PRERESIDENT TRAINING SUPPORT PACKAGE

U.S. ARMY SERGEANTS MAJOR ACADEMY (FSC-TATS) W663 JUN 06 PREVENTIVE MEDICINE MEASURES PRERESIDENT TRAINING SUPPORT PACKAGE

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PRERESIDENT TRAINING SUPPORT PACKAGE (TSP) TSP Number / Title W663 / PREVENTIVE MEDICINE MEASURES Effective Date 01 Jun 2006 Supersedes TSP(s) / Lesson(s) TSP Users Proponent Improvement Comments W663, Preventive Medicine Measures, Jun 04. 521-SQIM (DL), First Sergeant Course The proponent for this document is the Sergeants Major Academy. Users are invited to send comments and suggested improvements on DA Form 2028, Recommended Changes to Publications and Blank Forms. Completed forms, or equivalent response, will be mailed or attached to electronic e-mail and transmitted to: COMDT USASMA ATTN ATSS DCF BLDG 11291 BIGGS FIELD FORT BLISS TX 79918-8002 Telephone (Comm) (915) 568-8875 Telephone (DSN) 978-8875 E-mail: atss-dcd@bliss.army.mil Security Clearance / Access Foreign Disclosure Restrictions Unclassified FD5. This product/publication has been reviewed by the product developers in coordination with the USASMA foreign disclosure authority. This product is releasable to students from all requesting foreign countries without restrictions. 1

PREFACE Purpose This Training Support Package provides the student with a standardized lesson plan of instruction for: Task Number Task Title 081-831-9023 Enforce Preventive Medicine Measures for Protection Against Disease and Nonbattle Injuries 2

This TSP Contains TABLE OF CONTENTS PAGE Preface... 2 Lesson Section I Administrative Data... 4 Section II Introduction... 6 Terminal Learning Objective - Identify actions to implement preventive medicine measures for protection against disease and nonbattle injuries.... 6 Section III Presentation... 8 Enabling Learning Objective A - Identify unit level preventive medicine measures... 8 Enabling Learning Objective B - Identify leader preventive medicine measures necessary to counter environmental threats.... 9 Section IV Summary... 10 Section V Student Evaluation... 11 Appendix A - Viewgraph Masters (N/A) A -... 1 Appendix B - Test(s) and Test Solution(s) (N/A) B -... 1 Appendix C - Practical Exercises and Solutions C -... 1 Appendix D - Student Handouts D -... 1 3

PREVENTIVE MEDICINE MEASURES W663 / Version 1 01 Jun 2006 SECTION I. ADMINISTRATIVE DATA All Courses Including This Lesson Task(s) Taught(*) or Supported Course Number Version Course Title 521-SQIM 1 First Sergeant Course Task Number Task Title 081-831-9023 Enforce Preventive Medicine Measures for Protection Against Disease and Nonbattle Injuries Reinforced Task(s) Task Number None Task Title Academic Hours The academic hours required to teach this lesson are as follows: Test Test Review Distance Learning Hours/Methods 40 mins / Study Assignment 1 hr 10 mins / Practical Exercise (Performance) 0 hrs 0 hrs Total Hours: 2 hrs Test Lesson Number Hours Lesson No. Testing (to include test review) 3 hrs W516 version 1 Prerequisite Lesson(s) Lesson Number None Lesson Title Clearance Access Foreign Disclosure Restrictions Security Level: Unclassified Requirements: There are no clearance or access requirements for the lesson. FD5. This product/publication has been reviewed by the product developers in coordination with the USASMA foreign disclosure authority. This product is releasable to students from all requesting foreign countries without restrictions. References Number Title Date Additional Information AR 40-5 FM 21-10 FM 4-25.12 PREVENTIVE MEDICINE FIELD HYGIENE AND SANITATION UNIT FIELD SANITATION TEAM 22 Jul 2005 21 Jun 2000 25 Jan 2002 Student Study Assignments All material included in this Training Support Package (TSP). 4

