OperationEnduringiFr eedom 06

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PREFACEPRESENTATION: 

PREFACE PRESENTATION Many of the graphics in this presentation are animated GIFs or animated graphics. They will not animate unless you view in Screen Show. Slide transitions are not recommended. The majority of the briefing slides have extensive briefer notes. The notes provide much more information than is needed for the audience. It is recommended that you edit the briefer notes to suit your requirements and level of expertise in the subject matter. Tailor this briefing to meet YOUR needs, hide the slides that are not used. There is no “one size fits all” briefing. Use the Regional approach or specific country approach. We have provided both formats for your use. Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men. Use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement by the Department of Defense (DOD). HIDE THIS SLIDE HIDDEN SLIDE

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PREFACE IMPROVEMENTS Users of this publication are encouraged to submit comments and recommendations to improve the publication. Comments should include the version number, page, paragraph, and line(s) of the text where the change is recommended. The proponent for this publication is the United States Army Center for Health Promotion and Preventive Medicine (USACHPPM). Comments and recommendations should be forwarded directly to: Commander, USACHPPM, ATTN: MCHB-CS-OHI, 5158 Blackhawk Road, Aberdeen Proving Ground, Maryland 21010--5403, or by using the E-mail address on the USACHPPM website at: http://chppm-www.apgea.army.mil/mtb/ If you develop new slides or revise existing slides, please forward to USACHPPM for future updates of this briefing. We will post future updates on the USACHPPM Internet site: http://chppm-www.apgea.army.mil/mtb/ HIDE THIS SLIDE HIDDEN SLIDE

VERSION UPDATESMonth.Year: 

VERSION UPDATES Month.Year 11.05 Changes: None (Baseline) 01.06 Added malaria chemoprohylaxis caveat for source information 03.06 Added Avian Flu to Animal Contact Diseases 06.06 added water, air, and soil information, temp/precip data for Kandahar, and Afghan Location Map HIDE THIS SLIDE HIDDEN SLIDE

Slide5: 

OPERATION ENDURING FREEDOM PREVENTIVE MEDICINE BRIEFING (AFGHANISTAN) Presenter’s Name Presenter’s Command Local Contact Information Prepared by: U.S. Army Center for Health Promotion and Preventive Medicine (800) 222-9698/ DSN 584-4375/(410) 436-4375 http://usachppm.apgea.army.mil

AGENDA: 

AGENDA Purpose Background Review of Guide to Staying Healthy Preparation for Deployment Deployment Post Deployment Summary Conclusion

PURPOSE: 

PURPOSE Inform Deploying Personnel (Military and Civilian) of the Potential Health Hazards and the Individual Countermeasures Necessary to Assure Personal Safety and Health

BACKGROUND: 

BACKGROUND US Forces are mobilizing and deploying in support of Operation Enduring Freedom (OEF) Environmental, safety, and occupational health hazards are a potential medical threat to deployed personnel Historical accounts of wars, battles, and military training consistently relate that the greatest loss of forces was not caused by combat wounds – rather the majority of losses were the result of disease and non-battle injury (DNBI).

AFGHANISTAN: 

AFGHANISTAN Civil war / damaged infrastructure Deteriorated public health systems

Where in the world is Afghanistan?: 

Where in the world is Afghanistan?

GUIDE TO STAYING HEALTHY: 

Unfold YOUR Afghanistan Deployment Health Guide Personal Protective Measures (PPM) – Individual Countermeasures Reference Guide for this Briefing GUIDE TO STAYING HEALTHY This guide is for use by all active/reserve component military, civilian, retiree, and contractor personnel. Any individual who trains and prepares for, or participates in any type of military operation should keep and refer to this guide.

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PREPARATION FOR DEPLOYMENT

PREPARING TO DEPLOY: 

Medical, Dental & Vision Screening (Soldier Readiness Processing) Prepare clothing and gear and personal hygiene items Complete Pre-deployment Health Assessment (DD Form 2795) Immunizations and chemoprophylaxis Begin malaria chemoprophylaxis two weeks prior to deployment (when directed by medical authority) PREPARING TO DEPLOY During medical screening, discuss prescribed medications with the examiner; obtain at least 90-day supply of medications

PREPARING TO DEPLOY: 

ADDITIONAL PACKING ITEMS: Cotton underwear (10 changes) Birth control supplies Personal Hygiene Products Anti-fungal cream/powder & shower shoes Insect repellent, sunscreen, eye and hearing protection, lip balm, skin lotion PREPARING TO DEPLOY If you need medications or hygiene items which may not be available through normal supply systems, obtain a 6-month supply, or enough for the duration of the operation

