VOLUME I
D-3. General
_a._ Volume I of the guide provides estimates of casualties and remaining operational strength after a nuclear detonation in a brigade-sized unit during an out-of-area contingency operation. These estimates include the numbers, injury type (initial nuclear radiation, blast, and thermal injuries), and injury severity of nuclear patients based on several brigade scenarios. The scenarios include three different brigade-sized units, in warned or unwarned posture, which have single detonation of 5, 20, or 50 KT in the unit area.
_b._ The guide is organized into 10 sections. Section 1 introduces the guide and presents background and medical planning considerations. Section 2 provides information on the methodology used to develop the estimates of fatalities, casualties, and effectiveness of individuals remaining in the unit. Section 3 explores the use of the casualty prediction tables based on combat effectiveness decrements and estimates of the number of casualties categorized by insult level. Sections 4 through 10 contain tables of casualty estimates.
_c._ A sample of this information is graphically depicted in Tables 1-1 and 1-2 of the guide. The casualty estimates used to prepare these tables are presented in the guide as Tables 6-4 and 10-4 in Sections 6 and 10 respectively. The use of these tables is explained in paragraphs 3.1 through 3.6 of the guide. Paragraphs 3.7 and 3.8 of the guide discuss how to use the guide for situations not explicitly addressed.
_d._ The effects of residual radiation on personnel are not included in the guide. AMedP-6 and AMedP-7 provide information on planning, operations, and treatment for a residual radiation situation. Also not included is the impact of tumbling; impact of glass shards from windows of vehicles or buildings; crushing deaths from building failure; or COSC casualties; thus causing underestimations on the number of patients. Further, there will be personnel who get radiation doses or burns and do not seek medical care.
_e._ A nuclear detonation may introduce new levels of destruction to the battlefield. There is very little experience with nuclear effects and there is certainly no experience with these weapons on a modern, highly technological battlefield. Therefore, there is little historical data on which to base estimates of personnel injured. Computer simulations are generally used to estimate numbers of personnel injured. Although these estimates may include significant uncertainty, they provide the best estimates to date.
D-4. Medical Planning Considerations
_a._ 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. In a nuclear environment, this may not be true, and consideration must be given to the increased need for medical support that would result from a high incidence of burn patients.
_b._ Prior to an attack, the data may be used by medical planners to augment the requirements for conventional combat as appropriate for the nuclear situation. The tables can be used to prepare estimates of the number of patients at all echelons.
_c._ After an attack, the effectiveness and adequacy of the medical support effort during the first 24 hours are critical. Commanders should be informed rapidly of the estimated medical load in order to provide rescue and treatment resources or request assistance from higher headquarters, adjacent units, or allied units. These estimates should be updated postattack based on aerial or ground reconnaissance and survey.
_d._ In addition to casualties, a nuclear weapon detonation can generate an EMP that may cause catastrophic failures of electronic equipment components and may adversely affect the capability of all units in the area of the detonation. Electromagnetic pulse has no direct effect on personnel and is not further addressed in this publication.
D-5. Triage
Since a nuclear detonation may produce mass casualties, plans for a triage system must be in place. Paragraphs 3.4 through 3.5 of the guide describe patient categories by injury severity and may be used to estimate the number and injury severity of patients for a particular operational scenario. The guide does not, however, provide estimates of the number of patients by triage classification.
D-6. Evacuation
_a._ An efficient and flexible evacuation plan is absolutely essential for the preservation of life and to retain the mobility of forward medical resources. In a potential mass casualty situation, the full range of evacuation assets should be considered.
_b._ The extended hospital time of nuclear casualties will influence levels of evacuation or hospitalization. In addition, estimates of the different types of casualties can be a consideration in evacuation planning. In planning for evacuation, estimates provided in the guide can be used as a starting point from which to estimate evacuation resources.
D-7. In-Unit Care
_a._ Some personnel within the military unit may not be classified medically as casualties, but will require some self-aid and buddy aid. A casualty is defined as anyone entering the medical system. Paragraph 2.5 of the guide further describes the basis for casualty calculation.
_b._ Nuclear detonations will produce a large number of blast, burn, and projectile injuries that initially must be treated by individual soldiers trained in first aid procedures. The physical damage to the surrounding area as a result of a nuclear detonation will increase delays in medical assistance and evacuation. Training in self-aid/buddy aid will improve casualty survival rates and conserve medical resources. The guide can be used to provide a conservative estimate of the numbers of injured that will require first aid. The tables in Sections 4 through 10 of the guide, showing the status of unit personnel by time period, can be used to indicate the numbers of personnel who are injured (but not casualties) who may require first aid.