Instructor Requirements Additional Support Personnel Requirements None Name MSG, FSC graduate, ITC, and SGITC graduate, (Enlisted) Stu Ratio Qty Man Hours 1:14 1 2 hrs Equipment Required for Instruction Id Name None Stu Ratio Instr Ratio Spt Qty Exp * Before Id indicates a TADSS Materials Required Instructor Materials: None Student Materials: TSP. Pen or pencil and paper. Classroom, Training Area, and Range Requirements None Ammunition Requirements Id Name Exp None Stu Ratio Instr Ratio Spt Qty Instructional Guidance None Proponent Lesson Plan Approvals Name Gaskin, John Rank CIV Position Training Specialist Date Smith, Sandra SGM Chief Instructor, FSC Estrada, Manuel. SGM USASMA, CI Salcido, Benjamin GS-09 Chief, FSC Todd, Raymond L. SGM Chief, Functional Course Bennett-Green, Agnes SGM Chief, CMDD 5

SECTION II. INTRODUCTION Method of Instruction: Study Assignment Technique of Delivery: Individualized, self-paced Instruction Instructor to Student Ratio is: 1:14 Time of Instruction: 5 mins Media: None Motivator Terminal Learning Objective In addition to the normal occupational hazards that Soldiers must face, they often have to live in primitive conditions that subject them to hundreds of diseases and nonbattle injuries (DNBI). Throughout history, armies have had tremendous problems with heat, cold, and disease. Diseases and nonbattle injuries (DNBI) have caused the greatest wartime loss of human resources. The preventive medicine measures (PMM) required by AR 40-5 can effectively counter the DNBI threat, but many of these PMM require actions or resources beyond the capabilities of the individual Soldier. If you fail to plan, resource, and enforce the essential PMM, DNBI can dramatically reduce the combat power of your unit. Preventive medicine for your Soldiers is just as essential as preventive maintenance for your vehicles. This lesson will provide you with a better understanding of the DNBI threat, your preventive medicine responsibilities, and the PMM planning process. Your actions in this area are essential to maintaining the welfare of your Soldiers and your unit's fighting strength. At the completion of this lesson, you [the student] will: Action: Conditions: Standards: Identify actions to implement preventive medicine measures for protection against disease and nonbattle injuries. As a first sergeant in a self-study environment given extracts from AR 40-5 (SH-1), FM 21-10 (SH-2), and FM 4-25.12 (SH-3). Identified actions to implement preventive medicine measures for protection against disease and nonbattle injuries IAW AR 40-5, FM 21-10, and FM 4-25.12. Safety Requirements Risk Assessment Level None Low 6

Environmental Considerations NOTE: It is the responsibility of all Soldiers and DA civilians to protect the environment from damage. None Evaluation Instructional Lead-In At the end of your Phase I training and before entering Phase II, you will take an on-line, multiple choice examination. It will test your comprehension of the learning objectives from this and other lessons in Phase I. You must correctly answer 70 percent or more of the questions on the examination to receive a GO. Failure to achieve a GO on the examination will result in a retest. Failure on the retest could result in your dismissal from the course. None 7

SECTION III. PRESENTATION A. ENABLING LEARNING OBJECTIVE ACTION: CONDITIONS: Identify unit level preventive medicine measures. As a first sergeant in a self-study environment given AR 40-5 (SH-1), FM 21-10 (SH-2), and FM 4-25.12 (SH-3). STANDARDS: Identify unit level preventive medicine measures IAW AR 40-5, FM 21-10, and FM 4-25.12. 1. Learning Step / Activity 1. Unit Level Preventive Medicine Measures Method of Instruction: Study Assignment Technique of Delivery: Individualized, self-paced instruction Instructor to Student Ratio is: 1:14 Time of Instruction: 15 mins Media: SH-1 thru SH-3 To complete this learning step activity, you are to-- Read the above ELO. Read AR 40-5 (SH-1) and FM 21-10, Chapter 1 and Chapter 3, pp 3-1 thru 3-4 (SH-2). Scan FM 4-25.12 (SH-3). 2. Learning Step / Activity 2. Unit Level Preventive Medicine Measures Method of Instruction: Practical Exercise (Performance) Technique of Delivery: Individualized, self-paced instruction Instructor to Student Ratio: 1:14 Time of Instruction: 30 mins Media: SH-1 thru SH-3 Try to complete the questions in this practical exercise without referring to the student handout. Write your answer in the space provided. This is a self-graded exercise. It should take you approximately 30 minutes to complete the questions. Complete questions 1 thru 12 of PE-1, pp C-2 thru C-4. Compare your responses with the solutions on pp C-6 thru C-8. If your response does not agree, review the appropriate reference/lesson material. CHECK ON LEARNING: The practical exercise serves as a check on learning for ELO A. 8

