(Corrected 2 October 1998)
Enforce Preventive Medicine Measures for Protection
Against Disease and Non-battle Injuries (DNBI)
081-831-9023
Conditions: Your company is deployed to the field. Given equipment authorized by your table of organization and equipment (TOE) and field sanitation equipment and supplies, AR 40-5 and a Field Sanitation Team (FST) for every unit subject to deployment in a field environment.
Standards: Enforce preventive medicine measures (PMM) against the seven components of the medical threat. Identify specific responsibilities of key personnel for preventing disease and non-battle injuries. Develop a viable plan for the medical threat in the environment to which your unit will deploy to reduce losses due to DNBI.
Training and Evaluation Guide
Performance steps:
1. Identify the three reasons soldiers are vulnerable to disease and non-battle injury.
a. Harshness of the environment such as deserts, jungles, and the Arctic.
b. Reduced natural defenses because of exposure and fatigue. Examples are:
(1) Climatic changes.
(2) Sleep deprivation.
(3) Irregular meals.
c. Breakdowns in basic sanitation such as the lack of safe water, improper waste disposal, and poor personal hygiene.
2. Enforce individual PMM to combat the components of the medical threat.
NOTE: Leaders At All Levels Must Be Aware Of The PMM Required For The Area. They Must Relay This Information Through Training, Information Sessions And Personal Contact. Checking With The Troops, Medical Personnel And The FST Staff Can Provide Information About The Lack Of Appropriate PM. Leaders Must Inspect Personnel And Take Appropriate Action To Correct Deficiencies.
a. PMM to prevent heat injuries.
(1) Drink plenty of water.
(2) Observe work and/or rest cycles.
(3) Eat all meals to replace salt.
(4) Recognize the increased risk of Mission Oriented Protective Posture (MOPP) or body armor and armored vehicles.
b. PMM to prevent cold injuries.
(1) Drink plenty of water and warm, nonalcoholic fluids.
(2) Wear the uniform properly.
(a) Wear clothing as the commander directs.
(b) Keep clothing clean and dry.
(c) Avoid overheating by removing excess clothing when possible.
(d) Wear clothing in loose layers.
(3) Avoid loss of body heat.
(a) Keep moving when possible.
(b) Avoid standing directly on cold, wet ground.
(c) Avoid smoking (smoking decreases blood flow to the skin).
(d) Eat all meals to maintain energy.
NOTE: Remind Soldiers Of Carbon Monoxide Threat Of Sleeping In Vehicles With The Engine Running Or In An Enclosed Area With The Combustible Heating Device.
(4) Protect feet and hands.
(a) Wear gloves or mittens.
(b) Change socks frequently.
(c) Avoid skin contact with snow, fuel, or bare metal.
(5) Use the buddy system to spot frostbite on exposed skin.
c. PMM to protect against biting insects.
(1) Use the Department of Defense (DOD) Repellent System properly.
(a) Permethrin for clothing.
(b) Deet lotion for exposed skin.
(2) Wear the uniform as the commander directs.
(3) Keep your uniform clean.
(4) Protect yourself at night.
(a) Use a bednet when sleeping.
(b) Use non-residual insecticide inside the bednet.
(5) Follow medical advice.
(a) Take antimalarial pills as directed.
(b) Use insect powder, cream, or shampoo when prescribed.
d. PMM to protect against diarrhea.
(1) Water sanitation.
(a) Fill the canteen with treated water from approved (potable) sources when possible.
(b) Disinfect water when water from an approved source is not available. Personal disinfection is done with iodine tablets or with chlorine ampules. Emergency disinfection is done by boiling for l5 minutes.
(2) Food sanitation.
(a) Use approved food sources.
(b) Wash your hands after using the latrine and before touching food.
(c) Dispose of waste properly.
(d) Conduct messkit laundries with treated water if messkits are used.
e. PMM to prevent injuries from non-NBC chemical hazards.
(1) Prevent carbon monoxide poisoning.
(a) Run engines outside when possible.
(b) Use natural ventilation or tailpipe extension systems to dispose of exhaust fumes if inside.
(c) Never use engine exhaust for heat.
(d) Never sleep in a vehicle with the engine running or in an enclosure with a combustible heating device.
