_b. Detection.__Health Service Support in a Nuclear, Biological, and Chemical Environment Tactics, Techniques, and Procedures

(1) Rapid identification of agents used is absolutely essential

to implement effective countermeasures. Agent identification

must be achieved quickly; it is the first step in answering

critical management questions. What adjustments must be made

in food preparation and distribution? What are the essential

countermeasures? What is the expected outcome of the incident?

(2) Samples of food that are suspected of being contaminated

are transported to the designated supporting laboratory.

Samples must be accompanied by a description of the samples,

the sample collection procedures, and the circumstances, which

prompted the collection. The designated medical laboratory in

the TO will provide a field confirmation identification of the

agent(s). Designated CONUS laboratories accomplish definitive

identification. See Appendix B for sampling procedures.

NOTE

New biological detection equipment is under development that

will enable units to conduct presumptive identification of

biological warfare agents. However, samples must also be

collected and processed as described in Appendix B.

_c. Decontamination._

(1) Food contaminated with toxins is handled in the same manner

as food contaminated with chemical agents. Food contaminated

with microorganisms is handled in the same manner as when

contaminated with the more common foodborne disease-producing

microorganisms.

(2) Several methods are available to decontaminate food

items contaminated with biological agents. The following

decontamination methods are considered to be the minimum. See

Table J-1.

(3) Group II food that is sealed in containers that are

resistant to the passage of biological agents requires

only that the exterior of the container be decontaminated.

Decontamination of these items is as follows:

(_a_) For containers made of metal, glass, plastic, or

porcelain:

_1._ Thoroughly wash the container in potable water and soap,

or in a disinfectant solution. If the water used for washing is

contaminated, the soap and water wash may increase, not reduce,

the contamination hazard. After which, the food containers are

immersed in a disinfectant solution for 30 minutes (see Table

J-3); then rinsed with potable water, if available and time

permits. Chlorine solutions are not as reactive or corrosive as

DS2.

_2._ Place the containers in boiling soapy water for 15

minutes; then rinse with potable water.

NOTES

1. The chemical field decontamination kits do not meet the

requirements to decontaminate food supplies exposed to

biological agents.

2. The same procedures should be followed even if there is

only suspicion of a biological warfare attack.

(_b_) Thoroughly wipe containers that will not withstand

soaking with a cloth soaked in a chlorine detergent solution.

Remove the food from the container and place it in Group III.

(_c_) Metal or glass containers determined to have

trichothecenes (Yellow Rain) present can be decontaminated

using DS2. Allow a contact time of 5 to 30 minutes for the DS2

to neutralize the toxin. Then rinse the container with potable

water.

(4) Group III food items that are not protected by the

packaging material are decontaminated or disposed of as follows:

(_a_) Decontaminate foods that can be peeled or pared by

immersing them in a disinfectant solution for 30 minutes, and

then rinsing them with potable water (see Table J-3). Peel

or pare the items after decontamination, then wash and, if

appropriate, cook before eating.

(_b_) With the exception of certain heat-stable toxins, heat

is the most practical means of decontaminating food. Several

heating methods may be used, but the method chosen depends upon

the type of food to be decontaminated. The key is to apply as

much heat as possible without rendering the food unfit.

_1._ Cook in a pressure-type cooker with 15 pounds of pressure

at 250°F (121°C) for 15 minutes.

_2._ Cook in a low-pressure cooker at 228°F (109°C) for 1 hour.

_3._ Bake bread or related items at 400°F (204°C) for 40

minutes.

+------------------------------------------------------+

| CAUTION |

| |

| Bread made with toxin-contaminated flour (especially |

| with trichothecenes) is still toxic. |

+------------------------------------------------------+

_4._ Bake or roast meat at 325°F (163°C) for 2 hours.

_5._ Boil for at least 15 minutes when no other method is

available.

(_c_) Although decontamination methods are provided above,

vegetables such as lettuce, broccoli, and cauliflower, or

unwrapped meats that have been exposed to biological agents

should not be eaten.

(_d_) Foods, such as butter, ice cream, and bread that will not

withstand any of the above treatments must be destroyed.

(5) Established meat inspection procedures are followed when

animals exposed to biological agents must be used for food. The

meat must be thoroughly cooked.

_Table J-3. Chlorine Solutions for Decontamination of Biological

Warfare Agents_

============================================================

CHLORINE | MIXTURE TO PRODUCE 200 PPM

SOURCE | SOLUTION OF AVAILABLE CHLORINE

-------------------------+----------------------------------

HOUSEHOLD BLEACH | 1/2 GAL/25 GAL WATER

HIGH-TEST HYPOCHLORITE | 1/2 LB/25 GAL WATER

(CALCIUM HYPOCHLORITE) |

SUPERTROPICAL BLEACH | 1 LB/25 GAL WATER

============================================================

J-5. Chemical

_a. Contamination._

(1) 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.

Field concentrations of phosgene, hydrocyanic acid, irritants,

and smokes will seldom be high enough to cause serious food

contamination. The effect of CK on food is not known. As a

precaution, foods exposed to CK should be considered toxic.

(2) The effects of chemical agents on food depend on the nature

of the agent and the type of the food. The extent to which

chemical agents penetrate food also depends on the amount, form

of dispersal (liquid [droplet size], or vapor) and duration of

exposure. Nerve agents and mustard will penetrate deeply into

unprotected fatty foods and will readily penetrate granular

products such as grain and sugar. Liquid food products can

be completely contaminated. Arsenicals readily hydrolyze to

poisonous arsenical oxides in some foods. Foods can be divided

into three categories based on their water content, fat

content, and crystalline structure:

(_a_) Foods having a high water content, a low fat content,

and/or a crystalline structure (fresh vegetables, fruits,

sugar, salt, and eggs) will absorb mustard and nerve agents,

either as a liquid or as a vapor. Nerve agents will be

hydrolyzed slowly.

(_b_) Foods having a low fat content and an irregular

(amorphous) structure (flour, bread, grain, rice, cereals,

dried fruits, dried vegetables, tea, coffee, peas, and beans)

readily absorb mustard and nerve agents in liquid form. As a

vapor, these agents are absorbed to some extent, but are easily

removed by airing.

(_c_) Foods having a low water content and a high fat content,

such as butter, fat, fatty oils, ham, cheese, milk, bacon,

fatty meat, and fish, absorb mustard and nerve agents such that

removal of the agents is virtually impossible.

(3) 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.

(4) 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. Table J-5 summarizes the

protection values of various packaging materials against vapors

and liquids.

(_a_) Operational rations are substantially protected while

contained in the shipping cases and especially if stored in the

original palletized unit load with an overlay of fiberboard,

shrink wrap, or film wrap. The worst case is pallets of

subsistence contaminated by liquid droplets during an attack.

After the attack, high vapor concentrations will exist in the

vicinity of the palletized loads. If the outer barrier is

permeable such as fiberboard, it is possible that a liquid

agent can seep through the overlay fiberboard and contact the

shipping containers in liquid form. Normally, with seepage

resistant materials, such as shrink wrap as the outer barriers,

only the vapors of the agent are found within the pallet.

(_b_) While MREs are stored, the food is protected by up to six

layers of material. Multilayer barriers result in a complex

diffusion process of the agent from the outside towards the

interior. Vapor penetration into nonhermetically sealed spaces

is a simple gaseous diffusion process. Permeation through

packaging is a much more complex process regardless of whether

the challenge is a liquid or a vapor.

_1._ Liquid is adsorbed into permeable materials such as

fiberboard or chipboard. With permeation-resistant materials

(such as shrink wrap), the agent dissolves into, seeps through,

and then desorbs from the barrier material. Shrink wrap

provides adequate protection. Fiberboard sheathing provides

adequate protection against mustard agents, but not against

nerve agents.

_2._ The low-density polyethylene used to construct the menu

bag can absorb chemical agents and possibly toxins. If the menu

bag is removed from the shipping container and is exposed to

liquid contamination, enough agent may pass through the bag to

create a health hazard. Keep MREs in the shipping container

until issued to the soldier. The menu bags should then be kept

under the same degree of protection as the soldier.

_3._ The aluminum-laminated materials used to construct the

MRE (retort and nonretort) pouches protect food from chemical

contamination if hermetically sealed. The only item in the MRE

meal bag that is not adequately protected is the spoon.

(5) Mylar and cellophane are resistant to chemical agents.

_Table J-4. Effects of Chemical Agents on Food_

=======================================================================

| INFLUENCE ON |

+--------+-------+-----------------------+ RESIDUAL

AGENT | TASTE | SMELL | COLOR | TOXICITY

----------------+--------+-------+-----------------------+-------------

MUSTARD | BAD | BAD | DISCOLORS MEAT | +

N-MUSTARDS | BAD | BAD | DOESN'T DISCOLOR MEAT | +

ARSENICALS | ACID | BAD | DISCOLORS MEAT AND | +, ARSENIC

| | | VEGETABLES |

NERVE AGENTS | BAD | NONE | NONE | +

PHOSGENE | ACID | NONE | ? | - AFTER

| | | | WEATHERING

CYANOGEN AGENTS | BITTER | BAD | NONE | - AFTER

| | | | WEATHERING

IRRITANTS | ACID | BAD | NONE | +

SMOKE | ACID | BAD | ? | -

WHITE | ? | ? | ? | +

PHOSPHOROUS | | | |

----------------+--------+-------+-----------------------+-------------

+ INDICATES THE PRESENCE OF RESIDUAL TOXICITY.

- DENOTES THAT RESIDUAL TOXICITY IS NOT PRESENT.

? THE INFLUENCE HAS NOT BEEN DETERMINED.