B. ENABLING LEARNING OBJECTIVE ACTION: Identify leader preventive medicine measures necessary to counter environmental threats. CONDITIONS: As a first sergeant in a self-study environment given FM 21-10 (SH-2). STANDARDS: Identify leader preventive medicine measures necessary to counter environmental threats IAW FM 21-10. 1. Learning Step / Activity 1. Leader Preventive Medicine Measures Method of Instruction: Study Assignment Technique of Delivery: Individualized, self-paced instruction Instructor to Student Ratio is: 1:14 Time of Instruction: 15 mins Media: SH-2 To complete this learning step activity, you are to-- Read the above ELO. Read FM 21-10, Chapter 3, pp 3-4 thru 3-35 (SH-2). 2. Learning Step / Activity 2. Leader Preventive Medicine Measures Method of Instruction: Practical Exercise (Performance) Technique of Delivery: Individualized, self-paced instruction Instructor to Student Ratio: 1:14 Time of Instruction: 30 mins Media: SH-2 Try to complete the questions in this practical exercise without referring to the student handout. Write your answer in the space provided. This is a self-graded exercise. It should take you approximately 30 minutes to complete the questions. Complete questions 13 thru 20 of PE-1, pp C-4 and C-5. Compare your responses with the solutions on pp C-8 and C-9. If your response does not agree, review the appropriate reference/lesson material. CHECK ON LEARNING: The practical exercise serves as a check on learning for ELO B. 9

SECTION IV. SUMMARY Method of Instruction: Study Assignment Technique of Delivery: Individualized, self-paced Instruction Instructor to Student Ratio is: 1:14 Time of Instruction: 5 mins Media: None Check on Learning Review / Summarize Lesson Complete PE-1 as the check on learning for this lesson. You and your Soldiers should be so familiar with preventive medicine measures that they are second nature to you. However, many units do not often spend continuous time in a field environment. Even units with extensive field time may train in an area where there are no latrines and facilities for washing. You must plan ahead for situations where these amenities are not available. Use FM 21-10 as your guide. The impact of losses due to DNBI is one prominent and continuous feature of military operations. Immense problems with heat, cold, and communicable diseases continue to plague modern armies. In all U.S. conflicts, the ratio of DNBI casualties to casualties due to enemy action is three to one. Maintaining your Soldiers' good health is essential to success in battle. Transition to Next Lesson None 10

SECTION V. STUDENT EVALUATION Testing Requirements At the end of your Phase I training and before entering Phase II, you will take an on-line, multiple choice examination. It will test your comprehension of the learning objectives from this and other lessons in Phase I. You must correctly answer 70 percent or more of the questions on the examination to receive a GO. Failure to achieve a GO on the examination will result in a retest. Failure on the retest could result in your dismissal from the course. Feedback Requirements NOTE: Feedback is essential to effective learning. 11

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STUDENT QUESTIONAIRE W663 Directions Enter your name, your rank, and the date you complete this questionnaire. Rank: Name: Date: Answer items 1 through 6 below in the space provided. Fold the questionnaire so the address for USASMA is visible. Print your return address, add postage, and mail. Note: Your response to this questionnaire will assist USASMA in refining and improving this course. While completing the questionnaire, answer each question frankly. Your assistance helps build and maintain the best curriculum possible. Item 1 Do you believe you have met the learning objectives of this lesson? Item 2 Was the material covered in this lesson new to you? Item 3 Which parts of the lesson were most helpful to you in learning the objectives? Item 4 How could we improve the format of this lesson? Item 5 How could we improve the content of this lesson? Item 6 Do you have additional questions or comments? If you do, please list them here. You may add additional pages if necessary. 13

ATTN ATSS DCF COMDT USASMA BLDG 11291 BIGGS FLD FORT BLISS TX 79918-8002 ----------------------------------------(Fold Here)------------------------------------------- 14

