FM 4-02.17 PREVENTIVE MEDICINE SERVICES (August 2000) - page 2

 

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FM 4-02.17 PREVENTIVE MEDICINE SERVICES (August 2000) - page 2

 

 

FM 4-02.17
medical defense against BW threats and infectious diseases. The USAMRIID plays a key role in national
defense and in infectious disease research as the only biological containment laboratory in the DOD for the
study of hazardous diseases. Medical products developed to protect military personnel against biological
attack or against endemic infectious diseases include vaccines, drugs, diagnostic tests, and medical
management procedures. Medical and scientific subject matter experts at USAMRIID provide technical
guidance to commanders and senior leaders on prevention and treatment of hazardous diseases and
management of BW casualties. In addition, the institute serves as the DOD reference center for identification
of biological agents from clinical specimens and other sources.
4-17. Walter Reed Army Institute of Research
a. The Walter Reed Army Institute of Research (WRAIR) is the center for infectious disease
surveillance. The WRAIR conducts research in naturally occurring infectious diseases, to include malaria
and other vectorborne diseases; diarrheal diseases; bacterial diseases, including meningitis; and viral
diseases, including hepatitis and human immunodeficiency virus (HIV).
b. The WRAIR also conducts research in combat casualty care; neuropsychiatry, including
performance enhancement and operational stress; laser injury and treatment; drug development; medical;
chemical and biological defense; and PVNTMED.
c.
The WRAIR satellite laboratories in Kenya, Brazil, and Thailand emphasize infectious disease
research, while the satellite laboratory in Germany emphasizes the basic and biomedical aspects of human
adaptation to stress.
4-18. Preventive Medicine Sections at Medical Department Activities or Regional Medical Commands
The PVNTMED sections of medical department activities and regional medical commands provide day-to-
day PVNTMED support for the installation and supported units. They perform sanitary inspections of food
service facilities, waste disposal facilities, sewage treatment plants, industrial complexes, water plants,
troop housing, family housing (at the request of the installation commander or the 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. During mobilization, they provide assistance to mobilizing
units in preparing their PVNTMED plan, determining immunization/prophylaxis requirements, training
unit FSTs, and obtaining essential field sanitation supplies and equipment. They also provide assistance to
local health authorities and provide local disaster relief assistance as directed by the command.
4-19. Armed Forces Medical Intelligence Center
The AFMIC is the sole producer of medical scientific and technical intelligence and general medical
intelligence for the DOD (see FM 8-10-8 for a comprehensive discussion on AFMIC). It responds to
requests from the armed forces for medical intelligence. The mission and functions of AFMIC are to—
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a. Produce required foreign scientific and technical intelligence (S&TI) and general medical
intelligence.
b. Produce foreign BW intelligence studies and reports on the capabilities of foreign countries to
acquire, develop, produce, or employ any agent of biological origin as a weapon.
c.
Produce intelligence studies on the medical aspects of foreign chemical warfare capabilities.
d. Organize and execute the medical aspects of the DOD Foreign Medical Materiel Exploitation
Program (FMMEP).
e.
Coordinate the acquisition, exploitation, and disposition of foreign medical materiel obtained
in support of DOD FMMEP.
f.
Plan, coordinate, and provide intelligence studies in accordance with DOD S&TI production
policies and procedures.
g. Prepare medical intelligence funding and manpower requirements for submission to the DOD
general defense intelligence program.
h. Manage and maintain the medical intelligence database and the medical portion of the DOD
S&TI database.
i.
Provide quick responses on foreign medical intelligence to DOD elements and other
government agencies as required.
j.
Assist in debriefing personnel on matters related to medical intelligence.
k.
Sponsor medical intelligence briefings and training for selected Reserve and active military
units and individual mobilization designees, as required.
l.
Maintain coordination and liaison with members of the technical intelligence community on
matters involving medical intelligence.
m. Provide a medical intelligence advisor to the military services.
n. Transmit a weekly wire of current medical intelligence developments.
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FM 4-02.17
CHAPTER 5
PREVENTIVE MEDICINE DETACHMENT MOBILIZATION
5-1.
General
The PVNTMED commander is responsible for the readiness of his detachment for deployment. He must be
prepared to deploy the unit from CONUS to an overseas area, from an overseas area to the CONUS, or
between major commands. This chapter contains guidance for the preparation and execution of unit
movement plans. When preparing a detailed movement plan, refer to AR 55-113, AR 220-10, FM 55-65,
FM 100-17, and all pertinent local directives.
5-2.
Planning
Planning for unit movement is continuous. It begins with the unit’s first day of activation, continues during
preparation for the move, and goes on until the move is completed. The commander reviews existing
movement plans, SOPs, and loading plans for completeness and correctness. If the unit is newly activated or
has no developed plans, the commander MUST prepare movement plans, including SOPs and loading
plans. Specific actions are detailed in the planning checklist at Appendix D.
5-3.
Warning Order
The first indication that a unit will move may be the receipt of a warning order establishing the personnel
shipment readiness data (PSRD). Receipt of this order prompts several actions. The unit begins preliminary
preparation for the move. The major Army commander gaining the unit furnishes preparation for overseas
movement information to the losing major Army commander. The losing commander distributes required
planning and equipment information to the affected units. Preparation for overseas movement information
normally includes—
• The unit’s new mailing address.
• A listing of authorized (TOE and CTA) items that need not be shipped with the unit.
• Additional items that the overseas commander desires to have shipped with the unit.
• Special clothing for the deployment area.
• Authorized stockage lists.
• Authorized prescribed load list.
• Expendable supply requirements.
Additional actions to be taken by a unit commander on receipt of a warning order are shown in Appendix D.
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5-4.
Movement Directive and Movement Order
The movement directive is the authority for unit movement and is the basis for actions by all agencies
concerned with the move. It is usually issued 90 days before the deploying unit’s PSRD. Based on this
directive, the installation or activity issues a movement order for the deploying unit. This order implements
the movement directive and provides additional instructions needed to prepare the unit for movement. Any
TOE modification is included in the movement order, along with a listing of equipment to be issued at the
port of embarkation or in country, if applicable. Actions required on receipt of the movement order are
outlined in Appendix D.
5-5.
Unit Movement Plans
These plans contain up-to-date logistical data summarizing transportation requirements, priorities, and
limitations that affect the unit’s movement. Movement may be by highway, water, rail, or air. Contents of
a movement plan may vary with the unit’s contingency status, guidance from higher headquarters, and the
effort the unit commander puts into preparing the plan. As a minimum, the unit movement plan should
contain the following elements:
a. Detailed listing of personal baggage, organizational equipment, expendable supplies, and
nonexpendable supplies.
b. The organization for movement, including the procedure for movement of the staff and
advance party, if applicable.
c.
Procedures to be followed at home station, en route, and at destination.
d. Unit load plans (see paragraph 5-7).
5-6.
Standing Operating Procedures for Unit Move
Details relating to a unit move are included in unit SOPs. These SOPs may include such things as duties of
an advance party; convoy security; and deployment procedures at destination. Although minor changes in
SOPs may be required, basic procedures should vary little from movement to movement. Preparation of an
SOP covering the details of unit movements relieves the commander of having to repeatedly plan and issue
directives for operations that follow established patterns.
5-7.
Unit Load Plans
Unit load plans are documents that present detailed instructions for hauling all unit personnel and equipment.
To ensure effective and expeditious movement of unit personnel and equipment, load plans should be kept
current. Load plans are based on TOE-authorized personnel (with their personal baggage), equipment,
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vehicle onboard equipment (including camouflage netting), and CTA items. Load plans are prepared and
maintained in each unit in anticipation of movement by the various transportation modes.
a. Unit Load Inventory and Checklist. This is prepared for each category of equipment, such as
vehicles, CTA items, and PVNTMED medical equipment sets. It is a numerical list of all containers and
vehicles to be shipped.
b. Unit Vehicle Load Plan. The vehicle load plan is used to move unit equipment, personnel, and
supplies with organic transportation. It lists the personnel, equipment, and supplies to be transported in
organic vehicles. Common table of allowances equipment is limited to that which is essential for mission
completion. Applicable CTAs that may be used are 8-100; 50-900; 50-909; and 50-970.
c.
Unit Train Load Plan. This plan is used when the unit moves by rail. It shows the proposed
distribution of personnel and equipment based on the rail cars tentatively available for the unit. It may
require adjustments when an actual move is made and specific rail cars are assigned.
d. Unit Air Load Plan. This plan is used when the unit moves by air. A separate plan for each
type of aircraft must be made. It covers the type of cargo to be loaded in each aircraft, loading start time,
estimated time required to load, special equipment requirements, and other data pertaining to the specific
aircraft.
e.
