Chapter I: Front Matter

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=FM 4-02.7= (FM 8-10-7)

HEALTH SERVICE
SUPPORT IN A NUCLEAR,
BIOLOGICAL, AND
CHEMICAL
ENVIRONMENT

TACTICS, TECHNIQUES, AND PROCEDURES

OCTOBER 2002

HEADQUARTERS, DEPARTMENT OF THE ARMY

DISTRIBUTION RESTRICTION: Approved for public release; distribution
is unlimited.

[*]FM 4-02.7 (FM 8-10-7)

FIELD MANUAL HEADQUARTERS
NO. 4-02.7 (8-10-7) DEPARTMENT OF THE ARMY
Washington, DC, 1 October 2002

HEALTH SERVICE SUPPORT IN A NUCLEAR, BIOLOGICAL, AND CHEMICAL ENVIRONMENT TACTICS, TECHNIQUES AND PROCEDURES

TABLE OF CONTENTS

=Page=

=Preface= viii

=CHAPTER 1. NUCLEAR, BIOLOGICAL, AND CHEMICAL WARFARE ASPECT
OF THE MEDICAL THREAT= 1-1

1-1. General 1-1

1-2. Medical Threat 1-1

1-3. Nuclear, Biological, Chemical, and Radiological Dispersal
Device Threats--The Health Service Perspective 1-2

=CHAPTER 2. COMMAND AND CONTROL= 2-1

2-1. General 2-1

2-2. Health Service Support Command and Control Planning
Considerations 2-1

2-3. Health Service Support Command and Control Appraisal of
the Support Mission 2-2

2-4. Health Service Support Units 2-2

2-5. Movement/Management of Contaminated Facilities 2-3

2-6. Leadership on the Contaminated Battlefield 2-5

2-7. Homeland Security 2-6

=CHAPTER 3. LEVELS I AND II HEALTH SERVICE SUPPORT= 3-1

3-1. General 3-1

3-2. Level I Health Service Support 3-2

3-3. Level II Health Service Support 3-2

3-4. Forward Surgical Team 3-3

3-5. Actions Before a Nuclear, Biological, or Chemical Attack 3-3

3-6. Actions During a Nuclear, Biological, or Chemical Attack 3-4

3-7. Actions After a Nuclear, Biological, or Chemical Attack 3-4

3-8. Logistical Considerations 3-5

3-9. Personnel Considerations 3-5

3-10. Disposition and Employment of Treatment Elements 3-6

3-11. Civilian Casualties 3-6

3-12. Nuclear Environment 3-7

3-13. Medical Triage 3-8

3-14. Biological Environment 3-8

3-15. Chemical Environment 3-9

3-16. Operations in Extreme Environments 3-10

3-17. Medical Evacuation in a Nuclear, Biological, and
Chemical Environment 3-10

=CHAPTER 4. LEVELS III AND IV HOSPITALIZATION= 4-1

4-1. General 4-1

4-2. Protection 4-3

4-3. Decontamination 4-8

4-4. Emergency Services 4-10

4-5. General Medical Services 4-11

4-6. Surgical Services 4-11

4-7. Nursing Services 4-12

4-8. Conventional Operations 4-13

=CHAPTER 5. OTHER HEALTH SERVICE SUPPORT= 5-1

=Section I. Preventive Medicine Services= 5-1

5-1. General 5-1

5-2. Disease Incidence Following the Use of Nuclear,
Biological, and Chemical Weapons 5-1

5-3. Preventive Medicine Section 5-3

5-4. Preventive Medicine Detachment 5-3

=Section II. Veterinary Services= 5-4

5-5. General 5-4

5-6. Food Protection 5-4

5-7. Food Decontamination 5-4

5-8. Animal Care 5-5

=Section III. Laboratory Services= 5-5

5-9. General 5-5

5-10. Level II 5-5

5-11. Level III 5-5

5-12. Level IV 5-6

5-13. Level V (Continental United States) 5-6

5-14. Field Samples 5-6

=Section IV. Dental Services= 5-7

5-15. General 5-7

5-16. Mission in a Nuclear, Biological, or Chemical
Environment 5-7

5-17. Dental Treatment Operations 5-7

5-18. Patient Treatment Considerations 5-7

5-19. Patient Protection 5-8

=Section V. Combat Operational Stress Control= 5-9

5-20. General 5-9

5-21. Leadership Actions 5-9

5-22. Individual Responsibilities 5-10

5-23. Mental Health Personnel Responsibilities 5-11

=Section VI. Health Service Logistics= 5-11

5-24. General 5-11

5-25. Protecting Supplies In Storage 5-12

5-26. Protecting Supplies During Shipment 5-12

5-27. Organizational Maintenance 5-12

=Section VII. Homeland Security Response= 5-13

5-28. Chemical, Biological, Radiological, Nuclear, and
High-Yield Explosive Response 5-13

