1. Purpose. This chapter provides medical support considerations for planning and conducting joint NBC defense operations.

2. Overview. Medical support for NBC defense operations will be performed during any phase of military operations. The combatant commander should plan for these medical aspects in the portions of campaign plans and orders that address NBC defense in the theater.

3. Health Service Support (HSS). HSS remains a Service responsibility, as outlined in Joint Publication 4-02, "Doctrine for Health Service Support in Joint Operations." As more nations develop and use WMD, the probability of US forces encountering these weapons will increase. Medical planning is one aspect of meeting this challenge. Because of the large number of casualties resulting from the use of such weapons, and the special handling required that can drain medical resources, the combatant commander must plan to use directive authority to ensure the proper coordination of health service to the force, to include adequate shelter, food, medical prophylaxis, and fluids.

4. Medical Intelligence. Armed Forces Medical Intelligence Center (AFMIC) can assist in the theater threat assessment by evaluating the state of a potential adversary's BW effort. Tactical medical intelligence units conduct investigations of disease resulting from suspected enemy biological agent employment and can provide limited analysis of enemy drugs, serums, and antibiotics. It is instrumental in gathering data from the various medical units and nonmedical units. The importance of medical alertness cannot be overemphasized.

5. Preventive Medicine Principles. In an NBC environment, preventive medicine services will be in great demand. There is a possibility that many deaths would occur if an effective biological agent attack occurred. Demands for military medical support to both military and civilian populations will probably be intense. Preventive medicine personnel must assist the commander in determining the health hazards associated with nuclear fallout and biological contamination, such as safe food and water sources, and in determining when to use prophylaxis, immunization, and other preventive measures associated with NBC warfare. Preventive medicine personnel must be aware of the NBC threat in the theater and continually update the informational data base on diseases, potential disease vectors, and the susceptibility of troops to these diseases. In NBC conditions, diseases known to exist in the area may be manifested but not transmitted to our forces. The appearance of a disease or vector not known to exist in the theater is an indication that biological warfare agents are being introduced into the area. Following an effective NBC attack, the application of general preventive medicine principles will be important.

6. Patient Evacuation. Forward evacuation within the combat zone is normally the responsibility of the respective component command using organic Service-assigned assets, e.g., Army, Marine, Navy, SOF fixed- and rotary-wing aircraft. Air Force fixed-wing aircraft with specialized aeromedical evacuation crews can assist with forward evacuation if the terrain, distance, and other related factors are not conducive to using organic assets. Movement of patients within the theater is the responsibility of the theater combatant commander. USCINCTRANS is responsible for establishing, operating, training, and maintaining the common-user aeromedical evacuation system for movement between theaters and from theaters to CONUS. An NBC environment forces the commander to consider to what extent he/she will commit evacuation assets to the contaminated area. If a task force is operating in a contaminated area, most of the medical evacuation assets will be operating there. There are three basic modes of evacuating casualties (personnel, ground vehicles, and aircraft) in the combat zone. Cumbersome MOPP gear, climate, increased workloads, and fatigue will greatly reduce personnel effectiveness. When evacuation personnel are sent into a radiologically contaminated area, the operational exposure guide (OEG) must be established. Based on the OEG, commanders decide which evacuation assets will be sent into the contaminated area. Every effort will be made to limit the number of evacuation assets that are contaminated. To ensure contamination of evacuation assets is limited, patients should be decontaminated before transport.

7. Patient Decontamination and Triage. The management and treatment of contaminated casualties will vary with the tactical situation and the nature of the contaminant. Each medical unit must have a plan that can be put into effect immediately. Decentralization is necessary-- casualties must not be forced to wait at a central point for decontamination. All medical units should have comparable sets of medical items and decontamination equipment for treatment of contaminated patients originating in their area. Decontamination of the patients serves two purposes: a. It prevents the patient's system from absorbing additional contaminants and b. It protects medical personnel treating the patient and other patients from contamination.

8. Medical Facilities. Because of the medical unit location, threat capabilities, and the unique aspects of NBC operations, the following factors must be considered:

9. Impact on Health Services Support. The contaminated battlefield will be a difficult environment in which to operate. Stress from MOPP, reduced visual and tactile senses from protective equipment, reduced communication capability, and a sense of isolation are all detrimental to military operations. The HSS system has several unique aspects that must be considered.

10. Special Medical Augmentation for Operations in an NBC Contaminated Environment. Decontamination operations are extremely resource intensive. It is unrealistic to expect that medical personnel will be able to manage both medical treatment and decontamination of patients. For this reason, plans must address how decontamination will be accomplished. Augmentation to provide decontamination support must also be addressed in planning.

07-10-1996; 10:42:28