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FM 4-02.17 PREVENTIVE MEDICINE SERVICES (August 2000) - page 1

 

 

FM 4-02.17
PREVENTIVE
MEDICINE
SERVICES
HEADQUARTERS, DEPARTMENT OF THE ARMY
DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.
FM 4-02.17
FIELD MANUAL
HEADQUARTERS
NO. 4-02.17
DEPARTMENT OF THE ARMY
Washington, DC, 28 August 2000
PREVENTIVE MEDICINE SERVICES
TABLE OF CONTENTS
Page
PREFACE
v
CHAPTER
1.
MEDICAL THREAT
1-1
1-1.
General
1-1
1-2.
Historical Perspective
1-2
1-3.
Disease and Nonbattle Injury
1-3
1-4.
Individual and Unit Preventive Medicine Measures
1-6
1-5.
Preventive Medicine Employment in Defeating the Threat
1-6
CHAPTER
2.
ROLE OF THE SOLDIER AND UNIT LEADER
2-1
2-1.
General
2-1
2-2.
Role of the Individual Soldier
2-1
2-3.
Role of Unit Leaders
2-4
CHAPTER
3.
PREVENTIVE MEDICINE STAFF IN A THEATER OF
OPERATIONS
3-1
3-1.
Staffing
3-1
3-2.
Army Service Component Command
3-1
3-3.
Medical Command
3-1
3-4.
Corps
3-1
3-5.
Medical Brigade
3-2
3-6.
Medical Group
3-2
3-7.
Division
3-2
3-8.
Separate Brigade
3-3
3-9.
Armored Cavalry Regiment
3-3
3-10.
Special Operations Forces
3-3
3-11.
Area Support Medical Battalion
3-4
3-12.
Engineer Units
3-4
3-13.
Military Police Units
3-4
3-14.
Civil Affairs Units
3-5
3-15.
Quartermaster Units
3-5
DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.
i
FM 4-02.17
Page
CHAPTER
4.
PREVENTIVE MEDICINE DETACHMENTS AND
ACTIVITIES
4-1
Section
I.
Table of Organization and Equipment Detachments
4-1
4-1.
General
4-1
4-2.
Operational Principles
4-1
4-3.
Operational Concept for the Preventive Medicine
Detachment (Sanitation)
4-3
4-4.
Location of the Preventive Medicine Detachment (Sanitation)
4-4
4-5.
Function of the Preventive Medicine Detachment (Sanitation)
4-4
4-6.
Operational Concept for the Preventive Medicine
Detachment (Entomology)
4-6
4-7.
Location of the Preventive Medicine Detachment (Entomology)
4-7
4-8.
Function of the Preventive Medicine Detachment (Entomology)
4-8
4-9.
Basis of Allocation
4-10
4-10.
Mobility
4-10
4-11.
Standing Operating Procedures, Checklists, and Movement Plans
4-10
Section
II.
Tables of Distribution and Allowances Activities
4-10
4-12.
General
4-10
4-13.
Center for Health Promotion and Preventive Medicine
4-11
4-14.
United States Army Medical Research Institute for Chemical
Defense
4-11
4-15.
United States Army Research Institute for Environmental Medicine
4-11
4-16.
United States Army Medical Research Institute of Infectious
Diseases
4-11
4-17.
Walter Reed Army Institute of Research
4-12
4-18.
Preventive Medicine Sections at Medical Department Activities
or Regional Medical Commands
4-12
4-19.
Armed Forces Medical Intelligence Center
4-12
CHAPTER
5.
PREVENTIVE MEDICINE DETACHMENT MOBILIZATION
5-1
5-1.
General
5-1
5-2.
Planning
5-1
5-3.
Warning Order
5-1
5-4.
Movement Directive and Movement Order
5-2
5-5.
Unit Movement Plans
5-2
5-6.
Standing Operating Procedures for Unit Move
5-2
5-7.
Unit Load Plans
5-2
CHAPTER
6.
PREVENTIVE MEDICINE SERVICES IN STABILITY
OPERATIONS AND SUPPORT OPERATIONS
6-1
6-1.
General
6-1
6-2.
Domestic Support
6-1
6-3.
Protection Against Epidemic Diseases
6-3
ii
FM 4-02.17
Page
6-4.
Humanitarian Assistance
6-4
6-5.
Peacekeeping/Peace Enforcement
6-4
6-6.
Environmental Health and Environment Surveillance
6-4
CHAPTER
7.
PREVENTIVE MEDICINE IN SUPPORT OF CIVIL-MILITARY
OPERATIONS
7-1
7-1.
Mission
7-1
7-2.
Command Approval
7-1
7-3.
Purpose
7-1
7-4.
Preventive Medicine Projects
7-1
7-5.
Health Screenings
7-2
7-6.
Health Education
7-2
CHAPTER
8.
PREVENTIVE MEDICINE REPORTS
8-1
8-1.
General
8-1
8-2.
Medical Statistical Report
8-1
8-3.
Sanitary Inspection Report
8-1
8-4.
Epidemiological Investigation/Surveillance Report
8-1
8-5.
Occupational Health Report
8-2
8-6.
Annual Historical Report
8-2
CHAPTER
9.
MEDICAL SURVEILLANCE
9-1
9-1.
Introduction
9-1
9-2.
Applicability and Scope
9-1
9-3.
Mission Objective of Medical Surveillance
9-1
9-4.
Principles of Medical Surveillance
9-2
9-5.
Responsibilities for Medical Surveillance
9-3
APPENDIX
A.
PLANNING/PREPARATIONS FOR PREVENTIVE MEDICINE
IN MILITARY OPERATIONS
A-1
Section
I.
General Planning Information
A-1
A-1.
General
A-1
A-2.
Facts and Assumptions
A-2
A-3.
Mission Analysis
A-4
A-4.
Developing Courses of Action
A-5
Section
II.
Sample Format for the Preventive Medicine Estimate
A-5
A-5.
General
A-5
Section
III.
Format for the Preventive Medicine Portion of the Combat
Health Support Plan (Medical Section of a Unit)
A-14
APPENDIX
B.
ARMY FORCE XXI PREVENTIVE MEDICINE SUPPORT
UNDER THE MEDICAL REENGINEERING INITIATIVE
B-1
B-1.
General
B-1
iii
FM 4-02.17
Page
B-2.
Medical Command, Echelons Above Corps
B-1
B-3.
Theater Medical Command, Corps
B-1
B-4.
Medical Brigade
B-1
B-5.
Combat Support Hospital
B-1
B-6.
Division Medical Companies
B-2
B-7.
Operational Concept for the Preventive Medicine Detachment
B-3
B-8.
Operational Capabilities for the Preventive Medicine Detachment
B-4
B-9.
Location, Assignment, and Basis of Allocation of the Preventive
Medicine Detachment
B-5
B-10.
Preventive Medicine Detachment Mobility
B-5
B-11.
Preventive Medicine Section, Area Support Medical Battalion
B-6
B-12.
Area Medical Laboratory
B-8
APPENDIX
C.
CONDUCT AERIAL SPRAY OPERATIONS
C-1
C-1.
General
C-1
C-2.
Prepare for Mission
C-1
C-3.
Set Up Equipment
C-2
C-4.
Conduct Spray Mission
C-2
C-5.
Conduct After-Spray Mission Maintenance on Sprayer
C-3
C-6.
Conduct Post-Mission Activities
C-3
C-7.
Conduct Follow-up Survey of Treated Area
C-3
APPENDIX
D.
COMMANDER’S CHECKLIST FOR UNIT MOVEMENT
D-1
Section
I.
Actions Conducted on a Continuing Basis
D-1
D-1.
General
D-1
D-2.
Standing Operating Procedures, Checklists, and Plans
D-1
D-3.
Personnel and Administrative Actions
D-2
D-4.
Security Actions
D-3
D-5.
Operations and Training Actions
D-3
D-6.
Logistics Actions
D-3
D-7.
Equipment, Accountability, Serviceability, and Testing Actions
D-4
Section
II.
Actions Taken on Receipt of Warning Order
D-5
D-8.
Warning Order Receipt
D-5
D-9.
Personnel and Administrative Actions
D-5
D-10.
Operations and Training Actions
D-5
D-11.
Logistics Actions
D-6
Section
III.
Actions Taken on Receipt of Movement Order
D-6
D-12.
General
D-6
D-13.
Personnel and Administrative Actions
D-6
D-14.
Security Actions
D-7
D-15.
Logistics Actions
D-7
APPENDIX
E.
CONDUCT AN ENTOMOLOGICAL SURVEY
E-1
E-1.
Prepare to Conduct an Entomological Survey
E-1
iv
FM 4-02.17
Page
E-2.
Required Actions to Ensure Survey Covers Area
E-1
E-3.
After-Action Requirements
E-2
APPENDIX
F. PREVENTIVE MEDICINE SITE SURVEY CHECKLIST
F-1
F-1.
Purpose
F-1
F-2.
Responsibilities
F-1
F-3.