=======================================================================

_Table J-5. Protection from Chemical Contamination by Packaging

Methods and Materials_

======================+=================+=============

| CHEMICAL VAPORS | LIQUIDS

----------------------+-----------------+-------------

=BOTTLES AND CANS= | |

| |

AIRTIGHT BOTTLES | COMPLETE | COMPLETE

SEALED METAL CANS | COMPLETE | COMPLETE

GLASS BOTTLES | GOOD | GOOD

METAL CONTAINERS | GOOD | GOOD

| |

=BOXES= | |

| |

CARDBOARD | MODERATE | MODERATE

WOODEN CRATES | MODERATE | POOR OR NONE

| |

=WRAPPINGS= | |

| |

METAL FOIL LAMINATES | COMPLETE | COMPLETE

PAPER | POOR | NONE

TEXTILES | NONE | NONE

WAXED PAPER | GOOD | MODERATE

MULTILAYER BAGS | GOOD | MODERATE

CELLOPHANE | GOOD | GOOD

CELLOPHANE, WET | NONE | NONE

CANVAS | POOR | POOR

======================+=================+=============

_b. Detection._

(1) 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; the integrity of the

packaging material; the protective qualities of the packaging

material; and the penetration characteristics of the suspected

chemical agents.

(2) Food may become toxic without any change in outward

appearance. Never taste or smell food to determine if

contamination is present in food.

(3) Veterinary and subsistence units have the following

equipment available to detect chemical agents in the field:

(_a_) The M8 Automatic Chemical Agent Alarm System consists

of the M43 detector unit and the M42 alarm unit. The detector

unit is a portable, automatic, point-monitoring device that is

designed to be hand carried from point to point. The M8 is used

to provide early warning of a toxic agent position and detects

the presence of chemical vapors and aerosols. The M43 detects

all nerve, blood, and choking agents, and some blister agents.

The M43A1 (the replacement for the M43) only detects nerve

agents.

(_b_) The M256 Chemical Agent Detector Kit detects and

identifies nerve, blood, and blister agents. The M256 is the

most sensitive of the chemical agent vapor detectors available.

However, it is not a continuous, real-time monitoring system.

It requires 15 to 20 minutes for sampling and analysis.

(_c_) The ABC-M8 VGH Chemical Agent Detector Paper can detect

and differentiate between nerve and blister agents by color

change. It is intended to be used by blotting and wiping

surfaces suspected of contamination. The M8 paper will respond

with a visual color change in 10 seconds or less.

(_d_) The M9 Chemical Agent Detector Paper will detect liquid

nerve (G & V) and blister agents (H & L), but will not identify

the specific agent or differentiate between nerve and blister

agents. The M9 tape is sensitive to droplets as small as 100 μ,

and will respond with a visual color change in 10 seconds or

less.

(4) All subsistence in a chemical attack area are considered

contaminated until a survey can be conducted, preferably by

veterinary and chemical personnel. Personnel must be at MOPP

Level 4 while conducting the survey. Concentrate the initial

portion of the survey on the adequacy of the storage facility

and other protective measures in preventing chemical agent

contact with subsistence items. The area surrounding the

storage facility is examined for the presence of animals,

rodents, birds, and arthropods acting unusual, or dead in

unusual numbers. If animals are present and assistance is

required in identifying the NBC agent, specimens can be

collected and submitted to the area medical laboratory. Damage

such as broken windows, holes, or loss of structural integrity

of the storage facility is noted. This information combined

with knowledge of the agent form (liquid or vapor), type of

agent (which will indicate the degree of persistency), and

approximate time of attack will provide a risk assessment.

Liquid agents should not significantly penetrate an intact

facility, but may produce vapor contamination by off-gassing.

(_a_) Upon entering the storage facility, the M8 can be used to

determine the presence of chemical vapors. However, precautions

must be taken. The M42 alarm is not to be used inside shelters,

vehicles, vans, or other interior modes. Therefore, when

checking food storage facilities, the alarm unit must be

left outside, turned off, or disconnected. Do not tilt the

M43 detector more than 45 degrees (because of the liquids it

contains). This is not a problem with the improved M43A1, but

the M43A1 requires attachment of an exit port filter when used

indoors. The M256 Chemical Agent Detector Kit can be used to

sample the air.

(_b_) Pre-position M9 chemical agent detector paper in food

storage areas; especially on the least protected pallets and in

areas where droplets may enter, such as near doors or windows.

Examine the M9 paper for indications of liquid chemical agents.

If the M9 paper is positive, or if the packaging materials show

the presence of liquids or stains, use the M8 detector paper to

determine the type of the agent. If an agent is not indicated

by the detector paper, then the amount of agent present will be

insufficient to cause secondary contamination when the outer

package is removed.

(5) Detection procedures become more complicated if a chemical

agent has penetrated or permeated through the packaging and

packing materials. Unless liquid has seeped through the

cardboard, any agent in the interior of the shipping case will

be in a vapor form. Liquid seeping should be obvious. The

sampler-detectors in the M256 Chemical Agent Detector Kit do

not have an aspirator for sampling the interior of the case.

However, there are several procedures that can be used. One is

to open the case, place the activated sampler-detectors inside

the case, and then reclose the case. Another is to punch holes

in the case, place the activated sampler-detector over the

holes, and cover the sampler-detector with an empty box or can

(open end down) to concentrate the vapors escaping from the

case. Alternatively, remove the food from the case and place

it in a plastic bag with the sampler-detectors to concentrate

the vapors. These procedures require two sampler-detectors; one

for blood agents and one for nerve and blister agents. Neither

method is very sensitive in low concentrations of vapor as is

expected to be present inside shipping containers. A better

method is to modify the M43 detector with a field expedient

probe of Teflon tubing attached to the detector's air inlet.

Insert the open end of the tubing into a hole in the case

or package to sample the interior air. When available, the

improved chemical agent monitor (ICAM) can be used; its design

will allow aspiration of air from inside shipping cases. The

ICAM can also be used to detect and identify liquid agents

on a surface provided the agent is vaporizing in sufficient

quantity. The ICAM gives a visual representation of a hazard

evaluation.

_c. Decontamination._

(1) Decontamination is only required for contamination

remaining 10 minutes or longer. Decontamination efforts on

subsistence items will normally be limited to removal of the

containers and carton overwrap material.

(2) The need for decontamination is primarily dictated by the

type of chemical agent used. The method of decontamination

selected will depend upon the type of packaging material used

and the urgency with which the food is required.

(3) Food supplies in storage are not likely to be seriously

contaminated if reasonable protection precautions are taken.

For this reason, large supplies of food are not to be

condemned as a whole simply because they have been exposed to

possible chemical contamination. A prompt and careful survey

of the supplies may reveal that only a few items have been

contaminated to a level that decontamination is required.

Prompt segregation of the heavily contaminated portions will

prevent, or minimize, contamination of the remainder. Foods

without protective packages constitute the major difficulty.

(4) Individual decontamination is performed by each soldier on

those subsistence items in his possession at the time of the

attack. Individual decontamination is limited to operational

rations that are in original, intact containers. Unit-level

decontamination is performed by unit personnel under the

supervision of unit NBC personnel. Support decontamination

is attempted at major subsistence storage facilities. Again,

decontamination is limited to packing material. Decontamination

of food itself is only attempted in emergency situations when

alternative supplies are not available.

(5) Start decontamination operations with the easiest method

and proceed to the most difficult. This allows for the removal

of a relatively large portion of the contamination in a minimum

of time. The simplest procedure is to allow the materials to

age and air ("weather"). Substantial self-decontamination will

occur with most agents. Exceptions are thickened mustard,

thickened GD, and VX. Table J-6 provides the length of time for

which contaminated subsistence supplies may present a contact

hazard. Weather elements that affect decontamination are--

(_a_) Warm temperatures speed liquid agent off-gassing and

hasten the dispersion of chemical agents into the air.

(_b_) High winds rapidly disperse chemical agent vapors and

speed off-gassing from surfaces.

(_c_) Moisture causes chemical agents to react with water to

form nontoxic or less toxic chemicals. Heavy rain or rain of

long duration can aid decontamination by mechanically removing

chemical agents.

(_d_) Even in cold weather, direct sunrays warm surfaces

above the air temperature and hasten the off-gassing and

decomposition of chemical agents.

_Table J-6. Persistency of Selected Liquid Chemical Agents_

================================================================

| WEATHER CONDITIONS

+---------------+----------------+-----------------

| | |

AGENT | SUNNY, | WET AND WINDY, | CALM, SUNNY,

| AROUND 20°C, | AROUND 10°C | LYING SNOW,

| LIGHT BREEZE | | AROUND -10°C

| | |

MUSTARD(HD) | 2-7 DAYS | 1/2-2 DAYS | 2-8 WEEKS

TABUN(GA) | 1-4 DAYS | 1/2-6 HOURS | 1 DAY-2 WEEKS

SARIN(GB) | 1/4-4 HOURS | 1/4-1 HOUR | 1-2 DAYS

SOMAN(GD) | 2-1/2 -5 DAYS | 3-36 HOURS | 1-6 WEEKS

NERVE(VX) | 3-21 DAYS | 1-12 DAYS | 1-16 WEEKS

=============+===============+================+=================

(6) Active decontamination is attempted only when weathering

will not decontaminate the packaging material in sufficient

time. Decontamination procedures can be enhanced by using

heat to vaporize the chemical agent; by reaction with

decontaminants; or by removing with hot soapy water.

(_a_) The simplest (standard) decontamination materials

are water and detergents. An effective decontaminant is

hot water used with the addition of soap or detergent and

scrubbing. Commercial abrasive powdered cleansers are effective

decontaminants for many surfaces (metal, glass, Formica), but

not wood or soft plastics.

(_b_) Water can be used to flush chemical agents from surfaces.

High-pressure application produces a better cleansing action

than low pressure. If the surface has absorbed the agent,

flushing will remove the surface contamination, but will not

affect the agent that is absorbed.

(_c_) Soaking contaminated items in boiling water is an

excellent decontamination method for some agents. Water alone

will not be sufficient to decontaminate all chemical agents.

Soaking in warm or cold water may reduce the contamination

slightly; however, the hazard may not be reduced sufficiently

even after prolonged soaking. If hot water is not available,

or if it might cause damage to the item, other methods of

decontamination should be considered, such as decontaminating

solutions or a caustic solution followed by thorough rinsing.

(_d_) Fibrous materials such as cloth and canvas are best

decontaminated by washing and scrubbing.

