DEPARTMENT OF THE ARMY FIELD MANUA L FM 8-9 DEPARTMENT OF THE NAVY PUBLICATION NAVME D-P-5059 DEPARTMENT OF THE AIR FORCE JOINT MANUAL AFJMAN 44- 151 NATO HANDBOOK ON THE MEDICAL ASPECTS OF NBC DEFENSIVE OPERATIONS AMedP-6(B) PART I- NUCLEAR PART II- BIOLOGICA L PART III- CHEMICAL DISTRIBUTION RESTRICTION: Distribution authorized to U.S. Government agencies only to protect technical or operational information from automatic dissemination under the International Exchange Program or by other means. This determination was made on 12 July 2001. Other request for this document will be referred to Commander, United States Army John F. Kennedy Special Warfare Center and School, ATTN: AOJK-DT-JAA, Fort Bragg, North Carolina 28310-5000. DISTRIBUTION NOTICE: Destroy by any method that will prevent disclosure of contents or reconstruction of the document. DEPARTMENTS OF THE ARMY, THE NAVY, AND THE AIR FORCE FEBRUARY 1996 NATO UNCLASSIFIED AMedP-6(B) NORTH ATLANTIC TREATY ORGANIZATION MILITARY AGENCY FOR STANDARDIZATION (MAS) NATO LETTER OF PROMULGATION July 1994 1. AMedP-6(B) - NATO HANDBOOK ON THE MEDICAL ASPECTS OF NBC DEFENSIVE OPERATIONS is a NATO UNCLASSIFIED publication. The agreement of nations to use this publication is recorded in STANAG 2500 NBC/MED. 2. AMedP-6(B) is effective upon receipt. AMedP-6(A) shall be destroyed in accordance with the local procedure for the destruction of documents. 304/59nh ORIGINAL NATO UNCLASSIFIED III (IV Blank) NATO UNCLASSIFIED AMedP-6(B) ORIGINAL NATO UNCLASSIFIED V (VI Blank) NATO UNCLASSIFIED AMedP-6(B) PREFACE The purpose of this handbook is to provide a guide for medical officers on the medical aspects of NBC operations. The handbook is intended as a compilation of reference material and as a source of information for training. It does not constitute an official position of NATO nations; certain aspects, however, are already covered by STANAGs and this is being extended. In addition, it provides the basic philosophy for the development of concepts of operations and in the management, including evacuation and treatment, of NBC casualties as well as conventional battle casualties in a NBC environment. There are many unresolved problems and it must be appreciated that a number of the philosophical concepts presented are provisional; their validity will require reassessment in the light of future trials and exercises. The handbook is in three parts, Part I-Nuclear, Part II-Biological, and Part III-Chemical. Each part is self-contained and presented separately. There is some necessary overlap and several aspects are common to all three, for example: combined injuries; the effect of radiation on the response to infection and on the healing of thermal and chemical burns; psychological factors and morale; public health aspects; and medical care in a mass casualty situation. It should be noted that detailed information on the treatment of burns and traumatic injuries is contained in the Emergency War Surgery Handbook covered by STANAG 2068, which should be used in conjunction with this handbook. ORIGINAL NATO UNCLASSIFIED VII (VIII Blank) NATO UNCLASSIFIED AMedP-6(B), Part I NATO HANDBOOK ON THE MEDICAL ASPECTS OF NBC DEFENSIVE OPERATIONS AMedP-6(B) PART I - NUCLEAR 1 FEBRUARY 1996 ORIGINAL NATO UNCLASSIFIED IX (X Blank) NATO UNCLASSIFIED AMedP-6(B), Part I NATO UNCLASSIFIED XI ORIGINAL AMedP-6(B), Part I NATO UNCLASSIFIED ORIGINAL XII NATO UNCLASSIFIED NATO UNCLASSIFIED AMedP-6(B), Part I NATO UNCLASSIFIED XIII ORIGINAL AMedP-6(b), Part I NATO UNCLASSIFIED ORIGINAL XIV NATO UNCLASSIFIED NATO UNCLASSIFIED AMedP-6(B), Part I NATO UNCLASSIFIED XV ORIGINAL NATO UNCLASSIFIED AMedP-6(B), Part I List of Figures NATO UNCLASSIFIED XV ORIGINAL AMedP-6(B), Part I NATO UNCLASSIFIED ORIGINAL XVI NATO UNCLASSIFIED NATO UNCLASSIFIED AMedP-6(B), Part I NATO UNCLASSIFIED XVII ORIGINAL NATO UNCLASSIFIED AMedP-6(B), Part I NATO UNCLASSIFIED XVII ORIGINAL AMedP-6(B), Part I NATO UNCLASSIFIED ORIGINAL XVIII NATO UNCLASSIFIED NATO UNCLASSIFIED AMedP-6(B), Part I CHAPTER 1 GENERAL INFORMATION 101. Purpose of AMedP-6(B), Part I. The purpose of this publication is to provide medical personnel of the NATO Armed Forces with information on the biomedical effects of nuclear weapons and the impact of the use of nuclear weapons on the different aspects of medical field operations. 