Chapter XVII: Appendix: C

GUIDELINES FOR OPERATIONAL PLANNING FOR HEALTH SERVICE SUPPORT IN A NUCLEAR, BIOLOGICAL, AND CHEMICAL ENVIRONMENT

C-1. General

As the HSS unit prepares for its support role, NBC, TIM, and CBRNE considerations must be included. This appendix provides guidelines for HSS planning, preparing for, and conducting operations in an NBC environment and responding to a homeland defense CBRNE event.

C-2. Predeployment

When preparing the unit's mobilization plan and TSOP, include the supplies and equipment that will be required for the unit to operate in an NBC environment. DO NOT wait until ordered to mobilize to begin preparation for the mission. A well-prepared and trained unit stands a much better chance of surviving and accomplishing their assigned mission. At a minimum include the following:

· Nerve agent pretreatment and antidotes (see FM 8-285).

· Blister agent antidote/treatment (see FM 8-285).

· Incapacitating agent treatment (see FM 8-285).

· Lung-damaging agents (choking agents) treatment (see FM
8-285).

· Blood agent (cyanogen) treatment (see FM 8-285).

· Biological agent immunizations and chemoprophylaxis (see FM
8-284).

· Biological agent treatment (see FM 8-284).

· Nuclear and radiological treatment (see FM 4-02.283).

· Protective mask with hood for each individual (see FM 3-4).

· Replacement filters for protective mask (see FM 3-4).

· Two sets of MOPP per individual assigned to unit (see FM 3-4).

· All authorized radiation detection equipment.

· All authorized chemical agent detection equipment.

· All authorized NBC alarm systems.

· Biological agent detection equipment, if available.

· Sample/specimen collection, packaging, and shipping supplies
for suspect NBC agents.

· Decontamination equipment and supplies (DS2, STB, pails,
sponges, mops, decontaminant application apparatus, individual
skin decontamination kits, and individual equipment
decontamination kits [see FM 3-5]).

· Material for covering supplies and equipment (such as plastic
sheeting, tape, and tarpaulins).

· Material for preparing improvised protection in shelters
(such as plastic sheeting, tarpaulins, tape, and sandbags).

· Collective protection shelter systems with repair parts, if
available.

· Chemical agent patient decontamination Medical Equipment Set
(MES). The MES can also be used to decontaminate nuclear and
biological patients, if authorized.

· Chemical agent patient treatment MES. Some components may
also be used to treat nuclear and biological patients, if
authorized.

· Water supply for patient decontamination, if required.

· Shovels, picks, and axes.

· Lightweight decontamination system M17 and other
decontamination apparatuses.

· Applicable references (Army Regulations [ARs], Joint
publications, FMs, technical manuals [TMs], training circulars
[TCs], and TSOPs).

C-3. Mobilization

During mobilization the unit must ensure that all supplies and equipment are on hand and are serviceable. Commanders and leaders must also ensure that--

· Movement plans are prepared.

· Transportation support requirements are identified and
requested.

· Load plans include provisions for the transportation of NBC
supplies and equipment (medical and nonmedical).

· A MOPP level has been established for the movement, if
applicable.

· A checklist of training shortfalls is prepared and a training
plan is in place.

C-4. Establish a Medical Treatment Facility

Plans for establishing a BAS, DCS, or FST for operating in a NBC environment must include employment of CBPS systems. When establishing a hospital using Deployable Medical Systems (DEPMEDS), the chemically protected (CP) DEPMEDS must be set up as the conventional shelters are being set up. Once the conventional shelter has been set up and is operational, CP DEPMEDS cannot be established without first taking down the existing shelter. Follow the technical manual provided with the CP DEPMEDS system issued to your unit. Plans for operating a DEPMEDS equipped hospital in the NBC environment should include, but not be limited to--

· Coordinating with the supported unit to ensure unit casualty
collecting points and patient decontamination points are on the
HSS template. If possible, integrate HSS units/elements into
local units NBC detection systems and communications systems.

· Surveying the AO. Survey the area to ensure contamination is
not present before establishing the MTF.

· Establishing detection stations on the unit's perimeter.

· Determining direction of prevailing wind. All contaminated
patients, ambulances, and helicopters must arrive on the
downwind side of the MTF; this must be done with or without CPS.

· Setting up the contaminated triage, patient decontamination,
and contaminated treatment areas (including overhead cover).

· Establishing the contaminated ambulance point.

· Establishing the contaminated helicopter landing area.

· Preparing the contaminated waste dump.

· Establishing the clean ambulance point.

· Establishing the clean helicopter landing area.

· Marking the hot line and preparing the shuffle pit.

· Employing CP DEPMEDS system (close shelter, turn on CB
filtration units, close air locks, and maintain overpressure),
if available.

· Establishing the clean treatment area 30 to 50 yards (meters)
upwind of hot line, when CPS is not available.

· Ensuring provisions for overhead cover at the patient
decontamination area.

· Requesting patient decontamination personnel from supported
units for the BAS and DCS, or from units located within the
geographic area for hospitals.

· Requesting issue of chemical patient treatment and chemical
patient decontamination MESs, if not on-hand.

· Establishing contamination monitoring procedures in CPS.

· Establishing control procedures for personnel crossing the
hot line (through the shuffle pit).

· Establishing CPS entry and exit control procedures (see
Appendix F).

· Making improvisations; if the MTF must operate in a
nuclear/radiological environment. For optional improvisations,
see Appendix H.

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

Individuals should have decontaminated themselves or have been decontaminated by unit personnel; however, an MTF must plan for and be prepared to receive contaminated patients. The patients may not have been decontaminated at the unit, or they may have become contaminated en route to the MTF. Selected CSHs may be designated as the primary NBC MTF and be augmented with additional supplies and medical staff. When designated as such, plans must be prepared designating the location of the CSH that can best support the forward deployed MTFs. All actions listed in paragraph C-4 must be taken. During operations, actions that must be taken are--

· Establishing a MOPP level commensurate with the operation.