(_e_) Glass, metal, porcelain, and plastic surfaces are best

decontaminated by using hot water or hot soapy water. Some

toxic materials are readily removed with no more than slight

abrasion or brushing.

(_f_) Painted, varnished, and waxed surfaces are generally

smooth and nonporous. Dust and liquids are readily removed by

wiping, brushing, or vacuuming. Absorbed materials are removed

by hot water, detergent, or complexing agents. None of these

surfaces stand up well to heavy abrasive techniques. Agents

can be attacked and removed by caustics, acids, and organic

chemicals. Some of these surfaces readily absorb agents, so

weathering following decontamination is advisable.

(_g_) Rubber is a porous material that can absorb agents. It is

not easily decontaminated by abrasive techniques. Warm, soapy

water used with brushing is effective since it removes some

absorbed contamination. Strong acids, alkalies, and organic

solvents may deteriorate and decompose rubber articles.

(7) Operational rations are the primary rations issued;

always issue uncontaminated stocks first. This allows for

decontamination of contaminated stocks without interrupting

supply support. Normally, contaminated stocks are not issued.

The decision to issue contaminated items is based on the

tactical situation, criticality of the items, type and extent

of contamination, and the time and resources available for

decontamination. Decontamination efforts on subsistence items

are limited to the containers and carton overwrap material.

(_a_) The MRE retort and nonretort food pouch may be

decontaminated with soap and water wash. The chemical agents

will be removed by the solutions.

(_b_) Semipermeable materials (polyethylene menu bag, shrink

wrap, and film wrap) may have chemicals deposited not only

on the surface, but also dissolved into the matrix of the

material. The chemicals can be removed from the surface by

washing with hot soapy water, but contaminant dissolved in

the material is not removed. The remaining agent can only be

removed by weathering which can be accelerated through the use

of heat and sweeping the surface with air.

(_c_) Fiberboard is both sorbent and permeable and acts like

a blotter. Liquid decontaminants can force the contaminant

further into the fiberboard. Any attempt to decontaminate

fiberboard would be futile. The only alternatives are to remove

the fiberboard, or to allow it to weather.

(_d_) Palletized unit loads of MRE and UGR outerwraps can be

decontaminated through the aid of a forced clean air sweep in 4

to 5 days, compared to 3 weeks or more under natural conditions

without a forced air sweep.

(8) Contaminated food supplies are only handled by personnel

trained in decontamination methods and in MOPP Level 4.

Contaminated food items are divided into three groups as

described below (see Table J-1 for additional information).

(_a_) Group 1 consists of canned and unopened packaged items

which have been exposed only to agent vapors. Most items in

this group will be safe to issue after a brief period of

outdoor airing to remove clinging vapors. Table J-7 lists the

decontamination procedures for packaging materials contaminated

with nerve agents, mustards, and arsenicals.

_Table J-7. Chemical Decontamination of Packaged Material_

======================================================================

PACKAGING MATERIAL CONTAMINATION DECONTAMINATION PROCEDURES

----------------------------------------------------------------------

AIRTIGHT METAL VAPOR AND AIR FOR 24 HOURS. WASH

CONTAINERS, GLASS LIQUID WITH HOT SOAPY WATER,

BOTTLES, FOIL SODA, OR BLEACH SOLUTION.

ALUMINATED LAMINATED RINSE WITH WATER.

MATERIALS.

POLYESTER, PVF. VAPOR REMOVE CONTAMINATED

WOODEN BOXES, CRATES, PACKAGE. AIR CONTENTS FOR

BOARD, MULTILAYER 24 HOURS.

BAGS.

CARDBOARD, LIQUID CONTAMINATED CONTENTS--TREAT

POLYETHYLENE. AS UNPACKAGED FOOD.

=======================================================================

(_b_) Group II consists of canned and unopened packaged items

which have been contaminated with a liquid chemical agent.

_1._ Attempts to decontaminate porous packaging materials,

such as cardboard or wood, are likely to be unsuccessful and

may result in spreading the contamination. The best procedure

in handling such items is to strip off the outer contaminated

coverings and examine the inner layer to see if penetration

of the agent has occurred. If it has, continue stripping off

layers until an uncontaminated layer is reached and place it in

Group I. If the agent has penetrated to the food, place it in

Group III.

_2._ Food in cans or in other sealed, impermeable containers is

not in danger of chemical contamination. Because contamination

is confined to the outer surface of the sealed container,

decontamination is accomplished by: immersion in boiling, soapy

water for 30 minutes and rinse; immersion in boiling water for

30 minutes; spray with DS2; or to wash in hot soapy water,

rinse, and aerate. Under no conditions should contaminated

containers be opened before they have been decontaminated and

monitored.

_3._ Supertropical bleach and DS2 can be used on the

polyethylene menu bag for up to 24 hours without a significant

change in appearance, tensile properties, and size of the

plastic. The use of DS2 will cause significant degradative

changes to most other plastics, while STB will cause little

or no change. Also, DS2 may cause false positive readings

when using M8 or M9 paper, or the M256 Detector Kit to check

completeness of decontamination.

(_c_) Group III will consist of unpackaged or poorly packaged

items which have been exposed to an agent in either vapor or

liquid form. Foodstuffs in this group should be decontaminated

only when absolutely necessary. =The decision to use foods

that have been contaminated is to be made by the commander.=

Decontamination procedure to be followed, in order, is: trim

surface fat and grossly contaminated areas; wash with water or

2-percent sodium bicarbonate solution; then boil in water.

_1._ Boiling in water may be eliminated when the contamination

has been only with the vapors of irritant agents. When such an

exposure has been light, aeration for a short time may be used

for decontamination.

_2._ Frying, roasting, or broiling will not remove traces of

blister agents from meats. In general, salvage of foods heavily

contaminated with droplets of the blister agents, especially

the arsenical blister agents, is not practical. Foods of high

water or fat content are unfit for consumption and reclamation

is not practical when contaminated with liquid mustard or a

liquid nitrogen mustard.

_3._ When foods have been exposed to blister agent vapor, they

can be reclaimed by washing with sodium bicarbonate solutions

and rinsing with clear water, by intensive cooking, or in

the case of dry provisions, by 24 to 48 hours of aeration.

Lean meat contaminated with mustard vapor can be reclaimed by

boiling in water for 30 minutes or more. With nitrogen mustard

vapor contamination, the meat should be boiled in a 2-percent

sodium bicarbonate solution. Discard the water used to boil the

meat.

_4._ Nerve agent contamination is treated the same as blister

agent contamination.

_5._ Foods, such as potatoes and hard-skinned fruits and

vegetables, can be decontaminated by washing or scrubbing,

followed by peeling or scraping, then washing again.

_6._ Prepared food in open containers will be contaminated;

it must be temporarily isolated, or disposed of (bury or as

directed by commander).

_7._ A food Item that is contaminated with irritants can be

decontaminated by airing. Consumability is determined by taste

rather than toxicity.

_8._ Phosgene is rapidly hydrolyzed, therefore, washing the

food with water or airing it will usually suffice.

_9._ Food contaminated with white phosphorous should be

destroyed.

_10._ Normally, hydrocyanic acid will have little effect on

food supplies. The exposures will most likely be as a vapor.

However, foods with a high water content may become unfit for

consumption after exposure to high concentrations.

_11._ The effect of CK on foods is not known. Foods exposed to

CK vapors are considered toxic.

_12._ Table J-8 lists the decontamination procedures for

unpackaged food contaminated with a chemical agent.

(9) Decontaminating cattle, poultry, and other livestock is

only attempted when other sources of food are not available.

Heavily contaminated animals should be destroyed. Livestock

contaminated lightly by phosgene, nerve agents, mustards, and

arsenicals (such as vapor or liquid) may be slaughtered in the

early stages of poisoning before the full effects of exposure

are shown. If these animals are slaughtered in the preliminary

stages of poisoning and all tissues exposed to the agent (the

head, blood, lungs, organs, and local areas) are discarded,

there is no danger in consumption of the meat, provided the

animal passes a pre-slaughter and slaughter inspection.

This is true even of animals poisoned by arsenical agents

since the edible tissue will contain amounts of arsenic too

small to be toxic. Organs (liver, brain, heart, kidney, and

lungs) will contain more arsenic than the musculature and are

discarded. The meat must be well cooked. Personnel involved in

slaughtering procedures must be careful to prevent spreading

contamination to the meat and to themselves.

(10) Decontaminating forage and grain exposed to only chemical

agent vapors is by aeration. Aerated supplies, especially if

mixed with larger amounts of uncontaminated supplies, produces

no ill effects when fed to animals. Forage or grain heavily

contaminated by liquid vesicants, especially arsenicals, should

not be used.

_Table J-8. Chemical Decontamination of Unpackaged Food_

========================================================================

FATTY FOODS NONFATTY FOODS, NONFATTY FOODS,

(BUTTER, BACON, High WATER CONTENT LOW WATER CONTENT,

CHEMICAL AGENT MILK, CHEESE, CRYSTALLINE (FRUITS, AMORPHOUS (FLOUR,

HAM). VEGETABLES, SALT, CEREALS, BREAD,

SUGAR). PEAS).

------------------------------------------------------------------------

=NERVE AGENTS=

VAPOR, HEAVY DESTROY DESTROY, UNLESS AIR FOR 48 HOURS,

POSSIBLE TO BOIL THEN BOIL.

AFTER AIRING 48

HOURS.

VAPOR, LIGHT DESTROY AIR FOR 48 HOURS, AIR FOR 48 HOURS,

THEN BOIL. THEN BOIL.

LIQUID DESTROY DESTROY DESTROY

=MUSTARDS=

VAPOR REMOVE 1-3 cm WASH WITH WATER. WASH WITH WATER.

OF OUTER LAYER AIR FOR 48 HOURS. AIR FOR 48 HOURS.

AND WASH WITH 2%

SODIUM BICARB-

ONATE SOLUTION.

BOIL FOR AT

LEAST 30 MINUTES.

DESTROY MILK.

