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Atp 4-02.84 Mcrp 3-40A.3 Ntrp 4-02.23 Afman 44-156 Ip Multi ATP 4-02.84 MCRP 3-40A.3 NTRP 4-02.23 AFMAN 44-156_IP MULTI-SERVICE TACTICS, TECHNIQUES, AND PROCEDURES FOR TREATMENT OF BIOLOGICAL WARFARE AGENT CASUALTIES November 2019 DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. This publication supersedes ATP 4-02.84/MCRP 4-11.1C/NTRP 4-02.23/AFMAN 44-156_IP, dated 25 March 2013. Headquarters, Department of the Army Foreword This publication has been prepared under our direction for use by our respective commands and other commands as appropriate. This publication is available at the Army Publishing Directorate site (https://armypubs.army.mil), and the Central Army Registry site (https://atiam.train.army.mil/catalog/dashboard). Also available through the United States Marine Corps Doctrine site at (https://www.marines.mil/News/Publications.aspx); through the United States Navy site at (https://portal.nwdc.navy.mil/NDLS); and through the United States Air Force Doctrine site at (https://doctrine.af.mil/). This publication contains copyrighted material. No endorsement by the Government is expressed or implied with any uniform resource locator (URL) associated with a non-Government Web site. *ATP 4-02.84 MCRP 3-40A.3 NTRP 4-02.23 AFMAN 44-156_IP Army Techniques Publication (ATP) Headquarters No. 4-02.84 Department of the Army Washington, DC Marine Corps Reference Publication (MCRP) Deputy Commandant for Combat No. 3-40A.3 Development and Integration Quantico, Virginia Navy Tactical Reference Publication (NTRP) Navy Warfare Development Command 4-02.23 Norfolk, Virginia Air Force Manual (AFMAN) Headquarters Air Force Doctrine Center 44-156_Integrated Policy (IP) Maxwell Air Force Base, Alabama 21 November 2019 Multi-Service Tactics, Techniques, and Procedures for Treatment of Biological Warfare Agent Casualties Contents Page PREFACE..................................................................................................................... v INTRODUCTION ......................................................................................................... ix Chapter 1 BIOLOGICAL WARFARE AGENTS ........................................................................ 1-1 General ...................................................................................................................... 1-1 Threat ........................................................................................................................ 1-1 Employment of Biological Warfare Agents ................................................................ 1-3 DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. *This publication supersedes ATP 4-02.84/MCRP 4-11.1C/NTRP 4-02.23/AFMAN 44-156_IP, dated 25 March 2013. Marine Corps PCN: 144 000080 00 i Contents Emerging Infectious Diseases .................................................................................. 1-4 Classification ............................................................................................................. 1-4 Dissemination ............................................................................................................ 1-7 Routes of Entry ......................................................................................................... 1-8 Prevention ................................................................................................................. 1-9 Medical Countermeasures ........................................................................................ 1-9 Physical Protection.................................................................................................. 1-10 Hazard Management............................................................................................... 1-12 Infection Control ...................................................................................................... 1-12 Casualty Management ............................................................................................ 1-13 Chapter 2 RECOGNITION ......................................................................................................... 2-1 General ..................................................................................................................... 2-1 Epidemiology ............................................................................................................. 2-1 Warning and Detection ............................................................................................. 2-4 Surveillance ............................................................................................................... 2-5 Sample Collection ..................................................................................................... 2-5 Medical Reporting ..................................................................................................... 2-6 United States Public Health Biological Warfare Monitoring and Assessment .......... 2-8 Chapter 3 BACTERIAL AGENTS ............................................................................................. 3-1 General ..................................................................................................................... 3-1 Bacterial Organisms .................................................................................................. 3-1 Chapter 4 VIRAL AGENTS ....................................................................................................... 4-1 General ..................................................................................................................... 4-1 Viruses ...................................................................................................................... 4-1 Chapter 5 TOXIN AGENTS ....................................................................................................... 5-1 General ..................................................................................................................... 5-1 Toxins ........................................................................................................................ 5-1 Chapter 6 IDENTIFICATION TECHNOLOGIES ....................................................................... 6-1 General ..................................................................................................................... 6-1 Identification Methods for Biological Warfare Agents ............................................... 6-1 Appendix A SPECIMEN COLLECTION, HANDLING, AND TRANSPORT ................................ A-1 Appendix B EMERGING INFECTIOUS DISEASES .................................................................... B-1 Appendix C PATIENT DECONTAMINATION .............................................................................. C-1 Appendix D MEDICAL MANAGEMENT AND TREATMENT IN BIOLOGICAL WARFARE OPERATIONS .......................................................................................................... D-1 Appendix E BIOLOGICAL WARFARE AGENTS CLINICAL DIAGNOSTIC ALGORITHM ....... E-1 GLOSSARY ................................................................................................ Glossary-1 REFERENCES ........................................................................................ References-1 INDEX ............................................................................................................... Index-1 ii ATP 4-02.84/MCRP 3-40A.3/NTRP 4-02.23/AFMAN 44-156_IP 21 November 2019 Contents Figures Figure 2-1. An example of an epidemic curve graph .................................................................... 2-3 Figure 3-1. Three drug combination therapy for systemic anthrax when meningitis has not been excluded ...................................................................................................................... 3-9 Figure 3-2. Two drug combinations for systemic anthrax when meningitis has been excluded . 3-10 Figure 6-1. Possible medical tasks, decisions, and actions at each level..................................... 6-4 Figure 6-2. Four levels of CBRN identification .............................................................................. 6-5 Figure E-1. A clinical algorithm for the diagnosis of biological agent-induced casualties .............E-3 Tables Introductory Table-1. Updated terms................................................................................................ x Table 1-1. Common units of measure associated with BW agents ............................................... 1-1 Table 1-2. Biological warfare agent classification ......................................................................... 1-5 Table 1-3. Disease threats from potential biological warfare agents ............................................ 1-6 Table 1-4. Biological warfare threat agents ................................................................................... 1-7 Table 2-1. Epidemiologic clues of a biological warfare agent or terrorist attack ........................... 2-2 Table 3-1. Inhalational anthrax symptoms .................................................................................... 3-3 Table 3-2. Inhalational anthrax cases systematic review .............................................................. 3-4 Table 3-3. Gastropharyngeal anthrax cases systematic review ................................................... 3-4 Table 3-4. Gastrointestinal anthrax cases systematic review ....................................................... 3-5 Table 3-5. Collection and transport
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