CHAPTER 5 OTHER HEALTH SERVICE SUPPORT

CHAPTER 5 OTHER HEALTH SERVICE SUPPORT

Section I. PREVENTIVE MEDICINE SERVICES

5-1. General

On the integrated battlefield, PVNTMED services will be in greater demand than at any other time, especially under BW conditions. Preventive medicine personnel will be called upon to assist the commander in determining the health hazards associated with nuclear fallout; the safety of drinking water in an NBC environment; as well as determining when to use prophylaxis, pretreatments, immunizations, and other PVNTMED measures (PMM) associated with NBC warfare. Preventive medicine personnel must be aware of the medical threat in the AO. They must continually update their medical surveillance activities to identify disease trends (endemic and epidemic), potential disease vectors, and the susceptibility of troops to these diseases. Under NBC conditions, diseases may manifest that exist in the area, but were not being transmitted to personnel. However, due to the reduced health status of personnel from exposures to or from stress-related NBC conditions, the troops begin to suffer their effects. The appearance of diseases or arthropods not known to exist in the AO are indicators that BW agents have been used. For details on PVNTMED operations, see FM 4-02.17.

5-2. Disease Incidence Following the Use of Nuclear, Biological, and Chemical Weapons

a. Determining Factors. Factors of prime importance in determining the nature and severity of the disease effects are—

Immunization status of personnel.

Population density.

Degree of industrialization in the operational area.

Availability of food supplies.

Availability of water.

Climate.

Finally, the manner and situation in which nuclear weapons are used are of importance. A single weapon detonated in a socially stable area will have far less serious effects than a detonation in an area where combat has already disrupted the social stability. At Hiroshima and Nagasaki, Japan (excellent examples of the first type of situation), the survivors who could get away were able to obtain food, shelter, and care from surrounding intact areas. With prolonged combat operations, such intact areas would not be available, resulting in no food, shelter, or care for survivors. There will be a breakdown in social order and there will be a lack of effective medical support; including PVNTMED functions and facilities.

b. Disease Incidence. Without PVNTMED capabilities, increased incidence and morbidity from diseases will follow. Some diseases will predominate in incidence, depending upon the geographical areas involved and the endemic diseases present.

(1) In urban areas in temperate climates, several diseases are epidemic threats. These epidemic threats may include—

Dysentery (due to a variety of pathogens).

Rickettsial diseases, particularly typhus and scrub typhus.

Hepatitis.

Tuberculosis.

Sexually transmitted diseases.

Malaria and cholera (in many parts of the world).

(2) There are several reasons for the increased risk of disease including, but not limited to—

Crowding of surviving populations with limited sanitary facilities, such as was seen in Europe at the end of World War II.

A lack of prophylaxis and immunizations with resultant increases in the susceptible faction of a given population.

A lack of pest management.

The effect of irradiation on susceptibility to infection. With the high levels of fallout covering wide areas, a large number of people will sustain sublethal whole-body doses of irradiation. The interaction of irradiation with infections is not clear; but it may be the result of latent infections manifesting and decreased resistance to infection. The result is an increased incidence of disease.

The ecological imbalance and host-parasite relationship following the use of nuclear weapons. Each class and order of animals has marked differences in sensitivity to irradiation. Arthropods, for example, are much more resistant than are vertebrates. The normal balance between arthropods and birds that prey upon them in a given area may be severely upset, producing a marked overgrowth of the arthropods. If the arthropods include vectors of disease there would be a serious increase in disease hazards. If there is an increase in arthropods that destroy vegetation there would be a serious destruction of food crops.

The introduction of a BW agent in an AO in which the disease organism is endemic or epidemic can increase the risk level for exposed personnel.