LIQUID DESTROY DESTROY DESTROY

=ARSENICALS=

DESTROY DESTROY DESTROY

========================================================================

GLOSSARY

ABBREVIATION, ACRONYMS, AND DEFINITIONS

=ABCA= American, British, Canadian, and Australian

=ABO= agents of biological origin

=AC= hydrogen cyanide

=AFJMAN= Air Force Joint Manual

=amb= ambulance

=AMEDD= Army Medical Department

=AMEDDC&S= Army Medical Department Center and School

=AMedP= Allied Medical Publication

=AML= area medical laboratory

=AN/PDR27= radiac meter

=AN/PDR77= radiac meter

=AN/VDR2= radiac meter

=AO= area of operations

=AR= Army regulation

=ATM= advanced trauma management

=ATTN= attention

=AXP= ambulance exchange point

=BAS= battalion aid station

=BAT= Biological Augmentation Team

=BC= blood culture

=bde= brigade

=BDU= battle dress uniform

=BI= battle injury

=BIDS= Biological Integrated Detection System

=Biological Warfare Agent Field Confirmation Identification=

Identification of a suspect biological warfare agent by means

of devices/materials/technologies that are based on detecting

biological markers using two or more independent biomarker results.

Examples might include the findings of the presumptive biomarker

identification with the addition of a positive PCR, ELISA, or

electrochemiluminescence (ECL) results, using specific target

nucleic acid sequences for the organism and antibody recognition

of agent-specific antigen sites, respectively. (Field sample/

specimen identification by forward deployed or forward positioned

laboratories [such as the US Air Force Biological Augmentation

Team (BAT), theater army medical laboratory, or forward deployed

preventive medicine unit (US Navy) and homeland security Laboratory

Response Network (LRN) Level B or C, US Army Community Hospitals or

Medical Centers].)

=Biological Warfare Agent Definitive Identification And

Confirmation= The specific identification of a suspect

biological agent as to genus and species, serological type,

or toxin. This level of identification is by means of

devices/materials/technologies that are based on two or more

independent biomarker results and using different methodologies.

This level of identification is performed in a reference laboratory

with a broader variety of methodologies available and highly

skilled testing personnel, thus providing the highest levels of

accuracy. (Sample/specimen identification is accomplished by

homeland security LRN Level C and D and nationally recognized

laboratory such as the US Army Medical Research Institute of

Infectious Disease or Centers for Disease Control and Prevention.)

=Biological Marker= Characteristics of a biological agent

(organism, virus, toxin, or product) that are specific to the

agent. This includes (1) recognition of specific nucleic add

sequences (DNA or ribonucleic acid [RNA]) unique to the bacteria

or virus by a technique such as PCR; (2) identification of

specific ECL assay; (3) specific growth properties as seen on

selective media such as characteristic colony morphology on culture

along with phage inhibition; (4) Identification using specific

microscopic characteristics such as Gram stain, fluorescent

antibody stain, immunohistochemical stain, or cytopathic effects.

=Biological Warfare Agent Presumptive Identification=

Identification of a suspect biological warfare agent by means of

devices/materials/technologies that are based detecting biological

markers (biomarkers) using a single methodology. The biomarkers

and/or methodologies used at this level of testing have significant

limits to their accuracy. Agent identification to species level,

or differentiation among a family of similar agents, may not be

possible. This is equivalent to the LRN Level A and the US Army

BIDS. (EXAMPLES: Identification by sensor triggering, hand-held

devices [hand-held assays] or initial systems, or laboratory

analysis employing one screening methodology [such as microscopic

morphology, antibody/protein, or nucleic acid-based test].)

=bot/pkg= bottle/package

=BSA= brigade support area

=BW= biological warfare

=BZ= an incapacitating chemical warfare agent

=C= Centigrade/Celsius

=C2= command and control

=C4I= Command, Control, Communications, Computers, and Intelligence

=CaCl= calcium hypochlorite

=cal/cm^2= calories per square centimeter

=cal/cm^2/sec= calories per square centimeter per second

=CAM= chemical agent monitor

=CANA= convulsant antidote for nerve agent (diazepam)

=CB= chemical/biological

=CBDA= Chemical Biological Defense Agency

=CBPS= chemically biologically protected shelter

=CBRNE= chemical, biological, radiological, nuclear, and high-yield

explosive

=CBSCC= Chemical-Biological Sampling Control Center

=CBSCE= Chemical-Biological Sampling Control Element

=cc= cubic centimeter

=CG= phosgene

=cGy= centigray

=CIS= Commonwealth of Independent States (Russia)

=CK= cyanogen chloride

=Cl= chlorine

=CLASS VIII= Classification of medical supplies and equipment

within the Federal Stock Classification System

=CLS= combat lifesaver

=cm= centimeter

=cm^2= square centimeter

=CNS= central nervous system

=CO_{2}= carbon dioxide

=CONUS= continental United States

=COSC= combat operational stress control

=CP= chemically protected

=CP DEPMEDS= chemically protected deployable medical system

=CPS= collective protection shelter

=CREST= Casualty Requirements Estimation Tool

=CS= combat support

=Cs-137= Cesium 137

=CSF= cerebrospinal fluid

=CSH= combat support hospital

=CSS= combat service support

=CW= chemical warfare

=CX= phosgene oxime

=DA= Department of the Army

=DAP= decontamination apparatus, portable

=DCS= division clearing station

DD Department of Defense

decon decontamination

DEPMEDS Deployable Medical System

DNA deoxyribonucleic acid

DNBI disease and nonbattle Injury

DOD Department of Defense

DP diphosgene

DS2 decontaminating solution Number 2

DTF dental treatment facility

E EDTA

EAC echelons above corps

ECL electochemiluminescence

ECP entry control point

ECU environmental control units

EDTA ethylenediaminetetraacetate

EEE eastern equine encephalitis

ELISA enzyme-linked immunosorbent assay

EM electron microscopy

EMP electromagnetic pulse

EMS emergency medical services

EMT emergency medical treatment

EOD explosive ordnance disposal

EPW enemy prisoner of war

ER emergency room

evac evacuation

F Fahrenheit

F-1 Fraction-1

FA fluorescent antibody

FDECU field deployable environmental control unit

FH field hospital

FLOT forward line of own troops

FM field manual

FMC Field Medical Card

FSOP field standing operating procedures

FST forward surgical team

g gram

G1 Assistant Chief of Staff (Adjutant)

G2 Assistant Chief of Staff (Intelligence)

G3 Assistant Chief of Staff (Operations and Training)

G4 Assistant Chief of Staff (Logistics)

GA Tabun

gal gallon

GB Sarin

GD Soman

=GF= a nerve agent

=GH= general hospital

=gm= gram

=GP= general purpose

=GVO= green vinyl overboots

=Gy= gray (100 cGy)

=H= heparin

=HD= sulfur mustard (a blister agent)

=HG= chemical symbol for mercury

=HL= mustard and Lewisite mix

=HMMWV= high mobility multi-purpose wheeled vehicle

=HN= nitrogen mustard

=HPLC= high-pressure liquid chromatography

=HSL= health service logistics

=HSS= health service support

=HUB= hospital unit base

=HUH= hospital unit holding

=HUM= hospital unit medical

=HUS= hospital unit surgical

=HTH= high test hypochlorite (70% available chlorine)

=I-131= Iodine-131

=IATA= International Air Transportation Association

=IAW= in accordance with

=IC= intensive care

=ICAM= improved chemical agent monitor

=ICC= incident command center

=ICU= intensive care unit

=ICW= intensive care ward

=ID= Incapacitation dose

=IgG= immunoglobulin class G

=IgM= immunoglobulin class M

=IMA= installation medical authority

=ISO= International Organization for Standardization

=IV= intravenous

=J2= Joint Intelligence Directorate

=J3= Joint Operations Directorate

=kg= kilogram

=km= kilometer(s)

=kph= kilometers per hour

=KT= kiloton

=L= Lewisite

=LAB= laboratory

=lb= pound

=LCE= load-carrying equipment

=LD= lethal dose

=LD 50/60= lethal dose for 50 percent of exposed persons within a

period of 60 days

=LRN= Laboratory Response Network

=LSD= d-lysergic acid diethylamide

=LZ= landing zone

=µ= micron

=m= meters

=m3= milligrams per minute

=MCRP= Marine Corps Reference Publication

=MEDEVAC= medical evacuation

=Medical Countermeasures= Those measures taken to maintain soldier

sustainability through the prevention and pretreatment of injury

from NBC agent hazards; and following injury those measures

taken to treat NBC casualties and improve medical capability for

diagnosis, physiological resuscitation and continued medical

management of NBC casualties.

=MES= medical equipment set

=MF2K= Medical Force 2000 (Army of Excellence Organizations)

=mg= milligram

=mg/kg= milligrams per kilogram

=MILVAN= military-owned demountable container

=ml= milliliter

=mm= millimeter

=MOPP= mission-oriented protective posture

=MOS= military occupational specialty

=MRE= meal ready-to-eat

=MRI= Medical Reengineering Initiative

=MSR= main supply route

=m/sec= meters per second

=MT= megaton

=MTF= medical treatment facility

=NaCl= sodium chloride (salt)

=NATO= North Atlantic Treaty Organization

=NAVMED P= Naval Medical Publication

=NBC= nuclear, biological, and chemical

=NBCC= nuclear, biological, and chemical control

=NBCWRS= nuclear, biological, and chemical warning and reporting

system

=NCO= noncommissioned officer

=NL= no limit

=NTTP= Navy Tactics Techniques and Procedures

=O_{2}= oxygen

=OEG= operational exposure guide

=OPLAN= operation plan

=OPSEC= operations security

=Patient Decontamination=--The removal and/or the neutralization of

hazardous levels of nuclear, biological, and chemical contamination

from patients at a medical treatment facility. Patient

decontamination is performed under the supervision of medical

personnel to prevent further injury to the patient and to maintain

the patient's health status during the decontamination process.

Patient decontamination serves multiple purposes; it protects the

patient from further injury, it prevents exposing medical personnel

to the contamination, and it prevents contamination of the medical

treatment facility.