· Requiring all ambulances and helicopters with contaminated
(or suspected) patients to stay downwind of the MTF.

· Conducting initial triage, decontamination, and contaminated
treatment downwind of the clean treatment area (Appendixes F
and H).

· Ensuring all personnel crossing the hot line are
decontaminated.

· Monitoring personnel entering clean area to ensure that they
are contamination free.

· Monitoring for contamination in the clean treatment area
(with or without CPS).

· Establishing an internal monitoring program to periodically
verify that the MTF is contamination free.

· Monitoring CPS for entry of contamination.

· Providing protection for patients if contamination enters the
MTF.

· Ensuring personnel drink sufficient quantities of water to
prevent heat injury (see FM 21-10).

· Providing protection for personnel and patients in a
cold environment. Use sheltered/heated area for patient
decontamination.

· Providing protection of personnel and patients in a hot
environment.

· Controlling contaminated waste.

· Isolating biological agent patients, if necessary, to control
spread of agent/disease (see FM 8-284).

· Protecting supplies and equipment from contamination.

· Providing medical resupply to clean areas.

· Providing food service for personnel and patients in CPS.

· Providing latrine facilities in CPS.

· Providing drinking water in CPS.

· Providing waste disposal support. Remove waste from the CPS
at least two times dally. More frequently if large amounts are
collected or if odors become a problem.

· Collecting suspect BW agent specimens from patients.
Packaging, preparing chain of custody document, and shipping
specimens to supporting medical laboratory.

C-6. Preventive Medicine Services

Plans for providing preventive medicine services must include monitoring water supplies for contamination. To perform this mission, equipment and supplies must be available and operational. Essential equipment and supplies include--

· Radiation detection equipment such as AN/PDR77, AN/PDR27,
AN/VDR2.

· Preventive Medicine Water Quality Control Set.

· M272 Chemical Agent Detection Set.

· Biological sample collection kit, shipping containers,
refrigerant, and chain of custody forms.

C-7. Veterinary Services

Plans for veterinary services must include provisioning for treatment to government-owned animals and quality control of food supplies. To perform their mission, essential supplies and equipment include--

· Treatment for NBC injured animals. Especially, antidotes and
treatment for CB agents.

· Radiation detection equipment.

· M272 Chemical Agent Detection Set.

· Biological sample/specimen collection kit, shipping
containers, refrigerant, and chain of custody forms.

C-8. Dental Services

Most dental services at the dental treatment facilities will have to be suspended in NBC contaminated areas due to a lack of CPS. Plans must include for emergency dental services to be provided in a clean area or in an MTF with a CPS. Essential supplies and equipment include--

· Dental treatment set for maxillofacial injuries.

· Material for covering and protecting supplies and equipment.

C-9. Combat Operational Stress Control

Although specific supplies and equipment are not required for COSC, plans must be prepared to provide these services under NBC conditions. The COSC staff must locate clean areas to conduct COSC activities or manage the COSC patients in a MOPP level commensurate with the command MOPP guidance.

C-10. Medical Laboratory Services

Planning for medical laboratory support must include plans for conducting analysis on suspect NBC samples/specimens. Designated supporting medical laboratories must be prepared to analyze and provide confirmation/identification on specimens/samples of suspect NBC agents from humans, water sources, food supplies, and the environment (air and soil). The samples/specimens may be collected by MTF personnel, chemical corps personnel, PVNTMED personnel, veterinary personnel, or other services personnel. To perform this mission, supplies and equipment should include--

· General supplies and equipment.

· Biological sample/specimen collection kits and supplies. To
provide capabilities for others to collect samples/specimens
(in the event that they do not have these items otherwise
available).

· Biological test kits or apparatus.

· Microbiology services.

· Immunology/serology MES.

· Microbiology MES.

· Laboratory, general MES.

· Veterinary services.

· Laboratory, veterinary MES.

· Veterinary postmortem field MES.

· Preventive medicine services.

· Water, biological sampling and analysis supplies and
equipment.

· Radiation protection MES.

· Entomology MES.

· Alpha/beta detectors.

· Microscope, phase.

· Ambient air analyzer.

· Epidemiology MES.

C-11. Health Service Logistics

Plans must include health service logistics support to continue under NBC conditions. To continue this role, all supplies must be protected from contamination. Materials required include--

· Detection equipment.

· Plastic sheeting.

· Tape.

· Tarpaulins.

· NBC detection equipment such as, M8 chemical agent detection
paper, M9 chemical agent detection tape, radiation detection
equipment, and biological agent sample/specimen collection
supplies.

NOTE

This guideline contains items that are required specifically
for HSS operations in an NBC environment. The items are in
addition to supplies and equipment required for conventional
operations. This guideline is not all inclusive, but is
a starting point for HSS units to develop their specific
guidelines.

C-12. Homeland Security

Health service support units and installation medical activities/centers must be prepared to provide support in the event that CBRNE are used on the United States. Medical commanders and leaders should develop plans on how the provision of medical support will be provided to a CBRNE event. The plan should include, but not be limited to--

· Number and type of units required to respond.

· Medical equipment and supplies required.

· Personal protective equipment required for medical response
personnel.

· Time required to prepare unit/personnel to respond.

· Length of time response support is required.

· Sources for food, shelter, local transportation, and resupply
of expended or lost equipment and supplies.

APPENDIX D

MEDICAL PLANNING GUIDE FOR THE ESTIMATION OF NUCLEAR, BIOLOGICAL, AND CHEMICAL BATTLE CASUALTIES