(2) Prevent hydrogen chloride poisoning (a by-product of rocket propellent).
(a) Keep upwind of rocket systems (when possible).
(b) Hold your breath (after the blast) until the cloud passes.
(3) Prevent injuries from bore/gun gases.
(a) Ensure on-board ventilation systems work.
(b) Ensure the bore evacuator on large weapons systems is well maintained.
(4) Prevent injuries from solvents, greases, and oils (liquid chemicals).
(a) Minimize exposure when possible by using the least harmful chemicals available.
(b) Use personal protective equipment.
(c) Comply with replacement and medical surveillance physical examinations to detect early signs of illness and disease.
f. PMM to prevent noise hazard injuries.
(1) Use protective devices (earplugs, ear canal caps, or earmuffs).
(2) Use vehicle headgear such as crew helmets for helicopters and armored vehicles.
(3) Ensure all hearing protection devices are kept clean to avoid ear infections.
(4) Avoid or limit the time spent in noise hazardous areas.
g. PMM to prevent the following:
(1) Skin disease.
(a) Protect skin from the elements.
(b) Use sunscreen if necessary.
(c) Keep skin as clean as possible.
(2) Altitude sickness.
(a) Acclimatize to new elevations.
(b) Increase aerobic activity before deployment.
(c) Follow medical advice.
(3) Harmful animals.
(a) Avoid habitats of harmful animals.
(b) Do NOT attempt to capture or make pets of harmful animals (dogs, monkeys, and other partially domesticated animals).
3. Identify specific responsibilities of key individuals at various echelons of command.
a. Individual soldier responsibilities.
(1) Perform good personal hygiene practices.
(2) Perform personal protective measures against components of the medical threat.
(3) Every individual knows and observes the rules of hygiene and sanitation as stated in AR 40-5, paragraph 14-2.
b. Supervisor responsibilities.
(1) Ensure that subordinates perform individual responsibilities.
(2) Ensure that daily unit sanitation practices are completed within established policies.
NOTE: Inspections Along With One-On-One Contact Can Reveal The Lack Of PMM.
c. Command responsibilities (company level).
(1) Assume responsibility for the health of the command.
(2) Direct the enforcement of those PMM that affect units as a whole or are beyond the resources of the individual soldier.
(3) Ensure the appointment of a FST with responsibilities defined below.
(4) Consult with environmental coordinator(s) of preventive medicine personnel on regulations and laws in dealing with waste disposal.
(5) Arrange for maintenance of immunizations and prophylaxis.
(6) Deploy to the field with field sanitation personnel and equipment.
(7) Assure command supervision of individual PMM.
(8) Use other appropriate measures outlined in FM 21-10 as necessary.
(9) Request assistance for problems exceeding unit capabilities.
d. FST responsibilities.
(1) Company-sized units must have an FST.
NOTE: Any Unit Subject To Deployment To The Field Should Have A Trained FST.
NOTE: Training Enables Unit Commanders To Provide For Control Of Insects, Proper Disinfection Of Water, And Safe Food Supplies.
(2) If no organic medical personnel are available--
(a) Two soldiers are selected to receive FST training.
(b) One soldier must be a NCO.
(c) Neither will have less than six months of unit time remaining.
(d) These soldiers should receive training from preventive medicine (PM) personnel in accordance with AR 40-5.
NOTE: All Unit Leaders Should Be Able To Perform The FST Duties.
(3) FST responsibilities. The unit FST performs the following duties in the unit area:
(a) Checks unit water supplies.
(b) Inspects unit water containers and unit water trailer(s).
(c) Inspects unit field food operations for application of PMM to prevent contamination.
(d) Conducts limited control of insects.
(e) Inspects unit waste disposal for compliance with PMM procedures.
(f) Conducts limited control of rodents.
(g) Provides training for the unit in individual PMM.
(h) Advises unit leaders on construction and maintenance of field waste disposal and personal hygiene devices.
e. Request use of division-level PM resources to support field forces. Resources and missions are--
(1) Division PM Section composition.
(a) One PM officer (MC--MAJ, 60C).
(b) One environmental science officer (ESO) (MS--CPT).
(c) Three to nine enlisted preventive medicine specialists (91S).
(2) Division PM Section missions.
