scope:

This document includes information necessary to estimate acute human response to a specific set of CBRN agents and effects. This set is not exhaustive, and other agents or effects could be incorporated at a later time as permitted by the availability of adequate, credible data. The agents and effects incorporated into this document are described below.

a. Chemical agents include two nerve agents, sarin (GB) and VX, and a blister agent, distilled mustard (HD).

b. Biological agents include the causative agents of anthrax, Venezuelan Equine Encephalitis (VEE), plague, and smallpox. In addition, although sometimes considered a chemical agent, botulinum neurotoxin will be treated as a biological agent for the purposes of this document. Anthrax, botulism, and VEE will be considered non-contagious diseases, while plague and smallpox will be treated as contagious diseases.

c. Radiological agents are modeled for two exposure sources: radiological dispersal devices (RDDs) and radioactive fallout resulting from a nuclear detonation. Radiological agents included in this document as potential RDD components are limited to those isotopes that are commercially available in sufficient quantities, possess sufficiently long half-lives, and have desirable energy characteristics suitable for use as RDDs. Specifically, the following radioisotopes are modeled: ⁶⁰Co, ⁹⁰Sr, ¹³¹I, ¹³⁷Cs, ¹⁹²Ir, ²³⁸Pu, and ²⁴¹Am. Radioactive fallout deposited on the ground, which is not isotope-specific, is also considered in this document as a separate source of radiological exposure.

d. Prompt nuclear effects include the initial radiation, static blast overpressure, and thermal fluence (radiant thermal energy) resulting from the detonation of a nuclear weapon. A consideration is also made for casualties due to whole-body translation coupled with decelerative tumbling resulting from the effects of dynamic pressure (winds).

2. With the exception of decelerative tumbling in nuclear events (normally described as a tertiary nuclear blast effect), human response is modeled solely as a function of primary and direct physiological effects. Battle stress cases and indirect effects (e.g., injuries resulting from car accidents following an attack, burns due to secondary fires, or opportunistic infections) are not considered. It is recognized that medical resources could be significantly impacted by psychological casualties as a result of a CBRN attack. However, at this time there is not adequate data to model and predict the impacts to medical triage and resources. Likewise, aside from decelerative tumbling, secondary and higher order (i.e., tertiary, quaternary, etc.) effects are not considered for nuclear events.

3. The methodology also does not estimate "detained, captured, or missing" casualties.⁷

4. Finally, although the methodology could be used to model casualties resulting from the ingestion of certain agents, the information required to incorporate this route of exposure has not been included in this document.

Purpose

1. The purpose of AMedP-8(C) is to provide a methodology for estimating casualties uniquely occurring as a consequence of CBRN attacks against Allied targets in order to support the planning processes in Allied Joint Publication 3.8 (AJP-3.8), Allied Joint Doctrine for NBC Defence,³ Allied Joint Publication 4.10 (AJP-4.10), Allied Joint Medical Support Doctrine,⁴ Allied Joint Medical Publication 1 (AJMedP-1), Allied Joint Medical Planning Doctrine,⁵ and Allied Medical Publication 7 (AMedP-7), Concept of Operations of Medical Support in Chemical, Biological, Radiological, and

Nuclear Environments.6 The methodology provides the capability to estimate the numbers of casualties over time as well as the incidence of injury by type and severity. These estimates assist planners, logisticians, and staff officers by allowing for more effective quantification of contingency requirements for medical personnel; medical materiel stockpiles; patient transport or evacuation capabilities; and facilities needed for patient decontamination, triage, treatment, and supportive care.

². The methodology described in this document is proposed solely for deliberative or crisis action planning purposes and does not account for real-time or dynamic (i.e., evolving exposure) use. Moreover, this methodology is not intended for use in deployment health surveillance or for any postevent uses including diagnosis, medical treatment, or epidemiology.

³ North Atlantic Treaty Organization (NATO), AJP-3.8(B): Allied Joint Doctrine for NBC Defence, STANAG 2451, 5 February 2004.

⁴ North Atlantic Treaty Organization (NATO), AJP-4.10(A): Allied Joint Medical Support Doctrine, STANAG 2228, 3 March 2006.

⁵ North Atlantic Treaty Organization (NATO), AJMedP-1: Allied Joint Medical Planning Doctrine, STANAG 2542, 3 November 2009.

⁶ North Atlantic Treaty Organization (NATO), AMedP-7(D): Concept of Operations of Medical Support in Chemical, Biological, Radiological, and Nuclear Environments, STANAG 2873, 6 December 2007.

Although the AAP-6 definition of casualty includes personnel who are "detained, captured, or missing," they are not considered in this document because they will not present to the medical system.