PREPARING TO DEPLOYFEMALE CONSIDERATIONS: 

PREPARING TO DEPLOY FEMALE CONSIDERATIONS Birth control pills Feminine Hygiene Products (non-deodorant tampons, sanitary napkins, panty liners; menstrual cramp reliever) Yeast infection medication (two courses of vaginal treatment) Portable Urinary Device For use by female personnel to reduce time needed to urinate and resolve privacy issues when latrines are not available (convoys, field operations) NSN: 8530-01-470-2805 If using birth control pills, continue as prescribed to regulate menstrual cycles and avoid problems resulting from inconsistent use

DEPLOYMENT HEALTH CARE: 

Know where to seek health care when deployed May or may not be through same channels as your home station Maintain your health and seek care whenever an illness or injury occurs DEPLOYMENT HEALTH CARE

PREVENTIVE MEDICINE COUNTERMEASURES: 

Medical Tests – All Personnel PPD – Purified Protein Derivative (TST – Tuberculin Skin Test) Within 12 months prior to deployment AND At time of redeployment AND Again between 3-6 months after redeployment HIV – Human Immunodeficiency Virus Required every 2 years. Serum collection before deployment will be tested regardless of date of last test. G6PD - Glucose-6-Phosphate Dehydrogenase Prior to taking Primaquine (anti-malarial drugs are contra-indicated for G6PD deficient individuals) PREVENTIVE MEDICINE COUNTERMEASURES

IMMUNIZATION REQUIREMENTS: 

IMMUNIZATION REQUIREMENTS All Personnel Hepatitis A Typhoid Tetanus-diphtheria Yellow fever Meningococcal Influenza (seasonal) Measles, Mumps, Rubella (MMR) Polio Selected Personnel Hepatitis B (medics, MPs, firefighters, combat lifesavers) Rabies (occupational risk of exposure) Pneumococcal (asplenic personnel) Anthrax (as directed from higher) Smallpox (as directed from higher) Confirm requirements with medical authority or OPORD

MALARIA CHEMOPROPHYLAXIS: 

Anti-Malaria Medication (as directed) malaria prophylaxis for deployments is guided by the G1 in its publication of the personnel policy guidance (PPG), Chapter 7, not by the CDC Take anti-malaria medication as directed by your health care provider Malaria kills at least 1 million people each year worldwide (World Health Organization) MALARIA CHEMOPROPHYLAXIS Personnel traveling to Afghanistan for even one day at any time of year must receive both primary and terminal malaria chemoprophylaxis

FIELD SANITATION TEAM: 

FIELD SANITATION TEAM Field Sanitation Teams (FST) train unit personnel in Preventive Medicine Measures (PMM) and advise the commander and unit leaders on implementation of unit-level PMM. Know who the members of your Field Sanitation Team are PRIOR to deployment The FST can assist in preventing medical threats to your health Deploy with all FST equipment Failure to apply PMM increases the risk of mission failure

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DEPLOYMENT

PERSONAL PROTECTIVE MEASURES: 

Wash hands frequently Do not rub eyes or inside of nose with bare finger(s) Bathe/shower regularly (field expedients will do); use unscented products Wear shower shoes to prevent athlete’s foot Dry thoroughly after showering Sleep head-to-toe if billeted in common areas Wear clean, dry uniforms; change socks daily and uniform at least weekly Do not wear nylon or silk undergarments; cotton undergarments are more absorbent and allow the skin to dry Seek prompt medical care if problem exists PERSONAL PROTECTIVE MEASURES

ORAL HEALTH: 

ORAL HEALTH Deploy with: Toothbrush Dental Floss Fluoride Toothpaste Brush twice-daily Daily in difficult tactical environments Floss daily Seek medical attention at the onset of any dental problems

SPIRITUAL HEALTH: 

SPIRITUAL HEALTH Maintain personal prayer/meditation Obtain and read wholesome religious/spiritual literature Attend religious/spiritual group discussions/studies Process anger, fear, anxiety & guilt through personal & group spiritual/religious activities Keep in touch with spiritual advisors/chaplains

NUTRITION: 

Drink fluids regularly (hourly fluid intake should not exceed 1.5 quarts, daily fluid intake should not exceed 12 quarts) Maintain weight; do not avoid food or attempt weight loss during a deployment Work in cold weather can increase energy needs by 10-25% Operations in high-altitude areas can increase energy needs by 50% or more NUTRITION

SMOKING: 

SMOKING March – August 2003: 19 cases of severe pneumonia in service members deployed to Southwest Asia 16 smokers, 8 began smoking during this deployment Two pneumonia deaths January 2004: 2 new severe cases of pneumonia Both began smoking during this deployment If you don’t smoke, don’t start during a deployment. If you do smoke, quit.

