*ATP 4-02.7 *MCRP 4-11.1F *NTTP 4-02.7 *AFTTP 3-42.3 MULTI-SERVICE TACTICS, TECHNIQUES, AND PROCEDURES FOR HEALTH SERVICE SUPPORT IN A CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR ENVIRONMENT MARCH 2016 DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. *This publication supersedes FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3, Multiservice Tactics, Techniques, and Procedures for Health Service Support in a Chemical, Biological, Radiological, and Nuclear Environment, dated 15 July 2009. FOREWORD This publication has been prepared under our direction for use by our respective commands and other commands as appropriate. STEPHEN L. JONES ROBERT S. WALSH Major General, USA Commanding Lieutenant General, US Marine Corps U.S. Army Medical Department Deputy Commandant, Combat Center and School Development and Integration S. A. STEARNEY ROOSEVELT ALLEN, JR. Rear Admiral, US Navy Major General, USAF, NC Commander Director, Medical Operations and Navy Warfare Development Command Research, Office of the Surgeon General This publication is available through Army Knowledge Online at https://armypubs.us.army.mil/doctrine/index.html. A common access card (CAC) is required. To receive publishing updates, please subscribe at http://www.apd.army.mil/AdminPubs/new_subscribe.asp). Also available through the United States Marine Corps Doctrine Web site at https://www.doctrine.usmc.mil/ (CAC required); through the United States Navy Web site at https://ndls.nwdc.navy.mil (CAC required); and through the United States Air Force at the Air Force Doctrine Web site at https://doctrine.af.mil/. *ATP 4-02.7 *MCRP 4-11.1F *NTTP 4-02.7 *AFTTP 3-42.3 Headquarters, Army Techniques Publication (ATP) Department of the Army No. 4-02.7 Washington, DC Marine Corps Reference Publication (MCRP) Marine Corps Combat Development Command No. 4-11.1F Quantico, Virginia Navy Tactics, Techniques, and Procedures (NTTP) Navy Warfare Development Command No. 4-02.7 Norfolk, Virginia Air Force Tactics, Techniques, and Procedures (AFTTP) Headquarters, Air Force Doctrine Center No. 3-42.3 Maxwell Air Force Base, Alabama 15 March 2016 Multi-Service Tactics, Techniques, and Procedures for Health Service Support in a Chemical, Biological, Radiological, and Nuclear Environment Contents Page PREFACE.............................................................................................................. vi INTRODUCTION .................................................................................................... x Chapter 1 CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR ASPECT OF HEALTH SERVICE SUPPORT .......................................................................... 1-1 General ............................................................................................................... 1-1 Health Threat ...................................................................................................... 1-1 Management of Chemical, Biological, Radiological, and Nuclear Casualties .... 1-3 Military Operations in a Chemical, Biological, Radiological, and Nuclear Environment ..................................................................................................... 1-11 Health Service Support Planning Considerations ............................................ 1-13 Distribution Restriction: Approved for public release; distribution is unlimited. *This publication supersedes FM 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3, Multiservice Tactics, Techniques, and Procedures for Health Service Support in a Chemical, Biological, Radiological, and Nuclear Environment, dated 15 July 2009. i Contents Command and Control Systems in a Chemical, Biological, Radiological, and Nuclear Environment......................................................................................... 1-14 Chapter 2 CASUALTY PREVENTION ................................................................................ 2-1 General ............................................................................................................... 2-1 Comprehensive Health Surveillance Activities ................................................... 2-2 Medical Countermeasures for Chemical, Biological, Radiological, and Nuclear Casualty Prevention .............................................................................. 2-4 Preparation, Planning, and Execution of Health Service Support in Chemical, Biological, Radiological, and Nuclear Environment ............................................ 2-6 Chapter 3 CASUALTY CARE AND MANAGEMENT ......................................................... 3-1 General ............................................................................................................... 3-1 Triage .................................................................................................................. 3-1 Mission-Oriented Protective Postures ................................................................. 3-2 Civilian Casualties ............................................................................................... 3-3 Management of Chemical, Biological, Radiological, and Nuclear Casualties in a Medical Treatment Facility ............................................................................... 3-6 Chapter 4 MEDICAL EVACUATION IN A CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR ENVIRONMENT ...................................................................... 4-1 General ............................................................................................................... 4-1 Medical Evacuation in a Chemical, Biological, Radiological, and Nuclear Environment ........................................................................................................ 4-1 Chapter 5 PATIENT DECONTAMINATION ........................................................................ 5-1 General ............................................................................................................... 5-1 Patient Decontamination Principles .................................................................... 5-5 Levels of Decontamination .................................................................................. 5-6 The Importance of Early Contaminant Removal and Medical Monitoring of Patients ............................................................................................................... 5-7 Chapter 6 VETERINARY SERVICE SUPPORT .................................................................. 6-1 General ............................................................................................................... 6-1 Food Protection Measures .................................................................................. 6-1 Chapter 7 PREVENTIVE MEDICINE/PUBLIC HEALTH SUPPORT .................................. 7-1 General ............................................................................................................... 7-1 Sample Management .......................................................................................... 7-1 Medical Chemical, Biological, Radiological, and Nuclear Reports ..................... 7-2 Initial Field Account Survey ................................................................................. 7-2 Incident Report Survey ....................................................................................... 7-3 Water Safety and Management .......................................................................... 7-5 Chapter 8 MEDICAL LABORATORY SUPPORT ............................................................... 8-1 General ............................................................................................................... 8-1 Medical Treatment Facility Clinical Laboratories ................................................ 8-1 Field (Environmental) Laboratories ..................................................................... 8-1 Sample Collection and Management of Chemical, Biological, Radiological, and Nuclear Hazards .......................................................................................... 8-2 Handling and Storage of Specimens/Samples Within the Laboratory ................ 8-4 Four Levels of Chemical, Biological, Radiological, and Nuclear Identification ... 8-6 ii ATP 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3 15 March 2016 Contents Chapter 9 COMBAT AND OPERATIONAL STRESS CONTROL ..................................... 9-1 General ............................................................................................................... 9-1 Combat and Operational Stress Reaction .......................................................... 9-2 Chapter 10 MEDICAL LOGISTICS SUPPORT .................................................................. 10-1 General ............................................................................................................. 10-1 Medical Logistics Support Considerations in a Chemical, Biological, Radiological, and Nuclear Environment ........................................................... 10-2 Chapter 11 HOMELAND DEFENSE ................................................................................... 11-1 General ............................................................................................................. 11-1 United States Army Role in Homeland Defense .............................................. 11-2 Other Department of Defense Response Assets (not inclusive) ...................... 11-8 Chapter 12 COLLECTIVE PROTECTIVE SHELTER