D-8. Hospital Bed Requirements
The data provided in the guide can be used to determine immediate additional bed requirements resulting from a nuclear detonation. In addition to the numbers of patients who will need beds, the data provided in the guide can also indicate the increased hospitalization time of nuclear casualties. Long-term bed requirements, greater than 30 days, are not provided. Based on the theater evacuation policy specified for the operation, the hospital bed days may be in theater or in CONUS.
D-9. Medical Logistics
The data provided in the guide can assist in estimating the needed supplies. The supply system must be prepared for increased demands for certain types of medical and general supplies and equipment, kits, dressings, and antibiotics. The treatment of combined injuries will not require any special types of supplies, although demands for certain types of supplies will increase.
D-10. Medical Force Planning
The assignment of medical support is normally based upon the total military population and the expected conventional casualty rate. The data provided in the guide may be used to assess the requirement for additional medical units. The planning guidance presented in this document can (and should) be modified to reflect the needs of the anticipated operation, including operational tempo, national/coalition priorities, medical resource allotment, and so forth. When trying to augment personnel, consider that the use of a nuclear weapon in a tactical situation could be an indication of an increased tempo of warfare. Therefore, even though a unit may be targeted with a nuclear detonation, that unit may not be the site where the highest numbers of casualties are being produced, and another unit may have priority of support.
+--------------------------------------+ | This Section Implements STANAG 2476. | +--------------------------------------+
Section III. MEDICAL PLANNING GUIDE FOR THE ESTIMATION OF NUCLEAR, BIOLOGICAL, AND CHEMICAL BATTLE CASUALTIES (BIOLOGICAL)--AMedP-8(A), VOLUME II
D-11. General
The guide, AMedP-8(A), Volume II, provides estimates of casualties, and remaining operational strength, after single BW attacks on tactically deployed, brigade-sized land force units, offshore naval and marine forces, and selected strategic targets in rear areas. These worst-case casualty estimates are for personnel within both the targeted and the downwind hazard areas of the attacked forces. They assume that all affected personnel will be unsheltered and unwarned. To further estimate worst-case outcomes, the guide assumes that exposed individuals have not been vaccinated against any of the evaluated agents, nor have they undergone any type of medical prophylactic treatment prior to exposure. The tables included in the guide are designed to show numbers of expected casualties; expected fatalities; personnel at different performance levels; and times after exposure. In selected scenarios, the guide provides a method for estimating casualties among collocated civilians based on local population density.
_a._ The guide presents casualty estimates for all possible combinations of the following conditions:
· Eleven operational scenarios.
· Seven biological agents.
· Four types of delivery systems.
· Three attack intensities.
_b._ The guide is subject to limitations of extent and content. Since there are many more possible attack variables than those considered, the guide presents a limited number of estimates and provisional guidance for estimating cases not modeled. These estimates are based upon the best available medical data, but such data result in qualified estimates. Therefore, for more authoritative medical descriptions, medical planners and staff personnel should use FM 8-9, NATO Handbook on the Medical Aspects of NBC Defensive Operations, AMedP-6(B), Part II--Biological. Users of the guide must amplify or modify these estimates to meet emergent requirements such as injuries resulting from combined biological and conventional attacks.
_c._ Computer models that integrate available information have been used to predict the effects of future biological attacks. These resultant estimates may include substantial uncertainties when applied to specific situations. However, they provide the best estimates available to date.
_d._ The guide is also organized into 10 sections. Section 1 introduces features of the guide, and then presents background and medical planning considerations. Section 2 provides information on the methodology used to develop the estimates. Section 3 describes how to use the tables presented in the guide. Sections 4 through 10 of the guide contain tables of casualty estimates, with one section for each of the seven biological agents.
_e._ Biological attacks are likely to have a significant impact on the medical system. As detailed elsewhere in the guide, victims may number in the hundreds or even thousands. Demand for medical care may quickly overwhelm available resources; this problem will be exacerbated if medical personnel themselves become victims of the attack. Local civilian populations will be victimized as well, limiting host-nation support and potentially adding to the demands on the military medical system.