5-3. Preventive Medicine Section

The PVNTMED sections of the brigade, divisional, and nondivisional medical companies perform analysis on water sources and supplies to determine the presence or absence of NBC/TIM contamination; see Appendix I for additional information. Based upon their findings, the water is released for consumption, or is restricted from use until it is treated (usually by water production personnel using the reverse osmosis water purification unit [ROWPU]). They also collect water samples for suspect biological agent contamination for supporting medical laboratory analysis (see Appendix B). They conduct medical surveillance activities, to include occupational and environmental health threat surveillance. They conduct limited entomological surveys to determine the existence of disease-vectoring arthropods in the AO. They inspect food service facilities to determine the extent, if any, of NBC contamination. They evaluate the unit's—

Immunization status.

Use of prophylaxis for specific diseases (such as antimalarial tablets) (see FM 4-02.33), for nuclear radiation exposure (such as granisetron for nausea and vomiting) (see FM 4-02.283), and for BW agents (such as Ciprofloxacin for postexposure chemoprophylaxis for Anthrax) (see FM 8-284).

Use of nerve agent pyridostigmine pretreatment tablets (see FM 8-285), if warranted.

Application of personal hygiene and field sanitation procedures (FM 21-10/MCRP 4-11.1D).

Based upon their findings, they provide recommendations for corrective actions to the commanders. They assist in training US Army unit field sanitation teams (FM 4-25.12); they are not members of the unit field sanitation team. They conduct medical surveillance activities for their command (FM 4-02.17).

5-4. Preventive Medicine Detachment

The PVNTMED detachment provides PVNTMED services on an area support basis to units within their assigned AO. These services include, but are not limited to—

Conducting water surveillance, including NBC contamination. Collecting water samples suspected of NBC/TIM contamination for analysis by supporting medical laboratory (see Appendix B).

Performing food service sanitary inspections.

Conducting medical surveillance and providing epidemiological consultation.

Conducting pest (arthropod and rodent) surveys and surveillance.

Conducting arthropod control operations. The aerial spraying missions are dependent upon availability of helicopter support.

Conducting occupational and industrial hygiene surveys.

Advising commanders on the application of PMM.

Training the supported units' field sanitation teams.

Section II. VETERINARY SERVICES

5-5. General

The US Army Veterinary Service is the Executive Agent for veterinary services to all Services within the DOD. They ensure that food and bottled water supplies are safe and provide veterinary medical and surgical care for government-owned animals throughout the AO. On the integrated battlefield, their role is particularly important; the potential for food supplies becoming contaminated with NBC agents is high. For detailed information on provision of veterinary services see FM 8-10-18.

5-6. Food Protection

Food may become contaminated from enemy employment of NBC weapons/agents or from terroristic contamination of food procurement facilities and food supplies. The NBC agents may be introduced during production or in the storage area of the procurement facility; while the product is in transit; at the military storage facility; or at the unit food service facility. Regardless of where the agent is used, the effect is the same; personnel will become ill or die if they consume the contaminated food. To ensure food safety, veterinary personnel inspect and monitor food from its procurement until it is issued to the consumer. Throughout the AO, all Services (Army, Navy, Marine, and Air Force) logistics and food service personnel must take precautions to protect subsistence from contamination.

5-7. Food Decontamination

Veterinary personnel are involved in the detection and monitoring of NBC contaminated rations; before use, they must inspect all food suspected of being contaminated with NBC agents. Appendix J provides guidance on food decontamination procedures. Veterinary personnel provide advice on the decontamination of food to unit personnel owning the food, or personnel performing the food decontamination. Depending on the type of contamination and packaging, the food may be—

Consumed without being decontaminated.

Decontaminated and then consumed.

Destroyed.

Some items may be held to allow time for natural decay of nuclear or chemical contamination before consumption. The commander, with advice from veterinary personnel, makes the decision on the disposition of the food. However, veterinary personnel make the final determination of food safety.

5-8. Animal Care

Veterinary personnel are concerned with the protection of government-owned animals and animals being procured for consumption. Animals must be protected from NBC contamination, whenever possible. Animals should be moved into enclosures to protect them as much as possible from contamination. Protective equipment is not available for military working dogs; however, protection of the animal's feet and body must be considered. When military working dogs must cross a contaminated area, protect their feet by using butyl rubber material to improvise booties. Since CPS systems are not available, animal treatment facilities must be established in contamination free areas. Veterinary treatment personnel must remain in MOPP Level 4 when caring for NBC animal casualties until the animals have been decontaminated. The treatment of military working dog NBC casualties is outlined in FM 8-10-18.

