United States. Department of the Army

“ Contamination of food and water. Aerosol, liquid, or solid dispersion. The only requirement is that they must be stable enough to survive transport and dissemination. The toxicity of biological agents is not the same for everyone; each individual does not react exactly the same way to the same amount of an agent. Some are more resistive than others because of race, sex, age, or other factors. The dose is the quantity of a biological agent received by the subject. ”

“ The protective properties of packaging materials are dependent upon a number of factors. The factors include the form of the agent (liquid versus vapor) ; concentration and exposure time; weather (temperature, wind speed, and humidity) ; and packaging material (the type of material, thickness, and the presence of folds, tears, and small holes) . Even the thinnest material will offer some protection and is better than nothing at all. Therefore, always cover food supplies with whatever material is available. ”

“ Because the effects on the body are direct, the symptoms of an attack may appear very rapidly. The potency of most toxins is such that very small doses will cause injuries and/or death. Thus, their use by an enemy may be an alternative to chemical agents because it allows the use of fewer resources to cover the same or a larger area. Slight exposure at the edges of an attack area may produce severe symptoms or death from exposure to toxins because of their extreme toxicity. Lethal or injury downwind hazard zones for toxins may be far greater than those of CW agents. ”

“ Effects of Chemical Weapons a. A chemical agent is a chemical that is used to kill, seriously injure, or incapacitate man because of its physiological effects. They can be disseminated by artillery, aircraft, rocket, or by nonconventional means used by terrorists. When first employed in combat during World War I, the chemical weapon (chlorine) was so effective that the attacking Germans were not prepared to exploit the success. ”

“ Comparing the risks of the threat with the increased risk of facing the conventional threat in varying levels of MOPP. The decision to initiate a MOPP level should be like deciding how much cover is needed to protect a unit from conventional weapons. Choosing the lowest MOPP level that protects the unit, yet permits accomplishment of the mission. Do not try to be 100 percent safe from chemical attack if it means that there is— Only a small chance of mission accomplishment. A high probability of being killed by the enemy. A high personnel loss due to heat injury. ”

“ Biological agents are easy to disperse on the battlefield without immediate detection; however, their effects on exposed troops can change the course of the battle. Some nations consider chemical weapons as a component of their munitions for the battlefield. As more nations enter the arena of developing biological and chemical weapons, their potential effects on our troops will increase. The enemy's use of TIMs as weapons or collateral damage to TIM storage faculties can severely affect the unit personnel's ability to continue the mission. ”

“ A surface burst is a detonation in which the fireball actually touches and vaporizes the land or water surface. In this case, the area affected by blast, thermal radiation, and initial nuclear radiation will be smaller than for an airburst of comparable yield. However, in the region around ground zero, the [A-3] destruction will be much greater and a crater is often produced. Additionally, all the material that was within the fireball becomes fallout and will be a hazard downwind. A surface burst is the most likely type of terrorist detonation. ”

“ Chemical agents can be physically and chemically absorbed into food. In addition to the toxic effect, they often adversely affect taste, smell, and the appearance of the food. However, chemical agents can cause the food to become very toxic without causing any other changes in the food. Table J-4 shows the effects of a number of chemical agents on food. Since food can be contaminated without any outward change in appearance, the possibility of contamination must be assumed in a chemical agent environment. Treat the food with the same precautions as established for known contaminated items. ”

“ If the threat is nuclear fallout, the hospital structure provides protection; the fallout can be brushed or washed off. This allows protection while permitting patient care to continue virtually uninterrupted. A need to relocate the hospital will depend upon the degree of contamination; the amount of decontamination possible; and the projected stay before a normal move in support of operations. Hospital tentage alone offers little protection against blast and missiling effects. If the patients are to remain in the tents, they are placed on the floor. ”

“ Contamination of foodstuffs by a chemical agent may occur at any point on the battlefield. This contact may render the food unpalatable also. In many cases, decontamination is difficult, thus, emphasis must be placed on protection. Keep food supplies covered at all times. Take special precautions to protect food that is not packed in protective packages. Unprotected food, forage, and grain supplies may be so contaminated that their consumption will produce gastrointestinal irritation, or systemic poisoning. Nerve agents, vesicants, and arsenicals are the most dangerous. ”

“ Toxins have several desirable traits. They are poisonous compounds that do not grow, reproduce, or die after they have been dispersed; they are more easily controlled than live organisms. Field [A-15] monitors capable of providing prompt warning of a toxin attack are not available; therefore, personnel must learn to quickly recognize signs of attack, such as observing unexplained symptoms of victims. Toxins produce effects similar to those caused by chemical agents; however, the victims will not respond to the first-aid measures that work against chemical agents. ”

“ Often the first indication of an attack with a biological agent will be the development of symptoms in exposed personnel. Diagnosis and treatment are complicated by the fact that many of the agent-induced diseases described in the guide begin with symptoms associated with common illnesses, such as influenza. In such cases, biological agent attacks may generally be distinguished from naturally occurring epidemics by the sudden onset of disease, the large number of personnel presenting with similar symptoms, and the concentration of those personnel in geographically contaminated areas. ”

“ For effective mass casualty management, key medical and related considerations must be well planned and practiced. These include on-site triage and emergency care, communications, health service logistics, evacuation by ground and air resources, and personnel training in self-aid/buddy aid. Plans need to be made for requirements that may differ from the usual combat situation. For example, in combat situations, severe burn injuries in large numbers are relatively uncommon. Therefore, no special planning for the care of large numbers of burn patients is required. ”

“ Medical Threat Medical threat is the composite of all ongoing or potential enemy actions and environmental conditions that [1-2] 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. ”

