em1 ensure t multiple specim5 ne$les & r$ top vacuum tubes are us$4 ,t5 cc ( blood is suffici5t = analytical te/+4 ,d n take m ?an #e cc f small1 maln\ri%$ *ildr54 ,aft] blood is collect$1 x %\ld be transf]r$ to a polypropyl5e-type conta9] & seal$ ) p>afilm be=e transport+4 ,all body fluids %\ld be collect$ )\t violat+ antiseptic te*niques4 ,also1 prior to transport+ specim5s1 collectors ne$ to *eck specim5 conta9]s = pap] labels ,,iaw guidel9es = label+ m$ical specim5s4 ,collect blood specim5s us+ ! foll[+ mat]ials equipm5t3 ,gloves4 #aj cc /]ile1 disposable syr+e4 #a- to #a4e-;in* /]ile ne$le 7#bj to #bb gauge74 ,vacuta9],,tm device 7adapt] ) ne$le74 ,con/rict+ b&4 ,dis9fectant pads1 ,betad9e1 or alcohol4 ,/]ile #bb-;in* gauze pads4 ,labels4 ,,note ,gloves %\ld be worn :5ev] h&l+ m$ical specim5s4 ,d n freeze liquid blood & ur9e specim5s 7ideal cool+ temp]ature is betwe5 #ce & #dj;,f #b to #d;,c47 d4 ,collect ur9e specim5s us+ ei!r a /&>d ur9e cup or by a ur9e ca!t] & ur9e cup4 ,:5 collect+ ! specim5 directly into a ur9e cup1 ! p]son mu/ ur9ate into ! cup until suffici5t fluid is collect$ 7#dj cc ( ur9e is pref]able1 al?\gh #aj cc c support analytical te/+74 ,:5 ! p]son is unable to ur9ate1 ! ca!t]ization te*nique is pref]able4 ,! ca!t]ization te*nique is be/ p]=m$ 9 a cl9ical environm5t4 ,z ) o!r body fluids collect$1 ur9e mu/ be kept cold4 ,d n freeze4 ,,note ,= correct proc$ures on ca!t]ization ref] to ,,/p #h-ia,w#ae-,,sm-,,tg4 e4 ,collect tissue specim5s us+ /]ile scissors & =ceps or z direct$ by ! att5d+ physician4 7#a7 ,:5 casualties h unid5tifi$ sk9 lesions1 photographs ( ! lesion7s7 & ov]all photos ( ! ext5t ( ! lesion7s7 %\ld be tak51 us+ color film be=e biopsy4 ,a specim5 ( ! lesion %\ld be obta9$4 ,?is is done by surgically remov+ a portion ( ! sk9 ) a /]ile pair ( scissors & =ceps4 7#b7 ,place tissue specim5s 9 a ,teflon,,tm conta9] fill$ in* f ! bottom ) a pres]vative1 7=mal9 #aj7 = pres]vation ( ! specim5 until x rea*es its prop] de/9ation4 ,seal ! conta9] & lid ) p>afilm4 ,z ) any o!r m$ical specim5s1 tissue specim5s are refrig]at$ prior to %ipm5t2 b d n freeze tissue specim5s4 f4 ,collect nasal swabs by us+ a cotton-tipp$ swab4 ,place ! swab ) collect$ specim5 9 a ,teflon,,tm conta9] fill$ in* f ! bottom ) a pres]vative = pres]vation ( ! specim5 until x rea*es its de/9ation4 ,seal ! conta9] & lid ) p>afilm4 ,refrig]ate ! specim5 = %ipm5t1 b d n freeze4 g4 ,collect sputum by hav+ ! pati5t dis*>ge ! sputum into a small1 /]ile screw-top j> or ur9e specim5 cup4 ,seal ! conta9] & refrig]ate ! specim5 = %ipm5t1 b d n freeze4 ,b-#ad4 ,po/ mortem ,specim5s ,po/ mortem specim5s %\ld be collect$ by individuals tra9$ 9 =5sics4 ,:5 =5sics-tra9$ individuals are n available1 ! mo/ qualifi$ m$ical p]son %\ld collect human specim5s4 ,specim5s f animals %\ld be collect$ by vet]9>y p]sonnel4 ,9 ei!r case1 ! foll[+ specim5s are collect$3 ,blood4 ,use a #ej to #fj cc /]ile syr+e ) an #ah-;gauge1 #e-;in* 7l>ge bore7 ne$le to collect blood f ! he>t1 & ur9e directly f ! bladd]4 ,use a sp9al ne$le to collect c]ebral sp9al fluids4 ,?ree ( ea* type ( specim5s mu/ be collect$4 ,lungs4 ,a biopsy ne$le is ne$$ to prop]ly collect lung tissue specim5s4 ,aft] collect+ specim5s f ! lungs1 place specim5s 9 a pla/ic or ,teflon,,tm conta9] fill$ ) #aj =mal9 7pres]vative7 & seal ! conta9] = transport+ to its de/9ation4 ,liv]4 ,if possible collect liv] core specim5s1 us+ a l>ge-gauge ne$le 7#ah-;gauge1 #e-;in* long7 via int]co/al or abdom9al puncture4 ,or1 if ! family cons5ts1 p]=m a m9ilap>otomy & obta9 "o or two #bbb cm sections ( liv]4 ,/ore & package ! specim5 z direct$ = tissue specim5s4 ,= suspect biological ag5ts1 see ,table ,b-#a = specific types ( specim5s1 am\nt1 collection m$ium1 & f :om to collect4 ,,note ,be=e attempt+ any ( ! above proc$ures1 collector mu/ be c]tifi$ by a qualifi$ p]son 7m$ical doctor7 on ! correct proc$ures to collect specim5s f cadav]s4 ,table ,b-#d4 ,/&>d ,sizes ( ,,cb ,samples_/,specim5s to be ,collect$ ,,type ,,size ,,notes ---------------------------------------- -------------------------------- ,,*emical ,,w>f>e ,,samples ,,soil 7#aj ,,cm ,x #e ,,cm ,x #a ,,cm7 ,,cig>ette-,,pack ,,size ,,or ,,l>g] ,,area ,,is ,,m ,,useful ,,?an ,,great] ,,dep? ,,dilute ,,ag5t #aj ,,ml ,,wat] #ejj ,,ml 7,,maximum7 ,c#ah ,,sep-,,pak,,tm #bjj ,,ml ,,vegetation 7,,equival5t ,,to #c ,,leaves ,,dep5ds ,,on ,,am\nt ,,( ,,contam9- ,,or #c ,,h&sful ,,( ,,grass7 ,,ation4 ,,be/ ,,samples ,,w ,,be ,,f\nd ,,ne> ,,! ,,release ,,po9t ---------------------------------------- -------------------------------- ,,biological ,,w>f>e ,,samples ,,soil 7#aj ,,cm ,x #e ,,cm ,x #a ,,cm7 ,,cig>ette-,,pack ,,size ,,or ,,l>g] ,,area ,,is ,,m ,,useful ,,?an ,,great] ,,dep? ,,liquid #be ,,to #ej ,,ml ,,d ,,n ,,use ,c#ah ,,sep-,,pak,,tm ,,) ,,m$ical ,,specim5s ,,vegetation ,,size ,,( ,,s(t ,,dr9k ,,c ,,be/ ,,samples ,,dep5d ,,on ,,! ,,am\nt ,,( ,,contam9ation ,,f\nd ,,ne> ,,! ,,release ,,po9t ---------------------------------------- -------------------------------- ,,m$ical ,,specim5s ,,ur9e #bj ,,to #ej ,,ml ,,mu/ ,,obta9 ,,cons5t ,,to ,,collect ,,specim5s ,,f ,,o!r ,,?an ,,u ,,casualties ,,:ole ,,blood ,,or #e ,,ml ,,mu/ ,,obta9 ,,cons5t ,,to ,,collect ,,s]um ,,specim5s ,,f ,,o!r ,,?an ,,u ,,casualties ,,c]ebral ,,sp9al #b ,,ml ,,mu/ ,,obta9 ,,cons5t ,,to ,,collect ,,fluid ,,specim5s ,,f ,,o!r ,,?an ,,u ,,casualties ,,organ ,,tissue #cj ,g 7,,m9imum7 ,,m$ia/9al #b ,,%\ld ,,be ,,remov$ ,,by ,a ,,surgeon ,,lymph ,,nodes ,,dur+ ,,an ,,autopsy ,b-#ae4 ,report+1 ,packag+1 & ,%ipm5t ,al?\gh a sample_/specim5 collect$ f an alleg$ attack area c be significant1 x c become useless if prop] /eps are n tak5 to record critical in=mation ab\t its collection or if x is improp]ly pack$ & breaks dur+ %ipm5t to an analysis c5t]4 ,?is section discusses ! in=mation ne$$ :5 acquir+ samples_/specim5s & ! pref]r$ me?ods = h&l+ & pack+ samples_/specim5s = %ipm5t4 a4 ,a complete backgr\nd in=mation hi/ory ( ! circum/ances ab\t ea* sample's_/specim5's acquisition mu/ be provid$ to ! ag5cy analyz+ ! sample_/specim54 b4 ,critical backgr\nd in=mation includes-- ,circum/ances ( acquisition4 ,h[ ! sample_/specim5 0 obta9$1 :]e x 0 f\nd1 & h[ x 0 collect$4 ,physical description4 ,! physical /ate 7solid1 liquid1 p[d]1 app>5t viscosity71 color1 approximate size1 id5tity ( ! specim5 7su* z milit>y nom5clature71 dirt1 leaves1 or s =?4 ,circum/ances ( ag5t deposition4 ,! type ( deliv]y sy/em1 a description ( h[ ! weapon function$1 h[ ! ag5t act$ on release1 s\nds he>d dur+ dissem9ation1 a description ( any crat]s or %rapnel f\nd associat$ ) a bur/1 & colors ( smoke1 flames1 or mi/ t may be associat$ ) ! attack4 c4 ,provide in=mation on ! ag5t effects on vegetation = soil or environm5tal samples4 ,a description ( ! g5]al area 7jungle1 m\nta91 grassl&7 & *anges 9 ! vegetation aft] ag5t deposition 7su* z color *ange1 wilt+1 dry+1 dead7 9 ! ma9 attack & fr+e areas4 d4 ,provide in=mation on ! ag5t effects on humans = m$ical specim5s4 ,describe h[ ! ag5t affect$ p]sonnel 9 ! ma9 attack area v]sus fr+e areas2 ! duration ( ag5t effects2 peculi> odors t may h be5 notic$ 9 ! area prior to1 dur+1 &_/or aft] an attack2 measures tak5 t alleviat$ or det]iorat$ ! effects2 & ! approximate numb] ( victims & survivors1 to include _! ages & g5d]s4 e4 ,describe ! ag5t effects on animals4 ,provide in=mation on ! types ( animals t 7 or 7 n affect$ by an attack & ( h[ !y 7 affect$4 ,b-#af4 ,h&l+ & ,packag+ ,mat]ials ,mat]ials us$ = packag+ samples_/specim5s prim>ily consi/ ( ,myl> collection bags1 ,teflon,,tm specim5 j>s & tubes1 pigs & piglettes1 ice *e/s1 seal+ mat]ials1 & wrapp+ & cu%ion+ supplies4 a4 ,collection ,bag4 ,use ! ,myl> bag z ! initial conta9] = su* samples z protective masks & filt] cani/]s1 individual antidote & decon kits1 munition fragm5ts1 & o!r items too l>ge to place 9 a specim5 j>4 ,use x also to package sample_/specim5 conta9]s to ensure a vapor b>ri] 9 case ! conta9] is brok5 9 transit4 ,! bag acts z an initial or second>y vapor b>ri] to prev5t air f leak+ inw>d & toxic mat]ial outw>d4 ,foll[ ! proc$ures bel[ :5 us+ ! bag4 ,if packag+ a specim5 conta9] or non5vironm5tal sample_/specim51 fir/1 v]ify x has a sample_/specim5 numb]4 ,c>efully place ! sample_/specim5 9 a bottom corn] ( ! ,myl> bag4 ,squeeze all ! air out ( ! bag & seal x by remov+ ! adhesive's protective /rip1 & press+ ! two sides toge!r4 ,place a piece ( #b-;in*-wide fib] or clo? tape across ! end ( ! bag t y j seal$ to reseal ! ,myl> bag on ! outside4 ,?is s]ves z extra insurance 9 case ! int]nal seal is brok54 ,) ! bag ly+ 9 front ( y & ! seal at ! top1 fold ! bag across its wid? to z small a size z possible )\t damag+ ! sample_/specim54 ,at ?is po9t1 use tape to hold ! fold4 ,next1 fold ! bag f ! top d[n to ! bottom ( ! bag to z small a size z possible4 ,! seal+ ( ! bag is ! mo/ critical /ep dur+ ! packag+ process4 ,at ?is po9t1 turn ! bag ov] & use a m>k] or file label to put ! sample_/specim5 numb] on ! outside ( ! bag s t analysis c5t] p]sonnel c id5tify ! sample_/specim54 ,place ! fold$ ,myl> bag 9 a cle> pla/ic reclosable bag1 if available4 ,foll[+ ! same /eps y us$ = ! ,myl> bag1 fold & seal ! pla/ic bag4 ,:5 ?is has be5 complet$1 aga9 m>k ! sample_/specim5 numb] on ! ext]ior ( ! bag4 b4 ,glass ,specim5 ,j>s & ,polypropyl5e ,tubes4 ,use glass conta9]s to hold small environm5tal samples1 wat] samples1 & m$ical & po/ mortem specim5s4 ,use polypropyl5e conta9]s to hold m$ical specim5s su* z blood or ur9e4 ,polypropyl5e conta9]s may be us$ = po/ mortem specim5s if requir$2 h[ev]1 glass conta9]s are pref]r$4 ,! use ( glass r ?an pla/ic conta9]s is pref]r$ = environm5tal samples because toxic ag5ts may lea* *emicals f pla/ics into a sample1 introduc+ contam9ation & confus+ ! analysis ef=ts4 ,if ! conta9] has a screw-on lid1 place ,teflon,,tm plumb]'s tape 7,,nsn #hjcj-jj-hhi-cece2 ,tape1 ,antiseize7 on ! ?reads ( ! conta9] be=e putt+ on ! lid4 ,?is helps to limit ! leakage ( liquids & vapor f ! conta9] & to assure ! lid w n fall (f :ile 9 transit4 ,if ! lid has a c>dbo>d l9]1 remove ! l9] & replace x ) "o or two lay]s ( p>afilm 7a laboratory sealant film74 ,once ! lid is on1 /ret* p>afilm ar\nd ! outside ( ! conta9] at ! junction ( ! lid & ! glass4 ,two wraps ( ! film are en\gh to provide a leakage b>ri] & m assurance t ! lid _c fall (f4 ,at ?is po9t1 ensure ! sample_/specim5 numb] is on ! outside ( ! conta9]4 ,use a diamond et*+ p5cil or an adhesive label to put ! sample_/specim5 numb] on ! ext]ior ( ! conta9]4 c4 ,six-,p\nd ,metal ,c4 ,use metal cans z ! ext]nal conta9] = packag+ small items t h be5 seal$ 9 ,myl> bags1 specim5 j>s1 & polypropyl5e tubes conta9+ m$ical specim5s4 ,! metal c helps absorb %ock f r\gh h&l+ dur+ %ipm5t & elim9ates ! spread ( contam9ation if a specim5 conta9] is brok54 ,! six-p\nd metal c is capable ( hold+ m ?an "o sample_/specim5 7dep5d+ ^u size ( samples_/specim5s74 ,be=e plac+ samples_/specim5s 9 ! c = %ipp+1 ensure a sample_/specim5 numb] is assign$ & is visible on ea* item4 ,place ab\t #a to #b in*es ( pack+ mat]ial 9 ! bottom ( ! c4 ,wrap j>s & tubes 9 pla/ic bubble wrap or - to -in*-?ick foam rubb] %eet+1 secure ! wrap ) tape or a rubb] b&1 & place ! wrapp$ item 9 ! c4 ,if bubble wrap or foam rubb] is n available1 use newspap]4 ,! guid+ pr9ciple is t ! sample_/specim5 conta9]s %\ld fit snugly & n be able to move 9 ! c4 d4 ,ice ,*e/4 ,/&>d polye?yl5e or metal ice *e/s are ! mo/ easily procur$ items us$ = transworld %ipm5t ( ,,cb samples_/specim5s4 ,! mo/ easily us$ size is ab\t #bd in*es long by #ah in*es high by #ae in*es deep4 ,?is size p]mits ! s5d] to %ip two or ?ree #f-p\nd metal cans 9 ea* *e/ ) suffici5t dry ice to ma9ta9 freez+ temp]atures = ab\t f\r days4 ,also1 ea* *e/ rema9s at a weight t "o individual c h&le4 e4 ,transport ,conta9]4 ,:5 ! samples_/specim5s mu/ be transport$ on comm]cial aircraft1 an ,,iata-approv$ sample transport conta9] mu/ be us$ = %ipm5t_/deliv]y to ! ,,conus laboratory4 f4 ,coolants4 ,samples_/specim5s submitt$ = laboratory analysis mu/ be prop]ly packag$1 label$1 & %ipp$ to ensure !y arrive 9 an analytically acceptable condition4 ,all samples %\ld be ma9ta9$ at a temp]ature ( #a to #d;,c dur+ transport4 ,ideally1 samples_/specim5s %\ld arrive at ! 9-!at] laboratory )9 #f h\rs ( collection4 ,! samples_/specim5s %\ld be deliv]$ to ! ,,conus laboratory )9 #bd to #dh h\rs4 ,if ! samples_/specim5s _c be deliv]$ to ! ,,conus laboratory )9 ?is "t1 !n !y %\ld be fla% froz5 to -#afe;,c1 if capabilities are available4 ,if available1 dry ice %\ld be us$ :5 fla% freez+ _c be accompli%$4 ,if ! samples_/specim5s _c be deliv]$ to ! ,,conus laboratory )9 #bd h\rs1 ! support+ laboratory %\ld subculture ! samples_/specim5s & s5d ! subculture ) ! samples_/specim5s to ! ,,conus laboratory4 ,! subcultur+ date %\ld also be provid$4 g4 ,int]nal ,insulation4 ,:ile a comm]cial ice *e/ provides good insulation ( bo? ! samples_/specim5s & ! coolant1 x is be/ to place extra insulation & cu%ion+ ar\nd ! metal cans inside ! *e/4 ,newspap]s1 pla/ic bubble wrap1 & foam rubb] may all be us$ ) almo/ equally good results except newspap]s & /&>d ice d n mix well4 ,b-#ag4 ,collection ,report+ a4 ,! collector mu/ provide a =matt$ message = transmission z soon z possible to report acquisition & %ipm5t ( samples_/specim5s4 ,dur+ special op]ations 9 a !at] 9 :i* a ,special ,=ces ,gr\p 7,,sfg7 is deploy$1 ! message is transmitt$ by ! fa/e/ means ?r\gh ! fewe/ *annels to ! ,,nbc control 7,,nbcc7 c5t]4 ,if a ,,nbcc c5t] has n be5 deploy$ to ! area ( op]ations1 z 9 l[-sample_/specim5 volume peacetime ,,nbc sampl+ op]ation1 ! message is transmitt$ by ! fa/e/ means ?r\gh ! fewe/ *annels to ! message addressees bel[4 ,9 addition1 a writt5 report accompanies ea* sample_/specim5 or bat* ( samples_/specim5s4 ,! collector ensures t ! acquisition message has be5 prop]ly classifi$4 b4 ,! collection report includes at lea/ ! foll[+ addressees3 ,,sec/ate ,,wa%dc ,,secdef ,,wa%d*osd-,,isa_/,,ous-,,dreh ,,jcs ,,wa%dc_/_/,j-#c_/;,j-#e;,h ,,cia ,,wa%d*oswr-,,/d-,,lsbnic-,,nio7,,/p7,h ,,dia ,,wa%dc_/_/,,dt-#c;,b_/,,dt-#e;,a_/_/ ,,dir ,,afmic ,,ft ,,detrick ,,md_/_/,,afmic-,,cr_/,,afmic-,,sa_/_/ ,,da ,,wa%dc_/_/,,dami-,,fit_/,,damo-,,swc_/_ / ,,cmdt ,,usacmls ,,ft ,,leon>d ,,wood ,,mo_/_/,,atsn-,,cm-,,co_/_/ ,,cdr ,,sbccom ,,apg ,,mdhsmccr-,,opf_/,,smcte-,,ope-,,ra-,,i d#b;,h ,,cdr ,,f/c ,,*>lottesville ,,va_/_/,,aia/-,,ra-,,id#b;,h ,,cdr ,,usamriid ,,ft ,,detrick ,,md 7,= suspect biological samples_/specim5s only47 c4 ,a collection message conta9s ! foll[+ in=mation3 ,! sample_/specim5 id5tification numb] is "p ( ! subject l9e if only a s+le sample_/specim5 is ref]r$ to 9 ! text4 ,o!rwise1 ref] to ! sample_/specim5 numb] )9 ! message body ) its backgr\nd in=mation4 ,! %ipm5t date1 mode ( transportation1 c\ri] id5tification1 air bill ( lad+ numb]1 flight numb] de/9ation1 & e/imat$ "t ( arrival are includ$ if ! sample_/specim5 is to be %ipp$ imm$iately4 ,also1 ! mat]ial c\ri] receipt =m 7,,dd ,=m #aiaa7 %\ld be us$ to ma9ta9 *a9 ( cu/ody4 ,backgr\nd in=mation on ! sample_/specim54 ,que/ionable circum/ances surr\nd+ acquisition ( a sample_/specim54 ,! "n ( ano!r c\ntry or ag5cy t acquir$ a sample_/specim5 f ! same ev5t or area & is n %[n on ! message address4 ,a recomm5d$ priority & rationale = analysis to guide ! analysis c5t] on ! assessm5t ( ! pot5tial value ( ! sample_/specim54 ,all details relat+ to ! collection ( ! sample_/specim51 reg>dless ( h[ insignificant !y may seem to ! collector4 d4 ,%ip all samples_/specim5s by ! fa/e/1 safe/ means1 pref]ably by a te*nical escort unit 7,,teu7 to ! !at] ,*emical-,biological ,sampl+ ,control ,elem5t 7,,cbsce7 or to a location ! ,,cbsce designates4 ,if !re is no ,,cbsce 9 ! !at]1 s5d ! samples_/specim5s ,,iaw preplann$ in/ructions f ! ,*emical-,biological ,sampl+ ,control ,c5t] 7,,cbscc7 at ,,cbda1 ,ab]de51 ,m>yl&4 ,! ,,cbscc uses ! foll[+ crit]ia to det]m9e ! f9al de/9ation ( ea* sample3 ,is ! sample_/specim5 *emical or biological 9 cont5t8 ,is ! sample_/specim5 cont5t completely unkn[n8 ,is ! sample_/specim5 a possible biological mat]ial8 7#a7 ,9 any case1 ! ,,nbcc c5t] mu/ be notifi$ 9 advance ( %ipm5t ( ! sample s additional in/ructions or deviations f /&>d in/ructions c be giv54 ,figure ,b-l %[s an example ( a %ipp+ notification message4 ,! ,,nbcc c5t] w direct1 9 advance1 t samples be s5t to "o or m ( ! foll[+ locations1 dep5d+ on ! category ( ! samples4 ,prior to %ipm5t ( samples_/specim5s1 contact mu/ be made )-- ,comm&] ,te*nical ,escort ,unit ,,attn3 ,,smcte-,,ope ,ab]de5 ,prov+ ,gr\nd1 ,,md #bajaj ,,dsn3 #ehd-dcha 7,duty h\rs7 ,,dsn3 #ehd-bggc 7,aft] duty h\rs7 7#b7 ,?is unit controls ! transport ( samples_/specim5s to _! f9al de/9ation7s74 ,d n %ip suspect$ toxic samples_/specim5s or munition sy/ems to ,,conus te*nical c5t]s or intellig5ce ag5cies )\t coord9ation & prior approval by ! recipi5t4 ,,note ,suspect ,,cb samples_/specim5s are fir/ deliv]$ to ! support+ m$ical laboratory 9 ! ,,ao = 9-!at] analysis be=e !y are transport$ out ( ! ,,ao4 ,! support+ laboratory w )draw an aliquot ( select$ samples_/specim5s = analysis4 ,! support+ m$ical laboratory is responsible = provid+ ! ,,ao comm&] confirmatory id5tification )9 ! ,,ao4 ,! ,,conus-bas$ ref]5ce laboratory is responsible = provid+ confirmatory id5tification = ,presid5t & ,secret>y ( ,def5se purposes4 ,,fm ,,amembassy ,,ddttttz ,,jan #jb ,,to ,,cdr ,,teu ,,apg ,,md_/_/,,smcte-,,ope_/_/ ,,sec/ate ,,wa%dc ,,secdef ,,wa%dc_/_/,,osd-,,isa_/,,ous-,,dre_/_/ ,,info ,,cia ,,wa%dc_/_/,,oswr-,,/d-,,lsb_/,,nic-,,ni o7,,/p7_/_/ ,,jcs ,,wa%dc_/_/,j-#c_/;,j-#e_/_/ ,,dia ,,wa%dc_/_/,,dt-#c;,b_/,,dt-#e;,a_/_/ ,,dir ,,nsa ,,ft ,,meade ,,md ,,dir ,,afmic ,,ft ,,detrick ,,md_/_/,,afmic-,,cr_/,,afmic-,,sa_/_/ ,,da ,,wa%dc_/,,dami-,,fit_/,,damo-,,swc_/_/ ,,cdr ,,f/c ,,*>lottesville ,,va_/_/,,aia/-,,ra-,,id#b_/_/ ,,cdr ,,cbda ,,apg ,,md_/_/,,smccr-,,opf_/_/ ,,cdr ,,usacmls ,,ft ,,mcclellan_/_/,,atzn-,,cm-,,cu_/_/ ,,classification ,,sec/ate ,,=444 ,,secdef ,,=444 ,,cia ,,=444 ,,jcs ,,= ,j-#c_/;,j-#e ,,=444 ,,da ,,= ,,damo-,,swc ,,=444 ,,afmic ,,=444 ,,cbda ,,= ,,fio444 ,,f/c ,,= ,,amx/-,,fw444 ,,usacmls ,,= ,,?reat ,,mgr444 ,e4#j4abcef3 ,,decl3 ,,oadr 7,note3 ,?is is includ$ if ! message is classifi$47 ,,tags3 444 ,subject3 ,%ipm5t ( ,,cb ,samples_/,specim5s ,,ref7,s73 ,,teu ,,msg 1 7,,dtg ,,ddtttt "t zone ,,jan #jb7 #a4 7,w7 ,,%ipp+ ,,in=mation3 ,a4 ,,date ,,%ipp$3 ,,janu>y #aa1 #bjjb4 ,b4 ,,mode ,,( ,,transportation3 ,,air ,,express1 ,,air ,,bill ,,numb] ,,rpt ,c4 ,,flight ,,s*$ule3 ,,to ,,tyo ,,by ,,jal ,,xxx1 ,,janu>y #aa1 #bjjb4 ,,to ,,jfk ,,by ,,jal ,,yyy1 ,,janu>y #ab1 #bjjb4 ,,to ,,iad ,,by ,,dec ,,zzz1 ,,janu>y #ab1 #bjjb4 ,d4 ,,de/9ation3 ,,dulles ,,int]national ,,airport4 ,e4 ,,e/imat$ ,,"t ,,( ,,arrival3 #bjaj ,,h\rs1 ,,janu>y #ab1 #bjjb4 #b4 ,,special ,,h&l+ ,,requirem5ts3 ,,dry ,,ice ,,enclos$ ,,z ,,coolant4 #c4 ,,%ipm5t ,,consi/s ,,( ,,two ,,ice ,,*e/s 7#a ,,= ,,crdec ,,& #a ,,= ,,afmic7 ,,conta9+ ,,six ,,samples_/,,specim5s4 ,,all ,,liquid ,,samples_/,,specim5s ,,are ,,9 ,,polypropyl5e ,,tubes ,,& ,,h ,,be5 ,,c>efully ,,pack$ ,,to ,,avoid ,,breakage4 ,,! ,,foll[+ ,,samples ,,are ,,includ$ ,,9 ,,! ,,%ipm5t3 ,,sample_/,,specim5 ,,numb] ,,message ,,ref]5ce ,,?-#hejajb-jja;,,ag ,,?ru ,,?-#hejajb-jje;,,ag ,,bangkok ,,ddttttz ,,jan #jb #d4 ,,usdao ,,has ,,/at$ ,,t ,,?is ,,%ipm5t ,,is ,,p>tial ,,fulfillm5t ,,( ,,cir4 ,figure ,b-l4 ,sample %ipp+ notification message4 ,b-#ah4 ,sample_/,specim5 ,backgr\nd ,docum5ts ,! sample_/specim5 backgr\nd docum5t all[s a collector to note ! mo/ relevant details associat$ ) pre- & po/-sample_/specim5 collection conditions4 ,d n consid] ! report to be all-inclusive4 ,! in=mation collect$ %\ld include at lea/ ! items li/$ 9 ,figure ,b-#b4 ,int]views %\ld be conduct$ ) individuals expos$ to ! ,,cb ag5t z well z individuals n expos$ 7see ,figure ,b-#c74 #a4 ,,id ,,numb] #b4 ,,collection 7,,date_/,,"t73 #c4 ,,collector_/,,unit3 #d4 ,,type3 ,,environm5tal ,,biom$ical ,,s+le ,,multiple #e4 ,,purpose3 ,,attack ,,*em_/,,bio ,,al>m ,,*em ,,detect ,,recon ,,illness_/,,dea? ,,o!r #f4 ,,po/exposure3 ,,h\rs ,,days ,,weeks ,,unkn[n #g4 ,,location3 ,,t[n ,,coord9ates ,a4 ,,t]ra93 ,,flat ,,hills ,,m\nta9 ,,des]t ,,jungle ,,sp>se ,,trees ,,grass ,,body ,,( ,,wat]_/,,type ,b4 ,,wea!r3 ,,cle> ,,cl\dy ,,ra9 ,,fog ,,sn[ ,,du/ ,c4 ,,w9d3 ,,light ,,heavy ,,gu/y ,,none ,d4 ,,odor3 ,,sweet ,,fruity ,,pepp] ,,fl[] ,,irritat+ ,,*ang+ ,,none ,,o!r ,e4 ,,temp]ature ,,at ,,"t ,,( ,,attack3 ,,temp]ature ,,at ,,"t ,,( ,,sample ,,collection3 #h4 ,,comm5ts3 #i4 ,,attack3 ,,date_/,,"t ,,me?od3 ,,artill]y ,,rocket ,,aircraft ,,mort> ,,rpg_/,,gr5ade ,,o!r1 ,,describe3 ,a4 ,,explosion3 ,,air 7,,height7 ,,gr\nd ,,size ,,di/ance ,,describe3 ,b4 ,,consi/5cy3 ,,smoke ,,mi/ ,,du/ ,,ra9 ,,gel ,,invisible1 ,,describe3 #aj4 ,,environm5tal ,,sample3 ,,soil ,,wat] ,,vegetation ,,air ,,o!r #aa4 ,,biom$ ,,specim53 ,,acute ,,convalesc5t ,,expos$ ,,n ,,ill ,,po/mortem ,,control1 ,,expla93 ,,blood ,,liv] ,,lung ,,sple5 ,,bra9 ,,sk9 ,,kidney ,,ur9e ,,o!r1 ,,describe3 #ab4 ,,comm5ts3 #ac4 ,,casualty3 ,,ssn ,,unit ,,sex #ad4 ,,signs_/,,symptoms3 ,,onset ,,duration ,a4 ,,head3 ,,fev] ,,*ills ,,heada*e ,,flu%$ ,,dizz9ess ,,unconsci\sness ,,coma ,,halluc9ations ,b4 ,,eyes3 ,,sunlight ,,s5sitive ,,pa9ful ,,burn+ ,,droopy ,,eyelids ,,d\ble ,,vision ,,blurr$ ,,vision ,,l>ge ,,pupils ,,p9po9t ,,pupils ,c4 ,,nose3 ,,runny ,,ble$+ ,d4 ,,?roat3 ,,sore ,,dry ,,salivat+ ,,bloody ,,sputum ,,ho>s5ess ,,difficulty ,,speak+ ,e4 ,,respiration3 ,,difficulty ,,brea?+ ,,*e/_/,,pa9 ,,discom=t ,,:eez+ 7,,9_/,,out7 ,,c\gh+ ,,labor$ ,,brea?+ ,f4 ,,he>t ,,p\nd+ ,,or ,,runn+ ,,irregul> ,,he>tbeat ,g4 ,,gi3 ,,loss ,,( ,,appetite ,,nausea ,,frequ5t ,,vomit+ ,,frequ5t ,,di>rhea ,,vomit+ ,,blood ,,di>rhea ,,) ,,blood ,h4 ,,ur9>y3 ,,bloody ,,ur9e ,,unable ,,to ,,ur9ate ,i4 ,,musculoskeletal3 ,,neck ,,pa9 ,,muscle ,,t5d]ness ,,muscle ,,trembl+_/,,twit*+ ,,weakness ,,p>alysis1 ,,describe3 ,,convulsions ,,tremors ,,muscle ,,a*es ,,back ,,pa9 ,,jo9t ,,pa9 ,j4 ,,sk93 ,,ra% ,,r$d5+ ,,it*+ ,,bli/]s ,,pa9 ,,numbness ,,pr(use ,,p]spiration #ae4 ,,comm5ts3 #af4 ,,animals ,,affect$3 ,,yes ,,no ,,describe3 #ag4 ,,relat$ ,,specim5s ,,id ,,numb] ,,description #ah4 ,,collector ,,signature ,,"n ,,phone ,,numb] ,e-,,mail #ai4 ,,review] ,,signature ,,"n ,,phone ,,numb] ,e-,,mail ,figure ,b-#b4 ,sample_/specim5 backgr\nd docum5t4 ,,cb ,,incid5t ,,int]view ,,date3 ,,int]view]3 ,,subject',s ,,"n3 ,,alias #a #b ,,age3 ,,sex3 ,m ,f ,,ye> ,,( ,,bir?3 ,,nationality3 ,,subject',s ,,address3 ,,id5tity ,,c>d 3 ,,deliv]y ,,me?ods3 ,,type3 ,,unkn[n ,,gr\nd ,,air ,,artill]y_/,,rocket ,,m9e ,,o!r1 ,,describe3 ,,height3 7,m7 ,,size3 7,,affect$ ,,area ,,9 ,,met]s7 ,,di/ance3 7,m7 ,,ag5t ,,*>act]i/ics ,,odor3 ,,none ,,sweet ,,fruity ,,irritat+ ,,pepp] ,,fl[] ,,*ang+ ,,o!r1 ,,describe3 ,,comm5ts3 ,,consi/5cy3 ,,smoke ,,mi/ ,,du/ ,,ra9 ,,gel ,,dry ,,visible ,,invisible ,,o!r1 ,,describe3 ,,color3 ,,describe ,,developm5t ,,( ,,color3 ,,area ,,cov]age3 ,,physical ,,dissem9ation_/,,cov]age 7i4e41 ,,droplet ,,size ,,& ,,di/ribution73 ,,write ,,or ,,draw ,,symptoms3 ,,individual',s ,,actions3 ,,dur+ ,,attack3 ,,aft] ,,attack3 ,,protective ,,measures3 ,,treatm5t ,,receiv$3 ,,environm5tal ,,effects3 ,,vegetation ,,*ange8 ,,yes ,,no ,,describe3 ,,animals ,,affect$8 ,,yes ,,no ,,describe3 ,,o!rs ,,affect$3 ,,"n ,,age ,,symptoms ,,resolution ,figure ,b-#c4 ,*emical_/biological incid5t int]view4 ,,fm ,,amembassy ,,ddttttz ,,jan #jb #a4jj ,,%ipp+ ,,to ,,cdr ,,teu ,,apg ,,md_/,,smcte-,,opei_/ ,,sec/ate ,,wa%dc ,,secdef ,,wa%dc_/_/,,osd-,,isa_/,,ous-,,dre_/_/ ,,info ,,cia ,,wa%dc_/_/,,oswr-,,/d-,,lsb_/,,nic-,,ni o7,,/p7_/_/ ,,jcs ,,wa%dc_/_/,j-#c_/;,j-#e_/_/ ,,dia ,,wa%dc_/_/,,dt-#c;,b_/,,dt-#e;,a_/_/ ,,dir ,,nsa ,,ft ,,meade ,,md ,,dir ,,afmic ,,ft ,,detrick ,,md_/_/,,afmic- ,,cr_/,,afmic-,,sa_/_/,,da ,,wa%dc_/_/ ,,dami-,,fit_/,,damo-,,swc_/_/ ,,cdr ,,f/c ,,*>lottesville ,,va_/_/,,aia/-,,ra-,,id#b_/_/ ,,cdr ,,crdec ,,apg ,,md_/_/,,smccr-,,ope_/_/ ,,cdr ,,usacmls ,,ft ,,leon>d ,,wood ,,mo_/_/,,atsn-,,cm-,,co_/_/ ,,cdr ,,usamriid ,,ft ,,detrick ,,md_/_/ 7,,= ,,suspect ,,biological ,,samples_/,,specim5s ,,only7 ,,classification ,,sec/ate ,,=444 ,,secdef ,,= ,,cia ,,= ,,jcs ,,= ,j-#c_/;,j-#e ,,= ,,da ,,= ,,damo-,,swc ,,= ,,afmic ,,= ,,crdec ,,= ,,fio ,,f/c ,,= ,,amx/-,,fm ,,usacmls ,,= ,,?reat ,,mgr ,e4,o4 #abcef3 ,,decl3 ,,oadr 7,,note3 ,?is is includ$ if ! message is classifi$47 ,,tags3 ,,subject3 ,,%ipm5t ,,( ,,cb ,,samples ,,ref7,s73 ,,teu ,,msg1 4 7,,dtg ,,ddtttt "t zone ,jan #jb7 #a4 ,,in=mation3 ,a4 ,,date ,,%ipp$3 ,,janu>y #aa4bjjb4 ,b4 ,,mode ,,( ,,transportation3 ,,air ,,express4 ,,air ,,bill ,,numb] ,,rpt ,c4 ,,flight ,,s*$ule3 ,,to ,,tyo ,,by ,,jal ,,xxx ,,janu>y #aa1 #bjjb4 ,,to ,,jfk ,,by ,,jal ,,yyy1 ,,janu>y #ac1 #bjjb4 ,,to ,,iad ,,by ,,dec ,,zzz1 ,,janu>y #ab1 #bjjb4 ,d4 ,,de/9ation3 ,,dulles ,,int]national ,,airport ,e4 ,,e/imat$ ,,"t ,,( ,,arrival2 #bjaj ,,h\rs4 ,,janu>y #ab1 #bjjb4 #b4 ,,special ,,h&l+ ,,requirem5ts3 ,,dry ,,ice ,,enclos$ ,,z ,,coolant4 #c4 ,,%ipm5t ,,consi/s ,,( ,,two ,,ice ,,*e/s 7#a ,,= ,,crdec ,,& #a ,,= ,,afmico7 ,,conta9+ ,,six ,,samples_/,,specim5s4 ,,all ,,liquid ,,samples_/,,specim5s ,,are ,,9 ,,polypropyl5e ,,tubes ,,& ,,h ,,be5 ,,c>efully ,,pack$ ,,to ,,avoid ,,breakage4 ,,! ,,foll[+ ,,samples_/,,specim5s ,,are ,,includ$ ,,9 ,,! ,,%ipm5t3 ,,sample_/,,specim5 ,,numb] ,,message ,,ref]5ce ,,?-#heja #a;,,ag ,,?ru ,,?-#hejajb-jje;,,ag ,,bangkok ,,ddttttz ,,jan #jbjb-jj #d4 ,,usdao ,,has ,,/at$ ,,t ,,?is ,,%ipm5t ,,is ,,p>tial ,,fulfillm5t ,,( ,,cir4 ,figure ,b-#d4 ,sample_/specim5 %ipp+ report4 ,,app5dix ,c ,,guidel9es ,,= ,,op]ational ,,plann+ ,,= ,,heal? ,,s]vice ,,support ,,9 ,a ,,nucle>1 ,,biological1 ,,& ,,*emical ,,environm5t ,c-#a4 ,g5]al ,z ! ,,hss unit prep>es = its support role1 ,,nbc1 ,,tim1 & ,,cbrne consid]ations mu/ be includ$4 ,?is app5dix provides guidel9es = ,,hss plann+1 prep>+ =1 & conduct+ op]ations 9 an ,,nbc environm5t & respond+ to a homel& def5se ,,cbrne ev5t4 ,c-#b4 ,pr$eploym5t ,:5 prep>+ ! unit's mobilization plan & ,,tsop1 include ! supplies & equipm5t t w be requir$ = ! unit to op]ate 9 an ,,nbc environm5t4 ,,d ,,n wait until ord]$ to mobilize to beg9 prep>ation = ! mission4 ,a well-prep>$ & tra9$ unit /&s a mu* bett] *ance ( surviv+ & accompli%+ _! assign$ mission4 ,at a m9imum include ! foll[+3 ,n]ve ag5t pretreatm5t & antidotes 7see ,,fm #h-bhe74 ,bli/] ag5t antidote_/treatm5t 7see ,,fm #h-bhe74 ,incapacitat+ ag5t treatm5t 7see ,,fm #h-bhe74 ,lung-damag+ ag5ts 7*ok+ ag5ts7 treatm5t 7see ,,fm #h-bhe74 ,blood ag5t 7cyanog57 treatm5t 7see ,,fm #h-bhe74 ,biological ag5t immunizations & *emoprophylaxis 7see ,,fm #h-bhd74 ,biological ag5t treatm5t 7see ,,fm #h-bhd74 ,nucle> & radiological treatm5t 7see ,,fm #d-jb4bhc74 ,protective mask ) hood = ea* individual 7see ,,fm #c-d74 ,replacem5t filt]s = protective mask 7see ,,fm #c-d74 ,two sets ( ,,mopp p] individual assign$ to unit 7see ,,fm #c-d74 ,all au?oriz$ radiation detection equipm5t4 ,all au?oriz$ *emical ag5t detection equipm5t4 ,all au?oriz$ ,,nbc al>m sy/ems4 ,biological ag5t detection equipm5t1 if available4 ,sample_/specim5 collection1 packag+1 & %ipp+ supplies = suspect ,,nbc ag5ts4 ,decontam9ation equipm5t & supplies 7,,ds#b1 ,,/b1 pails1 sponges1 mops1 decontam9ant application app>atus1 individual sk9 decontam9ation kits1 & individual equipm5t decontam9ation kits see ,,fm #c-e74 ,mat]ial = cov]+ supplies & equipm5t 7su* z pla/ic %eet+1 tape1 & t>paul9s74 ,mat]ial = prep>+ improvis$ protection 9 %elt]s 7su* z pla/ic %eet+1 t>paul9s1 tape1 & s&bags74 ,collective protection %elt] sy/ems ) repair p>ts1 if available4 ,*emical ag5t pati5t decontam9ation ,m$ical ,equipm5t ,set 7,,mes74 ,! ,,mes c also be us$ to decontam9ate nucle> & biological pati5ts1 if au?oriz$4 ,*emical ag5t pati5t treatm5t ,,mes4 ,"s compon5ts may also be us$ to treat nucle> & biological pati5ts1 if au?oriz$4 ,wat] supply = pati5t decontam9ation1 if requir$4 ,%ovels1 picks1 & axes4 ,lightweight decontam9ation sy/em ,m#ag & o!r decontam9ation app>atuses4 ,applicable ref]5ces 7,army ,regulations ,a,rs1 ,jo9t publications1 ,f,ms1 te*nical manuals ,t,ms1 tra9+ circul>s ,t,cs1 & ,t,s,o,ps74 ,c-#c4 ,mobilization ,dur+ mobilization ! unit mu/ ensure t all supplies & equipm5t are on h& & are s]viceable4 ,comm&]s & lead]s mu/ also ensure t-- ,movem5t plans are prep>$4 ,transportation support requirem5ts are id5tifi$ & reque/$4 ,load plans include provisions = ! transportation ( ,,nbc supplies & equipm5t 7m$ical & nonm$ical74 ,a ,,mopp level has be5 e/abli%$ = ! movem5t1 if applicable4 ,a *eckli/ ( tra9+ %ortfalls is prep>$ & a tra9+ plan is 9 place4 ,c-#d4 ,e/abli% a ,m$ical ,treatm5t ,facility ,plans = e/abli%+ a ,,bas1 ,,dcs1 or ,,f/ = op]at+ 9 a ,,nbc environm5t mu/ include employm5t ( ,,cbps sy/ems4 ,:5 e/abli%+ a hospital us+ ,deployable ,m$ical ,sy/ems 7,,depm$s71 ! *emically protect$ 7,,cp7 ,,depm$s mu/ be set up z ! conv5tional %elt]s are be+ set up4 ,once ! conv5tional %elt] has be5 set up & is op]ational1 ,,cp ,,depm$s _c be e/abli%$ )\t fir/ tak+ d[n ! exi/+ %elt]4 ,foll[ ! te*nical manual provid$ ) ! ,,cp ,,depm$s sy/em issu$ to y\r unit4 ,plans = op]at+ a ,,depm$s equipp$ hospital 9 ! ,,nbc environm5t %\ld include1 b n be limit$ to-- ,coord9at+ ) ! support$ unit to ensure unit casualty collect+ po9ts & pati5t decontam9ation po9ts are on ! ,,hss template4 ,if possible1 integrate ,,hss units_/elem5ts into local units ,,nbc detection sy/ems & communications sy/ems4 ,survey+ ! ,,ao4 ,survey ! area to ensure contam9ation is n pres5t be=e e/abli%+ ! ,,mtf4 ,e/abli%+ detection /ations on ! unit's p]imet]4 ,det]m9+ direction ( prevail+ w9d4 ,all contam9at$ pati5ts1 ambulances1 & helicopt]s mu/ arrive on ! d[nw9d side ( ! ,,mtf2 ?is mu/ be done ) or )\t ,,cps4 ,sett+ up ! contam9at$ triage1 pati5t decontam9ation1 & contam9at$ treatm5t areas 7includ+ ov]head cov]74 ,e/abli%+ ! contam9at$ ambulance po9t4 ,e/abli%+ ! contam9at$ helicopt] l&+ area4 ,prep>+ ! contam9at$ wa/e dump4 ,e/abli%+ ! clean ambulance po9t4 ,e/abli%+ ! clean helicopt] l&+ area4 ,m>k+ ! hot l9e & prep>+ ! %uffle pit4 ,employ+ ,,cp ,,depm$s sy/em 7close %elt]1 turn on ,,cb filtration units1 close air locks1 & ma9ta9 ov]pressure71 if available4 ,e/abli%+ ! clean treatm5t area #cj to #ej y>ds 7met]s7 upw9d ( hot l9e1 :5 ,,cps is n available4 ,ensur+ provisions = ov]head cov] at ! pati5t decontam9ation area4 ,reque/+ pati5t decontam9ation p]sonnel f support$ units = ! ,,bas & ,,dcs1 or f units locat$ )9 ! geographic area = hospitals4 ,reque/+ issue ( *emical pati5t treatm5t & *emical pati5t decontam9ation ,m,e,ss1 if n on-h&4 ,e/abli%+ contam9ation monitor+ proc$ures 9 ,,cps4 ,e/abli%+ control proc$ures = p]sonnel cross+ ! hot l9e 7?r\gh ! %uffle pit74 ,e/abli%+ ,,cps entry & exit control proc$ures 7see ,app5dix ,f74 ,mak+ improvisations2 if ! ,,mtf mu/ op]ate 9 a nucle>_/radiological environm5t4 ,= optional improvisations1 see ,app5dix ,h4 ,c-#e4 ,op]ate a ,m$ical ,treatm5t ,facility ,receiv+ ,contam9at$ ,pati5ts ,individuals %\ld h decontam9at$ !mselves or h be5 decontam9at$ by unit p]sonnel2 h[ev]1 an ,,mtf mu/ plan = & be prep>$ to receive contam9at$ pati5ts4 ,! pati5ts may n h be5 decontam9at$ at ! unit1 or !y may h become contam9at$ en r\te to ! ,,mtf4 ,select$ ,c,s,hs may be designat$ z ! prim>y ,,nbc ,,mtf & be augm5t$ ) additional supplies & m$ical /aff4 ,:5 designat$ z su*1 plans mu/ be prep>$ designat+ ! location ( ! ,,c% t c be/ support ! =w>d deploy$ ,m,t,fs4 ,all actions li/$ 9 p>agraph ,c-#d mu/ be tak54 ,dur+ op]ations1 actions t mu/ be tak5 are-- ,e/abli%+ a ,,mopp level comm5surate ) ! op]ation4 ,requir+ all ambulances & helicopt]s ) contam9at$ 7or suspect$7 pati5ts to /ay d[nw9d ( ! ,,mtf4 ,conduct+ initial triage1 decontam9ation1 & contam9at$ treatm5t d[nw9d ( ! clean treatm5t area 7,app5dixes ,f & ,h74 ,ensur+ all p]sonnel cross+ ! hot l9e are decontam9at$4 ,monitor+ p]sonnel ent]+ clean area to ensure t !y are contam9ation free4 ,monitor+ = contam9ation 9 ! clean treatm5t area 7) or )\t ,,cps74 ,e/abli%+ an int]nal monitor+ program to p]iodically v]ify t ! ,,mtf is contam9ation free4 ,monitor+ ,,cps = entry ( contam9ation4 ,provid+ protection = pati5ts if contam9ation ent]s ! ,,mtf4 ,ensur+ p]sonnel dr9k suffici5t quantities ( wat] to prev5t heat injury 7see ,,fm #ba-aj74 ,provid+ protection = p]sonnel & pati5ts 9 a cold environm5t4 ,use %elt]$_/heat$ area = pati5t decontam9ation4 ,provid+ protection ( p]sonnel & pati5ts 9 a hot environm5t4 ,controll+ contam9at$ wa/e4 ,isolat+ biological ag5t pati5ts1 if necess>y1 to control spread ( ag5t_/disease 7see ,,fm #h-bhd74 ,protect+ supplies & equipm5t f contam9ation4 ,provid+ m$ical resupply to clean areas4 ,provid+ food s]vice = p]sonnel & pati5ts 9 ,,cps4 ,provid+ latr9e facilities 9 ,,cps4 ,provid+ dr9k+ wat] 9 ,,cps4 ,provid+ wa/e disposal support4 ,remove wa/e f ! ,,cps at lea/ two times dally4 ,m frequ5tly if l>ge am\nts are collect$ or if odors become a problem4 ,collect+ suspect ,,bw ag5t specim5s f pati5ts4 ,packag+1 prep>+ *a9 ( cu/ody docum5t1 & %ipp+ specim5s to support+ m$ical laboratory4 ,c-#f4 ,prev5tive ,m$ic9e ,s]vices ,plans = provid+ prev5tive m$ic9e s]vices mu/ include monitor+ wat] supplies = contam9ation4 ,to p]=m ?is mission1 equipm5t & supplies mu/ be available & op]ational4 ,ess5tial equipm5t & supplies include-- ,radiation detection equipm5t su* z ,,an_/,,pdr#gg1 ,,an_/,,pdr#bg1 ,,an_/,,vdr#b4 ,prev5tive ,m$ic9e ,wat] ,quality ,control ,set4 ,m#bgb ,*emical ,ag5t ,detection ,set4 ,biological sample collection kit1 %ipp+ conta9]s1 refrig]ant1 & *a9 ( cu/ody =ms4 ,c-#g4 ,vet]9>y ,s]vices ,plans = vet]9>y s]vices mu/ include provision+ = treatm5t to gov]nm5t-own$ animals & quality control ( food supplies4 ,to p]=m _! mission1 ess5tial supplies & equipm5t include-- ,treatm5t = ,,nbc injur$ animals4 ,especially1 antidotes & treatm5t = ,,cb ag5ts4 ,radiation detection equipm5t4 ,m#bgb ,*emical ,ag5t ,detection ,set4 ,biological sample_/specim5 collection kit1 %ipp+ conta9]s1 refrig]ant1 & *a9 ( cu/ody =ms4 ,c-#h4 ,d5tal ,s]vices ,mo/ d5tal s]vices at ! d5tal treatm5t facilities w h to be susp5d$ 9 ,,nbc contam9at$ areas due to a lack ( ,,cps4 ,plans mu/ include = em]g5cy d5tal s]vices to be provid$ 9 a clean area or 9 an ,,mtf ) a ,,cps4 ,ess5tial supplies & equipm5t include-- ,d5tal treatm5t set = maxill(acial injuries4 ,mat]ial = cov]+ & protect+ supplies & equipm5t4 ,c-#i4 ,combat ,op]ational ,/ress ,control ,al?