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
FM 8-284
NAVMED P-5042
AFMAN (I) 44-156
MCRP 4-11.1C
FIELD MANUAL HEADQUARTERS
NO. 8-284 DEPARTMENTS OF THE ARMY,
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

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
CHAPTER 2. BACTERIAL AGENTS
Section I. Introduction ........................................................................... 2-1
2-1. General ................................................................................. 2-1
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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
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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
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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
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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
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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

In addition, about 40 pages of supplementary medical information (up to October, 2001) on Anthrax, Plague, Botulism and Smallpox as Biological weapons has been added.

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