LESSON 2
PRACTICE INDIVIDUAL PREVENTIVE MEDICINE COUNTERMEASURES
(TASK 081-831-1053)

TASK:

Practice Individual Preventive Medicine Countermeasures.

CONDITION:

Given multiple-choice questions about preventive medicine countermeasures.

STANDARD:

Score 70 or more points on a 100-point comprehensive examination.

REFERENCE:

AR 40-5, Preventive Medicine.
AR 600-63, Army Health Promotion.
FM 21-10, Field Hygiene and Sanitation.
FM 21-11, First Aid For Soldiers.

NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at:
http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.

2-1. INTRODUCTION

Preventive medicine measures (PMMs) are simple, common sense actions that any soldier can perform and must know, for protection against cold weather conditions, heat injury, insect-borne disease, intestinal disorders known as diarrhea and dysentery, and hearing loss. It is each individual's responsibility to maintain good health and use PMMs to reduce time lost due to disease and nonbattle injuries.

2-2. PMMs FOR PROTECTION AGAINST COLD INJURIES

Cold injuries are caused by the body losing heat faster than it can be replaced. Cold injuries are most likely to occur when an unprepared person is exposed to cold winter temperatures. Cold injuries can be painful and are sometimes fatal. A person may be unaware that he is developing 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°F or below. Wind and moisture increase the rate at which the body loses heat. Trench foot can occur when feet remain wet for a long period of time. Fear, fatigue, dehydration (not drinking enough water), inadequate food intake, inadequate rest, inadequate clothing, sustained contact with cold ground, and long periods of immobilization also contribute to cold injury. A person who has previously suffered from cold injuries has a higher-than-normal risk of having another cold injury.

Wear of the uniform

Wear an adequate amount of properly fitting clothes as directed by your commander. The clothing should be worn in loose layers. Layering clothing allows air to be trapped inside the clothing. This trapped air helps to slow down the loss of heat produced by the body.

Loose clothing also helps to promote blood circulation. The blood carries oxygen and nutrients which cells need in order to produce heat.

When clothing becomes wet, it loses its ability to keep the body warm. One way that clothing becomes wet is by absorbing perspiration. You should, therefore, try to prevent excessive sweating whenever possible. If you have some hard work to do, remove a layer or two of clothing before starting the work in order to reduce sweating. When you have completed your work, replace the dry clothing that you removed.

Launder clothing regularly. Dirty or wet clothing adds to the cold injury process.

Exercise Your Muscles

When your body performs work, heat is produced. Exercise the large muscle groups (shoulders, trunk, and legs) to produce heat and to increase blood circulation.

If your situation prevents excessive movement, change positions frequently, move your feet, wiggle your toes, and exercise your arms, hands, and fingers. Use your hands to massage and warm your face.

Protect your feet

Your feet probably perspire more and are less ventilated than other parts of your body. This moisture accumulates in socks and decreases their ability to insulate your feet from the cold. Being moist and being close to the cold ground makes your feet especially susceptible to cold injury. Since your feet are more difficult to observe than other parts of your body, special care is needed to prevent cold injury.

Wear proper-fitting (not tight) boots and socks. Boots should be laced loosely so that blood circulation is not impaired. Inactive feet in damp or wet socks and boots or tightly laced boots that impair circulation are even more susceptible to injury.

Keep your socks clean and dry. Change wet or damp socks as soon as practical, usually during a rest break. Wet or damp socks can be dried by placing them inside your shirt. The heat from your body will dry the socks.

Bring at least five pair of boot socks with you.

Wash your feet daily and use foot powder.

Wear overshoes to keep your boots dry.

Avoid standing on cold, wet ground.

Drink and eat adequate amounts

Many people 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. Drink plenty of water, juices, and warm fluids. Do not drink alcoholic beverages. Dark-yellow urine is an indication that you are not drinking enough fluids.

Eat all of your meals. Your body needs food to produce heat energy.

Avoid drinking alcoholic beverages. Although they may make you feel warmer, the alcohol will cause your body to lose heat faster.

Do not smoke. The chemicals in tobacco result in decreased blood flow to the skin.

Protect your hands

Wear your gloves or mittens (with inserts) to protect your hands and wrists. Lengthy exposure of your hands and wrists to cold will cause blood circulation to be reduced. Once the hands and wrists "stiffen," considerable time may be required for rewarming and reconditioning the hands for normal use.

Warm your hands under clothing if they become numb. You may need to remove your gloves and stick your hands beneath your uniform so that your body heat can rewarm your fingers.