Preventive Medicine Site Survey Checklist
F-1
APPENDIX
G. TRAINING PROCEDURES GUIDE
G-1
G-1. Purpose
G-1
G-2. Planning
G-1
G-3. Preparing
G-2
G-4. Presenting
G-2
G-5. Practicing
G-3
G-6. Performing
G-3
APPENDIX
H. STRATEGIC DEPLOYABILITY DATA FOR THE MEDICAL
DETACHMENT, PREVENTIVE MEDICINE
H-1
H-1. General
H-1
H-2. Strategic Deployability Data
H-1
GLOSSARY
Glossary-1
REFERENCES
References-1
INDEX
Index-1
PREFACE
This field manual (FM) provides information on the mission, organization, and responsibilities for
preventive medicine (PVNTMED) support operations throughout the operational continuum. It is directed
toward the commanders at all levels of deployment, their staffs, the command surgeons, the PVNTMED
planning staffs at the Army, joint, combined, allied, and coalition staff levels, and to the individual soldier
and unit leaders on their role in the application of preventive medicine measures (PMM). It further defines
each staff element of PVNTMED and lists the functions, capabilities, and management requirements
associated with each. It provides procedures for directing, controlling, and managing PVNTMED assets
within the area of operations (AO).
This publication outlines the functions and operations of each PVNTMED section and how it integrates
its activities in support of those operations.
v
FM 4-02.17
This publication contains tactics, techniques, and procedures relative to PVNTMED support in the
following specific areas:
• Unit and area PVNTMED support to the sustaining base, the combat zone (CZ), and at
echelons above corps (EAC).
• The organization, mission, functions, capabilities, and employment of PVNTMED units and
tables of distribution and allowances (TDA) activities.
• Preventive medicine support in disaster relief.
• Preventive medicine staff functions.
• The relationship between PVNTMED staffs and the surgeons at each level of command.
• The command and technical relationship to supported and supporting units.
• The PVNTMED role in civil-military operations (CMO).
• Preventive medicine mobilization procedures.
• Preventive medicine support in stability operations and support operations.
This publication is in agreement with the following North Atlantic Treaty Organization (NATO)
Standardization Agreements (STANAGs) and American, British, Canadian, and Australian (ABCA)
International and Quadripartite Standardization Agreements (QSTAGs):
NATO ABCA
STANAG QSTAG
TITLE
2037
Vaccination of NATO Forces
2048
Chemical Methods of Insect and Rodent Control–AMedP-3
2050
Statistical Classification of Diseases, Injuries, and Causes of Death
2136
245
Minimum Standards of Water Potability in Emergency Situations
2885
Emergency Supply of Water in War
2908
Preventive Measures for an Occupational Health Programme
2981
Prevention of Cold Injury
889
Essential Field Sanitary Requirements
vi
FM 4-02.17
The staffing and organization structure presented in this publication reflects those established in base
table(s) of organization and equipment (TOE). However, such staffing is subject to change to comply with
manpower requirements criteria outlined in Army Regulation (AR) 71-32 and can be subsequently changed
by your modification table(s) of organization and equipment (MTOE).
As the Army Medical Department (AMEDD) transitions to the 91W military occupational specialty
(MOS), positions for 91B and 91C will be replaced by 91W when new unit MTOE take effect.
Users of this publication are encouraged to submit comments and recommendations to improve the
publication. Comments should include the page, paragraph, and line(s) of the text where the change is
recommended. The proponent for this publication is the United States (US) AMEDD Center and School
(AMEDDC&S). Comments and recommendations should be forwarded directly to: Commander,
AMEDDC&S, ATTN: MCCS-FCD-L, 1400 East Grayson Street, Fort Sam Houston, Texas 78234-6175,
or by using the E-mail addresses on the Doctrine Literature website at http://dcdd.amedd.army.mil/index1.htm
(click on Doctrine Literature).
Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.
Use of trade or brand names in this publication is for illustrative purposes only and does not imply
endorsement by the Department of Defense (DOD).
vii
FM 4-02.17
CHAPTER 1
MEDICAL THREAT
1-1.
General
a. The term medical threat is defined as “a collective term used to designate all potential or
continuing enemy actions and environmental situations that could adversely affect the combat effectiveness
of friendly forces, to include wounds, injuries, or sickness incurred while engaged in a joint operation.”
(Joint Publication 4-02). In Army and multiservice publications, the term is defined as a composite of all
ongoing potential enemy actions and environmental conditions (disease and nonbattle injuries [DNBIs]) that
may render a soldier combat ineffective. Commanders and unit leaders are responsible for protecting and
preserving Army personnel and equipment against injury, damage, or loss that may result from food-,
water-, and arthropodborne diseases, as well as environmental injuries (for example, heat and cold injuries)
and occupational hazards.
b. The term health threat refers to an individual soldier’s health. The term can include hereditary
conditions which manifest themselves in adulthood, individual exposure to an industrial chemical or toxin
where others are not exposed, or other injuries and traumas which affect an individual’s health rather than
the health of the unit. For example, an individual who has a food allergy inadvertently eats the offending
food; he may become incapacitated with diarrhea but the remainder of the unit is not affected by this
condition. On the other hand, in a unit where 40 to 50 percent of its personnel contract Salmonella (an
infectious disease), the unit can no longer complete its mission. A health threat may be more individualized
in nature and may not be of any military significance. The significant difference in these terms lies with the
effects on the ability of a military unit to successfully execute its mission.
c.
The elements of the medical threat include infectious diseases that occur naturally, but are not
limited to—
• Diseases endemic to the AO.
• Environmental factors (heat, cold, humidity, and significant elevations above sea level).
• Diseases caused by zoonotic/animal bites.
• The presence of poisonous animals, plants, and insects.
(These are important
considerations as causative agents of DNBI casualties.)
• Diseases stemming from weapons of mass destruction (WMD) (such as nuclear,
biological, and chemical [NBC], and directed-energy [DE] weapons/devices such as radiation composed of
three types—radio frequency, laser, and charged particle beam). Blast effect weapons, such as fuel and air
explosives, represent an emerging medical threat. This includes terrorist (individuals or groups) actions
directed against defenseless targets.
• Prolonged periods of intense, continuous operations under all types of conditions that tax
soldiers to the limits of their physiological and emotional endurance.
1-1
FM 4-02.17
1-2.
Historical Perspective
Throughout history, DNBI resulting from medical threats (including, but not limited to, heat, cold, and
disease) have accounted for more losses to fighting forces than combat-related injuries. Even prominent
military personalities, such as Alexander, Hannibal, Frederick, and Napoleon, suffered setbacks due to loss
of forces as a result of DNBI. Despite considerable advances in the technology of war, the medical threat
still presents a significant danger to our forces. For example:
a. Lebanon Intervention of 1958. Half of the deployed US force in Beirut suffered the misery of
diarrhea. Five percent of those were sick enough to require hospitalization.
b. Vietnam War in the Republic of Vietnam. Nearly half the US troops deployed to Vietnam had
one or more significant bouts with diarrhea during their first 4 months in country.
c.
Sinai Campaign in Egypt, 1967. Twenty percent of the entire Egyptian force deployed across
the peninsula died from heat, even though the war only lasted a few days.
d.
Jerusalem Campaign in Israel, 1967. Forty percent of Israeli infantry units operating within
the ancient city contracted cutaneous leishmaniasis.
e.
Canal Clearance Operation in Egypt, 1975. Eighty percent of the US Navy personnel
deployed to Egypt in support of clearance operations suffered diarrhea and dysentery from eating in poorly
maintained food service facilities.
f.
Operation Bright Star in Egypt, 1980. The exercise ended miserably for many US troops
because of diarrhea and dysentery. They had eaten in civilian restaurants just before returning home.
g. Peacekeeping Operations in the Sinai, 1982. Thirty percent of one US airborne company was
incapacitated by the Sinai heat and required intravenous (IV) fluids to recover from dehydration.
h. Operation Just Cause, Republic of Panama, 1989. Many US personnel suffered heat
prostration/injuries due to a lack of acclimatization and a shortage of drinking water. Airborne personnel
jumped into the mangrove swamps around Panama City without adequate amounts of water to drink. Each
individual only had one canteen of water. The water in these swamps is brackish (salt) water; therefore, the
personnel could not refill their canteens and treat the water with iodine tablets. Unit combat lifesavers cut
off the tops of 500 cubic centimeter (cc) IV solution bags and had the individuals drink the solution to
relieve the heat effects.
i.
Operation Desert Shield/Operation Desert Storm in Saudi Arabia, 1990-1991. At ports and
other large troop concentration areas, sanitation safeguards were nonexistent or poorly controlled. In order
to get to showers, soldiers had to pass through areas where human waste was leaking from outdoor latrines
(some were positioned too closely). These conditions along with other sanitation problems, contributed to
many cases of Shigella (a diarrheal disease).
j.