Unit Estimate of Aircraft Required. This is used to determine the number and type of aircraft
required to airlift a unit’s personnel and equipment.
f.
Unit Vessel Loading Plan. This plan is used when the unit moves by watercraft or ship.
(See
Appendix H.)
5-3
FM 4-02.17
CHAPTER 6
PREVENTIVE MEDICINE SERVICES IN STABILITY
OPERATIONS AND SUPPORT OPERATIONS
6-1.
General
The role of PVNTMED in stability operations and support operations encompasses a wide range of
support activities. Preventive medicine personnel will have much closer contact with the local populace.
In most stability operations and support operations, the primary mission of PVNTMED is to support US,
allied, and coalition forces; they may provide limited support to HN civilians. However, in domestic
support, the PVNTMED mission is to provide assistance to civilians affected by disaster. Preventive
medicine is not the lead agency; any PVNTMED support provided to civilians must be preapproved by
DA, the ASCC commander, or the task force commander. The PVNTMED staff may be from TDA or
TOE organizations. Personnel assigned to TDA activities will find their role greatly increased in support
of many stability operations and support operations. Personnel assigned to TDA organizations will be
called upon to assist units during their preparation for stability operations and support operations, and in
some situations, to continue this support during the mission. During preparation for stability operations
and support operations, supported units will require PVNTMED support as if they were preparing for a
war; however, they may have to provide for themselves or rely on the HN for housing, water supplies,
and waste disposal support. Therefore, PVNTMED personnel must be actively involved in all phases of
their preparation for the mission and during the mission. See FM 8-42 for detailed information on CHS
in stability operations and support operations.
6-2.
Domestic Support
Domestic support operations are normally conducted under the authority of the Federal Emergency
Management Agency (FEMA). At the request of FEMA, the DOD may direct Army units and personnel
(including PVNTMED) to assist in the operation. When deployed in support of such missions,
PVNTMED personnel will NOT assume the primary role of providing public health support. Instead,
they will assist FEMA and local or state health authorities as directed by the Army command and control
(C2) organization.
a. Initial Actions. Upon arrival in the disaster area, PVNTMED personnel establish contact with
the Army C2 organization for instructions on their mission. After receiving their initial instructions,
PVNTMED personnel should determine—
• Where they are to be headquartered.
• What FEMA and the health authorities have identified as the medical threat in relationship
to the disaster. Based upon the identified medical threat, PVNTMED personnel establish priorities for
PVNTMED support.
b. Information Flow. Preventive medicine personnel establish procedures for acquiring early
access to local information of PVNTMED concern. The information flow at a minimum should be—
• From the PVNTMED support element and staff through the chain of command to FEMA
and the health authorities.
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FM 4-02.17
• From FEMA and the health authorities down through the chain of command to the
PVNTMED staff.
• Between other supporting agencies and the PVNTMED staff.
• Information pertaining to engineering support, for example, should also be provided to
the PVNTMED staff. This information is important in the PVNTMED decision-making process, especially
in determining the best recommendations for provision of sanitation facilities, safe water supplies, and food
service sources. EXAMPLE: The supporting engineers may know that the local water supply system is
functioning in one area of the disaster area, but not in other areas. This information will assist PVNTMED
personnel in making recommendations on how to provide safe water in all areas. If water is safe in one
area, then transport of this water to unsafe areas can be employed, rather than having to rely on trying to
disinfect water at the user level.
c.
Life Support. Life support services are not a direct responsibility of PVNTMED personnel.
However, such services are of considerable interest because of their impact on the health of the disrupted
community. Preventive medicine personnel can assist local authorities in these services by providing
technical advice on—
• The adequacy of expedient shelters such as schools, churches, warehouses, and other
structures which survived the devastation. If tent villages are necessary, they provide advice on the
configuration of the communities and the adequacy of available tentage.
• The adequacy of food service facilities, water supplies, waste disposal, personal hygiene,
and laundry facilities.
d. Emergency Supplies. Preventive medicine personnel assist with the identification of emergency
supplies needed by the disrupted community. The supplies may include—
• Clothing and blankets.
• Cooking utensils.
• Supplies to treat drinking water. If bulk chlorine is provided, measuring devices and
instructions on its use must also be included.
• Chemicals for use in improvised portable toilets. Chemical toilets may be constructed by
using scrap lumber, canvas or tarpaulins, and buckets. The chemicals are added to the buckets for odor
control and to begin waste decomposition.
e.
Water. Technical advice on the adequacy of the water supply to the disrupted community,
including advice on cleaning or rejecting contaminated wells and water distribution systems, is provided by
PVNTMED personnel. Attention is focused on—
• Restoration of wells and water distribution systems. Even if only limited portions of a
distribution system are restored, the restored system can make providing a safe water supply much easier.
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• Acquisition of other sources until restoration efforts can be completed.
• Transportation of water from those sources.
• Management of distribution points.
• Quality of the water as it impacts on the individual consumer.
f.
Food. Preventive medicine personnel provide technical advice concerning the adequacy of
food supplies for the disrupted community. Attention is focused on sanitation, to include storage,
preparation, and distribution of available food. They help local authorities evaluate food stocks (when
veterinary personnel are not available) in the disrupted area with emphasis on salvage, when possible.
6-3.
Protection Against Epidemic Diseases
Disaster situations often overwhelm the capabilities of local public health agencies. Local public health
agencies may not be fully aware of diseases being introduced into their area by refugees or multinational
forces. The PVNTMED mission may include assisting public health officials in identifying diseases and
recommending or providing measures to reduce the incidence of disease. Ways in which PVNTMED
personnel can assist may include—
a. Suppression of Arthropod Vectors. They provide technical advice concerning the suppression
of mosquitoes, flies, lice, other arthropods, animals, and rodents. With the concurrence of local authorities,
they may conduct limited pest management operations to reinforce local efforts.
b. Investigation of Disease Outbreaks. Preventive medicine personnel assist local authorities by
investigating reported disease outbreaks. Their findings are used to dispel rumors or to provide early
warning for local action if the threat is confirmed.
c.
Immunizations and Prophylaxis. Although mass immunization operations are seldom
warranted, PVNTMED personnel must be prepared to assist local health authorities if called upon to do so.
Provisions for prophylaxis, such as malaria pills, may be required to counter some diseases.
d. Control of Human Waste. Lack of human waste control can lead to a number of disease
outbreaks. Simple control procedures can prevent their occurrence. Improvised waste disposal devices can
be prepared for use until standard sanitary facilities can be restored. Preventive medicine personnel can
provide advice on the construction and maintenance of these devices. The use of chemical toilets or burnout
latrines can greatly reduce the health hazard from inadequate control of human waste.
e.
Recovery from Disruption. Return to normal or near-normal living conditions is the central
motivation of all individuals who are displaced by a disaster. Before individuals are allowed to return home,
several important tasks must be considered. Preventive medicine personnel provide technical advice on the—
• Clearance of debris from drainage structures. Badly damaged homes represent a major
debris removal problem, but the basis for condemnation is structural (not health) and such decisions are left
to local authorities.
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FM 4-02.17
• Collection and disposal of animal carcasses.
• Collection and disposal of food that has been condemned by local authority.
f.
Preparation of Homes for Reoccupancy. Preventive medicine personnel provide technical
advice on cleaning, disinfecting, and spraying homes that were affected by the disaster. Contact surfaces
(such as tabletops, countertops, and cooking and eating utensils) are of primary concern because of their
potential for vectoring enteric diseases carried by water. Also, provisions are made for refrigeration units
or ice chests with ice to protect perishable food from extended exposure to temperatures at which organisms
can grow. Perishable food should be stored at temperatures below 45°F.
6-4.
Humanitarian Assistance
During humanitarian assistance operations, PVNTMED personnel may provide assistance in restoring
public health services. The assistance may include, but not be limited to, the areas of food sanitation,
entomology, epidemiology, occupational health, housing, water treatment, and waste disposal. Preventive
medicine personnel will provide this assistance as directed by the lead agency for the operation. They will
not volunteer to provide any services outside of those areas to which they are assigned a mission. Any
assistance provided must be coordinated with local public health officials. This coordination will help the
local public health officials maintain the services upon the departure of PVNTMED personnel. The
PVNTMED personnel should not perform the actual activities of restoring public health services; their role
should be to provide guidance to the public health officials and the local populace. This does not mean that
in the absence of individuals to perform the restoration activities that PVNTMED personnel cannot start the
restoration process.
6-5.
