21st Century Essential NBC Reference Series: Health Service Support in a Nuclear, Biological, and Chemical Environment Field Manual (Bioterrorism, Nuclear, . Destruction WMD, First Responder Ringbound)

This is an up-to-date version of a important military field manual considered to be a vital reference for the treatment of biological weapons and bioterrorism attacks. The purpose of this field manual is to provide doctrine and tactics, techniques, and procedures for health service support (HSS) units and personnel operating in a nuclear, biological, and chemical (NBC), radiological dispersal device (RDD), and toxic industrial material (TIM) environment. The manual provides information for use by commanders, planners, leaders, and individuals in providing HSS under these adverse conditions. The use of the term "Health Service Support" in this publication is synonymous with Combat Health Support as used in other publications. Health Service Support is the term used in Joint Publications to describe medical support to Joint Forces.

Medical threat is the composite of all ongoing or potential enemy actions and environmental conditions that will reduce combat effectiveness through wounding, injuring, causing disease, and/or degrading performance. Soldiers are the targets of these threats. Weapons or environmental conditions that will generate wounded, injured, and sick soldiers, beyond the capability of the HSS system to provide timely medical care from available resources, are considered major medical threats. Weapons or environmental conditions that produce qualitatively different wound or disease processes are also major medical threats. Added to the combat operational and disease and nonbattle injury (DNBI) medical threats are adversary use of the following types of weapons, agents, and devices: Biological warfare agents; Chemical warfare agents; Nuclear weapons; Toxic industrial materials; Radiological dispersal devices; Directed-energy devices/weapons; Chemical, biological, radiological, nuclear, and high-yield explosives;

Nuclear, Biological, Chemical, and Radiological Dispersal Device Threats—The Health Service Perspective - Since the breakup of the Soviet Union, the number of countries with known nuclear capable military forces has almost doubled. Available information suggests that a number of countries in the Middle East, Asia, and Africa have or may have nuclear weapons capability within the next decade. Planners can expect, as a minimum, 10 to 20 percent casualties within a division-sized force that has experienced a nuclear strike. In addition to the casualties, a nuclear weapon detonation can generate an electromagnetic pulse (EMP) that will cause catastrophic failures of electronic equipment components. Radiological dispersal devices, comprised of an explosive device with radioactive material, can be detonated without the need for the components of a nuclear weapon. The RDD can disperse radioactive material over an area of the battlefield causing effects from nuisance levels of radioactive material to life-threatening levels without the thermal and, in most cases, the blast effects of a nuclear detonation.

US forces may be attacked by or exposed to NBC, TIM, lasers, advanced electronics, high explosives, fuel-air, thermobaric, and conventional weapons; or a combination of these weapons/materiel. Mass casualty situations will be the rule and not the exception. Mass casualty situations can occur anyplace on the battlefield. Combined NBC and conventional weapons injuries may predominate. Command and control (C2) will be essential to prevent casualties and to provide effective HSS. However, C2 (to include HSS C2) elements may be primary targets. Effective HSS in an NBC environment can be accomplished, but only if necessary preparations to survive and to be mission capable are taken. Increased HSS C2 actions are needed to maintain HSS proximity to the supported force; to clear the battlefield; to move and resupply the HSS units, while managing multiple simultaneous mass casualty incidents; and to rapidly evacuate patients. Health service support C2 units must push HSS augmentation to mass casualty sites, clear