Operation Restore Hope in Somalia, 1993-1994. In the process of upgrading and moving a
unit to a new location, a US unit selected an area that had been occupied by a coalition force. The
1-2
FM 4-02.17
assumption was made that because these forces had found the area suitable that it would probably
accommodate the unit’s soldiers. After expending considerable time and resources on construction of
facilities in the area, the unit contacted the surgeon to assist in dealing with a fly problem. When the
PVNTMED team arrived, they quickly discovered that the source of the flies was a dump adjacent to the
site into which Somalis were discharging raw sewage. The solution was to relocate the unit to another area.
k.
Haiti. US personnel did not employ personal protective measures against arthropodborne
diseases. They failed to correctly use the insect repellent, permethrin, and bed nets. Failure to use these
protective measures contributed to a dengue fever rate of over 30 percent among febrile hospitalized soldiers.
l.
Bosnia. One US dining facility was implicated in an outbreak of Salmonella. The cooks were
preparing eggs that had been in an unrefrigerated container express (CONEX) for days. The food service
manager ordered the remaining eggs destroyed.
1-3.
Disease and Nonbattle Injury
a. General. Disease and nonbattle injuries are the major medical threat during military
operations. Preventive medicine DNBI surveillance must include their effects on US, allied, coalition, and
host-nation (HN) forces, and the local populace. As in war, DNBIs are the leading cause of manpower
losses in stability operations and support operations. Individual, unit, and field sanitation team (FST) PMM
must be stressed and applied. Preventive medicine personnel can identify the diseases and recommend
control and preventive measures (see Appendix A).
b. Person-to-Person. Soldiers can prevent or reduce the incidence of diseases transmitted person-
to-person by observing basic PMM (including use of masks, gloves, and eye protection)—
• When working around or with local national or refugee populations.
• When handling or exposed to human fluids or waste.
• By avoiding sneezing or coughing toward/from others.
• By sleeping head-to-toe.
• By ensuring working and living areas are well-ventilated.
• By practicing good personal hygiene (such as washing hands before eating and after
using the latrine) and avoiding unprotected sex.
c.
Arthropodborne Disease.
(1) These diseases are transmitted through the biting process of arthropods or by the physical
transfer of disease-causing organisms. In endemic disease areas, the native population may appear healthy;
however, they may be carriers of, or immune to, diseases that they have been exposed to repeatedly since
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FM 4-02.17
birth. The pathogen is kept at a low level by the host immune system. This smoldering infection can be
transmitted to a new host (US forces) by arthropods. Forces introduced into the AO may lack immunity
from arthropodborne diseases, and if bitten, their body’s immune system may not be prepared to prevent the
disease from progressing. The result from soldiers becoming ill from arthropodborne disease includes loss
of manpower which reduces the commander’s ability to execute the mission and reduces combat health
support (CHS) resources to support the mission.
(2) Prevention of these diseases is much more cost-effective than treatment. Personnel
applying basic PMM can reduce their susceptibility to the diseases. The PMM include the use of arthropod
(insect) repellents; insect netting; aerosol sprays; prophylaxis; and periodic self and buddy checks for the
presence of arthropods on the body (such as ticks, lice, and fleas). Also, eliminating arthropod breeding
areas (such as standing water) and access to food sources for arthropods (such as covering trash and rubbish
collection areas) aids in preventing these diseases.
d. Foodborne and Waterborne Diseases.
(1) In areas of poor sanitation, locally procured foods present a high risk of disease for US
forces. Therefore, PVNTMED personnel must work closely with the veterinary personnel that are
responsible for approving locally procured foods. Food- and waterborne diseases are usually transmitted by
or result from—
• Food handlers during food preparation and serving.
• Food preparation facilities that lack adequate refrigeration for food storage.
• Inadequate or absent arthropod and rodent control.
• Animals that are permitted free access to food storage, preparation, and serving areas.
• Improperly treated or stored water.
• Contaminated or improperly treated ice.
(2) Potable water for drinking and food preparation is often scarce. Deployed forces cannot
be assured of the quality of local water supplies. Quartermaster water production personnel may not be
available to treat water for the forces; especially in the early days of the mission. Locally purchased ice
poses the same health risks as food and water.
(3) The risk of food- and waterborne diseases to US forces can be minimized by command
enforcement of basic PMM.
• Personnel should only eat food prepared by US military food service personnel;
when not available, maximize the use of meals, ready to eat (MREs), T-Rations, or other similarly
prepackaged foods. Commanders and unit leaders must be sensitive to HN customs as local hosts may
consider refusal to eat their foods an insult. The risk of experiencing a foodborne illness must be weighed
against the impact on relationships with HN personnel.
1-4
FM 4-02.17
• Personnel should only consume water that has been treated to US military standards
and inspected by PVNTMED personnel. Commanders and unit leaders must ensure that personnel carry
their own supply of water purification material (iodine tablets, calcium hypochlorite ampoules, or Chlor-
Floc™). Bottled water does not guarantee purity; personnel should only drink US-approved and properly
bottled water. Commanders and unit leaders must ensure personnel are familiar with other water purification
techniques (boiling and use of bleach). Since ice from approved facilities may have been packed in
contaminated materials to prevent melting, they must ensure it is inspected by PVNTMED personnel prior
to consumption or use in beverages.
(4) Commanders and leaders should be on the alert for possible terrorist contamination of
US military water supplies. Possible targets include water treatment plants and equipment, reservoirs,
storage tanks, and water distribution systems. Water supplies must be closely monitored to ensure any
contamination is identified before soldiers begin presenting at medical treatment facilities with symptoms.
(5) Use of local water treatment facilities may provide needed water sources for our forces.
Such facilities may require supplemental treatment to meet US drinking water standards. In all cases,
PVNTMED personnel must closely monitor water treatment.
e.
Environmental Injury/Illness. Injury and illness from heat, cold, or sudden exposure to high
elevations is serious, sometimes deadly, and usually preventable. Units that are not alert to this medical
threat can quickly reduce their effectiveness and ability to accomplish their mission. Commanders and unit
leaders must ensure that personnel are informed of risks associated with environmental medical threats and
plan for the necessary equipment and clothing.
(1) Commanders and leaders can reduce the threat of heat injury by emphasizing that all
personnel apply PMM. They must ensure that adequate water supplies are available and enforce a liberal
water consumption policy. Further, they must ensure that all soldiers consume all meals to minimize the
impact of deployment to hot areas. The standard military menu provides adequate amounts of salt to
replace what is lost through sweat. Until soldiers are fully acclimatized, and when the mission permits,
operations should be conducted in the cooler parts of the day to minimize the risk of heat injury. Work/rest
cycles should also be used, mission permitting (see FM 21-10).
(2) Commanders and leaders can minimize the threat of cold injury by ensuring personnel
use PMM (dress in layers, keep dry, change socks often). Soldiers performing at low levels of activity
should be reminded to increase exercise or movement (even moving toes and fingers results in increased
blood circulation to the extremities). As in hot weather, soldiers must drink adequate amounts of water and
consume all meals. Commanders and leaders should provide warm, well-ventilated areas for personnel to
get out of the cold, mission permitting. To avoid carbon monoxide poisoning, they must ensure that
personnel do not sleep in unventilated areas or in vehicles with the windows closed and the engines running.
(3) Mountain and high altitude illness and injuries adds a new dimension in military
operations. Commanders and leaders must be aware of the effect this environment will have on their
personnel. Personnel must not be allowed to ascend to high altitudes at a rapid pace; to do so can cause
acute mountain sickness and/or other more serious illnesses and injuries that will prevent the accomplishment
of their mission. Acclimatization to high altitudes is based on altering the ascent rate to allow soldiers to
1-5
FM 4-02.17
partially acclimatize.
“Graded ascent” limits the daily altitude gain to allow partial acclimatization. The
altitude at which soldiers sleep is critical. Have soldiers spend two nights at 9,000 feet and limit sleeping
altitude to no more than 1,000 feet above the previous night’s sleeping altitude. When personnel begin to
show the effects of high elevation, they may have to be evacuated to below 8,000 feet to recover. At very
high elevations (above 14,000 feet), personnel may only be able to work for a few minutes at a time. Rest
periods may have to be extended until the personnel can acclimatize to the environment.
1-4.
Individual and Unit Preventive Medicine Measures
The impact of the medical threat and measures taken to minimize those threats significantly affects an
Army’s ability to fight and win. Forces who take the medical threat seriously gain an advantage over other
forces who do not. Application of individual and unit PMM gives forces who observe and counter medical
threats a strategic advantage, by minimizing losses from DNBI. For example, US forces can reduce or
minimize losses from—
• Malaria or other arthropodborne diseases by using repellents on skin and clothing and taking
prescribed prophylaxis.
• Waterborne diseases by only drinking approved water or purifying water with purification
materials, or boiling.
• Diarrhea and other foodborne diseases by only eating approved foods.
• Dehydration in hot or cold climates by increasing fluid (preferably water) consumption and
avoiding self-dehydration (reducing fluids to minimize trips to the latrine).
• Heat injuries by ensuring personnel follow work/rest cycles, keep skin covered, and consume
sufficient quantities of food and fluids.