Peacekeeping/Peace Enforcement
As in war, PVNTMED support during peacekeeping and peace enforcement operations will comprise all
activities with an increased surveillance for occupational exposure to numerous industrial chemical,
biological, and radiological hazards. EXAMPLE: Troops may be housed near steel foundries; these
facilities may have high levels of components such as lead, chromium, zinc, cyanides, and radiation. The
exposure levels may be so low that limited immediate effects do not manifest in the troops; however, the
long-term effects could be serious. Preventive medicine personnel must closely monitor areas habitually
occupied by US forces for such exposures. Local water supplies may have to be used by US forces; these
supplies may not meet US standards and will require supplemental chlorination before use.
6-6.
Environmental Health and Environment Surveillance
Preventive medicine personnel conducting environmental health surveillance in stability operations and
support operations may use several techniques to verify the presence or absence of industrial chemicals in
the environment. In Bosnia, the M93 Series NBC Reconnaissance Vehicle System (FOX) was used to
collect air samples for industrial waste vapor surveillance. When used for this mission, the FOX employed
the industrial surveillance equipment; in its chemical agent surveillance mode, it does not have the correct
sample collecting supplies.
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FM 4-02.17
CHAPTER 7
PREVENTIVE MEDICINE IN SUPPORT OF
CIVIL-MILITARY OPERATIONS
7-1.
Mission
Winning indigenous population support is an important facet of military operations. Civil-military operations
are an important part of that effort. As part of CMO, PVNTMED can make a significant contribution to
this support. Preventive medicine support may be provided by personnel organic to the CMO organization
or may be provided by TDA and TOE personnel and units.
7-2.
Command Approval
Any PVNTMED participation in CMO is first coordinated with the C2 authority, then with the agencies
designated by that headquarters to conduct the project. Command approval is required when substantial
resources are involved. Command approval is also important from the standpoint of HN agreements, which
could be violated by well-intentioned efforts.
7-3.
Purpose
The dominant theme in the design of a CMO project is “local sufficiency.” The community must have the
aptitude and resources to sustain the project after US forces leave, or the whole effort is for naught. Other
constraints include local customs and taboos; some are so grounded in culture that to challenge them will
result in a loss of credibility rather than winning support.
7-4.
Preventive Medicine Projects
There are a variety of projects that PVNTMED elements can undertake to win the support of the local
populace. However, all projects undertaken should be designed to make lasting improvements in the
community’s overall health. Emphasis is placed on training the community in self-sufficiency to conduct
such services. If equipment or materiel is involved, the training must include procedures for procuring the
equipment or materiel and repair parts; repair parts must be readily available in the region. Equipment
from a distant country will be of little value to a community unless the repair parts are also provided; in
many instances, the high cost for repair parts will create problems that the community cannot handle. Many
communities are so poor that they cannot afford even the basic items. Projects that may be undertaken
include actions or activities such as—
• Health screening to identify endemic diseases with recommendations on how the people can
counter the effects of the disease.
• Health education on how the people can reduce disease and illness risk.
• Immunization programs to reduce the spread of diseases.
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• Projects to upgrade or improve the local water supply and waste disposal facilities. If the
improvement to the water supply system includes installation of power-driven pumps, training must include
maintenance and repair parts procurement procedures (if repair parts are not provided with the pump).
Installing a pump system without training the people on maintaining the pump, including repair parts
procurement, will not be an improvement; it will be an additional problem.
7-5.
Health Screenings
When conducting health screenings, PVNTMED personnel must ensure that the local population understands
actions taken are to aid in improving their health and well-being. Preventive medicine personnel—
• Collect only those human specimens necessary to evaluate suspect diseases in the area such as
malaria, hepatitis, dysentery, and intestinal parasites.
• Evaluate the prevalence of skin diseases and body lice among the population.
• Evaluate the nutritional status of the population, to include daily dietary intake of vitamins,
minerals, fats, proteins, fibers, and carbohydrates.
• Provide guidance to the local population on how they may improve their health by applying
basic procedures to prevent disease and how to improve their nutritional intake with the available food
sources.
7-6.
Health Education
Health education must be taught at the educational level of the population. All classes should be short in
duration; interactive, hands-on, if possible; and directed toward achievable goals. Simple procedures, such
as washing their hands after using the bathroom or before eating, are much more effective than trying to
explain the process by which diseases are spread. Explain that burying human waste can prevent flies from
spreading diseases to food, rather than how flies pick up disease organisms and deposit them on the food.
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FM 4-02.17
CHAPTER 8
PREVENTIVE MEDICINE REPORTS
8-1.
General
Reports are documents provided to leaders and commanders that record PVNTMED support. The reports
give immediate feedback to leadership on medical threat findings; the medical threat may adversely affect a
unit’s ability to perform its assigned mission. Included in the reports are recommendations for the
commander to use in countering the medical threat. Reports also serve as a historical account of medical
threat effects on a force during the conduct of operations.
8-2.
Medical Statistical Report
The occurrence of certain diseases of man and animals must be reported to higher headquarters. Army
Regulation 40-5 lists diseases of interest and the reporting requirements, including frequency of reporting.
The frequency for statistical reports may be on a daily, weekly, monthly, quarterly, or annual basis.
8-3.
Sanitary Inspection Report
The findings of PVNTMED inspections, such as inspections of food service facilities, troop billeting/bivouac
areas, and field water supplies are documented on inspection reports. These reports are provided to the
immediate supervisor or commander for their use in ensuring corrective actions are taken.
8-4.
Epidemiological Investigation/Surveillance Report
A report must be prepared for each epidemiological investigation or surveillance activity. At a minimum,
the report should include the following:
• Suspect disease.
• Number of cases (individuals).
• Age of persons affected.
• Nationality of involved individuals.
• Locality (area/region) of the occurrence.
• Findings.
• Recommendations to control/prevent the spread of the disease.
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8-5.
Occupational Health Report
Occupational health surveys are conducted on motor pools and other industrial-type operations. Findings of
these surveys are documented in an occupational health report. This report is provided to the immediate
supervisor or commander. When conditions merit reporting to higher command authorities, then the results
of the survey are also reported to the employee and a copy of the report is filed in the employee’s medical
record.
8-6.
Annual Historical Report
a. Annual reports of administrative, professional, and operational activities of the AMEDD are
the basic files of the Historical Unit, AMEDD. They are used as reference and source material for historical
programs, AMEDD missions, and teaching material. Particular attention should be given to personnel
rosters, TOE, unit participation in support of battle, and movement orders.
b. All PVNTMED detachments prepare the report in accordance with AR 40-226. The report is
submitted for each calendar year. Reports from small medical units, such as detachments and teams that are
functionally integrated with larger medical units, may be included with the larger unit’s report. The title
page of the consolidated report must list each unit included in the report. The information reported from
each small medical unit must be attached to an identified tab or appendix of the basic report. Upon
deactivation, agencies prepare and forward final reports covering the calendar year of deactivation.
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CHAPTER 9
MEDICAL SURVEILLANCE
9-1.
Introduction
Medical surveillance (MEDSURV) is the ongoing, systematic collection, analysis, and interpretation of data
essential to the planning, implementation, and evaluation of military force health. The determination of
unit-specific rates of illness and injuries of public health significance is the foundation of the MEDSURV
program. Medical surveillance is closely integrated with the timely dissemination of these data to those
responsible for prevention and control of DNBI. Implementing guidance for DOD is found in DOD
Instruction
6490.3. The establishment of uniform and standardized health surveillance and readiness
procedures for all deployments are listed in Chairman of the Joint Chiefs of Staff (CJCS) Memorandum
MCM-251-98. Deployment mental health screening will be addressed in separate policy memorandums.
9-2.
Applicability and Scope
The DOD Instruction mentioned above applies to the Office of the Secretary of Defense, the military
departments, the CJCS, the combatant commands, the Defense agencies and the DOD field activities. The
term military service refers to the Army, the Navy, the Air Force, and the Marine Corps. When the Coast
Guard is operating as a military service in the Navy, it will be included in the military MEDSURV system.
a. Preventive medicine assets, both TOE and garrison, monitor DNBI in the force in order to
identify and reduce incidents and to identify and counter medical threats.
b. Medical surveillance teams provide timely reports to commanders, medical clinicians, planners,
and others who require this information in a timely manner. This information and analysis provides
decision support to commanders, so that the commanders have an understanding of the potential combat
effectiveness of their units before, during and after operational deployments.
c.
Medical surveillance forms a basis for medical resource allocations, refines knowledge of the
medical threat, and permits continual assessment of the effectiveness of measures used to prevent and
control DNBI.
d. The term medical surveillance as used here is different than its meaning in occupational
medicine; occupational medical surveillance is the monitoring applied to individual workers based on actual
or presumed workplace exposures.
9-3.
Mission Objective of Medical Surveillance
The mission objective of the AMEDD, to conserve the fighting strength, mirrors PVNTMED’s mission
objective for MEDSURV: to protect the health of the force. Together they improve soldier performance
and unit effectiveness, minimizing the demand for a more logistically intensive health restoration capability.