5-29. Capabilities of Response Elements 5-14

=APPENDIX A. MEDICAL EFFECTS OF NUCLEAR, BIOLOGICAL, AND
CHEMICAL WEAPONS AND TOXIC INDUSTRIAL MATERIAL= A-1

A-1. General A-1

A-2. Physical Effects of Nuclear Weapons A-1

A-3. Physiological Effects of Nuclear Weapons A-4

A-4. Biological Effects of Thermal Radiation A-7

A-5. Physiological Effects of Ionizing Radiation A-8

A-6. Handling and Managing Radiologically Contaminated
Patients A-10

A-7. Radiological Patients in Stability Operations and
Support Operations A-13

A-8. Effects of Biological Weapons A-14

A-9. Behavior of Biological Weapons A-15

A-10. Management of Biological Warfare Patients A-16

A-11. Effects of Chemical Weapons A-17

A-12. Behavior of Chemical Weapons A-17

A-13. Characteristics of Chemical Agents A-19

A-14. Management of Chemical Agent Patients A-23

A-15. Management of Toxic Industrial Material Patients A-23

=APPENDIX B. SAMPLE/SPECIMEN COLLECTION AND MANAGEMENT= B-1

=Section I. Introduction= B-1

B-1. General B-1

B-2. Sample/Specimen Background Information B-2

B-3. Sample/Specimen Collection and Preservation B-3

B-4. Chain of Custody B-8

=Section II. Sampling Techniques and Procedures= B-9

B-5. General B-9

B-6. Expended Material B-11

B-7. Environmental Samples B-11

B-8. Collection of Air and Vapors B-12

B-9. Collection of Water Samples B-13

B-10. Collection of Soil Samples B-15

B-11. Collection of Contaminated Vegetation B-16

B-12. Medical Specimens B-16

B-13. Collection of Medical Specimens B-17

B-14. Post Mortem Specimens B-19

B-15. Reporting, Packaging, and Shipment B-20

B-16. Handling and Packaging Materials B-21

B-17. Collection Reporting B-23

B-18. Sample/Specimen Background Documents B-27

=APPENDIX C. GUIDELINES FOR OPERATIONAL PLANNING FOR HEALTH
SERVICE SUPPORT IN A NUCLEAR, BIOLOGICAL, AND
CHEMICAL ENVIRONMENT= C-1

C-1. General C-1

C-2. Predeployment C-1

C-3. Mobilization C-2

C-4. Establish a Medical Treatment Facility C-3

C-5. Operate a Medical Treatment Facility Receiving
Contaminated Patients. C-4

C-6. Preventive Medicine Services C-5

C-7. Veterinary Services C-6

C-8. Dental Services C-6

C-9. Combat Operational Stress Control C-6

C-10. Medical Laboratory Services C-6

C-11. Health Service Logistics C-7

C-12. Homeland Security C-8

=APPENDIX D. MEDICAL PLANNING GUIDE FOR THE ESTIMATION OF
NUCLEAR, BIOLOGICAL, AND CHEMICAL BATTLE
CASUALTIES= D-1

=Section I. Introduction= D-1

D-1. General D-1

D-2. Medical Planners' Tool D-1

=Section II. Medical Planning Guide for the Estimation of
Nuclear, Biological, and Chemical Battle Casualties
(Nuclear)--AMedP-8(A), Volume I= D-1

D-3. General D-1

D-4. Medical Planning Considerations D-2

D-5. Triage D-3

D-6. Evacuation D-3

D-7. In-Unit Care D-3

D-8. Hospital Bed Requirements D-4

D-9. Medical Logistics D-4

D-10. Medical Force Planning D-4

=Section III. Medical Planning Guide for the Estimation of
Nuclear, Biological, and Chemical Battle Casualties
(Biological)--AMedP-8(A), Volume II= D-4

D-11. General D-4

D-12. Medical Planning Considerations D-6

D-13. Triage D-6

D-14. Evacuation D-6

D-15. In-Unit Care D-7

D-16. Patient Bed Requirements D-7

D-17. Medical Logistics D-7

D-18. Medical Force Planning D-8

=Section IV. Medical Planning Guide for the Estimation of
Nuclear, Biological, and Chemical Battle Casualties
(Chemical)--AMedP-8(A), Volume III= D-8