• Cold injuries by dressing in layers and keeping dry, working and resting in warm, well-
ventilated areas, and consuming sufficient quantities of food and fluids.
• High altitude illness and injuries by ascending to high elevations in a slow steady pace and
observing each other for signs of mountain sickness.
1-5.
Preventive Medicine Employment in Defeating the Threat
The employment of PVNTMED personnel in defeating the threat is one of the least expensive means of
maintaining a fighting force. When PVNTMED is employed early in the mission, fewer personnel are lost
to DNBI. Once DNBIs appear, the effectiveness of the force has been compromised. However, PVNTMED
personnel and FSTs can do much to reduce the impact of DNBI and other medical threats on the mission.
Early PVNTMED emphasis is essential in deploying and sustaining a fit, healthy force.
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CHAPTER 2
ROLE OF THE SOLDIER AND UNIT LEADER
2-1.
General
The mobility and dispersion of modern fighting forces increases the need for soldiers and their leaders to
apply PMM to protect themselves against the medical threat. The application of basic PMM can reduce
and, in some instances, eliminate the incidence of DNBI resulting from the medical threat. Commanders
and leaders planning for and using basic PMM can rapidly achieve mission objectives by quickly and
efficiently executing the mission with healthy and fit soldiers.
2-2.
Role of the Individual Soldier
Individual soldiers can reduce the threat of disease by applying basic PMM. These PMM include the
soldier protecting himself against—
a. Heat injuries (heat cramps, heat exhaustion, or heatstroke) by—
• Following acclimatization guidance, mission permitting.
• Avoiding alcoholic and caffeinated drinks.
• Keeping physically fit.
• Avoiding medications (antidiarrheal or cold medicines), except when prescribed.
• Drinking plenty of water to replace lost body fluids through sweating; remembering that
thirst is not an indicator of the body’s need for fluids.
• Following the correct work/rest cycle (see FM 21-10).
• Eating all meals to replace lost salt.
• Keeping the skin covered and clean; rolling down the shirtsleeves; wearing full-length
trousers and headgear; and wearing cotton undergarments to increase ventilation.
• Using sunblock (at least a sun protection factor [SPF] of 15) and lip balm. Apply the
sunblock on all exposed skin, (face, neck, ears, and under the chin).
• Avoiding exposure to direct sunlight for long periods, mission permitting.
• Using the buddy system and seeking medical assistance if experiencing symptoms of
heat injury.
b. Cold injuries (chilblain, trench foot, frostbite, hypothermia) by—
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FM 4-02.17
• Wearing clothing in layers (creating air spaces) to hold maximum body heat; ensuring
clothing is fitted properly; reducing the layers of clothing when exercising or working to prevent sweating
(sweating reduces the protective effects of layered clothing).
• Keeping dry and changing socks several times a day to keep the feet dry.
• Frequently exercising the entire body, when the tactical situation permits. At a minimum,
exercise the feet, hands, and face to increase circulation.
• Drinking sufficient water to prevent dehydration (thirst is not an indicator of the body’s
need for water).
• Eating regularly. Required calories increase during cold weather operations; therefore,
eat all meals to ensure adequate body heat can be generated.
• Using sunblock (at least an SPF of 15) and lip balm. Apply the sunblock on all exposed
skin (face, neck, ears, and under the chin).
• Wearing ultraviolet (UV) eye protection to prevent snow blindness.
• Being aware that a high altitude (above 8,000 feet) affects mental abilities. The higher
the altitude, the lower the oxygen content in the air; thus causing mental confusion in personnel due to the
lack of adequate oxygen.
c.
Arthropodborne diseases (such as malaria, tick-borne encephalitis, leishmaniasis, and Lyme
disease) by—
• Taking all prescribed prophylaxis as directed before, during, and after deployment.
• Using the DOD repellent system:
•
Applying insect/arthropod repellent on all exposed skin and on tight-fitting areas of
their uniforms.
•
Applying permethrin to uniforms (that have not been treated and marked prior to
deployment), using the individual dynamic absorption kit (preferred method, good for life of uniform) or
spray-can method (reapply after sixth laundering).
•
Wearing the uniform with the pants tucked into the boots, sleeves rolled down, and
the undershirt tucked into the pants.
•
Applying permethrin on bed nets, and tucking bed net under bedding; using bed net
poles or other devices to keep bed net off of the individual.
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FM 4-02.17
• Using the buddy system to inspect the scalp, skin, and clothing at least twice daily for
ticks or other arthropods.
• Practicing good personal hygiene, showering often and changing to a clean uniform at
least weekly.
• Avoiding the establishment of bivouac areas near arthropod breeding areas.
• Discouraging pests by disposing of trash, garbage and rubbish in designated disposal
areas. Eating and storing food only in designated areas, not in sleeping areas. Minimizing contact with
animals (alive or dead).
• Remembering to also use PMM when not in uniform (continue prophylaxis and apply
insect repellent to exposed skin, remembering feet and ankles).
• Using bed nets to protect from biting arthropods when sleeping.
d. Diarrheal diseases by—
• Avoiding food, drink, or ice from unapproved sources.
• Drinking approved water provided by the quartermaster water production support unit.
When approved water supplies are not available, treat water with iodine water purification tablets, chlorine
ampoules, Chlor-Floc™, or boil it before drinking. REMEMBER: Boiling water does not provide any
lasting disinfecting features; it is the least preferred method.
• Washing hands before eating, after using the latrine, after handling or exposure to dirt,
dust, animals, rodents, local nationals, refugees, food waste, used serving and eating utensils, pesticides,
fuel and lubricant products, or other sources of contamination.
• Washing field eating utensils immediately after use. Resanitizing field eating utensils by
dipping them in boiling water just before eating.
e.
Nonbattle injuries by—
• Wearing hearing protection in all areas with constant or high-level noise. Avoid high-
level noise areas if hearing protection is not worn.
• Wearing ballistic- and laser-protective eyewear.
• Wearing safety goggles or other protective eyewear when riding in vehicles with the
windshield down, in the back of open vehicles, in the driver and track commander position of tracked
vehicles, or in areas with blowing dust or sand.
• Wearing gloves and other safety devices when handling metal objects in extreme cold
weather and when working with dirt and dusts.
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FM 4-02.17
• Wearing respiratory protective equipment when in occupational hazard areas. Self-contained
breathing equipment is required when in confined areas with hazardous gases, vapors, or aerosols present.
• Using safe, approved solvents (not gasoline or diesel fuel) to clean equipment.
• Resting, sleeping, and working in designated areas that are well-ventilated. Sleeping on
the ground or other nonapproved area could result in being run over or hit by a vehicle. Sleeping or working
in poorly ventilated areas being warmed with field heaters or in vehicles with engines running can be fatal.
• Practicing the buddy system when operating in high altitude areas to prevent high altitude
illness from advancing too rapidly.
• Using safety gear during contact sports.
• Applying defensive driving techniques, especially in foreign countries.
• Staying alert and being cautious. Keep the leadership informed of hazards or unsafe areas.
2-3.
Role of Unit Leaders
Unit leaders can reduce the threat of DNBI by staying informed of the medical threat. They must also
motivate, train, and equip subordinates prior to and during deployment to defeat the medical threat. To
defeat the medical threat, commanders/unit leaders must work closely with PVNTMED personnel and
emphasize the use of PMM within their unit.
a. Unit Headquarters Staff Responsibilities.
(1) Prepare the unit for deployment by—
• Requesting medical threat information on the AO from the Center for Health
Promotion and Preventive Medicine (CHPPM) and the Armed Forces Medical Intelligence Center (AFMIC).
• Confirming all personnel have up-to-date prescribed immunizations for the AO and
are physically fit for deployment.
• Ensuring each soldier receives DOD-prescribed immunizations, medications,
prophylaxis, and NBC pretreatments.
• Ensuring unit personnel treat uniforms with approved insect repellent. They should
mark the uniforms to indicate treatment has been accomplished.
• Incorporating PMM into the unit standing operating procedures (SOPs).
• Ensuring that FST members are trained and equipped (see FM 21-10-1).
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FM 4-02.17
• Ensuring required field sanitation devices are on hand and operational (see FM 21-10).
• Designating safety personnel to ensure safety procedures are being practiced.
• Ensuring personnel have adequate personal hygiene supplies, to include sunscreen
and insect repellent, if required.
• Ensuring personnel have adequate clothing and equipment for the mobilization AO
(hot or cold); also, the chemical protective overgarment, gloves, overboots, and protective mask. Clothing
requirements may include special items for high altitude (above 8,000 feet) operations. Personnel should
have sunscreen, sunglasses, and wind barriers when operating in high altitudes.
• Educating soldiers and their families prior to deployment to dispel rumors. Ensure
personnel and families receive current information from the command, not from rumor sources; see
FM 8-51 for detailed information within the bounds of operational security.
• Distributing PVNTMED deployment guidelines.
(2) Prepare unit during deployment by—
• Medical surveillance/documentation.