Section III. LABORATORY SERVICES

5-9. General

Laboratory services must continue their support role even under NBC conditions. For the provision of clinical and diagnostic support, the facility must be located in a contamination-free area or be inside collective protection. Designated laboratories within the theater will analyze NBC samples/specimens (including in theater field confirmation identification of biological agents by evaluating specimens from symptomatic patients and animals and environmental samples collected from the AO). See Appendix B for procedures in collecting biological samples/specimens, handling/packaging, maintaining chain of custody, transporting samples/specimens, and analysis.

5-10. Level II

Laboratory support at this level is extremely limited; it consists of laboratory procedures in direct support of MTF and FST activities. Laboratory personnel prepare collected suspect NBC specimens for submission to the supporting laboratory for analysis; the specimens are forwarded to supporting medical laboratories (Appendix B).

5-11. Level III

Laboratory support in a CSH is intended for providing clinical laboratory support and is primarily in support of acute surgical cases, blood services, and statim (STAT) services required for intensive care operations. Only extremely limited microbiology services (parasitological exams and gram stains) are provided. In a mature theater, the microbiology services may be augmented to include limited cultures and sensitivity testing. Patients with documented or suspected exposure to NBC weapons/agents will be medically evaluated, specimens will be collected, packaged, and have chain of custody established. The specimens will be forwarded through technical channels to the supporting medical laboratory (such as the theater Army medical laboratory [TAML]) for analysis. See Appendix B for specimen collection, packaging, chain of custody, and processing requirements.

5-12. Level IV

a. Clinical Laboratories. The clinical laboratories in the combat support, field, and general hospitals have the ability to perform a general, but limited, array of analytical procedures in hematology, urinalysis, chemistry, microbiology, serology, and blood bank. Patient specimens of suspected biological or chemical agent exposures are forwarded through technical channels to the supporting medical laboratory. See Appendix B for sample/specimen collection, packaging, chain of custody, processing, and transporting requirements.

b. Field Laboratories.

(1) Theater Army Medical Laboratory. The TAML is the specialized echelons above corps (EAC) laboratory that provides clinical and nonclinical medical laboratory support. When equipped and staffed, the TAML provides in-theater field confirmation identification of NBC samples or specimens. Using sophisticated equipment and methods, the TAML has the capability to detect and identify NBC agents in a variety of specimens/samples (such as human, air, soil, water, animals, vegetation, and food). Direct support from continental United States (CONUS)-based laboratories aids the TAML with identification of NBC agents. Command decision on use of protective/preventive measures and patient care may be based on the TAML findings. Proper collection, packaging, and rapid shipment of specimens by MTFs and samples from other sources will ensure effective, timely, and accurate laboratory analyses.

(2) Area Medical Laboratory. The Area Medical Laboratory (AML) is the specialized laboratory within the theater that provides nonclinical medical laboratory support. The AML can be deployed in the corps or to EAC for support missions. When fielded, the AML will replace the TAML in the force structure. The AML provides in-theater field confirmation identification of NBC samples or specimens. Using sophisticated equipment and methods, the AML has the capability to detect and identify NBC agents in a variety of specimens/samples (such as human, air, soil, water, animals, vegetation, and food). Direct support from CONUS-based laboratories aids the AML with identification of NBC agents. Command decision on use of protective/preventive measures and patient care may be based on the AML findings. Proper collection, packaging, and rapid shipment of specimens by MTFs and samples from other sources will ensure effective, timely, and accurate laboratory analyses.

5-13. Level V (Continental United States)

Designated Level V medical laboratories perform analyses to provide definitive identification of suspect biological agents for the President and Secretary of Defense purposes. The definitive identification of suspect biological agents also aids commanders in the AO in maintaining the health of their command.