Appendix A - Viewgraph Masters (N/A) A-1

Appendix B - Test(s) and Test Solution(s) (N/A) B-1

PRACTICAL EXERCISE 1 Title Lesson Number/Title Introduction Motivator Terminal Learning Objective Safety Requirements PREVENTIVE MEDICINE MEASURES W663 version 1 / Preventive Medicine Measures None None At the completion of this lesson, you [the student] will: Action: Conditions: Standards: None Identify actions to implement preventive medicine measures for protection against disease and nonbattle injuries. As a first sergeant in a self-study environment given extracts from AR 40-5 (SH-1), FM 21-10 (SH-2), and FM 4-25.12 (SH-3). Identify actions to implement preventive medicine measures for protection against disease and nonbattle injuries IAW AR 40-5, FM 21-10, and FM 4-25.12. Risk Assessment Level Environmental Considerations Low None Evaluation At the end of your Phase I training and before entering Phase II, you will take an on-line, multiple choice examination. It will test your comprehension of the learning objectives from this and other lessons in Phase I. You must correctly answer 70 percent or more of the questions on the examination to receive a GO. Failure to achieve a GO on the examination will result in a retest. Failure on the retest could result in your dismissal from the course. Instructional Lead-In Resource Requirements None Instructor Materials: None Student Materials: TSP. Pen or pencil and paper. C-1

Special Instructions Do not use any reference material or refer to the solution until after you complete the items in this practical exercise (PE). Write your answers in the space provided. Procedures This is a self-graded exercise. Question 1 What are the categories of Disease and Nonbattle Injury (DNBIs)? Question 2 What are some things that will cause diarrheal diseases? Question 3 What is your option upon deployment and your unit does not have a Field Sanitation Team (FST)? Question 4 Question 5 Field preventive medicine service focuses on what three things? What are the objectives of field preventive medicine? C-2

Question 6 To defeat the medical threat through the use of individual and unit preventive medicine measures; what must be done prior to and during exercises and all deployments? Question 7 According to FM 21-10, what are the eight elements of the medical threat? Question 8 According to FM 21-10, what are the three principles of preventive medicine measures? Question 9 When you plan for high heat conditions, who should you use to train individuals and their leaders in preventive medicine measures (PMM)? Question 10 When you plan for high heat conditions, you must consider how much potable water you may need. Each Soldier may need up to how many gallons per day just for drinking? Question 11 You may receive heat condition information in two different formats. What are they? Question 12 Heat category 3 (yellow) equates to what WBGT Index degrees F? C-3

Question 13 During high heat conditions, you must ensure the leaders in your unit enforce water intake. What seven things does FM 21-10 say leaders should do to enforce water intake? Question 14 When your unit is under high heat conditions, you must recognize conditions that increase the risk of heat casualties. If Soldiers are in MOPP, how many degrees do you add to the wet bulb globe index measurement? Question 15 When your unit is under high heat conditions, you may need to direct Soldiers to modify the wear of the uniform. However, you should NOT direct or authorize Soldiers to unblouse their pants or roll up their sleeves when your unit is under what medical threat? Question 16 If your unit is in a field environment where the wind chill is -20 F and below, what preventive medicine measures does FM 21-10 recommend? Question 17 What conditions place Soldiers at higher risk for cold injuries? Question 18 What does FM 21-10 suggest is an adequate supply of iodine water purification tablets? C-4

Question 19 Where should you emplace field latrines? Question 20 In order to enforce preventive medicine measures, you need to know the effects of sleep loss. Which Soldiers need the most sleep? Feedback Requirements None C-5