The PVNTMED functions include assessing the medical threat, identifying and recommending PMM, and
conducting surveillance. The traditional yardstick of deployed force health is the DNBI rate. The primary
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mission objective is to deploy a healthy force having a DNBI rate equal to, or less than, the average DNBI
rate for the nondeployed force.
a. Predeployment PVNTMED assets determine the baseline readiness of the force by conducting
predeployment health screening assessments. These assessments are documented on standardized forms for
inclusion in individual medical records.
b. Once in theater, the PVNTMED’s mission objective is to sustain the health of the force in the
field. Soldier performance equals soldier health and fitness being sustained for the duration of the
deployment. The medical threat is not limited to infectious disease, nor is the medical threat any less
dynamic than the enemy threat. Preventive medicine assets provide troop commanders with appropriate
information on troop health status, illness and disease threat analyses, and redeployment health concerns.
c.
Finally, during the postdeployment phase of operations, PVNTMED’s MEDSURV will
continuously monitor the health status of the force just as judiciously as organizational equipment and
training status are monitored. As was done during predeployment activities, a postdeployment health
assessment will be conducted. Together, these health assessments—
(1) Define the rates and trends of DNBI in the force.
(2) Provide commanders an accurate description of the health status of their force.
(3) Validate new or continuing preventive and curative medicine needs for the force.
(4) Contribute to the ongoing determination of the medical threat.
9-4.
Principles of Medical Surveillance
Several controlling principles govern MEDSURV. These state that MEDSURV is—
• Useful. The information collected and reported is directly applicable to the commander’s
critical information requirements, prevention of DNBI, and to ongoing appreciation of the medical threat in
the AO. The MEDSURV information is always immediately applied to PVNTMED activities. It prompts
immediate corrective action for identified DNBI, but more importantly, it is applied to adjust PMM. For
example, a dramatic increase in the rate of acute diarrhea among the troops in one or several units may be a
sign of contaminated food or water in the affected units, warranting additional investigation. An increase in
the rate of nonbattle injuries in a unit will prompt an investigation that results in reinforcement of control
measures and proper use of protective equipment. Thus, MEDSURV contributes to prevention and serves
as a force multiplier.
• Systematic. Medical surveillance is executed throughout the force by the same methods.
Transmission of the information collected is uniform in method and schedule. Reporting of the interpreted
information is clear, predictable, and coordinated with OPLANs and concerns.
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• Timely. Information collected loses value rapidly. It must be transmitted up the chain of
command and medical chains efficiently. Integrating reports must be similarly disseminated back down the
chain of command.
• Tailorable. Medical surveillance can be focused to reflect the intensity of specific elements of
the medical threat to the force. For example, dermatological conditions may be highlighted in data
collected within the force deployed to a location with a high prevalence of skin disease or continuous
exposure to high humidity or water that threatens combat effectiveness.
• Interconnected. Medical surveillance exploits the communications and network capabilities of
the theater and the sustaining base to rapidly disseminate its data and reporting results throughout the CHS
system. Using analog and digital media, and employing legacy and emerging systems, MEDSURV results
are communicated and applied to PMM selection and employment at all levels of the deployed force.
• Simple. The flow of information is direct and clear. The elements of information collected
are sparse and concise.
• Acceptable. The burden on the soldier, leader, and unit is light. The tasks of MEDSURV are
embedded in the tasks of the CHS system. The reports generated support the mission and planning needs of
the receivers.
• Sensitive, Predictive, and Representative. The means of collection must be sensitive to ensure
elements of the DNBI are not overlooked. The information gathering structure/process must allow for rapid
interpretations of data to provide the commander with timely and factual information on DNBI prevention.
9-5.
Responsibilities for Medical Surveillance
The responsibilities for MEDSURV are shared by the individual soldier, unit leaders, senior commanders,
and the CHS system.
a. Unit leaders and commanders—
• Inform troops of illness, injury, and disease threats, the risks associated with those
threats, and the countermeasures in place, or to be used, to minimize those risks while deployed.
• Ensure compliance with PVNTMED guidance.
• Promote combat stress control programs and policies.
• Ensure completion of pre- and postdeployment health assessments.
b. Senior commanders—
• Support MEDSURV within their units and by their CHS personnel with appropriate
planning, resources, policy, enforcement, education, and training.
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• Use MEDSURV information as the basis for unit health reporting and in all phases of
planning.
•
Report unit DNBI rates and health readiness in accordance with joint guidance (see
CJCS Memorandum, MCM-251-98), service policy, OPORD, and OPLAN.
•
Provide unit personnel strength figures to supporting medical units for calculation
of unit-specific MEDSURV rates and trends.
•
Consolidate MEDSURV report information from subordinate units in determining
health status and medical threat. For example, the brigade will incorporate reports from subordinate
battalions and separate companies; the division will use brigade reports, and so forth.
•
Ensure that soldiers complete pre- and postdeployment survey forms and other
requirements in accordance with joint guidance.
(See DOD Directive 6490.2.)
c.
Medical commanders and officers in charge—
(1) Ensure that each case of DNBI that is defined as a reportable event is reported through
command channels to the appropriate MEDSURV activity (such as CHPPM, AFMIC, Defense Medical
Surveillance System).
(a) In garrison and on fixed installations, reporting is routed through the PVNTMED
service of the MTF.
(b) In theater, reports are routed through senior medical channels to the appropriate
MEDSURV activity.
(2) Assist in preparation of weekly DNBI reports for supported units by recording returned
to duty and admission to Echelons III-V facilities in accordance with joint guidance.
d. Preventive medicine officers—
(1) Assist surgeons in tabulating, interpreting, and reporting MEDSURV data.
(2) Provide technical assistance to supported units and staffs in deriving and applying
MEDSURV data.
(3) Maintain oversight of MEDSURV reporting in supported units.
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APPENDIX A
PLANNING/PREPARATIONS FOR PREVENTIVE
MEDICINE IN MILITARY OPERATIONS
Section I. GENERAL PLANNING INFORMATION
A-1. General
The precursor in all military operations must be planning. Plans must be clear. They must explain how and
why forces are employed, what forces are to be deployed, and when. Ultimately, the plan that is developed
must stand up to the strongest scrutiny—execution. All plans must be prudent and relevant to current and
projected threats. The PVNTMED plans must keep deployed forces in the most vigorous health possible
wherever and whenever they are employed. This appendix will assist task force commanders and their
staffs in understanding the complexity and the necessity of PVNTMED to their overall plan.
a. Joint Military Missions. In today’s world, the Services will not fight or deploy alone. Each of
the Services will have a part in all military missions of the US no matter how small or large. Joint medical
planning must be done with the knowledge and awareness of each Service’s capabilities in any given
situation. The mission of PVNTMED is to counter the health threat.
b. Common Problems in Planning for Preventive Medicine During Military Operations. The
CHS planner must use professional judgment and common sense to omit nonapplicable portions of the
PVNTMED estimates and plans. Planning is ongoing and the planner will need to adjust certain elements of
the PVNTMED plan to stay current with the development of a military operation. The planner may expand
certain areas of the plan that require more detailed information in subsequent phases of the operation or may
have to redirect PVNTMED emphasis in other areas. The planner’s job is never over.
(1) One of the common problems in planning for PVNTMED during ongoing operations is
that the perspective of the MEDCOM PVNTMED officer, the ASMB PVNTMED officer and the divisional
PVNTMED officer are different. These perspectives can be vastly different from one another and each
planner has different aspects to consider when preparing estimates and plans and submitting them to the
CHS planner. The best way to alleviate this potential problem is to maintain communication with all
associated planners during the ongoing planning process.
(2) Another problem that the PVNTMED planner may have is many of the tasks for the
PVNTMED detachments are implied and not clearly stated in any of the plans. The PVNTMED planner
must guard against assuming that the PVNTMED detachments will know what was intended by the
commander/PVNTMED planner in vague and poorly worded plans.
(3) Always a constant concern for the PVNTMED planner is the frequently changing mission
statement. The planner must guard against misinterpreting the changes to the CHS mission statement when
revamping/updating the PVNTMED plan.
(4) The PVNTMED planner must stay abreast of all medical intelligence information that is
applicable to PVNTMED. Medical intelligence is obtained from sources listed in the medical intelligence
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annex to the CHS plan. The most common problem comes as the theater or operation develops and current
medical intelligence is not brought up to date to reflect the current situation. Digitization will help alleviate
that problem to a certain degree, but it will not totally do away with the PVNTMED planner being caught in
a data/information vacuum during critical times of an operation or during planning sessions. There is little
a planner can do about the situation but he must be aware that the problem exists and be prepared to deal
with the fact when it occurs.
c.