Avoid coming into direct skin contact with snow, ice, bare metal, or fuel since all of these items increase heat loss.

Exercise your hands and fingers if they become tingly or numb.

Use the buddy system

Many times it is easier to notice the first signs of frostbite on someone else rather than on yourself. Because of this, soldiers should watch one another's face and hands for signs of frostbite (a red or a pale, waxy area on a light-skinned soldier; a gray area on a dark-skinned soldier). It you notice signs of frostbite, have the person massage his face, put his hands under his arms for warmth, or take some other measure to counteract the frostbite.

2-3. PMMs FOR PROTECTION AGAINST HEAT INJURIES

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. This is not so. Even a healthy person can suffer heat injury. Heat injuries can be painful and, in some cases, fatal.

Heat injuries are caused by insufficient water in the body, by insufficient salt in the body, or by a combination of the two. Heat injuries can be avoided by consuming adequate amounts of water and salt, wearing clothing properly, and taking rest breaks.

Drink sufficient water

The amount of water a person needs to drink depends upon the temperature and the work being done (figures 2-1 & 2-2). A person working in a hot environment should drink at least one full canteen (one quart) of cool water every hour. A person who is performing strenuous physical labor or who is working in a very hot environment should drink at least one quart of cool water every hour.

Drink small quantities of cool water frequently, even if you are not thirsty.

Follow your leader's instructions concerning water intake. Drink water when you are ordered to do so even if you are not thirsty.

Do not rely on thirst to remind you when to drink water. People in a hot climate seldom feel thirsty enough to replace all the water that is lost through perspiration and urination.

Refill your canteen with cool, disinfected water at every opportunity.

Drink extra water before an attack or mission or before starting hard work. The excess water in your system will help to keep you physically strong and mentally alert until the situation allows you time to drink again.

A person wearing chemical protection (MOPP) gear is especially prone to heat injury and should drink plenty of water.

Use work/rest cycles

Work and rest as your leader directs. Rest breaks give the body a chance to cool off. A soldier performing moderate work in a hot (WBGT Index 88-89.9) environment should rest about 30 minutes for each hour he works.

NOTE: The asterisked (*) fluid retention information is per: "Memorandum, Policy Guidance for Fluid Replacement During Training, 29/04/98, Office of the Surgeon General".

FIGURE 2-1. FLUID REPLACEMENT POLICY

*NL = no limit to work time per hour.

FIGURE 2-2. CATEGORIES OF WORK

Rest breaks should be taken only if the tactical situation allows time to stop and rest.

If possible, work and rest in a shaded area.

Eat meals to replace salt

A person who eats regular meals should get enough salt to replace the salt lost through perspiration. You should eat three full meals each day even if you are not hungry. You should not take additional salt (salt tablets, salty water, etc.) except when directed by medical personnel.

Protect yourself from exposure

Wear clothing to protect your skin from solar radiation (sunlight). Unprotected skin may develop serious sunburn. Using barrier creams and lotions may help protect the skin. Some situations may not permit the use of the lotions and creams.

When possible, clothing should be loose fitting, especially at the neck, wrists, and legs. This allows for better air circulation which helps to cool off the body. Soldiers wearing chemical protective overgarments are especially prone to heat injury because the protective clothing traps much of the heat energy produced by the body.

2-4. PMMS FOR PROTECTION AGAINST ARTHROPOD BITES AND ARTHROPOD-BORNE DISEASES

NOTE: An arthropod is a segmented invertebrate of the phylum arthropoda that includes insects, arachnids, crustaceans, centipedes and millipedes. Some examples are given at figure 2-3.

FIGURE 2-3. EXAMPLES OF BITING INSECTS

NOTE: The Department of Defense Arthropod Repellent System -- DEET on the skin + permethrin on the uniform + wear of the uniform = total protection.

"Arthropod-borne diseases" refers to diseases transmitted by insects (such as mosquitoes, lice, and fleas) and by certain other animals that closely resemble insects (such as ticks and mites). Examples of communicable arthropod-borne diseases include malaria (transmitted by mosquitoes), yellow fever (transmitted by mosquitoes), typhus (transmitted by lice), Rocky Mountain spotted fever (transmitted by ticks), and plague (transmitted by fleas).

Apply insect repellent

NOTE: Read instructions that accompany the repellents before use.

One of the best ways to keep the insects from transmitting diseases to you is to keep them away by using arthropod repellent. Some guidelines are given below.