SOLUTION FOR PRACTICAL EXERCISE 1 Question 1 The correct response is: (1) Heat injuries caused by heat stress and insufficient water consumption. (2) Cold injuries caused by combinations of low temperatures, wind, and wetness. (3) Diseases and injuries caused by arthropods, other animals, and hazardous plants. (4) Diarrheal diseases caused by drinking contaminated water, eating contaminated foods, and not practicing good personal and unit sanitation and hygiene measures. (5) Diseases, trauma, or injuries caused by poor health or fitness or injuries caused by training or sports. (6) Occupational and environmental diseases and injuries caused by physical, chemical, biological, and radiological hazards. (7) Disease threats resulting from exposure at high altitudes. (8) Communicable diseases and sexually transmitted diseases. Ref: AR 40-5, p 17, para 2-28a(1) thru (8) Question 2 The correct response is: Drinking contaminated water. Eating contaminated foods. Not practicing good personal and unit sanitation and hygiene measures. Ref: AR 40-5, p 17, para 2-28a(4) Question 3 The correct response is: Obtain FST support from another unit. Ref: AR 40-5, p 17, para 2-28(d) Question 4 The correct response is: The health and fitness components of force medical readiness. The operational management. Effective communication of health risks. Ref: AR 40-5, p 3, para 1-7b(1) C-6

Question 5 The correct response is: Provide commanders with healthy and fit deployable forces. To sustain the health and fitness in any military operation. To prevent casualties from DNBI and stress reactions. Ref: AR 40-5, p 3, para 1-7b(2) Question 6 The correct response is: Unit leaders will motivate, train, and equip subordinates. Ref: AR 40-5, p 3, para 1-7b(4)a Question 7 The correct response is: Heat, cold, arthropods and other animals, food/waterborne diseases, toxic industrial chemicals/materials, noise, nonbattle injury, and the unfit service member. Ref: FM 21-10, Chap 1, section II, pp 1-3 and 1-4 Question 8 The correct response is: Service members perform individual techniques of PMM. Chain of command plans for and enforces PMM. Field sanitation teams train service members in PMM and advise the commander and unit leaders on implementation of unit-level PMM. Ref: FM 21-10, Chap 1, Section II, p 1-4 Question 9 The correct response is: Your field sanitation team (FST). Ref: FM 21-10, Chap 3, Section I, under "Plan for the Heat", p 3-1 Question 10 The correct response is: Up to 3 gallons of water per day. Ref: FM 21-10, Chap 3, Section I, under "Plan for the Heat," p 3-2 C-1

Question 11 The correct response is: Category: 1, 2, 3, 4, and/or 5. Wet bulb globe temperature (WBGT) index. Ref: FM 21-10, Chap 3, Section I, under "Obtain and Use Heat Condition Information," p 3-3 Question 12 The correct response is: 85-87.9 F. Ref: FM 21-10, Chap 3, Section I, Table 3-1, under "Obtain and Use Heat Condition Information," p 3-4 _ Question 13 The correct response is: Observing service members drinking required amounts. Encourage frequent drinking of water in small amounts. Ensuring that service members practice good field hygiene. Providing cool water; if desired, you can add flavoring after disinfection to enhance consumption (not in canteens). Ensuring troops drink water before starting any hard work or mission (in the morning, with/after meals). Ensuring buddy system is being used. Frequently checking service members' canteens for water; not beverages. Making sure service members have adequate time to eat and drink as mission permits. Ref: FM 21-10, Chap 3, Section I, under "Enforce Individual Preventive Medicine Measures", p 3-6 Question 14 The correct response is: 10 F. Ref: FM 21-10, Chap 3, Section I, Table 3-1, under "Obtain and Use Heat Condition Information, p 3-4 Question 15 The correct response is: If the medical threat from biting arthropods is high. Ref: FM 21-10, Chap 3, Section I, under NOTE in "Modify Wear of the Uniform," p 3-8 Question 16 The correct response is: Modify or curtail all but mission essential field operations. Ref: FM 21-10, Chap 3, Section II, Table 3-4 "Determine and Use Windchill Factor, p 3-13 C-2

Question 17 The correct response is: Previous trench foot or frostbite. Fatigue. Use of alcohol. Significant injuries. Poor nutrition. Use of medications which cause drowsiness. Little previous experience in cold weather. Immobilized or subject to greatly reduced activity. Service members wearing wet clothing. Sleep deprivation. Ref: FM 21-10, Chap 3, Section II, under "Identify Special Considerations," pp 3-14 and 3-15 Question 18 The correct response is: One bottle for each individual. Ref: FM 21-10, Chap 3, Section V, under "Plan for Safe Water," p 3-23 Question 19 The correct response is: As far from food operations as possible (100 meters or more). Downwind and down slope, if possible. Down slope from wells, springs, streams, and other water sources (30 meters or more). Ref: FM 21-10, Chap 3, Section V, under "Plan for the Construction and Maintenance of Field Sanitation Devices," p 3-25 Question 20 The correct response is: Those Soldiers with the most complex mental or decision-making jobs need the most sleep--this means you and your most critical leaders and operators. Ref: FM 21-10, Chap 3, Section V, under "Enforce Preventive Medicine Measures for the Effects of Sleep Loss," p 3-29 C-3