_f._ A variety of medical responses to BW attacks are available, depending on the agent used and whether medical countermeasures are employed prior to attack or after exposure has already occurred. For many agents, immunization or pre-exposure prophylaxis with antibiotics may prevent illness in those subsequently exposed. After exposure, disease can often be prevented or ameliorated via immunization and therapeutic use of antibiotics, antiviral drugs, and hyperimmune gammaglobulins.
D-12. Medical Planning Considerations
_a._ Effective mass casualty management requires careful planning. The guide is designed to support such planning by providing medical planners and staff personnel with a systematic means for estimating the number of biological casualties. However, casualty management also involves practice of self-aid and buddy aid, on-site triage and emergency care, decontamination, transport to medical facilities, infection control measures, communications, health services, logistics, and evacuation by ground or air transportation.
_b._ Medical requirements resulting from attacks with biological agents may be substantially different from those resulting from conventional, nuclear, or chemical combat. There would be no indication of the presence of biological agents in most tactical situations. Units downwind from an attack area may be unexpectedly exposed to biological agents. In some cases, there will also be a risk of secondary infection and subsequent epidemics amongst troops and/or the local population. Additionally, use of biological agents may generate reservoirs within the local animal population that may serve as a further source of infection.
_c._ 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.
D-13. Triage
_a._ Since a biological attack may produce mass casualties, preparations for a triage system should be in place before the attack. Paragraph 3.3.8 of the guide describes patient categories by illness severity. For a particular described operational scenario, this information may be used to estimate the number of patients with specified levels of illness. The guide does not provide estimates of the number of patients by triage classification or usual medical descriptions.
_b._ Decontamination of patients must be considered before further evacuation.
D-14. Evacuation
_a._ An efficient and flexible evacuation plan is essential for adequate casualty treatment and to retain mobility of forward medical resources. For an assessment of a potential mass casualty situation, the medical planner should consider the full range of evacuation assets, limitations, and obstacles. After an attack, the medical staff may need to estimate the number of casualties that could require evacuation at given postexposure times.
_b._ Evacuation requirements will vary with the type of biological agent used. Casualties resulting from some agents may not be evacuated because the time course of effects is relatively short. For others, like botulinum toxin, casualties may require evacuation to a facility where they can receive care for weeks or even months. Estimates provided in the guide can be used as a starting point from which to plan for evacuation resources, including those required for decontamination of personnel and transportation assets.
D-15. In-Unit Care
The casualty estimates in the guide are presented without allowance for in-unit care. However, there may be need for rapid intervention. Delays in obtaining medical care may occur because of physical damage or contamination of the surrounding area. Soldiers trained in first aid procedures may be the first to provide aid to biological agent casualties. The guide provides a conservative estimate of the numbers of exposed personnel who will require first aid. The tables described in paragraphs 3.3.2 through 3.3.4 of the guide give the time courses of effects that may apply to estimation of in-unit care and delayed medical requirements.
D-16. Patient Bed Requirements
Bed requirements can be estimated using the tables described in paragraphs 3.3.2 through 3.3.4 of the guide. The latter type of table is useful after an attack since it shows gains and losses of casualties over time. The type of table described in paragraph 3.3.5 of the guide may be more useful for long-range planning. It shows maximum numbers of personnel by illness severity category. The tables in the guide only provide estimates for the first 35 days after attack. Based on the theater evacuation policy specified for the operation, hospital days may be in theater or in the national area.
D-17. Medical Logistics
_a._ The estimates provided in the guide are intended to support projections of medical materiel and logistical requirements. Increased demands may occur for certain types of medical and general supplies, including equipment, kits, antibiotics, disinfectants, and other critical medical materiel. Demands may also increase for items unique to the prevention and treatment of biological agent casualties, such as vaccines, antibiotics, and antisera, as well as items adapted to contaminated environments. Tables showing maximum numbers of personnel by illness severity category can provide useful input for logistical planning.
_b._ 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 diseases.
D-18. Medical Force Planning
_a._ The assignment of medical support is normally based upon the total military population and the expected conventional casually rate. The guide may be used to assess requirements for additional medical units.
_b._ 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.
+--------------------------------------+ | This Section Implements STANAG 2477. | +--------------------------------------+
Section IV. MEDICAL PLANNING GUIDE FOR THE ESTIMATION OF NUCLEAR, BIOLOGICAL, AND CHEMICAL BATTLE CASUALTIES (CHEMICAL)--AMedP-8(A),