Identify preventive measures for protection against arthropod bites and arthropod-borne diseases, water and food borne diseases, respiratory diseases, sexually transmitted diseases and AIDS, heat injures, and cold injuries.

Given multiple-choice items pertaining to preventive measures.

Score 70 or more points on the 100-point written examination.

FM 21-10, Field Hygiene and Sanitation.

FM 21-11, First Aid for Soldiers.

DA Pam 40-12, Who Needs *It? *VD.

History has often demonstrated that the course of battle is influenced more by the health of the troops than by strategy or tactics. Part of your function as a combat soldier is to recognize potentially dangerous situations and take preventive measures. This includes taking measures against potential health hazards as well as protecting yourself against enemy action. As a combat lifesaver, it is easier for you to remind a soldier in your squad or team to take preventive measures against disease and environmental injuries than it is to treat and evacuate the soldier later because he is too ill to perform his combat duties.

Biting insects are a source of discomfort, minor pain, and skin irritation. This, in itself, should be enough to make soldiers take preventive measures against these pests. However, biting insects also contribute to the spread of disease. These diseases can incapacitate soldiers and, in some cases, be fatal. "Insect-borne diseases" (diseases transmitted by insects) include diseases transmitted by true insects (such as mosquitoes, lice, and fleas) and by certain other pests that closely resemble insects (such as ticks and mites). Examples of insect-borne diseases include malaria (mosquitoes), yellow fever (mosquitoes), typhus (lice), Rocky Mountain spotted fever (ticks), and plague (fleas).

One of the best ways to keep insects from transmitting a disease to you is to use insect repellent. Some guidelines are given below.

Apply the insect repellent (DEET) to all exposed skin areas other than the skin around the eyes. The repellent skin lotion is also applied two inches under the edges of the battle dress uniform.

Cover ankle and wrist areas with repellent to keep ticks and mites from creeping through openings in the uniform.

Blouse the uniform inside boots and apply repellent where they meet.

Apply repellent to the shirt area over the shoulder blades and any other areas where the uniform fits tightly. Mosquitoes usually cannot "bite" (puncture the skin) through clothing unless the clothing is tight against the skin.

Reapply repellent every 6 hours if strenuous work is being performed.

Reapply repellent as soon as practical after stream crossings since much of the repellent was probably washed off.

Soldiers should wear their uniforms as the commander directs. This usually includes wearing headgear to protect the top of the head, rolling sleeves down, tucking shirts and undershirts in at the waist, blousing the uniform, and lacing boots completely. Tears and holes in clothing should be repaired.

Soldiers should wash daily with soap and water if the tactical situation permits. Take a full bath or shower at least once every week. If showers or baths are not available, you should use a washcloth daily to wash your genital area, your armpits, your feet, and any other areas where you sweat or which become wet. These areas include the thighs and, for females, under the breasts. Use of perfumed soaps or feminine deodorants in the field could cause irritation. . Use improvised showers if regular showering devices are not available. Avoid bathing in stagnant water.

Use a buddy system to examine each other for the presence of ticks, lice, fleas, and mites.

Uniforms should be washed at least once each week by supporting military laundries. If a military laundry is not available, uniforms should be scrubbed with soap and water to eliminate the ticks and mites that are on the uniform.

If ticks, mites, or lice are a problem, uniforms should be treated with permethrin clothing repellent (IDA kit) to kill these pests. Special attention must be paid to the seams of uniforms since the seams may contain insect eggs which will hatch unless the uniform is properly treated.

Soldiers in an area where malaria may be a problem will be given medication to take. This medication protects against the worst effects of the disease, but does not make a soldier immune to malaria. Soldiers must still take preventive measures against mosquitoes and other insects.

Diarrhea refers to the frequent passage of abnormally watery bowel movements. Dysentery is a term applied to a number of intestinal diseases characterized by inflammation of the intestines, abdominal pain, and bowl movements containing blood and mucus. Diarrhea and dysentery are often caused by disease organisms found in human and animal feces. These organisms enter the body through the consumption of water or food that has been contaminated with feces, such as water in a lake contaminated by untreated sewage. Food can be contaminated by fecal material on a person's hands or under his fingernails.

Whenever possible, drinking water should be obtained from a source that has been approved for consumption. In the field, however, water may have to be obtained from other sources. Always assume that water from an unapproved source is contaminated and must be disinfected before drinking. The following procedures are used to disinfect water with iodine tablets.

Fill a canteen with the cleanest, clearest water available.