\gh specific supplies & equipm5t are n requir$ = ,,cosc1 plans mu/ be prep>$ to provide ^! s]vices "u ,,nbc conditions4 ,! ,,cosc /aff mu/ locate clean areas to conduct ,,cosc activities or manage ! ,,cosc pati5ts 9 a ,,mopp level comm5surate ) ! comm& ,,mopp guidance4 ,c-#aj4 ,m$ical ,laboratory ,s]vices ,plann+ = m$ical laboratory support mu/ include plans = conduct+ analysis on suspect ,,nbc samples_/specim5s4 ,designat$ support+ m$ical laboratories mu/ be prep>$ to analyze & provide confirmation_/id5tification on specim5s_/samples ( suspect ,,nbc ag5ts f humans1 wat] s\rces1 food supplies1 & ! environm5t 7air & soil74 ,! samples_/specim5s may be collect$ by ,,mtf p]sonnel1 *emical corps p]sonnel1 ,,pvntm$ p]sonnel1 vet]9>y p]sonnel1 or o!r s]vices p]sonnel4 ,to p]=m ?is mission1 supplies & equipm5t %\ld include-- ,g5]al supplies & equipm5t4 ,biological sample_/specim5 collection kits & supplies4 ,to provide capabilities = o!rs to collect samples_/specim5s 79 ! ev5t t !y d n h ^! items o!rwise available74 ,biological te/ kits or app>atus4 ,microbiology s]vices4 ,immunology_/s]ology ,,mes4 ,microbiology ,,mes4 ,laboratory1 g5]al ,,mes4 ,vet]9>y s]vices4 ,laboratory1 vet]9>y ,,mes4 ,vet]9>y po/mortem field ,,mes4 ,prev5tive m$ic9e s]vices4 ,wat]1 biological sampl+ & analysis supplies & equipm5t4 ,radiation protection ,,mes4 ,entomology ,,mes4 ,alpha_/beta detectors4 ,microscope1 phase4 ,ambi5t air analyz]4 ,epidemiology ,,mes4 ,c-#aa4 ,heal? ,s]vice ,logi/ics ,plans mu/ include heal? s]vice logi/ics support to cont9ue "u ,,nbc conditions4 ,to cont9ue ?is role1 all supplies mu/ be protect$ f contam9ation4 ,mat]ials requir$ include-- ,detection equipm5t4 ,pla/ic %eet+4 ,tape4 ,t>paul9s4 ,,nbc detection equipm5t su* z1 ,m#h *emical ag5t detection pap]1 ,m#i *emical ag5t detection tape1 radiation detection equipm5t1 & biological ag5t sample_/specim5 collection supplies4 ,,note ,?is guidel9e conta9s items t are requir$ specifically = ,,hss op]ations 9 an ,,nbc environm5t4 ,! items are 9 addition to supplies & equipm5t requir$ = conv5tional op]ations4 ,?is guidel9e is n all inclusive1 b is a />t+ po9t = ,,hss units to develop _! specific guidel9es4 ,c-#ab4 ,homel& ,security ,heal? s]vice support units & in/allation m$ical activities_/c5t]s mu/ be prep>$ to provide support 9 ! ev5t t ,,cbrne are us$ on ! ,unit$ ,/ates4 ,m$ical comm&]s & lead]s %\ld develop plans on h[ ! provision ( m$ical support w be provid$ to a ,,cbrne ev5t4 ,! plan %\ld include1 b n be limit$ to-- ,numb] & type ( units requir$ to respond4 ,m$ical equipm5t & supplies requir$4 ,p]sonal protective equipm5t requir$ = m$ical response p]sonnel4 ,"t requir$ to prep>e unit_/p]sonnel to respond4 ,l5g? ( "t response support is requir$4 ,s\rces = food1 %elt]1 local transportation1 & resupply ( exp5d$ or lo/ equipm5t & supplies4 ,,app5dix ,d ,,m$ical ,,plann+ ,,guide ,,= ,,! ,,e/imation ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,battle ,,casualties ,section ,i4 ,,introduction ,d-#a4 ,g5]al ,! prim>y purpose ( ! ,m$ical ,plann+ ,guide = ! ,e/imation ( ,nucle>1 ,biological1 & ,*emical ,battle ,casualties--,a,med,p-#h7;,a71 a ?ree-volume publication = ,,nbc1 is to assi/ m$ical plann]s1 m$ical logi/icians1 & m$ical /aff (fic]s 9 pr$ict+ ,,nbc w>f>e cont+5cy requirem5ts = ,,hss p]sonnel1 m$ical mat]iel /ockpiles1 pati5t transport or evacuation capabilities1 & facilities ne$$ = pati5t decontam9ation1 triage1 treatm5t1 & supportive c>e4 ,! optional use ( ^! guides is = project+ m$ical ,,nbc op]ational e/imates at brigade1 division1 corps1 & ,,eac4 ,,note ,! use ( ! guide 9 ?is app5dix ref]s to ,a,med,p-#h7;,a71 ,volume ,i1 ,,ii1 or ,,iii4 ,! ,a,med,p-#h7;,a71 ,volume ,i1 ,,ii1 or ,,iii1 is ! text = ea* ( ! ,s,t,a,n,a,gs4 ,! cont5ts ( ?is app5dix are extracts f ,sections #a1 #b1 & #c ( ! guide4 ,d-#b4 ,m$ical ,plann]s' ,tool ,m$ical plann]s' e/imates 7su* z casualty1 logi/ics1 evacuation1 & p]sonnel cross level+7 mu/ be modifi$ = ! ,,nbc environm5t4 ,e/imates ( ,,nbc m$ical workload c be f\nd 9 ,a,med,p-#h7;,a74 ,a compact disk conta9+ ^! docum5ts & an automat$ v]sion ( ,a,med,p-#h7;,a71 ! ,casualty ,requirem5ts ,e/imation ,tool 7,,cre/71 c be obta9$ f ,headqu>t]s1 ,dep>tm5t ( ! ,army1 ,,attn3 ,,dasg-,,hcz-,,fd1 #eaji ,leesburg ,pike1 ,falls ,*ur*1 ,,va #bbjda-cbeh4 ,! ,,cre/ is prim>ily an ,army tool focus+ on corps1 brigades1 & battalions1 b also models a]ial ports ( deb>kation1 seaports ( deb>kation1 & o!r units4 -------------------------------------- ,?is ,section ,implem5ts ,,/anag #bdge4 -------------------------------------- ,section ,,ii4 ,,m$ical ,,plann+ ,,guide ,,= ,,! ,,e/imation ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,battle ,,casualties 7,,nucle>7--,a,med,p-#h7;,a71 ,,volume ,i ,d-#c4 ,g5]al a4 ,volume ,i ( ! guide provides e/imates ( casualties & rema9+ op]ational /r5g? aft] a nucle> detonation 9 a brigade-siz$ unit dur+ an out-(-area cont+5cy op]ation4 ,^! e/imates include ! numb]s1 injury type 7initial nucle> radiation1 bla/1 & !rmal injuries71 & injury sev]ity ( nucle> pati5ts bas$ on sev]al brigade sc5>ios4 ,! sc5>ios include ?ree diff]5t brigade-siz$ units1 9 w>n$ or unw>n$ po/ure1 :i* h s+le detonation ( #e1 #bj1 or #ej ,,kt 9 ! unit area4 b4 ,! guide is organiz$ into #aj sections4 ,section #a introduces ! guide & pres5ts backgr\nd & m$ical plann+ consid]ations4 ,section #b provides in=mation on ! me?odology us$ to develop ! e/imates ( fatalities1 casualties1 & effectiv5ess ( individuals rema9+ 9 ! unit4 ,section #c explores ! use ( ! casualty pr$iction tables bas$ on combat effectiv5ess decrem5ts & e/imates ( ! numb] ( casualties categoriz$ by insult level4 ,sections #d ?r\gh #aj conta9 tables ( casualty e/imates4 c4 ,a sample ( ?is in=mation is graphically depict$ 9 ,tables #a-a & #a-b ( ! guide4 ,! casualty e/imates us$ to prep>e ^! tables are pres5t$ 9 ! guide z ,tables #f-d & #aj-d 9 ,sections #f & #aj respectively4 ,! use ( ^! tables is expla9$ 9 p>agraphs #c4a ?r\gh #c4f ( ! guide4 ,p>agraphs #c4g & #c4h ( ! guide discuss h[ to use ! guide = situations n explicitly address$4 d4 ,! effects ( residual radiation on p]sonnel are n includ$ 9 ! guide4 ,a,med,p-#f & ,a,med,p-#g provide in=mation on plann+1 op]ations1 & treatm5t = a residual radiation situation4 ,also n includ$ is ! impact ( tumbl+2 impact ( glass %>ds f w9d[s ( vehicles or build+s2 cru%+ dea?s f build+ failure2 or ,,cosc casualties2 ?us caus+ und]e/imations on ! numb] ( pati5ts4 ,fur!r1 !re w be p]sonnel :o get radiation doses or burns & d n seek m$ical c>e4 e4 ,a nucle> detonation may introduce new levels ( de/ruction to ! battlefield4 ,!re is v little exp]i5ce ) nucle> effects & !re is c]ta9ly no exp]i5ce ) ^! weapons on a mod]n1 highly te*nological battlefield4 ,!re=e1 !re is little hi/orical data on :i* to base e/imates ( p]sonnel injur$4 ,comput] simulations are g5]ally us$ to e/imate numb]s ( p]sonnel injur$4 ,al?\gh ^! e/imates may include significant unc]ta9ty1 !y provide ! be/ e/imates to date4 ,d-#d4 ,m$ical ,plann+ ,consid]ations a4 ,= effective mass casualty managem5t1 key m$ical & relat$ consid]ations mu/ be well plann$ & practic$4 ,^! include on-site triage & em]g5cy c>e1 communications1 heal? s]vice logi/ics1 evacuation by gr\nd & air res\rces1 & p]sonnel tra9+ 9 self-aid_/buddy aid4 ,plans ne$ to be made = requirem5ts t may diff] f ! usual combat situation4 ,= example1 9 combat situations1 sev]e burn injuries 9 l>ge numb]s are relatively uncommon4 ,!re=e1 no special plann+ = ! c>e ( l>ge numb]s ( burn pati5ts is requir$4 ,9 a nucle> environm5t1 ?is may n be true1 & consid]ation mu/ be giv5 to ! increas$ ne$ = m$ical support t w\ld result f a high incid5ce ( burn pati5ts4 b4 ,prior to an attack1 ! data may be us$ by m$ical plann]s to augm5t ! requirem5ts = conv5tional combat z appropriate = ! nucle> situation4 ,! tables c be us$ to prep>e e/imates ( ! numb] ( pati5ts at all e*elons4 c4 ,aft] an attack1 ! effectiv5ess & adequacy ( ! m$ical support ef=t dur+ ! fir/ #bd h\rs are critical4 ,comm&]s %\ld be in=m$ rapidly ( ! e/imat$ m$ical load 9 ord] to provide rescue & treatm5t res\rces or reque/ assi/ance f high] headqu>t]s1 adjac5t units1 or alli$ units4 ,^! e/imates %\ld be updat$ po/attack bas$ on a]ial or gr\nd reconnaissance & survey4 d4 ,9 addition to casualties1 a nucle> weapon detonation c g5]ate an ,,emp t may cause cata/rophic failures ( electronic equipm5t compon5ts & may adv]sely affect ! capability ( all units 9 ! area ( ! detonation4 ,electromagnetic pulse has no direct effect on p]sonnel & is n fur!r address$ 9 ?is publication4 ,d-#e4 ,triage ,s9ce a nucle> detonation may produce mass casualties1 plans = a triage sy/em mu/ be 9 place4 ,p>agraphs #c4d ?r\gh #c4e ( ! guide describe pati5t categories by injury sev]ity & may be us$ to e/imate ! numb] & injury sev]ity ( pati5ts = a p>ticul> op]ational sc5>io4 ,! guide does n1 h[ev]1 provide e/imates ( ! numb] ( pati5ts by triage classification4 ,d-#f4 ,evacuation a4 ,an effici5t & flexible evacuation plan is absolutely ess5tial = ! pres]vation ( life & to reta9 ! mobility ( =w>d m$ical res\rces4 ,9 a pot5tial mass casualty situation1 ! full range ( evacuation assets %\ld be consid]$4 b4 ,! ext5d$ hospital "t ( nucle> casualties w influ5ce levels ( evacuation or hospitalization4 ,9 addition1 e/imates ( ! diff]5t types ( casualties c be a consid]ation 9 evacuation plann+4 ,9 plann+ = evacuation1 e/imates provid$ 9 ! guide c be us$ z a />t+ po9t f :i* to e/imate evacuation res\rces4 ,d-#g4 ,9-,unit ,c>e a4 ,"s p]sonnel )9 ! milit>y unit may n be classifi$ m$ically z casualties1 b w require "s self-aid & buddy aid4 ,a casualty is def9$ z anyone ent]+ ! m$ical sy/em4 ,p>agraph #b4e ( ! guide fur!r describes ! basis = casualty calculation4 b4 ,nucle> detonations w produce a l>ge numb] ( bla/1 burn1 & projectile injuries t initially mu/ be treat$ by individual soldi]s tra9$ 9 fir/ aid proc$ures4 ,! physical damage to ! surr\nd+ area z a result ( a nucle> detonation w increase delays 9 m$ical assi/ance & evacuation4 ,tra9+ 9 self-aid_/buddy aid w improve casualty survival rates & cons]ve m$ical res\rces4 ,! guide c be us$ to provide a cons]vative e/imate ( ! numb]s ( injur$ t w require fir/ aid4 ,! tables 9 ,sections #d ?r\gh #aj ( ! guide1 %[+ ! /atus ( unit p]sonnel by "t p]iod1 c be us$ to indicate ! numb]s ( p]sonnel :o are injur$ 7b n casualties7 :o may require fir/ aid4 ,d-#h4 ,hospital ,b$ ,requirem5ts ,! data provid$ 9 ! guide c be us$ to det]m9e imm$iate additional b$ requirem5ts result+ f a nucle> detonation4 ,9 addition to ! numb]s ( pati5ts :o w ne$ b$s1 ! data provid$ 9 ! guide c also indicate ! increas$ hospitalization "t ( nucle> casualties4 ,long-t]m b$ requirem5ts1 great] ?an #cj days1 are n provid$4 ,bas$ on ! !at] evacuation policy specifi$ = ! op]ation1 ! hospital b$ days may be 9 !at] or 9 ,,conus4 ,d-#i4 ,m$ical ,logi/ics ,! data provid$ 9 ! guide c assi/ 9 e/imat+ ! ne$$ supplies4 ,! supply sy/em mu/ be prep>$ = increas$ dem&s = c]ta9 types ( m$ical & g5]al supplies & equipm5t1 kits1 dress+s1 & antibiotics4 ,! treatm5t ( comb9$ injuries w n require any special types ( supplies1 al?\gh dem&s = c]ta9 types ( supplies w increase4 ,d-#aj4 ,m$ical ,=ce ,plann+ ,! assignm5t ( m$ical support is normally bas$ ^u ! total milit>y population & ! expect$ conv5tional casualty rate4 ,! data provid$ 9 ! guide may be us$ to assess ! requirem5t = additional m$ical units4 ,! plann+ guidance pres5t$ 9 ?is docum5t c 7& %\ld7 be modifi$ to reflect ! ne$s ( ! anticipat$ op]ation1 includ+ op]ational tempo1 national_/coalition priorities1 m$ical res\rce allotm5t1 & s =?4 ,:5 try+ to augm5t p]sonnel1 consid] t ! use ( a nucle> weapon 9 a tactical situation c\ld be an indication ( an increas$ tempo ( w>f>e4 ,!re=e1 ev5 ?\gh a unit may be t>get$ ) a nucle> detonation1 t unit may n be ! site :]e ! highe/ numb]s ( casualties are be+ produc$1 & ano!r unit may h priority ( support4 -------------------------------------- ,?is ,section ,implem5ts ,,/anag #bdgf4 -------------------------------------- ,section ,,iii4 ,,m$ical ,,plann+ ,,guide ,,= ,,! ,,e/imation ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,battle ,,casualties 7,,biological7--,a,med,p-#h7;,a71 ,,volume ,,ii ,d-#aa4 ,g5]al ,! guide1 ,a,med,p-#h7;,a71 ,volume ,,ii1 provides e/imates ( casualties1 & rema9+ op]ational /r5g?1 aft] s+le ,,bw attacks on tactically deploy$1 brigade-siz$ l& =ce units1 (f%ore naval & m>9e =ces1 & select$ /rategic t>gets 9 re> areas4 ,^! wor/-case casualty e/imates are = p]sonnel )9 bo? ! t>get$ & ! d[nw9d haz>d areas ( ! attack$ =ces4 ,!y assume t all affect$ p]sonnel w be un%elt]$ & unw>n$4 ,to fur!r e/imate wor/-case outcomes1 ! guide assumes t expos$ individuals h n be5 vacc9at$ aga9/ any ( ! evaluat$ ag5ts1 nor h !y und]gone any type ( m$ical prophylactic treatm5t prior to exposure4 ,! tables includ$ 9 ! guide are design$ to %[ numb]s ( expect$ casualties2 expect$ fatalities2 p]sonnel at diff]5t p]=mance levels2 & times aft] exposure4 ,9 select$ sc5>ios1 ! guide provides a me?od = e/imat+ casualties among collocat$ civilians bas$ on local population d5sity4 a4 ,! guide pres5ts casualty e/imates = all possible comb9ations ( ! foll[+ conditions3 ,elev5 op]ational sc5>ios4 ,sev5 biological ag5ts4 ,f\r types ( deliv]y sy/ems4 ,?ree attack int5sities4 b4 ,! guide is subject to limitations ( ext5t & cont5t4 ,s9ce !re are _m m possible attack v>iables ?an ^? consid]$1 ! guide pres5ts a limit$ numb] ( e/imates & provisional guidance = e/imat+ cases n model$4 ,^! e/imates are bas$ ^u ! be/ available m$ical data1 b su* data result 9 qualifi$ e/imates4 ,!re=e1 = m au?oritative m$ical descriptions1 m$ical plann]s & /aff p]sonnel %\ld use ,,fm #h-i1 ,,nato ,h&book on ! ,m$ical ,aspects ( ,,nbc ,def5sive ,op]ations1 ,a,med,p-#f7;,b71 ,"p ,,ii--,biological4 ,us]s ( ! guide mu/ amplify or modify ^! e/imates to meet em]g5t requirem5ts su* z injuries result+ f comb9$ biological & conv5tional attacks4 c4 ,comput] models t integrate available in=mation h be5 us$ to pr$ict ! effects ( future biological attacks4 ,^! resultant e/imates may include sub/antial unc]ta9ties :5 appli$ to specific situations4 ,h[ev]1 !y provide ! be/ e/imates available to date4 d4 ,! guide is also organiz$ into #aj sections4 ,section #a introduces features ( ! guide1 & !n pres5ts backgr\nd & m$ical plann+ consid]ations4 ,section #b provides in=mation on ! me?odology us$ to develop ! e/imates4 ,section #c describes h[ to use ! tables pres5t$ 9 ! guide4 ,sections #d ?r\gh #aj ( ! guide conta9 tables ( casualty e/imates1 ) "o section = ea* ( ! sev5 biological ag5ts4 e4 ,biological attacks are likely to h a significant impact on ! m$ical sy/em4 ,z detail$ else:]e 9 ! guide1 victims may numb] 9 ! hundr$s or ev5 ?\s&s4 ,dem& = m$ical c>e may quickly ov]:elm available res\rces2 ?is problem w be exac]bat$ if m$ical p]sonnel !mselves become victims ( ! attack4 ,local civilian populations w be victimiz$ z well1 limit+ ho/-nation support & pot5tially add+ to ! dem&s on ! milit>y m$ical sy/em4 f4 ,a v>iety ( m$ical responses to ,,bw attacks are available1 dep5d+ on ! ag5t us$ & :e!r m$ical c\nt]measures are employ$ prior to attack or aft] exposure has already occurr$4 ,= _m ag5ts1 immunization or pre-exposure prophylaxis ) antibiotics may prev5t illness 9 ^? subsequ5tly expos$4 ,aft] exposure1 disease c (t5 be prev5t$ or ameliorat$ via immunization & !rapeutic use ( antibiotics1 antiviral drugs1 & hyp]immune gammaglobul9s4 ,d-#ab4 ,m$ical ,plann+ ,consid]ations a4 ,effective mass casualty managem5t requires c>eful plann+4 ,! guide is design$ to support su* plann+ by provid+ m$ical plann]s & /aff p]sonnel ) a sy/ematic means = e/imat+ ! numb] ( biological casualties4 ,h[ev]1 casualty managem5t also involves practice ( self-aid & buddy aid1 on-site triage & em]g5cy c>e1 decontam9ation1 transport to m$ical facilities1 infection control measures1 communications1 heal? s]vices1 logi/ics1 & evacuation by gr\nd or air transportation4 b4 ,m$ical requirem5ts result+ f attacks ) biological ag5ts may be sub/antially diff]5t f ^? result+ f conv5tional1 nucle>1 or *emical combat4 ,!re w\ld be no indication ( ! pres5ce ( biological ag5ts 9 mo/ tactical situations4 ,units d[nw9d f an attack area may be unexpect$ly expos$ to biological ag5ts4 ,9 "s cases1 !re w also be a risk ( second>y infection & subsequ5t epidemics among/ troops &_/or ! local population4 ,additionally1 use ( biological ag5ts may g5]ate res]voirs )9 ! local animal population t may s]ve z a fur!r s\rce ( infection4 c4 ,(t5 ! fir/ indication ( an attack ) a biological ag5t w be ! developm5t ( symptoms 9 expos$ p]sonnel4 ,diagnosis & treatm5t are complicat$ by ! fact t _m ( ! ag5t-induc$ diseases describ$ 9 ! guide beg9 ) symptoms associat$ ) common illnesses1 su* z influ5za4 ,9 su* cases1 biological ag5t attacks may g5]ally be di/+ui%$ f naturally occurr+ epidemics by ! sudd5 onset ( disease1 ! l>ge numb] ( p]sonnel pres5t+ ) simil> symptoms1 & ! conc5tration ( ^? p]sonnel 9 geographically contam9at$ areas4 ,d-#ac4 ,triage a4 ,s9ce a biological attack may produce mass casualties1 prep>ations = a triage sy/em %\ld be 9 place be=e ! attack4 ,p>agraph #c4c4h ( ! guide describes pati5t categories by illness sev]ity4 ,= a p>ticul> describ$ op]ational sc5>io1 ?is in=mation may be us$ to e/imate ! numb] ( pati5ts ) specifi$ levels ( illness4 ,! guide does n provide e/imates ( ! numb] ( pati5ts by triage classification or usual m$ical descriptions4 b4 ,decontam9ation ( pati5ts mu/ be consid]$ be=e fur!r evacuation4 ,d-#ad4 ,evacuation a4 ,an effici5t & flexible evacuation plan is ess5tial = adequate casualty treatm5t & to reta9 mobility ( =w>d m$ical res\rces4 ,= an assessm5t ( a pot5tial mass casualty situation1 ! m$ical plann] %\ld consid] ! full range ( evacuation assets1 limitations1 & ob/acles4 ,aft] an attack1 ! m$ical /aff may ne$ to e/imate ! numb] ( casualties t c\ld require evacuation at giv5 po/exposure times4 b4 ,evacuation requirem5ts w v>y ) ! type ( biological ag5t us$4 ,casualties result+ f "s ag5ts may n be evacuat$ because ! "t c\rse ( effects is relatively %ort4 ,= o!rs1 l botul9um tox91 casualties may require evacuation to a facility :]e !y c receive c>e = weeks or ev5 mon?s4 ,e/imates provid$ 9 ! guide c be us$ z a />t+ po9t f :i* to plan = evacuation res\rces1 includ+ ^? requir$ = decontam9ation ( p]sonnel & transportation assets4 ,d-#ae4 ,9-,unit ,c>e ,! casualty e/imates 9 ! guide are pres5t$ )\t all[ance = 9-unit c>e4 ,h[ev]1 !re may be ne$ = rapid int]v5tion4 ,delays 9 obta9+ m$ical c>e may occur because ( physical damage or contam9ation ( ! surr\nd+ area4 ,soldi]s tra9$ 9 fir/ aid proc$ures may be ! fir/ to provide aid to biological ag5t casualties4 ,! guide provides a cons]vative e/imate ( ! numb]s ( expos$ p]sonnel :o w require fir/ aid4 ,! tables describ$ 9 p>agraphs #c4c4b ?r\gh #c4c4d ( ! guide give ! "t c\rses ( effects t may apply to e/imation ( 9-unit c>e & delay$ m$ical requirem5ts4 ,d-#af4 ,pati5t ,b$ ,requirem5ts ,b$ requirem5ts c be e/imat$ us+ ! tables describ$ 9 p>agraphs #c4c4b ?r\gh #c4c4d ( ! guide4 ,! latt] type ( table is useful aft] an attack s9ce x %[s ga9s & losses ( casualties ov] "t4 ,! type ( table describ$ 9 p>agraph #c4c4e ( ! guide may be m useful = long-range plann+4 ,x %[s maximum numb]s ( p]sonnel by illness sev]ity category4 ,! tables 9 ! guide only provide e/imates = ! fir/ #ce days aft] attack4 ,bas$ on ! !at] evacuation policy specifi$ = ! op]ation1 hospital days may be 9 !at] or 9 ! national area4 ,d-#ag4 ,m$ical ,logi/ics a4 ,! e/imates provid$ 9 ! guide are int5d$ to support projections ( m$ical mat]iel & logi/ical requirem5ts4 ,increas$ dem&s may occur = c]ta9 types ( m$ical & g5]al supplies1 includ+ equipm5t1 kits1 antibiotics1 dis9fectants1 & o!r critical m$ical mat]iel4 ,dem&s may also increase = items unique to ! prev5tion & treatm5t ( biological ag5t casualties1 su* z vacc9es1 antibiotics1 & antis]a1 z well z items adapt$ to contam9at$ environm5ts4 ,tables %[+ maximum numb]s ( p]sonnel by illness sev]ity category c provide useful input = logi/ical plann+4 b4 ,(t5 ! fir/ indication ( an attack ) a biological ag5t w be ! developm5t ( symptoms 9 expos$ p]sonnel4 ,diagnosis & treatm5t are complicat$ by ! fact t _m ( ! ag5t-induc$ diseases describ$ 9 ! guide beg9 ) symptoms associat$ ) common illnesses1 su* z influ5za4 ,9 su* cases1 biological ag5t attacks may g5]ally be di/+ui%$ f naturally occurr+ diseases4 ,d-#ah4 ,m$ical ,=ce ,plann+ a4 ,! assignm5t ( m$ical support is normally bas$ ^u ! total milit>y population & ! expect$ conv5tional casually rate4 ,! guide may be us$ to assess requirem5ts = additional m$ical units4 b4 ,al?\gh a specific unit may be ! t>get ( a biological attack1 m casualties c\ld be suff]$ by o!r units d[nw9d4 ,accord+ly1 a unit o!r ?an ! t>get$ "o may h priority = support4 ,! tables pres5t$ 9 ! guide c be us$ 9 plann+ = ei!r situation4 ,"s tables %[ e/imat$ maximum numb]s ( p]sonnel by illness sev]ity category4 ,su* e/imates %\ld be comb9$ ) a compreh5sive array ( o!r available in=mation to increase ! effectiv5ess ( m$ical =ce plann+4 -------------------------------------- ,?is ,section ,implem5ts ,,/anag #bdgg4 -------------------------------------- ,section ,,iv4 ,,m$ical ,,plann+ ,,guide ,,= ,,! ,,e/imation ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,battle ,,casualties 7,,*emical7--,a,med,p-#h7;,a71 ,,volume ,,iii ,d-#ai4 ,g5]al a4 ,! prim>y purpose ( ,volume ,,iii is to assi/ m$ical plann]s1 logi/icians1 & /aff (fic]s 9 pr$ict+ ,,cw cont+5cy requirem5ts4 ,requirem5ts include m$ical p]sonnel1 m$ical mat]iel /ockpiles1 pati5t transport or evacuation capabilities1 & facilities ne$$ = pati5t decontam9ation1 triage1 treatm5t1 & supportive c>e4 ,an optional purpose is to support m$ical op]ational e/imates4 b4 ,! guide provides m$ical wor/-case e/imates ( casualties & rema9+ op]ational /r5g? aft] a s+le ,,cw attack on a tactically deploy$1 brigade-siz$ l& =ce units1 ) protection available & protection unavailable4 ,^! wor/-case casually e/imates are = p]sonnel locat$ )9 bo? ! t>get$ & ! d[nw9d haz>d areas ( ! brigade4 ,x is assum$ t all t>get$ p]sonnel w be un%elt]$ & )\t m$ical pre-exposure prophylactic treatm5t4 ,tables 9 ! guide are design$ to %[ total numb]s (-- ,casualties ) diff]5t types & sev]ities ( injury at v>i\s times aft] exposure4 ,p]sonnel at diff]5t p]=mance levels & times aft] exposure4 ,fatalities at specifi$ times aft] exposure4 c4 ,! guide pres5ts e/imates ( p]sonnel /atus at specific "t po9ts4 ,^! range f #a to #c h\rs to #g to #cj days aft] an attack1 dep5d+ on ! type ( ag5t consid]$4 ,su* e/imates are project$ f all possible comb9ations ( ! foll[+ conditions3 ,sev5 op]ational sc5>ios involv+ ?ree types ( units3 heavy brigade1 support brigade1 & light infantry brigade4 ,?ree *emical ag5ts3 ! n]ve ag5ts ,,gb & ,,vx1 & ! bli/] ag5t ,,hd4 ,?ree types ( munitions deliv]+ ! ag5ts3 a]ial bombs1 tactical balli/ic missiles1 & r\nds f multiple laun* rocket sy/ems_/artill]y batt]ies-- ,?ree attack int5sities = ea* type ( munition3 light1 mod]ate1 & heavy4 ,two po/ures ( individual physical protection aga9/ ! attacks3 unavailable & available4 d4 ,an index to ess5tial in=mation & f\r sample problems to illu/rate use ( ?is in=mation are at ! end ( ! guide 7see ,section #aa74 ,section #aa provides a plann+ guide ov]view1 describes applications1 & pres5ts a brief explanation ( model+ me?ods us$ to prep>e e/imates4 e4 ,! guide is subject to limitations ( ext5t & cont5t4 ,s9ce !re are _m m possible attack v>iables ?an ^? consid]$1 ! guide pres5ts a limit$ numb] ( e/imates4 ,^! e/imates are bas$ ^u ! be/ available toxicological values1 b su* values are qualifi$ e/imates4 ,!re=e1 m$ical plann]s & /aff p]sonnel %\ld use ,,fm #h-i1 ,,nato ,h&book on ! ,m$ical ,aspects ( ,,nbc ,def5sive ,op]ations1 ,a,med,p-#f 7,b71 ,"p ,,iii--,*emical1 = m au?oritative m$ical descriptions & in=mation on effects ( long] duration4 f4 ,! guide is mo/ value to ! us] :o ne$s to "k :at k9ds ( casualties to expect1 relative numb]s ( ea*1 & ! "t frames 9 :i* !y are likely to appe>4 ,to assi/ ! us]1 :o lacks exp]i5ce 9 actual ,,cw1 ! guide describes types ( injury1 relevant factors1 g5]al magnitudes ( effects1 & effects ( "t c\rses on *emical casualty numb]s4 ,! casualty e/imates are appropriate = tra9+ ex]cises4 ,h[ev]1 ?is initial attempt to provide complex e/imates has limitations = battlefield use4 ,! limitations are describ$ z foll[s3 ,! guide provides e/imates = a few ( _m possible *emical attacks4 ,ea* e/imate is bas$ ^u comput] model+ ( ! consequ5ces ( specifi$ conditions4 ,?is is l say+ t ! numb]s ( m5 :o sneeze1 aft] inhal+ an all]gic fl[] poll51 might be pr$ict$ if specific in=mation 7,,example3 ,! w9d spe$ & direction1 ! curr5t wea!r1 altitude1 "t ( day1 & sites ( conc5trat$ fl[] gr[?7 is kn[n = ! specific geographic location ( a p>ticul> brigade on a giv5 m\nta94 ,if su* e/imates are made = a few widely diff]5t m\nta9s1 a us] ( ! e/imates may be able to guess ! numb]s ( sneez+ m5 9 8 own brigade1 locat$ on a sep>ate m\nta94 ,h[ev]1 if ! conditions on bo? m\nta9s are n ne>ly id5tical1 ! us] w ne$ to e/imate a scal+ factor & apply x to adju/ ! numb] pr$ict$ = a diff]5t environm5t4 ,x is unlikely t exactly id5tical conditions w exi/ = any two m\nta9s or *emical attacks4 ,! us] ( ! guide mu/ decide :i* sc5>io be/ repres5ts 8 conditions 7or int]polate f two sc5>ios71 !n use or adju/ ! e/imates4 ,!re=e1 ea* us] mu/ recognize any diff]5ces f model$ conditions t might require him to increase1 or decrease1 an e/imate4 ,! us] may ne$ to apply a comm&]'s guidance on acceptable risk levels1 or consid] re/rictions ( available res\rces1 be=e accept+1 int]pret+1 or modify+ ! relevant plann+ guide numb]s4 ,! mo/ difficult problem = ! us] w be to det]m9e h[ mu* to increase1 or decrease1 plann+ guide numb]s to fit ! us]'s situation4 ,?is problem is discuss$ 9 p>agraph #c4d ( ! guide4 ,! us] %\ld be aw>e t m$ical wor/-case t>get+ selects = maximal numb]s ( survivors ent]+ ! m$ical sy/em1 n = maximal op]ational losses4 ,! tabulat$ e/imates are v highly s5sitive to ! degree ( clu/]+ ( p]sonnel & _! assum$ location )9 a /&>diz$ brigade area4 ,accord+ly1 use ( ?is t>get+ me?od leads to l>ge v>iations t are bas$ ^u ! probabilities ( hitt+ clu/]$ p]sonnel1 n ev5ly or widely di/ribut$ p]sonnel4 ,!re=e1 ^! e/imates d n provide a good basis = e/imat+ ! mo/ likely outcomes = a s]ies ( av]age attacks1 or = comp>+ a sc5>io ) an actual attack4 ,al?