• Coordinating with PVNTMED personnel prior to and during site selection.
• Ensuring personnel use work/rest cycle during early stages of deployment to become
acclimatized to the AO, mission permitting. When the mission permits, personnel should perform heavy
work in the early morning or late evening until they are acclimatized to the heat.
• Coordinating with the supply and logistics channel for food, water and ice from US
military-approved sources.
• Ensuring water is procured from approved sources and kept cool. When water from
approved sources is not available, ensuring that the water is correctly treated before releasing for troop use.
• Ensuring personnel take prophylaxis and pretreatments as prescribed.
• Ensuring that all personnel keep their immunizations up-to-date for the AO.
• Ensuring that all personnel practice good personal hygiene and making provisions
for showers and laundry when possible.
(3) Prepare unit for postdeployment by—
• Ensuring soldiers continue taking prescribed prophylaxis for the specified period
of time.
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FM 4-02.17
• Planning a unit and family gathering upon return to reduce the stress associated
with the reunion.
• Monitoring soldiers for signs of illness, ensuring affected soldiers receive prompt
medical attention.
• Continuing postdeployment medical surveillance reporting.
b. Commander/Executive Officer/First Sergeant Responsibilities.
(1) Prior to deployment—
• Meet with FST members early and regularly to ensure requirements and guidance
are clearly established and understood. Ensure FST kits are well-stocked and in good condition.
• Ensure required field sanitation devices are on hand and operational (see FM 21-10).
• Ensure soldiers receive personal and organizational supplies and equipment packing
guidelines for the AO and mission. Emphasize the need for adequate clothing for cold weather operations
(to layer) or correct clothing for hot weather conditions (including headgear and sunglasses).
• Reinforce command emphasis regarding prescribed immunizations, prophylaxis,
and pretreatments.
• Eliminate rumors by ensuring information is passed down quickly and accurately.
(2) During deployment—
• Ensure, in coordination with the FST, the setup or construction and maintenance
of showers, latrines, and handwashing devices; see FM 21-10 and FM 21-10-1 for details on requirements.
• Ensure drinking water supplies are from approved sources and the chlorine residual
is maintained at the level established by the command medical authority. When treated water is not
available, instruct individuals to treat their water by using iodine tablets, chlorine ampoules, Chlor-Floc™,
or by boiling it. REMEMBER: Boiling water does not provide protection from recontamination. See
Technical Bulletin, Medical (TB Med) 577, FM 21-10, and FM 21-10-1 for details.
• Ensure all personnel drink adequate amounts of water to prevent dehydration and
heat injuries.
• Ensure personnel drink adequate amounts of water in cold weather to prevent
dehydration; individuals can become dehydrated, even in cold weather.
• Provide warm water for handwashing and personal hygiene. Male personnel should
shave daily to ensure proper fit of the protective mask; female personnel should avoid shaving to minimize
infections or skin irritation.
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• Provide safe, well-ventilated sleeping, working, and recreational areas.
• Enforce the use of individual PMM among their troops.
• Monitor the heat index/windchill information regularly. Direct personnel to observe
work/rest cycles to prevent heat injuries, mission permitting. Direct personnel to use the buddy system
during cold weather operations to prevent cold injuries.
• Ensure personnel wear clothing in layers during cold weather operations and remove
outer layers during work or exercise. Ensure personnel wear headgear to prevent body heat loss during
cold weather.
• Ensure personnel change their socks at frequent intervals to keep their feet dry and
prevent heat or cold injuries.
• Ensure personnel keep their sleeves rolled down and their headgear on during hot
weather to prevent heat injuries.
• Rotate personnel with outside exposure to extreme heat or cold (guard duty,
maintenance, and observation post) to reduce the extreme temperature effects.
• Ensure personnel are trained to use the equipment that they will be using during the
mission.
• Ensure personnel use approved solvents to clean unit equipment; not gasoline or
other fuels.
• Ensure personnel wear their ballistic and laser protective eyewear.
• Ensure personnel wear safety goggles when operating vehicles or riding in the
commander position with the windshield down and when riding in the back of open vehicles.
• Ensure personnel turn off vehicle engines or vent exhaust fumes to the outside when
repairing vehicles in enclosed areas.
• Ensure personnel wear hearing protection when working in noise hazard areas.
• Minimize contact with animals, especially rodents. Discourage pests by ensuring
proper disposal of trash and elimination of food consumption or storage in living areas.
• Ensure the FST performs its roles and responsibilities. Ensure that they have all
required supplies and equipment. Ensure that they are trained in their duties.
• Request PVNTMED support for conditions that are beyond unit capabilities.
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FM 4-02.17
(3) Postdeployment—
• Reinforce command emphasis regarding continued use of prophylaxis and medical
screening.
• Provide encouragement and support to soldiers during reunions.
• Monitor soldiers for signs of illness, ensuring affected soldiers receive prompt
medical attention.
• Ensure FST materials are checked and restocked immediately upon return to the
home station.
c.
Field Sanitation Team Responsibilities.
(1) Prior to deployment—
• Ensure FST materials are complete and operational. Report FST material
deficiencies through the chain of command.
• Ensure the unit has the required personal hygiene supplies and equipment.
• Ensure required field sanitation devices are on hand and operational (see FM 21-10).
(2) During deployment—
• Coordinate with unit leaders for personnel to set up or construct showers, latrines,
and handwashing devices. The FST is responsible for supervising the setup or construction of devices; they
are not responsible for setting up or constructing the devices.
• Ensure handwashing devices are placed close to food service areas and that food
handlers wash their hands—
•
After handling equipment, trash, garbage, and after smoking or using the latrine.
•
Before handling, preparing, or serving food. Also, after handling one raw
food, but before handling clean utensils or another food item.
• Ensure personnel wash their hands and pre-dip field eating utensils before eating.
• Check the unit water supply for adequacy of chlorine residual and add chlorine, if
needed. Chlorine residual should be kept at or above the level established by the command medical
authority. Ensure individuals have water purification material when departing unit area for extended
periods of time.
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FM 4-02.17
• Ensure that food is stored properly. Hot food is maintained above 140° Fahrenheit
(F) and cold food is maintained below 45° F. Food should be covered except during serving.
• Use the 2-gallon sprayer to control arthropods.
• Ensure latrines are being maintained and cleaned.
• Ensure handwashing devices are being maintained (have soap and water).
• Ensure all trash and waste is controlled from point of origin to time of disposal.
• Train unit personnel in the application of individual PMM.
• Tell the commander when problems appear which leaders, individuals, and the FST
cannot correct or control.
• Request PVNTMED support to assist in correcting or controlling problems that are
beyond the capabilities of unit personnel.
(3) Postdeployment—
• Immediately restock FST material upon return to home station. Replace equipment
or items that were damaged or lost during deployment.
• Prepare after-action report for submission through the chain of command.
• Provide support to unit leaders, as needed, to complete medical surveillance reports.
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FM 4-02.17
CHAPTER 3
PREVENTIVE MEDICINE STAFF
IN A THEATER OF OPERATIONS
3-1.
Staffing
Command emphasis has a critical impact on how well soldiers and their leaders follow the PMM summarized
in Chapter 2. To assist the command in ensuring PMM are applied, PVNTMED personnel are assigned to
various Army command staffs. The PVNTMED staff advises the command surgeon, represents the
commander on PVNTMED matters, and directs his attention to problems worthy of command emphasis.
To ensure PVNTMED support is provided when and where it is required, the PVNTMED staff prepares a
PVNTMED estimate of the situation and the PVNTMED portion of the operation plan (OPLAN). The
estimate and the plan are constantly updated to ensure all actions are taken to best support the mission. See
Appendix A for sample formats. The PVNTMED staff conducts and monitors disease surveillance activities
and provides recommendations on preventive measures. The staffing indicated at the following command
levels is provided as a starting point for establishment of a PVNTMED staff structure to meet mission
requirements.
3-2.
Army Service Component Command
Army Service Component Command (ASCC) is the major Army headquarters in the theater of operations
(TO). This staff publishes PVNTMED policy on behalf of the ASCC commander. It exercises technical
control over PVNTMED resources in the TO. It recommends the employment of PVNTMED
detachments (sanitation) and PVNTMED detachments (entomology) within the TO in accordance with the
medical threat.
3-3.
Medical Command
The medical command (MEDCOM) is the major coordinating headquarters for CHS at EAC. This staff
publishes PVNTMED policy on behalf of the MEDCOM commander and exercises technical control over
PVNTMED resources at EAC. The staff prepares the PVNTMED estimate and the PVNTMED portion of
the MEDCOM CHS plan. They monitor and analyze DNBI reporting to ensure timely information is
presented to the leadership to counter the DNBI effects on the mission.
3-4.