Preventive Medicine Versus Patient Care and Management. Often, the problem occurs because
each piece is so important to the success of the mission. The one principle that must be remembered is that
the medical footprint must always be constrained. Many of the problems that occur can be averted if the
following items are dealt with at the outset:
• Define the health threat.
• Identify the threat assessment factors.
• Communicate the health threat.
• Include PVNTMED in the OPLAN.
• Understand that planners are staff members, not commanders.
• Read the OPLAN/OPORD.
• Stovepipe to Service surgeon generals.
• Understand the difference between executing and planning.
• Address the necessary PVNTMED skills among the force.
A-2. Facts and Assumptions
During this phase of the planning process, the force surgeon usually attends the facts and assumption
meetings. If possible, the PVNTMED planner should try to attend these meetings also.
a. The PVNTMED planner should develop personal working relationships with the operations
staff officer, G3/J3/S3; the personnel staff officer, G1/J1/S1 and the intelligence officer, G2/J2/S2. To a
lesser degree, the PVNTMED planner needs to be able to work with the logistics staff officer, G4/J4/S4 and
the overall planning cell, the G5/J5/S5; and the communications staff officer, the G6/J6/S6.
b. In joint operations, the J3 operations staff officer has the information that will allow the
PVNTMED planner to formulate many of the PVNTMED facts and assumptions. The PVNTMED planner
must be proactive; from the J3, the following information is attainable:
• Mission and commander’s intent (one or two levels up).
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• Current task organization (two levels down).
• Current unit status.
•
Unit locations.
•
Unit combat capabilities.
•
Unit activities.
• Other Services’ CHS.
• Other unit information.
• Area NBC exposure status.
• Time of exposure.
c.
From the J2, the intelligence staff officer, the PVNTMED planning officer can obtain the following:
• Battlefield analysis (not usually considered, but should be, is whether blood and blood
products will be necessary in the theater).
• Terrain analysis (surface water; need to purify water or use bottled water).
• Current weather status.
• Known enemy status.
d. The PVNTMED planner needs to develop relationships with the J1/G1 in order to obtain
information regarding the following:
• Personnel readiness.
• Unit strength, maintenance, and replacements.
• Service support/noncombat matters.
• Organizational climate.
• Commitment/cohesion.
e.
From the logistics staff officer, the J4, the following facts and assumptions can be found:
• Maintenance.
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• Supply/services.
• Transportation.
• Labor.
• Facilities and construction.
• Airspace for medical supplies and personnel.
• Contracting support.
f.
The planning staff officer, J5, has access to the following information:
• Civil Affairs unit locations and capabilities.
• Local government support availability.
• Constraints or restrictions.
• Area intelligence information.
A-3. Mission Analysis
Once the facts and assumptions have been collected, the PVNTMED planner moves to the third phase of the
appendix development process. The nature of the second phase makes it important to continually update the
facts and assumptions as the operation develops. Facts that may have been important initially may move to
the background, and assumptions may prove to be false or less important. The reverse of those instances
can also occur and the planner must stay on top of all situations.
a. The PVNTMED planner develops a mission analysis from the data collected during the fact-
finding portion of the planning process. The planner then develops the PVNTMED estimate of the mission.
The planner lists any critical assumptions or commander’s requirements applicable to the operation.
b. The planner describes, in general terms, how the medical support system addresses the
infectious disease, vectorborne disease, sanitation, and environmental threats prevalent throughout the AO.
He outlines what types of PVNTMED resources will be introduced early in the development process to
institute basic measures and describes how the overall PVNTMED capabilities will be phased into and
positioned throughout the theater. The planner identifies tasks to be performed, specified, and implied.
c.
The planner describes the medical intelligence used to develop this appendix and outlines how
medical intelligence is gathered, processed, and disseminated to the deployed and deploying units. The
planning staff lists the assets available, the essential tasks that must be accomplished, the acceptable levels
of risk, constraints, restrictions, and the initial time analysis.
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d. During development of the PVNTMED planning stages for an operation, a mission analysis is
necessary. The commander’s intent has been clarified, the tasks to be performed (specified and implied)
have been identified. The planner knows what assets are now and will be available; he knows the
constraints and restrictions established for the mission. He has identified the acceptable levels of risk. A
list of essential tasks has been identified and the planning cell has restated the mission, to include who,
what, when, where, and why. The mission analysis is forwarded to the commander for approval. The
commander will review and approve the analysis; or he may clarify and/or restate the mission.
A-4. Developing Courses of Action
The first stage in developing courses of action (COA) is the situation and the considerations that need to be
identified and answers found. The amount of time available significantly influences the planning process.
Military solutions may be constrained; a COA may be limited by available resources, or political and
diplomatic considerations may need to be taken into account. A regional, rather than global, focus for
deliberate planning allows increased flexibility in apportionment of available combat forces.
Section II. SAMPLE FORMAT FOR THE
PREVENTIVE MEDICINE ESTIMATE
A-5. General
a. The purpose of the PVNTMED estimate is to recommend COA to the commander on issues
such as site selection and risk management. The planning process for CHS operations in stability operations
and support operations is the same process as used for traditional CHS operations. The CHS estimate of the
situation is the basic tool used by the CHS planner. A detailed discussion of each subparagraph of the CHS
estimate is provided in FM 8-55. The information contained in this appendix supplements the discussion in
FM 8-55. The considerations are similar; however, the range of options and COA are expanded. These
expanded options include missions and functions not accomplished during the more traditional CHS
operations (such as the assessment of the HN medical infrastructure).
b. All of the categories of the CHS estimate are presented in FM 8-55. Some of the categories
may seem contrived when applying them to stability operations and support operations situations. The CHS
planner must, therefore, interpret the categories and apply the pertinent information or modify the categories
to fit the operational scenario. In some stability operations and support operations scenarios, there may not
be a recognizable enemy; the enemy and friendly situation paragraphs of the estimate can be thought of as
negative and positive factors impacting on the successful accomplishment of the mission. For example, in a
discussion of opposition groups, it is conceivable that an organized opposition may not be apparent in a
country where a humanitarian assistance program or disaster relief effort is being conducted. The CHS
planner should, therefore, consider those situations and factors which could foster an insurgency or the
formation of opposition groups and focus the CHS operations to correct anticipated deficiencies, thereby
eliminating the possible threat.
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c.
Field Manual 8-55 contains a format for preparing the veterinary, PVNTMED, dental, CSC,
and combat health logistics estimates.
d. The examples provided in this appendix do not include all possible scenarios or information
needed to complete an estimate. They are intended to be thought-provoking and are included for illustrative
purposes only.
(Classification)
Headquarters
Location
Date, time, and zone
PREVENTIVE MEDICINE ESTIMATE OF THE SITUATION
References: List all maps, overlays, charts, or other documents required to understand the plan. References
to a map will include the map series number and country or geographic area, if required; sheet number and
name, if required; edition; and scale.
1. MISSION (Statement of the specific PVNTMED mission in support of various activities [such as support
for insurgency and counterinsurgency, combating terrorism, peace support, or domestic support operations].)
2. SITUATION AND CONSIDERATIONS
a. Enemy (Opposition) Situation/Negative Factors.
(Information contained in this section of the
estimate is similar to that contained in paragraph A-2; however, it is tailored to PVNTMED concerns.)
(1) Communicable diseases. (This should include endemic and epidemic diseases and their impact
on mission effectiveness.)
(2) Sanitation levels.
(This can include the opposition’s ability/resources to raise/provide for
standards of sanitation for the populace.)
(3) Public health capabilities.
(This can include the opposition’s ability to provide primary care
and health development programs, such as well-baby clinics; to conduct epidemiological investigations; to
provide guidance on water treatment/purification; to provide guidance on waste disposal; and to provide
inspection of food service operations.)
(4) Immunization status.
(This can include both the opposition and general public, especially
children. Does the opposition have the resources available to provide immunizations to their forces and
(Classification)
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(Classification)
the populace? Do they possess special immunizations/prophylaxis to protect their forces from potential
BW agents?)
(5) Level of field sanitation training.
(6) Nuclear, biological, and chemical and DE capabilities.
(This can include the opposition’s
ability to employ weapons of mass destruction, disperse biological agents, disseminate radioactive material,
and employ DE devices/weapons.)
b. Friendly Situation/Positive Factors.
(1) Status of individual and unit PVNTMED supplies.
(2) Operational situation.
(Factors such as the state of sanitation, type of billeting, and reliance
on local economy for food and water will dictate the PVNTMED support requirements. Are the available
sources sufficient to support US forces, allies, coalition partners, HN forces, and domestic and humanitarian
assistance operations? If not, what will be the source of potable water?)
(3) Types of rations used.
(In stability operations and support operations, units may have to rely
on local vendors for food items; caution should be exercised when relying on these food supplies. Veterinary
inspection support is essential to ensure wholesomeness and quality.)
