FIELD MANUAL, TREATMENT OF BIOLOGICAL WARFARE AGENT CASUALTIES-
HEADQUARTERS, DEPARTMENTS OF THE ARMY, THE NAVY, AND THE AIR FORCE, AND
COMMANDANT, MARINE CORPS DISTRIBUTION RESTRICTION: Approved for public
release; distribution is unlimited.17 July 2000
FM 8-284
NAVMED P-5042
AFMAN (I) 44-156
MCRP 4-11.1C
FIELD MANUAL HEADQUARTERS
NO. 8-284 DEPARTMENTS OF THE ARMY,
NAVMED P-5042 THE NAVY, AND THE AIR FORCE,
AIR FORCE MANUAL (INTERSERVICE) AND COMMANDANT, MARINE
CORPS NO. 44-156 Washington, DC 17 July 2000
MARINE CORPS MCRP 4-11.1C
PREFACE ...........................................................................................
vii
CHAPTER 1. INTRODUCTION
1-1. The Threat of Biological Warfare Agents Against United States
Forces and Civilian Populations .................................................
1-1
1-2. Modes of Delivery ....................................................................
1-1
1-3. Employment of Biological Warfare Agents ......................................
1-2
1-4. Classification of Biological Warfare Agents .....................................
1-3
1-5. Portals of Entry .......................................................................
1-3
1-6. Environmental Detection ............................................................
1-4
1-7. Diagnosis ...............................................................................
1-5
1-8. Specimen Collection ..................................................................
1-6
1-9. Specimen Labeling ....................................................................
1-9
1-10. Specimen Handling and Shipment .................................................
1-10
1-11. Chain of Custody Responsibilities .................................................
1-10
1-12. Identification Methods for Biological Warfare Agents .........................
1-11
1-13. Therapy .................................................................................
1-12
1-14. Case Reporting and Epidemiological Assessment ...............................
1-12
1-15. Prevention ..............................................................................
1-12
1-16. Protective Equipment.................................................................
1-13
1-17. First Aid ................................................................................
1-14
1-18. Protective Measures and Handling of Casualties ................................
1-14
1-19. Patient Decontamination .............................................................
1-15
1-20. Infection Control ......................................................................
1-16
1-21. Medical Evacuation ...................................................................
1-16
1-22. Aeromedical Isolation Team ........................................................
1-18
CHAPTER 2. BACTERIAL AGENTS
Section I. Introduction ...........................................................................
2-1
2-1. General .................................................................................
2-1
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Section II. Anthrax ................................................................................
2-1
2-2. General .................................................................................
2-1
2-3. Biological Warfare Agent Delivery ................................................
2-2
2-4. Environmental Detection ............................................................
2-2
2-5. Prevention ..............................................................................
2-2
2-6. Biological Warfare Clinical Presentation .........................................
2-3
2-7. Diagnosis ...............................................................................
2-3
2-8. Treatment ..............................................................................
2-4
2-9. Control of Patients, Contacts, and Treatment Areas ............................
2-4
2-10. Medical Evacuation ...................................................................
2-4
Section III. Brucellosis .............................................................................
2-5
2-11. General .................................................................................
2-5
2-12. Biological Warfare Agent Delivery ................................................
2-6
2-13. Environmental Detection ............................................................
2-6
2-14. Prevention ..............................................................................
2-6
2-15. Biological Warfare Clinical Presentation .........................................
2-7
2-16. Diagnosis ...............................................................................
2-7
2-17. Treatment ..............................................................................
2-7
2-18. Control of Patients, Contacts, and Treatment Areas ............................
2-8
2-19. Medical Evacuation ...................................................................
2-8
Section IV. Melioidosis.............................................................................
2-8
2-20. General .................................................................................
2-8
2-21. Biological Warfare Agent Delivery ................................................
2-9
2-22. Environmental Detection ............................................................
2-9
2-23. Prevention ..............................................................................
2-9
2-24. Biological Warfare Clinical Presentation .........................................
2-9
2-25. Diagnosis ...............................................................................
2-9
2-26. Treatment ..............................................................................
2-10
2-27. Control of Patients, Contacts, and Treatment Areas ............................
2-11
2-28. Medical Evacuation ...................................................................
2-11
Section V. Glanders ...............................................................................
2-11
2-29. General .................................................................................
2-11
2-30. Biological Warfare Agent Delivery ................................................
2-11
2-31. Environmental Detection ............................................................
2-11
2-32. Prevention ..............................................................................
2-11
2-33. Biological Warfare Clinical Presentation .........................................
2-12
2-34. Diagnosis ...............................................................................
2-12
2-35. Treatment ..............................................................................
2-12
2-36. Control of Patients, Contacts, and Treatment Areas ............................