Check the color of the iodine tablets. The tablets should be gray in color. Discard any tablets which are not uniformly steel gray, that are stuck together or crumbled should not be used.

Add two tablets to the one-quart canteen. (NOTE: If a two-quart canteen is being used, add four tablets to the water.)

Replace the cap on the canteen and wait 5 minutes for the tablets to dissolve.

Shake the canteen to mix the dissolved tablets and the water.

Loosen the cap on the canteen, turn the canteen upside down, and squeeze. This will force water to flow over the threads of the cap and canteen neck and will disinfect them.

Turn the canteen upright and tighten the cap on the canteen.

Wait an additional 30 minutes before drinking the water. The time is needed to ensure that the iodine has sufficient time to kill all of the harmful microorganisms in the water.

If iodine tablets are not available, disinfect contaminated water by boiling.

Fill your canteen cup with water and bring to a rolling boil for 5 to 10 minutes. Allow the water to cool before drinking. In an emergency, bringing the water to a boil for as little as 15 seconds will help.

Add two drops of household bleach (5% sodium hypochlorite) to a one-quart canteen filled with water. If the water is cloudy or very cold, add an additional two drops. (NOTE: If a two-quart canteen is being used, double the amount of bleach added to the water.) Replace the cap on the canteen and shake vigorously. Loosen the canteen cap, disinfect the threads as described above, and retighten the cap. Wait 30 minutes before drinking or using the water.

Mix one ampule with 1/2 canteen cup of water. Pour 1/2 capful into your canteen. Shake, disinfect threads, and wait 30 minutes before drinking.

Obtain food, liquid refreshments, and ice only from sources approved by the local military medical authority. Do not buy food or drink from unapproved civilian sources. These sources almost never meet the high standards of the medical authority. Obtaining ice from an unapproved source is particularly dangerous because few civilian vendors disinfect their water before freezing it. Freezing does not kill bacteria. As the ice melts, bacteria in the ice will become active again.

Hands can collect germs from many sources (the ground, dust in the air, the latrine door, weapons, the hands of other soldiers, etc.).

Soldiers should wash their hands after using the latrine and before eating. At least 30 seconds should be spent washing with soap and water, paying special attention to cleaning under fingernails. Handwashing devices should be set up near latrines and dining areas. Water from canteens can be used if other sources are not available.

Respiratory diseases are usually transmitted from person to person by droplets spread from the nose, mouth, throat, or lungs of an infected person. A person who sneezes or coughs throws many droplets into the air. These droplets carry disease germs that can be inhaled by another person. Examples of communicable respiratory diseases include the common cold, influenza (flu), pneumonia, and streptococcal throat infection (strep). Protect against respiratory diseases by using the following guidelines.

Avoid close contact with soldiers that have respiratory diseases.

Encourage sick soldiers to go to sick call.

Avoid using towels, caps, cigarettes, eating utensils, cups, and other objects handled by people with respiratory diseases.

Have an opening in fighting positions for fresh air since fresh air dilutes contaminated air and carries much of the contamination away.

Sexually transmitted diseases (also called venereal diseases) are transmitted from person to person by sexual intercourse (heterosexual or homosexual). Examples of sexually transmitted diseases (STD) include syphilis and gonorrhea. Although these diseases will not prevent a soldier from fighting, they may make him miserable. Left untreated, some sexually transmitted diseases can cause death. The best preventive measure is to refrain from sexual contact (abstinence) or to have sexual contact with only one partner who has no other sexual contacts. Casual sex is to be avoided. Using a prophylactic (latex condom) provides reasonably good protection against these diseases for both males and females since it provides physical separation of the sex organs. (There is no other practical mechanical device that will protect females from contamination by male secretions.) Washing the sexual parts and urinating immediately after sexual intercourse may decrease, but not eliminate the chance of becoming infected. Seek medical attention if discharge or sores on sexual parts are noted.

AIDS (acquired immunodeficiency syndrome) is a fatal disease contracted through sexual contact (homosexual or heterosexual) with an infected person or from the transfer of blood (usually through used intravenous needles) from an infected person. AIDS is not transmitted through casual contact, such as touching. Preventive measures against sexually transmitted diseases are also effective against AIDS. In addition, illicit, intravenous (I.V.) drugs should not be used. Sexual partners of I.V. drug abusers are also at risk of exposure to AIDS.