Apply the extended-duration arthropod repellent skin lotion to all exposed skin except your eyes, lips and other sensitive skin. Also apply the repellent two inches under the edges of the battle dress uniform (BDU). This includes the wrists, ankles, and waistline.

Blouse your uniform inside your boots and apply permethrin clothing repellent where they meet.

NOTE: Use the IDA (most effective) or aerosol treatments.

Apply permethrin clothing repellent to all areas of the uniform that fit tightly enough for mosquitoes to bite through. This includes the upper back, buttocks, and knees. Do not apply the clothing repellent while wearing the uniform and do not apply to undergarments.

Reapply repellent as soon after stream crossings as practical since the water will dilute and wash away much of the repellent on your clothing.

Reapply repellent every 6 hours if you are performing strenuous work.

Take malaria pills

If you are in an area where malaria may be a problem, you will be given medication to take. You will be told how many to take at one time and when to take them (usually at mealtime). This medication, commonly referred to as "malaria pills," will help to protect you from the full effects of the disease, but does not make you immune to malaria. If you should have the pills but have not been issued them, contact your NCO.

Wear your uniform properly

Wear your uniform as your commander directs.

Wear your headgear to protect the top of your head.

Roll your sleeves down.

Tuck your shirt and undershirt in at the waist.

Blouse your uniform inside your boots.

Lace your boots completely.

Repair any tears or holes in your uniform.

Keep yourself clean

Wash yourself daily if the tactical situation permits. Pay special attention to hairy regions of the body, including armpits and groin, where insects may deposit their eggs. Sometimes a shower will be available. At other times creeks, streams, or individual temporary showers will have to be used.

Use a buddy-system to examine each other for the presence of ticks, lice, fleas, and mites. The buddy can look at hard to see areas such as the back of the head.

Seek medical help if an insect problem exists. Insecticide powder, cream, or shampoo may be prescribed by medical personnel to eliminate the insects.

Keep your uniform clean

Your uniform should be washed at least once each week. Use the supporting laundry unit if possible. If one is not available, scrub the uniform with soap and water. A good washing will eliminate ticks and mites that are on the uniform. Lice eggs in the seams of your uniform can be killed if the uniform is washed in water heated to at least 140°F.

If ticks, mites, or lice are a problem, dust your clothing with insecticide powder to kill these pests. Pay special attention to the seams of your uniform. Seams may contain eggs, which may hatch if not dusted. The powder can be applied to delouse infected clothing and as a louse prevention measure to keep clothing from becoming infested.

Insecticide powder can be obtained from the unit's field sanitation team.

Protect yourself at night

When you rest at night, no one wants to be bothered, especially by insects. Your sleep is important. Protecting yourself against biting arthropods at night includes the use of your bednet and the use of insect spray inside the bednet.

The proper use of the bednet is important. Suspend the bednet above the sleeping area and tuck the edges of the net under the sleeping pad or bag. You should treat the net with permethrin clothing repellent and spray the interior space with d-phenothrin (or other approved spray) aerosol spray insecticide. Avoid breathing vapors from the spray.

2-5. PMMS FOR PROTECTION AGAINST WATER-BORNE AND FOOD-BORNE DISEASES

Food-borne and water-borne diseases can cause diarrhea or dysentery. 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, but not limited to, 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. Water in a stream or lake can be contaminated by untreated sewage. Food can be contaminated by fecal material on a person's hands or under his fingernails.

Disinfect your drinking water.

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

Fill your canteen with the cleanest, clearest water available.

Check the color of the iodine tablets in the bottle. The tablets should be uniformly steel gray in color. Discard any tablet which is not gray in color.

Add two tablets to your one-quart canteen of water. If you are using a two-quart canteen, add four tablets.

Replace the cap on the canteen and wait five 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 allow the water to flow over the threads of the cap and canteen neck to disinfect them.

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

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

There are other methods for purifying water, such as chlorine ampoules, tincture of iodine, and common household bleach. If none of the purifying agents are available, boil the water for five to ten minutes.

Obtain food and drink from approved sources.

Obtain food, drink, and ice only from sources approved by the local military medical authority. Do not buy food and 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. As the ice melts in your glass or mouth, bacteria in the ice will become active again.

If you must eat in a local establishment, eat only hot, cooked food. Again, only eat at the approved establishments.

The food product container condition plays a part in the maintenance of the food. Inspect all cans and food packets prior to use. Discard cans with leaks or bulges. Discard food packets with visible holes or obvious signs of deterioration. Do not eat food or drink beverages prepared in galvanized containers.

Wash your hands

Wash your hands after using the latrine. Pay special attention to cleaning under your fingernails.