STRESS: 

Operational stressors Different types and intensities Recognize the symptoms of depression Seek or encourage help Take steps to reduce operational stress STRESS Stress can be intensified for personnel who are exposed to or observe human suffering and/or death

IMPROVE RESISTANCE TO STRESS: 

IMPROVE RESISTANCE TO STRESS Fear and physical signs or symptoms of stress are normal reactions before and during combat or other dangerous/life-threatening situations Talk about what is happening with your buddies Learn ways to relax quickly Quickly integrate new replacements If you must join a new group, be active in establishing friendships Give each other moral support Care for your buddies and work together

HEARING CONSERVATION: 

Authorized wear IAW AR 670-1 HEARING CONSERVATION Loud noise causes permanent hearing loss COUNTERMEASURES Have your hearing protection with you at all times and use it Be sure your ear plugs, noise muffs or helmets fit properly and are in good condition Avoid noise or limit time around noise to only critical tasks If you have to raise your voice to be understood, it is too noisy. Put on hearing protection.

VISION CONSERVATION: 

VISION CONSERVATION Preventive Measures and Eye Protection Contact lens use is prohibited for use in environments where exposure to smoke, toxic chemical vapors, sand, or dust occurs If required, maintain 2 pair of glasses and 1 protective mask insert Use eye protection when in any potentially eye hazardous environment Safety goggles or spectacles with side shields* Chemical splash goggles* *(ANSI Z87.1 approved) Vision Ready is Mission Ready!

MOUTH GUARDS: 

MOUTH GUARDS OR

Physical Environment: 

Physical Environment Topography If operating above 6,000ft implement high elevation countermeasures Climate Arid to semiarid; cold winters and hot summers Terrain: mostly rugged mountains; plains in north and southwest lowest point:  Amu Darya 258 m = approx 846 ft highest point:  Nowshak 7,485 m = approx 24,557ft

Physical Environment: 

Physical Environment

Physical Environment: 

Physical Environment

Physical Environment: 

Physical Environment

Physical Environment: 

Physical Environment

HEAT INJURY PREVENTION: 

Heat Cramps, Exhaustion, or Stroke COUNTERMEASURES Drink fluids continuously (hourly fluid intake should not exceed 1.5 quarts, daily fluid intake should not exceed 12 quarts) Maintain acclimatization Protect yourself from exposure to sunlight and wind Maintain good physical condition Establish work/rest schedules Wear proper clothing Participate in training HEAT INJURY PREVENTION You should receive annual unit training on prevention of heat injury. Heat injuries are preventable!

Slide38: 

H: Heat category – WBGT Index E: Exertion level (prior 3 days) A: Acclimatization T: Tables – Water/Work/Rest Units which have soldiers who do not drink because they do not have opportunities to urinate have a leadership problem. REMEMBER Water requirements are not reduced by any form of training or acclimatization.

SUNBURN: 

SUNBURN Sunburn reduces soldier readiness and increases the likelihood of skin cancer. Prevent overexposing skin and eyes to solar radiation and wind COUNTERMEASURES Use sunscreen and lip balm Use protective eyewear Limit exposure Cover nose and mouth to limit drying

COLD INJURY PREVENTION: 

COLD INJURY PREVENTION Hypothermia, Frostbite, Chilblains COUNTERMEASURES When possible, remain inside warming tents/buildings and drink warm, uncaffeinated liquids for relief from the cold If working outside or on guard duty, insulate yourself from the ground and wind. Rotate duty as frequently as mission allows. Properly wear the Extended Cold Weather Clothing System You should receive annual unit training on prevention of cold injury

COLDER: 

COLDER C: Keep clothing Clean O: Avoid Overheating. L: Wear clothing Loose and in layers D: Keep clothing as Dry as possible E: Examine clothing (holes, tears, broken fasteners) R: Repair or replace damaged clothing Notify your first-line supervisor if you have had a previous cold injury. Use the buddy system.

WIND CHILL TEMPERATURE: 

WET SKIN CAN SIGNIFICANTLY DECREASE THE TIME FOR FROSTBITE TO OCCUR WIND CHILL TEMPERATURE

CARBON MONOXIDE: 

Carbon monoxide (CO) is a colorless, odorless, and tasteless gas produced by engines, stoves, and gas/oil heaters. CO replaces oxygen in the body, causing headache, sleepiness, coma, and death. COUNTERMEASURES Keep sleeping area windows slightly open for ventilation and air movement. DO NOT sleep in vehicles with the engine running or use engine exhaust for heat. DO NOT park vehicles near air intakes to tents, trailers, or environmental control units. CARBON MONOXIDE Do not use unapproved commercial off-the-shelf heaters. Check with your unit Safety Officer.