HANDOUTS FOR LESSON: W663 version 1 This appendix contains the items listed in this table-- Title/Synopsis SH-1, Extracted Material from AR 40-5 SH-2, Extracted Material from FM 21-10 SH-3, Extracted Material from FM 4-25.12 Pages SH-1-1 SH-2-1 SH-3-1 D-1

Extracted Material from AR 40-5 Student Handout 1 This student handout contains three pages of extracted material from the following publication: AR 40-5, Preventive Medicine, 22 Jul 2005 Chapters 1 and 2 pages 3, 4, and 17 Disclaimer: The training developer downloaded the extracted material from the United States Army Publishing Agency Home Page. The text may contain passive voice, misspellings, grammatical errors, etc., and may not be in compliance with the Army Writing Style Program. SH-1-1

(5) Demonstration of accomplishments using process and outcome measurements. f. Knowledge and application of the principles of obtaining and executing resources through the Military Planning, Programming, Budgeting, and Execution System are essential skills for Army preventive medicine personnel. Without such skills, preventive medicine personnel responsible and accountable for obtaining and executing resources will not be able to perform those functions. 1 7. Preventive medicine programs and services This paragraph broadly describes the components and scope of the Army preventive medicine functional areas. It directs the development and implementation of a wide range of specific preventive medicine programs and services. Health surveillance and epidemiology; toxicology and laboratory services; health risk assessment; and health risk communication are foundation components of Army preventive medicine that directly support and must be integrated into the other components of preventive medicine. The detailed implementing guidance and instructions for each of the required programs and services in this regulation are provided in Department of the Army Pamphlet (DA Pam) 40 11. The publication of new Army documents with guidance and instructions specific to any of the required individual programs and services is authorized. The following describe the Army preventive medicine functional areas: a. Disease prevention and control. (1) Primary care, preventive medicine, and other health care providers in both tables of distribution and allowances (TDA) and tables of organization and equipment (TO&E) medical organizations deliver disease prevention and control services. These services, delivered in clinical and nonclinical settings, are initiated to prevent the occurrence and reduce the severity and consequences of diseases in individuals and populations. Examples include screening and monitoring procedures for early detection of disease (using a variety of clinical examinations and laboratory tests), immunizations to prevent disease, chemoprophylaxis for individuals exposed to infectious diseases, infection control, and preventive medicine counseling. (2) Disease prevention and control programs and services will be provided according to the detailed implementing instructions and guidance published in DA Pam 40 11, chapter 2. Specific programs, services, and capabilities will be established and provided for the following areas: (a) Communicable disease prevention and control to include 1. Immunization and chemoprophylaxis. 2. Acute respiratory disease. 3. Meningococcal infection. 4. Malaria. 5. Viral hepatitis. 6. Sexually transmitted diseases. 7. Rabies. 8. Tuberculosis. 9. Biowarfare threat. (b) Travel medicine. (c) Population health management. (d) Hospital-acquired infection control. b. Field preventive medicine. (1) The principles and practices of Army preventive medicine will apply to all Army individuals and units in all field-training environments and across the full spectrum of military operations. Field preventive medicine services will focus on the health and fitness components of force medical readiness and on the operational management and effective communication of health risks. (2) The overall objectives of field preventive medicine are to provide commanders with healthy and fit deployable forces; to sustain the health and fitness in any military operation; and to prevent casualties from DNBI and stress reactions. (3) Field preventive medicine services will include capabilities from the following U.S. Army Medical Department (AMEDD) functional areas, as described in Field Manual (FM) 4 02, chapter 5: (a) Preventive medicine services. (b) Veterinary services. (c) Combat and operational stress control. (d) Dental services (preventive dentistry). (e) Laboratory services (those supporting the above four AMEDD functional areas). (4) Field preventive medicine services will be provided according to Army doctrine published in FM 4 02, FM 4 02.17, FM 4 02.18, FM 4 02.19, FM 4 25.12, FM 8 51, FM 8 55, and their supporting references, as well as in DA Pam 40 11, chapter 3. (a) Soldiers will apply the basic individual preventive medicine measures prescribed in FM 8 55, paragraph 11 5, and FM 21 10/MCRP 4 11.1D, chapter 2. Unit leaders will motivate, train, and equip subordinates prior to and during AR 40 5 22 July 2005 3