\gh ! tabul> =mat ( ! guide sugge/s t ! li/$ numb]s are exact1 ! us] %\ld und]/& t diff]5t t>get+ c\ld readily produce o!r numb]s4 ,selection ( a scal+ factor ,is discuss$ 9 p>agraph #c4d ( ! guide4 ,d-#bj4 ,m$ical ,plann+ ,consid]ations a4 ,! guide provides m$ical plann]s & /aff p]sonnel ) a sy/ematic means = e/imat+ *emical casualties 9 v>i\s-siz$ units1 )\t reg>d to composition4 ,?is docum5t provides m accurate & detail$ e/imates & is bas$ ^u detail$ op]ational sc5>ios = brigade-siz$ units4 ,bo? *emical plann+ guides support e/imates ( combat p]=mance f individuals rema9+ 9 ! unit4 b4 ,effective mass casualty managem5t requires c>eful plann+4 ,! guide is design$ to support su* plann+ by provid+ m$ical plann]s & /aff p]sonnel ) a sy/ematic means = e/imat+ ! numb]1 type1 & "t-relat$ /atus ( *emical casualties4 ,,note ,ea* us] is advis$ to consult any available national milit>y ,,nbc def5se doctr9al publications ( simil> nature4 c4 ,m$ical requirem5ts dur+ ,,cw may be sub/antially diff]5t f ^? = ! usual combat situation4 ,!re may be no indication ( ! pres5ce ( *emical ag5ts 9 "s tactical situations4 ,unprotect$ units d[nw9d f an attack area1 or ^? ent]+ contam9at$ areas 9 an unprotect$ po/ure1 may be unexpect$ly expos$ to *emical ag5ts4 ,h[ev]1 casualty managem5t also involves practice ( self-aid & buddy aid1 on-site m$ical triage & em]g5cy c>e1 transport to m$ical facilities1 communications1 heal? s]vices1 logi/ics1 & evacuation by gr\nd or air transportation4 d4 ,! signs & symptoms ( *emical ag5t exposure may be sudd5 & int5se1 or delay$ & subtle1 dep5d+ on ! ag5t us$ & ! level ( exposure4 ,individuals may n rea* ! fir/ level ( c>e = #ae to #fj m9utes aft] ! onset ( effects4 ,decontam9ation may delay m$ical treatm5t4 ,/abilization %\ld occur be=e casualties leave em]g5cy c>e areas1 b contam9ation ( ^! areas may delay ! /abilization process4 ,h[ev]1 effects ( decontam9ation or second>y contam9ation on e/imat$ doses & effects are n consid]$ 9 ! guide4 ,= m$ical plann+1 us]s ( ! guide ne$ to consid] ! v>i\s qualifications ( its casualty e/imates1 z discuss$ 9 p>agraphs #c4d & #c4d4b ( ! guide4 e4 ,a *emical burn caus$ by ,,hd c require m c>e ?an a same-siz$ burn induc$ by conv5tional munitions4 ,!re=e1 ! initial prognosis may require revision aft] treatm5t is und]way1 & e/imates ( p]c5t capable by p]=mance b& may require adju/m5t4 ,d-#ba4 ,triage ,s9ce a *emical attack may produce mass casualties1 prep>ations = a triage sy/em %\ld be 9 place be=e ! attack4 ,p>agraph #b4e4a ( ! guide describes pati5t categories by injury sev]ity4 ,= a p>ticul> describ$ op]ational sc5>io1 ?is in=mation may be us$ to e/imate ! numb] ( pati5ts ) specifi$ levels ( injury4 ,! guide does n provide e/imates ( ! numb] ( pati5ts by triage classification or usual m$ical & toxicological descriptions4 ,d-#bb4 ,evacuation a4 ,an effici5t & flexible evacuation plan is ess5tial = adequate casualty treatm5t & to reta9 mobility ( =w>d m$ical res\rces4 ,= assessm5t ( a pot5tial mass casualty situation1 ! full range ( evacuation assets1 limitations1 & ob/acles %\ld be consid]$ by ! m$ical plann]4 ,aft] an attack1 ! m$ical /aff may ne$ to e/imate ! numb] ( casualties t require evacuation res\rces at giv5 po/exposure times4 b4 ,evacuation requirem5ts w v>y ) ! type ( *emical ag5t us$4 ,n]ve ag5t casualties may n be evacuat$ because ! "t c\rse ( sev]e effects is relatively %ort4 ,dep5d+ ^u exposure conditions1 ,,hd casualties may or may n require evacuation to a facility :]e !y c receive c>e = sev]al days1 or possibly #f to #i mon?s4 ,e/imates provid$ 9 ! guide c be us$ z a />t+ po9t f :i* to plan = evacuation res\rces4 ,d-#bc4 ,9-,unit ,c>e ,! casualty e/imates 9 ! guide are pres5t$ ) no all[ance = 9-unit c>e su* z self-aid or buddy aid4 ,soldi]s tra9$ 9 fir/ aid proc$ures may be ! fir/ to see *emical injuries4 ,! guide c provide an e/imate ( ! numb]s ( injur$ p]sonnel :o w require fir/ aid4 ,h[ev]1 !re may be ne$ = rapid augm5tation1 support1 or o!r int]v5tion4 ,delays 9 obta9+ m$ical c>e may occur because ( physical damage or contam9ation ( ! surr\nd+ area4 ,! tables describ$ 9 p>agraphs #c4c4b & #c4c4c ( ! guide give ! "t c\rses ( effects t may apply to e/imation ( 9-unit & delay$ m$ical requirem5ts4 ,d-#bd4 ,pati5t ,b$ ,requirem5ts ,requirem5ts = pati5t b$s & hospitalization "t may be great] aft] *emical exposures ?an aft] a conv5tional attack4 ,su* increases are p>ticul>ly important = ag5ts1 su* z ,,hd1 t produce injuries foll[$ by a long recov]y p]iod4 ,b$ requirem5ts c be e/imat$ us+ ! tables describ$ 9 p>agraphs #c4c4b & #c4c4c ( ! guide4 ,casualties ,occurr+ by ,"t ,p]iod tables 7see p>agraph #c4c4c7 9 ! guide are useful aft] an attack s9ce !y %[ ga9s & losses ( casualties ov] "t4 ,p]sonnel by ,injury ,category tables 7z describ$ 9 p>agraph #c4c4d7 9 ! guide may be m useful 9 long-range plann+4 ,!y %[ maximum numb]s ( p]sonnel by injury sev]ity category4 ,! tables 9 ! guide only provide e/imates = ! fir/ #cj days aft] attack4 ,dep5d+ ^u ! !at] evacuation policy specifi$ = ! op]ation1 hospital days may be ei!r 9 !at] or 9 ! national area4 ,d-#be4 ,m$ical ,logi/ics ,! e/imates provid$ 9 ! guide are int5d$ to support projections ( m$ical mat]iel & logi/ical requirem5ts4 ,increas$ dem&s may occur = c]ta9 types ( m$ical & g5]al supplies4 ,^! may include specific equipm5t1 kits1 dress+s1 antibiotics1 & o!r critical m$ical mat]iel4 ,dem&s may also increase = items unique to ! *emical battlefield 7su* z n]ve ag5t antidote auto9jectors71 z well z items adapt$ to *emical environm5ts 7includ+ ,,iv sy/ems & special self-conta9$ int5sive c>e units74 ,tables %[+ maximum numb]s ( p]sonnel by injury sev]ity category 7see p>agraph #c4c4d 9 ! guide7 c provide useful input = logi/ical plann+4 ,d-#bf4 ,m$ical ,=ce ,plann+ a4 ,! assignm5t ( m$ical support is normally bas$ ^u ! total milit>y population & ! expect$ conv5tional casualty rate4 ,! guide may be us$ to assess requirem5ts = additional m$ical units4 ,! use ( *emical weapons 9 tactical situations c\ld be "o indication ( an increas$ tempo ( w>f>e & ne$ = additional p]sonnel4 b4 ,al?\gh a unit may be t>get$ = *emical attack1 t unit might n be locat$ :]e ! highe/ numb] ( casualties c\ld occur 7z 9 a d[nw9d haz>d area74 ,accord+ly1 ano!r unit might h priority = support4 ,! tables pres5t$ 9 ! guide c be us$ 9 plann+ = ei!r situation4 ,"s tables 7see p>agraph #c4c4d 9 ! guide7 %[ e/imat$ maximum numb]s ( p]sonnel by injury sev]ity category4 ,su* e/imates %\ld be comb9$ ) a compreh5sive array ( o!r available in=mation to increase ! effectiv5ess ( m$ical =ce plann+4 c4 ,! guide is organiz$ into #aa sections4 ,section #a introduces ! guide & pres5ts backgr\nd & m$ical plann+ consid]ations4 ,section #b provides in=mation on ! me?odology us$ to develop ! e/imates ( fatalities1 casualties1 & effectiv5ess ( individuals rema9+ 9 ! unit4 ,section #c explores ! use ( ! casualty pr$iction tables bas$ on combat effectiv5ess decrem5ts & e/imates ( ! numb] ( casualties categoriz$ by insult level4 ,sections #d ?r\gh #aj conta9 tables ( casualty e/imates4 ,section #aa is a tutorial on use ( ! tool4 d4 ,^! m$ical wor/-case casualty e/imates 7see p>agraph #b4a4b ?r\gh #b4a4g 9 ! guide7 are = p]sonnel 9 ! *emical-t>get$ & d[nw9d haz>d areas ( ! brigade sector4 ,! actual areas pres5t+ *emical ag5t haz>ds to p]sonnel are relatively small & localiz$ :5 comp>$ to ! entire brigade sector4 ,^! e/imates are n valid = acute effects f repeat$ exposures1 possible delay$ effects ( l[ dosage exposures1 op]ational wor/-case t>get+1 t>gets ) diff]5t numb]s or di/ributions ( expos$ p]sonnel1 or attacks involv+ diff]5t conditions 7( meteorology1 t]ra91 protective /atus1 & s =?7 ?an are model$4 ,al?\gh ! guide is prim>ily design$ to support m$ical =ce plann+ = future ,,cw def5se1 x may be us$ to anticipate %ort-t]m requirem5ts4 ,= example1 delay$ requirem5ts ( ,,hd victims = c>e or evacuation res\rces may be pr$ict$ f tables t give e/imates ( casually numb]s by injury type at giv5 times aft] a ,,cw attack 7see p>agraphs #c4c4b & #c4c4c 9 ! guide74 ,,app5dix ,e ,example ,x-1 ,,annex1 ,,to ,,hss ,,plan_/,,op]ation ,,ord]1 ,,m$ical ,,nbc ,,/aff ,,(fic] ,,plann+ ,,= ,,hss ,,9 ,,an ,,nbc ,,environm5t #a4 ,,purpose4 ,e/abli% /&>diz$ proc$ures = m$ical ,,nbc /aff (fic]s plann+1 prep>+ =1 detect+1 report+1 & provid+ prev5tive_/protective measures = ,,nbc_/,,tim haz>ds4 ,e/abli% plann+ proc$ures = conduct+ ,,hss 9 ,,nbc_/,,tim environm5ts4 ,also1 e/abli% proc$ures = provid+ te*nical guidance_/support to lead]%ip be=e1 dur+1 & aft] an ,,nbc_/,,tim ev5t4 #b4 ,,proc$ures a4 ,m$ical ,,nbc /aff (fic]s prep>e li/ ( equipm5t & proc$ural guidel9es = ,,hss op]ations "u ,,nbc_/,,tim conditions4 7,provide a li/ ( radiological detection devices1 *emical ag5t detection_/id5tification kits_/devices1 compon5ts ( biological sample_/specim5 collection1 & %ipp+ conta9]s4 ,provide guidel9es_/ref]5ces = op]at+ detection_/id5tification devices47 b4 ,plann+ actions = use be=e an ,,nbc_/,,tim ev5t4 7,provide prev5tive_/protective measures t ! lead]%ip c employ to r$uce ! heal? effects ( a ,,nbc_/,,tim ev5t4 ,also1 provide prev5tive_/protective measures t lead]%ip c employ to r$uce ! heal? effects ( exi/+ ,,nbc_/,,tim haz>ds_/contam9ation 9 an ,,ao4 ,provide ,,hss lead]%ip ) proc$ures t c be employ$ to protect _! unit & pati5ts47 c4 ,plann+ action = use dur+ an ,,nbc_/,,tim ev5t4 7,provide prev5tive_/protective measures t ! lead]%ip c employ to r$uce ! heal? effects ( a ,,nbc_/,,tim ev5t4 ,provide ,,hss lead]%ip ) proc$ures t c be employ$ to protect _! unit & pati5ts47 d4 ,plann+ actions = use aft] an ,,nbc_/,,tim ev5t4 7,provide prev5tive_/protective measures t l9e lead]%ip c employ to r$uce_/mitigate ! heal? effects ( an ,,nbc_/,,tim ev5t on ! =ce4 ,provide ,,hss lead]%ip ) proc$ure t c be employ$ to mitigate ! effects on _! unit & pati5ts47 e4 ,plann+ actions = prev5tive m$ic9e support = ,,nbc_/,,tim ev5ts4 7,provide types & numb]s ( ,,pvntm$ units_/p]sonnel requir$ to p]=m ,,pvntm$ missions dur+ su* ev5ts4 ,describe mission requirem5ts = units_/p]sonnel prep>+ = & react+ to ! ev5t4 ,describe types ( samples requir$ & h[ samples mu/ be collect$1 pres]v$1 packag$1 & %ipp$ to support+ m$ical laboratory = analysis4 ,describe detection_/monitor+ equipm5t requir$ = ! ev5t2 su* z ,,an_/,,pdr#gg1 ,,an_/,,vdr#b radiac met]1 *emical ag5t monitor 7,,cam71 & ,m#bgb wat] te/ kit47 f4 ,plann+ actions = vet]9>y support = ,,nbc_/,,tim ev5ts4 7,provide types & numb]s ( vet]9>y units_/p]sonnel requir$ to p]=m ! vet]9>y s]vice missions dur+ su* ev5ts4 ,describe mission requirem5ts = units_/p]sonnel prep>+ = & react+ to ! ev5t4 ,describe types ( samples_/specim5s requir$ & h[ samples_/specim5s mu/ be collect$1 pres]v$1 packag$1 & %ipp$ to support+ m$ical laboratory = analysis4 ,describe food contam9ation & decontam9ation proc$ures4 ,describe detection_/monitor+ equipm5t requir$ = ! ev5t2 su* z ,,an_/,,pdr#gg1 ,,an_/ ,,vdr#b radiac met]1 & ,,cam47 g4 ,plann+ actions = m$ical laboratory support = ,,nbc_/,,tim ev5ts4 7,provide requirem5ts = m$ical laboratory support = an ,,nbc_/,,tim ev5t4 ,describe types ( laboratory te/_/ proc$ures requir$ to provide comm& v]ification on ! use ( an ,,nbc device_/weapon4 ,provide m$ical laboratory report+ requirem5ts2 example3 provide report to comm& surgeon2 ,jo9t ,task ,=ce_/!at] comm&]2 s5ior comm&] 9 affect$ op]ational area47 h4 ,plann+ actions = combat heal? logi/ics support = ,,nbc_/,,tim ev5ts4 7,provide requirem5ts = combat heal? logi/ics support units & p]sonnel4 ,describe types ( ,class ,,viii supplies requir$ to support ,,hss response to an ev5t4 ,examples3 ,numb]s ( *emical ag5t pati5t decontam9ation ,m,e,ss1 *emical ag5t pati5t treatm5t sets1 numb] ( packets ( *emical ag5t pretreatm5t tablets requir$1 & *emoprophylaxis requir$ = p]sonnel expos$ to a biological ag5t47 i4 ,plann+ actions = combat /ress control_/m5tal heal? support = ,,nbc_/,,tim ev5ts4 7,provide requirem5ts = ,,cosc_/m5tal heal? support units_/p]sonnel4 ,describe :]e & h[ ,,cosc_/ m5tal heal? p]sonnel w provide _! support 9 response to ! ev5t47 j4 ,plann+ = m$ical treatm5t ( ,,nbc_/,,tim ev5t casualties4 7,provide requirem5ts = m$ical evacuation & treatm5t 7includ+ em]g5cy d5tal c>e7 support units_/p]sonnel4 ,provide requirem5ts = nonm$ical p]sonnel to p]=m pati5t decontam9ation at ! ,,mtf4 ,describe :]e & h[ evacuation & treatm5t p]sonnel w provide _! support 9 response to include sup]vision ( pati5t decontam9ation proc$ures47 #c4 ,,coord9ation ,,requirem5ts4 7,provide requirem5ts = support su* z :o %\ld transport_/escort samples_/specim5s f unit ( orig9 to support m$ical laboratory & on to ! ,,conus gold /&>d laboratory4 ,example3 ,! ,te*nical ,escort ,unit normally provides transportation & escort = suspect ,,nbc samples1 9 _! abs5ce describe :o w provide ?is s]vice4 ,provide requirem5ts = numb]s ( p]sonnel requir$ to p]=m pati5t decontam9ation at support+ ,m,t,fs4 ,describe decontam9ation support requirem5ts = m$ical units2 especially hospitals & major combat heal? logi/ics facilities47 #d4 ,,reports4 7,describe types ( reports requir$ & frequ5cy ( report+ on ,,hss aspects ( ,,nbc_/,,tim ev5ts4 ,reports %\ld provide1 at a m9imum1 aspects ( ev5t & recomm5d$ prev5tive_/ protective actions ne$$ to prev5t or m9imize casualties47 ,,app5dix ,f ,,employm5t ,,( ,,*emical ,,& ,,biological ,,collective ,,protection ,,%elt] ,,sy/ems ,,by ,,m$ical ,,units ,section ,i4 ,,introduction ,f-#a4 ,g5]al ,to cont9ue ! ,,hss mission "u ,,cb conditions1 ,m,t,fs mu/ se>* out contam9ation free areas or employ ,,cps sy/ems4 ,levels ,i & ,,ii ,m,t,fs may be able to locate contam9ation free areas2 h[ev]1 due to ! mobility limitations ( hospitals1 !y mu/ always be prep>$ to op]ate "u ,,cb conditions if ! area is "u attack4 ,sy/ems t c be employ$ z an ,,mtf 7,levels ,i1 ,,ii1 ,,iii1 & ,,iv7 are describ$ 9 ?is app5dix4 ,f-#b4 ,types ( ,collective ,protection ,%elt] ,sy/ems a4 ,! ,,cbps sy/em is employ$ at ! ,,bas1 ,,dcs1 & ,,f/4 ,! ,,cbps is atta*$ to ! h>d-wall$ box on ! re> ( a high mobility multi-purpose :eel$ vehicle 7,,hmmwv74 ,! ,,bas w h "o ,,cbps sy/em p] treatm5t team2 ! ,,dcs w h f\r ,,cbps sy/ems2 ! ,,f/ w h ?ree ,,cbps sy/ems4 ,also1 sy/ems w be issu$ to o!r select$ m$ical treatm5t teams4 ,:5 employ$ at ! ,,dcs1 ! pati5t hold+ team w also require ,,gp t5ts to hold _! requir$ numb] ( pati5ts 7see ,*apt] #d74 ,pati5ts held inside ! ,,cbps w be ^? t h be5 decontam9at$ & admitt$ into ! sy/em = treatm5t & are recov]+ f ! treatm5t proc$ures & are await+ evacuation4 ,any pati5ts held 9 ! ,,gp t5t mu/ rema9 9 ,,mopp ,level #d 7! ,,gp t5t w n h collective protection72 ^! pati5ts are ^? t are expect$ to ,,rtd )9 #gb h\rs4 ,,notes #a4 ,normally1 pati5ts w n be held at ! ,,dcs "u ,,nbc conditions unless evacuation _c be accompli%$4 ,!y %\ld be ,,rtd or evacuat$ to a clean ,,mtf1 z soon z ! mission p]mits4 #b4 ,! ,,cbps c also be employ$ z ! ,,dcs 9 ! conv5tional mode4 ,employm5t 9 ei!r mode /ill requires ,,gp t5tage = pati5t hold+ to meet total pati5t hold+ requirem5ts4 b4 ,! ,,depm$s-equipp$ pati5t c>e areas ( ! ,,u ,army ,=ce ,,xxi hospital & ! hospital unit base 7,,hub7 ( ! ,m$ical ,=ce #bjjj 7,,mf#b,k7 w employ ! ,,cp ,,depm$s4 ,x w n protect p]sonnel or pati5ts f ! !rmal1 bla/1 & initial radiation effects ( nucle> weapons2 h[ev]1 x w provide "s protection aga9/ fall\t effects4 ,areas ( ! hospital t are n includ$ 9 ! *emically protect$ 7,,cp7 ,,depm$s are ,,mf#b,k g5]al hospital unit m$ical 7,,hum71 ,,mf#b,k field hospital unit hold+ 7,,huh71 ,,mf#b,k combat support & g5]al hospital unit surgical 7,,hus71 m9imum c>e w>ds1 adm9i/rative areas1 food s]vice1 supply 7includ+ ,class ,,viii71 & /aff qu>t]s4 ,! sy/em includes-- ,*emically_/biologically protect$ l9]s = t5t1 exp&able1 modul>1 p]sonnel 7,,temp]7 & passageways4 ,,cb-filt]$ & condition$ 7heat$ or cool$7 air 7field deployable environm5tal control unit ,,fdecu or ,h#hj ,army ,/&>d ,heat]74 ,*emically_/biologically protect$ ambulatory1 litt]1 & supply air locks4 ,*emically_/biologically protect$ latr9es4 ,*emically_/biologically protect$ seals = ,,iso %elt]s4 ,*emically_/biologically protect$ wat] supply sy/em4 c4 ,! ,m#bj simplifi$ collective protection sy/em is ano!r sy/em t is available4 ,x consi/s ( a *emically protect$ room l9]1 a ,,cb filt] bl[]1 & an ambulatory air lock4 ,h[ev]1 x does n h a litt] air lock mak+ x unsuitable = litt] pati5t c>e4 ,! ,m#bj may be us$ to protect m$ical /affs at ! ,,dcs1 ,,f/1 & hospitals1 pati5ts held 9 ! ,,gp t5ts at ! ,,dcs & 9 ! m9imum c>e w>ds & /aff qu>t]s ( ! hospitals4 ,?us provid+ additional ,,cb protection = /affs & pati5ts4 ,section ,,ii4 ,,employm5t ,,( ,,! ,,*emically ,,biologically ,,protect$ ,,%elt] ,,sy/em ,f-#c4 ,e/abli% a ,battalion ,aid ,/ation 9 a ,*emically ,biologically ,protect$ ,%elt] ,to e/abli% a ,,bas 9 a ,,cbps1 use "o ,,cbps p] treatm5t team = conv5tional op]ations 9 a split-team mode4 ,:5 op]at+ 9 a squad configuration & 9 ! conv5tional mode1 ! two ,,cbps sy/ems may be complex$ to provide m workspace4 ,h[ev]1 keep 9 m9d t ! treatm5t squad is n /aff$ to op]ate ! two sy/ems 9 ! ,,cb mode4 ,!re=e1 :5 ! two sy/ems are complex$ & ! treatm5t squad mu/ conv]t & op]ate 9 ! ,,cb mode1 !y may want to close ! complex+ door & only use "o sy/em4 ,:5 initially sett+ up ! ,,cbps = op]ations 9 ! ,,cb mode1 only "o ,,cbps is setup2 see ,note #b bel[4 ,set up ! sy/em z describ$ 9 ,,tm #aj-edaj-bbh-aj4 ,to be op]ational z a ,,bas1 set up m$ical supplies & equipm5t z requir$ or z designat$ 9 ! ,,tsop4 ,a ,,pds consi/+ ( a contam9at$ ambulance po9t1 contam9at$ triage po9t1 a pati5t decontam9ation area1 & a contam9at$ treatm5t area is e/abli%$ on ! d[nw9d 7prevail+ w9d7 side ( ! ,,cbps4 ,an ov]head cov] ( pla/ic %eet+ 7approximately #bj feet wide by #ej feet long7 is set up ov] ! ,,pds1 ! hot l9e1 & ! clean treatm5t_/wait+ area2 ! cov] ov]laps ! air locks4 ,! clean treatm5t_/wait+ area %\ld h an area at lea/ #bj feet wide by #ae feet long to all[ space = plac+ pati5ts into ! litt] air lock )\t cross+ ! hot l9e4 ,a second area cov]$ ) #bj #be feet ( pla/ic %eet+ 7! evacuation hold+ area7 is set up beside ! %elt] on ! opposite side f ! g5]ator4 ,! clean treatm5t area is sep>at$ f ! decontam9ation area by a hot l9e ) a %uffle pit4 ,only clean 7decontam9at$7 pati5ts or p]sonnel are all[$ to cross ! hot l9e into ! clean treatm5t area1 or are admitt$ into ! ,,cbps4 ,figure ,f-#a pres5ts "o lay\t ( a ,,bas us+ ! ,,cbps4 ,see ,,tm #aj-edaj-bbh-aj = complete details on sett+ up1 op]at+1 & ma9ta9+ ! ,,cbps4 ,ea* ,,cbps provides #cjj squ>e feet ( "w area4 ,,notes #a4 ,! ov]head cov] is n ne$$ :5 ! w9d spe$ exce$s #aj knots p] h\r4 ,! pla/ic w n /ay 9 place4 #b4 ,al?\gh ea* treatm5t team ( ! ,,bas has a ,,cbps2 only "o sy/em is set up :5 op]at+ 9 ! ,,cb mode4 ,?is is due to ! lack ( au?oriz$ p]sonnel to op]ate all sy/ems at "o "t 9 ! ,,cb mode4 ,eight m$ical p]sonnel are requir$ to op]ate ! ,,bas 7employ+ "o ,,cbps7 9 ! ,,cb mode4 ,at lea/ eight nonm$ical p]sonnel are requir$ to p]=m pati5t decontam9ation "u m$ical sup]vision4 ,also1 only sett+ up "o sy/em 9 ! ,,cb mode provides ! ,,bas ! ability to reta9 its flexibility 9 ord] to ma9ta9 its support mission ( be+ :]e x is ne$$ & :5 x is ne$$4 ,! ,,cbps c be us$ z ! treatm5t %elt] 9 ! conv5tional mode z well4 ,:5 ! treatm5t squad is op]at+ 9 ! split-team mode1 ea* team w h a ,,cbps = use z its treatm5t %elt]4 ,:5 op]at+ "o sy/em 9 ! ,,cb mode1 ! o!r sy/em provides a replacem5t 9 ! ev5t ! "o 9 use 9 ! ,,cb mode is damag$ beyond repair4 ,?is ensures cont9u$ ,,hss to ! comm&4 ,illu/ration3 ,figure ,f-#a4 ,battalion aid /ation us+ ! *emically biologically protect$ %elt]4 ,f-#d4 ,division ,cle>+ ,/ation 9 a ,*emically ,biologically ,protect$ ,%elt] ,to e/abli% a ,,dcs us+ ! ,,cbps1 set up f\r %elt]s z describ$ 9 ! ,,tm4 ,to be op]ational1 m$ical supplies & equipm5t are set up z outl9$ 9 ! unit ,,tsop4 ,! f\r %elt]s are complex$ z %[n 9 ,figure ,f-#b4 ,) f\r ,,cbps sy/ems set up & op]ational1 a total ( #a1bjj squ>e feet ( "w area is available4 ,! contam9at$ triage1 decontam9ation1 & contam9at$ treatm5t areas are sep>at$ f ! clean treatm5t_/wait+ area by a hot l9e ) a %uffle pit4 ,ov]head cov]+ is provid$ z describ$ = ! ,,bas4 ,pati5ts are admitt$ ?r\gh ! ,,emt litt] or ambulatory air lock4 ,pati5ts are releas$ ?r\gh ! pati5t hold+ air locks4 ,?is aids 9 controll+ entry & exits2 ?us prev5t+ ! introduction ( contam9ation into ! sy/ems4 ,at lea/ eight nonm$ical p]sonnel f support$ units are requir$ to p]=m pati5t decontam9ation "u m$ical sup]vision at ! ,,dcs4 ,,note ,9 ! ev5t t ! ov]pressure sy/em fails on a sy/em t is 9 use ) entry_/exit air locks1 move to ! available %elt] ) an entry_/exit air lock 9 ! same direction = use z ! entry_/exit until ! fail$ sy/em c be re/or$4 ,example #a3 ,at ! ,,dcs ! ,,emt sy/em fails1 move to ! ,,atm %elt] to receive pati5ts until ! ,,emt sy/em has be5 re/or$4 ,example #b3 ,at ! ,,dcs ! pati5t hold sy/em fails1 move exits to ! d5tal_/lab_/x-ray %elt] until ! pati5t hold sy/em c be re/or$4 ,example #c3 ,at ! ,,f/ ! po/op]ative sy/em fails1 use ! preop]ative %elt] until ! po/op]ative sy/em c be re/or$4 ,^! options w all[ pati5t c>e op]ations to cont9ue until ! fail$ sy/ems c be re/or$4 ,illu/ration3 ,figure ,f-#b4 ,*emically biologically protect$ %elt] configuration z a division cle>+ /ation4 ,f-#e4 ,=w>d ,surgical ,team 9 a ,*emically ,biologically ,protect$ ,%elt] ,to e/abli% a ,,f/ us+ ! ,c,b,p,ss1 foll[ ! proc$ures = ! ,,dcs except set up ?ree ,c,b,p,ss4 ,all equipm5t is set up inside ! ,,cbps z requir$ by y\r unit ,,tsop4 ,) ?ree ,c,b,p,ss set up & op]ational1 a total ( #ijj squ>e feet ( "w area is available 7,figure ,f-#c74 ,:5 ! ,,f/ is =w>d 9 support ( a m$ical company & op]at+ 9 ! ,,cb mode1 ! ,,f/ sy/ems are connect$ to ! ,,dcs ( ! support$ m$ical company4 ,figure ,f-#d %[s ! ,,f/ & ,,dcs connect$4 ,:5 op]at+ 9 ! ,,cb mode ) ! m$ical company1 all pati5ts are receiv$ ?r\gh ! ,,emt air lock ( ! ,,dcs4 ,! pati5ts are triag$ 9 ! ,,dcs &1 bas$ ^u _! injuries1 !y are r\t$ to ! ,,dcs treatm5t area or to ! ,,f/ = surgical c>e4 ,pati5ts releas$ f ! ,,f/ = evacuation are plac$ 9 a ,,ppw & process$ ?r\gh ! litt] air lock 9 ! ,,f/ recov]y section4 ,pati5t decontam9ation is p]=m$ at ! ,,pds op]at$ by ! ,,dcs4 ,! ,,f/ _c op]ate 9 a ,,cb environm5t )\t be+ complex$ ) ! ,,dcs4 ,!y d n h any pati5t decontam9ation capabilities4 ,illu/ration3 ,figure ,f-#c4 ,=w>d surgical team configuration = op]ations 9 conv5tional mode4 ,illu/ration3 ,figure ,f-#d4 ,=w>d surgical team & division cle>+ /ation configuration = op]ations 9 a nucle>1 biological1 *emical environm5t4 ,section ,,iii4 ,,employm5t ,,( ,,! ,,*emically ,,protect$ ,,deployable ,,m$ical ,,sy/ems ,,& ,,simplifi$ ,,collective ,,protection ,,sy/ems ,f-#f4 ,collective ,protection 9 a ,deployable ,m$ical ,sy/em-,equipp$ ,hospital a4 ,:5 ! ?reat ( ,,nbc action is anticipat$ 9 ! ,,ao1 ! ,,cp ,,depm$s compon5ts mu/ be set up z ! hospital is be+ e/abli%$4 ,! sy/em _c be set up 9 a hospital t has already be5 e/abli%$2 to d s requires ! hospital to be clos$1 all ,t,e,m,p,e,rs be /ruck1 & erect$ ) ! ,m#bh l9]s in/all$ dur+ ! erection process4 ,to e/abli% ,,cps 9 a ,,depm$s-equipp$ hospital1 foll[ ! proc$ures z describ$ 9 ,,tm #aj-edaj-bhc-ad,p4 ,tra9+ ,circul> #h-ac provides in/ructions on e/abli%+ a ,,u ,army ,,depm$s-equipp$ hospital 7)\t ,,cps74 ,figure ,f-#e pres5ts "o lay\t ( ! ,,depm$s-equipp$ pati5t c>e area ( a ,,mf#b,k ,,c% ,,hub employ+ ! ,,cp ,,depm$s ) an int]nal wat] supply sy/em4 ,figure ,f-#f pres5ts a lay\t ( ! pati5t c>e area ( ! ,,depm$s-equipp$ portion ( an #hd-;b$ ,,mri hospital4 ,figure ,f-#g pres5ts a lay\t ( ! pati5t c>e area ( ! ,,depm$s-equipp$ portion ( a #afd-;b$ ,,mri hospital4 b4 ,:5 employ+ ,,cp ,,depm$s1 provisions = wa/e disposal & protect$ wat] & food supplies )9 ! sy/em are e/abli%$4 ,additionally1 ,class ,,viii supplies mu/ be protect$ f contam9ation4 ,supplies n 9 use or ne$$ 9 ! protect$ op]ational areas are /or$ 9 m$ical *e/s1 %ipp+ conta9]s1 or wrapp$ 9 lay]s ( pla/ic t are inside cov]$ areas1 su* z clos$ ,m,i,l,v,a,ns or t5ts4 ,:5 contam9ation is pres5t1 only op5 ^! /orage areas = op]ational area em]g5cy resupply4 ,use pla/ic %eet+ or o!r leak-pro( mat]ial to provide an additional b>ri] betwe5 ! supplies & ! contam9ation4 ,wrap supplies 9 pla/ic or o!r b>ri] mat]ial = movem5t f ! /orage area to ! resupply air lock ( ! ,,cp ,,depm$s4 ,a wat] supply sy/em ) di/ribution hoses is e/abli%$ inside ! ,,cp ,,depm$s areas 7,figure ,f-#e74 ,pumps cont9u\sly circulate ! wat] f ! /orage tank ?r\gh ! hose sy/em back to ! /orage tank4 ,! cont9u\s circulation ensures t ! *lor9e residual is ma9ta9$ 9 ! wat] supply4 ,p]sonnel 9 areas t are n includ$ 9 ! cont9u\s fl[ sy/em mu/ draw wat] f ! sy/em & c>ry x to _! "w areas 9 #e-;gallon wat] cans or o!r conta9]s4 ,wat] resupply is accompli%$ by pass+ a hose ?r\gh ! utility port at ! end ( ! ,,temp] & ,m#bh l9] = a connection to ! wat] transport vehicle4 ,! ends ( bo? hoses mu/ be decontam9at$ ) a #e p]c5t *lor9e solution be=e connect+ !m toge!r4 ,! vehicle mu/ h a tank or wat] supply conta9] t is ,,nbc protect$ to ensure t ! wat] suppli$ is free ( ,,nbc contam9ation4 ,rations1 z det]m9$ by ! hospital comm&]1 %\ld be available )9 ! protect$ area = p]sonnel & pati5ts4 ,"u em]g5cy conditions ! comm&] c au?orize fe$+ pati5ts ,,mre rations = limit$ p]iods ( "t 7up to #gb h\rs71 if !y are able to *ew & swall[4 ,h[ev]1 attempts mu/ be made to ensure ! requir$ types ( rations = pati5t fe$+ are available 9 ! ,,cps4 ,! rations c be /or$ 9 any available space2 h[ev]1 ! rations mu/ be protect$ f exposure to possible contam9ants1 especially liquids4 ,ration control measures are e/abli%$ to ensure t ! rations are only consum$ z provid$ = 9 ! hospital ,,tsop4 ,two ,,cb protect$ latr9e sy/ems are includ$ 9 ! ,,cp ,,depm$s4 ,! latr9es conta9 b$pan wa% areas4 ,! wa/e f ! latr9es is collect$ 9 an outside receiv+ conta9]4 ,! wa/e is remov$ f ! conta9] & dispos$ ( z outl9$ 9 ! unit ,,tsop4 ,solid wa/e 7includ+ m$ical7 mu/ be plac$ 9 pla/ic bags4 ,seal ! top ( ! bags to prev5t spillage1 odors1 or spread ( infections_/disease4 ,,nev] ov]fill ! bags2 always leave en\gh room 9 ! bag to make a good seal4 ,place ! seal$ bags 9 ! supply air lock4 ,inside p]sonnel close ! inn] door to ! air lock4 ,outside p]sonnel *eck to ensure t ! inn] air lock door is clos$ be=e op5+ ! outside door4 ,remove ! bags & take !m to ! designat$ wa/e collection_/disposal site4 ,disposal may be by burial on site or by transport to a designat$ disposal facility4 ,transport may be by organic vehicles or contractor support vehicles4 ,! specific te*nique = disposal w be outl9$ 9 ! unit ,,tsop4 ,all liquid wa/e produc$ )9 ! ,,cp ,,depm$s is collect$ ?r\gh a pip$ liquid wa/e sy/em to a c5tral collection conta9]4 ,! wa/e conta9] = ! latr9es may be us$ to collect ! liquid wa/e f ! op]ational areas ( ! ,,cp ,,depm$s4 ,! conta9] is empti$ & ! wa/e dispos$ ( z outl9$ 9 ! unit ,,tsop4 ,illu/ration3 ,figure ,f-#e4 ,sample lay\t ( a m$ical =ce #bjjj combat support hospital unit base employ+ *emically protect$ deployable m$ical sy/em4 ,illu/ration3 ,figure ,f-#f4 ,sample lay\t ( an #hd-;b$ m$ical re5g9e]+ initiative hospital employ+ *emically protect$ deployable m$ical sy/em4 ,illu/ration3 ,figure ,f-#g4 ,sample lay\t ( a #afd-;b$ m$ical re5g9e]+ hospital employ+ *emically protect$ deployable m$ical sy/em4 ,f-#g4 ,*emically_/,biologically ,protect+ ! ,int]national ,organization = ,/&>dization ,%elt] ,to *emically_/biologically protect ! ,,iso %elt]s1 seal all seams & op5+s ( ! ,,iso to prev5t ! entry ( ,,cb ag5ts4 ,! seals connect+ ! v>i\s sides & floor ( ! %elt] may be a ,,cb protect$ mat]ial2 ?us provid+ a seal to ! %elt]4 ,:5 ! seals are n ( a ,,cb protect$ mat]ial1 ! seams mu/ be tap$ to provide a ,,cb protect$ b>ri] ov] ! s(t seals4 ,any op5+s n be+ us$ = introduction ( support p[] l9es1 wat] l9es or wa/e wat] l9es mu/ be seal$ to prev5t entry ( ,,cb ag5ts4 ,all access panels mu/ be securely clos$ to prev5t entry ( vapors4 ,f-#h4 ,*emically_/,biologically ,protect+ ! ,ve/ibules ,! ve/ibules connect ,t,e,m,p,e,rs to ,t,e,m,p,e,rs1 ,i,s,os to ,i,s,os1 & ,i,s,os & ,t,e,m,p,e,rs4 ,to h>d5 ! ve/ibules1 in/all ! ,,cb l9]s inside & fa/5 ! ends to ! l9]s ( ! ,,temp] or to ! doors ( ! ,i,s,os4 ,ve/ibule l9] connectors are provid$ = use at ! entry ( ea* ,,iso4 ,f-#i4 ,*emically_/,biologically ,protect+ ,air ,h&l] ,equipm5t a4 ,! ,,fdecu is *emically_/biologically protect$4 ,! sy/em c be op]at$ )\t ! ,,cb filt]s4 ,:5 requir$ to op]ate 9 ! ,,cb mode1 ! fre% air intake on ! ,,fdecu is clos$ & ! ,,cb filt] bl[] is turn$ on draw+ fre% air ?r\gh ! filt]s to support ! ,,fdecu & to provide clean air = ! ,,cps4 ,additionally1 recirculation filt]s are plac$ )9 ! %elt] sy/em to remove any ag5t t may h ent]$ ?r\gh any ( ! entry_/exit areas or ?r\gh brea*es 9 ! %elt] sy/em4 b4 ,:5 heat]s are requir$1 !y mu/ be *emically_/biologically protect$ to prev5t entry ( contam9ation4 ,! ,,cb filt] units are connect$ to ! fre% air intake side ( ! heat] & ! heat$ air dis*>ge side ( ! heat] is connect$ to ! air supply ( ! ,,temp]_/,,iso4 ,f-#aj4 ,e/abli% ,collective ,protection ,%elt] ,us+ ! ,m#bj ,simplifi$ ,collective ,protection ,sy/em ,! ,m#bj is us$ to e/abli% a ,,cps )9 a room ( opportunity1 or inside a t5t2 h[ev]1 ! available space w be limit$ by t5t poles & o!r compon5ts ( ! t5t4 ,curr5tly ?is sy/em only provides ambi5t temp]ature air4 ,see ! ,,tm & manufactur]'s publication provid$ ) ! sy/em & sy/em compon5ts = details4 ,,note ,! ,m#bj does n h a litt] air lock4 ,only /aff or ambulatory pati5ts c ent]4 ,see ! ,,tm provid$ ) ! sy/em = setup proc$ures4 ,f-#aa4 ,casualty ,decontam9ation ,pati5ts admitt$ into ! ,,mtf mu/ be contam9ation free4 ,!re=e1 a casualty decontam9ation area mu/ be e/abli%$ ne> ! ,,mtf4 ,! casualty decontam9ation area %\ld be provid$ ) an ov]head cov] z describ$ = ! ,,cbps sy/em1 except t x does n ov]lap ! entry to ! hospital4 ,also1 consid]ation mu/ be giv5 to ! location ( o!r op]ations at ! hospital site :5 e/abli%+ ! casualty decontam9ation area4 ,h[ev]1 ! area mu/ be close en\gh to ! entry_/exit ( ! ,,cps to protect ! pati5ts f ! environm5t & r$uce _! exposure to recontam9ation4 ,keep 9 m9d t "u ,,nbc conditions p]sonnel outside ( ! ,,cps are at ,,mopp ,level #d 7except decontam9at$ pati5ts2 !y h _! mask on71 ?us increas+ ! /ress load & r$uc+ _! ov]all p]=mance capabilities4 ,! entry_/exit area mu/ h ov]head cov] to protect pati5ts await+ access to ! ,,cps4 ,see ,app5dix ,i = sett+ up a casualty decontam9ation area & = decontam9ation proc$ures4 ,section ,,iv4 ,,op]ations1 ,,entry1 ,,& ,,exit ,,guidel9es ,f-#ab4 ,op]ations ,^! op]ations1 entry1 & exit guidel9es may be us$ to prep>e a unit ,,sop = ! op]ation ( ,,cps sy/ems 9 y\r unit4 a4 ,:5 us+ ^! guidel9es1 ! foll[+ %\ld be consid]$3 ,location ( ! %elt] 7flat1 hilly1 rocky gr\nd74 ,g5]al climate ( ! ,,ao 7high & l[ temp]ature v>iations dur+ op]ation74 b4 ,in=mation on sett+ up1 /rik+1 & op]at+ ! ,,cps is conta9$ 9 ! equipm5t publications4 ,:]e applicable1 special proc$ures are provid$ 9 ^! publications = sett+ up 9 bo? clean & ,,cb vapor haz>d areas4 ,h[ev]1 ! ,,cp ,,depm$s is ,,n set up 9 a ,,cb vapor haz>d area4 ,! comm&] w det]m9e :i* proc$ures to use4 c4 ,dur+ op]ations1 p]iodic *ecks are made ( ! atmosph]e )9 ! %elt]4 ,^! *ecks are made by us+ available *emical ag5t detection equipm5t & mat]ial to det]m9e if *emical ag5t p5etration has occurr$4 ,%\ld *emical ag5t p5etration occur1 all p]sonnel mu/ mask2 !n ensure t pati5ts are protect$ until ! ag5t has be5 purg$ f ! %elt]4 ,f-#ac4 ,decontam9ation ( ,entrance ,area a4 ,normally1 ! ,,mtf w n op]ate 9 a ,,cb vapor haz>d environm5t4 ,h[ev]1 if ! ,,mtf mu/ rema9 9 an area on a tempor>y basis & liquid ag5t contam9ation is pres5t1 ! imm$iate area ar\nd ! entrance mu/ be decontam9at$4 b4 ,to decontam9ate ! area ar\nd ! entrance1 use "o or m ( ! foll[+ me?ods3 ,turn ov] ab\t #b in*es ( soil4 ,remove ! top #a-;in* lay] ( soil conta9+ ! liquid ag5t4 ,use ! ,,cam or ,m#h detector pap] to *eck ! area aft] ! topsoil is remov$ to ensure complete ag5t removal4 ,add sev]al in*es ( clean soil or s&4 ,mix ,,/b into ! top #a_/b to #a in* ( soil4 ,use ,,ds#b on contam9at$ h>d-surfac$ areas or froz5 gr\nd4 ,f-#ad4 ,proc$ures ,prior to ,entry ,all p]sonnel 7/aff & pati5ts7 mu/ be decontam9at$ be=e !y are p]mitt$ entry into ! ,,cps4 ,use *emical detection equipm5t to *eck = ! pres5ce ( contam9ation on individuals & _! equipm5t2 also *eck = pres5ce ( contam9ation on individual weapons if !y are all[$ 9 ! ,,cps4 ,normally1 weapons w n be all[$ 9 ! pati5t c>e areas1 b w be /or$ outside ne> ! entry_/exit4 ,?or\gh decontam9ation is critical 9 prev5t+ contam9ation transf] into ! ,,cps4 ,:5 a *emical ag5t is detect$1 foll[ ! proc$ures 9 ,app5dix ,c = pati5t decontam9ation & ,,fm #c-e = o!r p]sonnel decontam9ation be=e ent]+ ! ,,cps4 ,all contam9at$ clo?