Wash your hands just before and after you eat. Also, wash your hands after smoking. Your hands may have collected germs from many sources (the ground, dust in the air, the latrine door, the hands of your friends, your own nose, your weapon, ammunition, etc.). You should spend at least 30 seconds washing your hands with soap and water. Water from your canteen can be used if other water is not available.

Handwashing devices should be set up near latrines and dining areas.

Dispose of food waste properly

Waste disposal is important for the protection of soldiers' health in the field. Intestinal diseases are usually spread through contact with infectious organisms, which can be spread by flies. A number of precautions that can be taken are:

• Use covered containers if available.
• Use plastic bags in the event you have a dumpster-type receptacle or regular waste pick-up.
• Bury your food waste if other options are not available.

2-6. PMMs FOR PROTECTION AGAINST HEARING LOSS

You may not be able to curtail the noise in your work environment, but you can take some protective measures to prevent damage to your hearing.

Soldiers should avoid high noise areas if possible. If noise avoidance is not possible you should take precautions like using protective devices: earplugs, ear canal caps, earmuffs over earplugs, vehicle headgear such as helicopter crew helmets and armored vehicle crew helmets.

2-7. PMMs FOR PROTECTION AGAINST SKIN INFECTIONS

We have heard how important keeping clean is to fighting disease. Well, it is no less important in preventing skin infections. 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.

Keep your skin dry. After bathing or as needed, use foot powder on your feet, especially if you have had fungal infections in the past. Talcum powder is recommended for areas where wetness is a problem. If talcum powder is not available, use cornstarch as a substitute.

After a bath or shower, you should change to clean clothing. The clean uniforms should fit a little loose. Loose-fitting uniforms allow for better ventilation and blood circulation. Wear the proper clothing for the environment. Nylon and silk-type undergarments are not suitable, especially in hot weather. Cotton undergarments are more absorbent, and they allow the skin to dry.

Males should shave facial hair often enough to allow a tight fit of the protective mask.

2-8. PMMs FOR CARE OF THE FEET

Your feet play a very important role in your ability to complete your mission. Technology has made many changes in our life, but keeping your feet in good condition is as important today as it was years ago.

Before you go on a movement, you must take care of your feet by wearing footgear that is correctly fitted. Wearing good clean socks and using foot powder will go a long way to protecting your feet. If blisters, pressure spots, or infections do occur, treat them before you go on the movement.

A bad time to have problems with your feet is during the movement. Actions to take during the movement to prevent foot problems are as follows:

• Keep your feet as dry as possible.
• Change your socks if they become damp or wet.
• Socks can be dried by putting them under your shirt around your waist.
• Try to relieve pressure spots on the feet by adjusting your gear.
• Dust your feet with foot powder once or twice daily.
• Elevate your feet while resting to help reduce congestion and swelling.
• Take care of blisters--wash with soap and water and seek medical treatment.

2-9. PMMs FOR ORAL HYGIENE

Brushing your teeth after each meal, using dental floss, and rinsing your mouth with potable water are all good oral hygiene practices. You can continue to have good oral hygiene while in the field. You can brush your teeth even if you don't have toothpaste. Toothpaste helps but it is not a necessity.

2-10. PMMs FOR PROTECTION AGAINST RESPIRATORY DISEASES

Respiratory diseases are usually transmitted from person to person by discharges 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. Sometimes, disease germs may exist on the ground until they come into contact with a person's bare skin or until they are stirred up and become airborne again. Examples of communicable respiratory diseases include the common cold, influenza (flu), pneumonia, and streptococcal throat infection (strep). Protect yourself from respiratory diseases by using the following guidelines.

If possible, avoid close contact with soldiers who have respiratory diseases whenever possible.

Encourage sick soldiers to go to sick call. Once the soldier is cured, he will not be able to transmit the disease to you.

Avoid using borrowed towels, caps, cigarettes, and other objects that have been handled by other people.

Provide an opening for fresh air into your fighting position, bunker, or shelter. Fresh air dilutes the contaminated air and carries much of the contamination away.

2-11. PMMs FOR PROTECTION AGAINST SEXUALLY-TRANSMITTED DISEASES (STD)

STD (including HIV, the virus that causes acquired immunondeficiency syndrome (AIDS)) are infections that are transmitted through sexual contact with persons who are already infected. HIV is a disease contracted through sexual contact (homosexual or heterosexual) with an infected person or from the transfer of blood (blood transfusion, used intravenous needles, etc.) from an infected person. HIV is not transmitted through casual contact such as touching.