field training exercises and all deployments to defeat the medical threat through the use of individual and unit preventive measures as described in FM 4 25.12, chapters 1 2 and appendices A D, and FM 21 10/MCRP 4 11.1D, chapters 2 4 and appendix A. (b) Company-sized units will establish and employ manned, trained, and equipped unit field sanitation teams (FSTs), according to the Army doctrine published in FM 4 02.17, chapter 2 and appendix A, and FM 4 25.12, chapters 1 2 and appendixes A D. (c) Medical and OEH surveillance will be provided for each Soldier from accession through the entire length of each Soldier s service commitment. Such surveillance will be provided according to the doctrinal principles defined in FM 4 02.17, chapters 3, 4, 6 through 9, and appendixes A, C, E, and F. Additional guidance can be found in DA Pam 40 11, chapter 6. (d) Field preventive medicine information management needs will be met using standard military medical and nonmedical information and communication systems, and tactics, techniques and procedures prescribed by doctrine (for example, FM 4 02.16, chapters 1 5 and appendixes A H). (e) Health risk communication will be provided in the field through planning and implementation using proven processes and tools. c. Environmental health. (1) In Army preventive medicine, environmental health consists of those capabilities and activities necessary to anticipate, identify, assess, and control risks of immediate and delayed-onset DNBI to personnel from exposures encountered in the environment. These exposures include risks from chemical, biological, radiological, and physical hazards. These risks will be evaluated using standardized risk assessment principles and procedures. (2) Environmental health programs and services will be provided according to the detailed implementing instructions and guidance published in DA Pam 40 11, chapters 3 and 4. Environmental health programs, services, and capabilities will be established and provided for the following specific areas: (a) Drinking water. (b) Recreational waters. (c) Ice manufacture. (d) Wastewater. (e) Pest and disease vector prevention and control. (f) Solid waste. (g) Hazardous waste. (h) Groundwater and subsurface release of hazardous constituents. (i) Regulated medical waste. (j) Waste disposal guidance. (k) Spill control. (l) Air quality. (m) Environmental noise. (n) Climatic injury prevention and control. (o) Sanitation and hygiene, including the following topics: 1. Troop housing sanitation. 2. Barber and beauty shops. 3. Dry cleaning operations. 4. Mobile home parks. 5. Child development services facilities. 6. Recreational areas. 7. Laundry operations. 8. Confinement facilities. 9. Food service sanitation. 10. Sports facilities, gymnasiums, and fitness centers. 11. Tattooing and piercing businesses. d. Occupational health. (1) In Army preventive medicine, occupational health consists of those capabilities and activities necessary to anticipate, identify, assess, communicate, mitigate, and control occupational disease and injury threats. This includes management of the risks to personnel from exposures encountered at their worksite in garrison and field settings. Occupational health hazards include risks from chemical, biological, radiological, physical, and psychological threats. These risks will be evaluated using standardized risk assessment methodologies. (2) The Army Occupational Health Program s medical components will be developed and provided consistent with the Defense Safety and Occupational Health Program and implemented according to the detailed instructions and 4 AR 40 5 22 July 2005