5-14. Field Samples

Chemical corps personnel collect environmental, air, soil, and vegetation samples. Preventive medicine personnel collect samples from drinking water sources and supplies. Veterinary personnel collect samples from food supplies and medical specimens from animals. All other units collect soil, vegetation, and small animal samples for laboratory analysis. Samples are subjected to initial screening with rapid test kits and in-theater confirmatory identification at the supporting medical laboratory. The President- and Secretary of Defense-required definitive identification is performed at the designated Level V medical laboratory. Comprehensive databases will be maintained to provide historical testing results and will aid in the AO commander's decisions to conduct operations in an NBC environment. See Appendix B for specific procedures for sample collection, packaging, transporting, maintaining chain of custody, and analysis.

Section IV. DENTAL SERVICES

5-15. General

Dental service support is provided in the AO at Levels II, III, and IV. Because of their location close to main supply routes and other support assets, dental units are vulnerable to an NBC strike. Nuclear, biological, and chemical operations have an impact at all levels; thus, dental units must be prepared to survive on the integrated battlefield. Defense against NBC weapons must be included in the dental unit's TSOP. Individual and collective tasks must be intensely trained on a regular basis; survival depends on the ability of personnel to use basic survival skills against an NBC attack. For details on provision of dental services, see FM 4-02.19.

5-16. Mission in a Nuclear, Biological, or Chemical Environment

The overall mission of dental units to provide dental services is greatly affected in the aftermath of an NBC attack. First, the unit must survive the attack and rapidly recover from its effects. Secondly, in the event of mass casualties, the dental patient care effort must be redirected from dental treatment to the alternate wartime role of augmenting the adjacent MTF. Dental units do not possess CPS; therefore, providing dental services in an NBC environment will be limited to the treatment of maxillofacial emergencies requiring immediate attention. This care will be provided at an MTF with a CPS.

5-17. Dental Treatment Operations

As a general rule, in the aftermath of an NBC attack, dental treatment operations cease until deliberate decontamination of the unit and its equipment has been accomplished. Only maxillofacial injuries of an immediate life-threatening nature should be considered for treatment. After an attack, the resources of the dental treatment facility (DTF) are redirected toward support of any mass casualty situation that may have been generated at an adjacent MTF, or toward decontamination and relocation to a noncontaminated area.

5-18. Patient Treatment Considerations

The only category of dental treatment appropriate in an NBC environment is emergency; and then, only those emergencies of an extreme nature which demand immediate attention. The most likely condition requiring such attention would be maxillofacial trauma and would most likely be treated at an MTF rather than a DTF. Although the likelihood of a requirement to treat dental patients in an NBC environment is extremely low, DTFs must have a plan in the event that such patients do present.

a. Patient Decontamination. Decontamination of patients, dental patients included, is an absolute requirement before admission into a clean MTF. Contaminated patients are triaged and decontaminated before treatment (except for life- or limb-saving care). Both triage and decontamination should be accomplished as far forward as possible. Specific details on patient decontamination are in Appendix G. It is important to note that normally patient decontamination is not performed by medical or dental personnel. Initial decontamination at the basic skill level is accomplished at the casualty's unit. Detailed patient decontamination is accomplished by the patient decontamination teams (made up of nonmedical personnel from the supported units) that are supervised by medical personnel at the MTF.

b. Patient Decontamination at Dental Treatment Facilities. Neither dental units nor their DTFs are equipped for patient decontamination. Any contaminated patients arriving at a DTF requiring urgent attention must be directed or evacuated to the nearest MTF with a patient decontamination capability.