There is no cure for AIDS and there is no vaccination to prevent HIV infection. Soldiers must take necessary precautions to protect themselves from being infected.

Avoiding sexual contact with persons who may have one of these infections is the surest way to avoid becoming infected. Because it is difficult to know who is infected with a STD or the HIV virus and who is not, the decision to have sex with someone should follow an estimate of the chances that the sexual partner may be infected. Persons who are more likely to be infected include those who have more than one sex partner, unprotected sex, anal sex, sex with casual partners, sex with prostitutes or their clients, or sex with partners who are HIV infected. In addition to sexual contact, the HIV virus can be spread through the practice among drug abusers of sharing needles when injecting drugs. The virus is passed from an infected person to another through the blood that contaminates the shared needles or syringes.

Using a latex prophylactic (condom) provides reasonably good protection against venereal disease 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.

Urinating immediately following sexual intercourse is considered to be of some value in flushing venereal disease organisms out of the urinary tract. This applies to both males and females.

Washing the genitals thoroughly with soap and water after intercourse may reduce the probability of acquiring a venereal infection for males and females. Vaginal douching after intercourse, however, is not effective since the washing action may actually push the disease organisms further into the female organs.

Do not use injected nonprescribed drugs or permit yourself to be injected or cut with a nonsterile sharp object. Avoid tattoos and body piercing with nonsterile needles.

Alcohol often plays a role in the sexual encounter that may lead to problems at a later date. Control alcohol intake (it effects your ability to use safe sex practices).

2-12. PMMs FOR HUMAN WASTE DISPOSAL

Human waste disposal is an important element in the protection of soldiers' health in the field. Intestinal diseases are usually spread through contact with infectious organisms that can be spread in human waste. The method used for disposal of human waste depends upon the military situation and the unit and its location. Waste disposal does impact upon the health of a unit's personnel and must be done correctly.

Recommended methods of disposing of human waste are as follows:

• Use the unit latrine when available. (Deep pit for extended bivouac.)
• Use a cat-hole latrine on marches. On a march, cover the cat-hole with dirt immediately after use.
• Use a straddle trench for 1-3 day bivouac.

2-13. PMMs FOR PREVENTION OF TOBACCO USE INJURIES

The DOD has a smoke-free workplace policy. The Army has the same policy. There are programs established to help you and family members become tobacco-free. AR 600-63, Army Health Promotion & Tobacco Use, provides the policy and guidelines.

The leading cause of death in the United States is heart and blood vessel disease. The leading preventable cause underlying death in the U.S is tobacco use. Tobacco use is responsible for more deaths than all other causes. Heart disease, cancer, emphysema, stroke are all diseases that are linked to tobacco use. The use of tobacco can cause poor circulation, increase risk during surgery, and prolong the healing process.

Smoking effects on the health of nonsmokers (or second hand smoke as it has been called) is linked to lung cancer, asthma attacks, low birth weight, and preterm births. It is also known that children exposed to cigarette smoke have more middle ear and lower respiratory infections.

Many people have switched to using smokeless tobacco products thinking it is safer than smoking. It is well established that smokeless tobacco of all types (chew, snuff, bandits) leads to the development of heart disease, various cancers, gum recession, and bone loss around the teeth.

Cancers of the mouth and throat are particularly deforming and deadly.

A soldier's performance and health is affected by tobacco use. Tobacco use increases the likelihood of cold weather injuries, respiratory infections (to include pneumonia), and longer hospital stays after surgery, all of which decrease soldier readiness. Smoking makes it far more likely that you will be susceptible to upper respiratory infections (colds and flu). The bottom line is that tobacco use decreases readiness.

Tobacco use impacts on the soldier's ability to do the job (readiness) as follows:

Despite the fact that people know tobacco is bad for their health and longevity and want to give it up, it is very difficult for most to do so. The physical and emotional dependence developed with tobacco use is very great. Withdrawal symptoms are unpleasant. Often tobacco users feel jittery and irritable after a certain period of time without nicotine. These are symptoms of withdrawal! We need soldiers who are alert, can concentrate on the task at hand, and who are team players, not individuals who are easily aggravated by other people or stressful situations due to their bodies' reaction to not having tobacco.

There are resources available for tobacco use cessation. Your health care provider may be able to prescribe medication to help with your cessation effort. Many of the cessation programs and materials are available through your health care facility or local preventive medicine service. There are community agencies such as the American Cancer Society (800-486-2345) or local public health department. Additionally, nicotine gum and or patches available on the economy can also help you quit using tobacco.