US Army, THE MEDICAL NBC BATTLEBOOK, Survival Medical Manual

Purpose and Scope
The purpose of this battlebook is to address operational health concerns in environments where Nuclear, Biological, and Chemical (NBC) threats exist. Potential NBC threats range from weapons of mass destruction to contamination of the battlefield by hazardous material. Medical personnel, in conjunction with chemical personnel, must be able to advise commanders on a wide range of issues including the health effects of NBC threats, protective clothing and measures, and management of NBC casualties.

This manual is not an emergency response book or treatment guide. It is intended to provide a quick reference for decision making as to whether to request expert consultation in a given area. Except in extreme emergency, the contents should not be construed as definitive.

The US Army conducts operations in areas where potential adversaries could use NBC weapons. These weapons range from a megaton nuclear weapon used to destroy an entire city to a barrel of
industrial chemicals used to contaminate an important road intersection. In addition to their destructive power, NBC weapons have political, psychological, operational, and strategic impact.
The use of passive measures such as proactive NBC defense procedures is a potential tool to reduce the threat of NBC weapons. In the event of the use of NBC weapons, the medical personnel must be prepared to provide a variety of services including medical treatment, site hazard surveys, and medical hazard assessments.

Threats
1. Nuclear Weapons. Although the threat of global nuclear annihilation has diminished, Russia and China still maintain large numbers of nuclear weapons. While direct confrontation with these nations is not likely at the present time, medical units must still be prepared for such conflicts. Several potential adversaries such as North Korea, Iraq, and Iran have tried to develop nuclear weapons. These countries could use nuclear weapons either to gain a tactical advantage or as a terrorist weapon. The employment of nuclear weapons in stability and support operations such as Bosnia is not likely; however, commanders must be prepared for their use. With the advent of new technologies, it is conceivable that a terrorist or terrorist organization could obtain a small nuclear device. This device could then be used to hold a city or state at ransom. The employment of nuclear weapons could rapidly escalate a stability and support operational scenario into a major war.

2. Radiological Hazards. Adversaries and even terrorist could spread radioactive material in an effort to deny US forces access to key terrain, roads, and buildings. The use of radiation dispersal devices and destruction of local nuclear reactors by terrorists are examples of radiological threats. Other radiological hazards present during deployments may include improperly dumped waste and accidents involving radioactive commodities.

3. Biological Warfare. Biological warfare agents range in spectrum from sophisticated, specifically engineered infectious microorganisms and toxins produced in modern biotechnology laboratories, to simple expedient food contaminants employed by insurgents or terrorists. Health care personnel must be alert to any increase in infectious disease rates or disease cases not commonly found in the area of operations. Because the use of biological weapons is not always initially evident and symptoms may take days to weeks to appear, epidemiology may provide the first clue to an attack.

4. Chemical Warfare Agents. Chemical agents are relatively simple to make and employ. Since their effects are immediate and dramatic, chemical weapons are used to kill and injure and also for terrain denial for persistent agents. For example, Iraq used large quantities of blister agents in its war against Iran. Although not classed as chemical warfare agents, incendiary/flame munitions, phosphorus compounds, and irritants O-chlorobenzylidene (CS) and chloroacetophenone (CN)