Introduction to Medical Threat

Introduction to Medical Threat

INTRODUCTION

As a soldier medic you will be called upon to assist field sanitation teams. The effectiveness with which you accomplish this responsibility will have a far-reaching effect upon the health of soldiers and, in turn, upon the success of your unit.

Importance of the Field Sanitation Team

(1) Field sanitation team (FST) is responsible for preventive medicine measures (PMM) that affect units

(2) Unit effectiveness dependent upon the health of its soldiers

The Role of the Soldier Medic

(1) Perform and maintain field hygiene and sanitation

(2) Promote good personal hygiene

(3) Disinfection of water

(4) Prevention and elimination of deficiencies in food service sanitation

(5) Construction of garbage and soaking pits

(6) Construction of field latrines and urinals

Medical Threat

Impact of casualties caused by Disease Non-Battle Injuries (DNBI) upon military campaigns has been a prominent and a continuous feature of military operations.

(1) Armies have had immense problems with heat, cold, and communicable diseases

(2) In all US conflicts, three times as many soldiers have been lost to DNBI as to enemy action

(3) The ultimate objective of a military force, success in battle, demands that troops be maintained in a constant state of good health

There are four major components of the medical threat to field forces

(1) Heat

(a) Most lethal category of all

(b) Example: During the 1967 Arab-Israeli conflict, the Israelis enveloped the Egyptians, severing their lines of support, the Egyptians suffered 20,000 deaths due to heat while the Israelis had no deaths and only 128 cases of heat injury.

(d) Effects of heat can be minimized by ensuring soldiers drink adequate amounts of water

(2) Cold

(a) Can also be very incapacitating on the battlefield

(b) Example: In World War II, during the winter of 44-45 in the European theater, over 54,000 US soldiers were admitted to hospitals with cold injuries. Over 90,000 US soldiers were admitted with cold injuries throughout the war. In the twenty-four days the British were in combat on the Falkland Islands, they sustained 777 total casualties, 109 (or 14%) were cold injuries. When the British had the Argentineans surrounded at Port Stanley, they could have waited until the Argentineans exhausted their food and water supplies.

(i) Incorporating weather data into operations planning

(ii) Enforcing the proper wearing of the uniform,

(iii) Frequent changing of wet or damp socks or gloves

(iv) When the tactical situation permits, providing warming areas

(3) Arthropods that transmit diseases that seriously affect military operations (discussed in LP C191W020)

(4) Diarrheal disease

(a) Can be contracted from contaminated water or food

(b) Can have catastrophic impact on a fighting force

(d) Waste disposal and handwashing devices are constructed

(e) Unit dining facilities are operated under sanitary conditions

Increased vulnerability to disease and nonbattle injury because of

(1) Harshness of the environment

(a) Mosquito-infested jungles

(b) Sandfly-infested villages

(d) Cold windy plains

(2) Disruption of the body’s natural defenses

(a) The human body has an excellent capacity to protect itself against disease and climatic injury

(b) Efficiency of these mechanisms is dependent upon our overall well being, but if the following are disrupted individuals are more susceptible to illness and combat stress

(i) Disruption of circadian rhythms

(ii) Adding heat or cold stressors

(iii) Feeding meals at irregular hours

(iv) Depriving soldiers of sleep

(3) Breakdowns in basic sanitation

(a) Potable water and proper waste disposal

(b) Using the latrine or changing your socks becomes a challenge when you are living in a muddy foxhole

The Individual in the Field Environment

In garrison

(1) An individual follows a rather routine course after arising in the morning

(2) Routine acts of personal hygiene are performed in a conveniently located latrine that is warm and has hot and cold water

In the field

(1) Proper sanitation requires coping with the elements of nature, a problem arises; the soldier is suddenly faced with inconveniences

(2) Too cold to change into clean underwear - Even in the summer, a cold-water shower is uncomfortable

(3) The toilet in the field is not as pleasant as the one in garrison

(4) An ordinarily well-groomed individual may become dirty and unkempt

(5) Filth and disease go hand in hand

(6) Dirty, sweaty socks may cause the feet to be more susceptible to disease

(7) Dirty clothing worn for a prolonged period of time and unwashed hair are open invitations to lice

(8) Reducing DNBI pertain

(a) To the existing elements of nature

(b) To the reactions of soldiers brought into the environment

(d) It requires a sense of responsibility on the part of each individual to try to maintain his health regardless of difficulties encountered

The Role of the 91W

Verify medical records for current immunization

NOTE: Immunization involves taking substances related to the biological agent to develop resistance or antibodies in the body.