=PCR= polymerase chain reaction

=PDS= patient decontamination station

=pH= symbol relating the hydrogen ion activity in gram equivalents

per liter used in expressing the acidity and alkalinity on a scale

whose values run from 0 to 14 with 7 representing neutrality.

Numbers less than 7 indicate increasing acidity, and numbers

greater than 7 indicate increasing alkalinity.

=PMM= preventive medicine measures

=pnt= patient

=ppm= parts per million

=PPW= patient protective wrap

=PS= chloropicrin

=PVF= polyvinyl fluoride

=PVNTMED= preventive medicine

=QSTA= Quadripartite Standardization Agreement

=RDD= radiological dispersal device

=recon= reconnaissance

=RES= radiation exposure status

=RNA= ribonucleic acid

=ROWPU= reverse osmosis water purification unit

=RT= red top

=RT-PCR= reverse transcriptase/polymerase chain reaction

=RTD= return to duty

=S1= Adjutant (US Army)

=S2= Intelligence Officer (U.S. Army)

=S3= Operations and Training Officer (U.S. Army)

=S4= Supply Officer (U.S. Army)

=SCUD= ballistic missile

=SDK= skin decontaminating kit

=SFG= Special Forces Group

=SMART= special medical assistance response team

=SOF= Special Operations Forces

=SOP= standing operating procedure

=Sr-89= Strontium-89

=Sr-90= Strontium-90

=STANAG= Standardization Agreement (NATO)

=STAT= statim

=STB= supertropical bleach

=Sv= Sievert

=T2= trichothecene

=TAML= theater Army medical laboratory

=TC= training circular

=TEU= technical escort unit

=TEMPER= tent, expandable, modular, personnel

=Toxic Industrial Biological (TIB)= Biological materials (bacteria,

viruses, and toxins) found in medical research, pharmaceutical, and

other manufacturing processes that are toxic to humans and animals,

or cause damage to plants.

=Toxic Industrial Chemical (TIC)= Chemical compounds used or

produced in industrial processes that are toxic to humans and

animals, or cause damage to plants. EXAMPLES include fuels,

solvents, heavy metals, and chemicals used in manufacturing

processes.

=Toxic Industrial Material (TIM)= Toxic industrial materials may be

toxic industrial chemical (TIC), toxic industrial biological (TIB)

and toxic industrial radiological (TIR) materials.

=Toxic Industrial Radiological (TIR)= Radiation-emitting materials

used in research, power generation, medical treatment, and other

non-weapon developmental activities that are harmful to humans and

animals if released outside their controlled environment.

=TIR= toxic industrial radiological

=TM= technical manual

^{=TM=} trademark

=TOE= table of organization and equipment (US Army organizational

structure document)

=TO= theater of operations

=trmt= treatment

=TSOP= tactical standing operating procedures

=TT= tiger top

=µ= microns

=UGR= unit group rations

=UN= United Nations

=US= United States

=USAF= United States Air Force

=V-agent= a nerve agent

=VEE= Venezuelan equine encephalitis

=VX= a persistent nerve agent

=WBGT= wet bulb globe temperature

=WEE= western equine encephalitis

=WMD-IST= weapons of mass destruction--installation support team

REFERENCES

=NATO=

_NATO Emergency War Surgery Handbook._ 1988.

=NATO STANAGs=

These agreements are available on request (using DD Form 1425)

from the Standardization Documents Order Desk, 700 Robins Avenue,

Building 4, Section D, Philadelphia, Pennsylvania 19111-5094.

2002. _Warning Signs for the Marking of Contaminated or

Dangerous Land Areas, Complete Equipments, Supplies and Stores.

Edition 8._ 29 January 1999.

2047. _Emergency Alarms of Hazard or Attack (NBC and Air Attack

Only). Edition 7._ 24 July 1998. (Latest Amendment, 7 February

2000.)

2068. _Emergency War Surgery. Edition 4._ 28 October 1986.

(Latest Amendment, 17 October 1991.)

2083. _Commander's Guide on Nuclear Radiation Exposure of

Groups. Edition 5._ 19 September 1986. (Latest Amendment, 26

June 1994.)

2103. _Reporting Nuclear Detonations, Biological and Chemical

Attacks, and Predicting and Warning of Associated Hazards and

Hazard Areas--ATP 45(A). Edition 8._ 31 August 2000.

2104. _Friendly Nuclear Strike Warning. Edition 7._ 28 June

1994. (Latest Amendment, 28 June 1995.)

2112. _Nuclear, Biological, and Chemical Reconnaissance.

Edition 4._ 6 March 1998.

2475. _Medical Planning Guide for the Estimation of NBC Battle

Casualties (Nuclear)--AmedP-8(A), Volume I._ December 2000.

2476. _Medical Planning Guide of NBC Battle Casualties

(Biological)--AmedP-8(A), Volume II._ March 2001.

2477. _Planning Guide for the Estimation of NBC Battle

Casualties (Chemical)--AmedP-8(A), Volume III._ March 2001.

2500. _NATO Handbook on the Medical Aspects of NBC Defensive

Operations--AMedP-6(B). Edition 4._ 11 February 1997.

2873. _Concept of Operations of Medical Support in Nuclear,

Biological, and Chemical Environments--AmedP-7(A). Edition 3._

16 October 1996.

2879. _Principles of Medical Policy in the Management of a Mass

Casualty Situation. Edition 3._ 7 September 1998.

2941. _Guidelines for Air and Ground Personnel Using Fixed and

Transportable Collective Protection Facilities on Land. Edition

2._ 19 June 1992. (Latest Amendment, 30 October 1995.)

2954. _Training of Medical Personnel for NBC Operations.

Edition 1._ 28 December 1987. (Latest Amendment, 6 June 1995.)

=ABCA QSTAGs=

These agreements are available on request (using DD Form 1425)

from the Standardization Documents Order Desk, 700 Robins Avenue,

Building 4, Section D, Philadelphia, Pennsylvania 19111-5094.

183. _Emergency Warning Signals and Alarms for NBCD Hazards or

Attacks (NBC and Air Attacks Only). Edition 3._ 12 August 1991.

187. _Reporting Nuclear Detonations Biological and Chemical

Attacks and Predicting and Warning of Associated Hazards and

Hazard Areas. Edition 5._ 21 May 1998.

189. _Friendly Nuclear Strike Warning. Edition 3._ 12 August

1991.

501. _Warning Signs for the Marking of Contaminated or

Dangerous Land Areas, Complete Equipment, Supplies and Stores.

Edition 2._ 11 May 1982.

608. _Interoperable Chemical Agent Detector Kits. Edition 3._

13 December 2000.

816. _Medical Aspects of Mass Casualty Situations. Edition 1._

August 1990.

1330. _Medical Aspects of NBC Defensive Operations._ Draft.

2000. _Guidelines on Entry and Exit Procedures for Using

Collective Protection Facilities._ 17 December 1996.

=JOINT OR MULTISERVICE PUBLICATIONS=

AR 40-535. _Worldwide Aeromedical Evacuation._ AFR 164-5;

OPNAVINST 4630.9C; MCO P4630.9A. 1 December 1975. (Reprinted

with basic including Change 1, 10 May 1979.)

AR 40-562. _Immunizations and Chemoprophylaxis._ AFJI 48-110;

BUMEDINST 6230.15; CG COMDTINST M6230.4E. 1 November 1995.

AR 40-656. _Veterinary Surveillance Inspection of Subsistence._

NAVSUPINST 4355.10; MCO 10110.45. 15 October 1986.

AR 40-657. _Veterinary/Medical Food Inspection and Laboratory

Service._ NAVSUPINST 4355.4F; MCO P10110.31G. 6 November 1997.

FM 3-3. _Chemical and Biological Contamination Avoidance._ FMFM

11-17. 16 November 1992. (Change 1, 29 September 1994.)

FM 3-4. _NBC Protection._ FMFM 11-9. 29 May 1992. (Reprinted

with basic including Changes 1-2, 21 February 1996.)

FM 3-5. _NBC Decontamination._ MCWP 3-37.3. 28 July 2000.

FM 3-6. _Field Behavior of NBC Agents (Including Smoke and

Incendiaries)._ AMF 105-7; FMFM 7-11 H. 3 November 1986.

FM 3-9. _Potential Military Chemical/Biological Agents and

Compounds._ NAVFAC P-467, AFR 355-7. 12 December 1990.

FM 3-11.34. _Multiservice Procedures for Nuclear, Biological,

and Chemical (NBC) Defense of Theater Fixed Sites, Ports, and

Airfields._ MCWP 3.37.5; NTTP 3-11.23; AFTTP(I) 3-2.33. 29

September 2000.

FM 3-19. _Nuclear, Biological and Chemical Reconnaissance._

FMFM 11-20. 19 November 1993.

FM 3-100. _Chemical Operations, Principles and Fundamentals._

MCWP 3-3.7.1. 8 May 1996.

FM 4-02.33. _Control of Communicable Diseases Manual._ 17th

Edition. NAVMED P-5038. 31 December 1999.

FM 4-02.283. _Treatment of Nuclear and Radiological

Casualties._ NTRP 4-02.21; AFMAN 44-161(I); MCRP 4-11.1B. 20

December 2001.

FM 6-22.5. _Combat Stress._ MCRP 6-11C; NTTP 1-15M. 23 June

2000.

FM 8-9. _NATO Handbook on the Medical Aspects of NBC Defensive

Operations AMedP-6(B), Part I--Nuclear, Part II--Biological,

Part III--Chemical._ NAVMED P-5059; AFJMAN 44-151V1V2V3. 1

February 1996.

FM 8-284. _Treatment of Biological Warfare Agent Casualties._

NAVMED P-5042; AFMAN(I) 44-156; MCRP 4-11.1C. 17 July 2000.

(Change 1, 8 July 2002.)

FM 8-285. _Treatment of Chemical Agent Casualties and

Conventional Military Chemical Injuries._ NAVMED P-5041; AFJMAN

44-149; FMFM 11-11. 22 December 1995.

FM 21-10. _Field Hygiene and Sanitation._ MCRP 4-11.1D. 21 June

2000.