5-19. Patient Protection

Dental treatment facilities must also consider the need to protect patients in their care in the event of an NBC attack, or when the threat of an attack is high. Special consideration must be made for maxillofacial patients whose condition prevents them from wearing their protective mask.

a. Immediate Response. In the event of an attack or when the alarm sounds, dental treatment providers immediately cease work and mask. The patients should do likewise. Only after putting on their own masks, do the dental treatment providers assist the patient, if necessary, by removing materials that impede the patient's masking. Only those materials that impede masking or may compromise the airway (such as rubber dam frames or impressions) are removed, the rest are left in place until the all clear is sounded. Special attention must be given to patients who may have been medicated into a less than fully conscious state, or are otherwise incapacitated.

b. Mission-Oriented Protective Posture Considerations. The MOPP level should be taken into account when determining the category and extent of dental treatment to be provided. Patients, including those seated in the dental chair, should be at the MOPP level prescribed for the DTF by its parent headquarters. Dental treatment at MOPP Levels 3 and 4 is, of course, impossible because of the requirement to wear the protective mask; however, treatment is still possible at MOPP Levels 0, 1, and 2. Treatment at MOPP Level 2 should be limited only to emergency care requiring urgent attention. At MOPP Level 1, most types of dental emergencies can be accommodated; however, only minimal essential treatment should be undertaken in order to reduce risk of the patient being caught in a compromised state. At MOPP Level 0, the provision of dental treatment generally is not limited. However, the degree of the NBC threat forecast for the area should be considered before undertaking extensive treatment.

c. Maxillofacial Injuries. Patients with maxillofacial injuries that prevent proper fit and seal of the individual protective mask must be placed in a PPW. Though patients with these types of injuries are most likely to be found only in MTF channels, DTFs should nevertheless be prepared in the event a patient presents to the DTF. Since the DTF does not have any PPWs; these patients should be immediately evacuated to the adjacent MTF for treatment.

Section V. COMBAT OPERATIONAL STRESS CONTROL

5-20. General

When operating under the threat of or under actual NBC conditions, soldiers will be at a high risk of suffering combat operational stress-related conditions. The invisible, pervasive nature of these weapons creates a higher degree of uncertainty and ambiguity, presenting fertile opportunities for false alarms, mass panic, and other maladaptive stress reactions. Therefore, commanders and leaders must take actions to prevent and reduce the numbers of combat operational stress cases in this environment. The symptoms and physical signs caused by excessive stress are similar to some signs of true NBC agent injury. In World War I, inexperienced units initially evacuated two stress cases for every one true chemical casualty. Some minor chemical casualties also had major stress symptoms. Therefore, far forward triage is essential to prevent over evacuation and loss of the individual to the unit. For details on provision of COSC see FM 8-51 and FM 22-51.

5-21. Leadership Actions

a. Keep Personnel Informed of the Situation. Keep information flowing, dispel myths, and control rumors by—

Discussing the situation and its possible long-term implications honestly.

Maintaining the perspective that the best chance for mission accomplishment is assured when the unit and the Army stays mission focused.

b. Train Soldiers to Survive. Use training procedures that—

Tell the lessons of history on NBC weapons employment. Show that the enemy's use of NBC weapons/agents will not give him enough advantage to justify the risk to his forces.

Increase the chance of surviving and winning should the enemy use NBC weapons/agents.

Emphasize the buddy system as a means of keeping watch for each other. Personnel must always seek buddy aid before taking additional antidotes. This will reduce the numbers of individuals using their antidotes when not needed; and prevent the increased heat stress caused by the effects of atropine on the body's cooling capabilities.

c. Put Nuclear, Biological, and Chemical Defense in Realistic Perspective. Continuously strive to maintain a realistic perspective in the unit by—

Comparing the risks of the threat with the increased risk of facing the conventional threat in varying levels of MOPP. The decision to initiate a MOPP level should be like deciding how much cover is needed to protect a unit from conventional weapons.

Choosing the lowest MOPP level that protects the unit, yet permits accomplishment of the mission. Do not try to be 100 percent safe from chemical attack if it means that there is—

Only a small chance of mission accomplishment.

A high probability of being killed by the enemy.

A high personnel loss due to heat injury.

d. Train in the Protective Mask. Train in the protective mask often. It takes repeated wear and time to acclimate and get over the claustrophobic feeling of wearing the mask. The training can be conducted during a variety of activities.