(4) Unit PVNTMED readiness.
(a)
Field sanitation team training and equipment.
(b)
Individual and unit PMM training and enforcement.
(5) Potable water and ice.
(a)
Sufficient production and distribution units.
(b)
Sufficient availability and quantity.
(c)
Access to and availability of clean water in HN communities.
(d)
Inspection/certification of water and ice sources and supplies.
(6) Availability of aircraft for aerial spray operations.
(Classification)
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(Classification)
(7) Status of HN and domestic public health system (to include health education programs).
(8) Status of sanitation facilities.
(9) Status of immunizations (especially for children).
(10) Off-limit establishments.
c. Characteristics of the AO.
(1) Terrain.
(Discuss the following questions.)
(a)
Does the AO favor arthropod/rodent populations?
(In military operations in urbanized
terrain [MOUT], are there fields of rubble where rodents can flourish? Are there open sewers or drainage
canals? Are there stagnant pools of water or open water storage containers [such as drums]?)
(b)
Is the AO at a high altitude, in a jungle, in the desert, or on mountainous terrain?
(c)
Is water available?
(What are the requirements for treatment and purification? Is it
plentiful? Is it easily accessible?)
(d)
How will the terrain affect pest management operations?
(Are there low-lying areas
where water can accumulate? Are there caves where bats can roost?)
(2) Climate and weather.
(Discuss the following questions.)
(a)
Will the season affect disease transmission?
(Upper respiratory infections in the winter
months; increased cases of malaria during rainy season.)
(b)
Will the season affect heat or cold injuries?
(How long will it take to acclimatize the
troops to the AO? Is heat complicated with high/low humidity? Will exposure to cold be complicated by
high winds? Will cold injuries be complicated by high altitudes? Will sunburn/windburn or snow blindness
be factors?)
(c)
Will the season affect disease vectors? (Are arthropod vectors or pests more prevalent
during the operational period in the AO?)
(d)
Will the season affect the water supply?
(Amount of rainfall such as flood or drought.)
(e)
Will the season affect pest management operations?
(Classification)
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(Classification)
(3) Civilian population.
(Discuss the following subjects. There may be different subpopulations
within the civilian community with different characteristics than other groups such as refugees from another
country or displaced persons from the surrounding countryside.)
(a)
Endemic diseases (especially those of military significance).
(b)
Epidemic diseases (especially those of military significance).
(c)
Sources of disease/illness on the main supply route (such as restaurants, lodging, or
swampy areas).
(d)
Immunization status (among the adult population; among the pediatric population).
(e)
Water treatment standards. (Do standards exist? Is water treatment a common practice?)
(f)
Waste disposal practices.
(Do community sanitary facilities exist? Is the water source
protected from contamination? Is garbage collected and disposed of in a sanitary landfill?)
(g)
Nutritional standards.
(In the short term [are food supplies and availability affected by
outbreaks of violence]? In the long term [is famine occurring/recurring]? Can the average family afford an
adequate diet?)
(h)
Civilian medical support and public health system.
(This should include capabilities/
deficiencies, facilities, and resources.)
(i)
Chemical hazards from industrial operations.
(j)
Radiation hazards from nuclear power plants or other sources.
(k)
Biological hazards from medical research and treatment operations.
(4) Flora and fauna.
(Discuss the following subjects.)
(a)
Arthropod vectors in the AO.
(b)
Arthropod vectors resistant to pesticides.
(c)
Venomous animals and insects.
(d)
Poisonous plants.
(Classification)
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(Classification)
(e)
Rodents.
(5) Enemy prisoners of war and/or detainees, if applicable.
(May also include internment and
resettlement operations. Discuss the following subjects.)
(a)
Presence of disease.
(b)
Number of detained public health officers.
(c)
Disease immunization status.
(d)
Nutritional standards.
(6) Other. (This could include cultural, religious, or ethnic practices that impact on the PVNTMED
arena.)
d. Strengths to be Supported.
(1) Army.
(2) Navy.
(3) Air Force.
(4) Marines.
(5) Coast Guard.
(6) Allied forces.
(7) Coalition forces.
(8) Host-nation forces.
(9) Enemy prisoners of war, if applicable.
(May also include internment and resettlement
operations.)
(10) Indigenous civilians. (This category is important if planning humanitarian assistance programs.)
(11) Detainees.
(Classification)
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(Classification)
(12) Retainees.
(13) Others.
(This can include DOD civilian employees, DOD civilian contractors, third country
civilians, nongovernmental organizations (NGO), private volunteer organizations (PVO), and refugees.)
e. Health Status of the Command.
(Discuss the following subjects.)
(1) Origin of the troops.
(This is of particular importance in multinational operations as the
forces from different nations will have different endemic diseases. Are the forces acclimated to the
environment [heat, cold, altitude]?)
(2) Presence of disease.
(Is the unit experiencing an outbreak of disease? Is it an endemic disease
or the effects from a BW agent?)
(3) Immunization status.
(Are the troops from all participating nations immunized for the same
diseases? If not, what are the differences? Are all immunizations current?)
(4) Status of nutrition.
(What is the diet of the troops and how long have they been consuming it
[such as MRE for 2 weeks]?)
(5) Clothing and equipment.
(This can include the availability of protective equipment such as
insect netting and insect repellent or special clothing for extreme environmental conditions.)
(6) Fatigue and resistance to disease.
(Are sleep plans developed and implemented? Are there
other factors contributing to fatigue [such as jet lag]?)
(7) Other.
(Availability of prophylaxis.)
f. Assumptions.
(1)
(Is the assumption really necessary for the solution?)
(2)
(Will the results change if the assumptions are not made?)
g. Special Factors.
(Coordination requirements with HN- or US-backed group, NGO, PVO, and other
US agencies. Additionally, the impact of culture, customs, or religious beliefs/practices on providing
PVNTMED services should be discussed.)
3. ANALYSIS
a. Estimates.
(Classification)
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FM 4-02.17
(Classification)
(1) Tasks involving arthropods and rodents.
(a)
Disease and nonbattle injury threat assessment.
(b)
Survey and identification of requirements.
(c)
Control requirements.
(2) Tasks involving environmental health.
(a)
Heat.
(b)
Cold.
(c)
Water and ice.
(d)
Sanitation.
(e)
Waste disposal.
(f)
Altitude.
(3) Tasks involving disease.
(a)
Epidemiology.
(Are laboratory resources available to support epidemiological
investigations?)
(b)
Immunizations.
(Are they current? In nation assistance and humanitarian assistance
operations, are they available to provide to the civilian population?)
(c)
Prophylaxis.
(Are supplies sufficient for the operation? Has a program been instituted
to ensure prophylaxes are taken on a scheduled basis [such as antimalarial tablets taken every Friday
morning with breakfast]?)
b. Requirements.
(1) Supplies.
(Are on-hand supplies sufficient to meet the requirements? What is the availability/
accessibility of resupply? Have unforeseen requirements been established that were not previously planned
for? If so, what are their impact?)
(Classification)
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(Classification)
(2) Equipment.
(Is equipment on hand and serviceable? Are repair parts and maintenance
support available?)
(3) Civil and military support.
c. Resources Available.
(1) Organic PVNTMED personnel.
(2) Attached PVNTMED personnel.
(3) Supporting PVNTMED personnel.
(4) Status of unit field sanitation teams.
(5) Other Services.
(6) Allied forces.
(7) Coalition forces.
(8) Host nation.
(9) Civilian public health personnel.
(10) Detained enemy (opposition) health personnel, if applicable.
(11) Preventive medicine troop ceiling.
(Discuss the impact [either negative or positive] that the
troop ceiling has on mission accomplishment.)
(12) Preventive medicine supply status.
d. Preventive Medicine Courses of Action.
(Determine, as a result of the above analysis, all logical
COA which support the commander’s OPLAN and accomplish the CHS mission. Courses of action are
expressed in terms of WHAT, WHEN, WHERE, HOW, and WHY.)
4. EVALUATION AND COMPARISON OF PREVENTIVE MEDICINE COURSES OF ACTION
a. Determine and state the probable outcome of each COA listed in paragraph 3d when opposed by
each identified significant difficulty. This may come in two steps:
(Classification)
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(Classification)
(1)
Determine and state those anticipated difficulties that will have an equal effect on the COA
listed.
(2)
Evaluate each COA against each significant difficulty to determine strengths and weaknesses
inherent in each.
b. Compare all COA listed in terms of significant advantages and disadvantages or in terms of the
major considerations that emerged during the above evaluations.
5. CONCLUSIONS
a. Indicate whether the mission set forth in paragraph 1 can or cannot be supported.
b. Indicate which COA can best be supported from the veterinary service standpoint.
c. Indicate the disadvantages of nonselected COA.
d. List the deficiencies in the preferred COA that must be brought to the attention of the commander.