a. Advise the command on all preventive medicine matters pertaining to the command. b. Provide staff and technical oversight of all preventive medicine assets of the command. c. Provide implementing guidance for field preventive medicine programs and services. d. Ensure that medical events on the current Tri-Service Reportable Events list are reported through the RMES as soon as possible after the diagnosis has been made or within 48 hours. e. Coordinate preventive medicine support provided to the command by installation medical assets with the medical asset commander or installation director of health services and the chief of preventive medicine services of the supporting MEDCEN or MEDDAC. 2 28. Unit commanders and leaders Unit commanders and leaders will a. Inform, motivate, train, and equip subordinates and work closely with Army preventive medicine personnel to defeat the threat of DNBI. Broad categories of DNBIs include (1) Heat injuries caused by heat stress and insufficient water consumption. (2) Cold injuries caused by combinations of low temperatures, wind, and wetness. (3) Diseases and injuries caused by arthropods, other animals, and hazardous plants. (4) Diarrheal diseases caused by drinking contaminated water, eating contaminated foods, and not practicing good personal and unit sanitation and hygiene measures. (5) Diseases, trauma, or injuries caused by poor health or fitness or injuries caused by training or sports. (6) Occupational and environmental diseases and injuries caused by physical, chemical, biological, and radiological hazards. (7) Disease threats resulting from exposure at high altitudes. (8) Communicable diseases and sexually transmitted diseases. b. Ensure compliance with preventive medicine guidance and the use of countermeasures. c. Promote combat and operational stress control programs and procedures. d. Ensure the establishment, manning, training, and equipping of unit FSTs at the company level, or obtain FST support from another unit, according to Army doctrine published in FM 4 02.17, chapters 1 2; FM 4 25.12, chapters 1 2 and appendixes A D; and FM 8 55, paragraphs 11 1 through 11 6. e. Execute the unit leader responsibilities defined in FM 4 02.17. U.S. Army Reserve Component unit commanders and leaders may request guidance and support from the local Active Army RMC, using the RMC point of contact for Reserve Component support. f. Provide after-action reports after deployments and training exercises that include preventive medicine issues to the AMEDDC&S as part of the Center for Army Lessons Learned Program (see AR 11 33). g. Record and report all pesticide applications, except arthropod skin and clothing repellent applications, according to the guidance in DA Pam 40 11, chapter 4. h. Ensure compliance with pre- and post-deployment surveillance procedures. 2 29. Managers and supervisors at all levels a. Army managers and supervisors at all levels will (1) Ensure that the health of all personnel under their supervision is sustained and protected in all Army activities through aggressive implementation of preventive medicine activities, to include (a) Training. (b) Hazard control. (c) Immunizations and chemoprophylaxis. (d) Health risk and hazard communication. (e) Worksite, OEH surveillance. (2) Program and budget resources to (a) Correct workplace deficiencies and control hazards. (b) Provide training to comply with individual and unit responsibilities according to FM 8 55, paragraphs 11 5 and 11 6, and FM 21 10/MCRP 4 11.1D, chapters 1 2 and appendix A. (3) Implement health surveillance requirements, ensuring that personnel enrolled in an occupational medicine surveillance program comply with the occupational medicine surveillance requirements including pre-placement, periodic, and outprocessing or termination medical evaluations (see DA Pam 40 11, chap 5, and FM 4 02.17, chap 9). (4) Provide leadership and personal example in improving and sustaining individual and unit health and fitness. (5) Ensure that contingency and operational plans include the appropriate elements of preventive medicine. (6) Minimize health risks using Army operational risk management principles (see FM 100 14). (7) Adhere to Federal, state, and host nation statutory and regulatory laws, directives, licenses, and guidance AR 40 5 22 July 2005 17

Extracted Material from FM 21-10 Student Handout 2 This student handout contains 39 pages of extracted material from the following publication: FM 21-10, Field Hygiene and Sanitation, 21 Jun 2000 Chapter 1 pages 1-1 thru 1-4 Chapter 3 pages 3-1 thru 3-35 Disclaimer: The training developer downloaded the extracted material from the General Dennis J. Reimer Training and Doctrine Digital Library Home Page. The text may contain passive voice, misspellings, grammatical errors, etc., and may not be in compliance with the Army Writing Style Program. SH-2-1

Extracted Material from FM 4-25.12 Student Handout 3 This student handout contains five pages of extracted material from the following publication: FM 4-25.12, Unit Field Sanitation Team, 25 Jan 2002 Appendix D pages D-1 thru D-5 Disclaimer: The training developer downloaded the extracted material from the General Dennis J. Reimer Training and Doctrine Digital Library Home Page. The text may contain passive voice, misspellings, grammatical errors, etc., and may not be in compliance with the Army Writing Style Program. SH-3-1