2-13
2-37. Medical Evacuation ...................................................................
2-13
Section VI. Plague ..................................................................................
2-13
2-38. General .................................................................................
2-13
2-39. Biological Warfare Agent Delivery ................................................
2-14
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2-40. Environmental Detection ............................................................
2-14
2-41. Prevention ..............................................................................
2-14
2-42. Biological Warfare Clinical Presentation .........................................
2-14
2-43. Diagnosis ...............................................................................
2-15
2-44. Treatment ..............................................................................
2-15
2-45. Control of Patients, Contacts, and Treatment Areas ............................
2-16
2-46. Medical Evacuation ...................................................................
2-16
Section VII. Q Fever ................................................................................
2-16
2-47. General .................................................................................
2-16
2-48. Biological Warfare Agent Delivery ................................................
2-17
2-49. Environmental Detection ............................................................
2-18
2-50. Prevention ..............................................................................
2-18
2-51. Biological Warfare Clinical Presentation .........................................
2-18
2-52. Diagnosis ...............................................................................
2-19
2-53. Decontamination ......................................................................
2-19
2-54. Treatment ..............................................................................
2-19
2-55. Control of Patients, Contacts, and Treatment Areas ............................
2-20
2-56. Medical Evacuation ...................................................................
2-20
Section VIII. Tularemia .............................................................................
2-20
2-57. General .................................................................................
2-20
2-58. Biological Warfare Agent Delivery ................................................
2-21
2-59. Environmental Detection ............................................................
2-21
2-60. Prevention ..............................................................................
2-21
2-61. Biological Warfare Clinical Presentation .........................................
2-22
2-62. Diagnosis ...............................................................................
2-22
2-63. Treatment ..............................................................................
2-22
2-64. Control of Patients, Contacts, and Treatment Areas ............................
2-23
2-65. Medical Evacuation ...................................................................
2-23
CHAPTER 3. VIRAL AGENTS
Section I. Introduction ...........................................................................
3-1
3-1. General .................................................................................
3-1
Section II. Smallpox ...............................................................................
3-1
3-2. General .................................................................................
3-1
3-3. Biological Warfare Agent Delivery ................................................
3-1
3-4. Environmental Detection ............................................................
3-1
3-5. Prevention ..............................................................................
3-2
3-6. Biological Warfare Clinical Presentation .........................................
3-3
3-7. Diagnosis ...............................................................................
3-4
3-8. Treatment ..............................................................................
3-4
3-9. Control of Patients, Contacts, and Treatment Areas ............................
3-4
3-10. Medical Evacuation ...................................................................
3-5
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Section III. Venezuelan Equine Encephalitis .................................................
3-5
3-11. General .................................................................................
3-5
3-12. Biological Warfare Agent Delivery ................................................
3-6
3-13. Environmental Detection ............................................................
3-6
3-14. Prevention ..............................................................................
3-6
3-15. Biological Warfare Clinical Presentation .........................................
3-6
3-16. Diagnosis ...............................................................................
3-6
3-17. Treatment ..............................................................................
3-7
3-18. Control of Patients, Contacts, and Treatment Areas ............................
3-7
3-19. Medical Evacuation ...................................................................
3-7
Section IV. Viral Hemorrhagic Fevers .........................................................
3-7
3-20. General .................................................................................
3-7
3-21. Biological Warfare Agent Delivery ................................................
3-9
3-22. Environmental Detection ............................................................
3-9
3-23. Prevention ..............................................................................
3-9
3-24. Biological Warfare Clinical Presentation .........................................
3-9
3-25. Diagnosis ...............................................................................
3-9
3-26. Treatment ..............................................................................
3-10
3-27. Control of Patients, Contacts, and Treatment Areas ............................
3-10
3-28. Medical Evacuation ...................................................................
3-12
CHAPTER 4. TOXINS
Section I. Introduction ...........................................................................
4-1
4-1. General .................................................................................
4-1
Section II. Clostridium Botulinum Toxin .....................................................
4-1
4-2. General .................................................................................
4-1
4-3. Biological Warfare Agent Delivery ................................................
4-2
4-4. Environmental Detection ............................................................
4-2
4-5. Biological Warfare Clinical Presentation .........................................
4-2
4-6. Prevention ..............................................................................
4-3
4-7. Diagnosis ...............................................................................
4-3
4-8. Treatment ..............................................................................
4-3
4-9. Control of Patients, Contacts, and Treatment Areas ............................
4-5
4-10. Medical Evacuation ...................................................................
4-5
Section III. Clostridium Perfringens Toxins ..................................................
4-5
4-11. General .................................................................................
4-5
4-12. Biological Warfare Agent Delivery ................................................