Corps
The corps surgeon’s staff is small and may not include PVNTMED personnel. When included, the
PVNTMED staff publishes PVNTMED policy on behalf of the corps commander. They incorporate the
employment of PVNTMED detachments into the corps operation order (OPORD), as appropriate, and
exercise technical control over their operations. They monitor and analyze DNBI reporting to ensure timely
information is presented to the leadership to counter the DNBI effects on the mission. They prepare the
PVNTMED estimate and the PVNTMED portion of the corps OPLAN. When not included, the corps
surgeon relies upon the medical brigade staff for PVNTMED advice (see paragraph 3-5).
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FM 4-02.17
3-5.
Medical Brigade
The medical brigade is the major coordinating headquarters for CHS in the CZ. The PVNTMED staff
publishes PVNTMED policy on behalf of the medical brigade commander. They prepare the PVNTMED
portion of the medical brigade CHS plan. They incorporate the employment of PVNTMED detachments
into the corps OPORD, as appropriate, and exercise technical control over their operations. They monitor
and analyze DNBI reporting to ensure timely information is presented to the leadership to counter the DNBI
effects on the mission.
3-6.
Medical Group
The medical group is the coordinating headquarters for CHS in a designated part of the CZ. This staff
publishes PVNTMED policy on behalf of the medical group commander. The staff prepares the PVNTMED
portion of the medical group CHS plan. It coordinates the administrative and logistical support for attached
PVNTMED teams or detachments. It also assigns missions to the teams or detachments and exercises
technical control over their operations.
NOTE
Under the Medical Reengineering Initiative (MRI) the medical group will not exist.
3-7.
Division
The division surgeon is responsible for coordinating CHS in the division area. The division PVNTMED
section is assigned to the medical company, main support battalion (see FM 8-10-1). The division
PVNTMED staff—
• Prepares an estimate of the situation to identify the medical threat in the division’s AO.
Advises the commander on the impact of the medical threat on his forces and provides recommended
techniques and procedures to defeat/minimize the medical threat.
• Prepares essential PVNTMED information for inclusion in the OPLAN, OPORD, and briefings
to ensure awareness of both the medical threat and the corresponding PMM.
• Performs sanitary inspections of supported units food service, field site, latrine, bathing, and
other facilities for accomplishment of basic sanitation practices.
• Provides early warning of any breakdown in basic sanitation within the division’s AO to
permit time for corrective actions before diseases are transmitted.
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FM 4-02.17
• Provides early detection and warning of potential disease epidemics or biological warfare
(BW) agent employment within the division AO. Early warnings permits implementation of control
measures before the disease or BW agent fully manifests itself among our forces. For some BW agents,
early warning is required to prevent death from occurring due to exposure to the agent.
• Provides limited pest management support to supported units.
• Assigns missions to attached PVNTMED teams/detachments. Exercises technical control and
coordinates the administrative and logistical support for the teams/detachments.
• Monitors field water supplies, to include possible NBC contamination.
• Collects water and environmental samples from suspect NBC-contaminated sources. Prepares
the samples for submission to the AO supporting medical laboratory for analysis. Prepares a chain of
custody document and ensures that the samples are not contaminated from sources outside the sampled site.
3-8.
Separate Brigade
The separate brigade surgeon is responsible for coordinating CHS in the separate brigade’s AO. The
PVNTMED staff performs the same functions as the division PVNTMED staff; see Section II of the unit’s
TOE for specific PVNTMED staff authorizations. See paragraph 3-7 for duties and responsibilities.
3-9.
Armored Cavalry Regiment
The armored cavalry regiment (ACR) surgeon is responsible for coordinating CHS in the ACR AO. The
PVNTMED staff performs the same functions as the division PVNTMED staff; see Section II of the unit’s
TOE for specific PVNTMED staff authorizations. See paragraph 3-7 for duties and responsibilities.
3-10. Special Operations Forces
Preventive medicine personnel are assigned to the medical section of various special operations forces
(SOF) units, some SOF support units, and to civil affairs (CA) units. Other Army SOF units, such as
Rangers and psychological operations, have no dedicated PVNTMED assets. In SOF units, PVNTMED
personnel teach SOF medics to perform PVNTMED services for their team and attached personnel. In SOF
support units, PVNTMED personnel perform most of the duties of the division PVNTMED staff on a
limited scale and without benefit of assigned PVNTMED teams or detachments. In CA units, assigned
PVNTMED personnel assess the PVNTMED capabilities of another country or area but are not responsible
for directly providing PVNTMED services to them. Army SOF PVNTMED personnel recommend PMM
to the commander or assigned unit surgeon to combat the medical threat. Some Army SOF operations may
require PVNTMED resources from conventional assets.
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FM 4-02.17
3-11. Area Support Medical Battalion
The PVNTMED section of the area support medical battalion (ASMB) provides PVNTMED support on an
area basis (see FM 8-10-24). The PVNTMED staff—
• Prepares an estimate of the situation to identify the medical threat in the support area.
• Incorporates essential information in the OPLAN, OPORD, and briefings to ensure awareness
of both the medical threat and the corresponding PMM.
• Provides early warning of any breakdown in basic sanitation within the support area to permit
time for corrective actions before diseases are transmitted.
• Provides limited pest management support to supported units.
• Prepares the command health report to document the impact of heat, cold, disease, and other
health hazards to units in the support area.
• Assigns missions to attached PVNTMED teams/detachments.
• Monitors field water supplies, to include possible NBC contamination.
3-12. Engineer Units
A PVNTMED staff is assigned to the facility engineer section in an engineer command. They serve as
technical advisors to the command on pest management, environmental health, and sanitation issues.
Furthermore, they serve as the liaison between the medical and engineer community.
3-13. Military Police Units
a. Preventive medicine personnel play a vital role in the oversight of health and sanitation
standards in displaced persons assembly areas, enemy prisoner(s) of war (EPW) camps, and confinement
facilities. To perform this mission, PVNTMED personnel are assigned to military police (MP) EPW
detachments, MP EPW battalions, MP EPW brigades, MP EPW commands, and MP confinement battalions.
b. The type and number of PVNTMED personnel assigned is dependent upon the assigned unit’s
mission. The PVNTMED element can range from a single PVNTMED noncommissioned officer (NCO) to
a staff consisting of an environmental science officer, a sanitary engineer, and PVNTMED specialists.
c.
They serve as technical advisors to the command on PVNTMED issues associated with the
supported population. Since the staff’s role is advisory, it has no organic equipment and must coordinate
for monitoring/testing support from PVNTMED detachments, ASMB or the Theater Army Medical
Laboratory (TAML).
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3-14. Civil Affairs Units
In CA units, assigned PVNTMED personnel assess the public health capabilities of a country or area, but
are not responsible for directly providing PVNTMED services to them. As such, PVNTMED personnel
are assigned to CA companies, detachments, brigades, and commands. The type and number of PVNTMED
personnel assigned is dependent upon the unit. Since the staff’s role is advisory, it has no organic
equipment and must coordinate for support from PVNTMED detachments and the AO supporting medical
laboratory. If available, CA units are also supported by PVNTMED detachments.
3-15. Quartermaster Units
a. In garrison, the PVNTMED team performs sanitary inspections of food service facilities,
waste disposal facilities, sewage treatment plants, industrial complexes, water plants, troop housing, family
housing (at request of installation commander or family housing manager), field training areas, ice plants,
and other activities, as directed. They provide consultation support for local Reserve and National Guard
units, as directed.
b. During mobilization, they provide assistance to mobilizing units in—
• Preparing their PVNTMED plan.
• Determining immunization/prophylaxis requirements.
• Training unit FSTs.
• Obtaining essential field sanitation supplies and equipment.
c.
They provide assistance to local health authorities as directed by command. They also provide
local disaster relief assistance as directed by the command.
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FM 4-02.17
CHAPTER 4
PREVENTIVE MEDICINE DETACHMENTS AND ACTIVITIES
Section I. TABLE OF ORGANIZATION AND EQUIPMENT DETACHMENTS
4-1.
General
a. There are two Medical Force 2000 (MF2K) PVNTMED TOE detachments in the current
force structure. Their mission is to prepare and update the medical threat database, publicize the medical
threat, and stimulate the employment of PMM. The detachments provide reinforcing PVNTMED services
to eliminate or reduce the medical threat, whenever possible. The MF2K PVNTMED detachments are—
• Medical Detachment, PVNTMED (Sanitation) (TOE 08498L000).
• Medical Detachment, PVNTMED (Entomology) (TOE 08499L000).
b. The two MF2K detachments will be replaced by a new PVNTMED detachment organized
under the MRI. The MRI process designed CHS organizations to support the Force XXI Army. The MRI
PVNTMED organizational changes are described in Appendix B.
4-2.
Operational Principles
a. Early Arrival. History strongly suggests that substantial sickness will occur among the armed
forces when deployment of PVNTMED support is delayed. Breakdowns in sanitation will occur while
troops are still in mobilization and debarkation assembly areas. These breakdowns in sanitation will appear
as increased cases of diarrhea and other illnesses. Arthropodborne diseases may begin to emerge as a
medical threat. Some illnesses will appear during the early stages of forward movement of the forces in the
AO. Preventive medicine must be considered during the initial operational planning; also, emphasis must
be placed on PVNTMED assistance during advance party site surveys. For units to be fully effective in
protecting themselves from the medical threat, PVNTMED personnel must be—
• Included in the unit’s day-to-day training while at their home station and during training
exercises to keep unit personnel trained in individual PMM.