/s/_________________________________
Preventive Medicine Staff Officer
Annexes (as required)
DISTRIBUTION: (Is determined locally and includes the command surgeon.)
Section III. FORMAT FOR THE PREVENTIVE MEDICINE PORTION
OF THE COMBAT HEALTH SUPPORT PLAN
(MEDICAL SECTION OF A UNIT)
The purpose of the PVNTMED plan is to outline the strategy necessary to implement the decided upon
COA. This PVNTMED plan format will assist those who are tasked with plan development. Remember the
PVNTMED plan is only a portion of the CHS plan.
PREVENTIVE MEDICINE
1. MEDICAL THREAT (From the PVNTMED estimate, give a brief picture of the size of the threat.)
(Classification)
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FM 4-02.17
(Classification)
a. Heat/cold. (Example: Units conducting combat operations, especially in mission-oriented protective
posture (MOPP) Level 4 and/or in enclosed vehicles, can expect heat casualties in excess of 10 percent of
strength within hours if PMM are not enforced.)
b. Diarrhea.
(Example: The threat from diarrheal casualties should be low for units consuming MRE
and treating all water. Units preparing Class A or B rations or not treating water could experience 20
percent diarrheal casualties within hours if PMM are not enforced.)
c. Biting Arthropods.
(Example: Units should experience few casualties from diseases caused by
biting arthropods if proper personal hygiene is practiced and required laundry support is provided.
Poor personal hygiene/laundry support could result in significant casualties from louse-carried diseases
within weeks.)
d. Other.
(Consider the threat from diseases such as those of the skin, upper respiratory infections,
and schistosomiasis. Also, consider performance detractors such as eye injury due to laser devices, hearing
threshold shifts due to noise exposure, or disrupted physical motor skills from carbon monoxide exposure
due to firing weapons in an enclosed vehicle.)
2. CONCEPT OF SUPPORT (Give a brief overview of the integration of PVNTMED at different levels.)
a. Individuals.
(Example: Perform individual PMM.)
b. Units.
(Example: Enforce individual PMM; perform unit PMM.)
c. Major Units.
(Example: Monitor PVNTMED status of command; request support.)
d. Division PVNTMED Personnel. (Example: Provide support on an area basis.)
e. PVNTMED Detachment. (Example: Provide support with priority to combat units.)
3. RESPONSIBILITIES
a. General Policies.
(State policies applying to all soldiers within the command.)
(1)
Individual PMM.
(2)
Specific policies.
(Example: Policies concerning off-limits areas and immunizations.)
b. Unit Commanders. (Indicate specific requirements, which all unit commanders must enforce within
their units. Start with unit PMM as a basis and add requirements specific for this operation.)
(Classification)
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FM 4-02.17
(Classification)
(1)
Heat/cold.
(Example: Ensure that each soldier is issued an additional canteen, sunscreen,
and specified zone clothing.)
(2)
Diarrhea.
(Example: Obtain food from Class I points only; obtain water from water supply
points only.)
(3)
Biting arthropods. (Example: Ensure each soldier is issued arthropod repellent before deploying.)
(4)
Other.
c. Specific Unit Commander’s Responsibilities. Examples:
(1)
Medical units: (*Reporting responsibilities for diseases/injuries received or admitted. Infectious
waste disposal policy.)
(2)
Quartermaster units: (*Reporting responsibilities of location of water supply points and laundry
exchange.)
(3)
Subordinate units:
(Attachments of PVNTMED teams.)
*These reporting requirements may already be defined in the unit tactical SOP.
(Classification)
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APPENDIX B
ARMY FORCE XXI PREVENTIVE MEDICINE SUPPORT
UNDER THE MEDICAL REENGINEERING INITIATIVE
B-1. General
This appendix provides information on the PVNTMED staff positions of the various command and control
headquarters and the PVNTMED detachment designed under the MRI. It also discusses the mission and
functions of this unit. Further, a discussion of the area medical laboratory PVNTMED staff is also included.
B-2. Medical Command, Echelons Above Corps
The PVNTMED staff (TOE 08611A000) publishes PVNTMED policy on behalf of the MEDCOM
commander and exercises technical control over PVNTMED resources at EAC. The staff prepares 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. This staff is
located in the Professional Services section in the Headquarters and Headquarters Company. The
PVNTMED staff at this level is comprised of a PVNTMED officer, an environmental science officer, and
one PVNTMED NCO.
B-3. Theater Medical Command, Corps
Within the corps MEDCOM, the PVNTMED staff (TOE 8411A000) is attached to the clinical services
section. This staff publishes PVNTMED policy on behalf of the MEDCOM commander; provides
consultation services and technical advice on PVNTMED subjects; and exercises technical control over
PVNTMED resources in the corps. The staff prepares the PVNTMED portion of the MEDCOM CHS
plan. The PVNTMED staff monitors and analyzes DNBI reporting and ensures timely information is
presented to the leadership to counter the DNBI effects on the mission. The PVNTMED staff is comprised
of a PVNTMED officer, a nuclear medical science officer, an entomologist, an environmental science
officer, and a PVNTMED NCO.
B-4. Medical Brigade
The PVNTMED section (TOE 8422A100) within the medical brigade has four staff positions. This section
is comprised of a PVNTMED officer, environmental science officer, a veterinary NCO, and a PVNTMED
NCO. This section carries out policy on behalf of the medical brigade commander; provides consultation
services and technical advice on PVNTMED subjects; and exercises technical control over PVNTMED
resources in the corps. This staff prepares the PVNTMED portion of the medical brigade CHS plan and
monitors and analyzes DNBI reporting to ensure timely information is presented to the leadership to counter
the DNBI effects on the mission.
B-5. Combat Support Hospital
A community health nurse and one PVNTMED specialist are assigned to the CSH to maintain DNBI
surveillance. The community health nurse is the primary officer within the hospital responsible for ensuring
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that basic principles of PVNTMED are met while assessing the medical threat from indigenous populations
and environments. This nurse—
• Plans appropriate interventions for individuals or groups.
• Mobilizes and integrates all available resources for interventions to minimize DNBI and
identified medical threats to the deployed force.
• Assesses health risk needs in all phases of the deployment cycle and humanitarian/disaster
relief operations.
• Recommends appropriate interventions.
• Interfaces with Civil Affairs, and/or NGO affecting civilian public health when the situation
warrants.
B-6. Division Medical Companies
a. The PVNTMED staff at the forward support medical company consists of an environmental
science officer and a PVNTMED specialist. This staff provides support to units located in the brigade
support area. This support includes technical advice to the commander; sanitary inspections of food service
facilities, field sites, latrine, bathing and other facilities; and monitoring field water supplies, including
sample collection for potential NBC contamination. Further, this staff coordinates and provides oversight
of medical surveillance activities, to include early recognition of potential epidemic disease outbreaks and
suspect BW agent employment.
b. The PVNTMED staff at the direct support medical company consists of a three-man team.
The team is comprised of a PVNTMED physician located with the division surgeon, an environmental
science officer, and a PVNTMED specialist. This staff provides subject matter expertise to the division
surgeon on PVNTMED issues.
c.
The PVNTMED staff of the division medical companies provide—
• Preventive medicine support to units located in the brigade support areas/division support
area. In addition, they provide technical advice to the company and the battalion commanders. This
support includes—
•
Training, monitoring, and technical assistance to supported unit FSTs.
•
Conducting sanitary inspections of supported units’ food service, field site, latrine,
bathing, and other facilities for basic sanitation practices. This is accomplished in order to provide early
warning of any breakdown in basic sanitation within the division’s AO. This permits the unit to take
corrective actions before diseases are transmitted.
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• Coordination/oversight and execution of MEDSURV information gathering and
reporting, which enables the early detection and identification of potential disease epidemics or BW agent
employment within the division AO.
• Limited pest management support to supported units.
• Mission assignments to attached PVNTMED teams/detachments. They exercise technical
control and coordinate the administrative and logistical support for the teams/detachments.
• Field water supplies monitoring, to include possible NBC contamination.
• Collection of water and environmental samples from suspect NBC contaminated sources.
They prepare the samples for submission to the supporting medical laboratory for analysis and safeguard
collected samples and ensure chain of custody procedures are followed.