=DEPARTMENT OF DEFENSE=

DOD 5100.52-M. _Nuclear Weapon Accident Response Procedures

(NARP)._ September 1990.

DOD Directive 3150.8. _DOD Response to Radiological Accidents._

13 June 1996.

DD Form 1380. _US Field Medical Card._ December 1991.

DD Form 1911. _Material Courier Receipt._ May 1982.

=DEPARTMENT OF THE ARMY FORM=

DA Form 4137. _Evidence/Property Custody Document._ 1 July 1976.

=ARMY PUBLICATIONS=

AR 40-5. _Preventive Medicine._ 15 October 1990.

AR 40-61. _Medical Logistics Policies and Procedures._ 25

January 1995.

AR 40-66. _Medical Records Administration and Health Care

Documentation._ 3 May 1999.

AR 40-400. _Patient Administration._ 12 March 2001.

FM 3-06.11. _Combined Arms Operations in Urban Terrain._ 28

February 2002.

FM 3-7. _NBC Field Handbook._ 29 September 1994.

FM 3-50. _Smoke Operations._ 4 December 1990. (Change 1, 11

September 1996).

FM 3-101. _Chemical Staffs and Units._ 19 November 1993.

FM 3-101-4. _Biological Detection Platoon Operations--Tactics,

Techniques, and Procedures._ 9 June 1997. (Reprinted with basic

including Changes 1-2, 1 September 2000.)

FM 4-02.1. _Combat Health Logistics._ 28 September 2001.

FM 4-02.4. _Medical Platoon Leaders' Handbook--Tactics,

Techniques, and Procedures._ 24 August 2001.

FM 4-02.6. _The Medical Company--Tactics, Techniques, and

Procedures._ 1 August 2002.

FM 4-02.10. _Theater Hospitalization._ 29 December 2000.

FM 4-02.17. _Preventive Medicine Services._ 28 August 2000.

FM 4-02.19. _Dental Service Support in a Theater of

Operations._ 1 March 2001.

FM 4-25.12. _Unit Field Sanitation Team._ 25 January 2002.

FM 8-10. _Health Service Support in a Theater of Operations._ 1

March 1991.

FM 8-10-1. _The Medical Company--Tactics, Techniques, and

Procedures._ 29 December 1994.

FM 8-10-6. _Medical Evacuation in a Theater of

Operations--Tactics, Techniques, and Procedures._ 14 April 2000.

FM 8-10-8. _Medical Intelligence in a Theater of Operations._ 7

July 1989.

FM 8-10-9. _Combat Health Logistics in a Theater of

Operations--Tactics, Techniques, and Procedures._ 3 October

1995.

FM 8-10-14. _Employment of the Combat Support

Hospital--Tactics, Techniques, and Procedures._ 29 December

1994.

FM 8-10-15. _Employment of the Field and General

Hospitals--Tactics, Techniques, and Procedures._ 26 March 1997.

FM 8-10-18. _Veterinary Service--Tactics, Techniques, and

Procedures._ 22 August 1997.

FM 8-10-24. _Area Support Medical Battalion--Tactics,

Techniques, and Procedures._ 13 October 1993.

FM 8-10-25. _Employment of Forward Surgical Teams--Tactics,

Techniques, and Procedures._ 30 September 1997.

FM 8-10-26. _Employment of the Medical Company (Air

Ambulance)._ 16 February 1999. (Change 1, 20 May 2002.)

FM 8-30. _Veterinary Food Inspection Specialist._ 12 August

1986.

FM 8-42. _Combat Health Support in Stability Operations and

Support Operations._ 27 October 1997.

FM 8-50. _Prevention and Medical Management of Laser Injuries._

8 August 1990.

FM 8-51. _Combat Stress Control in a Theater of

Operations--Tactics, Techniques, and Procedures._ 29 September

1994.

FM 8-55. _Planning for Health Service Support._ 9 September

1994.

FM 8-250. _Preventive Medicine Specialist._ 27 January 1986.

(Reprinted with basic including Change 1, 12 September 1986.)

FM 8-500. _Hazardous Materials Injuries: A Manual for

Pre-Hospital Care. Edition 4._ 17 January 1997.

FM 10-52. _Water Supply in Theaters of Operations._ 11 July

1990.

FM 21-11. _First Aid for Soldiers._ 27 October 1988. (Reprinted

with basic including Changes 1-2, 4 December 1991.)

FM 22-51. _Leaders' Manual for Combat Stress Control._ 29

September 1994.

FM 31-71. _Northern Operations._ 21 June 1971.

FM 90-3. _Desert Operations._ FMFM 7-27. 24 August 1993.

FM 90-5. _Jungle Operations._ 16 August 1982.

FM 90-10. _Military Operations on Urbanized Terrain (MOUT)._ 15

August 1979.

STP 8-91 W15-SM-TG. _Soldier's Manual, Skill Levels 1/2/3/4/5

and Trainer's Guide, MOS 91W, Health Care Specialist._ 10

October 2001.

TC 8-13. _Deployable Medical Systems--Tactics, Techniques, and

Procedures._ 7 December 1990.

TM 3-4240-288-12&P. _Operator's and Unit Maintenance

Manual including Repair Parts and Special Tool List for

Collective Protection Equipment NBC, Simplified M20 (NSN

4240-01-166-2254)._ NAVFAC P-475. 20 August 1987. (Reprinted

with basic including Changes 1-2, 3 May 1989.)

TM 10-5410-228-10. _Operator's Manual for Chemical Biological

Protective Shelter System._ 31 August 2001.

TM 10-5410-283-14&P. _Operator's Unit, Direct Support,

and General Support Maintenance Manual (Including Repair

Parts and Special Tools Lists) for Chemically Protected

Deployable Medical System (CP DEPMEDS) (NSN 5410-01-479-9730)

(5410-01-479-9727) and CP DEPMEDS Training Set

(6910-01-479-2464)._ 30 November 2001.

INDEX

References are to paragraph numbers unless otherwise indicated.

advanced trauma management, 3-1_e_, 3-9

Allied medical publications, viii, D-1, D-3_d_, D-11_b_, D-19_e_

animals

consumption, for, 5-8, J-3_a_(5), J-3_b_(5), J-5_c_(9)

contamination of, J-3

decontamination of, 5-8, J-3_d_, J-4_d_, J-5_d_(9)

government-owned, 5-5, 5-8, C-7

protection of, 5-8, J-3_a_(5)

specimens, from, 5-9, 5-14, J-5_b_(4)

treatment of, 5-5, 5-8

area of operations, 1-3_b_(4)

attack, nuclear, biological, or chemical actions

after, 2-6_a_, 3-1_c_, 3-7

before, 3-5

detection of, 5-7, A-1, F-14, I-2, J-1, J-3_b_, J-4_b_, J-5_b_

during, 2-6a, 3-6, 3-9, 3-10b

monitoring, 3-10_d_, 4-2_d_(2)(_a_), 4-7_h_, 5-7, A-6_a_, C-4--5,

Appendix E, F-4, F-15_b_, G-10_f_, J-3_b_, J-4_b_, J-5_b_

personnel considerations, 3-9

prediction for, D-3_d_, D-26_b_

responsibilities, 2-3, 2-6_a_, 5-22, 5-23

supplies, 3-5_b_, 3-8_b_, 4-1--2, 5-2_a_, 5-3, 5-5--6, 5-14, 5-24--26,

C-2--3, C-5--12

survey, 3-7, 3-14_c_, C-4, D-4_c_, G-11_j_(4), J-3_b_, J-5_b_(4)

treatment, 3-7, 4-1_a_(3), 4-4, 4-7_g_

disposition, 3-10, 3-15b

elements, 2-1_b_(3), 3-10

operations, 2-2_a_

battlefield, 1-3_a_, 2-1, 2-2_a_, 2-3, 2-5_a_, 2-6, 3-1, 3-9, 3-12, 4-1,

5-1, 5-5, 5-15, 5-24, A-1, D-3, D-19, G-3, H-2

contaminated, 1-3_a_, 2-1, 2-6_a_, 3-1_e_, 3-9, 3-12_d_, 4-1, 5-1,

5-5, 5-15, 5-24, A-1, D-3, D-19f, D-25, G-8, J-5_a_

conventional, 3-1_a_ and _e_, 3-10

care, in unit, D-7, D-15, D-23

casualties

biological, C-2, C-5, D-1, D-20

chemical, D-1

civilian, 3-11

estimates, D-3_b_, D-11

mass casualties, 2-1

nuclear, 3-7, A-6, D-1, D-6_b_, D-8

requirements estimation tool, D-2

chemical, biological, radiological, nuclear, and high-yield explosive,

5-28, C-1

collective protection systems

advanced simplified, F-2_c_, F-10

alternate facilities, 2-5_b_(4)

available, 2-5_b_

decontamination of entrance area, F-13

employment

battalion aid station, 3-2_b_, F-2_a_, F-3

division clearing station, 3-3_c_, F-2_a_, F-4

forward surgical team, 3-4, F-2_a_, F-5

in DEPMEDS hospital, 4-1_a_, F-2_b_, F-6--9

operation, entry, and exit guidelines, 3-2_b_, F-12

procedures, 3-2_b_, 3-3_c_, 3-4

entry/exit, F-14--15

ambulatory patients, 3-2_b_, F-15

litter patient, 3-2_b_, F-15_b_

establish, 2-5_b_(1), F-3--6

radiation exposure, 3-12_b_ and _d_, 5-3, A-6_a_

resupply of protected areas, F-16

shielding, 4-2_b_(2)(_b_)