• Consulted as the units are preparing for mobilization.
• Employed in the mobilization assembly areas.
• Deployed with the first forces entering the AO. The PVNTMED detachments are
tailored for early deployment to provide support to the forces.
• Employed at locations throughout the AO during the deployment.
• Redeployed with the last units/personnel exiting an AO to ensure PVNTMED support
remains until all personnel have departed the AO.
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• Used to assist postdeployment units in their recovery from the effects of the deployment.
Also, they must assist units in day-to-day preparation for future operations.
b. Preemptive Action. Preventive medicine operations are most effective when they are based on
preemptive threat-based actions; that is, recommending procedures that promote a healthy and fit force
before the first case of illness/disease is manifested. The detachments must continually assist supported
units while at the home station. The support must continue as the units prepare for deployment; move
through the mobilization sites; and deploy and conduct their mission in the AO. The detachments must not
wait for the incidence of diseases to appear. They must initiate action on presumptive information to reduce
the medical threat early. Actions performed by PVNTMED detachments include, but are not limited to—
• Advising the unit of the medical threat in the AO.
• Ensuring that DNBI surveillance is conducted in supported units.
• Monitoring for diseases and arthropods not native to the AO (potential BW agent
employment).
• Advising the commander on immunization, prophylaxis, and pretreatment requirements
for the AO (AR 40-5, AR 40-562, FM 8-285, and as directed by medical authorities for AO-specific
immunizations and prophylaxis).
• Ensuring that units have essential field sanitation supplies and equipment on hand
(FM 21-10-1).
• Providing training for unit FSTs (FM 21-10-1).
• Providing personal hygiene and field sanitation training to unit personnel (FM 21-10).
• Providing pest management assistance to control arthropod and rodent infestations that
are beyond unit capabilities.
• Assisting engineer personnel in selecting water supply sources and assisting quartermaster
personnel in establishing water production points.
• Advising quartermaster water production and distribution personnel on field water
treatment procedures and techniques to ensure a safe supply for US forces.
• Maintaining surveillance of field water supplies to ensure adequacy of treatment, quality,
and quantity (including monitoring water supplies for possible NBC contamination). Collecting water
samples from suspect NBC-contaminated supplies for laboratory analysis. Protecting, preserving, and
documenting the collected samples while in their possession and ensuring that they are forwarded to the
supporting laboratory with documented chain of custody.
• Monitoring unit food service operations to ensure adequacy of sanitation procedures.
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• Monitoring unit waste disposal facilities and techniques for compliance with sanitation
standards (US, HN, or overseas environmental baseline guidance document).
• Monitoring unit occupational health programs and advising commanders on the
application of occupational health practices and procedures.
• Providing retrograde cargo inspections, as required.
c.
Priority to Combat Elements. Tactical dispersion places combat elements largely on their own
for PVNTMED self-protection; however, there are opportunities for PVNTMED detachments to provide
support in these situations. The detachments must seek out such opportunities and give priority to the
combat elements. The detachments can do much for dispersed combat units by ensuring that water supplies
and food service operations are safe; this helps to ensure that the force is ready to perform their mission.
d. Decentralized Command and Control. Initially PVNTMED detachments are assigned to an
ASMB, medical group, medical brigade, or medical command. As missions for detachments require their
employment in specific roles, they may be attached to other medical units. Preventive medicine detachments
provide the most responsive support when they work directly with units at the greatest risk. The preferred
support relationship is attachment; direct support is the next best; and general support is employed when the
situation is too unclear to establish realistic priorities within the AO. The exact command relationship is
dependent on mission, enemy, terrain, troops, and time available.
4-3.
Operational Concept for the Preventive Medicine Detachment (Sanitation)
This detachment provides PVNTMED support and consultation to minimize the effects of occupational
hazards; enteric diseases; arthropod-, food-, and waterborne diseases; and other medical threats on deployed
forces including—
• Field sanitation and personal hygiene.
• Sanitary engineering.
• Disease surveillance.
• Occupational health.
• Health promotion.
• Limited entomology.
• Limited pest management.
• Limited ground pesticide spraying.
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4-4.
Location of the Preventive Medicine Detachment (Sanitation)
Normally, the detachment is deployed to specific areas in the corps or EAC. However, the detachment may
be deployed to any area within the AO.
a. When attached to (or in direct support of) units in the corps or EAC, the detachment generally
collocates on a temporary basis with the supported unit until the task is done or the mission priorities shift.
b. When attached to a division, the detachment generally collocates with the medical company,
forward support battalion or main support battalion, to ensure coordination of support efforts.
c.
When deployed in general support, the detachment generally collocates with a medical unit or
medical headquarters on a temporary basis with the supported unit until the task is accomplished or the
mission priority shifts.
d. The detachment is dependent upon the unit to which it is attached or in support of for the
following:
• Food service.
• Religious support.
• Legal services.
• Combat health support.
• Finance services.
• Personnel and administrative support.
• Bath and laundry service.
• Clothing exchange.
• Unit maintenance.
• Communications maintenance.
• Resupply of all classes of supply.
4-5.
Function of the Preventive Medicine Detachment (Sanitation)
The detachment provides PVNTMED support at the home station, during field training exercises, during
organizational rotations through the combat training centers, and during mobilization. The detachment
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conducts surveillance of troop assembly areas to ensure individuals and units are applying PMM to protect
themselves. When such measures are inadequate, the detachment offers on-site advice to unit leaders.
When requested, the detachment conducts training on PMM for unit members and assists units in training
their FSTs. The detachment may function as a single operational activity or may split into a headquarters
section and two teams to provide support to a greater number of units. When operating in the split-team
configuration, the teams must maintain contact with the detachment headquarters section. In preparation for
deployment, during deployment, and postdeployment, the detachment performs the following support
functions (many of these functions are also performed during training exercises):
a. Predeployment.
• Obtain medical threat information, including medical intelligence reports, medical threat
products, and briefings.
• Brief mobilizing unit commanders, leaders, and soldiers on the medical threat.
• Provide mobilizing unit commanders and leaders predeployment information related
to medical screening, immunizations, and prophylaxis and recommended packing lists to counter the
medical threat.
• Assist supported unit commanders and leaders to ensure their personnel have the required
immunizations, prophylaxis, pretreatment, dental care, and other medical needs completed.
b. During Deployment.
• Coordinate with and support commanders and unit leaders to establish base camps, food
service areas, latrines, and showers and to perform inspections of living and work areas.
• Provide guidance to commanders and unit leaders concerning PMM to reduce the
incidence of DNBI.
• Assist engineer personnel in water site selection and preparation.
• Assist quartermaster water production personnel in setting up water production site.
• Inspect water sources, supply points, and supplies (including monitoring for NBC
contamination), ice plants, food service facilities, and waste disposal facilities for compliance with established
sanitation standards. Provide guidance on corrective actions for identified deficiencies.
• Maintain surveillance on endemic and epidemic diseases in the AO. Collect medical data
to assist in evaluating conditions affecting the health of the supported military and civilian population.
Conduct epidemiological surveillance for endemic diseases to reduce the disease effects on personnel in
the area. Conduct investigations on disease outbreaks to determine the source(s) and to recommend
control measures.
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• Analyze DNBI data to evaluate trends and patterns and disseminate information on such
data to the higher headquarters for use in reevaluating CHS priorities and/or effectiveness of PMM.
• Monitor industrial operations (motor pools, maintenance depots, aircraft repair facilities,
and other locations with industrial waste/hazards) for compliance with established health standards.
• Monitor supported units noise protection programs.
• Monitor troop housing/sleeping areas for compliance with sanitation standards.
• Monitor supported units eye protection programs (particularly issue and wear of ballistic-
laser protective spectacles).
• Provide retrograde cargo inspection support, as required. Issue vessel clearance for
entry into destination ports, as authorized.
• Provide entomological consultation and limited pest management.
• Provide continuous training for supported units on field hygiene and sanitation, prevention
of DNBI resulting from hot and cold weather, high altitudes, industrial/occupational hazards, and other
related conditions.
c.
Postdeployment.
• Provide guidance on site/area restoration operations, including removal and disposal of
general and hazardous waste. Perform sampling to ensure site/area is restored.
• Continue medical surveillance monitoring and reporting on units redeployed from an AO.
• Provide assistance to supported commanders and leaders to ensure timely follow-up
visits for health screening.
• Provide after-action reports and lessons learned.
• Ensure all detachment equipment is serviceable or replacements are ordered for items
missing or damaged. The detachment must begin preparing for future deployment.
• Ensure supported unit and detachment personnel continue on prophylaxis or pretreatments
for the required time.
4-6.