+ & equipm5t are plac$ 9 ! contam9at$ dump4 ,weapons %\ld n h be5 evacuat$ ) pati5ts4 ,h[ev]1 if weapons are evacuat$ ) ! pati5t1 !y are decontam9at$ & held by ! ,,mtf 7adm9i/rative p]sonnel or hospital supply7 = disposition in/ructions4 ,decontam9ation mu/ be ?or\gh2 proc$ures mu/ be /rictly foll[$4 ,failure to d s c contam9ate ! int]ior ( ! ,,mtf & injure m$ical treatm5t p]sonnel2 ?us r$uc+ _! mission support capabilities4 ---------------------------------------- --------- ,,w>n+s #a4 ,,always ,,purge ,,! ,,air ,,lock ,,be=e ,,op5+ ,,! ,,inn] ,,door1 ,,if ,,! ,,out] ,,door ,,has ,,be5 ,,op5$4 #b4 ,,:5 ,,op]at+ ,,9 ,a ,,toxic ,,environm5t1 ,,nev] ,,op5 ,,! ,,out] ,,& ,,inn] ,,doors ,,( ,,! ,,air ,,locks ,,at ,,! ,,same ,,"t4 ---------------------------------------- --------- ,f-#ae4 ,entry_/,exit = ! ,collective ,protection ,%elt] ,sy/em a4 ,ambulatory ,p]sonnel4 7#a7 ,entry proc$ures4 7a7 ,ambulatory pati5ts & o!rs remove _! ,,mopp 7except _! mask71 ,b,d,us1 & boots outside ! air lock4 ,?is proc$ure r$uces ! am\nt ( possible contam9ation ent]+ ! air lock4 7b7 ,a *eck is made to ensure t ! ambulatory air lock is empty & ! inn] door is clos$4 7c7 ,! individual ent]s ! air lock & closes ! out] door4 7d7 ,! air lock is purg$ = #c m9utes4 ,at ! end ( ! purge cycle1 ! individual *ecks = contam9ation4 ,if contam9at$1 ! individual mu/ return to ! outside & decontam9ate 8 sk92 !n return to ! air lock & repeat ! purge cycle & contam9ation *eck4 ,if no contam9ation is detect$1 ! protective mask is remov$ & plac$ 9 a pla/ic bag4 ,! pla/ic bag is seal$ & label$4 ,! individual op5s ! inn] air lock door & ent]s ! ,,cps2 ! pla/ic bag is c>ri$ into ! %elt] ) ! individual4 7#b7 ,exit proc$ures4 7a7 ,a *eck is made to ensure t ! ambulatory air lock is empty & ! out] door is clos$4 7b7 ,! individual ent]s ! air lock & closes ! inn] door4 7c7 ,! individual puts on 8 protective mask2 !n exits ?r\gh ! out] door4 7d7 ,! individual puts on 8 ,,bdu & boots !n assumes ! e/abli%$ ,,mopp level be=e dep>t+ ! imm$iate area ( ! exit door4 ---------------------------------------- --------- ,,w>n+ ,,d ,,n ,,op5 ,,! ,,out] ,,door ,,until ,,! ,,protective ,,mask ,,has ,,be5 ,,put ,,on4 ---------------------------------------- --------- ,,notes #a4 ,ambulatory pati5ts t ent] ! ,,cbps become litt] pati5ts & are plac$ 9 ,,ppw :5 releas$ because ! ,,mtf does n h replacem5t ,,mopp ensembles = pati5t issue4 #b4 ,exits mu/ be spac$ s t at lea/ a #c m9ute purge ( ! air lock is accompli%$ be=e ! inside door is op5$4 ,only op5 ! doors long en\gh to p]mit passage4 b4 ,litt] ,pati5ts4 7#a7 ,entry proc$ures4 7a7 ,an outside aidman notifies an inside aidman t a litt] pati5t is ready = admission4 7b7 ,! inside aidman ensures t ! inn] litt] air lock door is clos$4 ,! outside aidm5 op5 ! out] air lock door & place ! litt] on ! litt] rails2 !y pu% ! pati5t into ! air lock headfir/2 !n !y close ! out] door4 ,aft] a purge "t ( #c m9utes1 an aidman inside ! ,,cps op5s ! inn] door & *ecks ! pati5t to ensure t he is contam9ation free4 ,! pati5t is *eck$ by plac+ ! ,,cam nozzle ne> absorptive surfaces1 su* z ! pati5t's hair4 ,if no contam9ation is f\nd1 ! aidman removes ! pati5t's mask & places x 9 a pla/ic bag4 ,! inside aidm5 remove ! pati5t f ! air lock & position him on treatm5t litt] /&s1 or move him to ! treatm5t area z direct$ by sup]visory p]sonnel4 7c7 ,pati5ts receiv$ at ! treatm5t facility 9 ! ,,ppw are *eck$ = contam9ation2 if !y are contam9ation free1 !y may be process$ ?r\gh ! litt] air lock 9 ! ,,ppw4 ,! inside aidm5 ensure t ! inn] litt] air lock door is clos$4 ,! outside aidm5 op5 ! out] air lock door & place ! litt] on ! litt] rails & pu% ! pati5t into ! litt] air lock headfir/1 !n close ! out] door4 ,purge ! air lock = #c m9utes4 ,aft] ! purge "t1 an aidman inside ( ! ,,cps op5s ! inn] air lock door & uses ! ,,cam to *eck ! pati5t to ensure t he is free ( contam9ation4 ,if no contam9ation is f\nd1 ! inside aidm5 remove ! pati5t f ! air lock4 7,if ! pati5t is we>+ a protective mask1 ! mask is remov$ & plac$ 9 a pla/ic bag be=e ! pati5t is mov$ f ! air lock47 ,z ! pati5t is remov$ f ! air lock1 ! ,,ppw is op5$ & roll$ inside out s t any desorb+ vapors are adsorb$ by ! *>coal lay]4 ,! inside aidm5 remove ! pati5t f ! air lock & position him on litt] /&s4 ,! pati5t is transf]r$ to a clean litt]2 !n mov$ to ! treatm5t area z direct$ by sup]visory p]sonnel4 ,! receiv+ litt] & ,,ppw is return$ to ! outside2 dispose ( ! ,,ppw 9 ! contam9at$ wa/e dump4 ,decontam9ate ! litt] & return x to ! litt] pool4 ,,note ,%\ld contam9ation be f\nd :5 monitor+ ! air lock 9 7b7 or 7c7 above1 repeat ! purge cycle1 !n rete/ = contam9ation4 ,all vapor haz>ds mu/ be elim9at$ be=e ! pati5t is mov$ into ! ,,cps4 ,repeat+ ! purge cycle may ,,n be possible if ! pati5t is 9 ne$ ( imm$iate lifesav+ c>e4 ,! pati5t may h to be return$ to ! outside treatm5t area = imm$iate c>e4 7#b7 ,exit proc$ures4 7a7 ,! litt] pati5t is plac$ 9 a ,,ppw4 ,a batt]y op]at$ bl[] unit ) a ,,cb filt] may be atta*$ to ! ,,ppw to provide fre% air to ! pati5t2 ?us r$uc+ ! heat load on ! pati5t & ! c>bon dioxide buildup inside ! ,,ppw4 7b7 ,an inside aidman notifies an outside aidman t ! pati5t is ready to exit ! %elt]4 ,an outside aidman ensures t ! out] air lock door is clos$4 ,! pati5t is plac$ 9 ! litt] air lock feet fir/4 ,! inn] air lock door is clos$4 ,! outside aidm5 op5 ! out] door & remove ! pati5t4 7c7 ,hospital /aff1 visitors1 or ambulatory pati5ts exit ?r\gh ! ambulatory air lock4 ,be=e ent]+ ! air lock1 ea* individual mu/ ensure t ! out] air lock door is clos$4 ,! individual ent]s ! air lock & closes ! inn] door2 puts on 8 protective mask & exits ?r\gh ! out] door4 ,! individual puts on 8 ,,bdu & boots1 & !n assumes ! e/abli%$ ,,mopp level be=e dep>t+ ! imm$iate area ( ! exit door4 ---------------------------------------- --------- ,,w>n+ ,,d ,,n ,,op5 ,,! ,,out] ,,door ,,until ,,! ,,inn] ,,door ,,has ,,be5 ,,clos$4 ---------------------------------------- --------- ,,note ,exits mu/ be spac$ at lea/ #c m9utes ap>t to all[ = a complete purge cycle ( ! air lock4 ,f-#af4 ,resupply ( ,protect$ ,areas ,resupply ( protect$ areas is accompli%$ by plac+ contam9ation-free supplies or equipm5t on a litt] & pass+ x ?r\gh ! litt] air lock1 or process+ x ?r\gh ! supply air lock4 ,! litt] air lock mu/ be purg$ = #c m9utes4 ,! supplies mu/ be *eck$ = contam9ation be=e !y are remov$ & plac$ )9 ! ,,cps4 ,! supply air lock mu/ be purg$ = ! /at$ "t z outl9$ 9 ! support+ te*nical manual2 usually #de m9utes4 ,aga9 ! supplies mu/ be *eck$ = contam9ation be=e !y are remov$ & plac$ )9 ! ,,cps4 ,,app5dix ,g ,,pati5t ,,decontam9ation ,section ,i4 ,,introduction ,g-#a4 ,g5]al a4 ,pati5t decontam9ation pres5ts special problems = units & ,,hss p]sonnel4 ,nucle>1 biological1 & *emical contam9at$ pati5ts create increas$ haz>ds to rescu]s & ,,hss p]sonnel2 ?us1 caus+ delays 9 provid+ ess5tial fir/ aid & m$ical treatm5t = injuries f s\rces o!r ?an ! exposure to ,,nbc weapons_/ag5ts4 ,casualty decontam9ation proc$ures are p]=m$ by ea* individual1 z buddy aid1 or at a unit decontam9ation /ation prior to ! arrival ( m$ical p]sonnel4 ,see ,,fm #c-e = proc$ures on individual1 buddy aid1 & unit decontam9ation4 ,pati5t decontam9ation proc$ures are normally p]=m$ at an ,,mtf "u m$ical sup]vision4 ,pati5t decontam9ation /ations may be e/abli%$ 7collocat$7 at c5tral unit decontam9ation faculties1 if m$ical support is available4 ,h[ev]1 augm5tation m$ical support mu/ be reque/$ to provide pati5t c>e & sup]vise ! pati5t decontam9ation process4 ,because1 :5 ! unit is und]go+ decontam9ation op]ations1 organic m$ical p]sonnel mu/ also decontam9ate _! equipm5t & p]sonnel4 ,!re=e1 !y are n available to provide m$ical support = op]at+ ! pati5t decontam9ation /ation t is collocat$ ) ! c5tral unit decontam9ation facility4 b4 ,! t]m decontam9ation z us$ h]e9 means ! removal or neutralization ( radioactive p>ticles1 ,,bw ag5ts1 & ,,cw ag5ts to levels l[ en\gh t pati5ts may be treat$ )\t contam9at+ ! ,,mtf & )\t pos+ heal? risks to unprotect$ m$ical provid]s4 ,decontam9ation does n imply absolute removal ( contam9ants4 ,,note ,! decontam9ation proc$ures describ$ bel[ are = ,,nbc contam9at$ pati5ts4 ,^! proc$ures may also be us$ = mo/ ,,tim contam9at$ pati5ts4 ,h[ev]1 soap & wat] w suffice = mo/ ,t,i,ms2 b "s ,t,i,ms react ) wat]4 ,= ^? ,t,i,ms ano!r mat]ial mu/ be us$ to decontam9ate pati5ts4 ,= detail$ in=mation on decontam9ation ( ,,tim contam9at$ pati5ts1 see ,,fm #h-ejj4 c4 ,physical removal ( contam9ants is ! prim>y me?od ( decontam9ation4 ,physical removal does n require vigor\s scrubb+2 9 fact1 vigor\s scrubb+ c =ce "s ag5ts deep] into ! sk92 ?us1 increas+ ! ag5t effect r ?an r$uc+ its effects4 ,! use ( a ,m#bia sk9 decontam9at+ kit 7,,sdk7 neutralizes_/r$uces ! effects ( an ag5t1 b physical removal is ( utmo/ importance4 ,:5 a ,,sdk is n available1 ! use ( soap & wat] %\ld be consid]$ z ! next be/ me?od4 ,h[ev]1 ! use ( soap & wat] requires l>ge am\nts ( wat] t may n be available because ! soap mu/ be r9s$ f ! sk9 to r$uce sk9 irritation f ! soap4 ,an alt]nate sk9 decontam9ant is a hypo*lorite solution2 b x %\ld only be us$ :5 ,s,d,ks &_/or suffici5t quantities ( wat] are n available4 ,use a #j4e p]c5t hypo*lorite solution on ! protective mask & sk94 ,a #e p]c5t hypo*lorite solution c be us$ on ! mask hood1 gloves1 & o!r out] g>m5ts4 ---------------------------------------- --------------- ,,caution ,d n use ! #e p]c5t solution on ! sk92 x c cause sev]e sk9 irritation4 ---------------------------------------- --------------- ,g-#b4 ,imm$iate ,decontam9ation ,decontam9ation mu/ beg9 at ! platoon & company level ) ! individual soldi]1 prior to ! arrival ( m$ical p]sonnel4 ,! soldi] himself or memb]s ( 8 team mu/ p]=m imm$iate decontam9ation4 ,:5 ! casualty's condition & ! mission p]mits1 !y may g ?r\gh a ,,mopp ge> ex*ange at _! unit be=e evacuation 7see ,,fm #c-e74 ,p]=m+ a ,,mopp ge> ex*ange at ! unit be=e evacuation w r$uce ! am\nt ( contam9ation t c be transf]r$ to ! ,,m$evac vehicle4 ,h[ev]1 ! ,,mopp ge> ex*ange mu/ n cause fur!r injury to ! casualty4 ,fir/ aid = ,,cw ag5t mu/ be adm9i/]$2 su* z adm9i/]+ n]ve ag5t antidotes 7su* z n]ve ag5t antidotes & convulsant antidote = n]ve ag5t ,,cana71 z requir$4 ,ent] ! "t & type ( contam9ation on a field exp$i5t ,,nbc casualty c>d 7,figure ,g-#a74 ,use ! ,,cam1 ,m#h *emical ag5t detector pap]1 or ,m#i tape to det]m9e ! type ( *emical contam9ation4 ,use a radiation detection met]_/device to det]m9e ! level ( radioactive contam9ation1 if requir$4 ,curr5tly1 !re are no ,,bw ag5t detectors t c be us$ to *eck pati5ts = ,,bw ag5t contam9ation4 ,!re=e1 all pati5ts suspect$ ( be+ contam9at$ ) a ,,bw ag5t mu/ be decontam9at$4 ,:5 m$ical p]sonnel arrive1 !y %\ld ent] ! "t & type ( contam9ation & numb] ( antidote injections t 7 adm9i/]$ z fir/ aid on ! ,dep>tm5t ( ,def5se 7,,dd7 ,=m #achj 7,field ,m$ical ,c>d ,,fmc74 ,illu/ration3 ,figure ,g-#a4 ,field exp$i5t nucle>1 biological1 & *emical pati5t c>d4 ,g-#c4 ,pati5t ,decontam9ation & ,?or\gh ,decontam9ation ,collocation a4 ,collocat+ pati5t & ?or\gh decontam9ation op]ations 9 ! ,,bsa may provide sev]al advantages 7,figure ,g-#b74 ,x-- ,pres]ves ! pr9ciple ( limit+ ! spread ( contam9ation4 ,r$uces confusion on ! battlefield4 ,r$uces dem& on logi/ics support elem5ts4 ,improves contam9ation control & report+3 ,"o location & "o p]son 9 *>ge4 ,r$uces ov]all security requirem5ts4 ,spe$s ,,pds closure by us+ ! ?or\gh decontam9ation site4 b4 ,an id5tifi$ disadvantage is ! increas$ size ( ! site & ! requirem5t = m$ical support augm5tation 7a treatm5t squad f ano!r organization ) requir$ pati5t decontam9ation & treatm5t ,m,e,ss7 to op]ate ! ,,pds4 ,,note ,organic m$ical p]sonnel mu/ n be us$ to p]=m ! ,,hss mission at ! collocat$ site4 ,!y mu/ g ?r\gh ! decontam9ation process ) _! unit4 c4 ,^! op]ations d n require t bo? pati5t decontam9ation & unit ?or\gh decontam9ation be execut$ simultane\sly4 ,! ,,pds c be runn+ :ile ! ?or\gh decontam9ation site is be+ prep>$4 ,pati5t decontam9ation _c be delay$ s9ce pati5ts may be suff]+ life-?reat5+ injuries z well z exposure to ,,nbc ag5ts4 ,!re=e1 ! ,,pds mu/ be e/abli%$ & op]ational be=e ! fir/ pati5ts arrive4 ,! w9d direction mu/ be common to bo? sites4 d4 ,! decontam9ation platoon lead] is responsible = e/abli%+ ! comb9$ decontam9ation site4 ,! m$ical unit comm&]_/surgeon coord9ates ) ! decontam9ation platoon lead] = ! location ( ! pati5t receiv+1 ,,pds1 & ,,mtf4 ,! l[e/ level at :i* ?is op]ation w usually be plann$ is brigade4 ,?is op]ation requires ext5sive plann+ & mu/ involve ! brigade *emical (fic]1 brigade ,s#d1 & ! m$ical company comm&]_/brigade surgeon4 ,decontam9ation support = special op]ation =ces1 o!r unique op]ational organizations1 or = nonl9e> op]ations may require execution at a l[] level4 ,! support+ m$ical p]sonnel op]ate ! ,,pds4 ,nonm$ical p]sonnel p]=m pati5t decontam9ation proc$ures "u m$ical sup]vision4 ,pati5t decontam9ation proc$ures are describ$ bel[4 ,,note ,pati5t decontam9ation diff]s f ?or\gh decontam9ation 9 t ! pati5ts' m$ical /atus mu/ be monitor$ & m$ical treatm5t mu/ be provid$ dur+ ! decontam9ation process4 e4 ,al?\gh a ,,pds may be collocat$ ) ?or\gh decontam9ation1 a ,,pds mu/ be op]ational at ,levels ,i1 ,,ii1 ,,iii1 & ,,iv ,m,t,fs4 ,contam9at$ pati5ts may pres5t directly to ! ,,mtf = c>e1 or pati5ts previ\sly decontam9at$ may become contam9at$ en r\te4 ,!re=e1 all pati5ts arriv+ at an ,,mtf mu/ be *eck$ = contam9ation4 ,if contam9at$1 !y mu/ be decontam9at$ be=e !y are admitt$ to ! ,,mtf4 ,illu/ration3 ,figure ,g-#b4 ,?or\gh decontam9ation site collocat$ ) pati5t decontam9ation /ation1 )\t collective protection %elt]4 ,g-#d4 ,pati5t ,decontam9ation at ! ,battalion ,aid ,/ation 7,level ,i7 a4 ,:5 battle conditions prev5t pati5t decontam9ation proc$ures =w>d or ! pati5t is contam9at$ en r\te1 ! pati5t may h to be decontam9at$ at ! ,,bas4 ,contam9at$ pati5ts arriv+ at ! ,,bas mu/ be decontam9at$ be=e admission into ! clean treatm5t area4 b4 ,pati5t decontam9ation is p]=m$ by eight nonm$ical p]sonnel f ! support$ unit at ! ,,bas4 ,! pati5t decontam9ation p]sonnel op]ate z two-man teams to p]=m ! pati5t decontam9ation proc$ures4 ,! pati5t decontam9ation teams op]ate "u ! sup]vision ( m$ical p]sonnel to ensure t no fur!r injury is caus$ to ! pati5t by ! decontam9ation process4 ,ea* team receives a pati5t f ! triage po9t & p]=ms bo? clo?+ removal & sk9 decontam9ation proc$ures4 ,! team requires assi/ance f ano!r team to p]=m litt] *anges2 see details bel[4 ,g-#e4 ,pati5t ,decontam9ation at ! ,m$ical ,company ,cle>+ ,/ation 7,level ,,ii7 ,! m$ical company cle>+ /ation may receive pati5ts f ! ,,bas or directly f o!r areas :o h n be5 decontam9at$4 ,! cle>+ /ation mu/ also h a pati5t decontam9ation area4 ,z ) ! ,,bas1 ! cle>+ /ation mu/ h a m9imum ( eight nonm$ical p]sonnel f ! support$ units to p]=m pati5t decontam9ation4 ,proc$ures = pati5t decontam9ation at ! cle>+ /ation are ! same z = ! ,,bas4 ,g-#f4 ,pati5t ,decontam9ation at a ,hospital 7,level ,,iii or ,,iv7 ,to ! maximum ext5t possible1 hospitals are locat$ away f tactical or logi/ical t>gets4 ,contam9at$ pati5ts w arrive f =w>d ,m,t,fs & units locat$ )9 ! geographical area ( ! hospital4 ,pati5t decontam9ation is done by at lea/ #bj nonm$ical p]sonnel f units locat$ 9 ! geographical area_/base clu/] ( ! hospital4 ,proc$ures = pati5t decontam9ation at ! hospital are ! same z = ! ,,bas4 ,h[ev]1 sev]al pati5t decontam9ation /ations c be op]at$ simultane\sly at ! hospital pati5t decontam9ation site4 ,fur!r1 all pati5ts arriv+ at ! hospital w be decontam9at$ & receive full treatm5t )9 ! capabilities ( ! hospital4 ,g-#g4 ,prep>e ,hypo*lorite ,solutions = ,pati5t ,decontam9ation ,an alt]native pati5t decontam9ation ag5t is a hypo*lorite solution2 h[ev]1 ! hypo*lorite solution mu/ be prep>$4 ,two conc5trations ( ! hypo*lorite solution are requir$4 ,a #e p]c5t hypo*lorite solution to decontam9ate gloves1 aprons1 litt]s1 cutt+ devices1 ! pati5t's mask hood1 & o!r nonsk9 contact areas4 ,! pati5t's mask1 sk91 spl9ts1 & t\rniquets & _! w\nds are irrigat$ us+ a #j4e 77 p]c5t hypo*lorite solution4 ,to prep>e ! solutions1 use calcium hypo*lorite 7,,h?7 granules 7suppli$ 9 #f-ounce j>s 9 ! *emical ag5t pati5t treatm5t & *emical ag5t pati5t decontam9ation ,,mes71 bulk ,,h?1 or sodium hypo*lorite 7h\sehold blea*74 ,prep>e ! requir$ solutions z %[n 9 ,table ,g-#a bel[4 ,table ,g-#a4 ,prep>ation ( ,hypo*lorite ,solutions = ,pati5t ,decontam9ation ,,h? ,,h? ,,mre ,,h\sehold ,,p]c5t ,,9 #e ,,ounces ,,spoonfuls ,,blea* ,,gallons ,,( ,,wat] ---------------------------------------- -------------------------- #f 99#e #b ,,qu>ts #j4e #dh #dj 9999 #e4j ---------------------------------------- -------------------------- 99 ,,^! ,,measurem5ts ,,are ,,us$ ,,:5 ,,bulk ,,h? ,,is ,,us$4 ,,to ,,measure ,,?is ,,prep>ation1 ,,use ,,! ,,pla/ic ,,spoon ,,suppli$ ,,) ,,y\r ,,meal1 ,,ready-,,to-,,eat 7,,mre74 ,,! ,,am\nt ,,( ,,hypo*lorite ,,to ,,be ,,us$ ,,is ,a ,,heap+ ,,spoonful 7,,t ,,is1 ,,all ,,t ,,! ,,spoon ,,w ,,hold74 ,,d ,,n ,,%ake ,,any ,,granules ,,(f ,,( ,,! ,,spoon ,,be=e ,,add+ ,,to ,,! ,,wat]4 9999 ,,d ,,n ,,dilute ,,9 ,,wat]2 ,,h\sehold ,,blea* ,,is #e ,,to #f4be ,,p]c5t ,,solution2 ,,x ,,is ,,us$ ,,full ,,/r5g? ,,= #e ,,p]c5t ,,applications4 ---------------------------------------- -------------- ,,cautions #a4 ,d n use ! #e p]c5t hypo*lorite solution on ! pati5t's sk94 ,! #e p]c5t solution c burn ! sk94 #b4 ,only wipe ! sk9 :5 apply+ ! #j4e p]c5t hypo*lorite solution4 ,vigor\s scrubb+ may =ce ! ag5t into ! sk94 ---------------------------------------- -------------- ,g-#h4 ,classification ( ,pati5ts ,on ! ,,nbc battlefield1 two classifications ( pati5ts w be enc\nt]$--contam9at$ & uncontam9at$4 ,^? contam9at$ may suff] f ! effects ( an ,,nbc ag5t1 ( a conv5tional w\nd1 or bo?4 ,"s may suff] combat /ress or heat injuries induc$ by ! /ress ( ,,nbc conditions & ext5d$ "t sp5t 9 ,,mopp ,level #d4 ,x is important to foll[ prop] decontam9ation proc$ures to limit ! spread ( contam9ation to o!rs & equipm5t4 ,! mo/ important decontam9ation is p]=m$ at ! site ( contam9ation4 ,decontam9ation at a lat] "t may be too late to prev5t injury to ! individual1 especially :5 expos$ to vesicants4 ,all ag5ts %\ld be promptly remov$ f ! sk94 ,g-#i4 ,pati5t ,treatm5t ,?is app5dix only describes pati5t decontam9ation proc$ures4 ,= ,,nbc treatm5t proc$ures1 ref] to ,,fm #d-jb4bhc1 ,,fm #h-bhd1 & ,,fm #h-bhe4 ,section ,,ii4 ,,pati5t ,,decontam9ation ,,proc$ures ,g-#aj4 ,decontam9ate a ,litt] ,*emical ,ag5t ,pati5t ,be=e contam9at$ pati5ts receive m$ical treatm5t 9 ! clean treatm5t area1 !y mu/ be decontam9at$4 ,place ! cutt+ device 9 a conta9] ( #e p]c5t hypo*lorite solution betwe5 ea* use4 ,ea* decontam9ation team memb] decontam9ates 8 gloves & apron ) ! #e p]c5t hypo*lorite solution frequ5tly to prev5t spread+ any contam9ation to pati5t's sk94 ,decontam9ate ! pati5t's sk91 b&ages1 w\nds1 mask1 id5tification tags ) *a91 & spl9ts ) a #j4e p]c5t hypo*lorite solution4 ,! litt] pati5t is decontam9at$ & undress$ z foll[s3 ,,note ,litt] pati5ts requir+ ,,emt or ,,atm 9 ! clean area ( ! ,,mtf w be completely decontam9at$4 ,a pati5t n requir+ clean ,,emt or ,,atm at ! ,,mtf1 b requir+ fur!r evacuation 7= example3 a /able pati5t ) a p>tial amputation ( a l[] extremity7 %\ld only h 8 w\nd area & ,,mopp spot decontam9at$ to remove any gross contam9ation4 ,! pati5t %\ld be evacuat$ 9 8 ,,mopp4 a4 ,/ep #a4 ,physically remove gross contam9ation4 ,use any /iff mat]ial 7/ick1 c>dbo>d1 pla/ic /rip1 metal b&+ /rap7 to physically remove gross contam9ation f ! pati5t's ,,mopp ensemble4 ,mu* ( ! ,,cw ag5t contam9ation c be remov$ ?r\gh physical means4 b4 ,/ep #b4 ,decontam9ate ! pati5t's mask & hood4 ,! pati5t has be5 triag$ & /abiliz$ 7if necess>y7 by ! s5ior trauma speciali/ 9 ! pati5t decontam9ation area4 ,a two-man decontam9ation team moves him to ! litt] /&s at ! clo?+ removal /ation4 7#a7 ,decontam9ate ! mask & hood4 ,use ! ,,sdk1 or use a #e p]c5t hypo*lorite solution or h\sehold blea* to sponge d[n ! front1 sides1 & top ( ! mask hood4 ,decontam9ate spots ) ! ,,sdk or ! #e p]c5t hypo*lorite solution4 7#b7 ,remove hood4 ,remove ! hood by cutt+ ! hood4 ,be=e cutt+ ! hood1 dip ! cutt+ device 9 a #e p]c5t hypo*lorite solution4 ,= ! ,m#ag-s]ies mask1 cut ! neck cord & ! small /r+ "u ! voicemitt]4 ,release or cut ! hood %\ld] /raps & unzip ! hood zipp]4 ,cut ! hood1 close to ! filt] inlet cov] & eye-l5s outs]t1 upw>d to ! top ( ! eye-l5s outs]t1 & across ! =ehead to ! out] edge ( ! o!r eye-l5s outs]t4 ,proce$ d[nw>d t[>d ! pati5t's %\ld]1 /ay+ close to ! eye-l5s1 !n across ! l[] "p ( ! voicemitt] to ! zipp]4 ,aft] dipp+ ! cutt+ device 9 ! #e p]c5t hypo*lorite solution1 cut ! hood f ! c5t] ( ! =ehead ov] ! top ( ! head 7see ,figure ,g-#c74 ,fold ! left & "r sides ( ! hood to ! side ( ! pati5t's head1 lay+ ! sides ( ! hood on ! litt]4 ,= ! ,m#dj-s]ies protective mask cut ! hood %\ld] /raps1 !n cut ! quick-d(f hood f ! front bottom c5t] to ! *9 ?r\gh ! ela/ic b& "u ! *94 ,fold ! left & "r sides ( ! hood ov] ! %\ld]s away f ! head4 ,illu/ration3 ,figure ,g-#c4 ,cutt+ ! ,m#ag protective mask hood4 7#c7 ,decontam9ate ! protective mask & expos$ sk94 ,us+ ! ,,sdk1 soap & wat]1 or a #j4e p]c5t hypo*lorite solution1 wipe ! ext]nal p>ts ( ! mask4 ,cov] ! mask air inlet7s7 ) gauze or y\r h& to keep ! mask filt] dry4 ,cont9ue by wip+ ! expos$ areas ( ! pati5t's face1 includ+ ! neck & beh9d ! e>s4 7#d7 ,remove ! ,field ,m$ical ,c>d4 ,cut ! pati5t's ,,fmc tie wire1 all[+ ! ,,fmc to fall into a pla/ic bag4 ,seal ! pla/ic bag & r9se ! outside ( ! bag ) a #e p]c5t hypo*lorite solution4 ,place ! pla/ic bag ) ! ,,fmc "u ! back ( ! protective mask head /raps4 ,! ,,fmc w rema9 ) ! pati5t4 c4 ,/ep #c4 ,remove gross contam9ation f ! pati5t's ov]g>m5t4 ,remove all visible gross contam9ation by scrap+ ) a /ick or o!r device4 d4 ,/ep #d4 ,remove ! pati5t's p]sonal effects & protective ov]g>m5t4 7#a7 ,remove pati5t's p]sonal effects4 ,remove ! pati5t's p]sonal effects f 8 protective ov]g>m5t & ,,bdu pockets4 ,place ! articles 9 a pla/ic bag1 label ) ! pati5t's id5tification1 & seal ! bag4 ,if ! articles are n contam9at$1 return !m to ! pati5t4 ,if ! articles are contam9at$1 place !m 9 ! contam9at$ hold+ area until !y c be decontam9at$1 & !n return !m to ! pati5t4 7#b7 ,cut ! pati5t's ov]g>m5t4 ,! ov]g>m5t jacket & tr\s]s may be cut simultane\sly4 ,two p]sons may be cutt+ clo?+ at ! same "t4 ,cut ar\nd b&ages1 t\rniquets1 & spl9ts1 leav+ !m 9 place4 ,,note ,a cut is a sep>ation ( mat]ial by use ( a cutt+ device t cuts mat]ial into two pieces4 ,,example3 ,cutt+ ! sleeve f ! cuff to ! jacket coll> is "o cut4 ---------------------------------------- ------------------- ,,caution ,b&ages may h be5 appli$ to control sev]e ble$+ & are treat$ l t\rniquets4 ,only m$ical p]sonnel remove b&ages1 t\rniquets1 & spl9ts4 ---------------------------------------- ------------------- 7#c7 ,remove ov]g>m5t jacket4 ,make two cuts1 "o up ea* sleeve f ! wri/ up to ! %\ld]1 & !n ?r\gh ! coll> 7,figure ,g-#d74 ,d n all[ ! gloves to t\* ! pati5t along ! cut l9e4 ,dip ! cutt+ device 9 ! #e p]c5t hypo*lorite solution be=e mak+ ea* cut to prev5t contam9ation ( ! pati5t's uni=m or und]clo?+4 ,keep ! cuts close to ! inside ( ! arms s t mo/ ( ! sleeve mat]ial c be fold$ outw>d4 ,unzip ! jacket2 roll ! *e/ sections to ! respective sides1 ) ! inn] surface outw>d4 ,cont9ue by tuck+ ! clo?+ betwe5 ! arm & *e/4 ,roll ! cut sleeves away f ! arms1 expos+ ! black l9]4 ,illu/ration3 ,figure ,g-#d4 ,cutt+ ! ov]g>m5t jacket4 7#d7 ,remove ov]g>m5t tr\s]s4 ,cut bo? tr\s] legs />t+ at ! ankle z %[n 9 ,figure ,g-#e4 ,keep ! cuts ne> ! inseams to ! crot*4 ,) ! left leg1 cont9ue cutt+ to ! wai/1 avoid+ ! pockets4 ,) ! "r leg1 cut across at ! crot* to ! left leg cut4 ,place ! cutt+ device 9 ! #e p]c5t hypo*lorite solution4 ,fold ! cut tr\s] halves away f ! pati5t & all[ ! halves to drop to ! litt] ) contam9at$ 7gre57 side d[n4 ,roll ! inn] leg portion "u & betwe5 ! legs4 ,illu/ration3 ,figure ,g-#e4 ,cutt+ ! ov]g>m5t tr\s]s4 7#e7 ,remove out] gloves4 ,?is proc$ure c be done ) "o p]son on ea* side ( ! pati5t work+ simultane\sly4 ,! decontam9ation team w decontam9ate _! gloves 9 #e p]c5t hypo*lorite solution4 ,next1 lift ! pati5t's arms up & out ( ! cutaway sleeves unless detrim5tal to ! pati5t's condition4 ,grasp ! f+]s ( ! glove1 roll ! cuff ov] ! f+]s1 turn+ ! glove inside out4 ,d n remove ! inn] cotton glove l9]s at ?is "t4 ,c>efully l[] ! arms across ! *e/ aft] ! out] gloves h be5 remov$ 7,figure ,g-#f74 ,d n all[ ! pati5t's arms to come into contact ) ! ext]ior ( 8 ov]g>m5t4 ,drop 8 gloves into ! contam9at$ wa/e bag4 ,dip y\r gloves 9 ! #e p]c5t hypo*lorite solution4 ,illu/ration3 ,figure ,g-#f4 ,remove out] gloves & position arms aft] glove removal4 7#f7 ,remove ov]boots4 ,cut ! ov]boot laces & fold ! lac+ eyelets flat outw>ds4 ,if ! gre5 v9yl ov]boot 7,,gvo7 is worn1 fir/ try to remove ! ov]boot )\t cutt+2 if necess>y1 cut ! boot along ! front4 ,:ile /&+ at ! foot ( ! litt]1 hold ! heel ) "o h&1 pull ov]boot d[nw>ds1 & !n pull t[>ds y to remove ! ov]boot ov] ! combat boot heel4 ,remove ! two ov]boots simultane\sly4 ,?is r$uces ! likelihood ( contam9at+ "o ( ! combat boots4 ,:ile hold+ ! heels (f ! litt]1 h a decontam9ation team memb] wipe ! end ( ! litt] ) ! #e p]c5t hypo*lorite solution to neutralize any liquid contam9ation t 0 transf]r$ to ! litt] f ! ov]boots4 ,l[] ! pati5t's heels onto ! decontam9at$ litt]4 ,place ! ov]boots 9 ! contam9at$ wa/e bag4 ,decontam9ation p]sonnel dip _! gloves 9 ! #e p]c5t hypo*lorite solution4 e4 ,/ep #e4 ,remove pati5t's battle dress uni=m4 7#a7 ,remove battle dress uni=m4 ,cut ! ,,bdu jacket & tr\s]s z describ$ above = ! protective ov]g>m5t4 ,roll ! jacket & tr\s]s z describ$ = ! protective ov]g>m5t4 7#b7 ,remove combat boots4 ,cut ! bootlaces along ! tongue4 ,remove ! boots by pull+ !m t[>ds y4 ,place ! boots 9 ! contam9at$ wa/e bag4 ,d n t\* ! pati5t's sk9 ) contam9at$ gloves :5 remov+ 8 boots4 7#c7 ,remove und]g>m5ts4 ,remove ! pati5t's tee %irt4 ,dip ! cutt+ device 9 ! #e p]c5t hypo*lorite solution betwe5 ea* cut4 ,cut bo? sleeves f ! inside1 />t+ at ! elb[1 up to ! armpit4 ,cont9ue cutt+ across ! %\ld] to ! coll>4 ,cut ar\nd b&ages or spl9ts1 leav+ !m 9 place4 ,next1 peel ! tee %irt away f ! body to avoid spread+ contam9ation4 ,if ! pati5t is we>+ a brassi]e1 cut x betwe5 ! cups4 ,cut bo? %\ld] /raps :]e !y atta* to ! cups & lay !m back (f ( ! %\ld]s4 ,remove ! pati5t's "u %orts_/panties by cutt+ f ! l[] side ( ! hip to ! wai/ on bo? sides4 ,fold ! front flap ( ! %orts_/panties d[n betwe5 ! pati5t's legs onto ! litt]4 ,d n all[ ! outside ( ! g>m5t to t\* ! pati5t's sk94 ,remove ! socks & cotton glove l9]s4 ,d n remove ! pati5t's id5tification tags4 f4 ,/ep #f4 ,transf] ! pati5t to a decontam9ation litt]4 ,aft] ! pati5t's clo?+ has be5 cut away1 he is transf]r$ to a decontam9ation litt] or a canvas litt] ) a pla/ic %eet+ cov]4 ,?ree decontam9ation team memb]s decontam9ate _! gloves & aprons ) ! #e p]c5t hypo*lorite solution4 ,"o memb] places 8 h&s "u ! pati5t's legs at ! ?ighs & ,a*illes t5dons1 a second memb] places 8 arms "u ! pati5t's back & buttocks1 & a ?ird memb] places 8 arms "u ! pati5t's %\ld]s & supports ! head & neck4 ,!y c>efully lift ! pati5t us+ _! knees 7n _! backs7 to m9imize back /ra94 ,:ile ! pati5t is elevat$1 ano!r decontam9ation team memb] removes ! litt] f ! litt] /&s & replaces x ) a decontam9at$ 7clean7 litt]4 ,! pati5t is c>efully l[]$ onto ! clean litt]4 ,! contam9at$ clo?+ & ov]g>m5ts are plac$ 9 bags & mov$ to ! contam9at$ wa/e dump4 ,! dirty litt] is r9s$ ) ! #e p]c5t hypo*lorite solution & plac$ 9 ! litt] /orage area4 g4 ,/ep #g4 ,decontam9ate sk94 7#a7 ,spot decontam9ation4 ,) ! pati5t 9 a sup9e position1 spot decontam9ate ! sk9 us+ ! ,,sdk or a #j4e p]c5t hypo*lorite solution4 ,decontam9ate areas ( pot5tial contam9ation4 ,include areas ar\nd ! neck1 wri/s1 & l[] p>ts ( ! face4 ,decontam9ate ! pati5t's id5tification tags & *a91 if necess>y4 ,,note ,complete body wa% is n appropriate & may be injuri\s to ! pati5t4 ,dur+ complete body wa%1 ! pati5t w\ld h to be roll$ ov] to rea* all areas ( ! sk94 ,?is is n necess>y = adequate decontam9ation4 7#b7 ,trauma speciali/ c>e4 ,dur+ decontam9ation1 ! clo?+ ar\nd b&ages1 t\rniquets1 & spl9ts 0 cut & left 9 place4 ,! trauma speciali/ replaces ! old t\rniquet by plac+ a new t\rniquet to #a in* above ! old "o4 ,he !n removes ! old t\rniquet & decontam9ates ! pati5t's sk9 us+ ! ,m#bia pads or a #j4e p]c5t hypo*lorite solution4 ,! trauma speciali/ g5tly cuts away b&ages & decontam9ates ! area ar\nd ! w\nd2 du/s ! w\nd ) ! ,,sdk1 or irrigates s(t tissue w\nds ) ! #j4e p]c5t hypo*lorite solution4 ,if ble$+ beg9s1 ! trauma speciali/ replaces ! b&age ) a clean "o4 ,! trauma speciali/ ensures spl9ts are n remov$1 b are decontam9at$ 9 place by apply+ ! #j4e p]c5t hypo*lorite solution to !m1 to include ! padd+ & cravats4 ,spl9ts w only be remov$ by a physician or "u ! sup]vision ( a physician4 ---------------------------------------- ------------ ,,w>n+s #a4 ,,d ,,n apply ! ,,sdk or irrigate w\nds 9 ! abdom9al & ?oracic cavities or intracranial head injuries4 #b4 ,,d ,,n remove spl9ts4 ---------------------------------------- ------------ 7#c7 ,*eck pati5t = complet5ess ( decontam9ation4 ,! pati5t is *eck$ ) ! ,,cam or ) ,m#h detector pap] = complet5ess ( decontam9ation4 ,,note ,o!r monitor+ devices may be us$ :5 available4 7#d7 ,dispose ( contam9at$ wa/e4 ,dispose ( contam9at$ b&ages & cov]+s by plac+ !m 9 a contam9at$ wa/e bag4 ,seal ! bag & place x 9 ! contam9at$ wa/e dump4 h4 ,/ep #h4 ,transf] ! pati5t across ! %uffle pit4 7#a7 ,! pati5t's clo?+ has be5 cut away2 8 sk91 b&ages1 & spl9ts h be5 decontam9at$4 ,n[ ! litt] is transf]r$ to ! %uffle pit & plac$ ^u ! litt] /&s4 ,! %uffle pit is wide en\gh to prev5t ! pati5t decontam9ation team memb]s f /raddl+ x :ile c>ry+ ! litt]4 ,f\r decontam9ation team memb]s transf] ! pati5t to a clean treatm5t litt] 9 ! %uffle pit4 ,a memb] ( ! pati5t decontam9ation team removes ! bagg$ ,,fmc & holds x s t a trauma speciali/ on ! clean side ( ! hot l9e c read x4 ,a trauma speciali/ on ! clean side ( ! hot l9e prep>es a new ,,fmc be=e ! pati5t is mov$ to ! clean area4 ,! old ,,fmc is dispos$ ( ) o!r contam9at$ wa/e4 7#b7 ,decontam9ation team memb]s r9se or wipe d[n _! aprons & gloves ) ! #e p]c5t hypo*lorite solution4 7#c7 ,?ree decontam9ation team memb]s lift ! pati5t (f ! decontam9ation litt] 7see ,/ep #f = lift+ proc$ures74 7#d7 ,:ile ! pati5t is elevat$1 ano!r decontam9ation team memb] removes ! litt] f ! /&s & returns x to ! decontam9ation area4 ,a trauma speciali/ f ! clean side ( ! %uffle pit replaces ! litt] ) a clean "o4 ,! pati5t is l[]$ onto ! clean litt]4 ,two trauma speciali/s f ! clean side ( ! %uffle pit move ! pati5t to ! clean treatm5t area4 ,! pati5t is treat$ 9 ?is area or waits = process+ into ! ,,cps4 ,! litt] remov$ by ! decontam9ation team memb] is wip$ d[n ) ! #e p]c5t hypo*lorite solution 9 prep>ation = reuse4 ,,note ,be=e decontam9at+ ano!r pati5t1 ea* decontam9ation team memb] dr9ks approximately "o-half qu>t ( wat]4 ,! exact am\nt ( wat] consum$ is increas$ or decreas$ accord+ to ! temp]ature 7see ,table ,g-#b bel[74 ,table ,g-#b4 ,heat ,injury ,prev5tion & ,wat] ,consumption4 ,,easy ,,"w ,,mod]ate ,,"w ,,h>d ,,"w ---------------------------------------- --- ,,heat ,,wbgt ,,"w_/ ,,wat] ,,"w_/ ,,wat] ,,"w_/ ,,wat] ,,category ,,index ,,re/ ,,intake ,,re/ ,,intake ,,re/ ,,intake ,,degrees ,f ,,m9 ,,qt_/,,hr ,,m9 ,,qt_/,,hr ,,m9 ,,qt_/,,hr ---------------------------------------- ----------------------- #a 7,,:ite7 #gh-ha4i ,,nl ,,nl #dj_/bj #b 7,,gre57 #hb-hd4i ,,nl #ej_/aj #cj_/cj #a #c 7,,yell[7 #he-hg4i ,,nl #dj_/bj #cj_/cj #a #d 7,,r$7 #hh-hi4i ,,nl #cj_/cj #bj_/dj #a #e 7,,black7 #ij #ej_/aj #a #bj_/dj #a #aj_/ej #a ---------------------------------------- ----------------------- ,,! ,,"w_/,,re/ ,,times ,,& ,,fluid ,,replacem5t ,,volumes ,,w ,,su/a9 ,,p]=mance ,,& ,,hydration ,,= ,,at ,,lea/ #d ,,h\rs ,,( ,,"w ,,9 ,,! ,,specifi$ ,,heat ,,category4 ,,nl,,no ,,limit ,,to ,,"w ,,"t ,,p] ,,h\r4 ,,re/ ,,means ,,m9imal ,,physical ,,activity 7,,sitt+ ,,or ,,/&+7 ,,accompli%$ ,,9 ,,%ade1 ,,if ,,possible4 ,,caution3 ,,h\rly ,,fluid ,,intake ,,%\ld ,,n ,,exce$ #a ,,qu>t4 ,,daily ,,fluid ,,intake ,,%\ld ,,n ,,exce$ #ab ,,qu>ts4 ,,we>+ ,,body ,,armor ,,adds #e ,f ,,to ,,wbgt ,,index4 ,,we>+ ,,all ,,mopp ,,ov]g>m5ts ,,adds #aj ,f ,,to ,,wbgt ,,index4 ---------------------------------------- ------------------ ,,w>n+ ,d n exce$ a fluid intake ( #a qu>t p] h\r4 ,d n exce$ a fluid intake ( #ab qu>ts p] day4 ---------------------------------------- ------------------ ,g-#aa4 ,decontam9ate an ,ambulatory ,*emical ,ag5t ,pati5t a4 ,all ambulatory pati5ts requir+ ,,emt or ,,atm 9 ! clean area ( ! ,,bas w be decontam9at$4 ,a memb] ( ! decontam9ation team or o!r ambulatory pati5ts w assi/ ! pati5t 9 remov+ 8 clo?