water supply, in, F-6_b_

combat operational stress control, 3-3_a_, 5-20, C-9

effects of, 3-1_a_, 5-20

leadership actions, 3-1_b_, 3-3_a_, 5-21

preventive, 5-23_b_

reactions, 5-23_c_

responsibilities, 5-20, 5-22, 5-23

sleep plans, 5-21_f_

command and control, 2-1, 2-5_a_, 4-1_a_

appraisal of the support mission, 2-3

health service support units, 2-4

homeland security, 2-7

leadership, 2-6, 3-1_b_

operations, 2-2_a_, 2-4--5, 2-6_b_

planning considerations, 2-2

communications, 2-4, 3-1_c_

contaminated

environment, 4-1_a_

facility, 2-5_c_

patients, A-6

contamination, 3-1_d_, 5-3

avoidance, 2-5_c_, 3-1_d_, 3-17_e_

control, 2-5_c_, 3-14_c_

detection, 3-1_d_, I-2

food, 4-1_a_, A-9_c_, J-1

free area, 3-2_b_, 3-3_b_, 3-10_d_, 3-15

hinder HSS operations, 3-1_d_

persistency, 2-1_b_(2)

water, 4-1_a_, A-9_c_, I-1

decontamination

augmentation, 3-5_c_, 4-1_a_(3), 4-4_a_, C-4, G-3_b_, G-4_b_, G-5, G-6

biological, A-10_c_, D-12_a_, D-13_b_, G-12

ambulatory patients, G-14

litter patient, G-13

chemical

ambulatory patients, G-11

litter patients, G-10

clothing removal, G-1O_c_, G-11_a_ and _i_, G-13_c_, G-14_b_, G-17_b_

collocation with thorough decontamination, G-3

complicating factors, 4-4_a_

dental, 3-3_a_, 3-15, C-8

facility, 2-5_b_(9), 3-1_c_, 4-1_a_(2), 4-3--4, G-3_f_

Field Medical Card, G-2, G-10_a_(4), G-11_f_, G-13_b_, G-14_b_

food, 5-7

gross contamination removal, G-10_a_, G-11_h_

heat injury prevention, during, G-8

immediate, G-2

litter, G-10_e_

mask, 4-2_b_(4), G-10_a_(1), G-11_e_

materials needed, 2-5_d_, 4-3, G-1_c_

medical treatment facility, at, G-4--6

monitor for completeness, G-10_g_, G-11_j_, G-15

nuclear, 4-4_a_-_c_, A-6_c_, G-15

ambulatory patients, G-17

litter patients, G-16

operations, G-1, G-3_a_, J-5_c_(5)

patient protective wrap, G-11_c_

patients, 2-5_b_(2) and (4), 2-5_d_, 3-2_b_, 3-14_d_, 3-15_c_,

4-1_a_(2), F-11, G-1_a_, G-8, G-13

personal effects, G-10_c_, G-13_a_, G-14_a_, G-16_a_, G-17_a_

personnel/equipment, 2-5_b_(2), 3-2_b_, 3-9, 4-3, G-11_d_, G-14_a_

shuffle pit, G-10_g_, G-11_l_, G-13_e_, G-14_e_, G-16_d_, G-17_d_

skin, G-10_a_ and _f_, G-11, G-13_d_, G-14_d_, G-16_c_, G-17_c_

solution preparation, G-1_c_, G-7

spot, 3-2b, 4-3c, G-10_f_, G-11_g_

treatment during, G-10, G-11_a_ and _k_(2)

bandages, G-10_c_(2) and f(2), G-11_k_(2)

splints, G-10_c_(2) and f(2), G-11_k_(2)

tourniquet, G-10_c_(2) and _f_(2), G-11_k_(2)

unit, G-2

waste, dispose of, G-10f(4), G-11_k_

water, G-7

defense, 3-14_b_

dental services, 3-3_a_, 5-15, C-8

decontamination, 5-17--18, C-8

mission, 5-16

operations, 5-17

patient protection, 5-19

treatment, 3-3_a_, 5-16, 5-17, 5-18

detection, 3-1_d_

diseases, 1-3_b_(4), 5-1, 5-2_b_, 5-3, A-8_b_(5), D-12_c_, D-17_b_

emergency medical treatment, 3-1_e_, 3-2_b_, 3-3_c_, 3-4, 3-7, 3-9,

3-15_b_, 4-1_a_(3), D-4_a_, D-12_a_

enemy prisoners of war, 2-2_a_

environment

biological, 3-14

chemical, 3-15

nuclear, 3-12

operations in extreme environments, 3-16

desert, 3-16_d_

jungle, 3-16_c_

mountain, 3-16_a_

NBC, 3-16

snow and extreme cold, 3-16_b_

urban terrain, 3-16

evacuation, 3-17, D-6, D-9, D-12_a_, D-14, D-22

aircraft, 3-17_b_ and _e_

contaminated areas, in, 3-17_b_

ground vehicles, 3-17_b_

nonmedical vehicles, 3-17_b_(1), 4-1_a_(3)

personnel, 3-17_b_

facilities, 2-5_b_(9), 3-1_c_

clean, 3-1--3, 3-10, 3-15, 3-17b(4)

contamination, 3-2, 3-3_c_, 3-15_a_(4)

move

alternate facilities, 2-1_b_(4), 3-1_d_

decision to, 2-1_b_(3)

mobility, 4-1_a_, 4-2_a_, D-6_a_, D-14_a_, D-23_a_, F-1

patients, 2-1_b_(3)

protection available, 2-1_b_(1) and (4)

principles, 4-2_b_(4)(_d_)

field expedient protective systems, H-1, H-4

foxholes and trenches, H-3

protection

biological agent, against, H-4_a_

chemical agent, against, H-4_a_

factors, H-2

radiation, against, H-2

shielding, H-2

shelters, expedient, H-1, H-3--4

building of opportunity, 2-1_b_(1), H-3

cave, 2-1_b_(1), H-3

culverts, H-3

ditches, H-3

dozer trenches, H-3

dug-in tents, H-3_d_

engineer support, H-3_c_

overpasses, H-3

sandbagging, H-3_e_

tents, H-3_e_

tunnels, 2-1_b_(1), H-3

Field Medical Card, G-2, G-10_a_(4), G-11_f_, G-13_b_, G-14_b_

first aid, 3-1_a_, 3-2_a_, 3-9, D-7_b_

buddy aid, 3-1_a_, 3-2_a_, D-4_a_, D-7_b_, D-12_a_, D-20_c_

combat lifesaver, 3-1_a_, 3-2_a_

self-aid, 3-1_a_, 3-2_a_, D-4_a_, D-7_b_, D-12_a_, D-20_c_

food

animal, J-3_c_(5)

considerations, J-3_d_

contamination avoidance, J-1_c_(1)

contamination of, 4-1_a_, J-3_a_, J-4_a_, J-5_a_

countermeasures, J-1_b_

decontamination of, J-1_a_, _c_(3), and _d_, J-3_c_, J-4_d_, J-5_c_

detection in, J-1_a_, J-4_b_, J-5_b_

disposition of, J-1_a_, J-5_d_(9)

monitoring, J-3_b_

operational rations, J-2_a_

priorities, J-1_c_

protection of, J-1_a_, J-2

storage

bulk, J-2_b_

expedient, J-2_b_

fresh food, J-2_b_

susceptibility of, J-1_a_

forward surgical team, 3-4

guidelines

chemical, biological, radiological, nuclear, and high-yield explosives,

C-1

conduct operations, A-2

evacuation, A-7

health service support planning, C-1

mobilization, for, A-2

operational exposure, 3-12_d_

planning, A-1

predeployment, A-2

health service logistics, 5-24, A-11

organizational maintenance, 5-27

protection of supplies

shipment, during, 5-26

storage, in, 5-25, A-11

health service support, D-9, D-12_a_

appraisal, 2-3

casualty collection point, 3-1_c_

conventional operations, 2-4

evacuation, 2-2_b_, 2-5_b_(5), 3-2--3, 3-16_a_, 3-17, 4-1, 4-2b(_2_),

4-7_i_, A-7, A-14_b_, A-15_b_, D-1--2, D-4_a_, D-6, D-7_b_, D-8,

D-12_a_, D-13_b_, D-14, D-16, D-19_a_, D-20_c_, D-22, D-24,

D-26_d_, Appendix E, F-2_a_, F-3, F-5, G-2, G-10, G-11_c_, G-14_e_,

G-17_d_

factors, medical planning, 2-3

levels of, 3-2, 3-3, 4-1_a_

operations in NBC, 2-2_g_, 2-5, 2-6_b_, 3-1--4, 3-17_d_, 4-1_a_

personnel protection, 2-6_a_, 3-8

planning, 3-8

proximity, 3-1_c_

replacements, 3-1_c_

survival, 3-5a, 3-16_c_, 5-15, 5-22_a_, D-7_b_

technical channels, 3-1_c_

treatment, 3-7, 4-1_a_(3)

heat stress, 2-6_a_

homeland security, 2-7, 5-28, C-12

hospitalization

bed requirements, D-8, D-16, D-24

blood services, 5-11

conventional operations, 4-8

decontamination, 4-1_a_(5)

defensive measures, 4-1_b_

emergency services, 4-4

general medical services, 4-5

integrated battlefield, on, 4-1_a_

intensive care, 5-11

locations, 4-1_a_(1)

logistics support, 4-1_b_(2), A-11

nursing services, 4-7

protection, 4-1_a_(5) and _b_(2), 4-2_b_(2)(_b_), 4-4

protective procedures, 4-1_a_(5) and _b_(1)

biological, 4-1_b_(3)

chemical, 4-2_b_(4)