D-19. General D-8

D-20. Medical Planning Considerations D-10

D-21. Triage D-11

D-22. Evacuation D-11

D-23. In-Unit Care D-11

D-24. Patient Bed Requirements D-12

D-25. Medical Logistics D-12

D-26. Medical Force Planning D-12

=APPENDIX E. EXAMPLE X-__, ANNEX__, TO HSS PLAN/OPERATION
ORDER__, MEDICAL NBC STAFF OFFICER PLANNING
FOR HSS IN AN NBC ENVIRONMENT= E-1

=APPENDIX F. EMPLOYMENT OF CHEMICAL AND BIOLOGICAL
COLLECTIVE PROTECTION SHELTER SYSTEMS BY MEDICAL UNITS= F-1

=Section I. Introduction= F-1

F-1. General F-1

F-2. Types of Collective Protection Shelter Systems F-1

=Section II. Employment of the Chemically and Biologically
Protected Shelter System= F-2

F-3. Establish a Battalion Aid Station in a Chemically
Biologically Protected Shelter F-2

F-4. Division Clearing Station in a Chemically Biologically
Protected Shelter F-4

F-5. Forward Surgical Team in a Chemically Biologically
Protected Shelter F-6

=Section III. Employment of the Chemically Protected
Deployable Medical Systems and Simplified Collective
Protection Systems= F-8

F-6. Collective Protection in a Deployable Medical
System-Equipped Hospital F-8

F-7. Chemically/Biologically Protecting the International
Organization for Standardization Shelter F-11

F-8. Chemically/Biologically Protecting the Vestibules F-12

F-9. Chemically/Biologically Protecting Air Handler Equipment F-12

F-10. Establish Collective Protection Shelter Using the M20
Simplified Collective Protection System F-12

F-11. Casualty Decontamination F-12

=Section IV. Operations, Entry, and Exit Guidelines= F-13

F-12. Operations F-13

F-13. Decontamination of Entrance Area F-13

F-14. Procedures Prior to Entry F-14

F-15. Entry/Exit for the Collective Protection Shelter System F-14

F-16. Resupply of Protected Areas F-17

=APPENDIX G. PATIENT DECONTAMINATION= G-1

=Section I. Introduction= G-1

G-1. General G-1

G-2. Immediate Decontamination G-2

G-3. Patient Decontamination and Thorough Decontamination
Collocation G-2

G-4. Patient Decontamination at the Battalion Aid Station
(Level I) G-5

G-5. Patient Decontamination at the Medical Company Clearing
Station (Level II) G-5

G-6. Patient Decontamination at a Hospital (Level III and IV) G-5

G-7. Prepare Hypochlorite Solutions for Patient
Decontamination G-5

G-8. Classification of Patients G-6

G-9. Patient Treatment G-6

=Section II. Patient Decontamination Procedures= G-7

G-10. Decontaminate a Litter Chemical Agent Patient G-7

G-11. Decontaminate an Ambulatory Chemical Agent Patient G-14

G-12. Biological Patient Decontamination Procedures G-18

G-13. Decontaminate a Litter Biological Agent Patient G-18

G-14. Decontaminate an Ambulatory Biological Agent Patient G-19

G-15. Decontaminate Nuclear-Contaminated Patients G-20

G-16. Decontaminate a Litter Nuclear-Contaminated Patient G-21

G-17. Decontaminate an Ambulatory Nuclear-Contaminated
Patient G-21

=APPENDIX H. FIELD EXPEDIENT PROTECTIVE SYSTEMS AGAINST
NUCLEAR, BIOLOGICAL, AND CHEMICAL ATTACK= H-1

H-1. General H-1

H-2. Protection Against Radiation H-1

H-3. Expedient Shelters for Protection Against Radiation H-2

H-4. Expedient Shelters Against Biological and Chemical Agents H-5

=APPENDIX I. DETECTION AND TREATMENT OF NUCLEAR, BIOLOGICAL,
AND CHEMICAL CONTAMINATION IN WATER= I-1

I-1. General I-1

I-2. Detection of Contamination in Water I-1

I-3. Procedures on Discovery of Contamination in Water I-1

I-4. Treatment of Contaminated Water I-2

=APPENDIX J. FOOD CONTAMINATION AND DECONTAMINATION= J-1

J-1. General J-1

J-2. Protection of Food From Contamination J-2

J-3. Nuclear J-3

J-4. Biological J-4

J-5. Chemical J-5

=GLOSSARY= Glossary-1

=REFERENCES= References-1

=INDEX= Index-1

DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

[*] This publication supersedes FM 8-10-7, 22 April 1993. Change 1, 26 November 1996