+ & decontam9at+ 8 sk94 b4 ,pati5ts requir+ only m9imal c>e w und]go spot decontam9ation ( _! ,,mopp ge> z requir$ = _! m$ical treatm5t4 ,!y w be treat$ 9 ! contam9at$ ,,emt area & return$ to duty4 ,!y w und]go decontam9ation & a ,,mopp ge> ex*ange ) _! unit4 c4 ,/able pati5ts n requir+ treatm5t at ! ,,bas1 b requir+ evacuation to a high] level ( c>e = treatm5t 7example3 ,a pati5t ) a brok5 arm7 %\ld be evacuat$ 9 ,,mopp ,level #d by any available transportation4 ,h[ev]1 be=e evacuation1 spot remove all ?ick5$_/p]si/5t ag5ts f protective clo?+4 ,,notes #a4 ,rememb]1 d n remove clo?+ f an ambulatory pati5t unless he requires treatm5t 9 ! clean treatm5t area ( ! ,,bas or cle>+ /ation4 ,only spot decontam9ate ! pati5t's clo?+ & evacuate him to ! next level ( c>e4 #b4 ,place cutt+ device us$ 9 ?is proc$ure 9 a conta9] ( #e p]c5t hypo*lorite solution :5 n 9 use4 ,mo/ ambulatory pati5ts w be treat$ 9 ! contam9at$ treatm5t area & return$ to duty4 ,^u removal ( an ambulatory pati5t's clo?+1 he becomes a litt] pati5t4 ,! ,,bas & cle>+ /ation d n h clo?+ to replace ^? cut (f dur+ ! decontam9ation process4 ,! pati5t mu/ be plac$ 9 a ,,ppw = protection dur+ evacuation4 ,a batt]y op]at$ bl[] unit ) a ,,cb filt] may be atta*$ to ! ,,ppw to provide fre% air to ! pati5t2 ?us r$uc+ ! c>bon dioxide buildup inside ! ,,ppw 7,figure ,g-#g74 ,illu/ration3 ,figure ,g-#g4 ,*emical w>f>e ag5t protective pati5t wrap4 d4 ,/ep #a4 ,remove load-c>ry+ equipm5t4 ,remove load-c>ry+ equipm5t 7,,lce7 by unfa/5+_/unbutton+ all connectors or tie /raps2 !n place ! equipm5t 9 a pla/ic bag4 ,place ! pla/ic bag 9 ! designat$ /orage area = lat] decontam9ation4 e4 ,/ep #b4 ,decontam9ate ! pati5t's mask & hood4 ,aft] ! pati5t has be5 triag$ & treat$ 7if necess>y7 by ! s5ior trauma speciali/ 9 ! ,,pds1 ! pati5t 7assi/$ by ano!r ambulatory pati5t or a memb] ( ! pati5t decontam9ation team1 if necess>y7 beg9s ! clo?+ removal process4 7#a7 ,decontam9ate & remove mask hood4 ,sponge d[n ! front1 sides1 & top ( ! hood ) a #e p]c5t hypo*lorite solution4 ,remove ! hood by cutt+ 7,figure ,g-#c7 or1 ) ! quick-d(f hood or o!r hoods1 by loos5+ ! hood f ! mask atta*m5t po9ts4 ,be=e cutt+ ! hood1 dip ! cutt+ device 9 ! #e p]c5t hypo*lorite solution4 ,beg9 by cutt+ ! neck cord & ! small /r+ "u ! voicemitt]4 ,next1 release or cut ! hood %\ld] /raps & unzip ! hood zipp]4 ,proce$ by cutt+ ! hood upw>d1 close to ! filt] inlet cov] & eye-l5s outs]ts1 to ! top ( ! eye-l5s outs]t1 across ! =ehead to ! out] edge ( ! o!r eye-l5s outs]t4 ,proce$ d[nw>d t[>d ! pati5t's %\ld]1 /ay+ close to ! eye-l5s & filt] inlet4 ,cut across ! l[] "p ( ! voicemitt] to ! zipp]4 ,aft] dipp+ ! cutt+ device 9 ! #e p]c5t hypo*lorite solution aga91 cut ! hood f ! c5t] ( ! =ehead ov] ! top ( ! head & fold ! "r & left sides ( ! hood away f ! pati5t's head1 remov+ ! hood4 7#b7 ,decontam9ate ! mask & pati5t's face4 ,decontam9ate ! mask & ! pati5t's face by us+ ! ,,sdk or a #j4e p]c5t hypo*lorite solution4 ,wipe ! ext]nal p>ts ( ! mask2 cov] bo? mask air inlets ) gauze or y\r h&s to keep ! mask filt]s dry4 ,cont9ue by wip+ ! expos$ areas ( ! pati5t's face1 to include ! neck & beh9d ! e>s4 f4 ,/ep #c4 ,remove ,field ,m$ical ,c>d4 ,cut ! ,,fmc tie wire1 all[+ ! c>d to fall into a pla/ic bag4 ,seal ! pla/ic bag & r9se x ) ! #e p]c5t hypo*lorite solution4 ,place ! pla/ic bag "u ! back ( ! protective mask head /raps4 g4 ,/ep #d4 ,remove all gross contam9ation f ! pati5t's ov]g>m5t4 ,remove all visible contam9ation spots by us+ ! ,,sdk 7pref]r$ me?od7 or a sponge dipp$ 9 a #e p]c5t hypo*lorite solution4 h4 ,/ep #e4 ,remove ov]g>m5ts4 7#a7 ,remove ! pati5t's p]sonal effects4 ,place ! pati5t's p]sonal effects 9 a clean bag & label ) ! pati5t's id5tification4 ,if !y are n contam9at$1 give !m to him4 ,if 8 p]sonal effects are contam9at$1 place ! bagg$ items 9 ! contam9at$ /orage area until !y c be decontam9at$1 !n return !m to ! pati5t4 7#b7 ,remove ov]g>m5t jacket4 ,h ! pati5t /& ) 8 feet spread ap>t at %\ld] wid?4 ,unsnap ! jacket front flap & unzip ! jacket4 ,if ! pati5t c ext5d 8 arms1 h him cl9* 8 fi/s & ext5d 8 arms backw>d at ab\t a #cj angle4 ,move beh9d ! pati5t1 grasp+ 8 jacket coll> at ! sides ( ! neck1 peel ! jacket (f ! %\ld]s at a #cj angle d[n & away f ! pati5t4 ,avoid any rapid or %>p j]ks t c spread contam9ation4 ,g5tly pull ! inside sleeves ov] ! pati5t's wri/s & h&s4 ,if ! pati5t _c ext5d 8 arms1 y mu/ cut ! jacket to aid 9 its removal4 ,dip ! cutt+ device 9 ! #e p]c5t hypo*lorite solution betwe5 ea* cut4 ,z ) ! litt] pati5t1 cut bo? sleeves f ! inside1 />t+ at ! wri/1 up to ! armpit4 ,cont9ue cutt+ across ! %\ld] to ! coll>4 ,cut ar\nd b&ages or spl9ts1 leav+ !m 9 place4 ,next1 peel ! jacket back & d[nw>d to avoid spread+ contam9ation4 ,ensure t ! outside ( ! jacket does n t\* ! pati5t or 8 inn] clo?+4 7#c7 ,remove ov]g>m5t tr\s]s4 ,unfa/5 or cut all ties1 buttons1 or zipp]s be=e grasp+ ! tr\s]s at ! wai/ & peel+ !m d[n ov] ! pati5t's combat boots4 ,aga91 ! tr\s]s are cut to aid 9 removal4 ,if necess>y1 cut bo? tr\s] legs />t+ at ! ankle1 keep+ ! cuts ne> ! inside ( ! legs1 along ! inseam1 to ! crot*4 ,cut ar\nd all b&ages1 t\rniquets1 or spl9ts4 ,cont9ue to cut up bo? sides ( ! zipp] to ! wai/ & all[ ! n>r[ /rip ) ! zipp] to drop betwe5 ! legs4 ,place ! cutt+ device 9 ! #e p]c5t hypo*lorite solution4 ,peel or all[ ! tr\s] halves to drop to ! gr\nd4 ,h ! pati5t /ep out ( ! tr\s] legs1 "o at a "t4 ,place ! tr\s]s 9 ! contam9at$ disposal bag4 7#d7 ,remove ov]boots4 ,remove ! pati5t's ov]boots by cutt+ ! laces ) cutt+ device dipp$ 9 ! #e p]c5t hypo*lorite solution4 ,fold ! lac+ eyelets flat on ! gr\nd4 ,/ep on ! toe & heel eyelets to hold ! ov]boot on ! gr\nd & h ! pati5t /ep out ( x4 ,repeat ?is proc$ure = ! o!r ov]boot4 ,if ! ,,gvo are worn1 fir/ try to remove ! ov]boots )\t cutt+2 if necess>y1 cut ! ov]boots along ! front4 ,if ! ov]boots are 9 good condition1 !y c be decontam9at$ & reissu$4 7#e7 ,remove ! pati5t's out] gloves4 ,grasp ! heel ( ! glove1 peel ! glove (f ) a smoo? d[nw>d motion4 ,place ! contam9at$ gloves 9 a pla/ic bag ) ! ov]g>m5t jacket4 ,d n all[ ! pati5t to t\* 8 clo?+ or o!r contam9at$ objects ) 8 expos$ h&s4 7#f7 ,remove ! pati5t's cotton glove l9]s4 ,h ! pati5t remove 8 cotton glove l9]s to r$uce ! possibility ( spread+ contam9ation4 ,h ! pati5t grasp ! heel ( "o glove l9] ) ! o!r glov$ h&1 peel+ x (f ( 8 h&4 ,hold ! remov$ glove by ! inside & grasp ! heel ( ! o!r glove1 peel+ x (f ( 8 h&4 ,place bo? glove ins]ts 9 ! contam9at$ wa/e bag4 i4 ,/ep #f4 ,remove pati5ts ,,bdu4 7#a7 ,remove ! pati5t's p]sonal effects4 ,place ! pati5t's p]sonal effects 9 a clean bag & label ) ! pati5t's id5tification4 ,if !y are n contam9at$1 give !m to him4 ,if 8 p]sonal effects are contam9at$1 place ! bagg$ items 9 ! contam9at$ /orage area until !y c be decontam9at$1 !n return !m to ! pati5t4 7#b7 ,remove ,,bdu jacket4 ,h ! pati5t /& ) 8 feet spread ap>t at %\ld] wid?4 ,unbutton ! front flap ( ! jacket4 ,if ! pati5t c ext5d 8 arms1 h him cl9* 8 fi/s & ext5d 8 arms backw>d at ab\t a #cj angle4 ,move beh9d ! pati5t1 grasp+ 8 jacket coll> at ! sides ( ! neck1 peel ! jacket (f ! %\ld]s at a #cj angle d[n & away f ! pati5t4 ,avoid any rapid or %>p j]ks t c spread contam9ation4 ,g5tly pull ! inside sleeves ov] ! pati5t's wri/s & h&s4 ,if ! pati5t _c ext5d 8 arms1 y mu/ cut ! jacket to aid 9 its removal4 ,dip ! cutt+ device 9 ! #e p]c5t hypo*lorite solution betwe5 ea* cut4 ,z ) ! litt] pati5t1 cut bo? sleeves f ! inside1 />t+ at ! wri/1 up to ! armpit4 ,cont9ue cutt+ across ! %\ld] to ! coll>4 ,cut ar\nd b&ages or spl9ts1 leav+ !m 9 place4 ,next1 peel ! jacket back & d[nw>d to avoid spread+ contam9ation4 ,ensure t ! outside ( ! jacket does n t\* ! pati5t or 8 inn] clo?+4 7#c7 ,remove ,,bdu tr\s]s4 ,unfa/5 or cut all ties1 buttons1 or zipp]s be=e grasp+ ! tr\s]s at ! wai/ & peel+ !m d[n ov] ! pati5t's combat boots4 ,aga91 ! tr\s]s are cut to aid 9 removal4 ,if necess>y1 cut bo? tr\s] legs />t+ at ! ankle1 keep+ ! cuts ne> ! inside ( ! legs1 along ! inseam1 to ! crot*4 ,cut ar\nd all b&ages1 t\rniquets1 or spl9ts4 ,cont9ue to cut up bo? sides ( ! zipp] to ! wai/ & all[ ! n>r[ /rip ) ! zipp] to drop betwe5 ! legs4 ,place ! cutt+ device 9 ! #e p]c5t hypo*lorite solution4 ,peel or all[ ! tr\s] halves to drop to ! gr\nd4 ,h ! pati5t /ep out ( ! tr\s] legs1 "o at a "t4 ,place ! tr\s]s 9 ! contam9at$ disposal bag4 7#d7 ,remove und]g>m5ts4 ,remove ! pati5t's tee %irt4 ,dip ! cutt+ device 9 ! #e p]c5t hypo*lorite solution betwe5 ea* cut4 ,cut bo? sleeves f ! inside1 />t+ at ! elb[1 up to ! armpit4 ,cont9ue cutt+ across ! %\ld] to ! coll>4 ,cut ar\nd b&ages or spl9ts1 leav+ !m 9 place4 ,next1 peel ! tee %irt away f ! body to avoid spread+ contam9ation4 ,if ! pati5t is we>+ a brassi]e1 cut x betwe5 ! cups4 ,cut bo? %\ld] /raps :]e !y atta* to ! cups & lay !m back (f ( ! %\ld]s4 ,remove ! pati5t's "u %orts_/panties by cutt+ f ! l[] side ( ! hip to ! wai/ on bo? sides4 ,all[ ! %orts_/panties to fall to ! gr\nd4 ,d n remove ! pati5t's id5tification tags4 j4 ,/ep #g4 ,*eck pati5t = contam9ation4 ,aft] ! pati5t's ,,bdu & und]we> has be5 remov$ *eck ! sk9 = contam9ation by us+ ,m#h detector pap] or ! ,,cam4 ,c>efully survey all areas ( ! pati5t's sk91 pay+ p>ticul> att5tion to areas ar\nd ! neck1 wri/1 e>s1 & dress+s1 spl9ts1 or t\rniquets4 k4 ,/ep #h4 ,decontam9ate sk94 7#a7 ,spot decontam9ation4 ,use ! ,,sdk or ! #j4e p]c5t hypo*lorite solution to spot decontam9ate expos$ neck & wri/ areas1 spl9ts1 o!r areas :]e ! protective ov]g>m5t 0 damag$1 & :]e dress+s or b&ages 7 remov$4 ,decontam9ate ! pati5t's id5tification tags1 if necess>y4 ,h ! pati5t hold 8 brea? & close 8 eyes4 ,h him1 or assi/ him1 lift 8 mask at ! *94 ,wipe 8 face ) ! ,m#bia pad or ! #j4e p]c5t hypo*lorite solution4 ,wipe quickly f bel[ ! top ( "o e>1 be+ c>eful to wipe all folds ( ! sk91 top ( ! upp] lip1 *91 dimples1 e>lobes1 & nose4 ,cont9ue up ! o!r side ( ! face to ! top ( ! o!r e>4 ,wipe ! inside ( ! mask :]e x t\*es ! face4 ,h ! pati5t reseal & *eck 8 mask4 ---------------------------------------- ------- ,,caution ,keep ! decontam9ation solution out ( ! pati5t's eyes4 ---------------------------------------- ------- 7#b7 ,trauma speciali/ c>e4 ,dur+ clo?+ removal1 ! clo?+ ar\nd b&ages1 t\rniquets1 & spl9ts 0 cut & left 9 place4 ,! trauma speciali/ replaces ! old t\rniquet by plac+ a new "o to #a in* above ! old t\rniquet4 ,:5 ! old t\rniquet is remov$1 ! sk9 is decontam9at$ ) ! ,,sdk or ! #j4e p]c5t hypo*lorite solution4 ,d n remove spl9ts4 ,decontam9ate !m by ?or\ghly r9s+ ! spl9t1 padd+1 & cravats ) ! #j4e p]c5t hypo*lorite solution4 ,usually1 ! trauma speciali/ w g5tly cut away b&ages4 ,! area ar\nd ! w\nd is du/$ ) ! ,m#bia pad or r9s$ ) ! #j4e p]c5t hypo*lorite solution1 & ! trauma speciali/ applies ! ,m#bia pad or irrigates ! s(t tissue w\nd ) ! #j4e p]c5t hypo*lorite solution4 ,if ble$+ beg9s1 ! trauma speciali/ replaces ! b&age ) a clean "o4 l4 ,/ep #i4 ,dispose ( contam9at$ wa/e4 ,dispose ( contam9at$ b&ages & cov]+s by plac+ !m 9 a pla/ic bag & seal+ ! bag ) tape4 ,place ! pla/ic bags 9 ! contam9at$ wa/e dump4 m4 ,/ep #aj4 ,proce$ ?r\gh ! %uffle pit to ! clean treatm5t area4 ,h ! decontam9at$ pati5t proce$ ?r\gh ! %uffle pit to ! clean treatm5t area4 ,make sure t ! pati5t's boots are ?or\ghly decontam9at$ by /irr+ ! cont5ts ( ! %uffle pit ) 8 boots z he crosses x4 ,! pati5t w remove 8 combat boots & socks at ! entrance ( ! clean treatm5t area or ,,cps2 remove ! protective mask at ! entrance to ! clean treatm5t area or inside ! ambulatory air lock ( ! ,,cps4 ,g-#ab4 ,biological ,pati5t ,decontam9ation ,proc$ures ,! decontam9ation /ation z e/abli%$ = *emical ag5t pati5ts is also us$ = biologically contam9at$ pati5ts4 ,! eight-man pati5t decontam9ation team is requir$ = biologically contam9at$ pati5t decontam9ation proc$ures4 ,g-#ac4 ,decontam9ate a ,litt] ,biological ,ag5t ,pati5t a4 ,remove ! pati5t's p]sonal effects4 ,place ! pati5t's p]sonal effects 9 a clean bag & label ) ! pati5t's id5tification4 ,if !y are n contam9at$1 give !m to him4 ,if 8 p]sonal effects are contam9at$1 place ! bagg$ items 9 ! contam9at$ /orage area until !y c be decontam9at$1 & !n return !m to ! pati5t4 b4 ,remove ! ,field ,m$ical ,c>d4 ,remove ! ,,fmc by cutt+ ! tie wire & all[+ ! ,,fmc to drop into a pla/ic bag4 ,keep ! ,,fmc ) ! pati5t4 c4 ,remove ! pati5t's clo?+4 ,pati5t decontam9ation team memb]s fir/ apply ! #e p]c5t hypo*lorite solution to ! pati5t's clo?+ & ! litt]4 ,!n1 remove ! pati5t's clo?+ z 9 decontam9ation ( *emical ag5t pati5ts4 ,b&ages1 t\rniquets1 & spl9ts are n remov$4 ,move pati5t to a clean litt] z describ$ = a *emical ag5t pati5t4 ,place pati5t's clo?+ 9 a pla/ic bag & dispose 9 ! contam9at$ wa/e dump4 d4 ,decontam9ate ! pati5t's sk94 ,ba! ! pati5t ) soap & w>m wat] or apply ! #j4e p]c5t hypo*lorite solution4 ,! trauma speciali/ places a new t\rniquet to #a in* above ! old t\rniquet1 & !n he removes ! old "o4 ,! trauma speciali/ removes b&ages & decontam9ates ! sk9 & w\nd ) ! #j4e p]c5t hypo*lorite solution2 he replaces ! b&age1 if ne$$1 to control hemorrhage4 ,spl9ts are dis9fect$ by soak+ ! spl9t1 cravats1 & /raps ) ! #j4e p]c5t hypo*lorite solution4 ,,note ,use a #j4e p]c5t hypo*lorite solution to decontam9ate pati5ts suspect$ ( be+ contam9at$ ) mycotox9s4 e4 ,transf] pati5t to hot l9e4 ,two decontam9ation team memb]s move pati5t to ! hot l9e4 ,reque/ assi/ance f two o!r decontam9ation team memb]s to transf] him to a clean litt] z describ$ = *emical ag5t pati5ts4 ,place ! pati5t's ,,fmc 9 ! pla/ic bag on ! clean litt] ) him4 ,two trauma speciali/s f ! clean side ( ! hot l9e move ! pati5t f ! hot l9e to ! clean treatm5t_/hold+ area4 ,g-#ad4 ,decontam9ate an ,ambulatory ,biological ,ag5t ,pati5t a4 ,remove ! pati5t's p]sonal effects4 ,place ! pati5t's p]sonal effects 9 a clean bag & label ) ! pati5t's id5tification4 ,if !y are n contam9at$1 give !m to him4 ,if 8 p]sonal effects are contam9at$1 place ! bagg$ items 9 ! contam9at$ /orage area until !y c be decontam9at$1 !n return !m to ! pati5t4 b4 ,remove ! ,field ,m$ical ,c>d4 ,remove ! ,,fmc by cutt+ ! tie wire & all[+ ! ,,fmc to drop into a pla/ic bag4 ,keep ! ,,fmc ) ! pati5t4 c4 ,remove ! pati5t's clo?+4 ,pati5t decontam9ation team memb]s fir/ apply ! #e p]c5t hypo*lorite solution to ! pati5t's clo?+4 ,!n remove ! pati5t's clo?+ z 9 decontam9ation ( *emical ag5t pati5ts4 ,b&ages1 t\rniquets1 & spl9ts are n remov$4 ,place pati5t's clo?+ 9 a pla/ic bag & dispose 9 ! contam9at$ wa/e dump4 d4 ,decontam9ate ! pati5t's sk94 ,h ! pati5t ba! ) soap & w>m wat] or apply ! #j4e p]c5t hypo*lorite solution4 ,if ! pati5t is unable to ba! himself1 a memb] ( ! decontam9ation team mu/ ba! him4 ,! trauma speciali/ places a new t\rniquet to #a in* above ! old t\rniquet1 & !n he removes ! old "o4 ,! trauma speciali/ removes b&ages & decontam9ates ! sk9 & w\nd ) ! #j4e p]c5t hypo*lorite solution2 he replaces ! b&age1 if ne$$1 to control hemorrhage4 ,spl9ts are dis9fect$ by soak+ ! spl9t1 cravats1 & /raps ) ! #j4e p]c5t hypo*lorite solution4 ,,note ,use a #j4e p]c5t hypo*lorite solution to decontam9ate ambulatory pati5ts suspect$ ( be+ contam9at$ ) mycotox9s4 e4 ,direct pati5t across hot l9e4 ,direct ! pati5t to cross ! hot l9e to ! clean treatm5t area4 ,8 boots mu/ be decontam9at$ at ! hot l9e be=e he ent]s ! clean treatm5t area4 ,,notes #a4 ,rememb]1 d n remove clo?+ f an ambulatory pati5t unless he requires treatm5t 9 ! clean treatm5t area ( ! ,,bas or cle>+ /ation4 ,only spot decontam9ate ! pati5t's clo?+ & evacuate him to ! next level ( c>e4 #b4 ,place cutt+ device us$ 9 ?is proc$ure 9 a conta9] ( #e p]c5t hypo*lorite solution :5 n 9 use4 ,mo/ ambulatory pati5ts w be treat$ 9 ! contam9at$ treatm5t area & return$ to duty4 ,^u removal ( an ambulatory pati5t's clo?+1 he becomes a litt] pati5t4 ,! ,,bas & cle>+ /ation d n h clo?+ to replace ^? cut (f dur+ ! decontam9ation process4 ,! pati5t mu/ be plac$ 9 a ,,ppw = protection dur+ evacuation 7,figure ,g-#g74 ,g-#ae4 ,decontam9ate ,nucle>-,contam9at$ ,pati5ts ,! practical decontam9ation ( nucle>-contam9at$ pati5ts is easily accompli%$ )\t int]f]+ ) ! requir$ m$ical c>e4 ,,note ,pati5ts mu/ be monitor$ by us+ a radiac met] 7,,an_/,,vdr#b1 ,,an_/,,pdr#bg1 or ,,an_/,,pdr#gg7 be=e1 dur+1 & aft] ea* /ep ( ! decontam9ation proc$ure4 ,g-#af4 ,decontam9ate a ,litt] ,nucle>-,contam9at$ ,pati5t a4 ,remove pati5t's p]sonal effects4 ,pati5t decontam9ation team memb]s remove ! pati5t's p]sonal effects & place !m 9 a pla/ic bag4 ,place pla/ic bag 9 a clean hold+ area4 b4 ,remove pati5t's clo?+4 ,pati5t decontam9ation team memb]s remove ! pati5t's out] clo?+ z describ$ = *emical ag5t pati5ts4 ,d n remove b&ages1 t\rniquets1 or spl9ts4 ,move ! pati5t to a clean litt]4 ,place ! pati5t's contam9at$ clo?+ 9 a pla/ic bag & move ! bagg$ clo?+ to ! contam9at$ wa/e dump4 ,,note ,pati5ts arriv+ at ! ,,mtf 9 ,,mopp w only h _! ,,mopp remov$4 ,!y c rema9 9 _! ,,bdu unless contam9ation is f\nd on x4 c4 ,spot decontam9ate pati5t's sk94 ,wa% expos$ sk9 surfaces ) soap & w>m wat]4 ,wa% ! hair ) soap & w>m wat]1 or clip ! hair & wa% ! scalp ) soap & w>m wat]4 d4 ,transf] pati5t to hot l9e4 ,move ! pati5t to ! hot l9e4 ,two trauma speciali/s f ! clean side ( ! hot l9e move ! pati5t into ! clean treatm5t area4 ,g-#ag4 ,decontam9ate an ,ambulatory ,nucle>-,contam9at$ ,pati5t a4 ,remove pati5t's p]sonal effects4 ,h ! pati5t remove 8 p]sonal effects & place !m 9 a pla/ic bag4 b4 ,remove pati5t's out] clo?+4 ,h ! pati5t remove 8 out] clo?+ 7or h a decontam9ation team memb] assi/ him74 ,place 8 contam9at$ clo?+ 9 a pla/ic bag & move ! bagg$ clo?+ to ! contam9at$ wa/e dump4 ,,note ,pati5ts arriv+ at ! ,,mtf 9 ,,mopp w only h _! ,,mopp remov$4 ,!y c rema9 ambulatory 9 _! ,,bdu unless contam9ation is f\nd on x4 c4 ,spot decontam9ate pati5t's sk94 ,h ! pati5t wa% 8 expos$ sk9 surfaces ) soap & w>m wat]4 ,wa% 8 hair ) soap & wat]1 or clip ! hair & wa% ! scalp ) soap & wat]4 d4 ,transf] pati5t to hot l9e4 ,direct ! pati5t to move to ! hot l9e4 ,decontam9ate 8 boots by /irr+ ! %uffle pit cont5ts ) 8 feet be=e he crosses into ! clean treatm5t area4 ,,note ,if a new protective ov]g>m5t is n available1 aft] treatm5t1 ! ambulatory pati5t mu/ be plac$ 9 a ,,ppw = protection dur+ ,,m$evac to ! next level ( c>e ,,mtf4 ,?us1 he becomes a litt] pati5t = evacuation4 ,,app5dix ,h ,,field ,,exp$i5t ,,protective ,,sy/ems ,,aga9/ ,,nucle>1 ,,biological1 ,,& ,,*emical ,,attack ,h-#a4 ,g5]al ,m$ical units mu/ h protection f ,,nbc attack & contam9ation to survive & function effectively4 ,! ext5t ( protection provid$ is only limit$ by ! res\rces available & ef=ts ( unit p]sonnel4 ,protection z simple z an individually dug foxhole or z elaborate z ! subbasem5t ( a concrete build+ may be us$4 ,exp$i5t protection f ! effects ( biological & *emical ag5ts are usually mu* less labor int5sive4 ,h-#b4 ,protection ,aga9/ ,radiation ,! level ( protection f radiation is express$ 9 t]ms ( %ield+4 ,mat]ial is available on ! battlefield to con/ruct_/prep>e exp$i5t fall\t %elt]s t (f] sub/antial %ield+ aga9/ gamma radiation 7see ,table ,h-#a74 ,g5]ally1 ! d5s] or heavi] ! mat]ial1 ! bett] %ield+ x (f]s4 ,! degree ( protection af=d$ by a fall\t %elt] is express$ z a protection factor1 or a transmission factor4 ,! protection factor is simply ! fraction ( ! available radiation dose t p5etrates ! %elt] & rea*es ^? inside comp>$ to ! radiation receiv$ by an unprotect$ p]son4 ,?us1 a protection factor ( #b indicates t an individual 9 ! %elt] receives "o-half ( ! radiation dose he w\ld receive if unprotect$4 ,a protection factor ( #ajj 7associat$ ) ab\t six half-value ?icknesses7 indicates t only #a_/ajj or #a p]c5t ( ! radiation dose rea*es ! inside4 ,transmission factors are express$ 9 p]c5tages1 or 9 decimals4 ,ei!r ref]s to t fraction ( ! ambi5t un%ield$ dose t is receiv$ by p]sonnel )9 ! %elt]4 ,fall\t gamma transmission factors = "s common %elt]s are %[n 9 ,table ,h-#b4 ,table ,h-#a4 ,%ield+ ,pot5tial ( ,common ,mat]ials--,fall\t ,gamma ,protection ,,mat]ial #a_/b ,,value ,,lay] ,,?ickness99 ---------------------------------------- --------------------- ,,/eel #a4h ,,cm 74#g7 ,,concrete #e4f ,,cm 7#b4b7 ,,e>? #h4d ,,cm 7#c4c7 ,,wat] #ab4b ,,cm 7#d4h7 ,,wood #bb4d ,,cm 7#h4h7 ---------------------------------------- --------------------- 99 #a_/b ,,value ,,lay] ,,?ickness--,,?ickness ,,( ,a ,,giv5 ,,mat]ial ,,:i* ,,r$uces ,,! ,,dose ,,or ,,dose ,,rate ,,to ,,approximately ,,"o-,,half ,,( ,,t ,,fall+ ,,^u ,,x4 ,table ,h-#b4 ,transmission factors = ,nucle> ,radiation99 ,,initial ,,environm5tal ,,%ield+ ,,neutrons ,,gamma ,,residual ---------------------------------------- -------------------------- ,,built-,,up ,,city ,,area 7,,9 ,,op57 #a4j #j4e #j4g ,,foxholes #j4c #j4b #j4a ,,frame ,,h\se3 ,,fir/ ,,floor #a4j #j4i #j4e ,,basem5t #j4e #j4c #j4a ,,multi/ory ,,build+s3 ,,top ,,floor #a4j #j4i #j4a ,,int]m$iate ,,floors #j4i #j4i #j4jb ,,l[] ,,floor #j4i #j4e #j4a ,,basem5t #j4e #j4c #j4ja ,,%elt]1 ,,clos$ #ia ,,cm 7#c ,,ft7 7,,e>? ,,cov]7 #j4je #j4jb #j4jje ,,armor$ ,,vehicles3 ,,armor$ ,,p]sonnel ,,c>ri] #j4c #j4b #j4a ,,tanks #j4c #j4b #j4a ,,wood$ ,,=e/ #a4j #a4j #j4h ---------------------------------------- -------------------------- 99 ,,inside ,,dose ,,transmission ,,factor ,,times ,,outside ,,dose4 ,h-#c4 ,exp$i5t ,%elt]s = ,protection ,aga9/ ,radiation a4 ,9 _m cases x w be unnecess>y to con/ruct field exp$i5t or o!r types ( fall\t %elt]s4 ,!re are _m /ructures & t]ra9 features available t af=d a degree ( fall\t protection4 ,exi/+ fall\t %elt]s are tunnels1 caves1 culv]ts1 ov]passes1 dit*es1 rav9es1 & man-made /ructures4 ,! be/ exi/+ %elt]s are basem5ts4 ,figure ,h-#a %[s typical protection provid$ 9 build+s4 ,w9d[s c be s&bagg$ or cov]$ ) dirt f ! outside to provide additional protection4 ,illu/ration3 ,figure ,h-#a4 ,typical %elt] protection provid$ 9 build+s4 b4 ,plann]s %\ld attempt to locate ,,hss units ne> exi/+ %elt]s1 :5ev] possible4 ,h[ev]1 if an ,,hss unit is already e/abli%$1 or mu/ be e/abli%$ :]e fall\t %elt]s are n available1 !n a %elt] mu/ be con/ruct$4 ,elaborate %elt]s are n requir$1 s9ce !y usually only ne$ to be occupi$ = a few days4 ,!re are a numb] ( field exp$i5ts t w s]ve to save p]sonnel & pati5ts ev5 ?\gh !y may n be com=table = ^? few days4 c4 ,:5 eng9e] support is available1 a bulldoz] tr5* ab\t #b4g met]s 7#i feet7 wide & #a4b met]s 7#d feet7 deep c be dug 7,figure ,h-#b74 ,! l5g? ( ! tr5* w be det]m9$ by ! numb] ( pati5ts_/p]sonnel to be %elt]$4 ,ab\t #j4f met] 7#b feet7 l5g? ( tr5* is requir$ = ea* p]son to be %elt]$4 ,^! tr5*es r$uce exposure ( p]sonnel ly+ on ! floor to ab\t #bj to #cj p]c5t ( ! radiation t !y w\ld receive 9 ! op54 ,protection & com=t c be improv$1 z "t p]mits1 by digg+ ! tr5*es deep]2 und]cutt+ ! walls 7c>e mu/ be tak5 9 ?is option2 ! e>? may cave 972 erect+ t5ts ov] ! tr5*es2 & provid+ improv$ floor+4 ,:5 us$ ) o!r individual & collective protection measures1 bulldoz] tr5*es provide adequate fall\t %elt]s = mo/ situations2 !y c be provid$ 9 a m9imum ( "t & ef=t4 ,tr5*es %\ld n be dug 9 areas subject to flood+ dur+ ra9/orms2 a b]m %\ld be =m$ on ! uphill side ( ! tr5* to direct wat] ar\nd ! tr5* 9 ! ev5t ra9fall occurs 9 ! area4 ,und]cutt+ w n be possible 9 s&y soil2 also "s =m ( support to keep ! walls f cav+ 9 is requir$4 ,illu/ration3 ,figure ,h-#b4 ,doz] tr5*4 d4 ,dug-9 t5ts 7,figure ,h-#c7 = hospitals provide m com=t & require less movem5t ?an ! bulldoz] tr5*2 h[ev]1 !y h two drawbacks4 ,fir/1 !y (f] f> less radiation protection ?an ! bulldoz] tr5*1 & second1 !y require consid]ably m eng9e] ef=t4 ,?is option %\ld "w well ) ,,gp t5ts1 b w probably be h>d to accompli% ) ! ,,temp]4 ,illu/ration3 ,figure ,h-#c4 ,dug-9 t5ts4 e4 ,s&bagg$ walls ar\nd ! hospital t5ts1 z %[n 9 ,figure ,h-#d1 or lightly con/ruct$ build+s provide protection f fall\t4 ,s&bagg$ walls #a4b met]s high give significant protection 7#bj to #dj p]c5t transmission factor72 h[ev]1 ! ef=t requir$ to a*ieve ! protection is su* t x is m>g9ally feasible4 ,s&bagg+ is an effective means = supplem5t+ o!r %elt]s by-- ,bol/]+ ! %ield+ at weak po9ts4 ,=m+ baffles at entryways4 ,block+ op5 ends ( tr5*es4 ,cov]+ w9d[s & gaps4 f4 ,:5 o!r %elt]s are n available1 ,,hss units mu/ prep>e foxholes & tr5*es = pati5ts & unit p]sonnel4 ,z "t p]mits1 improve ^! %elt]s by deep5+1 cov]+1 und]cutt+1 & s&bagg+4 ,illu/ration3 ,figure ,h-#d4 ,s&bag walls ar\nd t5ts4 ,h-#d4 ,exp$i5t ,%elt]s ,aga9/ ,biological & ,*emical ,ag5ts a4 ,:5 ,,cps sy/ems are n available1 well-seal$ %elt]s 7,,temp]1 ,,iso1 & ,,gp7 c significantly m9imize or prev5t ! entry ( ,,cb ag5ts4 ,! v5tilation sy/em mu/ be turn$ (f1 & kept (f1 be=e1 dur+1 & aft] ! attack4 ,! %elt] mu/ be totally seal$ dur+ ?is "t to maximize protection4 ,table ,h-#c provides examples ( protection values = well-seal$ %elt]s4 ,= example1 a well-seal$ ,,temp] w only p]mit #a_/fj ( ! ,,cb ag5t outside to ent] ! %elt]4 ,if a p]si/5t ag5t is us$1 be aw>e ( ag5t (f-gass+ haz>ds4 ,p]si/5t ag5ts c p5etrate ,,temp] fabric & create a vapor haz>d inside4 ,9 a ,,cb ag5t attack1 ensure t all /aff & pati5ts are protect$ by we>+ _! ,,mopp or are 9 ,p,p,ws4 ,table ,h-#c4 ,ratio at ,nonp]si/5t ,ag5t ,conc5trations 7,inside_/,outside7 = ,diff]5t ,%elt]s ,,%elt] ,,ratio ,,inside_/,,outside ---------------------------------------- ------------------------- ,,temp] ,,t5t #a3fj99 ,,g5]al ,,purpose ,,t5t1 ,,m$ium1 ,,) ,,cotton ,,l9] #a3ej ,,g5]al ,,purpose ,,t5t1 ,,l>ge1 ,,) ,,cotton ,,l9] #a3cj ,,iso ,,%elt] #a3fj ---------------------------------------- ------------------------- 99 ,,! ,,v5tilation ,,sy/em ,,mu/ ,,be ,,turn$ ,,(f ,,on ,,all ,,%elt]s ,,to ,,provide ,,?is ,,level ,,( ,,protection4 b4 ,seal+ %elt]s to prev5t entry ( ,,cb ag5ts does n require elaborate mat]ials or proc$ures4 7#a7 ,mat]ials ne$$ = seal+ %elt]s include1 b are n limit$ to ! foll[+3 ,duct tape 7or simil> tape7 = seal+4 ,velcro kits = ,,temp]4 ,s&_/dirt to seal base ( ,,gp t5ts4 ,pla/ic %eet+ & tape to seal l>ge op5+s1 su* z doors & w9d[s ( ,,gp t5ts4 7#b7 ,all vuln]able areas mu/ be seal$4 ,seal-- ,jo9ts 9 ,,iso %elt]s & ,,gp t5ts ) tape4 ,tape does n "w v well on ,,temp] fabrics2 use ,velcro kits4 ,base ( ,,gp t5ts ) s&_/dirt4 ,/ove pipe op5+s ) tape & pla/ic4 ,w9d[s ( ,,gp t5ts ) tape & pla/ic4 ,seal ,,temp] t5t w9d[s by align+ & secur+ ! ,velcro bord] tightly2 tape may be appli$ to ! seams to provide "s additional b>ri]4 ,all ,,iso %elt] doors t d n h ,,cb protective seals1 ) tape4 ,seal ,,gp t5t doors ) pla/ic %eet+ & tape4 ,all w9d[s1 doors1 & o!r op5+s ( fix$ sites ) pla/ic & tape4 ,all air v5tilation sy/em v5ts4 ,,notes #a4 ,d n all[ any entries_/exits to %elt]s dur+ a ,,cb attack4 #b4 ,9 hot climates ! heat load w rise 9 seal$ %elt]s ) ! v5tilation sy/em turn$ (f4 ,p]sonnel mu/ c>efully monitor ea* o!r & ! pati5ts4 ,all p]sonnel mu/ dr9k pl5ty ( wat] to prev5t heat injuries2 see ,,fm #ba-aj4 ,,app5dix ,i ,,detection ,,& ,,treatm5t ,,( ,,nucle>1 ,,biological1 ,,& ,,*emical ,,contam9ation ,,9 ,,wat] ,i-#a4 ,g5]al ,wat] supplies 9 areas ) ,,nbc contam9ation & 9 surface wat] suppli$ by run(f f su* areas w mo/ likely be contam9at$4 ,! contam9ation ( wat]1 :e!r int5tional or inadv]t5t1 may rea* conc5trations t w produce casualties4 ,by special me?ods ( analysis1 ! pres5ce ( contam9ation c be det]m9$4 ,treatm5t ( contam9at$ wat] requires *emicals & equipm5t t are only available to qu>t]ma/] wat] purification units2 individuals or units %\ld n attempt to treat _! wat]4 ,decontam9ation ( wat] is only und]tak5 :5 uncontam9at$ s\rces are n available2 !n ,,only ) ! approval ( ! m$ical au?ority 7,,pvntm$ or surgeon74 ,i-#b4 ,detection ( ,contam9ation 9 ,wat] a4 ,detection ( nucle> contam9ation 9 wat] is accompli%$ by us+ ! ,,an_/,,pdr#gg1 ,,an ,,pdr_/#bg or ,,an ,,vdr_/#b radiac met]s4 ---------------------------------------- -------------- ,,caution ,,d ,,n all[ ! probe to come into contact ) ! wat] s\rce2 all[ at lea/ "o in* ( air space betwe5 ! probe & wat] surface4 ---------------------------------------- -------------- b4 ,detection ( ,,bw ag5ts 9 wat] is accompli%$ by ! use ( field biological wat] te/ kits & specially design$ collection & detection kits4 ,! specialty kits w be provid$ z ne$$1 & w be available to ,,pvntm$ & support+ m$ical laboratory p]sonnel4 ,:5 requir$ = ! ,presid5t & ,secret>y ( ,def5se purpose1 samples mu/ be collect$ & prep>$ = %ipm5t to ! support+ m$ical laboratory4 ,a *a9 ( cu/ody docum5t mu/ be prep>$ by ! collector & ma9ta9$ z ! sample7s7 is be+ transport$ to ! support+ m$ical laboratory & ?r\gh\t its transit to ! ,,conus laboratory4 ,see ,app5dix ,f = details on suspect ,,bw sample collection1 packag+1 *a9 ( cu/ody1 & h&l+4 c4 ,! ,*emical ,ag5t ,wat] ,te/+ ,kit1 ,m#bgb1 provides a rapid field te/ to detect *emical ag5t contam9ation 9 wat]4 ,! te/ mu/ be conduct$ be=e ! wat] is treat$ ) *lor9e2 ! *lor9e w affect ! accuracy ( ! te/ = *emical ag5ts4 ,i-#c4 ,proc$ures on ,discov]y ( ,contam9ation 9 ,wat] ,:5 contam9ation is discov]$ ! foll[+ actions are tak53 a4 ,m>k ! wat] s\rce1 us+ ! /&>d ,,nbc contam9ation m>k]s1 & ensure t p]sonnel d n consume ! wat] until approv$4 b4 ,notify ! comm&] t ! wat] s\rce is contam9at$ & unfit = dr9k+1 food prep>ation1 & p]sonal hygi5e4 c4 ,notify ! support+ wat] production unit1 su* z ! qu>t]ma/] wat] production & di/ribution unit ( ! contam9at$ wat] s\rce4 d4 ,! comm&] e/abli%es safegu>ds to prev5t p]sonnel f us+ ! contam9at$ wat] supply4 e4 ,an alt]native s\rce ( uncontam9at$ wat] is s\ght & us$4 ,! prim>y s\rce = obta9+ wat] is f qu>t]ma/]-op]at$ wat] production & di/ribution po9ts4 ,o!r s\rces are consid]$ only :5 qu>t]ma/]-op]at$ faculties are n available4 ,alt]native s\rces t may be consid]$ include-- ,gr\nd wat] s\rces t are lea/ likely to be contam9at$4 ,local fix$ facility wat] supplies4 ,h[ev]1 ^! supplies mu/ be te/$ be=e use4 ,if ,,nbc contam9ation is f\nd d n use4 ,us+ ano!r location to obta9 an uncontam9at$ wat] s\rce1 :5 ! tactical situation p]mits4 f4 ,contam9at$ wat] mu/ n be us$ until x has be5 treat$ by qu>t]ma/] wat] production & di/ribution units or o!r equally capable wat] purification units & approv$ = use by ! m$ical au?ority4 ,i-#d4 ,treatm5t ( ,contam9at$ ,wat] ,contam9at$ wat] requires additional equipm5t & supplies to remove ! contam9ation4 ,qu>t]ma/] wat] purification & di/ribution units are equipp$ to p]=m ^! duties4 ,see ,,fm #aj-eb = details4 ,,app5dix ,j ,,food ,,contam9ation ,,& ,,decontam9ation ,j-#a4 ,g5]al a4 ,food ,susceptibility4 ,/or$1 transport$1 & prep>$ food is susceptible to ,,nbc contam9ation ?r\gh\t ! ,,to4 ,plann+ = any battle or op]ation mu/ include food protection f contam9ation2 food contam9ation detection2 & contam9at$ food disposition 7decontam9ate or de/roy74 b4 ,c\nt]measures4 ,!re are ?ree prim>y c\nt]measures to ov]come or r$uce ! ,,nbc haz>d to food3 7#a7 ,contam9ation avoidance4 7#b7 ,nucle>1 biological1 & *emical ag5t detection4 7#c7 ,nucle>1 biological1 & *emical ag5t decontam9ation4 c4 ,priorities4 ,! priorities = conduct+ ,,nbc c\nt]measures are-- 7#a7 ,contam9ation avoidance4 ,contam9ation avoidance includes us+ natural & fabricat$ b>ri]s to prev5t1 or significantly r$uce ! spread ( contam9ation4 ,also1 us+ specific proc$ures = entry & exit betwe5 contam9at$ & uncontam9at$ areas r$uce ! pot5tial = spread+ contam9ation4 ,use ( ^! b>ri]s & proc$ures may r$uce ! subsequ5t ne$ = detection & decontam9ation4 7#b7 ,detection1 measurem5t1 & id5tification4 ,^! activities are ess5tial = det]m9+ ! pres5ce1 ext5t1 & nature ( ,,nbc contam9ation4 ,?is in=mation is ess5tial 9 id5tify+ ! exi/5ce ( uncontam9at$ supplies1 or decontam9ation requirem5ts4 7#c7 ,decontam9ation4 ,decontam9ation removes ! contam9ant & provides food t is safe = consumption4 d4 ,decontam9ation4 ,decontam9ation ef=ts require an ext5sive am\nt ( labor1 "t1 & supplies4 ,! use ( ha/y decontam9ation is emphasiz$4 ,t is1 decontam9ate j en\gh to su/a9 op]ations & keep fight+1 r ?an to make a contam9ation-free environm5t4 ,normally1 decontam9ation ef=ts w be limit$ to ! packag+ & pack+ mat]ials4 ,food decontam9ation w only occur 9 critical situations :]e o!r food supplies are n available4 ,mo/ decontam9ation is p]=m$ 9 or v ne> ! ,,ao4 ,be=e beg9n+ decontam9ation proc$ures1 divide expos$ food items into gr\ps bas$ on protection ( item at "t ( exposure4 ,^! gr\ps e/abli% priorities bas$ on ease ( decontam9ation & ! ability to monitor ! food4 7#a7 ,gr\p ,i--,cann$ or packag$ items expos$ only to a *emical ag5t vapor4 7#b7 ,gr\p ,,ii--,cann$ or packag$ items t are contam9at$ on ! outside ) a liquid *emical ag5t1 a biological ag5t1 or radioactive fall\t4 7#c7 ,gr\p ,,iii--,unpack$ or poorly packag$ items t h be5 expos$ to any ,,nbc ag5t4 7#d7 ,gr\p ,,iv--,food contam9at$ ?r\gh ! food *a94 ,j-#b4 ,protection ( ,food f ,contam9ation ,an adequate def5sive po/ure = a *emical attack w also protect food aga9/ biological contam9ation & radiation fall\t4 a4 ,op]ational ,rations4 ,op]ational rations include1 b are n limit$ to1 ,m,r,es2 unit gr\p ration 7,,ugr71 ,a2 unit gr\p ration1 heat & s]ve2 & m$ical diet supplem5t4 7#a7 ,packag+ mat]ials & /orage me?ods normally protect ^! rations4 ,! packag+ & pack+ ( op]ational rations protect ! cont5ts f det]ioration4 ,z a result1 ! cont5ts are protect$ f moi/ure1 to include *emical liquids1 *emical vapors1 & biological ag5ts4 ,op]ational rations deliv]$ to an ,,ao w usually h increas$ levels ( packag+ &_/or pack+ protection4 ,op]ational rations are sub/antially protect$ :ile conta9$ 9 ! %ipp+ cases1 especially if protect$ ) an ov]lay ( fib]bo>d1 %r9k wrap1 or film wrap4 7#b7 ,enclos$ /orage is us$ :5ev] possible4 ,refrig]at$ w>eh\ses1 cold /orage rooms1 & ev5 prefabricat$ refrig]ators & trail]s provide excell5t protection4 ,und]gr\nd %elt]s1 caves1 & tunnels t c be made airtight provide maximum ,,nbc protection4 ,build+s provide protection dep5d+ on h[ well !y c be clos$ & seal$4 ,! basem5t ( a build+ is a good /orage place4 ,h[ev]1 keep 9 m9d t *emical vapors t5d to seek out l[-ly+ areas4 ,/or+ rations indoors w protect !m f liquid droplet & fall\t contam9ation unless ! build+ is damag$ by an attack4 ,complete protection aga9/ *emical vapors is only (f]$ by airtight clos$ spaces l cold /orage facilities4 7#c7 ,*emical protective measures are to be integrat$ into daily logi/ical op]ation to avoid ! contam9ation ( op]ational rations4 ,maximum use is made ( al>m & detection equipm5t1 ov]head %elt]1 %ield+ mat]ials1 & protective cov]s4 ,back up /ocks ( op]ational rations %\ld be disp]s$ to m9imize ! risk ( de/ruction or contam9ation4 7#d7 ,an ,,nbc ,protective ,cov] or simil> equipm5t w help greatly4 ,! ,,nbc ,protective ,cov] is disc>d$ & replac$ ^u becom+ contam9at$2 x r$uces ov]all decontam9ation requirem5ts2 & x improves ! survivability ( supplies & equipm5t4 ,! ,,nbc ,protective ,cov] provides #bd-;h\r protection aga9/ liquid *emical contam9ation4 ,detection pap] us$ on ! ,,nbc ,protective ,cov] w rapidly id5tify a contam9at$ cov]4 b4 ,bulk & ,fre% ,foods4 7#a7 ,field exp$i5t or improvis$ /orage may be ! only *oice available "u high-risk conditions4 ,exp$i5t /orage = food supplies may be a natural or man-made depression l9$ to protect cont5ts aga9/ moi/ure1 & !n cov]$ ) e>? & sod4 ,! e>? gives good protection aga9/ all =ms ( *emical or biological contam9ation & nucle> fall\t4 7#b7 ,foods are only /or$ outdoors or 9 p>tially protect$ areas :5 absolutely necess>y4 ,only cases ( foods pack$ 9 cans1 bottles1 or airtight foil or film wraps1 & foods pack$ 9 seal$ boxes or multilay]$ wrapp+s c be subject$ to expos$ /orage4 ,p>tial protection is provid$ by op5 %$s1 tempor>y ro(+1 or t5ts4 ,:5 subsi/5ce mu/ be /or$ 9 ! op51 give z mu* protection z possible4 ,protection mat]ial may include ,,nbc ,protective ,cov]s1 t>paul9s1 t>paul9 %$s1 or any o!r available cov]+ su* z pla/ic %eet+4 ,t>paul9s & o!r treat$ or wat]pro( cov]+s d n prev5t contam9ation by *emical vapors1 b !y d r$uce contam9ation f liquid ag5ts4 ,canvas w keep out m ?an #ie p]c5t ( liquid contam9ation = a %ort p]iod ( "t aft] ! attack4 ,! canvas mu/ be remov$ soon aft] ! attack to prev5t ! ag5t f seep+ ?r\gh onto ! subsi/5ce2 placem5t ( spac]s betwe5 ! cov]+ & ! food w greatly r$uce ?is problem4 ,ev5 ! ?9ne/ mat]ial w (f] "s protection & is bett] ?an no?