B-7. Operational Concept for the Preventive Medicine Detachment
a. This detachment provides technical consultation support on PVNTMED issues throughout the
TO. The unit provides specialized PVNTMED support in the areas of DNBI surveillance, health physics,
disease-vector identification, environmental engineering, medical threat profile, and health hazard
assessment. The detachment conducts surveillance of troop assembly areas to ensure the adequacy of
PMM; particularly those performed by individuals and small units to protect themselves.
b. 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. The detachment may
function as a single operational activity or may split into a headquarters section and three teams to provide
support to a greater number of units. When the teams are operating in the split-team mode, they must
maintain contact with the detachment headquarters for instructions and guidance. The team is comprised of
an environmental science officer, an entomologist, a senior PVNTMED NCO, one PVNTMED NCO, and
six PVNTMED specialists. The detachment commander may be an environmental science officer or
entomologist. The executive officer will be an officer of the other area of concentration (AOC).
c.
The detachment is:
• Commanded by an environmental science officer or entomologist. The executive officer
will be an officer of the other AOC.
• Dependent upon elements of the corps or EAC for religious, legal, CHS, finance,
personnel and administrative services, graves registration, bath and laundry services, clothing exchange,
unit maintenance, communications maintenance, food service, and resupply of all classes of supply.
• Dependent upon the units to which they are attached for rations, quarters, CHS, religious,
personnel and administrative services, resupply of all classes of supply, and maintenance for vehicles,
communication equipment, and generators.
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B-8. Operational Capabilities for the Preventive Medicine Detachment
The operational capabilities remain the same, however, early arrival of the detachment is essential to
providing preemptive action in identifying, controlling, and protecting troops from the effects of DNBI.
Operational capabilities of the detachment include, but are not limited to—
a. Disease and Nonbattle Injury Surveillance and Epidemiology.
• Gather information systematically to input into an automated medical surveillance system
which produces real-time tactically significant medical threat profiles.
• Provide guidance to the command concerning PMM by performing a medical assessment
of the command and the potential impact of DNBI on military operations.
• Conduct epidemiological investigations to include case-contact interviewing, contact
tracing, and outbreak investigations.
b. Environmental Health.
• Perform on-site water quality analysis.
• Monitor water and field ice production and distribution.
• Collect water, soil, and air samples from sources that may pose environmental,
occupational, or industrial hazards to US troops for definitive laboratory analysis.
• Conduct food service sanitation inspections.
• Monitor and provide guidance on proper field sanitation and waste disposal techniques.
• Provide guidance on the prevention of climatic injuries (heat, cold, and altitude).
c.
Medical Entomology Services.
• Provide direct pest management support, including aerial spray missions. When
directed to conduct aerial spray missions, the detachment must request issue of the aerial spray equipment
from the ASMB.
• Provide entomology consultation on arthropodborne diseases; on poisonous plants or
animals; measures for control or avoidance of disease vectors of military significance; and use of pesticides.
d. Nuclear, Biological, and Chemical Threat.
• Collect water and ice samples for NBC surveillance. Establish and maintain chain of
custody for samples, and forward samples to supporting medical laboratory for identification.
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FM 4-02.17
• Coordinate with Chemical Corps NBC reconnaissance and biological detection units for
the collection of environmental samples (air and soil) for laboratory analysis.
e.
Health Promotion and Education.
• Provide information on specific PMM to counter medical threats.
• Conduct FST and food service sanitation training and certification.
• Conduct health promotion education.
f.
Retrograde Cargo Inspections.
• Conduct inspections of cargo destined out of theater for plants, arthropods, rodents, soil, and
other items as specified to prevent their introduction into the US, its territories and possessions, or other nations.
• Issue vessel clearances for entry into the destination ports, as authorized.
B-9. Location, Assignment, and Basis of Allocation of the Preventive Medicine Detachment
Normally, the detachment is deployed to specific areas in the corps or EAC. However, the detachment may
be deployed to any area within the TO. The detachment may be assigned to the MEDCOM, a medical
brigade, ASMB, or a task force medical C2 headquarters. The detachment may be further attached to a unit
in the division, corps, or EAC.
a. When attached to units in the corps or EAC, the detachment generally collocates on a
temporary basis with the supported unit until the mission is completed or the mission priority changes.
EXAMPLE: The detachment may be assisting in establishment of a refugee camp when a major outbreak
of diarrhea occurs at a debarkation assembly area. In this example, the detachment would end its support
role at the refugee camp and proceed to the debarkation area. At the debarkation area, it would begin the
mission of identifying the source of the diarrhea and establishing control measures.
b. When attached to a division, the detachment generally collocates with the PVNTMED section
of a medical company to ensure coordination of support efforts.
c.
When deployed in general support, the detachment collocates with a medical unit or
headquarters, as discussed above.
d. The basis of allocation for this detachment is one detachment per 17,000 personnel supported.
B-10. Preventive Medicine Detachment Mobility
The PVNTMED detachment is 100 percent mobile. All personnel with personal gear, TOE equipment and
supplies, and required CTA items may be transported on organic vehicles in a single lift. See Appendix H
for strategic deployment information.
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B-11. Preventive Medicine Section, Area Support Medical Battalion
a. The PVNTMED Section of the Area Support Medical Battalion. Within the ASMB the
PVNTMED section has the responsibility for providing PVNTMED support on an area support basis. This
section is responsible for maintaining the aerial spray equipment and supplies. This is a new mission for
this section. Although, the ASMB has the mission of maintaining the spray equipment, it is not staffed to
perform the spray mission. The PVNTMED detachment is staffed to perform this mission. When a
PVNTMED detachment is tasked to perform aerial spray missions, it requests the aerial spray equipment
from the ASMB and also requests the use of a medical evacuation helicopter from the medical evacuation
battalion. The PVNTMED detachment sets up the spray equipment and installs it on the supporting
helicopter. Detachment personnel fly with the helicopter crew to ensure that the sprayer disperses the
insecticide correctly and that the desired area is covered. Upon completion of the aerial spray mission,
detachment personnel clean, pack, and return the spray equipment to the ASMB. The detachment personnel
also prepare a report on the amount of supplies used for the mission so that replacement supplies can be
ordered. The PVNTMED staff provides:
• An estimate of the situation to identify the medical threat in the supported area.
• Essential PVNTMED information for inclusion in the OPLAN, OPORD, and briefings
to ensure awareness of both the medical threat and the corresponding PMM.
• Early warning of any breakdown in basic sanitation within the support area to permit
time for corrective actions before diseases may be transmitted.
• Early detection and warning of potential epidemics within the supported area. Early
warning of disease outbreaks permits implementation of control measures before the disease fully manifests
itself among the forces.
• Limited pest management support to supported units.
• The command health report to document the impact of heat, cold, disease, and other
health hazards to units in the supported area.
• Missions to attached PVNTMED teams/detachments.
• Technical control and coordinates the necessary administrative and logistical support for
the teams/detachments.
• Monitoring of field water supplies, to include possible NBC contamination.
b. The Preventive Medicine Detachment’s Split Teams. The staffing of this section allows for
personnel to be split into teams to conduct evaluations within their assigned AO and/or to be task-organized
to provide direct support to designated corps/EAC units, as required. Specific functions of the PVNTMED
section include, but are not limited to, the following:
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• Assisting the commander in preparing staff estimates by identifying the medical threat.
• Assisting the battalion S2/S3 in determining requirements for medical intelligence
assessments, particularly with respect to disease prevalence.
• Conducting surveillance of corps/EAC units to ensure implementation of PMM at all
levels and to identify actual or potential medical threats and recommending corrective action, as required.
• Assisting corps/EAC units in the training of PMM against environmental (heat and cold)
injuries, as well as food-, water-, and arthropodborne diseases.
• Monitoring the supported units’ immunization program.
• Monitoring and approving the health-related aspects of field water and ice sources, to
include production, distribution, and consumption.
• Monitoring DNBI incidence to optimize early recognition of disease trends and to initiate
preemptive disease suppression measures.
• Conducting epidemiological investigations of disease outbreak and recommending PMM
to minimize effects.
• Monitoring the levels of resupply of field sanitation supplies.
• Conducting limited entomological investigations and control measures.
• Monitoring environmental and meteorological conditions, assessing their health-related
impact on corps/EAC operations, and recommending preventive measures to minimize heat or cold injuries,
as well as selected arthropodborne diseases.
• Assessing the effectiveness of unit field sanitation teams.
• Deploying PVNTMED teams in support of specific units or operations, as required.
• Monitoring disposal practices/facilities for all classes of waste in the ASMB AO.
(1) Preventive medicine officer.
The PVNTMED officer is responsible for the
implementation of the command PVNTMED program. He determines the status of and conditions
influencing the health of units located in the ASMB AO. He formulates and recommends measures for
health improvements. Based on command guidance and corps/EAC requirements, he plans, directs, and
prioritizes the PVNTMED section’s activities. He serves as the principal advisor on medical threats that
will be encountered by supported units in corps/EAC and recommends PMM to minimize these threats in
the AO.
(2) Sanitary engineer officer. The sanitary engineer officer/environmental science officer
serves as the principal assistant to the PVNTMED officer in developing and implementing the command
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