Operational Concept for the Preventive Medicine Detachment (Entomology)
This detachment provides PVNTMED support and consultation to minimize the effects of arthropod-,
food-, and waterborne diseases; environmental injuries; enteric diseases; and other health threats on deployed
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forces. The detachment provides pest management direct support to units and general support on an area
support basis. Pest management support is provided using both aerial spray (see Appendix C) and ground
spray equipment. The PVNTMED support and consultation includes—
• Entomology.
• Aerial and ground pesticide spraying.
• Pest management.
• Disease surveillance.
• Field sanitation and personal hygiene.
• Health promotion.
• Occupational health.
4-7.
Location of the Preventive Medicine Detachment (Entomology)
The detachment normally deploys near potential pest infestations to identify and apply control measures
before the pest can affect the health of US forces. They may be located anywhere within the corps or EAC.
a. When providing direct support to a specific unit in the corps or EAC, the detachment collocates
with the supported unit.
b. When attached to a division to provide aerial spray missions, the detachment generally locates
near a divisional airfield. The airfield serves as an excellent source of real-time information on weather
conditions, the availability of rotary-wing aircraft, and the tactical situation. All three elements are essential
when conducting aerial spray operations. Proximity to the airfield also minimizes nonproductive shuttle
time for the aircraft concerned. Since these airfields are located in the division support areas, the detachment
can also meet its surveillance and ground spray mission responsibilities with minimal travel. All detachment
activities conducted in the division area are coordinated with the PVNTMED section of the main support
medical company. This coordination ensures continuity of support to the divisional units.
c.
Attachment and direct support missions are usually for limited periods of time. Therefore, the
detachment relocates frequently as problems are resolved and the medical threat changes.
d. When providing general support to units in the corps or EAC, the detachment generally
collocates with another medical unit on a temporary basis with the supported unit until the task is done or
the mission priorities shift. The precise location is dependent upon time required for travel, type of terrain,
and the medical threat.
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e.
The detachment is dependent upon the unit to which it is attached or in support of for the
following:
• Food service.
• Religious support.
• Legal services.
• Combat health support.
• Finance services.
• Personnel and administrative support.
• Bath and laundry service.
• Clothing exchange.
• Unit maintenance.
• Communications maintenance.
• Resupply of all classes of supply.
4-8.
Function of the Preventive Medicine Detachment (Entomology)
The detachment employs a combination of aerial and ground spray equipment to suppress arthropods. It
applies measures to control rodents. The detachment may function as a single operational activity or may
split into a headquarters section and two teams to provide support to a greater number of units. When the
two teams are operating in the split team configuration, they must maintain contact with the detachment
headquarters section. In preparation for deployment, during deployment, and postdeployment, the
detachment performs the following support functions (many of these functions are also performed during
training exercises):
a. Predeployment.
• Obtain medical threat information, including medical intelligence reports, medical
surveillance products, and briefings. Provide commanders and leaders predeployment information related
to medical screening, immunizations, and prophylaxis and recommend packing lists to counter the medical
threat.
• Brief supported unit commanders, leaders, and soldiers on the medical threat.
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• Assist supported unit commanders and leaders to ensure that their personnel have required
immunizations, prophylaxis, pretreatment, dental care, and other medical needs completed.
b. During Deployment.
• Conduct entomological surveillance to ensure early warning of disease-vectoring and
nuisance pest populations.
• Provide technical consultation on entomological matters.
• Conduct pest management operations, to include aerial pesticide spraying.
• Perform pesticide-resistance tests on arthropods in the AO to ensure the efficacy of the
pest control procedures.
• Provide retrograde cargo inspection support, as required. Issue vessel clearance for
entry into destination ports, as authorized.
• Provide limited consultation on sanitary engineering.
• Conduct food sanitation, water supply, and field sanitation inspections.
• Provide DNBI and occupational health/industrial hygiene consultation.
c.
Postdeployment.
• Provide guidance on site/area restoration operations, including removal and disposal of
general and hazardous waste. Perform sampling to ensure site/area is restored.
• Continue medical surveillance monitoring and reporting on units redeployed from an AO.
• Provide assistance to supported commanders and leaders to ensure timely follow-up
visits for health screening.
• Provide after-action reports and lessons learned.
• Ensure all detachment equipment is serviceable or that replacements are ordered for
items missing or damaged. The detachment must begin preparing for future deployment.
• Ensure supported unit and detachment personnel continue their prophylaxis or
pretreatments for the required time.
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4-9.
Basis of Allocation
a. The basis of allocation for the PVNTMED detachment (sanitation) is one per 28,000 personnel
and one per 50,000 prisoners of war. Rule of thumb: Two per division supported.
b. The basis of allocation for the PVNTMED detachment (entomology) is one per 66,000
personnel and one per 100,000 prisoners of war. Rule of thumb: One per division supported.
4-10. Mobility
The strategic deployability for each PVNTMED detachment is 100 percent mobile. See Appendix H for
deployment data.
4-11. Standing Operating Procedures, Checklists, and Movement Plans
Every unit must have SOPs, checklists, and movement plans prepared. An SOP must be prepared for many
activities in a unit; for example, an SOP for classified document security is prepared to ensure that everyone
handling classified documents understands the commander’s intent and requirements. The SOP specifies
who has the authority to receive, review, safeguard, and destroy these documents. Many activities related
to unit movement must be conducted far in advance of the actual movement date; these activities are
controlled through SOPs and checklists. As a specific action is accomplished, it can be recorded on a
checklist, thus ensuring that others are aware that the action is completed. The use of SOPs and checklists
also ensure that the unit is prepared for its designated support mission. The SOPs and checklists let
members of the unit know what needs to be done and when, where, and how it must be done. All TOE
equipment must be on hand and in a serviceable condition. Special equipment, organizational clothing, and
required repair parts must be on hand. Essential common table of allowances (CTA) items must be on hand
and in a serviceable condition. Personnel records, immunizations, and family support plans must be up to
date. Appendix A provides sample formats for the PVNTMED estimate and plan. Appendix D provides a
sample commander’s checklist for mobilization. Appendix E provides information on conducting an
entomological survey. Appendix F provides a sample checklist for conducting a PVNTMED site survey.
Appendix G provides a training procedures guide.
Section II. TABLES OF DISTRIBUTION AND ALLOWANCES ACTIVITIES
4-12. General
The mission of PVNTMED TDA activities is to prepare and update the medical threat database, publicize
the medical threat, and stimulate the employment of PMM. The TDA activities provide reinforcing
PVNTMED services to eliminate or reduce the medical threat, whenever possible. The PVNTMED TDA
activities are located within the sustaining base and in locations outside the continental United States
(CONUS). The TDA activities provide day-to-day PVNTMED support to military installations. They may
also provide PVNTMED support to US Army Reserve and National Guard units on an area support basis.
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During the unit’s preparation for mobilization and during mobilization, the TDA activities provide support
to the alerted units in the form of training; assistance in obtaining a list of PVNTMED supplies and
equipment required in the unit’s assigned AO; identification of the medical threat in the unit’s assigned AO;
and assurance that the unit’s personnel receive their required immunizations, prophylaxis, and pretreatments
for their mobilization AO. Some TDA activities continue to support the units during their deployment by
having teams in the AO for specific PVNTMED surveillance activities. The CHPPM provides day-to-day
PVNTMED support on a worldwide basis. The CHPPM has regional offices that provide PVNTMED
support on an area basis. Other TDA organizations also provide PVNTMED support on a daily basis; they
are discussed later in the chapter.
4-13. Center for Health Promotion and Preventive Medicine
The CHPPM provides technical support teams for various PVNTMED missions, including—
• Detailed laboratory analysis of environmental
(air, soil, water) samples collected by
PVNTMED detachments or other teams. In some cases, CHPPM deploys its own specialized teams (both
military and civilian) to perform highly technical field sampling missions.
• Expertise for the analysis of threats posed by low-level toxic industrial chemicals and radiation,
arthropodborne disease threats, and occupational hazards.
4-14. United States Army Medical Research Institute for Chemical Defense
The US Army Medical Research Institute for Chemical Defense provides technical teams to assist medical
commanders and leaders in preparing units to provide CHS in a chemical environment. The technical
teams provide on-site consultation on medical management of chemical agent casualties and training for
health care providers. They perform research on the medical effects of chemical warfare agents on personnel.
They provide technical data for use in protecting US forces from the effects of chemical warfare agents.
4-15. United States Army Research Institute for Environmental Medicine
The US Army Research Institute for Environmental Medicine (a TDA organization) provides research on
the medical effects of the environment (heat, cold, and high altitude) on personnel. They provide technical
guidance to commanders and leaders on the effects of heat, cold, altitude, and adequate nutrition and
recommend measures to protect personnel. They also perform research on the effects of physical training
and physical performance and interventions to eliminate musculoskeletal injury, especially with respect to
carrying load-bearing equipment.
4-16. United States Army Medical Research Institute of Infectious Diseases
The US Army Medical Research Institute of Infectious Diseases (USAMRIID) (a TDA organization)
conducts research to develop strategies, products, information, procedures, and training programs for
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