+ at all4 ,!re=e1 food supplies mu/ be cov]$ by :atev] mat]ial is available4 ,j-#c4 ,nucle> a4 ,contam9ation4 7#a7 ,foll[+ a nucle> detonation1 food c become contam9at$ 9 ?ree ways3 ,direct contam9ation4 ,direct contam9ation results by fall\t collect+ on plants1 animals1 & /or$ food 7surface contam9ation74 ,fall\t has two effects4 ,fir/1 x produces a gamma radiation field ov] ! fall\t area4 ,second1 x contam9ates ! surface ( any?+ on :i* x is deposit$4 ,! :ole-body gamma irradiation haz>d to an individual f> outweighs any pot5tial haz>d f food contam9ation4 ,! basic rule is3 ,if y c safely be 9 ! area to salvage ! food1 !n ! food salvag$ is safe to use 7al?\gh slightly contam9at$74 ,indirect contam9ation4 ,?is =m ( contam9ation c be spread ?r\gh\t ! food *a94 ,humans c +e/ contam9ation by eat+ plants t h absorb$ radioactive isotopes2 products 7milk or meat7 f animals all[$ to graze on contam9at$ pa/ures2 or fi% f contam9at$ wat]4 ,induc$ radiation4 ,x is possible t food w be expos$ to suffici5t neutron flux 7an increase 9 ! numb] ( free neutrons7 z ! result ( a nucle> explosion to produce consid]able induc$ radioactivity 9 food )\t x be+ de/roy$ by bla/ & heat4 ,?is is possible ) enhanc$ radiation weapons 9 ! en]gy range ( #a ,,kt :]e ! radiation kill radius exce$s ! bla/ de/ruction zone4 ,! elem5ts t are mo/ prom95tly involv$ are sodium1 potassium1 sulfur1 copp]1 brom9e1 z9c1 & especially phosphor\s4 ,?us1 9 an area ( induc$ radiation1 foods requir+ ! mo/ caution are dairy products1 high salt cont5t foods1 dry beans1 rais9s1 & ready-mix$ cake & biscuit fl\rs4 ,! radioactivity has a %ort half-life2 !re=e1 ! radiation w decay v rapidly4 ,x %\ld be possible to consume foods conta9+ induc$ radiation )9 a week or two4 ,cans1 p>ticul>ly ^? ) ,c enamel1 may incur a high level ( induc$ radiation 7f z9c 9 ! enamel1 n f iron 9 ! c74 ,glass1 because ( its high salt cont5t1 w %[ v high levels ( activity2 cle> glass w turn br[n4 ,conta9] radioactivity has no be>+ on ! food1 x is safe to use4 ,! radioactivity is n transf]r$ to ! cont5ts4 ,no significant toxic by-products are =m$ 9 ! expos$ cann$ food4 7#b7 ,consumption ( food contam9at$ ) radioactive fall\t may cause a risk ( radiation injuries f int]nal radiation2 t is1 radiation f radioactive s\rces )9 ! body4 ,mo/ isotopes w pass ?r\gh ! dige/ive tract or be excret$ v quickly4 ,h[ev]1 ! inte/9al tract may receive a consid]able dose4 ,"s isotopes are m haz>d\s because !y are absorb$ f ! dige/ive tract & ent] ! metabolism ( man & animals4 ,/rontium-#hi 7,sr-#hi7 & ,/rontium-#ij 7,sr-#ij7 are beta emitt]s & h half-lives ( #ea days & #bh ye>s1 respectively4 ,!re=e1 ,sr-#ij is ! greate/ radiation haz>d 9 ! long t]m4 ,^! two isotopes are absorb$ 9 ! body & us$ 9 ! same way z calcium4 ,!y accumulate 9 bone1 :]e bone m>r[ ) its blood =m+ cells is vuln]able4 ,milk & o!r dairy products are ! prim>y s\rces ( ,sr-#hi & ,sr-#ij 9 ! human diet4 ,iod9e-#aca 7,i-#aca7 is a beta & gamma emitt] & has a %ort physical half-life ( approximately #h days4 ,x is effici5tly absorb$ & us$ by ! body4 ,iod9e-#aca w contam9ate plants t w be eat5 by graz+ animals4 ,small] am\nts c also be absorb$ by brea?+ contam9at$ air4 ,cattle w excrete a l>ge am\nt ( ,i-#aca 9 milk4 ,milk & o!r dairy products are ! prim>y s\rces ( ,i-#aca intake4 ,"o c also get small] am\nts by eat+ contam9at$ fruits & vegetables4 ,iod9e-#aca w be conc5trat$ 9 ! ?yroid gl&4 ,! intake ( ,i-#aca w h its greate/ impact ! fir/ few days to weeks foll[+ a nucle> explosion4 ,cesium-#acg 7,cs-#acg7 is a beta emitt] & has a half-live ( #cj ye>s1 b is elim9at$ relatively quickly f ! body4 ,! biological half-live is #gj to #adj days4 ,cesium-#acg is f\nd 9 mo/ tissues ( ! body1 b x w conc5trate 9 muscle tissue4 ,cesium-#acg is absorb$ & us$ ! same way z potassium4 ,meat & milk are ! prim>y s\rces ( ,cs-#acg4 ,mu* precipitation1 lack ( m9]als 9 ! soil1 & ext5sive cultivation increase ! plants' absorption ( ,cs-#acg2 ?us1 ! contam9ation ( plant products4 7#c7 ,op]ational rations are safe :5 surface decontam9ation is p]=m$ be=e break+ ! package4 ,op]ational rations /or$ close to gr\nd z]o may become radioactive f induc$ radiation4 ,x is m likely1 h[ev]1 t ! food w be damag$ or de/roy$ by ! bla/ & !rmal effects ( ! nucle> explosion4 7#d7 ,bulk & fre% food /or$ 9 ! op5 )\t protection w be contam9at$4 ,decontam9ation is v difficult & "t-consum+4 ,ef=ts %\ld be made to ensure prop] pack+ to prev5t food contam9ation f radioactive fall\t4 ,pack+ made f h>d & nonpor\s mat]ials1 su* z pla/ic or multilay] c>dbo>d ) a smoo? surface1 %\ld be us$4 ,9 addition1 /orage facilities %\ld be enclos$ to avoid ! entry ( fall\t4 ,any mat]ial us$ z a protective cov] w give "s protection aga9/ nucle> fall\t4 ,protection aga9/ induc$ radiation1 bla/1 & !rmal effects requires a h>d5$ %elt] or und]gr\nd /orage4 7#e7 ,food supplies require protection ?r\gh\t ! *a9 ( production or procurem5t4 ,protection ( ! civilian-bas$ food supply includes c\nt]measures along ! production *a94 ,meats & milk are ! mo/ vuln]able products because ( ! possibility = conc5tration ( radioactive isotopes 7,/rontium1 ,cesium1 & ,iod9e74 ,! prim>y1 & possibly ! only1 protection ( animal products is to keep ! animals indoors & to avoid contam9at$ fodd]4 ,imm$iate slaught] ( food animals is recomm5d$ if !re is a %ortage ( uncontam9at$ fodd]4 ,also1 food animals expos$ to fall\t %\ld be consid]$ fit = consumption & slaught]$ us+ r\t9e proc$ures4 ,unh>ve/$ crops _c be protect$4 b4 ,inspection & ,monitor+4 7#a7 ,fall\t close to gr\nd z]o1 especially aft] a surface bur/1 may be visible z du/4 ,! pres5ce ( du/ is an imm$iate indicator ( contam9ation4 ,fall\t on unprotect$ food produces a gritt9ess t is unpleasant & w>ns aga9/ eat+ ! food4 ,! degree & means ( food protection 7packag+ & /orage faculties7 mu/ be consid]$4 ,food 9 a build+ t rema9s intact %\ld n receive en\gh contam9ation to be dang]\s :5 eat54 7#b7 ,vet]9>y units h ! ,,an_/,,vdr#b ,radiac ,set & ,,udr#ac dosimet] to conduct gr\nd or a]ial surveys = gamma radioactive contam9ation levels 9 an area4 ,! measurem5t ( ! ext]nal gamma radiation 9 ! fall\t area is an indication1 b n a quantitative measure1 = ! degree ( haz>d f food contam9ation4 ,^! units also use ! ,,an_/,,vdr#b ,radiac ,set = po9t detection ( gamma & beta radiation s\rces4 ,food monitor+ is conduct$ 9 an area ) l[ backgr\nd radiation4 ,if ! /orage area is contam9at$1 ! food mu/ be mov$ to a clean] area = monitor+4 ,) ! ,,an_/,,vdr#b1 ! initial food monitor+ is p]=m$ ) ! probe cov] 9 place & ! probe pass$ approximately #f in*es f ! surface4 ,if ! read+ is twice ! backgr\nd dose rate1 ! food is consid]$ contam9at$4 ,if ! read+ is n above ! backgr\nd level b contam9ation is /ill suspect$1 place ! probe clos] to ! food ) ! beta probe cov] (f4 ,monitor meat & fi% ) ! probe cov] (f2 pass ! probe approximately "o-half in* f ! surface ( ! food4 7#c7 ,monitor+ food contam9at$ ?r\gh ! food *a9 is m complicat$2 dep5d+ on ! detection in/rum5t us$1 special proc$ures mu/ be foll[$4 ,gamma & beta emitt+ radionuclides 9 small volumes may be detect$ us+ radiac sets su* z ! ,,an_/,,vdr#b2 h[ev]1 alpha emitt+ ones _c4 ,!y are r\gh in/rum5ts & may be us$ only = scre5+ surface contam9at$ food4 ,to evaluate ! haz>ds2 ! isotopes contribut+ to ! radioactivity mu/ be id5tifi$4 ,surface contam9at$ food w conta9 a mixture ( isotopes ) "s m haz>d\s ?an o!rs1 dep5d+ ^u :e!r !y are us$ by ! body4 ,milk w conta9 mo/ly ,i-#aca1 ,cs-#acg1 ,sr-#hi1 & ,sr-#ij4 ,meat & fi% w conta9 mo/ly ,cs-#acg4 ,to v]ify ,i-#aca1 ,cs-#acg1 ,sr-#hi1 & ,sr-#ij contam9ation1 samples mu/ be s5t to laboratories equipp$ to analyze ! samples4 7#d7 ,all newly select$ food supplies mu/ be survey$4 ,beg9 cont9u\s monitor+ imm$iately foll[+ receipt ( a fall\t w>n+1 or :5 increas$ levels ( radiation are detect$ by p]iodic monitor+4 7#e7 ,p]iodic monitor+ is ne$$ to e/abli% basel9e levels ( backgr\nd radiation 9 ! environm5t & v>i\s food products4 ,?is monitor+ is p]=m$ dur+ peacetime1 :5 possible1 & ?r\gh\t ! "t ,,u =ces are deploy$ 9 a ,,to4 ,,note ,! ,,an_/,,vdr#b is be+ replac$ by ! ,,an_/,,pdr#gg ,radiac ,set4 c4 ,decontam9ation4 ,!re are two me?ods = nucle> decontam9ation3 ag+ & remov+4 ,ag+ is ! process ( all[+ natural radiation decay to occur4 ,! "t necess>y = ?is decay to take place dep5ds ^u ! isotopes pres5t2 ea* has a diff]5t decay rate 7half-life74 ,ag+ may n be possible :5 !re is a %ort food supply4 ,9 "s in/ances1 su* z ) induc$ radioactivity1 x may be ! only way to decontam9ate4 ,remov+ nucle> contam9ation f areas1 p]sonnel1 food1 or mov+ equipm5t to ano!r location elim9ates ! imm$iate haz>d4 ,to det]m9e :i* decontam9ation me?od is requir$1 food supplies are divid$ into gr\ps4 ,see ,table ,j-#a = additional in=mation on food items & decontam9ation4 7#a7 ,gr\p ,,ii--,food 9 seal$ & du/-pro( pack+ su* z cans1 j>s1 fib]bo>d1 & cellophane4 ,^! products are easily decontam9at$ by remov+ ! radioactive du/ cov]+ ! pack+2 bru%1 wa% ) soap & wat]1 or remove ! pack+ 7dep5d+ on ! type ( pack+ mat]ial74 ,if radiation is /ill detect$ aft] remov+ ! du/1 repeat ! bru%_/wa% proc$ure & remonitor4 ,if radiation is /ill pres5t1 ! food itself is !n consid]$ radioactive 7induc$ radiation7 & is unfit = consumption4 ,decontam9ation ( induc$ radiation is possible only ?r\gh ag+4 ,aft] ag+ "o to two weeks1 ! food %\ld be safe = consumption4 ,aft] surface decontam9ation1 ! cont5ts are safe to eat unless ! food has induc$ radiation4 7#b7 ,gr\p ,,iii--,unprotect$ food4 ,! me?od *os5 to decontam9ate unprotect$ food items w dep5d ^u :e!r or n ! food supply is critical4 ,if ! food supply is n critical1 ! contam9at$ items are isolat$ & all[$ to decontam9ate by ag+4 ,if ! food supply is critical1 food ) surface contam9ation c1 9 pr9ciple1 be decontam9at$ by remov+ ! contam9at$ surface1 or by wa%+4 7#c7 ,"s products c be decontam9at$ by wa%+1 peel+1 or trimm+ ! out] sk9 or leaves4 ,decontam9ate potatoes & h>d-sk9n$ fruits & vegetables by wa%+ or scrubb+ "u runn+ wat]1 foll[$ by peel+ or scrap+1 !n wa%+ aga94 ,potatoes1 c>rots1 beets1 & turnips c be wa%$ at ! supply depot4 ,h[ev]1 d n wa% beans1 rice1 & onions until !y are deliv]$ to ! field kit*52 wa%+ r$uces _! /orage quality & %elf life4 ,citrus fruits1 p9eapples1 corn1 peas1 beans1 melons1 pumpk9s1 cabbage1 & nuts c be peel$4 ,decontam9ate cucumb]s1 tomatoes1 *]ries1 cranb]ries1 grapes1 pe>s1 plums1 & ?9-sk9n$ squa% by soak+ 9 a wat] or det]g5t solution & r9s+ ) vigor\s agitation or bru%+4 ,apricots1 pea*es1 mo/ b]ries1 asp>agus1 broccoli1 & leafy vegetables _c be satisfactorily decontam9at$ because ( fuzzy surfaces1 irregul> %apes1 or small size1 :i* makes wa%+ difficult4 ,fre% c>cass meat1 sausages1 & fi% c be decontam9at$ by sev]al wa%+s ) cold wat]4 ,! ext]ior lay] ( ! food item is remov$ if radioactivity is /ill pres5t4 ,!re is1 h[ev]1 a risk ( contam9at+ ! inn] p>ts ( ! food/uff 9 ! process4 ,cook+ ) sev]al *anges ( wat] is ! la/ /ep 9 decontam9ation4 ,table ,j-#a4 ,decontam9ation ( ,food ,supplies ,,type ,,( ,,contam9ation ,,surface ---------------------------------------- -------------- ,,or ,,mat]ial ,,*emical ,,biological ,,nucle> ---------------------------------------- ------------------------------ ,,cann$1 ,,bottl$1,,imm]se ,,9 ,,wa% ,,) ,,soap ,,& ,,wa% ,,) ,,soap ,,or ,,protect$ ,,by ,,boil+1 ,,wat]1 ,,!n ,,imm]se ,,& ,,wat]1 ,,r9se4 ,,imp]meable ,,soapy ,,wat] ,,9 ,,dis9fectant ,,conta9]4 ,,= #cj ,,m9utes ,,solution4 7,,imm]se ,,9 ,,bru%1 ,,wipe ,,& ,,r9se4 ,,boil+ ,,wat] ,,= #cj ,,*lor9e1 ,,food ,,m9utes4 ,,food ,,dis- ,,contam9ation ,,infectant1 ,,or #a_/c ,,f ,,surface ,,( ,,cante5 ,,cup ,,( ,,h\se- ,,conta9]4 ,,hold ,,blea* ,,9 #aj ,,gal ,,( ,,wat]74 ,,spray ,,) ,,ds#b ,,& ,,r9se ,,wa% ,,9 ,,hot1 ,,boil ,,9 ,,wat] #ae ,,soapy ,,wat]1 ,,m9utes2 ,,n ,,effective ,,r9se1 ,,& ,,on ,,tox9s ,,& ,,"s ,,a]ate4 ,,spores4 ,,imm]se ,,9 #e ,,sodium ,,c>bonate 7#d ,,lb ,,wa%+ ,,soda ,,9 #aj ,,gal ,,wat]71 ,,r9se ,,) ,,potable ,,wat]4 ,,imm]se ,,9 ,,h\sehold ,,blea* ,,solution 7#a_/b ,,gal ,,blea* ,,9 #be ,,gal ,,wat]7 ,,= #cj ,,m9utes ,,!n ,,r9se ,,& ,,a]ate ,,= #aj ,,m9utes4 ,,imm]se ,,9 ,,h? ,,solution 7#a_/b ,,lb ,,9 #be ,,gal ,,wat]7 #bj ,,m9utes1 ,,!n ,,r9se4 ,,imm]se ,,9 ,,/b ,,solution 7#a ,,lb ,,9 #be ,,gal ,,wat]7 #cj ,,m9utes1 ,,!n ,,r9se4 ,,imm]se ,,9 #b ,,p]acetic ,,acid ,,= #aj ,,m9utes1 ,,r9se1 ,,& ,,a]ate ,,= #aj ,,m9utes4 ,,n ,,cann$ ,,or ,,food ,,kn[n ,,or ,,boil ,,9 ,,wat] #ae ,,m9utes4,,wa% ,,or ,,trim ,,imp]meable ,,suspect$ ,,to ,,cook4 ,,contam9ation ,,conta9]4 ,,be ,,contam9at$ ,,f ,,unpack- ,,%\ld ,,n ,,be ,,imm]se ,,9 ,,or ,,spray ,,) ,,ag$ ,,food4 ,,consum$ ,,until #b ,,h\sehold ,,blea* ,,approv$ ,,by ,,solution4 ,,packag$1 ,,vet]9>y ,,peel$1 ,,or ,,p>$ ,,food ,,may ,,p]sonnel4 ,,be ,,imm]s$ ,,or ,,spray$4 ,decontam9ate h>d *eeses1 m>g>9e1 & butt] by cutt+ (f ! out] lay] to a dep? ( #b4e to #c cm4 ,let cook+ oils /& = #c to #e days1 !n p\r (f ! contam9at$ lay]2 use a funnel to control spillage4 ,nonp]i%able items t are h>d to decontam9ate1 su* z fl\r1 sug>1 & salt1 c be set aside all[+ natural radioactive decay4 ,:5 supplies are %ort1 dilute ! contam9ation by mix+ ) uncontam9at$ food4 ,?is w r$uce ! total am\nt ( radioactive exposure 9 foods prep>$ us+ ^! contam9at$ items4 ,decontam9ate air p]meable1 d\ble-sack$ goods by remov+ ! out] sack4 ,if ! inn] sack is free ( radiation1 d\ble sack ! food aga9 to re/ore protection4 ,h[ev]1 :5 contam9ation is pres5t on ! inside bag1 ! food 9 contact ) ! bag is likely to be contam9at$4 ,?ree me?ods c be us$ to h&le ?is type ( contam9at$ product4 ,! easie/ me?od involves spray+ ! bag ( dry goods 7except sug> or salt7 ) wat]4 ,?is w wet a lay] ( ! food inside ! bag4 ,! wet lay] c be remov$ :5 ! bag cont5ts are empti$4 ,! uncontam9at$ cont5ts are scoop$ back into clean packag+4 ,ano!r me?od involves us+ melt$ p>aff9 to uni=mly coat ! outside ( ! bag4 ,! p>aff9 solidifies aft] #cj to #dj m9utes1 & !n ! bag ) ! radioactive contam9ation c be remov$ f ! cont5ts4 ,al?\gh ?is me?od w seal ! radioactive sub/ance 9 ! wax1 x probably w n remove ! lay] ( contam9at$ food product inside ! bag4 ,= ! ?ird me?od1 =m a piece ( %eet metal into a cyl9d] ! same height z ! bag & #d to #f cm small] 9 diamet]4 ,ins]t ! cyl9d] into ! bag1 !n remove ! top #c to #d cm ( ! contam9at$ product4 ,c>efully scoop ! rema9+ product out into a clean sack4 ,) ! cyl9d] /ill 9 place1 fold ! bag d[n cat*+ ! contam9at$ product on pla/ic %eet+1 or a t>paul94 ,:5 us+ ?is me?od1 mix+ ! contam9at$ portion ) ! uncontam9at$ portion is a problem4 ,*eck = contam9ation rema9+ 9 ! product4 ,boil+ or cook+ has no effect on radioactive contam9ation4 7#d7 ,gr\p ,,iv--,food contam9at$ ?r\gh ! food *a94 ,x is n practical to decontam9ate ?is food4 ,meat & milk are ! two mo/ common food/uffs contam9at$ 9 ?is way4 ,milk may be decontam9at$ to a safe level by a complicat$ ion ex*ange process4 ,! ,i-#aca activity w decl9e rapidly dur+ /orage ( milk & milk-products1 al?\gh ! ,cesium & ,/rontium activity w rema9 almo/ con/ant = ye>s4 ,9 an area ) high-level fall\t1 milk is )drawn f human consumption4 ,! duration ( )drawal w be dep5d5t ^u ! type ( fall\t & levels4 ,meat may be decontam9at$ to a safe level by soak+ 9 wat] or br9e4 ,cesium is loosely b\nd 9 ! meat4 ,by repeat$ soak+ ( meat cut 9 small pieces1 mo/ ( ! ,cesium activity w be remov$4 ,traditional meat pres]v+1 su* z salt+ ) br9e1 w remove up to #fj to #gj p]c5t ( ! ,cesium activity4 ,see ,table ,j-#b4 ,fruits1 vegetables1 root crops1 & gra9 products may also conta9 haz>d\s am\nts ( radioactivity if +e/$4 7#e7 ,food animals4 ,food animals t h be5 expos$ to fall\t %\ld be consid]$ fit = consumption & slaught]$ us+ r\t9e inspection & slaught] proc$ures4 ,9 ^? cases :]e ! animal has be5 expos$ to fall\t1 b is n s*$ul$ = imm$iate slaught]1 ! radiation burd5 c be r$uc$ by mov+ ! animal to an uncontam9at$ area 7b>n if available7 & wa%+ x ) soap & wat]4 ,mild radiation sickness does n necess>ily mean t ! animals _c be us$ = food4 ,if ! animals h be5 expos$ to an int]nal radiation haz>d1 ! meat c be eat5 if ! int]nal organs are disc>d$4 ,*ick5s t h eat5 radioactive mat]ial may lay contam9at$ eggs1 b mo/ ( ! radioactivity w be conc5trat$ 9 ! %ells4 ,! :ite & yolk w be free ( h>mful am\nts ( radiation & c be eat54 ,*ick5s w n lay eggs if ! radioactive body burd5 is l>ge en\gh t _! eggs are unfit to eat4 ,table ,j-#b4 ,traditional ,salt ,pres]v+ ,br9e ,,meat1 ,,:ole #d-e ,,kg #be ,na,cl 7,,salt7 ,,br9e #e-,,lit] ,,br9e ,,p] ,,kg4 ,,keep ,,meat ,,9 ,,br9e ,,= #c ,,weeks1 ,,temp]ature ,,bel[ #aj;,c4 ,,soak ,,9 ,,wat] ,,= #a-b ,,days4 #fe-gj ,,( ,,cs ,,activity ,,w ,,be ,,remov$4 ---------------------------------------- ------------------------------ ,,meat1 ,,cut #a-b ,,kg #be ,na,cl ,,br9e #e-,,lit] ,,br9e ,,p] ,,kg4 ,,keep ,,meat ,,9 ,,br9e ,,= #d ,,days4 ,,soak ,,9 ,,wat] ,,= #d ,,h\rs4 #fe-gj ,,( ,,cs ,,activity ,,w ,,be ,,remov$4 ---------------------------------------- ------------------------------ ,,mutton_/,,lamb ,,rib ,,piece ,,( ,,rib #a-e ,,kg4 #be ,na,cl ,,br9e #e-,,lit] ,,br9e ,,p] ,,kg4 ,,keep ,,9 ,,br9e ,,= #b ,,days4 ,,soak ,,9 ,,wat] ,,= #b ,,h\rs4 ,,air-,,dry+ ,,= #aj ,,days4 ,,soak ,,9 ,,wat] ,,= #b ,,h\rs4 ,,boil ,,9 ,,wat] ,,= #c ,,h\rs4 #he-ij ,,cs ,,activity ,,w ,,be ,,remov$4 ---------------------------------------- ------------------------------ ,,decontam9ation ,,( ,,co>sely ,,*opp$ ,,meat #j4i ,na,cl ,,solution4 #b-,,lit] ,,solution ,,p] ,,kg4 ,,soak ,,9 ,na,cl ,,solution ,,= #aj ,,m94 #fj-gj ,,cs ,,activity ,,w ,,be ,,remov$4 ,,repeat$ ,,proc$ures ,,w ,,remove ,,! ,,same ,,p]c5tage ,,( ,,cs ,,activity4 ,,six ,,times ,,repeat$ ,,treatm5t ,,w ,,remove ,,ne>ly #ajj ,,( ,,cs ,,activity4 d4 ,consid]ations ,:5 ,decontam9ation is ,n ,possible4 ,:5 food _c be decontam9at$1 seal+ ! product 9 a wrapp+ mat]ial or conta9] may be ne$$4 ,seal+ ! product c r$uce or %ield ! emanation ( ! contam9ation &_/or fix ! contam9ation 9 place4 ,! haz>d f contam9at$ food is small comp>$ ) t f ext]nal gamma radiation4 ,hungry p or animals %\ld n be d5i$ food because ( possible fall\t contam9ation4 ,x is n practicable or desirable to preset maximum p]missible limits ( gross fall\t radioactivity z a basis = judg+ :e!r or n food %\ld be us$4 ,common s5se mu/ be appli$ 9 e/abli%+ priorities = di/ribution ( available food4 ,= example1 use ! lea/ contam9at$ & ! mo/ protect$ food fir/2 hold milk products = #a to #b weeks be=e use4 ,j-#d4 ,biological a4 ,contam9ation4 ,biological w>f>e ag5ts exi/ 9 ! =m ( tox9s & microorganisms4 ,! normal packag+ & pack+ ( food 7to protect aga9/ moi/ure1 du/1 & bact]ial or o!r contam9ation7 provides protection aga9/ mo/ biological ag5ts4 ,! exception may be tox9s & biologically d]iv$ sub/ances4 ,h[ev]1 ! protective me?ods us$ = *emical ag5ts w also protect aga9/ tox9s & d]iv$ sub/ances4 ,food 9 freez]s1 refrig]ators1 & 9 refrig]at$ trucks or rail c>s w be safe if ^! conta9]s rema9 seal$ until ! out] surfaces are decontam9at$4 7#a7 ,x is unlikely t a biological ag5t w affect ! appe>ance1 ta/e1 or smell ( ! food en\gh = ! *ange to be app>5t4 7#b7 ,packag+ & pack+ mat]ials are n life supportive to pa?og5ic ag5ts & are1 !re=e1 self-decontam9at+ ) ! exception ( spore-=m+ organisms4 7#c7 ,mo/ op]ational rations are packag$ 9 metal conta9]s1 or encas$ 9 heavy alum9um lam9at$ pla/ics t c )/& boil+ wat]2 also1 !y are imp]vi\s to ar?ropod p5etration4 ,?is food is highly resi/ant to biological ag5ts4 7#d7 ,! use ( unpackag$ items 7unwrapp$ meats1 fre% fruits1 & vegetables7 %\ld be re/rict$2 use only op]ational rations4 ,unprotect$ fre% food /or$ 9 ! op5 & close to ! s\rce ( dissem9ation w become contam9at$4 b4 ,detection4 7#a7 ,rapid id5tification ( ag5ts us$ is absolutely ess5tial to implem5t effective c\nt]measures4 ,ag5t id5tification mu/ be a*iev$ quickly2 x is ! fir/ /ep 9 answ]+ critical managem5t que/ions4 ,:at adju/m5ts mu/ be made 9 food prep>ation & di/ribution8 ,:at are ! ess5tial c\nt]measures8 ,:at is ! expect$ outcome ( ! incid5t8 7#b7 ,samples ( food t are suspect$ ( be+ contam9at$ are transport$ to ! designat$ support+ laboratory4 ,samples mu/ be accompani$ by a description ( ! samples1 ! sample collection proc$ures1 & ! circum/ances1 :i* prompt$ ! collection4 ,! designat$ m$ical laboratory 9 ! ,,to w provide a field confirmation id5tification ( ! ag5t7s74 ,designat$ ,,conus laboratories accompli% def9itive id5tification4 ,see ,app5dix ,b = sampl+ proc$ures4 ,,note ,new biological detection equipm5t is "u developm5t t w enable units to conduct presumptive id5tification ( biological w>f>e ag5ts4 ,h[ev]1 samples mu/ also be collect$ & process$ z describ$ 9 ,app5dix ,b4 c4 ,decontam9ation4 7#a7 ,food contam9at$ ) tox9s is h&l$ 9 ! same mann] z food contam9at$ ) *emical ag5ts4 ,food contam9at$ ) microorganisms is h&l$ 9 ! same mann] z :5 contam9at$ ) ! m common foodborne disease-produc+ microorganisms4 7#b7 ,sev]al me?ods are available to decontam9ate food items contam9at$ ) biological ag5ts4 ,! foll[+ decontam9ation me?ods are consid]$ to be ! m9imum4 ,see ,table ,j-#a4 7#c7 ,gr\p ,,ii food t is seal$ 9 conta9]s t are resi/ant to ! passage ( biological ag5ts requires only t ! ext]ior ( ! conta9] be decontam9at$4 ,decontam9ation ( ^! items is z foll[s3 7a7 ,= conta9]s made ( metal1 glass1 pla/ic1 or porcela93 #a4 ,?or\ghly wa% ! conta9] 9 potable wat] & soap1 or 9 a dis9fectant solution4 ,if ! wat] us$ = wa%+ is contam9at$1 ! soap & wat] wa% may increase1 n r$uce1 ! contam9ation haz>d4 ,aft] :i*1 ! food conta9]s are imm]s$ 9 a dis9fectant solution = #cj m9utes 7see ,table ,j-#c72 !n r9s$ ) potable wat]1 if available & "t p]mits4 ,*lor9e solutions are n z reactive or corrosive z ,,ds#b4 #b4 ,place ! conta9]s 9 boil+ soapy wat] = #ae m9utes2 !n r9se ) potable wat]4 ,,notes #a4 ,! *emical field decontam9ation kits d n meet ! requirem5ts to decontam9ate food supplies expos$ to biological ag5ts4 #b4 ,! same proc$ures %\ld be foll[$ ev5 if !re is only suspicion ( a biological w>f>e attack4 7b7 ,?or\ghly wipe conta9]s t w n )/& soak+ ) a clo? soak$ 9 a *lor9e det]g5t solution4 ,remove ! food f ! conta9] & place x 9 ,gr\p ,,iii4 7c7 ,metal or glass conta9]s det]m9$ to h tri*o!c5es 7,yell[ ,ra97 pres5t c be decontam9at$ us+ ,,ds#b4 ,all[ a contact "t ( #e to #cj m9utes = ! ,,ds#b to neutralize ! tox94 ,!n r9se ! conta9] ) potable wat]4 7#d7 ,gr\p ,,iii food items t are n protect$ by ! packag+ mat]ial are decontam9at$ or dispos$ ( z foll[s3 7a7 ,decontam9ate foods t c be peel$ or p>$ by imm]s+ !m 9 a dis9fectant solution = #cj m9utes1 & !n r9s+ !m ) potable wat] 7see ,table ,j-#c74 ,peel or p>e ! items aft] decontam9ation1 !n wa% &1 if appropriate1 cook be=e eat+4 7b7 ,) ! exception ( c]ta9 heat-/able tox9s1 heat is ! mo/ practical means ( decontam9at+ food4 ,sev]al heat+ me?ods may be us$1 b ! me?od *os5 dep5ds ^u ! type ( food to be decontam9at$4 ,! key is to apply z mu* heat z possible )\t r5d]+ ! food unfit4 #a4 ,cook 9 a pressure-type cook] ) #ae p\nds ( pressure at #bej;,f 7#aba;,c7 = #ae m9utes4 #b4 ,cook 9 a l[-pressure cook] at #bbh;,f 7#aji;,c7 = #a h\r4 #c4 ,bake bread or relat$ items at #djj;,f 7#bjd;,c7 = #dj m9utes4 ---------------------------------------- -------------- ,,caution ,bread made ) tox9-contam9at$ fl\r 7especially ) tri*o!c5es7 is /ill toxic4 ---------------------------------------- -------------- #d4 ,bake or roa/ meat at #cbe;,f 7#afc;,c7 = #b h\rs4 #e4 ,boil = at lea/ #ae m9utes :5 no o!r me?od is available4 7c7 ,al?\gh decontam9ation me?ods are provid$ above1 vegetables su* z lettuce1 broccoli1 & caulifl[]1 or unwrapp$ meats t h be5 expos$ to biological ag5ts %\ld n be eat54 7d7 ,foods1 su* z butt]1 ice cream1 & bread t w n )/& any ( ! above treatm5ts mu/ be de/roy$4 7#e7 ,e/abli%$ meat inspection proc$ures are foll[$ :5 animals expos$ to biological ag5ts mu/ be us$ = food4 ,! meat mu/ be ?or\ghly cook$4 ,table ,j-#c4 ,*lor9e ,solutions = ,decontam9ation ( ,biological ,w>f>e ,ag5ts ,,*lor9e ,,mixture ,,to ,,produce #bjj ,,ppm ,,s\rce ,,solution ,,( ,,available ,,*lor9e ---------------------------------------- ------------------- ,,h\sehold ,,blea* #a_/b ,,gal_/#be ,,gal ,,wat] ,,high-,,te/ ,,hypo*lorite #a_/b ,,lb_/#be ,,gal ,,wat] 7,,calcium ,,hypo*lorite7 ,,sup]tropical ,,blea* #a ,,lb_/#be ,,gal ,,wat] ,j-#e4 ,*emical a4 ,contam9ation4 7#a7 ,contam9ation ( food/uffs by a *emical ag5t may occur at any po9t on ! battlefield4 ,?is contact may r5d] ! food unpalatable also4 ,9 _m cases1 decontam9ation is difficult1 ?us1 emphasis mu/ be plac$ on protection4 ,keep food supplies cov]$ at all times4 ,take special precautions to protect food t is n pack$ 9 protective packages4 ,unprotect$ food1 =age1 & gra9 supplies may be s contam9at$ t _! consumption w produce ga/ro9te/9al irritation1 or sy/emic poison+4 ,n]ve ag5ts1 vesicants1 & ars5icals are ! mo/ dang]\s4 ,field conc5trations ( phosg5e1 hydrocyanic acid1 irritants1 & smokes w seldom be high en\gh to cause s]i\s food contam9ation4 ,! effect ( ,,ck on food is n kn[n4 ,z a precaution1 foods expos$ to ,,ck %\ld be consid]$ toxic4 7#b7 ,! effects ( *emical ag5ts on food dep5d on ! nature ( ! ag5t & ! type ( ! food4 ,! ext5t to :i* *emical ag5ts p5etrate food also dep5ds on ! am\nt1 =m ( disp]sal 7liquid droplet size1 or vapor7 & duration ( exposure4 ,n]ve ag5ts & mu/>d w p5etrate deeply into unprotect$ fatty foods & w readily p5etrate granul> products su* z gra9 & sug>4 ,liquid food products c be completely contam9at$4 ,ars5icals readily hydrolyze to poison\s ars5ical oxides 9 "s foods4 ,foods c be divid$ into ?ree categories bas$ on _! wat] cont5t1 fat cont5t1 & cry/all9e /ructure3 7a7 ,foods hav+ a high wat] cont5t1 a l[ fat cont5t1 &_/or a cry/all9e /ructure 7fre% vegetables1 fruits1 sug>1 salt1 & eggs7 w absorb mu/>d & n]ve ag5ts1 ei!r z a liquid or z a vapor4 ,n]ve ag5ts w be hydrolyz$ sl[ly4 7b7 ,foods hav+ a l[ fat cont5t & an irregul> 7amorph\s7 /ructure 7fl\r1 bread1 gra91 rice1 c]eals1 dri$ fruits1 dri$ vegetables1 tea1 c(fee1 peas1 & beans7 readily absorb mu/>d & n]ve ag5ts 9 liquid =m4 ,z a vapor1 ^! ag5ts are absorb$ to "s ext5t1 b are easily remov$ by air+4 7c7 ,foods hav+ a l[ wat] cont5t & a high fat cont5t1 su* z butt]1 fat1 fatty oils1 ham1 *eese1 milk1 bacon1 fatty meat1 & fi%1 absorb mu/>d & n]ve ag5ts su* t removal ( ! ag5ts is virtually impossible4 7#c7 ,*emical ag5ts c be physically & *emically absorb$ into food4 ,9 addition to ! toxic effect1 !y (t5 adv]sely affect ta/e1 smell1 & ! appe>ance ( ! food4 ,h[ev]1 *emical ag5ts c cause ! food to become v toxic )\t caus+ any o!r *anges 9 ! food4 ,table ,j-#d %[s ! effects ( a numb] ( *emical ag5ts on food4 ,s9ce food c be contam9at$ )\t any outw>d *ange 9 appe>ance1 ! possibility ( contam9ation mu/ be assum$ 9 a *emical ag5t environm5t4 ,treat ! food ) ! same precautions z e/abli%$ = kn[n contam9at$ items4 7#d7 ,! protective prop]ties ( packag+ mat]ials are dep5d5t ^u a numb] ( factors4 ,! factors include ! =m ( ! ag5t 7liquid v]sus vapor72 conc5tration & exposure "t2 wea!r 7temp]ature1 w9d spe$1 & humidity72 & packag+ mat]ial 7! type ( mat]ial1 ?ickness1 & ! pres5ce ( folds1 te>s1 & small holes74 ,ev5 ! ?9ne/ mat]ial w (f] "s protection & is bett] ?an no?