A soldier who is in good physical condition and is not injured or sick may think he has nothing to worry about when working or marching in a hot climate. Even a healthy person can suffer heat injury. Heat injuries can be painful and, in some cases, fatal. Heat injuries may result when a soldier is exposed to extreme heat from the sun or high temperatures. The body can loose more than a quart of water per hour through sweat. Lost fluids must be replaced quickly since the body relies upon water to cool itself. Preventive measures against heat injuries include consuming adequate amounts of water and salt, wearing clothing properly, and taking rest breaks. Acclimation and protection from undue heat exposure are also important. A soldier who has previously suffered a heat injury is at higher-than-normal risk of having another heat injury. Dark-yellow urine is an indication that not enough fluids are being consumed.

The amount of water a soldier needs to drink depends upon the temperature and upon the work being done. A soldier working in a hot environment should drink at least one full canteen (one quart) of cool water every hour, but not more than 12 quarts daily. A soldier performing strenuous physical labor or working in a very hot environment should drink at least one to one and a half quarts of cool water every hour; daily intake should not exceed 12 quarts. Soldiers should drink small quantities of cool water frequently, even if they are not thirsty.

Soldiers should drink extra water before an attack or mission or before starting hard work. The excess water will help to keep them physically strong and mentally alert until the situation allows time to drink again.

A soldier wearing individual protective equipment (IPE), which is worn at mission-oriented protective posture (MOPP) levels, is especially prone to heat injury and should drink plenty of water.

A soldier who eats three full meals each day should get enough salt to replace the salt lost through perspiration. Encourage soldiers to eat meals even if they are not hungry.

Soldiers should not take salt tablets as a preventive measure against heat injuries.

Rest breaks should be taken if the tactical situation allows. Rest breaks give the body a chance to cool off. A soldier performing heavy work in a hot (85-87.9 ° F) environment should rest about 30 minutes for each hour worked. If possible, soldiers should rest in a shaded area. Working in the shade whenever possible will also help to prevent heat injury.

In hot environments, soldiers should wear their uniforms loosely fitting, especially at the neck, wrists, and legs. This allows better air circulation that helps to cool off the body. If the mission permits, clothing should be loosened and web gear and packs removed during rest breaks.

Cold injuries are caused by the body losing heat faster than the heat can be replaced. Cold injuries are most likely to occur when an unprepared soldier is exposed to cold winter temperatures. Cold injuries can be painful and are sometimes fatal. A soldier may be unaware that he is developing a cold injury until it is too late. Although cold injuries are often associated with very cold weather, preventive measures against cold are needed anytime the temperature drops to 50^oF or below. Wind will also accelerate the loss of body heat (wind-chill factor).

A person who has previously suffered from cold injuries has a higher-than-normal risk of having another cold injury.

Soldiers should wear an adequate amount of properly fitting clothing. The clothing should be worn in loose layers as layering allows air to be trapped inside the clothing. This trapped air helps to slow down the loss of body heat.

When clothing becomes wet, it loses much of its ability to keep the body warm. Therefore, sweating should be kept to a minimum. If a soldier has strenuous work to do, he should remove a layer or two of outer clothing before starting the work in order to reduce sweating. When he has completed his work, the dry clothing should be put on again.

Exercising the large muscle groups (shoulders, trunk, and legs) produces heat and increases blood circulation. If the military situation prevents excessive movement, soldiers should change their positions frequently, move their feet, wiggle their toes, exercise their fingers, and use their hands to massage and warm their faces.

Many soldiers do not drink enough fluids in cold weather, especially if it is inconvenient to drink such as during cold weather operations. Dehydration (excessive loss of body fluids) is a risk in cold weather just as it is during hot weather. Dark-yellow urine is an indication that not enough fluids are being consumed.

Alcoholic beverages should be avoided since they cause the body to loose heat faster. Tobacco should also be avoided as it inhibits circulation.

Feet probably perspire more and are less ventilated than other parts of the body. This moisture accumulates in socks and decreases their ability to insulate feet from the cold. Soldiers should carry dry pairs of socks with them and change wet or damp socks as soon as practical, usually during a rest break. Body heat can be used to dry wet socks if they are placed inside the soldier's shirt.

Boots should fit and be laced loosely.

Feet should be washed daily and foot powder applied as needed.

Soldiers should wear gloves or mittens (with inserts) to protect their hands and wrists.

Soldiers should avoid direct skin contact with snow, ice, bare metal, or fuel.

It is often easier to notice the first signs of frostbite and other cold injuries on someone else rather than on yourself. Because of this, soldiers should watch one another's faces and hands for signs of cold injury. If signs of cold injury are noticed, have the soldier massage his face, put his hands under his arms for warmth, or take other measures to restore warmth and adequate blood circulation to the affected body part.