“ Aging may not be possible when there is a short food supply. In some instances, such as with induced radioactivity, it may be the only way to decontaminate. Removing nuclear contamination from areas, personnel, food, or moving equipment to another location eliminates the immediate hazard. To determine which decontamination method is required, food supplies are divided into groups. See Table J-1 for additional information on food items and decontamination. ”

“ Political, economic, and social instability and religious, cultural, and economic competition will continue to erode the influence of the US over the rest of the world. This erosion will also reduce the US influence of traditional regional powers over their neighbors. This environment will encourage the continued development, or acquisition, of modern armed forces and equipment by less influential nations; thus raising the potential for the use of NBC/RDD weapons during internal conflict and armed confrontations in developing regions of the world. ”

“ Gamma rays, emitted during the nuclear detonation and in fallout, are uncharged radiation similar to X rays. They are highly energetic and pass through matter easily. Because of its high penetrability, radiation can be distributed throughout the body, resulting in whole body exposure.
d. Neutrons, like gamma rays, are uncharged, are only emitted during the nuclear detonation, and are not a fallout hazard. However, neutrons have significant mass and interact with the nuclei of atoms, severely disrupting atomic structures. Compared to gamma rays, they can cause 20 times more damage to tissue. ”

“ The agents may seep down around the threads of bolts, in cracks and crevices of the equipment, and inside the cabinets or enclosures of equipment. These potential contamination sources produce an increased hazard to maintenance personnel. Decontamination of some items, especially medical equipment, may be a problem for maintenance personnel. The use of standard decontamination agents will cause damage beyond repair to most medical equipment and electronic equipment. In some instances, removal of chemical agents will require aging (off-gassing) of the agent. ”

“ Accidental spills or releases and terrorist actions can all lead to release of these materials into the environment causing potential casualty producing effects. Medical treatment facilities and nuclear power plants use radioactive materials that can pose a health hazard if accidentally released or used by hostile forces, terrorists, or others to contaminate an area. Biological materials used in medical research and pharmaceutical manufacturing may be used by hostile forces, terrorists, or others to produce casualties. ”

“ Although a specific unit may be the target of a biological attack, more casualties could be suffered by other units downwind. Accordingly, a unit other than the targeted one may have priority for support. The tables presented in the guide can be used in planning for either situation. Some tables show estimated maximum numbers of personnel by illness severity category. Such estimates should be combined with a comprehensive array of other available information to increase the effectiveness of medical force planning. ”

“ Hospital electrical and electronic medical equipment is vulnerable to the effects of the EMP produced by nuclear weapons. The EMP is not harmful to humans, animals, or plants, but is very damaging to electronic equipment. Hospital equipment is very difficult to decontaminate. Aging (allowing the agent to off-gas) may be the only means of decontamination. Hospitals are not kept in reserve. All personnel and equipment losses due to NBC contamination or radiation will have to be replaced. ”

“ The patient decontamination station should be established in a contamination-free area of the battlefield. However, it may be necessary to establish a patient decontamination station that is collocated with an MTF that is employing a CBPS, in a chemical vapor hazard area in order to decontaminate patients and clear the battlefield before moving the MTF to a clean area. When CPS systems are not available, the clean treatment area is located upwind 30 to 50 meters of the contaminated work area. When personnel in the clean working area are away from the hot line, they may reduce their MOPP level. ”

“ A third dimension to the threat is terrorist, rogue groups, and belligerents employing a number of chemical and biological agents and the possible use of TIM to injure or kill US personnel. The actions may be isolated or may be imposed by groups of individuals. Most will have the financial backing of nations, large organizations, or groups that have the desire to cause harm and create public distrust in our government. ”

“ The externally contaminated patient is decontaminated at the earliest time consistent with required medical care. Lifesaving care is always rendered, when necessary, before decontamination. The internally contaminated patient is one that has ingested or inhaled radioactive material, or radioactive material has entered the body through an open wound. The radioactive material continues to irradiate the patient internally until radioactive decay and/or biological elimination removes the radioactive isotope. Attending medical personnel are shielded, to some degree, by the patient's body. ”

“ Determining Factors. Factors of prime importance in determining the nature and severity of the disease effects are—
Immunization status of personnel. Population density. Degree of industrialization in the operational area. Availability of food supplies. Availability of water. Climate. Finally, the manner and situation in which nuclear weapons are used are of importance. A single weapon detonated in a socially stable area will have far less serious effects than a detonation in an area where combat has already disrupted the social stability. ”

“ Currently, a field method for detecting chemical agent contamination in food does not exist. Contamination is not always spread evenly throughout food; this makes it impossible to take a single sample and determine the presence or absence of chemical agents in the entire lot. Additionally, standardized laboratory tests have not been developed for determining levels of chemical agents in food. Until a specific method to detect chemical agents in food is available, reliance will have to be made upon determination of contamination, or lack thereof, on the packaging material ”

“ Food animals. Food animals that have been exposed to fallout should be considered fit for consumption and slaughtered using routine inspection and slaughter procedures. In those cases where the animal has been exposed to fallout, but is not scheduled for immediate slaughter, the radiation burden can be reduced by moving the animal to an uncontaminated area (barn if available) and washing it with soap and water. Mild radiation sickness does not necessarily mean that the animals cannot be used for food. ”

“ General When operating under the threat of or under actual NBC conditions, soldiers will be at a high risk of suffering combat operational stress-related conditions. The invisible, pervasive nature of these weapons creates a higher degree of uncertainty and ambiguity, presenting fertile opportunities for false alarms, mass panic, and other maladaptive stress reactions. Therefore, commanders and leaders must take actions to prevent and reduce the numbers of combat operational stress cases in this environment. ”