(1) Anthrax (on hold)

(2) Plague (if needed)

(3) Hepatitis A

(4) Hepatitis B

(5) Japanese B encephalitis

(6) Rabies

(7) Typhoid

(8) Yellow fever

Gather medical intelligence

(1) Perform a medical threat assessment

(2) Gather information on medical facilities

(3) Assess evacuation assets

(4) Report intelligence findings

NOTE: Medical intelligence gathering is the process for gathering essential medical information BEFORE an operation begins, that will allow unit leaders and medics to tailor operational plans. Medical intelligence should continued to be gathered during an operation, and should be followed by an assessment after an operation has ended.

Perform and maintain field hygiene and sanitation

(1) Promote good personal hygiene

(a) Arrange for facilities such as handwashing and showering devices, hot water for shaving, and heated dressing area

(b) Assist in inspecting soldiers to ensure adequate personal hygiene measures

(2) Verify water sanitation

(a) Drink approved water only

(b) Prevent water waste

(d) Identify water sources

(e) Treat water source

(i) Coagulate and sediment to remove turbidity

(ii) Filter to remove remaining turbidity

(iii) Disinfect to kill pathogenic organisms

(iv) Consider addition of chlorine

NOTE: Calcium hypochlorite is added to the water in amount necessary, with a chlorine demand, to destroy organisms.

NOTE: The sudden disappearance of all chlorine probably indicates recontamination.

(v) Consider Lyster bag for disinfecting water

(3) Verify food service sanitation

(a) Identify factor causing foodborne disease

(i) Improper refrigeration

(ii) Not maintaining hot foods at product temperature

(iii) Not protecting foods from cross-contamination

(iv) Improper transportation and storage practices

(v) Not protecting foods from contamination

(b) Store foods

(i) Upon receipt, inspect food

(ii) Identify if foods need refrigeration or heating

(iii) Transport any potentially hazardous foods in insulated food containers

(d) Clean and sanitize utensils

(e) Wash, rinse, and properly store utensils

(f) Follow food preparation guidelines

(i) Potentially hazardous foods should be prepared immediately before serving

(ii) Plan meals to reduce amount of leftovers

(iii) Thoroughly wash and rinse fruits and vegetables

NOTE: Fruits and vegetables grown in areas where human excreta is used as fertilizer must not be consumed raw except with the approval of medical authority.

(g) Inspect food service facilities

(i) Identify basic defects

(ii) Recommend corrective measures

Identify the Hazards

(1) Identify the elements of medical threats

(a) Heat

(i) Recognize conditions

* Increasing temperature

* Increasing humidity

* Direct sunlight

(ii) Identify strategies to protect against heat injury

* Drink plenty of water

* Enforce work-rest cycles

* Stay in shade

* Choose evening or morning for strenuous work

* Avoid tight, nonbreathable clothing

* Maintain physical fitness

* Avoid medications that increase heat injury risk

(b) Cold

(i) Recognize conditions

* Decreasing temperature

* Moisture

* Wind speed

(ii) Identify strategies to protect against cold injury

* Avoid cold, wind, and moisture

* Wear multiple layers of loose-fitting clothing

* Wear a water repellent but "breathable" shell

* Change socks frequently

* Drink plenty of fluids

* Get plenty of rest, and eat all meals

* Avoid alcohol and tobacco

(i) Tick

(ii) Housefly

(iii) Tse tse fly

(d) Diarrhea (Contaminated Food & Water)

(i) Consider food preparation and handling

(ii) Consider field sanitation

(e) Communicable Diseases in AO

(f) Toxic Industrial Materials

(g) Noise Hazards

(h) Animal & Plant Threats

(i) Combat Stress Concerns - Consider normal symptoms of acute psychological stress