MOPP levels, 4-1_b_

nuclear, 4-2_b_(2)

response, 4-2_a_

surgical services, 4-6, 5-11

warning system, 4-1_b_(4)

initial effects

alternate operational sites, 3-10

detection, 3-1_d_, 5-7, 5-27, A-1, C-2, C-4, C-6--7, C-11, Appendix E,

F-12_c_, F-14, I-2, J-1, J-2_a_, J-4_b_

installation medical authority, 5-28

International Standardization Agreements, D-1

STANAG 2475, p. viii, D-3

STANAG 2476, p. viii, D-11

STANAG 2477, p. viii, D-19

laboratory services, 5-9--11, A-1O_a_, Appendix E

biological specimens, 5-11, 5-14

chain of custody, 5-14

clinical, 5-11

levels, 5-11

samples, 5-10

animals, small, 5-14

environmental, 5-14

field, 5-14

food, 5-14

soil, 5-14

vegetation, 5-14

support, 5-11

theater Army medical laboratory, 5-11

leadership

logistics, 2-6, 3-8, 4-2b(4)(_c_), 5-6, D-9, D-12_a_, D-17, D-25,

Appendix E

main supply routes, 3-5_c_

mass casualties, 2-1, 5-15--16, 5-29, A-10_b_, A-14_b_, A-15_b_, D-4_a_,

D-12_a_, D-20_b_

medical equipment sets

chemical agent patient decontamination, 3-8_b_, 4-3_c_(3), C-2, C-4

chemical agent patient treatment, 3-8_b_, 4-3_c_(3), C-2, C-4

medical evacuation, 2-5_b_(3) and (5), 3-1_c_ and _e_, 3-2_a_, 3-3_a_,

3-10_b_, 3-12_b_, 3-17, 4-1, 5-28

medical surveillance, 3-3_a_, 3-14_f_

medical treatment facility, 2-1, 2-2_a_, 2-5_b_, 3-3_c_

mission-oriented protective posture

clothing, 2-5_b_, 3-1_a_--_b_, 3-9--10, 3-15_a_, 5-19_b_, 5-21_e_, C-3,

F-2_a_

equipment, 2-5_b_

performance degradation, 2-6

movement and management of contaminated facilities, 2-5_b_, 3-10_d_

nuclear, biological, and chemical battlefield

considerations, C-1

defense, 3-1b, 5-21

leadership, 2-6, 3-1, 3-6, 3-17_a_, 5-21, Appendix E

operational exposure guide, nuclear, 2-5_a_, 3-1_b_

operations in, 1-3_b_(4), 2-2_a_, 2-4--5, 3-5_a_, 3-9, 3-12_d_, 3-16,

4-2b(1)(_c_), (2), and (4)(_c_), 4-3_a_, 5-14--15, 5-17, A-7, C-2,

C-11, Appendix E, F-4--5

strikes, 4-1_a_

warning and reporting system, 4-1_b_

nursing services, 4-7, A-10

operational

exposure guide, nuclear, 2-5_a_, 3-1_b_, 3-12_d_, 3-17_b_

plans, 2-5_a_, 3-1_a_

operations, 4-2_b_(1)(_c_) and (2)(_a_), 4-3_a_(2), A-1, A-7, C-1, C-5,

C-11, D-3_d_, F-3--5, F-11--12, G-1_a_, J-1_d_, J-5_c_(5)

security, 4-1_b_(1), 4-2_b_

passive defense measures, 3-14_b_

patient

chemical agent, A-14

contaminated, 3-10_c_, 3-12, 4-1_a_(3), C-5

decontamination, 3-3_b_, 3-10, 4-1_a_(3) and _b_, A-14_c_, A-15_c_

externally contaminated, 3-12_a_

holding, 3-3_a_

internally contaminated, 3-12_a_

irradiated, 3-12_a_

management of, A-10_c_

number of, 2-1_b_(3)

protective wrap, 3-17_f_, F-15_b_(2)(_a_), G-11_c_

stability operations and support operations, in, A-7

types of, 2-1_b_(3), 3-12_b_, C-4

personnel

protection of, 2-1_b_(9), 2-6_a_

replacement of, 3-1_c_

planning

considerations for, D-4, D-20_a_

estimates, D-2, D-4, D-11_c_, D-17, D-19

health service support, 3-9

medical force, for, D-10, D-18, D-20, D-26

medical NBC staff officer, Appendix E

mobilization, C-2--3

NBC, 3-5_c_, p. D-1

predeployment, C-2

tool, medical, D-2

plans

establish a medical treatment facility, C-1

HSS, 3-17_d_

load, C-3

movement, C-3

operation, 2-5_a_, 3-1_a_

tactical, 3-17_d_

preventive medicine

arthropods, 5-2_b_, 5-3

climate, 5-2_a_

detachments, 5-4

determining factors, 5-1, 5-2_a_

disease, 5-1

divisional, 3-3_a_, 5-3

field hygiene and sanitation, 5-3

field sanitation team, unit, 5-3--4

immunizations, 5-3, D-11_f_

incidents and morbidity, 5-2_b_

measures, 3-1e, 5-1, 5-4, 5-11--12

medical surveillance, 5-4

occupational and environmental health threat, 5-3--4

operations, 5-1--2, 5-4

pest management, 5-2_b_, 5-4

prophylaxis, D-11_f_

services, 3-3_a_, 5-1, 5-14, C-6, Appendix E

water and food, 5-2_a_, 5-3--4

protection

buildings of opportunity, use of, 3-1_d_, 3-5_b_, 3-12

collective, 3-1_d_, 3-2_b_, 3-3_b_, 3-4, 3-10_a_, 3-15, 4-7, C-2, C-4

covers, 3-1_d_, 3-12

environmental, 4-2_b_(2), 4-5, 4-6_a_ and _c_, 4-7_c_

hospital, 4-2_a_

individual, 4-2_b_, 5-21_d_

mask-only, 4-2_b_(4)(_a_), 4-7_b_

materiel, 3-1_d_, 4-2_b_(4)(_d_)

overhead, 3-1_d_, 3-12

patient, 3-5d, 4-2b(4)(_c_), A-6

personnel, 3-5_b_, 4-2b(4)(a)

proximity, 3-1_c_

shielding, 3-5_b_, 4-2_b_(2)

site selection, 3-12

supplies, 3-5_b_

types of, 3-1_d_

warning system, 4-2_b_(4)

expedient, 2-5_b_(1), 3-5_b_, 3-12

shielding, 4-2_b_(2)(_b_)3

radiation exposure status, 3-12_d_, 3-17_b_

radiological dispersal devices, 1-1_a_, 4-1_a_, A-1

rations, F-6_b_, J-5_a_(4)

reporting, Appendix E

return to duty, 3-1_e_

samples, 5-3--4, 5-9, C-6--7, C-10, Appendix E

analysis of, B-1--2

chain of custody, 5-9, 5-14_a_ and _b_(1), C-6--7

documentation, 5-9

collection, 5-9, B-1--2, B-4_b_

description of, B-2

environmental, 5-9, 5-14, B-1, B-3_b_, B-5

air, 5-12_b_(1), 5-14, B-1, B-8

soil, 5-12_b_(1), 5-14, B-1, B-10

vapor, B-8

vegetation, 5-12_b_(1), 5-14, B-1, B-4

water, 5-12_b_(1), 5-14, B-1, B-3_c_, B-9

food, 5-9_b_(1), 5-14, J-4_b_(1), B-1, B-3_d_

handling, 5-9

history of, B-2

identification, 5-9_b_(1), 5-13

labeling, 5-9, 5-13, B-4_b_

preservation, 5-9_b_(1), B-2, B-4_b_, C-6--7

transportation, 5-9_b_(1)

sleep loss, 2-6_a_

special medical response teams, 5-28--29

specimens, Appendix E

analysis, 5-10--11, 5-12_b_, A-10, B-1--3

ante mortem, B-3_a_

background documents, B-18

biological, 5-3--4, 5-9, A-10, B-1, B-5, B-12--13, p. C-6--7

chain of custody, 5-9_a_, 5-11--12, 5-14_b_(1), B-4, B-17, C-6--7,

C-10--11

civilians, from, B-1_b_, B-13

collection of, 5-3--4, 5-9_b_(1), 5-10--12, 5-14, B-1, B-4_b_,

B-12--13, C-7, C-10--11

description of, B-2

documentation of, B-2

field, 5-14

history of, B-2, B-15

identification, 5-9b(1), 5-12_b_, 5-13, A-10_a_

post mortem and forensic, B-3_b_, B-14

preservation, 5-9_b_(1), 5-11--12, B-2--3, B-4_b_, B-15--16, C-6--7,

C-10--11

reporting, 5-12_b_, B-15, B-17

transportation, 5-9_a_ and _b_(1), 5-12

types of, B-3

stability operations and support operations, A-7

Standardization Agreement (STANAG). See International Standardization

Agreements.

stress, 2-6_a_

supply, Class VIII

tactical standing operating procedures, C-2

threat, 1-1_a_

biological warfare, 1-2, 1-3_b_, 3-14

chemical, biological, radiological, nuclear, and high-yield explosive,

1-2

chemical warfare, 1-2, 1-3_c_

directed energy, 1-2

medical, 1-2

nuclear, 1-2, 1-3_a_

radiological dispersal device, 1-2, 1-3_a_

toxic industrial material, 1-1_b_, 1-3_d_

toxic industrial material, 1-1_b_, 1-2, 3-1_a_ and _d_, 4-1_a_, 5-3, A-1,

A-15, Appendix E

training, 3-1_b_, C-3

treatment, 3-1--2, 3-7, 3-9--10, 3-13--16, 5-29, A-3_a_(3), A-6_e_,

A-10_d_, A-14_d_, A-15_d_, Appendix E

advanced trauma management, 3-1_e_, 3-9

clean area, 3-1--3, 3-10, 3-15, 3-17_b_(4)

emergency medical treatment, 3-1_e_, 3-3_b_, 3-7, 3-9, 3-15_b_,

4-1_a_(3), D-4_a_, D-12_a_

triage, 2-3, 3-13, 4-1_a_(3) and _b_, 4-4_b_, 5-20, 5-29, C-2, C-5,

D-4_a_, D-5, D-12_a_, D-13, D-21

veterinary services, 5-5, 5-14, C-7, Appendix E

animal care, 5-8

food protection, 5-6

waste disposal, F-6_b_

water supply, 4-1_a_, C-2, F-6_b_, I-1--4

actions to protect, I-3

detection in, I-2

treatment of, I-4

weapons, 1-3, 3-1_b_ and _c_, 4-1_a_, A-1

biological, 4-2_b_(3), 5-2_b_, A-8, D-11_e_, D-12_b_

agents, A-8

behavior, A-9

dispersion, A-8--9

effects, 3-7, A-7, A-10, D-11_c_

incubation period, A-8_a_(3)

individual, F-14

infection, A-8_a_(2)

live agents, A-8_a_

spore-forming, A-8_b_

toxins, A-8_c_