Have personnel wear the mask often in garrison or during lulls in other activities, even at desk jobs. If on average, one person in five wears the mask, on a rotational basis, at any given time, everyone will quickly become accustomed to wearing it.

Periodic prolonged wear (8 hours or more) helps soldiers gain confidence and realize that they can tolerate the discomfort.

Have personnel wear the mask while performing combat-related (mission essential) tasks.

e. Train in Mission-Oriented Protective Posture Level 4. Training in MOPP Level 4 (or simulated MOPP 4, which is to overdress while wearing the protective mask, overboots, and gloves) will increase personnel confidence in their ability to wear the ensemble.

f. Ensure Sleep Plans are Safely Practiced. Have everyone practice wearing the mask while sleeping. Ensure personnel only sleep in safe places; do not allow personnel to sleep under or near vehicles or other motorized machinery. Require ground guides for all vehicles in the unit bivouac area. Ensure that each individual get at least 4 hours of uninterrupted sleep during every 24-hour period, mission permitting (See FM 21-10).

5-22. Individual Responsibilities

a. Follow Orders. By following orders, individuals can increase their ability to cope with and prevent combat operational stress-related conditions. Coping with the stresses of an NBC environment requires extra individual action. Concentrate on the positive aspects of survival, not the negatives of illness or death.

b. Train. Use every opportunity to wear the protective mask or the entire MOPP ensemble during training, when permitted. You build self-confidence and endurance by frequently training with your protective mask, or at MOPP Level 4. Perform refresher training in basic NBC survival skills.

c. Use Buddy System. Use the buddy system to increase your ability to survive. Service members looking out for each other give a sense of security that relieves stress. Looking out for each other improves every individual's ability to perform his duties.

5-23. Mental Health Personnel Responsibilities

a. Staffing for Combat Operational Stress Control. Combat operational stress control is provided by the following activities or units:

Brigade mental health section.

Division mental health section.

Area support medical battalion mental health section.

Neuropsychiatric ward and consultation service of each CSH, field hospital, and general hospital.

Medical detachment, COSC.

Medical company, COSC.

b. Conduct Preventive Activities. In an NBC environment, prevention is the most economical means of controlling combat operational stress reactions. Mental health personnel must begin consultation services before NBC weapons/agents have been employed.

c. Control Stress Reactions. Individuals with combat operational stress reactions require prompt intervention. The evaluation of over-stressed personnel is difficult but not impossible when both the soldier and the evaluator are in MOPP. The primary method of mental health evaluation is the interview and mental status examination. For details on controlling stress reactions, see FM 8-51.

Section VI. HEALTH SERVICE LOGISTICS

5-24. General

As in all combat situations, the protection of medical supplies and equipment on the integrated battlefield is a must. Without medical supplies and equipment, HSS will be greatly diminished. Thus, the flow of supplies must continue to forward units as they are requested, including during NBC operations. For detailed information on providing health service logistics see FM 4-02.1 and FM 8-10-9.

5-25. Protecting Supplies in Storage

Protecting supplies can be accomplished by placing them under tents, using plastic wraps, or providing storage warehouses with CB filtered-conditioned (heated or cooled) air systems. Wrapping supplies in two layers of plastic material provides protection from most agents for a short period of time; the thicker the plastic material, the longer the protection. Effectiveness of protective procedures can be checked by placing M9 tape on supplies and between layers of the covering. Protection from the thermal and blast effects of nuclear detonations requires much more elaborate measures. Placing the supplies in trenches, inside earthen berms, behind stonewalls, or in other field expedient facilities will enhance the protective posture of supplies from the nuclear effects. Even when taking these protective measures, a quantity of supplies will become contaminated and must be replaced. Plans should be in place for replacement of lost items.

5-26. Protecting Supplies During Shipment

During shipment, supplies are protected by placement inside MILVANs, in covered enclosed vehicles, or by wrapping them in several layers of plastic, in tarpaulins, or in other protective material. To monitor exposure of supplies to chemical agents during shipment, place M9 detector paper between the wrappings. If exposure is limited to the outer layer, simple removal of this layer may be all that is required to eliminate the contamination. Decontamination is much easier when the supplies and equipment have been protected by multilayers of over-wraps.