102. General Impact of Nuclear Weapons. a. Total nuclear war with utilization of all available nuclear weapons could result in complete devastation of the involved nations’ military combat and logistic systems as well as their supporting civilian social structures and economies. (See paragraphs 625 and 631.) However, situations short of total nuclear war are possible in which nuclear weapons could be employed in limited numbers or for a limited time, along with conventional weapons. Under such circumstances, effective military operations could continue and would require the continuing support of an effective medical service. b. It is essential that medical personnel at all levels be prepared for the problems associated with limited nuclear warfare. This handbook has been prepared to provide those responsible for medical support planning, training, and field operations with specific information critical to the understanding and solution of these special problems. The subjects covered in this publication are many and varied, reflecting the complexities involved in the nuclear sciences and the varied needs of the people for whom this book was prepared. Accordingly, the subject matter presented includes discussions of atomic structure and radioactivity, characteristics of nuclear detonations, descriptions of the factors related to the diagnosis, treatment and prognosis of nuclear warfare casualties, and guidance applicable to the organization and operation of medical units on a nuclear battlefield. In addition, information has been included on the special problems associated with nuclear accidents in peacetime. ORIGINAL NATO UNCLASSIFIED 1-1 (Reverse Blank) NATO UNCLASSIFIED AMedP-6(B), Part I CHAPTER 2 CONVENTIONAL AND NUCLEAR WEAPONS - ENERGY PRODUCTION AND ATOMIC PHYSICS SECTION I - GENERAL 201. Introduction. As a first step in developing an understanding of the medical implications of nuclear warfare, it is essential to understand how a nuclear weapon differs from a conventional high explosive weapon. Accordingly, a comparison will be made in this chapter between the mechanisms of energy production in conventional and nuclear detonations. In addition, certain principles of atomic structure and physics are presented to aid in the understanding of these differences. SECTION II - MECHANISMS OF ENERGY PRODUCTION 202. Definition of Explosion. An explosion can be described as the sudden release of large amounts of energy within a limited space as the system involved is converted to a more stable one. The basic laws of thermodynamics pertaining to the conservation of energy require that energy must be released when a system is converted to another of greater stability, i.e., one containing less energy. 203. Conventional Chemical Explosion. a. The molecules of conventional chemical explosives are considered to be in a high-energy or unstable state. When such a system is made to react, products of greater stability are formed and energy is released. With a conventional explosive, such as trinitrotuluene (TNT), the energy is derived from a sudden, violent chemical reaction, altering various bonds between the molecules of the explosive’s chemical compounds, i.e., 2 Molecules TNT+Heat=Reaction Products+Energy 31.3 X 10-19 joules (7.5 X 10-19 Cal (net)). The amount of energy released in such a reaction is directly proportional to the difference between the total binding energy contained within the initial, unstable system and that contained within the final, more stable system. This net energy release is called the heat of explosion. b. As in all chemical reactions, mass and energy are conserved separately; i.e., by the best methods of measurement available, the total mass and the total energy, including the heat of explosion, are found to be exactly the same, respectively, before and after the explosion. NATO UNCLASSIFIED 2-1 ORIGINAL AMedP4(B), Part I NATO UNCLASSIFIED 204. Nuclear Detonations. Energy released in a nuclear explosion is not produced by chemical reactions. Rather, it results from so-called nuclear reaction, fission and fusion, in which fundamental changes occur in the composition of the nuclei of the reacting material rather than in the electron shells as is the case in chemical reactions. In these nuclear reactions mass is actually converted to energy, and the amount of energy produced is many orders of magnitude greater than that available from chemical reactions. To fully appreciate the nature of these reactions, certain basic concepts related to atomic structure and nuclear reactions must first be understood. 205. Elements and Atomic Structure. a. Elements. All substances are composed of one or more of over 100 different kinds of basic materials known as elements. There are 92 naturally occurring and at least 11 artificially produced elements, ranging from the simplest and lightest naturally occurring element hydrogen to the heaviest artificial element lawrencium. b. Atomic Structure. The simplest structural unit of any element that can exist, while still retaining the chemical and physical characteristics of the element, is called an atom. An atom is composed of a central nucleus containing most of its mass and electrons orbiting in shells around the nucleus (Figure 2-I). The nucleus consists of a number of fundamental particles, the most important of which are the protons and neutrons. (1) The proton is a particle having a positive charge, equal in magnitude and opposite in sign to that of the electron. The proton’s mass is approximately 1845 times greater than that of the electron. (2) The neutron is an uncharged particle having a mass slightly greater than that of the proton, approximately equal to the sum of the masses of a proton and an electron.