(i) Feelings of fear and anxiety

(ii) Rapid, pounding heartbeat

(iii) Sweaty palms and forehead

(iv) Nausea and vomiting

(v) Rapid, shallow breathing

(vi) Trembling, shaking

(vii) Dilated pupils

(2) Identify operational threats

(a) Sleep Deprivation for Ambulance Drivers

(b) PMCS of medical equipment/vehicles

Assess the Hazards

(1) Assess each hazard in relation to probability of a hazardous incident

(a) Frequent (A)

(b) Likely (B)

(d) Seldom (D)

(e) Unlikely (E)

(2) Identify the severity of each hazard

(a) Catastrophic (I)

(b) Critical (II)

(d) Negligible (IV)

(3) Estimate level of risk for each identified hazard and an estimate of overall risk for operation

(a) E - Extremely High Risk

(i) Loss of ability to accomplish the mission

(ii) A frequent or likely probability of catastrophic loss or critical loss

(b) H - High Risk

(i) Significant degradation of mission capabilities in terms of required mission standard

(ii) Inability to accomplish all parts of mission

(iii) Inability to complete the mission to standard

(iv) Occasional to seldom probability of catastrophic loss

(v) Likely to occasional probability exists of a critical loss

(vi) Frequent probability of marginal losses

(i) Expected degraded mission capabilities in terms of required mission standard

(ii) Reduced mission capability

(iii) Unlikely probability of catastrophic loss

(iv) Probability of a critical loss is seldom

(v) Marginal losses occur with likely or occasional probability

(vi) Frequent probability of negligible losses

(d) L - Low Risk

(i) Expected losses have little or no impact on accomplishing the mission

(ii) Probability of critical loss is unlikely

(iii) Marginal loss is seldom

(iv) Probability of negligible loss is likely or less

Develop Controls and Make Risk Assessment

(1) Develop controls

(a) Type of controls

(i) Educational controls

* Based on knowledge and skills of units and individuals

* Implemented through individual and collective training

(ii) Physical controls

* May take form of barriers and guards

* Signs to warn individuals and units

* Special controller or oversight personnel responsible for locating specific hazards

(iii) Avoidance

(b) Criteria for controls

(i) Suitability - must remove the hazard or mitigate residual risk to acceptable level

(ii) Feasibility - unit must have capability to implement the control

(iii) Acceptability

* Benefit gained by implementing control

* Must justify the cost in resources and time

* Assessment of acceptability is largely subjective

(2) Make a risk decision, determine if the risk is justified

Implement Controls

(1) Ensure controls are integrated into SOPs, written and verbal orders, mission briefings, and staff estimated

(2) Ensure controls are converted into clear, simple execution orders understood at all levels

Supervise and evaluate

(1) Supervise

(a) Spot-checks

(b) Inspections

(d) Brief-backs

(e) Buddy checks

(f) Monitor controls to ensure remain effective

(g) Continually assess variable hazards

(2) Evaluate

(a) Determine how to ensure successes are continued

(b) Capture and disseminate lessons learned

(d) Determine whether the level of residual risk of each hazard and overall mission were accurately estimated

(e) Evaluate effectiveness of each control in reducing or removing risk

Preventive Medicine Measures

(1) Provide guidance in the use of PMM to prevent cold injuries. Hypothermia or frostbite may be prevented by

(a) Wearing several layers of warm, loosely fitting clothing

(b) Protecting the face from the wind

(2) Trench foot, which results from standing in cold water or slush when the temperature is between 32° and 50°F may be prevented by the use of protective footgear and dry socks

(3) Snow blindness, which occurs when the sun shines brightly on unbroken ice or snow, can be prevented by

(a) Wearing sunglasses or an improvised device made of cardboard or cloth

(b) Blackening the areas around the eyes

SUMMARY

The success or failure of any army, the outcome of a war, and the fate of a nation may rest upon how well diseases are prevented through effective field sanitation and preventive medicine measures. The extent to which diseases are prevented in the unit area depends upon the effectiveness with which you, a member of the field sanitation team, perform your role. Preventive medicine measures must be adapted to the existing medical threat elements of a specific field environment.