4-5
4-13. Environmental Detection ............................................................
4-6
4-14. Prevention ..............................................................................
4-6
4-15. Biological Warfare Clinical Presentation .........................................
4-6
4-16. Diagnosis ...............................................................................
4-6
4-17. Treatment ..............................................................................
4-6
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4-18. Control of Patients, Contacts, and Treatment Areas ............................
4-6
4-19. Medical Evacuation ...................................................................
4-7
Section IV. Ricin ....................................................................................
4-7
4-20. General .................................................................................
4-7
4-21. Biological Warfare Agent Delivery ................................................
4-7
4-22. Environmental Detection ............................................................
4-8
4-23. Prevention ..............................................................................
4-8
4-24. Biological Warfare Clinical Presentation .........................................
4-8
4-25. Diagnosis ...............................................................................
4-8
4-26. Treatment ..............................................................................
4-8
4-27. Control of Patients, Contacts, and Treatment Areas ............................
4-9
4-28. Medical Evacuation ...................................................................
4-9
Section V. Saxitoxin ...............................................................................
4-9
4-29. General .................................................................................
4-9
4-30. Biological Warfare Agent Delivery ................................................
4-10
4-31. Environmental Detection ............................................................
4-10
4-32. Prevention ..............................................................................
4-10
4-33. Biological Warfare Clinical Presentation .........................................
4-10
4-34. Diagnosis ...............................................................................
4-10
4-35. Treatment ..............................................................................
4-11
4-36. Control of Patients, Contacts, and Treatment Areas ............................
4-11
4-37. Medical Evacuation ...................................................................
4-11
Section VI. Staphylococcal Enterotoxin B.....................................................
4-11
4-38. General .................................................................................
4-11
4-39. Biological Warfare Agent Delivery ................................................
4-12
4-40. Environmental Detection ............................................................
4-12
4-41. Prevention ..............................................................................
4-12
4-42. Biological Warfare Clinical Presentation .........................................
4-12
4-43. Diagnosis ...............................................................................
4-13
4-44. Treatment ..............................................................................
4-13
4-45. Control of Patients, Contacts, and Treatment Areas ............................
4-13
4-46. Medical Evacuation ...................................................................
4-13
Section VII. Trichothecene Mycotoxins .........................................................
4-14
4-47. General .................................................................................
4-14
4-48. Biological Warfare Agent Delivery ................................................
4-14
4-49. Environmental Detection ............................................................
4-14
4-50. Prevention ..............................................................................
4-14
4-51. Biological Warfare Clinical Presentation .........................................
4-15
4-52. Diagnosis ...............................................................................
4-15
4-53. Treatment ..............................................................................
4-15
4-54. Control of Patients, Contacts, and Treatment Areas ............................
4-15
4-55. Medical Evacuation ...................................................................
4-15
FM 8-284/NAVMED P-5042/AFMAN (I) 44-156/MCRP 4-11.1C
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APPENDIX A. RECOGNITION OF A BIOLOGICAL WARFARE
AGENT CASUALTY
A-1. General .................................................................................
A-1
A-2. Types of Casualties ...................................................................
A-1
A-3. Recognize Biological Casualties ....................................................
A-2
APPENDIX B. MEDICAL MANAGEMENT AND TREATMENT IN
BIOLOGICAL WARFARE OPERATIONS
Section I. US Army Medical Treatment Facilities.........................................
B-1
B-1. General .................................................................................
B-1
B-2. Objectives of Health Service Support in Biological Warfare Operations
.... B-1
B-3. Planning for the Management and Treatment of Biologically
Contaminated Casualties ..........................................................
B-2
B-4. Emergency Medical Treatment of Biologically Contaminated
Casualties ............................................................................
B-2
B-5. Patient Decontamination Methods..................................................
B-3
B-6. Logistics ................................................................................
B-5
B-7. Training ................................................................................
B-5
B-8. Casualty Evacuation ..................................................................
B-5
Section II. US Air Force Medical Treatment Facilities....................................
B-6
B-9. General .................................................................................
B-6
B-10. Detection of Biological Agents .....................................................
B-7
B-11. Identification ...........................................................................
B-8
B-12. Decontamination ......................................................................
B-8
Section III. US Navy Medical Treatment Facilities .........................................
B-9
B-13. General .................................................................................
B-9
GLOSSARY ....................................................................................
Glossary-1
Section I. Abbreviations and Acronyms ..............................................
Glossary-1
Section II. Definitions ......................................................................
Glossary-6
REFERENCES ..................................................................................
References-1
INDEX ........................................................................................
Index-1
In addition, about 40 pages of supplementary medical information (up to October, 2001) on Anthrax, Plague, Botulism and Smallpox as Biological weapons has been added.