(a) Identify breakdowns in PMM (individual and leader/unit).
(b) Inform commanders on specific measures to repair the breakdowns.
(c) Provide technical assistance for training the unit FSTs.
(d) Monitor training of individual and unit PMM.
(e) Perform limited sanitation and vector control work.
f. Request use of corps-level PM resources to support field forces. Resources and missions are--
(1) Corps PM detachments (Medical Detachment, Preventive Medicine [Med Det, PM], Med Det, PM (Sanitation [SANI]) and Med Det, PM (Entomology [ENTO]).
(a) Two officers and nine enlisted personnel each (Med Det, PM (SANI), a commander (ESO) or a sanitary engineer and an executive officer (entomologist). Med Det, PM (ENTO), a commander (entomologist) and an executive officer (ESO or sanitary engineer). Each 100 percent armed and mobile.
(b) Provide PM support to deployed forces in the corps/COMMZ in a direct support role or a general support role. Transport organic personnel and equipment with logistical support from a unit in the geographic area. Perform area and aerial spraying missions, Med Det, PM (ENTO) only.
(c) Allocation to a theater. Med Det, PM (SANI), one per 22,500 personnel supported (nondivisional/corps units) or two per division. Med Det, PM (ENTO), one per 45,000 soldiers supported or one for two Med Det, PM (SANI) detachments. Med Det, PM (SANI), one for every 50,000 EPWs and/or refugees/ displaced persons. Med Det, PM (ENTO), one for every 100,000 EPWs and/or refugees/displaced persons.
g. Armored cavalry regiment (ACR).
(1) One PM specialist (91S30/E-6) to support a squadron.
(2) Provide the same type of support to the regiment as the division PM Section provides to the division.
h. Separate brigades (Separate Infantry Brigade [SIB] and Heavy Separate Brigade [HSB]).
(1) PM assets assigned to the medical company of the support battalion. (Requirement [on the TO&E] in both for an ESO and for three 91S personnel.)
(2) Provide the same type of support to the SIB/HSB that the Division PM Section provides to the division.
I. Civil Affairs Units (CA).
(1) PM resources (on the TO&E) at the CA command level, CA brigade level, and at the general support and direct support detachments. Assigned personnel may include a sanitary engineer, an ESO, a preventive medicine physician (60C), and a preventive medicine specialist (91S).
(2) Provide support for displaced persons (Dps), refugees, and evacuees. Re-establish essential public health services.
4. Plan for the medical threat in the area to which your unit will be or is deployed.
a. Obtain medical intelligence on the deployment area. Some sources for the medical threat material are:
(1) Supporting preventive medicine section and/or unit.
(2) Command surgeon.
(3) Armed Forces Medical Intelligence Agency.
b. Inform personnel of the medical threat in the deployment area.
c. Obtain materials needed to combat the medical threat.
(1) Obtain needed PMM equipment and supplies.
(2) Obtain immunizations and chemoprophylaxis before deployment.
Performance Evaluation Guide
Evaluation Preparation: Evaluate this task during a normal training session. If the evaluation is conducted during a field training exercise (FTX), the environmental and physical conditions at the FTX will be used as the scenario for which PMM measures are implemented. Select performance measures appropriate for the FTX scenario. If the evaluation is done during a normal training session, create a scenario to include environmental and physical conditions, then select the appropriate performance measures to be evaluated.
Brief Soldier: Tell the soldier he or she will be evaluated on his or her ability to enforce appropriate PMM for protection against disease and non-battle injuries. The evaluation will be based on performance measures listed for the task.
Performance measures / Results1. Identified the three reasons soldiers are vulnerable to disease and non-battle injuries. / GO / NO-GO
2. Identified PMM actions to combat components of the medical threat. / GO / NO-GO
3. Identified responsibilities of individuals and echelons of command for preventing disease and non-battle injuries. / GO / NO-GO
4. Identified sources of medical threat information. / GO / NO-GO
Evaluation Guidance: Score the soldier GO if all performance measures are passed. Score the soldier NO-GO if any performance measure is failed. If the soldier scores NO-GO, show what was done wrong and how to do it correctly.
Required References:
AR 40-5
AR 600-63
FM 21-10
FM 21-10-1
1
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