+ at all4 ,!re=e1 always cov] food supplies ) :atev] mat]ial is available4 ,table ,j-#e summ>izes ! protection values ( v>i\s packag+ mat]ials aga9/ vapors & liquids4 7a7 ,op]ational rations are sub/antially protect$ :ile conta9$ 9 ! %ipp+ cases & especially if /or$ 9 ! orig9al palletiz$ unit load ) an ov]lay ( fib]bo>d1 %r9k wrap1 or film wrap4 ,! wor/ case is pallets ( subsi/5ce contam9at$ by liquid droplets dur+ an attack4 ,aft] ! attack1 high vapor conc5trations w exi/ 9 ! vic9ity ( ! palletiz$ loads4 ,if ! out] b>ri] is p]meable su* z fib]bo>d1 x is possible t a liquid ag5t c seep ?r\gh ! ov]lay fib]bo>d & contact ! %ipp+ conta9]s 9 liquid =m4 ,normally1 ) seepage resi/ant mat]ials1 su* z %r9k wrap z ! out] b>ri]s1 only ! vapors ( ! ag5t are f\nd )9 ! pallet4 7b7 ,:ile ,m,r,es are /or$1 ! food is protect$ by up to six lay]s ( mat]ial4 ,multilay] b>ri]s result 9 a complex diffusion process ( ! ag5t f ! outside t[>ds ! int]ior4 ,vapor p5etration into nonh]metically seal$ spaces is a simple gase\s diffusion process4 ,p]meation ?r\gh packag+ is a mu* m complex process reg>dless ( :e!r ! *all5ge is a liquid or a vapor4 #a4 ,liquid is adsorb$ into p]meable mat]ials su* z fib]bo>d or *ipbo>d4 ,) p]meation-resi/ant mat]ials 7su* z %r9k wrap71 ! ag5t dissolves into1 seeps ?r\gh1 & !n desorbs f ! b>ri] mat]ial4 ,%r9k wrap provides adequate protection4 ,fib]bo>d %ea?+ provides adequate protection aga9/ mu/>d ag5ts1 b n aga9/ n]ve ag5ts4 #b4 ,! l[-d5sity polye?yl5e us$ to con/ruct ! m5u bag c absorb *emical ag5ts & possibly tox9s4 ,if ! m5u bag is remov$ f ! %ipp+ conta9] & is expos$ to liquid contam9ation1 en\gh ag5t may pass ?r\gh ! bag to create a heal? haz>d4 ,keep ,m,r,es 9 ! %ipp+ conta9] until issu$ to ! soldi]4 ,! m5u bags %\ld !n be kept "u ! same degree ( protection z ! soldi]4 #c4 ,! alum9um-lam9at$ mat]ials us$ to con/ruct ! ,,mre 7retort & nonretort7 p\*es protect food f *emical contam9ation if h]metically seal$4 ,! only item 9 ! ,,mre meal bag t is n adequately protect$ is ! spoon4 7#e7 ,myl> & cellophane are resi/ant to *emical ag5ts4 ,table ,j-#d4 ,effects ( ,*emical ,ag5ts on ,food ,,influ5ce ,,on -------------------------------------- ,,residual ,,ag5t ,,ta/e ,,smell ,,color ,,toxicity ---------------------------------------- --------------------------- ,,mu/>d ,,bad ,,bad ,,discolors ,,meat ,n-,,mu/>ds ,,bad ,,bad ,,doesn',t ,,discolor ,,meat ,,ars5icals ,,acid ,,bad ,,discolors ,,meat ,,& 1 ,,ars5ic ,,vegetables ,,n]ve ,,ag5ts ,,bad ,,none ,,none ,,phosg5e ,,acid ,,none 8 - ,,aft] ,,wea!r+ ,,cyanog5 ,,ag5ts ,,bitt] ,,bad ,,none - ,,aft] ,,wea!r+ ,,irritants ,,acid ,,bad ,,none ,,smoke ,,acid ,,bad 8 - ,,:ite 8 8 8 ,,phosphor\s ---------------------------------------- --------------------------- ,,indicates ,,! ,,pres5ce ,,( ,,residual ,,toxicity4 - ,,d5otes ,,t ,,residual ,,toxicity ,,is ,,n ,,pres5t4 8 ,,! ,,influ5ce ,,has ,,n ,,be5 ,,det]m9$4 ,table ,j-#e4 ,protection f ,*emical ,contam9ation by ,packag+ ,me?ods & ,mat]ials ,,*emical ,,vapors ,,liquids ---------------------------------------- ------------ ,,bottles ,,& ,,cans ,,airtight ,,bottles ,,complete ,,complete ,,seal$ ,,metal ,,cans ,,complete ,,complete ,,glass ,,bottles ,,good ,,good ,,metal ,,conta9]s ,,good ,,good ,,boxes ,,c>dbo>d ,,mod]ate ,,mod]ate ,,wood5 ,,crates ,,mod]ate ,,poor ,,or ,,none ,,wrapp+s ,,metal ,,foil ,,lam9ates ,,complete ,,complete ,,pap] ,,poor ,,none ,,textiles ,,none ,,none ,,wax$ ,,pap] ,,good ,,mod]ate ,,multilay] ,,bags ,,good ,,mod]ate ,,cellophane ,,good ,,good ,,cellophane1 ,,wet ,,none ,,none ,,canvas ,,poor ,,poor b4 ,detection4 7#a7 ,curr5tly1 a field me?od = detect+ *emical ag5t contam9ation 9 food does n exi/4 ,contam9ation is n always spread ev5ly ?r\gh\t food2 ?is makes x impossible to take a s+le sample & det]m9e ! pres5ce or abs5ce ( *emical ag5ts 9 ! entire lot4 ,additionally1 /&>diz$ laboratory te/s h n be5 develop$ = det]m9+ levels ( *emical ag5ts 9 food4 ,until a specific me?od to detect *emical ag5ts 9 food is available1 reliance w h to be made ^u det]m9ation ( contam9ation1 or lack !re(1 on ! packag+ mat]ial2 ! integrity ( ! packag+ mat]ial2 ! protective qualities ( ! packag+ mat]ial2 & ! p5etration *>act]i/ics ( ! suspect$ *emical ag5ts4 7#b7 ,food may become toxic )\t any *ange 9 outw>d appe>ance4 ,nev] ta/e or smell food to det]m9e if contam9ation is pres5t 9 food4 7#c7 ,vet]9>y & subsi/5ce units h ! foll[+ equipm5t available to detect *emical ag5ts 9 ! field3 7a7 ,! ,m#h ,automatic ,*emical ,ag5t ,al>m ,sy/em consi/s ( ! ,m#dc detector unit & ! ,m#db al>m unit4 ,! detector unit is a portable1 automatic1 po9t-monitor+ device t is design$ to be h& c>ri$ f po9t to po9t4 ,! ,m#h is us$ to provide e>ly w>n+ ( a toxic ag5t position & detects ! pres5ce ( *emical vapors & a]osols4 ,! ,m#dc detects all n]ve1 blood1 & *ok+ ag5ts1 & "s bli/] ag5ts4 ,! ,m#dc;,a#a 7! replacem5t = ! ,m#dc7 only detects n]ve ag5ts4 7b7 ,! ,m#bef ,*emical ,ag5t ,detector ,kit detects & id5tifies n]ve1 blood1 & bli/] ag5ts4 ,! ,m#bef is ! mo/ s5sitive ( ! *emical ag5t vapor detectors available4 ,h[ev]1 x is n a cont9u\s1 real-"t monitor+ sy/em4 ,x requires #ae to #bj m9utes = sampl+ & analysis4 7c7 ,! ,,abc-,m#h ,,vgh ,*emical ,ag5t ,detector ,pap] c detect & diff]5tiate betwe5 n]ve & bli/] ag5ts by color *ange4 ,x is int5d$ to be us$ by blott+ & wip+ surfaces suspect$ ( contam9ation4 ,! ,m#h pap] w respond ) a visual color *ange 9 #aj seconds or less4 7d7 ,! ,m#i ,*emical ,ag5t ,detector ,pap] w detect liquid n]ve 7,g ,v7 & bli/] ag5ts 7,h ,l71 b w n id5tify ! specific ag5t or diff]5tiate betwe5 n]ve & bli/] ag5ts4 ,! ,m#i tape is s5sitive to droplets z small z #ajj 1 & w respond ) a visual color *ange 9 #aj seconds or less4 7#d7 ,all subsi/5ce 9 a *emical attack area are consid]$ contam9at$ until a survey c be conduct$1 pref]ably by vet]9>y & *emical p]sonnel4 ,p]sonnel mu/ be at ,,mopp ,level #d :ile conduct+ ! survey4 ,conc5trate ! initial portion ( ! survey on ! adequacy ( ! /orage facility & o!r protective measures 9 prev5t+ *emical ag5t contact ) subsi/5ce items4 ,! area surr\nd+ ! /orage facility is exam9$ = ! pres5ce ( animals1 rod5ts1 birds1 & ar?ropods act+ unusual1 or dead 9 unusual numb]s4 ,if animals are pres5t & assi/ance is requir$ 9 id5tify+ ! ,,nbc ag5t1 specim5s c be collect$ & submitt$ to ! area m$ical laboratory4 ,damage su* z brok5 w9d[s1 holes1 or loss ( /ructural integrity ( ! /orage facility is not$4 ,?is in=mation comb9$ ) k ( ! ag5t =m 7liquid or vapor71 type ( ag5t 7:i* w indicate ! degree ( p]si/5cy71 & approximate "t ( attack w provide a risk assessm5t4 ,liquid ag5ts %\ld n significantly p5etrate an intact facility1 b may produce vapor contam9ation by (f-gass+4 7a7 ,^u ent]+ ! /orage facility1 ! ,m#h c be us$ to det]m9e ! pres5ce ( *emical vapors4 ,h[ev]1 precautions mu/ be tak54 ,! ,m#db al>m is n to be us$ inside %elt]s1 vehicles1 vans1 or o!r int]ior modes4 ,!re=e1 :5 *eck+ food /orage facilities1 ! al>m unit mu/ be left outside1 turn$ (f1 or disconnect$4 ,d n tilt ! ,m#dc detector m ?an #de degrees 7because ( ! liquids x conta9s74 ,?is is n a problem ) ! improv$ ,m#dc;,a#a1 b ! ,m#dc;,a#a requires atta*m5t ( an exit port filt] :5 us$ indoors4 ,! ,m#bef ,*emical ,ag5t ,detector ,kit c be us$ to sample ! air4 7b7 ,pre-position ,m#i *emical ag5t detector pap] 9 food /orage areas2 especially on ! lea/ protect$ pallets & 9 areas :]e droplets may ent]1 su* z ne> doors or w9d[s4 ,exam9e ! ,m#i pap] = indications ( liquid *emical ag5ts4 ,if ! ,m#i pap] is positive1 or if ! packag+ mat]ials %[ ! pres5ce ( liquids or /a9s1 use ! ,m#h detector pap] to det]m9e ! type ( ! ag5t4 ,if an ag5t is n indicat$ by ! detector pap]1 !n ! am\nt ( ag5t pres5t w be insuffici5t to cause second>y contam9ation :5 ! out] package is remov$4 7#e7 ,detection proc$ures become m complicat$ if a *emical ag5t has p5etrat$ or p]meat$ ?r\gh ! packag+ & pack+ mat]ials4 ,unless liquid has seep$ ?r\gh ! c>dbo>d1 any ag5t 9 ! int]ior ( ! %ipp+ case w be 9 a vapor =m4 ,liquid seep+ %\ld be obvi\s4 ,! sampl]-detectors 9 ! ,m#bef ,*emical ,ag5t ,detector ,kit d n h an aspirator = sampl+ ! int]ior ( ! case4 ,h[ev]1 !re are sev]al proc$ures t c be us$4 ,"o is to op5 ! case1 place ! activat$ sampl]-detectors inside ! case1 & !n reclose ! case4 ,ano!r is to pun* holes 9 ! case1 place ! activat$ sampl]-detector ov] ! holes1 & cov] ! sampl]-detector ) an empty box or c 7op5 end d[n7 to conc5trate ! vapors escap+ f ! case4 ,alt]natively1 remove ! food f ! case & place x 9 a pla/ic bag ) ! sampl]-detectors to conc5trate ! vapors4 ,^! proc$ures require two sampl]-detectors2 "o = blood ag5ts & "o = n]ve & bli/] ag5ts4 ,nei!r me?od is v s5sitive 9 l[ conc5trations ( vapor z is expect$ to be pres5t inside %ipp+ conta9]s4 ,a bett] me?od is to modify ! ,m#dc detector ) a field exp$i5t probe ( ,teflon tub+ atta*$ to ! detector's air inlet4 ,ins]t ! op5 end ( ! tub+ into a hole 9 ! case or package to sample ! int]ior air4 ,:5 available1 ! improv$ *emical ag5t monitor 7,,icam7 c be us$2 its design w all[ aspiration ( air f inside %ipp+ cases4 ,! ,,icam c also be us$ to detect & id5tify liquid ag5ts on a surface provid$ ! ag5t is vaporiz+ 9 suffici5t quantity4 ,! ,,icam gives a visual repres5tation ( a haz>d evaluation4 c4 ,decontam9ation4 7#a7 ,decontam9ation is only requir$ = contam9ation rema9+ #aj m9utes or long]4 ,decontam9ation ef=ts on subsi/5ce items w normally be limit$ to removal ( ! conta9]s & c>ton ov]wrap mat]ial4 7#b7 ,! ne$ = decontam9ation is prim>ily dictat$ by ! type ( *emical ag5t us$4 ,! me?od ( decontam9ation select$ w dep5d ^u ! type ( packag+ mat]ial us$ & ! urg5cy ) :i* ! food is requir$4 7#c7 ,food supplies 9 /orage are n likely to be s]i\sly contam9at$ if reasonable protection precautions are tak54 ,= ?is reason1 l>ge supplies ( food are n to be condemn$ z a :ole simply because !y h be5 expos$ to possible *emical contam9ation4 ,a prompt & c>eful survey ( ! supplies may reveal t only a few items h be5 contam9at$ to a level t decontam9ation is requir$4 ,prompt segregation ( ! heavily contam9at$ portions w prev5t1 or m9imize1 contam9ation ( ! rema9d]4 ,foods )\t protective packages con/itute ! major difficulty4 7#d7 ,individual decontam9ation is p]=m$ by ea* soldi] on ^? subsi/5ce items 9 8 possession at ! "t ( ! attack4 ,individual decontam9ation is limit$ to op]ational rations t are 9 orig9al1 intact conta9]s4 ,unit-level decontam9ation is p]=m$ by unit p]sonnel "u ! sup]vision ( unit ,,nbc p]sonnel4 ,support decontam9ation is attempt$ at major subsi/5ce /orage facilities4 ,aga91 decontam9ation is limit$ to pack+ mat]ial4 ,decontam9ation ( food itself is only attempt$ 9 em]g5cy situations :5 alt]native supplies are n available4 7#e7 ,/>t decontam9ation op]ations ) ! easie/ me?od & proce$ to ! mo/ difficult4 ,?is all[s = ! removal ( a relatively l>ge portion ( ! contam9ation 9 a m9imum ( "t4 ,! simple/ proc$ure is to all[ ! mat]ials to age & air 7wea!r74 ,sub/antial self-decontam9ation w occur ) mo/ ag5ts4 ,exceptions are ?ick5$ mu/>d1 ?ick5$ ,,gd1 & ,,vx4 ,table ,j-#f provides ! l5g? ( "t = :i* contam9at$ subsi/5ce supplies may pres5t a contact haz>d4 ,wea!r elem5ts t affect decontam9ation are-- 7a7 ,w>m temp]atures spe$ liquid ag5t (f-gass+ & ha/5 ! disp]sion ( *emical ag5ts into ! air4 7b7 ,high w9ds rapidly disp]se *emical ag5t vapors & spe$ (f-gass+ f surfaces4 7c7 ,moi/ure causes *emical ag5ts to react ) wat] to =m nontoxic or less toxic *emicals4 ,heavy ra9 or ra9 ( long duration c aid decontam9ation by me*anically remov+ *emical ag5ts4 7d7 ,ev5 9 cold wea!r1 direct sunrays w>m surfaces above ! air temp]ature & ha/5 ! (f-gass+ & decomposition ( *emical ag5ts4 ,table ,j-#f4 ,p]si/5cy ( ,select$ ,liquid ,*emical ,ag5ts ,,wea!r ,,conditions ---------------------------------------- -------- ,,ag5t ,,sunny1 ,,wet ,,& ,,w9dy1 ,,calm1 ,,sunny1 ,,ar\nd #bj;,c1 ,,ar\nd #aj;,c ,,ly+ ,,sn[1 ,,light ,,breeze ,,ar\nd -#aj;,c ,,mu/>d7,,hd7 #b-g ,,days #a_/b-b ,,days #b-h ,,weeks ,,tabun7,,ga7 #a-d ,,days #a_/b-f ,,h\rs #a ,,day-#b ,,weeks ,,s>97,,gb7 #a_/d-d ,,h\rs #a_/d-a ,,h\r #a-b ,,days ,,soman7,,gd7 #b-a_/b -#e ,,days #c-cf ,,h\rs #a-f ,,weeks ,,n]ve7,,vx7 #c-ba ,,days #a-ab ,,days #a-af ,,weeks 7#f7 ,active decontam9ation is attempt$ only :5 wea!r+ w n decontam9ate ! packag+ mat]ial 9 suffici5t "t4 ,decontam9ation proc$ures c be enhanc$ by us+ heat to vaporize ! *emical ag5t2 by reaction ) decontam9ants2 or by remov+ ) hot soapy wat]4 7a7 ,! simple/ 7/&>d7 decontam9ation mat]ials are wat] & det]g5ts4 ,an effective decontam9ant is hot wat] us$ ) ! addition ( soap or det]g5t & scrubb+4 ,comm]cial abrasive p[d]$ cleans]s are effective decontam9ants = _m surfaces 7metal1 glass1 ,=mica71 b n wood or s(t pla/ics4 7b7 ,wat] c be us$ to flu% *emical ag5ts f surfaces4 ,high-pressure application produces a bett] cleans+ action ?an l[ pressure4 ,if ! surface has absorb$ ! ag5t1 flu%+ w remove ! surface contam9ation1 b w n affect ! ag5t t is absorb$4 7c7 ,soak+ contam9at$ items 9 boil+ wat] is an excell5t decontam9ation me?od = "s ag5ts4 ,wat] alone w n be suffici5t to decontam9ate all *emical ag5ts4 ,soak+ 9 w>m or cold wat] may r$uce ! contam9ation slightly2 h[ev]1 ! haz>d may n be r$uc$ suffici5tly ev5 aft] prolong$ soak+4 ,if hot wat] is n available1 or if x might cause damage to ! item1 o!r me?ods ( decontam9ation %\ld be consid]$1 su* z decontam9at+ solutions or a cau/ic solution foll[$ by ?or\gh r9s+4 7d7 ,fibr\s mat]ials su* z clo? & canvas are be/ decontam9at$ by wa%+ & scrubb+4 7e7 ,glass1 metal1 porcela91 & pla/ic surfaces are be/ decontam9at$ by us+ hot wat] or hot soapy wat]4 ,"s toxic mat]ials are readily remov$ ) no m ?an slight abrasion or bru%+4 7f7 ,pa9t$1 v>ni%$1 & wax$ surfaces are g5]ally smoo? & nonpor\s4 ,du/ & liquids are readily remov$ by wip+1 bru%+1 or vacuum+4 ,absorb$ mat]ials are remov$ by hot wat]1 det]g5t1 or complex+ ag5ts4 ,none ( ^! surfaces /& up well to heavy abrasive te*niques4 ,ag5ts c be attack$ & remov$ by cau/ics1 acids1 & organic *emicals4 ,"s ( ^! surfaces readily absorb ag5ts1 s wea!r+ foll[+ decontam9ation is advisable4 7g7 ,rubb] is a por\s mat]ial t c absorb ag5ts4 ,x is n easily decontam9at$ by abrasive te*niques4 ,w>m1 soapy wat] us$ ) bru%+ is effective s9ce x removes "s absorb$ contam9ation4 ,/rong acids1 alkalies1 & organic solv5ts may det]iorate & decompose rubb] articles4 7#g7 ,op]ational rations are ! prim>y rations issu$2 always issue uncontam9at$ /ocks fir/4 ,?is all[s = decontam9ation ( contam9at$ /ocks )\t int]rupt+ supply support4 ,normally1 contam9at$ /ocks are n issu$4 ,! decision to issue contam9at$ items is bas$ on ! tactical situation1 criticality ( ! items1 type & ext5t ( contam9ation1 & ! "t & res\rces available = decontam9ation4 ,decontam9ation ef=ts on subsi/5ce items are limit$ to ! conta9]s & c>ton ov]wrap mat]ial4 7a7 ,! ,,mre retort & nonretort food p\* may be decontam9at$ ) soap & wat] wa%4 ,! *emical ag5ts w be remov$ by ! solutions4 7b7 ,semip]meable mat]ials 7polye?yl5e m5u bag1 %r9k wrap1 & film wrap7 may h *emicals deposit$ n only on ! surface1 b also dissolv$ into ! matrix ( ! mat]ial4 ,! *emicals c be remov$ f ! surface by wa%+ ) hot soapy wat]1 b contam9ant dissolv$ 9 ! mat]ial is n remov$4 ,! rema9+ ag5t c only be remov$ by wea!r+ :i* c be accel]at$ ?r\gh ! use ( heat & sweep+ ! surface ) air4 7c7 ,fib]bo>d is bo? sorb5t & p]meable & acts l a blott]4 ,liquid decontam9ants c =ce ! contam9ant fur!r into ! fib]bo>d4 ,any attempt to decontam9ate fib]bo>d w\ld be futile4 ,! only alt]natives are to remove ! fib]bo>d1 or to all[ x to wea!r4 7d7 ,palletiz$ unit loads ( ,,mre & ,,ugr out]wraps c be decontam9at$ ?r\gh ! aid ( a =c$ clean air sweep 9 #d to #e days1 comp>$ to #c weeks or m "u natural conditions )\t a =c$ air sweep4 7#h7 ,contam9at$ food supplies are only h&l$ by p]sonnel tra9$ 9 decontam9ation me?ods & 9 ,,mopp ,level #d4 ,contam9at$ food items are divid$ into ?ree gr\ps z describ$ bel[ 7see ,table ,j-#a = additional in=mation74 7a7 ,gr\p #a consi/s ( cann$ & unop5$ packag$ items :i* h be5 expos$ only to ag5t vapors4 ,mo/ items 9 ?is gr\p w be safe to issue aft] a brief p]iod ( outdoor air+ to remove cl++ vapors4 ,table ,j-#g li/s ! decontam9ation proc$ures = packag+ mat]ials contam9at$ ) n]ve ag5ts1 mu/>ds1 & ars5icals4 ,table ,j-#g4 ,*emical ,decontam9ation ( ,packag$ ,mat]ial ,,packag+ ,,mat]ial ,,contam9ation ,,decontam9ation ,,proc$ures ---------------------------------------- ------------------------------ ,,airtight ,,metal ,,vapor ,,& ,,air ,,= #bd ,,h\rs4 ,,wa% ,,conta9]s1 ,,glass ,,liquid ,,) ,,hot ,,soapy ,,wat]1 ,,bottles1 ,,foil ,,soda1 ,,or ,,blea* ,,solution4 ,,alum9at$ ,,lam9at$ ,,r9se ,,) ,,wat]4 ,,mat]ials4 ,,polye/]1 ,,pvf4 ,,vapor ,,remove ,,contam9at$ ,,wood5 ,,boxes1 ,,crates1 ,,package4 ,,air ,,cont5ts ,,= ,,bo>d1 ,,multilay] #bd ,,h\rs4 ,,bags4 ,,c>dbo>d1 ,,liquid ,,contam9at$ ,,cont5ts--,,treat ,,polye?yl5e4 ,,z ,,unpackag$ ,,food4 7b7 ,gr\p ,,ii consi/s ( cann$ & unop5$ packag$ items :i* h be5 contam9at$ ) a liquid *emical ag5t4 #a4 ,attempts to decontam9ate por\s packag+ mat]ials1 su* z c>dbo>d or wood1 are likely to be unsuccessful & may result 9 spread+ ! contam9ation4 ,! be/ proc$ure 9 h&l+ su* items is to /rip (f ! out] contam9at$ cov]+s & exam9e ! inn] lay] to see if p5etration ( ! ag5t has occurr$4 ,if x has1 cont9ue /ripp+ (f lay]s until an uncontam9at$ lay] is rea*$ & place x 9 ,gr\p ,i4 ,if ! ag5t has p5etrat$ to ! food1 place x 9 ,gr\p ,,iii4 #b4 ,food 9 cans or 9 o!r seal$1 imp]meable conta9]s is n 9 dang] ( *emical contam9ation4 ,because contam9ation is conf9$ to ! out] surface ( ! seal$ conta9]1 decontam9ation is accompli%$ by3 imm]sion 9 boil+1 soapy wat] = #cj m9utes & r9se2 imm]sion 9 boil+ wat] = #cj m9utes2 spray ) ,,ds#b2 or to wa% 9 hot soapy wat]1 r9se1 & a]ate4 ,"u no conditions %\ld contam9at$ conta9]s be op5$ be=e !y h be5 decontam9at$ & monitor$4 #c4 ,sup]tropical blea* & ,,ds#b c be us$ on ! polye?yl5e m5u bag = up to #bd h\rs )\t a significant *ange 9 appe>ance1 t5sile prop]ties1 & size ( ! pla/ic4 ,! use ( ,,ds#b w cause significant degradative *anges to mo/ o!r pla/ics1 :ile ,,/b w cause little or no *ange4 ,also1 ,,ds#b may cause false positive read+s :5 us+ ,m#h or ,m#i pap]1 or ! ,m#bef ,detector ,kit to *eck complet5ess ( decontam9ation4 7c7 ,gr\p ,,iii w consi/ ( unpackag$ or poorly packag$ items :i* h be5 expos$ to an ag5t 9 ei!r vapor or liquid =m4 ,food/uffs 9 ?is gr\p %\ld be decontam9at$ only :5 absolutely necess>y4 ,! decision to use foods t h be5 contam9at$ is to be made by ! comm&]4 ,decontam9ation proc$ure to be foll[$1 9 ord]1 is3 trim surface fat & grossly contam9at$ areas2 wa% ) wat] or #b-p]c5t sodium bic>bonate solution2 !n boil 9 wat]4 #a4 ,boil+ 9 wat] may be elim9at$ :5 ! contam9ation has be5 only ) ! vapors ( irritant ag5ts4 ,:5 su* an exposure has be5 light1 a]ation = a %ort "t may be us$ = decontam9ation4 #b4 ,fry+1 roa/+1 or broil+ w n remove traces ( bli/] ag5ts f meats4 ,9 g5]al1 salvage ( foods heavily contam9at$ ) droplets ( ! bli/] ag5ts1 especially ! ars5ical bli/] ag5ts1 is n practical4 ,foods ( high wat] or fat cont5t are unfit = consumption & reclamation is n practical :5 contam9at$ ) liquid mu/>d or a liquid nitrog5 mu/>d4 #c4 ,:5 foods h be5 expos$ to bli/] ag5t vapor1 !y c be reclaim$ by wa%+ ) sodium bic>bonate solutions & r9s+ ) cle> wat]1 by int5sive cook+1 or 9 ! case ( dry provisions1 by #bd to #dh h\rs ( a]ation4 ,lean meat contam9at$ ) mu/>d vapor c be reclaim$ by boil+ 9 wat] = #cj m9utes or m4 ,) nitrog5 mu/>d vapor contam9ation1 ! meat %\ld be boil$ 9 a #b-p]c5t sodium bic>bonate solution4 ,disc>d ! wat] us$ to boil ! meat4 #d4 ,n]ve ag5t contam9ation is treat$ ! same z bli/] ag5t contam9ation4 #e4 ,foods1 su* z potatoes & h>d-sk9n$ fruits & vegetables1 c be decontam9at$ by wa%+ or scrubb+1 foll[$ by peel+ or scrap+1 !n wa%+ aga94 #f4 ,prep>$ food 9 op5 conta9]s w be contam9at$2 x mu/ be tempor>ily isolat$1 or dispos$ ( 7bury or z direct$ by comm&]74 #g4 ,a food ,item t is contam9at$ ) irritants c be decontam9at$ by air+4 ,consumability is det]m9$ by ta/e r ?an toxicity4 #h4 ,phosg5e is rapidly hydrolyz$1 !re=e1 wa%+ ! food ) wat] or air+ x w usually suffice4 #i4 ,food contam9at$ ) :ite phosphor\s %\ld be de/roy$4 #aj4 ,normally1 hydrocyanic acid w h little effect on food supplies4 ,! exposures w mo/ likely be z a vapor4 ,h[ev]1 foods ) a high wat] cont5t may become unfit = consumption aft] exposure to high conc5trations4 #aa4 ,! effect ( ,,ck on foods is n kn[n4 ,foods expos$ to ,,ck vapors are consid]$ toxic4 #ab4 ,table ,j-#h li/s ! decontam9ation proc$ures = unpackag$ food contam9at$ ) a *emical ag5t4 7#i7 ,decontam9at+ cattle1 p\ltry1 & o!r live/ock is only attempt$ :5 o!r s\rces ( food are n available4 ,heavily contam9at$ animals %\ld be de/roy$4 ,live/ock contam9at$ lightly by phosg5e1 n]ve ag5ts1 mu/>ds1 & ars5icals 7su* z vapor or liquid7 may be slaught]$ 9 ! e>ly /ages ( poison+ be=e ! full effects ( exposure are %[n4 ,if ^! animals are slaught]$ 9 ! prelim9>y /ages ( poison+ & all tissues expos$ to ! ag5t 7! head1 blood1 lungs1 organs1 & local areas7 are disc>d$1 !re is no dang] 9 consumption ( ! meat1 provid$ ! animal passes a pre-slaught] & slaught] inspection4 ,?is is true ev5 ( animals poison$ by ars5ical ag5ts s9ce ! edible tissue w conta9 am\nts ( ars5ic too small to be toxic4 ,organs 7liv]1 bra91 he>t1 kidney1 & lungs7 w conta9 m ars5ic ?an ! musculature & are disc>d$4 ,! meat mu/ be well cook$4 ,p]sonnel involv$ 9 slaught]+ proc$ures mu/ be c>eful to prev5t spread+ contam9ation to ! meat & to !mselves4 7#aj7 ,decontam9at+ =age & gra9 expos$ to only *emical ag5t vapors is by a]ation4 ,a]at$ supplies1 especially if mix$ ) l>g] am\nts ( uncontam9at$ supplies1 produces no ill effects :5 f$ to animals4 ,=age or gra9 heavily contam9at$ by liquid vesicants1 especially ars5icals1 %\ld n be us$4 ,table ,j-#h4 ,*emical ,decontam9ation ( ,unpackag$ ,food ,,fatty ,,foods ,,nonfatty ,,foods1 ,,nonfatty ,,foods1 7,,butt]1 ,,bacon1 ,high ,,wat] ,,cont5t ,,l[ ,,wat] ,,cont5t1 ,,*emical ,,ag5t ,,milk1 ,,*eese1 ,,cry/all9e 7,,fruits1 ,,amorph\s 7,,fl\r1 ,,ham74 ,,vegetables1 ,,salt1 ,,c]eals1 ,,bread1 ,,sug>74 ,,peas74 ---------------------------------------- -------------------------------- ,,n]ve ,,ag5ts ,,vapor1 ,,heavy ,,de/roy ,,de/roy1 ,,unless ,,air ,,= #dh ,,h\rs1 ,,possible ,,to ,,boil ,,!n ,,boil4 ,,aft] ,,air+ #dh ,,h\rs4 ,,vapor1 ,,light ,,de/roy ,,air ,,= #dh ,,h\rs1 ,,air ,,= #dh ,,h\rs1 ,,!n ,,boil4 ,,!n ,,boil4 ,,liquid ,,de/roy ,,de/roy ,,de/roy ,,mu/>ds ,,vapor ,,remove #a-c cm ,,wa% ,,) ,,wat]4 ,,wa% ,,) ,,wat]4 ,,( ,,out] ,,lay] ,,air ,,= #dh ,,h\rs4 ,,air ,,= #dh ,,h\rs4 ,,& ,,wa% ,,) #b ,,sodium ,,bic>b- ,,onate ,,solution4 ,,boil ,,= ,,at ,,lea/ #cj ,,m9utes4 ,,de/roy ,,milk4 ,,liquid ,,de/roy ,,de/roy ,,de/roy ,,ars5icals ,,de/roy ,,de/roy ,,de/roy ,,gloss>y ,,abbreviation1 ,,acronyms1 ,,& ,,def9itions ,,abca ,am]ican1 ,briti%1 ,canadian1 & ,au/ralian ,,abo ag5ts ( biological orig9 ,,ac hydrog5 cyanide ,,afjman ,air ,=ce ,jo9t ,manual amb ambulance ,,am$d ,army ,m$ical ,dep>tm5t ,,am$dc,s ,army ,m$ical ,dep>tm5t ,c5t] & ,s*ool ,a,med,p ,alli$ ,m$ical ,publication ,,aml area m$ical laboratory ,,an_/,,pdr#bg radiac met] ,,an_/,,pdr#gg radiac met] ,,an_/,,vdr#b radiac met] ,,ao area ( op]ations ,,ar ,army regulation ,,atm advanc$ trauma managem5t ,,attn att5tion ,,axp ambulance ex*ange po9t ,,bas battalion aid /ation ,,bat ,biological ,augm5tation ,team ,,bc blood culture bde brigade ,,bdu battle dress uni=m ,,bi battle injury ,,bids ,biological ,integrat$ ,detection ,sy/em ,biological ,w>f>e ,ag5t ,field ,confirmation ,id5tification ,id5tification ( a suspect biological w>f>e ag5t by means ( devices_/mat]ials_/te*nologies t are bas$ on detect+ biological m>k]s us+ two or m indep5d5t biom>k] results4 ,examples might include ! f9d+s ( ! presumptive biom>k] id5tification ) ! addition ( a positive ,,pcr1 ,,elisa1 or electro*emilum9esc5ce 7,,ecl7 results1 us+ specific t>get nucleic acid sequ5ces = ! organism & antibody recognition ( ag5t-specific antig5 sites1 respectively4 7,field sample_/ specim5 id5tification by =w>d deploy$ or =w>d position$ laboratories su* z ! ,,u ,air ,=ce ,biological ,augm5tation ,team 7,,bat71 !at] army m$ical laboratory1 or =w>d deploy$ prev5tive m$ic9e unit 7,,u ,navy7 & homel& security ,laboratory ,response ,network 7,,lrn7 ,level ,b or ,c1 ,,u ,army ,community ,hospitals or ,m$ical ,c5t]s47 ,biological ,w>f>e ,ag5t ,def9itive ,id5tification ,& ,confirmation ,! specific id5tification ( a suspect biological ag5t z to g5us & species1 s]ological type1 or tox94 ,?is level ( id5tification is by means ( devices_/mat]ials_/te*nologies t are bas$ on two or m indep5d5t biom>k] results & us+ diff]5t me?odologies4 ,?is level ( id5tification is p]=m$ 9 a ref]5ce laboratory ) a broad] v>iety ( me?odologies available & highly skill$ te/+ p]sonnel1 ?us provid+ ! highe/ levels ( accuracy4 7,sample_/specim5 id5tification is accompli%$ by homel& security ,,lrn ,level ,c & ,d & nationally recogniz$ laboratory su* z ! ,,u ,army ,m$ical ,rese>* ,in/itute ( ,infecti\s ,disease or ,c5t]s = ,disease ,control & ,prev5tion47 ,biological ,m>k] ,*>act]i/ics ( a biological ag5t 7organism1 virus1 tox91 or product7 t are specific to ! ag5t4 ,?is includes 7#a7 recognition ( specific nucleic add sequ5ces 7,,dna or ribonucleic acid ,,rna7 unique to ! bact]ia or virus by a te*nique su* z ,,pcr2 7#b7 id5tification ( specific ,,ecl assay2 7#c7 specific gr[? prop]ties z se5 on selective m$ia su* z *>act]i/ic colony morphology on culture along ) phage inhibition2 7#d7 ,id5tification us+ specific microscopic *>act]i/ics su* z ,gram /a91 fluoresc5t antibody /a91 immunohi/o*emical /a91 or cytopa?ic effects4 ,biological ,w>f>e ,ag5t ,presumptive ,id5tification ,id5tification ( a suspect biological w>f>e ag5t by means ( devices_/mat]ials_/te*nologies t are bas$ detect+ biological m>k]s 7biom>k]s7 us+ a s+le me?odology4 ,! biom>k]s &_/or me?odologies us$ at ?is level ( te/+ h significant limits to _! accuracy4 ,ag5t id5tification to species level1 or diff]5tiation among a family ( simil> ag5ts1 may n be possible4 ,?is is equival5t to ! ,,lrn ,level ,a & ! ,,u ,army ,,bids4 7,,examples3 ,id5tification by s5sor trigg]+1 h&-held devices h&-held assays or initial sy/ems1 or laboratory analysis employ+ "o scre5+ me?odology su* z microscopic morphology1 antibody_/prote91 or nucleic acid-bas$ te/47 bot_/pkg bottle_/package ,,bsa brigade support area ,,bw biological w>f>e ,,bz an incapacitat+ *emical w>f>e ag5t ,c ,c5tigrade_/,celsius ,c#b comm& & control ,c#d;,i ,comm&1 ,control1 ,communications1 ,comput]s1 & ,intellig5ce ,ca,cl calcium hypo*lorite cal_/cm#b calories p] squ>e c5timet] cal_/cm#b_/sec calories p] squ>e c5timet] p] second ,,cam *emical ag5t monitor ,,cana convulsant antidote = n]ve ag5t 7diazepam7 ,,cb *emical_/biological ,,cbda ,*emical ,biological ,def5se ,ag5cy ,,cbps *emically biologically protect$ %elt] ,,cbrne *emical1 biological1 radiological1 nucle>1 & high-yield explosive ,,cbscc ,*emical-,biological ,sampl+ ,control ,c5t] ,,cbsce ,*emical-,biological ,sampl+ ,control ,elem5t cc cubic c5timet] ,,cg phosg5e c,gy c5tigray ,,cis ,commonweal? ( ,indep5d5t ,/ates 7,russia7 ,,ck cyanog5 *loride ,cl *lor9e ,,class ,,viii ,classification ( m$ical supplies & equipm5t )9 ! ,f$]al ,/ock ,classification ,sy/em ,,cls combat lifesav] cm c5timet] cm#b squ>e c5timet] ,,cns c5tral n]v\s sy/em ,,co#b c>bon dioxide ,,conus cont95tal ,unit$ ,/ates ,,cosc combat op]ational /ress control ,,cp *emically protect$ ,,cp ,,depm$s *emically protect$ deployable m$ical sy/em ,,cps collective protection %elt] ,,cre/ ,casualty ,requirem5ts ,e/imation ,tool ,,cs combat support ,cs-#acg ,cesium #acg ,,csf c]ebrosp9al fluid ,,c% combat support hospital ,,css combat s]vice support ,,cw *emical w>f>e ,,cx phosg5e oxime ,,da ,dep>tm5t ( ! ,army ,,dap decontam9ation app>atus1 portable ,,dcs division cle>+ /ation ,,dd ,dep>tm5t ( ,def5se decon decontam9ation ,,depm$s ,deployable ,m$ical ,sy/em ,,dna deoxyribonucleic acid ,,dnbi disease & nonbattle ,injury ,,dod ,dep>tm5t ( ,def5se ,,dp diphosg5e ,,ds#b decontam9at+ solution ,numb] #b ,,dtf d5tal treatm5t facility ,e ,,edta ,,eac e*elons above corps ,,ecl electo*emilum9esc5ce ,,ecp entry control po9t ,,ecu environm5tal control units ,,edta e?yl5$iam9etetraacetate ,,eee ea/]n equ9e encephalitis ,,elisa enzyme-l9k$ immunosorb5t assay ,,em electron microscopy ,,emp electromagnetic pulse ,,ems em]g5cy m$ical s]vices ,,emt em]g5cy m$ical treatm5t ,,eod explosive ordnance disposal ,,epw enemy prison] ( w> ,,er em]g5cy room evac evacuation ,f ,fahr5heit ,f-#a ,fraction-#a ,,fa fluoresc5t antibody ,,fdecu field deployable environm5tal control unit ,,fh field hospital ,,flot =w>d l9e ( own troops ,,fm field manual ,,fmc ,field ,m$ical ,c>d ,,fsop field /&+ op]at+ proc$ures ,,f/ =w>d surgical team g gram ,g#a ,assi/ant ,*ief ( ,/aff 7,adjutant7 ,g#b ,assi/ant ,*ief ( ,/aff 7,intellig5ce7 ,g#c ,assi/ant ,*ief ( ,/aff 7,op]ations & ,tra9+7 ,g#d ,assi/ant ,*ief ( ,/aff 7,logi/ics7 ,,ga ,tabun gal gallon ,,gb ,s>9 ,,gd ,soman ,,gf a n]ve ag5t ,,gh g5]al hospital gm gram ,,gp g5]al purpose ,,gvo gre5 v9yl ov]boots ,gy gray 7#ajj c,gy7 ,h hep>9 ,,hd sulfur mu/>d 7a bli/] ag5t7 ,,hg *emical symbol = m]cury ,,hl mu/>d & ,lewisite mix ,,hmmwv high mobility multi-purpose :eel$ vehicle ,,hn nitrog5 mu/>d ,,hplc high-pressure liquid *romatography ,,hsl heal? s]vice logi/ics ,,hss heal? s]vice support ,,hub hospital unit base ,,huh hospital unit hold+ ,,hum hospital unit m$ical ,,hus hospital unit surgical ,,h? high te/ hypo*lorite 7#gj available *lor9e7 ,i-#aca ,iod9e-#aca ,,iata ,int]national ,air ,transportation ,association ,,iaw 9 accordance ) ,,ic int5sive c>e ,,icam improv$ *emical ag5t monitor ,,icc incid5t comm& c5t] ,,icu int5sive c>e unit ,,icw int5sive c>e w>d ,,id ,incapacitation dose ,ig,g immunoglobul9 class ,g ,ig,m immunoglobul9 class ,m ,,ima in/allation m$ical au?ority ,,iso ,int]national ,organization = ,/&>dization ,,iv intrav5\s ,j#b ,jo9t ,intellig5ce ,directorate ,j#c ,jo9t ,op]ations ,directorate kg kilogram km kilomet]7s7 kph kilomet]s p] h\r ,,kt kiloton ,l ,lewisite ,,lab laboratory lb p\nd ,,lce load-c>ry+ equipm5t ,,ld le?al dose ,,ld #ej_/fj le?al dose = #ej p]c5t ( expos$ p]sons )9 a p]iod ( #fj days ,,lrn ,laboratory ,response ,network ,,lsd d-lys]gic acid die?ylamide ,,lz l&+ zone micron m met]s m#c milligrams p] m9ute ,,mcrp ,m>9e ,corps ,ref]5ce ,publication ,,m$evac m$ical evacuation ,m$ical ,c\nt]measures ,^? measures tak5 to ma9ta9 soldi] su/a9ability ?r\gh ! prev5tion & pretreatm5t ( injury f ,,nbc ag5t haz>ds2 & foll[+ injury ^? measures tak5 to treat ,,nbc casualties & improve m$ical capability = diagnosis1 physiological resuscitation & cont9u$ m$ical managem5t ( ,,nbc casualties4 ,,mes m$ical equipm5t set ,,mf#b,k ,m$ical ,=ce #bjjj 7,army ( ,excell5ce ,organizations7 mg milligram mg_/kg milligrams p] kilogram ,,milvan milit>y-own$ dem\ntable conta9] ml millilit] mm millimet] ,,mopp mission-ori5t$ protective po/ure ,,mos milit>y occupational specialty ,,mre meal ready-to-eat ,,mri ,m$ical ,re5g9e]+ ,initiative ,,msr ma9 supply r\te m_/sec met]s p] second ,,mt megaton ,,mtf m$ical treatm5t facility ,na,cl sodium *loride 7salt7 ,,nato ,nor? ,atlantic ,treaty ,organization ,,navm$ ,p ,naval ,m$ical ,publication ,,nbc nucle>1 biological1 & *emical ,,nbcc nucle>1 biological1 & *emical control ,,nbcwrs nucle>1 biological1 & *emical w>n+ & report+ sy/em ,,nco noncommission$ (fic] ,,nl no limit ,,nttp ,navy ,tactics ,te*niques & ,proc$ures ,o#b oxyg5 ,,oeg op]ational exposure guide ,,oplan op]ation plan ,,opsec op]ations security ,pati5t ,decontam9ation--,! removal &_/or ! neutralization ( haz>d\s levels ( nucle>1 biological1 & *emical contam9ation f pati5ts at a m$ical treatm5t facility4 ,pati5t decontam9ation is p]=m$ "u ! sup]vision ( m$ical p]sonnel to prev5t fur!r injury to ! pati5t & to ma9ta9 ! pati5t's heal? /atus dur+ ! decontam9ation process4 ,pati5t decontam9ation s]ves multiple purposes2 x protects ! pati5t f fur!r injury1 x prev5ts expos+ m$ical p]sonnel to ! contam9ation1 & x prev5ts contam9ation ( ! m$ical treatm5t facility4 ,,pcr polym]ase *a9 reaction ,,pds pati5t decontam9ation /ation p,h symbol relat+ ! hydrog5 ion activity 9 gram equival5ts p] lit] us$ 9 express+ ! acidity & alkal9ity on a scale ^: values run f #j to #ad ) #g repres5t+ neutrality4 ,numb]s less ?an #g indicate increas+ acidity1 & numb]s great] ?an #g indicate increas+ alkal9ity4 ,,pmm prev5tive m$ic9e measures pnt pati5t ppm p>ts p] million ,,ppw pati5t protective wrap ,,ps *loropicr9 ,,pvf polyv9yl fluoride ,,pvntm$ prev5tive m$ic9e ,,q/a ,quadrip>tite ,/&>dization ,agreem5t ,,rdd radiological disp]sal device recon reconnaissance ,,res radiation exposure /atus ,,rna ribonucleic acid ,,r[pu rev]se osmosis wat] purification unit ,,rt r$ top ,,rt-,,pcr rev]se transcriptase_/polym]ase *a9 reaction ,,rtd return to duty ,s#a ,adjutant 7,,u ,army7 ,s#b ,intellig5ce ,(fic] 7,u4,s4 ,army7 ,s#c ,op]ations & ,tra9+ ,(fic] 7,u4,s4 ,army7 ,s#d ,supply ,(fic] 7,u4,s4 ,army7 ,,scud balli/ic missile ,,sdk sk9 decontam9at+ kit ,,sfg ,special ,=ces ,gr\p ,,sm>t special m$ical assi/ance response team ,,s( ,special ,op]ations ,=ces ,,sop /&+ op]at+ proc$ure ,sr-#hi ,/rontium-#hi ,sr-#ij ,/rontium-#ij ,,/anag ,/&>dization ,agreem5t 7,,nato7 ,,/at /atim ,,/b sup]tropical blea* ,sv ,siev]t ,t#b tri*o!c5e ,,taml !at] ,army m$ical laboratory ,,tc tra9+ circul> ,,teu te*nical escort unit ,,temp] t5t1 exp&able1 modul>1 p]sonnel ,toxic ,indu/rial ,biological 7,,tib7 ,biological mat]ials 7bact]ia1 viruses1 & tox9s7 f\nd 9 m$ical rese>*1 ph>maceutical1 & o!r manufactur+ processes t are toxic to humans & animals1 or cause damage to plants4 ,toxic ,indu/rial ,*emical 7,,tic7 ,*emical comp\nds us$ or produc$ 9 indu/rial processes t are toxic to humans & animals1 or cause damage to plants4 ,,examples include fuels1 solv5ts1 heavy metals1 & *emicals us$ 9 manufactur+ processes4 ,toxic ,indu/rial ,mat]ial 7,,tim7 ,toxic indu/rial mat]ials may be toxic indu/rial *emical 7,,tic71 toxic indu/rial biological 7,,tib7 & toxic indu/rial radiological 7,,tir7 mat]ials4 ,toxic ,indu/rial ,radiological 7,,tir7 ,radiation-emitt+ mat]ials us$ 9 rese>*1 p[] g5]ation1 m$ical treatm5t1 & o!r non-weapon developm5tal activities t are h>mful to humans & animals if releas$ outside _! controll$ environm5t4 ,,tir toxic indu/rial radiological ,,tm te*nical manual ,,tm tradem>k ,,toe table ( organization & equipm5t 7,,u ,army organizational /ructure docum5t7 ,,to !at] ( op]ations trmt treatm5t ,,tsop tactical /&+ op]at+ proc$ures ,,tt tig] top microns ,,ugr unit gr\p rations ,,un ,unit$ ,nations ,,u ,unit$ ,/ates ,,usaf ,unit$ ,/ates ,air ,=ce ,v-ag5t a n]ve ag5t ,,vee ,v5ezuelan equ9e encephalitis ,,vx a p]si/5t n]ve ag5t ,,wbgt wet bulb globe temp]ature ,,wee we/]n equ9e encephalitis ,,wmd-,,i/ weapons ( mass de/ruction--in/allation support team ,,ref]5ces ,,nato ,,nato ,em]g5cy ,w> ,surg]y ,h&book4 #aihh4 ,,nato ,s,t,a,n,a,gs ,^! agreem5ts are available on reque/ 7us+ ,,dd ,=m #adbe7 f ! ,/&>dization ,docum5ts ,ord] ,desk1 #gjj ,rob9s ,av5ue1 ,build+ #d1 ,section ,d1 ,philadelphia1 ,p5nsylvania #aiaaa-ejid4 #bjjb4 ,w>n+ ,signs = ! ,m>k+ ( ,contam9at$ or ,dang]\s ,l& ,areas1 ,complete ,equipm5ts1 ,supplies & ,/ores4 ,edition #h4 #bi ,janu>y #aiii4 #bjdg4 ,em]g5cy ,al>ms ( ,haz>d or ,attack 7,,nbc & ,air ,attack ,only74 ,edition #g4 #bd ,july #aiih4 7,late/ ,am5dm5t1 #g ,febru>y #bjjj47 #bjfh4 ,em]g5cy ,w> ,surg]y4 ,edition #d4 #bh ,octob] #aihf4 7,late/ ,am5dm5t1 #ag ,octob] #aiia47 #bjhc4 ,comm&]'s ,guide on ,nucle> ,radiation ,exposure ( ,gr\ps4 ,edition #e4 #ai ,septemb] #aihf4 7,late/ ,am5dm5t1 #bf ,june #aiid47 #bajc4 ,report+ ,nucle> ,detonations1 ,biological & ,*emical ,attacks1 & ,pr$ict+ & ,w>n+ ( ,associat$ ,haz>ds & ,haz>d ,areas--,,atp #de7;,a74 ,edition #h4 #ca ,augu/ #bjjj4 #bajd4 ,fri5dly ,nucle> ,/rike ,w>n+4 ,edition #g4 #bh ,june #aiid4 7,late/ ,am5dm5t1 #bh ,june #aiie47 #baab4 ,nucle>1 ,biological1 & ,*emical ,reconnaissance4 ,edition #d4 #f ,m>* #aiih4 #bdge4 ,m$ical ,plann+ ,guide = ! ,e/imation ( ,,nbc ,battle ,casualties 7,nucle>7--,amed,p-#h7;,a71 ,volume ,i4 ,decemb] #bjjj4 #bdgf4 ,m$ical ,plann+ ,guide ( ,,nbc ,battle ,casualties 7,biological7--,amed,p-#h7;,a71 ,volume ,,ii4 ,m>* #bjja4 #bdgg4 ,plann+ ,guide = ! ,e/imation ( ,,nbc ,battle ,casualties 7,*emical7--,amed,p-#h7;,a71 ,volume ,,iii4 ,m>* #bjja4 #bejj4 ,,nato ,h&book on ! ,m$ical ,aspects ( ,,nbc ,def5sive ,op]ations--,a,med,p-#f7;,b74 ,edition #d4 #aa ,febru>y #aiig4 #bhgc4 ,concept ( ,op]ations ( ,m$ical ,support 9 ,nucle>1 ,biological1 & ,*emical ,environm5ts--,amed,p-#g7;,a74 ,edition #c4 #af ,octob] #aiif4 #bhgi4 ,pr9ciples ( ,m$ical ,policy 9 ! ,managem5t ( a ,mass ,casualty ,situation4 ,edition #c4 #g ,septemb] #aiih4 #bida4 ,guidel9es = ,air & ,gr\nd ,p]sonnel ,us+ ,fix$ & ,transportable ,collective ,protection ,facilities on ,l&4 ,edition #b4 #ai ,june #aiib4 7,late/ ,am5dm5t1 #cj ,octob] #aiie47 #bied4 ,tra9+ ( ,m$ical ,p]sonnel = ,,nbc ,op]ations4 ,edition #a4 #bh ,decemb] #aihg4 7,late/ ,am5dm5t1 #f ,june #aiie47 ,,abca ,q,s,t,a,gs ,^! agreem5ts are available on reque/ 7us+ ,,dd ,=m #adbe7 f ! ,/&>dization ,docum5ts ,ord] ,desk1 #gjj ,rob9s ,av5ue1 ,build+ #d1 ,section ,d1 ,philadelphia1 ,p5nsylvania #aiaaa-ejid4 #ahc4 ,em]g5cy ,w>n+ ,signals & ,al>ms = ,,nbcd ,haz>ds or ,attacks 7,,nbc & ,air ,attacks ,only74 ,edition #c4 #ab ,augu/ #aiia4 #ahg4 ,report+ ,nucle> ,detonations ,biological & ,*emical ,attacks & ,pr$ict+ & ,w>n+ ( ,associat$ ,haz>ds & ,haz>d ,areas4 ,edition #e4 #ba ,may #aiih4 #ahi4 ,fri5dly ,nucle> ,/rike ,w>n+4 ,edition #c4 #ab ,augu/ #aiia4 #eja4 ,w>n+ ,signs = ! ,m>k+ ( ,contam9at$ or ,dang]\s ,l& ,areas1 ,complete ,equipm5t1 ,supplies & ,/ores4 ,edition #b4 #aa ,may #aihb4 #fjh4 ,int]op]able ,*emical ,ag5t ,detector ,kits4 ,edition #c4 #ac ,decemb] #bjjj4 #haf4 ,m$ical ,aspects ( ,mass ,casualty ,situations4 ,edition #a4 ,augu/ #aiij4 #accj4 ,m$ical ,aspects ( ,,nbc ,def5sive ,op]ations4 ,draft4 #bjjj4 ,guidel9es on ,entry & ,exit ,proc$ures = ,us+ ,collective ,protection ,facilities4 #ag ,decemb] #aiif4 ,,jo9t ,,or ,,multis]vice ,,publications ,,ar #dj-ece4 ,worldwide ,a]om$ical ,evacuation4 ,,afr #afd-e2 ,,opnav9/ #dfcj4i;,c2 ,,mco ,p#dfcj4i;,a4 #a ,decemb] #aige4 7,repr9t$ ) basic includ+ ,*ange #a1 #aj ,may #aigi47 ,,ar #dj-efb4 ,immunizations & ,*emoprophylaxis4 ,,afji #dh-aaj2 ,,bum$9/ #fbcj4ae2 ,,cg ,,comdt9/ ,m#fbcj4d;,e4 #a ,novemb] #aiie4 ,,ar #dj-fef4 ,vet]9>y ,surveillance ,inspection ( ,subsi/5ce4 ,,navsup9/ #dcee4aj2 ,,mco #ajaaj4de4 #ae ,octob] #aihf4 ,,ar #dj-feg4 ,vet]9>y_/,m$ical ,food ,inspection & ,laboratory ,s]vice4 ,,navsup9/ #dcee4d;,f2 ,,mco ,p#ajaaj4ca;,g4 #f ,novemb] #aiig4 ,,fm #c-c4 ,*emical & ,biological ,contam9ation ,avoidance4 ,,fmfm #aa-ag4 #af ,novemb] #aiib4 7,*ange #a1 #bi ,septemb] #aiid47 ,,fm #c-d4 ,,nbc ,protection4 ,,fmfm #aa-i4 #bi ,may #aiib4 7,repr9t$ ) basic includ+ ,*anges #a-b1 #ba ,febru>y #aiif47 ,,fm #c-e4 ,,nbc ,decontam9ation4 ,,mcwp #c-cg4c4 #bh ,july #bjjj4 ,,fm #c-f4 ,field ,behavior ( ,,nbc ,ag5ts 7,includ+ ,smoke & ,inc5di>ies74 ,,amf #aje-g2 ,,fmfm #g-aa ,h4 #c ,novemb] #aihf4 ,,fm #c-i4 ,pot5tial ,milit>y ,*emical_/,biological ,ag5ts & ,comp\nds4 ,,navfac ,p-#dfg1 ,,afr #cee-g4 #ab ,decemb] #aiij4 ,,fm #c-aa4cd4 ,multis]vice ,proc$ures = ,nucle>1 ,biological1 & ,*emical 7,,nbc7 ,def5se ( ,!at] ,fix$ ,sites1 ,ports1 & ,airfields4 ,,mcwp #c4cg4e2 ,,nttp #c-aa4bc2 ,,afttp7,i7 #c-b4cc4 #bi ,septemb] #bjjj4 ,,fm #c-ai4 ,nucle>1 ,biological & ,*emical ,reconnaissance4 ,,fmfm #aa-bj4 #ai ,novemb] #aiic4 ,,fm #c-ajj4 ,*emical ,op]ations1 ,pr9ciples & ,fundam5tals4 ,,mcwp #c-c4g4a4 #h ,may #aiif4 ,,fm #d-jb4cc4 ,control ( ,communicable ,diseases ,manual4 #ag? ,edition4 ,,navm$ ,p-#ejch4 #ca ,decemb] #aiii4 ,,fm #d-jb4bhc4 ,treatm5t ( ,nucle> & ,radiological ,casualties4 ,,ntrp #d-jb4ba2 ,,afman #dd-afa7;,i72 ,,mcrp #d-aa4a;,b4 #bj ,decemb] #bjja4 ,,fm #f-bb4e4 ,combat ,/ress4 ,,mcrp #f-aa;,c2 ,,nttp #a-ae,m4 #bc ,june #bjjj4 ,,fm #h-i4 ,,nato ,h&book on ! ,m$ical ,aspects ( ,,nbc ,def5sive ,op]ations ,a,med,p-#f7;,b71 ,"p ,i--,nucle>1 ,"p ,,ii--,biological1 ,"p ,,iii--,*emical4 ,,navm$ ,p-#ejei2 ,,afjman #dd-aea,v#a,v#b,v#c4 #a ,febru>y #aiif4 ,,fm #h-bhd4 ,treatm5t ( ,biological ,w>f>e ,ag5t ,casualties4 ,,navm$ ,p-#ejdb2 ,,afman7,i7 #dd-aef2 ,,mcrp #d-aa4a;,c4 #ag ,july #bjjj4 7,*ange #a1 #h ,july #bjjb47 ,,fm #h-bhe4 ,treatm5t ( ,*emical ,ag5t ,casualties & ,conv5tional ,milit>y ,*emical ,injuries4 ,,navm$ ,p-#ejda2 ,,afjman #dd-adi2 ,,fmfm #aa-aa4 #bb ,decemb] #aiie4 ,,fm #ba-aj4 ,field ,hygi5e & ,sanitation4 ,,mcrp #d-aa4a;,d4 #ba ,june #bjjj4 ,,dep>tm5t ,,( ,,def5se ,,dod #eajj4eb-,m4 ,nucle> ,weapon ,accid5t ,response ,proc$ures 7,,n>p74 ,septemb] #aiij4 ,,dod ,directive #caej4h4 ,,dod ,response to ,radiological ,accid5ts4 #ac ,june #aiif4 ,,dd ,=m #achj4 ,,u ,field ,m$ical ,c>d4 ,decemb] #aiia4 ,,dd ,=m #aiaa4 ,mat]ial ,c\ri] ,receipt4 ,may #aihb4 ,,dep>tm5t ,,( ,,! ,,army ,,=m ,,da ,=m #dacg4 ,evid5ce_/,prop]ty ,cu/ody ,docum5t4 #a ,july #aigf4 ,,army ,,publications ,,ar #dj-e4 ,prev5tive ,m$ic9e4 #ae ,octob] #aiij4 ,,ar #dj-fa4 ,m$ical ,logi/ics ,policies & ,proc$ures4 #be ,janu>y #aiie4 ,,ar #dj-ff4 ,m$ical ,records ,adm9i/ration & ,heal? ,c>e ,docum5tation4 #c ,may #aiii4 ,,ar #dj-djj4 ,pati5t ,adm9i/ration4 #ab ,m>* #bjja4 ,,fm #c-jf4aa4 ,comb9$ ,arms ,op]ations 9 ,urban ,t]ra94 #bh ,febru>y #bjjb4 ,,fm #c-g4 ,,nbc ,field ,h&book4 #bi ,septemb] #aiid4 ,,fm #c-ej4 ,smoke ,op]ations4 #d ,decemb] #aiij4 7,*ange #a1 #aa ,septemb] #aiif74 ,,fm #c-aja4 ,*emical ,/affs & ,units4 #ai ,novemb] #aiic4 ,,fm #c-aja-d4 ,biological ,detection ,platoon ,op]ations--,tactics1 ,te*niques1 & ,proc$ures4 #i ,june #aiig4 7,repr9t$ ) basic includ+ ,*anges #a-b1 #a ,septemb] #bjjj47 ,,fm #d-jb4a4 ,combat ,heal? ,logi/ics4 #bh ,septemb] #bjja4 ,,fm #d-jb4d4 ,m$ical ,platoon ,lead]s' ,h&book--,tactics1 ,te*niques1 & ,proc$ures4 #bd ,augu/ #bjja4 ,,fm #d-jb4f4 ,! ,m$ical ,company--,tactics1 ,te*niques1 & ,proc$ures4 #a ,augu/ #bjjb4 ,,fm #d-jb4aj4 ,!at] ,hospitalization4 #bi ,decemb] #bjjj4 ,,fm #d-jb4ag4 ,prev5tive ,m$ic9e ,s]vices4 #bh ,augu/ #bjjj4 ,,fm #d-jb4ai4 ,d5tal ,s]vice ,support 9 a ,!at] ( ,op]ations4 #a ,m>* #bjja4 ,,fm #d-be4ab4 ,unit ,field ,sanitation ,team4 #be ,janu>y #bjjb4 ,,fm #h-aj4 ,heal? ,s]vice ,support 9 a ,!at] ( ,op]ations4 #a ,m>* #aiia4 ,,fm #h-aj-a4 ,! ,m$ical ,company--,tactics1 ,te*niques1 & ,proc$ures4 #bi ,decemb] #aiid4 ,,fm #h-aj-f4 ,m$ical ,evacuation 9 a ,!at] ( ,op]ations--,tactics1 ,te*niques1 & ,proc$ures4 #ad ,april #bjjj4 ,,fm #h-aj-h4 ,m$ical ,intellig5ce 9 a ,!at] ( ,op]ations4 #g ,july #aihi4 ,,fm #h-aj-i4 ,combat ,heal? ,logi/ics 9 a ,!at] ( ,op]ations--,tactics1 ,te*niques1 & ,proc$ures4 #c ,octob] #aiie4 ,,fm #h-aj-ad4 ,employm5t ( ! ,combat ,support ,hospital--,tactics1 ,te*niques1 & ,proc$ures4 #bi ,decemb] #aiid4 ,,fm #h-aj-ae4 ,employm5t ( ! ,field & ,g5]al ,hospitals--,tactics1 ,te*niques1 & ,proc$ures4 #bf ,m>* #aiig4 ,,fm #h-aj-ah4 ,vet]9>y ,s]vice--,tactics1 ,te*niques1 & ,proc$ures4 #bb ,augu/ #aiig4 ,,fm #h-aj-bd4 ,area ,support ,m$ical ,battalion--,tactics1 ,te*niques1 & ,proc$ures4 #ac ,octob] #aiic4 ,,fm #h-aj-be4 ,employm5t ( ,=w>d ,surgical ,teams--,tactics1 ,te*niques1 & ,proc$ures4 #cj ,septemb] #aiig4 ,,fm #h-aj-bf4 ,employm5t ( ! ,m$ical ,company 7,air ,ambulance74 #af ,febru>y #aiii4 7,*ange #a1 #bj ,may #bjjb47 ,,fm #h-cj4 ,vet]9>y ,food ,inspection ,speciali/4 #ab ,augu/ #aihf4 ,,fm #h-db4 ,combat ,heal? ,support 9 ,/ability ,op]ations & ,support ,op]ations4 #bg ,octob] #aiig4 ,,fm #h-ej4 ,prev5tion & ,m$ical ,managem5t ( ,las] ,injuries4 #h ,augu/ #aiij4 ,,fm #h-ea4 ,combat ,/ress ,control 9 a ,!at] ( ,op]ations--,tactics1 ,te*niques1 & ,proc$ures4 #bi ,septemb] #aiid4 ,,fm #h-ee4 ,plann+ = ,heal? ,s]vice ,support4 #i ,septemb] #aiid4 ,,fm #h-bej4 ,prev5tive ,m$ic9e ,speciali/4 #bg ,janu>y #aihf4 7,repr9t$ ) basic includ+ ,*ange #a1 #ab ,septemb] #aihf47 ,,fm #h-ejj4 ,haz>d\s ,mat]ials ,injuries3 ,a ,manual = ,pre-,hospital ,c>e4 ,edition #d4 #ag ,janu>y #aiig4 ,,fm #aj-eb4 ,wat] ,supply 9 ,!at]s ( ,op]ations4 #aa ,july #aiij4 ,,fm #ba-aa4 ,fir/ ,aid = ,soldi]s4 #bg ,octob] #aihh4 7,repr9t$ ) basic includ+ ,*anges #a-b1 #d ,decemb] #aiia47 ,,fm #bb-ea4 ,lead]s' ,manual = ,combat ,/ress ,control4 #bi ,septemb] #aiid4 ,,fm #ca-ga4 ,nor!rn ,op]ations4 #ba ,june #aiga4 ,,fm #ij-c4 ,des]t ,op]ations4 ,,fmfm #g-bg4 #bd ,augu/ #aiic4 ,,fm #ij-e4 ,jungle ,op]ations4 #af ,augu/ #aihb4 ,,fm #ij-aj4 ,milit>y ,op]ations on ,urbaniz$ ,t]ra9 7,,m\t74 #ae ,augu/ #aigi4 ,,/p #h-ia ,w#ae-,,sm-,,tg4 ,soldi]'s ,manual1 ,skill ,levels #a_/b_/c_/d_/e & ,tra9]'s ,guide1 ,,mos #ia,w1 ,heal? ,c>e ,speciali/4 #aj ,octob] #bjja4 ,,tc #h-ac4 ,deployable ,m$ical ,sy/ems--,tactics1 ,te*niques1 & ,proc$ures4 #g ,decemb] #aiij4 ,,tm #c-dbdj-bhh-ab,p4 ,op]ator's & ,unit ,ma9t5ance ,manual includ+ ,repair ,p>ts & ,special ,tool ,li/ = ,collective ,protection ,equipm5t ,,nbc1 ,simplifi$ ,m#bj 7,,nsn #dbdj-ja-aff-bbed74 ,,navfac ,p-#dge4 #bj ,augu/ #aihg4 7,repr9t$ ) basic includ+ ,*anges #a-b1 #c ,may #aihi47 ,,tm #aj-edaj-bbh-aj4 ,op]ator's ,manual = ,*emical ,biological ,protective ,%elt] ,sy/em4 #ca ,augu/ #bjja4 ,,tm #aj-edaj-bhc-ad,p4 ,op]ator's ,unit1 ,direct ,support1 & ,g5]al ,support ,ma9t5ance ,manual 7,includ+ ,repair ,p>ts & ,special ,tools ,li/s7 = ,*emically ,protect$ ,deployable ,m$ical ,sy/em 7,,cp ,,depm$s7 7,,nsn #edaj-ja-dgi-igcj7 7#edaj-ja-dgi-igbg7 & ,,cp ,,depm$s ,tra9+ ,set 7#fiaj-ja-dgi-bdfd74 #cj ,novemb] #bjja4 ,,index ,ref]5ces are to p>agraph numb]s unless o!rwise indicat$4 advanc$ trauma managem5t1 #c-a;e1 #c-i ,alli$ m$ical publications1 viii1 ,d-#a1 ,d-#c;d1 ,d-#aa;b1 ,d-#ai;e animals consumption1 =1 #e-h1 ,j-#c;a7#e71 ,j-#c;b7#e71 ,j-#e;c7#i7 contam9ation (1 ,j-#c decontam9ation (1 #e-h1 ,j-#c;d1 ,j-#d;d1 ,j-#e;d7#i7 gov]nm5t-own$1 #e-e1 #e-h1 ,c-#g protection (1 #e-h1 ,j-#c;a7#e7 specim5s1 f1 #e-i1 #e-ad1 ,j-#e;b7#d7 treatm5t (1 #e-e1 #e-h area ( op]ations1 #a-c;b7#d7 attack1 nucle>1 biological1 or *emical actions aft]1 #b-f;a1 #c-a;c1 #c-g be=e1 #c-e detection (1 #e-g1 ,a-#a1 ,f-#ad1 ,i-#b1 ,j-#a1 ,j-#c;b1 ,j-#d;b1 ,j-#e;b dur+1 #b-f;a1 #c-f1 #c-i1 #c-aj;b monitor+1 #c-aj;d1 #d-b;d7#b77;a71 #d-g;h1 #e-g1 ,a-#f;a1 ,c-#d--e1 ,app5dix ,e1 ,f-#d1 ,f-#ae;b1 ,g-#aj;f1 ,j-#c;b1 ,j-#d;b1 ,j-#e;b p]sonnel consid]ations1 #c-i pr$iction =1 ,d-#c;d1 ,d-#bf;b responsibilities1 #b-c1 #b-f;a1 #e-bb1 #e-bc supplies1 #c-e;b1 #c-h;b1 #d-a--b1 #e-b;a1 #e-c1 #e-e--f1 #e-ad1 #e-bd--bf1 ,c-#b--c1 ,c-#e--ab survey1 #c-g1 #c-ad;c1 ,c-#d1 ,d-#d;c1 ,g-#aa;j7#d71 ,j-#c;b1 ,j-#e;b7#d7 treatm5t1 #c-g1 #d-a;a7#c71 #d-d1 #d-g;g disposition1 #c-aj1 #c-ae;b elem5ts1 #b-a;b7#c71 #c-aj op]ations1 #b-b;a battlefield1 #a-c;a1 #b-a1 #b-b;a1 #b-c1 #b-e;a1 #b-f1 #c-a1 #c-i1 #c-ab1 #d-a1 #e-a1 #e-e1 #e-ae1 #e-bd1 ,a-#a1 ,d-#c1 ,d-#ai1 ,g-#c1 ,h-#b contam9at$1 #a-c;a1 #b-a1 #b-f;a1 #c-a;e1 #c-i1 #c-ab;d1 #d-a1 #e-a1 #e-e1 #e-ae1 #e-bd1 ,a-#a1 ,d-#c1 ,d-#ai;f1 ,d-#be1 ,g-#h1 ,j-#e;a conv5tional1 #c-a;a & e1 #c-aj c>e1 9 unit1 ,d-#g1 ,d-#ae1 ,d-#bc casualties biological1 ,c-#b1 ,c-#e1 ,d-#a1 ,d-#bj *emical1 ,d-#a civilian1 #c-aa e/imates1 ,d-#c;b1 ,d-#aa mass casualties1 #b-a nucle>1 #c-g1 ,a-#f1 ,d-#a1 ,d-#f;b1 ,d-#h requirem5ts e/imation tool1 ,d-#b *emical1 biological1 radiological1 nucle>1 & high-yield explosive1 #e-bh1 ,c-#a collective protection sy/ems advanc$ simplifi$1 ,f-#b;c1 ,f-#aj alt]nate facilities1 #b-e;b7#d7 available1 #b-e;b decontam9ation ( entrance area1 ,f-#ac employm5t battalion aid /ation1 #c-b;b1 ,f-#b;a1 ,f-#c division cle>+ /ation1 #c-c;c1 ,f-#b;a1 ,f-#d =w>d surgical team1 #c-d1 ,f-#b;a1 ,f-#e 9 ,,depm$s hospital1 #d-a;a1 ,f-#b;b1 ,f-#f--i op]ation1 entry1 & exit guidel9es1 #c-b;b1 ,f-#ab proc$ures1 #c-b;b1 #c-c;c1 #c-d entry_/exit1 ,f-#ad--ae ambulatory pati5ts1 #c-b;b1 ,f-#ae litt] pati5t1 #c-b;b1 ,f-#ae;b e/abli%1 #b-e;b7#a71 ,f-#c--f radiation exposure1 #c-ab;b & d1 #e-c1 ,a-#f;a resupply ( protect$ areas1 ,f-#af %ield+1 #d-b;b7#b77;b7 wat] supply1 91 ,f-#f;b combat op]ational /ress control1 #c-c;a1 #e-bj1 ,c-#i effects (1 #c-a;a1 #e-bj lead]%ip actions1 #c-a;b1 #c-c;a1 #e-ba prev5tive1 #e-bc;b reactions1 #e-bc;c responsibilities1 #e-bj1 #e-bb1 #e-bc sleep plans1 #e-ba;f comm& & control1 #b-a1 #b-e;a1 #d-a;a appraisal ( ! support mission1 #b-c heal? s]vice support units1 #b-d homel& security1 #b-g lead]%ip1 #b-f1 #c-a;b op]ations1 #b-b;a1 #b-d--e1 #b-f;b plann+ consid]ations1 #b-b communications1 #b-d1 #c-a;c contam9at$ environm5t1 #d-a;a facility1 #b-e;c pati5ts1 ,a-#f contam9ation1 #c-a;d1 #e-c avoidance1 #b-e;c1 #c-a;d1 #c-ag;e control1 #b-e;c1 #c-ad;c detection1 #c-a;d1 ,i-#b food1 #d-a;a1 ,a-#i;c1 ,j-#a free area1 #c-b;b1 #c-c;b1 #c-aj;d1 #c-ae h9d] ,,hss op]ations1 #c-a;d p]si/5cy1 #b-a;b7#b7 wat]1 #d-a;a1 ,a-#i;c1 ,i-#a decontam9ation augm5tation1 #c-e;c1 #d-a;a7#c71 #d-d;a1 ,c-#d1 ,g-#c;b1 ,g-#d;b1 ,g-#e1 ,g-#f biological1 ,a-#aj;c1 ,d-#ab;a1 ,d-#ac;b1 ,g-#ab ambulatory pati5ts1 ,g-#ad litt] pati5t1 ,g-#ac *emical ambulatory pati5ts1 ,g-#aa litt] pati5ts1 ,g-#aj clo?+ removal1 ,g-#a,oc1 ,g-#aa;a & i1 ,g-#ac;c1 ,g-#ad;b1 ,g-#ag;b collocation ) ?or\gh decontam9ation1 ,g-#c complicat+ factors1 #d-d;a d5tal1 #c-c;a1 #c-ae1 ,c-#h facility1 #b-e;b7#i71 #c-a;c1 #d-a;a7#b71 #d-c--d1 ,g-#c;f ,field ,m$ical ,c>d1 ,g-#b1 ,g-#aj;a7#d71 ,g-#aa;f1 ,g-#ac;b1 ,g-#ad;b food1 #e-g gross contam9ation removal1 ,g-#aj;a1 ,g-#aa;h heat injury prev5tion1 dur+1 ,g-#h imm$iate1 ,g-#b litt]1 ,g-#aj;e mask1 #d-b;b7#d71 ,g-#aj;a7#a71 ,g-#aa;e mat]ials ne$$1 #b-e;d1 #d-c1 ,g-#a;c m$ical treatm5t facility1 at1 ,g-#d--f monitor = complet5ess1 ,g-#aj;g1 ,g-#aa;j1 ,g-#ae nucle>1 #d-d;a-c1 ,a-#f;c1 ,g-#ae ambulatory pati5ts1 ,g-#ag litt] pati5ts1 ,g-#af op]ations1 ,g-#a1 ,g-#c;a1 ,j-#e;c7#e7 pati5t protective wrap1 ,g-#aa;c pati5ts1 #b-e;b7#b7 & 7#d71 #b-e;d1 #c-b;b1 #c-ad;d1 #c-ae;c1 #d-a;a7#b71 ,f-#aa1 ,g-#a;a1 ,g-#h1 ,g-#ac p]sonal effects1 ,g-#aj;c1 ,g-#ac;a1 ,g-#ad;a1 ,g-#af;a1 ,g-#ag;a p]sonnel_/equipm5t1 #b-e;b7#b71 #c-b;b1 #c-i1 #d-c1 ,g-#aa;d1 ,g-#ad;a %uffle pit1 ,g-#aj;g1 ,g-#aal1 ,g-#ac;e1 ,g-#ad;e1 ,g-#af;d1 ,g-#ag;d sk91 ,g-#aj;a & f1 ,g-#aa1 ,g-#ac;d1 ,g-#ad;d1 ,g-#af;c1 ,g-#ag;c solution prep>ation1 ,g-#a;c1 ,g-#g spot1 #c-b;b1 #d-c;c1 ,g-#aj;f1 ,g-#aa;g treatm5t dur+1 ,g-#aj1 ,g-#aa;a & k7#b7 b&ages1 ,g-#aj;c7#b7 & f7#b71 ,g-#aak7#b7 spl9ts1 ,g-#aj;c7#b7 & f7#b71 ,g-#aak7#b7 t\rniquet1 ,g-#aj;c7#b7 & f7#b71 ,g-#aak7#b7 unit1 ,g-#b wa/e1 dispose (1 ,g-#aj;f7#d71 ,g-#aak wat]1 ,g-#g def5se1 #c-ad;b d5tal s]vices1 #c-c;a1 #e-ae1 ,c-#h decontam9ation1 #e-ag--ah1 ,c-#h mission1 #e-af op]ations1 #e-ag pati5t protection1 #e-ai treatm5t1 #c-c;a1 #e-af1 #e-ag1 #e-ah detection1 #c-a;d diseases1 #a-c;b7#d71 #e-a1 #e-b;b1 #e-c1 ,a-#h;b7#e71 ,d-#ab;c1 ,d-#ag;b em]g5cy m$ical treatm5t1 #c-a;e1 #c-b;b1 #c-c;c1 #c-d1 #c-g1 #c-i1 #c-ae;b1 #d-a;a7#c71 ,d-#d;a1 ,d-#ab;a enemy prison]s ( w>1 #b-b;a environm5t biological1 #c-ad *emical1 #c-ae nucle>1 #c-ab op]ations 9 extreme environm5ts1 #c-af des]t1 #c-af;d jungle1 #c-af;c m\nta91 #c-af;a ,,nbc1 #c-af sn[ & extreme cold1 #c-af;b urban t]ra91 #c-af evacuation1 #c-ag1 ,d-#f1 ,d-#i1 ,d-#ab;a1 ,d-#ad1 ,d-#bb aircraft1 #c-ag;b & e contam9at$ areas1 91 #c-ag;b gr\nd vehicles1 #c-ag;b nonm$ical vehicles1 #c-ag;b7#a71 #d-a;a7#c7 p]sonnel1 #c-ag;b facilities1 #b-e;b7#i71 #c-a;c clean1 #c-a--c1 #c-aj1 #c-ae1 #c-ag;b7#d7 contam9ation1 #c-b1 #c-c;c1 #c-ae;a7#d7 move alt]nate facilities1 #b-a;b7#d71 #c-a;d decision to1 #b-a;b7#c7 mobility1 #d-a;a1 #d-b;a1 ,d-#f;a1 ,d-#ad;a1 ,d-#bc;a1 ,f-#a pati5ts1 #b-a;b7#c7 protection available1 #b-a;b7#a7 & 7#d7 pr9ciples1 #d-b;b7#d77;d7 field exp$i5t protective sy/ems1 ,h-#a1 ,h-#d foxholes & tr5*es1 ,h-#c protection biological ag5t1 aga9/1 ,h-#d;a *emical ag5t1 aga9/1 ,h-#d;a factors1 ,h-#b radiation1 aga9/1 ,h-#b %ield+1 ,h-#b %elt]s1 exp$i5t1 ,h-#a1 ,h-#c--d build+ ( opportunity1 #b-a;b7#a71 ,h-#c cave1 #b-a;b7#a71 ,h-#c culv]ts1 ,h-#c dit*es1 ,h-#c doz] tr5*es1 ,h-#c dug-9 t5ts1 ,h-#c;d eng9e] support1 ,h-#c;c ov]passes1 ,h-#c s&bagg+1 ,h-#c;e t5ts1 ,h-#c;e tunnels1 #b-a;b7#a71 ,h-#c ,field ,m$ical ,c>d1 ,g-#b1 ,g-#aj;a7#d71 ,g-#aa;f1 ,g-#ac;b1 ,g-#ad;b fir/ aid1 #c-a;a1 #c-b;a1 #c-i1 ,d-#g;b buddy aid1 #c-a;a1 #c-b;a1 ,d-#d;a1 ,d-#g;b1 ,d-#ab;a1 ,d-#bj;c combat lifesav]1 #c-a;a1 #c-b;a self-aid1 #c-a;a1 #c-b;a1 ,d-#d;a1 ,d-#g;b1 ,d-#ab;a1 ,d-#bj;c food animal1 ,j-#c;c7#e7 consid]ations1 ,j-#c;d contam9ation avoidance1 ,j-#a;c7#a7 contam9ation (1 #d-a;a1 ,j-#c;a1 ,j-#d;a1 ,j-#e;a c\nt]measures1 ,j-#a;b decontam9ation (1 ,j-#a;a1 c7#c71 & d1 ,j-#c;c1 ,j-#d;d1 ,j-#e;c detection 91 ,j-#a;a1 ,j-#d;b1 ,j-#e;b disposition (1 ,j-#a;a1 ,j-#e;d7#i7 monitor+1 ,j-#c;b op]ational rations1 ,j-#b;a priorities1 ,j-#a;c protection (1 ,j-#a;a1 ,j-#b /orage bulk1 ,j-#b;b exp$i5t1 ,j-#b;b fre% food1 ,j-#b;b susceptibility (1 ,j-#a;a =w>d surgical team1 #c-d guidel9es *emical1 biological1 radiological1 nucle>1 & high-yield explosives1 ,c-#a conduct op]ations1 ,a-#b evacuation1 ,a-#g heal? s]vice support plann+1 ,c-#a mobilization1 =1 ,a-#b op]ational exposure1 #c-ab;d plann+1 ,a-#a pr$eploym5t1 ,a-#b heal? s]vice logi/ics1 #e-bd1 ,a-#aa organizational ma9t5ance1 #e-bg protection ( supplies %ipm5t1 dur+1 #e-bf /orage1 91 #e-be1 ,a-#aa heal? s]vice support1 ,d-#i1 ,d-#ab;a appraisal1 #b-c casualty collection po9t1 #c-a;c conv5tional op]ations1 #b-d evacuation1 #b-b;b1 #b-e;b7#e71 #c-b--c1 #c-af;a1 #c-ag1 #d-a1 #d-b;b7#b71 #d-g;i1 ,a-#g1 ,a-#ad;b1 ,a-#ae;b1 ,d-#a--b1 ,d-#d;a1 ,d-#f1 ,d-#g;b1 ,d-#h1 ,d-#ab;a1 ,d-#ac;b1 ,d-#ad1 ,d-#af1 ,d-#ai;a1 ,d-#bj;c1 ,d-#bb1 ,d-#bd1 ,d-#bf;d1 ,app5dix ,e1 ,f-#b;a1 ,f-#c1 ,f-#e1 ,g-#b1 ,g-#aj1 ,g-#aa;c1 ,g-#ad;e1 ,g-#ag;d factors1 m$ical plann+1 #b-c levels (1 #c-b1 #c-c1 #d-a;a op]ations 9 ,,nbc1 #b-b;g1 #b-e1 #b-f;b1 #c-a--d1 #c-ag;d1 #d-a;a p]sonnel protection1 #b-f;a1 #c-h plann+1 #c-h proximity1 #c-a;c replacem5ts1 #c-a;c survival1 #c-e;a1 #c-af;c1 #e-ae1 #e-bb;a1 ,d-#g;b te*nical *annels1 #c-a;c treatm5t1 #c-g1 #d-a;a7#c7 heat /ress1 #b-f;a homel& security1 #b-g1 #e-bh1 ,c-#ab hospitalization b$ requirem5ts1 ,d-#h1 ,d-#af1 ,d-#bd blood s]vices1 #e-aa conv5tional op]ations1 #d-h decontam9ation1 #d-a;a7#e7 def5sive measures1 #d-a;b em]g5cy s]vices1 #d-d g5]al m$ical s]vices1 #d-e integrat$ battlefield1 on1 #d-a;a int5sive c>e1 #e-aa locations1 #d-a;a7#a7 logi/ics support1 #d-a;b7#b71 ,a-#aa nurs+ s]vices1 #d-g protection1 #d-a;a7#e7 & b7#b71 #d-b;b7#b77;b71 #d-d protective proc$ures1 #d-a;a7#e7 & b7#a7 biological1 #d-a;b7#c7 *emical1 #d-b;b7#d7 ,,mopp levels1 #d-a;b nucle>1 #d-b;b7#b7 response1 #d-b;a surgical s]vices1 #d-f1 #e-aa w>n+ sy/em1 #d-a;b7#d7 initial effects alt]nate op]ational sites1 #c-aj detection1 #c-a;d1 #e-g1 #e-bg1 ,a-#a1 ,c-#b1 ,c-#d1 ,c-#f--g1 ,c-#aa1 ,app5dix ,e1 ,f-#ab;c1 ,f-#ad1 ,i-#b1 ,j-#a1 ,j-#b;a1 ,j-#d;b in/allation m$ical au?ority1 #e-bh ,int]national ,/&>dization ,agreem5ts1 ,d-#a ,,/anag #bdge1 p4 viii1 ,d-#c ,,/anag #bdgf1 p4 viii1 ,d-#aa ,,/anag #bdgg1 p4 viii1 ,d-#ai laboratory s]vices1 #e-i--aa1 ,a-#a,oa1 ,app5dix ,e biological specim5s1 #e-aa1 #e-ad *a9 ( cu/ody1 #e-ad cl9ical1 #e-aa levels1 #e-aa samples1 #e-aj animals1 small1 #e-ad environm5tal1 #e-ad field1 #e-ad food1 #e-ad soil1 #e-ad vegetation1 #e-ad support1 #e-aa !at] ,army m$ical laboratory1 #e-aa lead]%ip logi/ics1 #b-f1 #c-h1 #d-b;b7#d77;c71 #e-f1 ,d-#i1 ,d-#ab;a1 ,d-#ag1 ,d-#be1 ,app5dix ,e ma9 supply r\tes1 #c-e;c mass casualties1 #b-a1 #e-ae--af1 #e-bi1 ,a-#aj;b1 ,a-#ad;b1 ,a-#ae;b1 ,d-#d;a1 ,d-#ab;a1 ,d-#bj;b m$ical equipm5t sets *emical ag5t pati5t decontam9ation1 #c-h;b1 #d-c;c7#c71 ,c-#b1 ,c-#d *emical ag5t pati5t treatm5t1 #c-h;b1 #d-c;c7#c71 ,c-#b1 ,c-#d m$ical evacuation1 #b-e;b7#c7 & 7#e71 #c-a;c & e1 #c-b;a1 #c-c;a1 #c-aj;b1 #c-ab;b1 #c-ag1 #d-a1 #e-bh m$ical surveillance1 #c-c;a1 #c-ad;f m$ical treatm5t facility1 #b-a1 #b-b;a1 #b-e;b1 #c-c;c mission-ori5t$ protective po/ure clo?+1 #b-e;b1 #c-a;a--b1 #c-i--aj1 #c-ae;a1 #e-ai;b1 #e-ba;e1 ,c-#c1 ,f-#b;a equipm5t1 #b-e;b p]=mance degradation1 #b-f movem5t & managem5t ( contam9at$ facilities1 #b-e;b1 #c-aj;d nucle>1 biological1 & *emical battlefield consid]ations1 ,c-#a def5se1 #c-a;b1 #e-ba lead]%ip1 #b-f1 #c-a1 #c-f1 #c-ag;a1 #e-ba1 ,app5dix ,e op]ational exposure guide1 nucle>1 #b-e;a1 #c-a;b op]ations 91 #a-c;b7#d71 #b-b;a1 #b-d--e1 #c-e;a1 #c-i1 #c-ab;d1 #c-af1 #d-b;b7#a77;c71 7#b71 & 7#d77;c71 #d-c;a1 #e-ad--ae1 #e-ag1 ,a-#g1 ,c-#b1 ,c-#aa1 ,app5dix ,e1 ,f-#d--e /rikes1 #d-a;a w>n+ & report+ sy/em1 #d-a;b nurs+ s]vices1 #d-g1 ,a-#aj op]ational exposure guide1 nucle>1 #b-e;a1 #c-a;b1 #c-ab;d1 #c-ag;b plans1 #b-e;a1 #c-a;a op]ations1 #d-b;b7#a77;c7 & 7#b77;a71 #d-c;a7#b71 ,a-#a1 ,a-#g1 ,c-#a1 ,c-#e1 ,c-#aa1 ,d-#c;d1 ,f-#c--e1 ,f-#aa--ab1 ,g-#a;a1 ,j-#a;d1 ,j-#e;c7#e7 security1 #d-a;b7#a71 #d-b;b passive def5se measures1 #c-ad;b pati5t *emical ag5t1 ,a-#ad contam9at$1 #c-aj;c1 #c-ab1 #d-a;a7#c71 ,c-#e decontam9ation1 #c-c;b1 #c-aj1 #d-a;a7#c7 & b1 ,a-#ad;c1 ,a-#ae;c ext]nally contam9at$1 #c-ab;a hold+1 #c-c;a int]nally contam9at$1 #c-ab;a irradiat$1 #c-ab;a managem5t (1 ,a-#aj;c numb] (1 #b-a;b7#c7 protective wrap1 #c-ag;f1 ,f-#ae;b7#b77;a71 ,g-#aa;c /ability op]ations & support op]ations1 91 ,a-#g types (1 #b-a;b7#c71 #c-ab;b1 ,c-#d p]sonnel protection (1 #b-a;b7#i71 #b-f;a replacem5t (1 #c-a;c plann+ consid]ations =1 ,d-#d1 ,d-#bj;a e/imates1 ,d-#b1 ,d-#d1 ,d-#aa;c1 ,d-#ag1 ,d-#ai heal? s]vice support1 #c-i m$ical =ce1 =1 ,d-#aj1 ,d-#ah1 ,d-#bj1 ,d-#bf m$ical ,,nbc /aff (fic]1 ,app5dix ,e mobilization1 ,c-#b--c ,,nbc1 #c-e;c1 p4 ,d-#a pr$eploym5t1 ,c-#b tool1 m$ical1 ,d-#b plans e/abli% a m$ical treatm5t facility1 ,c-#a ,,hss1 #c-ag;d load1 ,c-#c movem5t1 ,c-#c op]ation1 #b-e;a1 #c-a;a tactical1 #c-ag;d prev5tive m$ic9e ar?ropods1 #e-b;b1 #e-c climate1 #e-b;a deta*m5ts1 #e-d det]m9+ factors1 #e-a1 #e-b;a disease1 #e-a divisional1 #c-c;a1 #e-c field hygi5e & sanitation1 #e-c field sanitation team1 unit1 #e-c--d immunizations1 #e-c1 ,d-#aa;f incid5ts & morbidity1 #e-b;b measures1 #c-a;e1 #e-a1 #e-d1 #e-aa--ab m$ical surveillance1 #e-d occupational & environm5tal heal? ?reat1 #e-c--d op]ations1 #e-a--b1 #e-d pe/ managem5t1 #e-b;b1 #e-d prophylaxis1 ,d-#aa;f s]vices1 #c-c;a1 #e-a1 #e-ad1 ,c-#f1 ,app5dix ,e wat] & food1 #e-b;a1 #e-c--d protection build+s ( opportunity1 use (1 #c-a;d1 #c-e;b1 #c-ab collective1 #c-a;d1 #c-b;b1 #c-c;b1 #c-d1 #c-aj;a1 #c-ae1 #d-g1 ,c-#b1 ,c-#d cov]s1 #c-a;d1 #c-ab environm5tal1 #d-b;b7#b71 #d-e1 #d-f;a & c1 #d-g;c hospital1 #d-b;a individual1 #d-b;b1 #e-ba;d mask-only1 #d-b;b7#d77;a71 #d-g;b mat]iel1 #c-a;d1 #d-b;b7#d77;d7 ov]head1 #c-a;d1 #c-ab pati5t1 #c-e;d1 #d-b;b7#d77;c71 ,a-#f p]sonnel1 #c-e;b1 #d-b;b7#d77;a7 proximity1 #c-a;c %ield+1 #c-e;b1 #d-b;b7#b7 site selection1 #c-ab supplies1 #c-e;b types (1 #c-a;d w>n+ sy/em1 #d-b;b7#d7 exp$i5t1 #b-e;b7#a71 #c-e;b1 #c-ab %ield+1 #d-b;b7#b77;b7#c radiation exposure /atus1 #c-ab;d1 #c-ag;b radiological disp]sal devices1 #a-a;a1 #d-a;a1 ,a-#a rations1 ,f-#f;b1 ,j-#e;a7#d7 report+1 ,app5dix ,e return to duty1 #c-a;e samples1 #e-c--d1 #e-i1 ,c-#f--g1 ,c-#aj1 ,app5dix ,e analysis (1 ,b-#a--b *a9 ( cu/ody1 #e-i1 #e-ad;a & b7#a71 ,c-#f--g docum5tation1 #e-i collection1 #e-i1 ,b-#a--b1 ,b-#d;b description (1 ,b-#b environm5tal1 #e-i1 #e-ad1 ,b-#a1 ,b-#c;b1 ,b-#e air1 #e-ab;b7#a71 #e-ad1 ,b-#a1 ,b-#h soil1 #e-ab;b7#a71 #e-ad1 ,b-#a1 ,b-#aj vapor1 ,b-#h vegetation1 #e-ab;b7#a71 #e-ad1 ,b-#a1 ,b-#d wat]1 #e-ab;b7#a71 #e-ad1 ,b-#a1 ,b-#c;c1 ,b-#i food1 #e-i;b7#a71 #e-ad1 ,j-#d;b7#a71 ,b-#a1 ,b-#c;d h&l+1 #e-i hi/ory (1 ,b-#b id5tification1 #e-i;b7#a71 #e-ac label+1 #e-i1 #e-ac1 ,b-#d;b pres]vation1 #e-i;b7#a71 ,b-#b1 ,b-#d;b1 ,c-#f--g transportation1 #e-i;b7#a7 sleep loss1 #b-f;a special m$ical response teams1 #e-bh--bi specim5s1 ,app5dix ,e analysis1 #e-aj--aa1 #e-ab;b1 ,a-#aj1 ,b-#a--c ante mortem1 ,b-#c;a backgr\nd docum5ts1 ,b-#ah biological1 #e-c--d1 #e-i1 ,a-#aj1 ,b-#a1 ,b-#e1 ,b-#ab--ac1 p4 ,c-#f--g *a9 ( cu/ody1 #e-i;a1 #e-aa--ab1 #e-ad;b7#a71 ,b-#d1 ,b-#ag1 ,c-#f--g1 ,c-#aj--aa civilians1 f1 ,b-#a;b1 ,b-#ac collection (1 #e-c--d1 #e-i;b7#a71 #e-aj--ab1 #e-ad1 ,b-#a1 ,b-#d;b1 ,b-#ab--ac1 ,c-#g1 ,c-#aj--aa description (1 ,b-#b docum5tation (1 ,b-#b field1 #e-ad hi/ory (1 ,b-#b1 ,b-#ae id5tification1 #e-i;b7#a71 #e-ab;b1 #e-ac1 ,a-#aj;a po/ mortem & =5sic1 ,b-#c;b1 ,b-#ad pres]vation1 #e-i;b7#a71 #e-aa--ab1 ,b-#b--c1 ,b-#d;b1 ,b-#ae--af1 ,c-#f--g1 ,c-#aj--aa report+1 #e-ab;b1 ,b-#ae1 ,b-#ag transportation1 #e-i;a & b7#a71 #e-ab types (1 ,b-#c /ability op]ations & support op]ations1 ,a-#g ,/&>dization ,agreem5t 7,,/anag74 ,see ,int]national ,/&>dization ,agreem5ts4 /ress1 #b-f;a supply1 ,class ,,viii tactical /&+ op]at+ proc$ures1 ,c-#b ?reat1 #a-a;a biological w>f>e1 #a-b1 #a-c;b1 #c-ad *emical1 biological1 radiological1 nucle>1 & high-yield explosive1 #a-b *emical w>f>e1 #a-b1 #a-c;c direct$ en]gy1 #a-b m$ical1 #a-b nucle>1 #a-b1 #a-c;a radiological disp]sal device1 #a-b1 #a-c;a toxic indu/rial mat]ial1 #a-a;b1 #a-c;d toxic indu/rial mat]ial1 #a-a;b1 #a-b1 #c-a;a & d1 #d-a;a1 #e-c1 ,a-#a1 ,a-#ae1 ,app5dix ,e tra9+1 #c-a;b1 ,c-#c treatm5t1 #c-a--b1 #c-g1 #c-i--aj1 #c-ac--af1 #e-bi1 ,a-#c;a7#c71 ,a-#f;e1 ,a-#aj;d1 ,a-#ad;d1 ,a-#ae;d1 ,app5dix ,e advanc$ trauma managem5t1 #c-a;e1 #c-i clean area1 #c-a--c1 #c-aj1 #c-ae1 #c-ag;b7#d7 em]g5cy m$ical treatm5t1 #c-a;e1 #c-c;b1 #c-g1 #c-i1 #c-ae;b1 #d-a;a7#c71 ,d-#d;a1 ,d-#ab;a triage1 #b-c1 #c-ac1 #d-a;a7#c7 & b1 #d-d;b1 #e-bj1 #e-bi1 ,c-#b1 ,c-#e1 ,d-#d;a1 ,d-#e1 ,d-#ab;a1 ,d-#ac1 ,d-#ba vet]9>y s]vices1 #e-e1 #e-ad1 ,c-#g1 ,app5dix ,e animal c>e1 #e-h food protection1 #e-f wa/e disposal1 ,f-#f;b wat] supply1 #d-a;a1 ,c-#b1 ,f-#f;b1 ,i-#a--d actions to protect1 ,i-#c detection 91 ,i-#b treatm5t (1 ,i-#d weapons1 #a-c1 #c-a;b & c1 #d-a;a1 ,a-#a biological1 #d-b;b7#c71 #e-b;b1 ,a-#h1 ,d-#aa;e1 ,d-#ab;b ag5ts1 ,a-#h behavior1 ,a-#i disp]sion1 ,a-#h--i effects1 #c-g1 ,a-#g1 ,a-#aj1 ,d-#aa;c incubation p]iod1 ,a-#h;a7#c7 individual1 ,f-#ad infection1 ,a-#h;a7#b7 live ag5ts1 ,a-#h;a spore-=m+1 ,a-#h;b tox9s1 ,a-#h;c categories nonp]si/5t1 ,a-#ab;a7#b7 p]si/5t1 ,a-#ab;b7#a7 protection aga9/1 #c-aj vapor haz>d1 #c-aj;d *emical1 #d-b;b7#d7 ag5ts1 #c-g1 ,a-#aa;b attacks types (1 ,a-#aa;b behavior1 ,a-#ab bli/]1 ,table ,a-#ab1 ,a-#ac;b1 ,d-#bj;e blood1 ,table ,a-#ab1 ,a-#ac;d *>act]i/ics1 ,a-#ab--ac incapacitat+1 ,a-#ab;a1 ,table ,a-#ab lung damag+1 ,table ,a-#ab1 ,a-#ac;c n]ve1 ,table ,a-#ab1 ,a-#ac;a effects1 #c-e;b1 ,a-#aa employm5t (1 ,a-#a nucle>1 #d-b;b7#b7 biological effects1 ,a-#d bla/1 #c-g1 #c-ab;a1 ,a-#b;c1 ,a-#c;a burns1 ,a-#d detonation (1 ,d-#c;e effects (1 ,d-#c;d electromagnetic pulse1 ,a-#b;a1 ,d-#d;d eye injuries1 ,a-#d;c fall\t1 #c-ab;b ov]pressure1 ,a-#c;a7#b7 physical effects1 ,a-#b physiological effects1 ,a-#c1 ,a-#e radiation injury1 #c-g1 #c-ab;a !rmal injury1 #c-g1 #c-ab;a1 ,d-#d;a radiological disp]sal device1 #a-a;b1 #a-c1 ,a-#a1 ,a-#c ?reat1 #a-a1 #c-a;a1 #c-b;b "w_/re/ cycles1 #b-f;a ,,fm #d-jb4g 7,,fm #h-aj-g7 #a ,,octob] 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