ARMY FM 8-284 NAVY NAVMED P-5042 AIR FORCE AFMAN (I) 44-156 MARINE CORPS MCRP 4-11.1C 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 C1, FM 8-284 NTRP 4-02.23 (NAVMED P-5042) AFMAN (I) 44-156 MCRP 4-11.1C Change 1 HEADQUARTERS DEPARTMENTS OF THE ARMY, THE NAVY, AND THE AIR FORCE, AND COMMANDANT, MARINE CORPS Washington, DC 8 July 2002 TREATMENT OF BIOLOGICAL WARFARE AGENT CASUALTIES 1. Change FM 8-284/NAVMED P-5042/AFMAN (I) 44-156/MCRP 4-11.1C, 17 July 2000, as follows: Remove old pages Insert new pages i and ii i and ii 1-11 and 1-12 1-11 and 1-12 1-17 and 1-18 1-17 and 1-19 2-1 through 2-4 2-1 through 2-4 2-13 and 2-14 2-13 and 2-14 2-21 and 2-22 2-21 and 2-22 Glossary-3 and Glossary-4 Glossary-3 and Glossary-4 Glossary-7 Glossary-7 References-1 and References-2 References-1 and References-2 Index-3 through Index-6 Index-3 through Index-6 Back cover Back cover 2. New or changed material is indicated by a star ((cid:144)). 3. File this transmittal sheet in front of the publication. DISTRIBUTION RESTRICTION: Approved for public release, distribution is unlimited. C1, FM 8-284/NTRP 4-02.23 (NAVMED P-5042)/AFMAN (I) 44-156/MCRP 4-11.1C By Order of the Secretary of the Army: ERIC K. SHINSEKI General, United States Army Official: Chief of Staff JOEL B. HUDSON Administrative Assistant to the Secretary of the Army By Direction of the Chief of Naval Operations: Official: R.G. SPRIGG Rear Admiral, USN Navy Warfare Development Command By Order of the Secretary of the Air Force: Official: PAUL K. CARLTON, JR. Lieutenant General, USAF, MC, CFS Surgeon General By Direction of the Commandant of the Marine Corps: Official: EDWARD HANLON, JR. Lieutenant General, U.S. Marine Corps Commanding General Marine Corps Combat Development Command DISTRIBUTION: US Army: Active Army, USAR, and ARNG: To be distributed in accordance with the initial distribution number 115795, requirements for FM 8-284. US Air Force: F US Marine Corps: PCN: 14400008000 PIN: 077922-000 PCN: 14400008000 C1, FM 8-284 NTRP 4-02.23 (NAVMED P-5042) AFMAN (I) 44-156 MCRP 4-11.1C FIELD MANUAL HEADQUARTERS NO. 8-284 DEPARTMENTS OF THE ARMY, NTRP 4-02.23 (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 TREATMENT OF BIOLOGICAL WARFARE AGENT CASUALTIES TABLE OF CONTENTS Page 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 (cid:144) 1-23. Investigational New Drugs and Off-Label Indications........................ 1-18 CHAPTER 2. BACTERIAL AGENTS Section I. Introduction......................................................................... 2-1 2-1. General ................................................................................. 2-1 i Distribution Restriction: Approved for public release; distribution is unlimited. C1, FM 8-284/NTRP 4-02.23 (NAVMED P-5042)/AFMAN (I) 44-156/MCRP 4-11.1C Page 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 ii FM 8-284/NAVMED P-5042/AFMAN (I) 44-156/MCRP 4-11.1C Page 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 iii FM 8-284/NAVMED P-5042/AFMAN (I) 44-156/MCRP 4-11.1C Page 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 iv FM 8-284/NAVMED P-5042/AFMAN (I) 44-156/MCRP 4-11.1C Page 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 v FM 8-284/NAVMED P-5042/AFMAN (I) 44-156/MCRP 4-11.1C Page 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 PREFACE Purpose This publication serves as a guide and a reference for trained members of the Armed Forces Medical Services and other medically qualified personnel on the recognition and treatment of biological warfare vi