5-27. Organizational Maintenance

Maintenance on vehicles, equipment, and medical equipment will become much more complex under NBC conditions. Most chemical agents are soluble in organic solvents such as gasoline, motor oils, and lubricants. The agent may be removed from the equipment by these solvents, but exposure to the contaminated solvents will produce the same effects as exposure to the agent on the equipment. The agents may seep down around the threads of bolts, in cracks and crevices of the equipment, and inside the cabinets or enclosures of equipment. These potential contamination sources produce an increased hazard to maintenance personnel. Decontamination of some items, especially medical equipment, may be a problem for maintenance personnel. The use of standard decontamination agents will cause damage beyond repair to most medical equipment and electronic equipment. In some instances, removal of chemical agents will require aging (off-gassing) of the agent. Turning the equipment on and running it, or just exposing the equipment to warm air will speed the off-gassing process. Maintenance personnel must perform all procedures in MOPP Level 4 until decontamination is completed. Radiation will penetrate the metal structures of vehicles and other equipment; radioactive material will be absorbed into the lubricants and fuels. Decontamination of this type of contamination is very difficult, if not impossible. Personnel must use radiation detection equipment to determine the extent of contamination and decontaminate the items as much as possible. Dusting or washing with water can remove any fallout on the surface of vehicles and nonelectrical/electronic components of equipment. Removal of radioactivity absorbed into metals or mixed in lubricants and fuels is beyond the capabilities of unit personnel. See FM 3-5 for decontamination procedures.

Section VII. HOMELAND SECURITY RESPONSE

5-28. Chemical, Biological, Radiological, Nuclear, and High-Yield Explosive Response

Although, homeland security is not a specific military mission, commanders must plan for and be prepared to support a lead federal agency (such as the Federal Bureau of Investigation or Federal Emergency Management Agency) in response to CBRNE event. When the CBRNE event occurs on a military installation, the Weapons of Mass Destruction—Incident Support Team (WMD-IST) is the lead federal agency in charge of responding and establishes an incident command center (ICC). The installation medical authority (IMA) provides the HSS initial response to the event site. Request for assistance from deployable HSS organizations and staffs are initiated by the IMA through military channels. The incident commander will submit a request for HSS assistance to a CBRNE event off the military installation through the appropriate federal channels. The President will direct any DOD response in support of a lead federal agency to a CBRNE event. The Presidential direction to assist will be passed down through military channels to the appropriate HSS organization for response. The HSS response may be in the form of special medical augmentation teams (SMART) support from US Army Medical Command resources or HSS (table of organization and equipment [TOE]) units may be directed to respond. Normally, responding TOE units will provide HSS to nonmedical military responders. However, the HSS mission may be to provide support to the lead federal agency or civilian public health organizations, emergency medical services (ambulance crews), or hospitals. The HSS response will include, but not be limited to—

Providing medical care to casualties at the incident casualty decontamination site and supervising the casualty decontamination process to ensure that no further injury is caused to the casualty.

Providing en route care for casualties from the incident site to an MTF or designated location for further care. Normally, TOE MEDEVAC assets are not used, but HSS personnel provide the en route care on locally provided transport vehicles.

Providing guidance to local responders in the management of CBRNE casualties. The guidance may be on the correct use of antidotes, chemoprophylaxis, prevention of contamination spread in the MTF, patient decontamination at the MTF, and other related medical management procedures.

Identifying suspect chemical, biological, or radiological materials used in the event.

Providing guidance on application of standard precautions for CBRNE, especially preventive measures to prevent spread of contagious agents.

Managing, triaging, and treating mass casualties.

5-29. Capabilities of Response Elements

For detailed Information on capabilities of SMARTs see FM 4-02 and FM 8-42. For detailed information on capabilities and functions of TOE HSS units see FM 4-02- and 8-series publications.