HIGH ELEVATIONS: 

HIGH ELEVATIONS High Altitude-elevations over 6,000 feet High Altitude illnesses can kill Stage ascents over time Environmental conditions are more severe at higher elevations Lower oxygen levels (“thin air”) Colder temperatures, high winds, low visibility Ice, snow, rocks, avalanches Remain well hydrated Be observant of the common symptoms of mountain sickness: headache, nausea, vomiting, dizziness, fatigue, irritability, and coughing. Seek medical attention immediately in you experience any of these symptoms.

Environmental Health Risk: 

Greatest short term risks associated with ingestion of contaminated food/water; extreme heat/cold; high altitude Greatest long term risks associated with air contamination and chemical contamination of food/water Environmental Health Risk

Environmental Issues: 

Environmental Issues Air Contamination Overall, minimal health effects High levels of particulate matter (PM10) able to reach the lungs recorded at Salerno, Kandahar, & Bagram Short-term (less than or equal to 14 days duration) exposure presents a risk of temporary respiratory symptoms such as coughing, wheezing, and reduced lung function

Environmental Issues Cont.: 

Environmental Issues Cont. Soil Contamination Localized to specific areas around industrial facilities, waste disposal ditches, and open sewage ditches Significant exposure is unlikely Water Contamination Contaminated with raw sewage One of the most significant health threats to deployed personnel Sewage contamination of drinking water in urban areas is common

DEPLETED URANIUM (DU): 

Depleted uranium (DU) is used in armor-piercing munitions and in enhanced tank armor protection DU can cause adverse health effects if it enters your body (inhaled, ingested, fragments). COUNTERMEASURES Receive Depleted Uranium Awareness Training Assume a DU contamination zone of 50 meters around actively burning fires involving any armored combat vehicles As with all battlefield debris-do not touch or move the object Notify authorities of the location of any debris Exercise standard field hygiene, to include washing hands and face No additional protective measures are required for handling unfired DU munitions other than those required for all munitions DEPLETED URANIUM (DU)

AIRBASE CONTAMINATION: 

AIRBASE CONTAMINATION Soil and ground water contamination as a result of poor storage management, accidental releases, and improper waste disposal techniques Kerosene, diesel fuel, gasoline, heating oil, lubricants, organic solvents, PCBs, heavy metals, rocket propellants, and de-icing compounds Volatile organic compounds evaporating from soil and ground water may accumulate in the airspace inside of tents or buildings constructed over contaminated areas

AIRBASE CONTAMINATION: 

AIRBASE CONTAMINATION Personnel exposed to these contaminants may experience adverse health effects COUNTERMEASURES Consult with preventive medicine personnel prior to engaging in soil excavation or other activities that involve direct contact with soil or ground water (example: construction of defensive positions) Do not work or bivouac over contaminated areas or in potentially contaminated buildings Exercise standard field hygiene (wash after contact) Seek medical care if you experience: eye, nose, and throat irritation; headaches, dizziness, weakness, loss of coordination, confusion, blurred vision, or nausea

Infectious Disease Risk: 

Infectious Disease Risk HIGH RISK for infectious diseases Inadequate force health protection (FHP) measures, will seriously jeopardize mission effectiveness

Infectious Diseases: 

Infectious Diseases Foodborne and Waterborne Diseases HIGH RISK = Diarrhea, hep A, typhoid fever INTERMEDIATE RISK = brucellosis, cholera, hep E FHP Priorities Deploy appropriate PM personnel and equipment Consume food, water, ice only from US-approved sources Operate food preparation facilities in accordance with Army doctrine Ensure proper hand washing facilities near all latrines and dining facilities and enforce

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NOT AN APPROVED SOURCE

Infectious Diseases Cont.: 

Infectious Diseases Cont. Vector-borne Diseases HIGH RISK = Malaria INTERMEDIATE RISK = Crimean-Congo hemorrhagic fever, leishmaniasis, sand fly fever, typhus, West Nile fever FHP Priorities Use DEET on all exposed skin Treat field uniforms with permethrin Use bed nets in field conditions, treat with permethrin Enforce malaria chemoprophylaxis as appropriate

PERSONAL PROTECTIVE MEASURES: 

PERSONAL PROTECTIVE MEASURES YOU NEED TO KNOW… Dry cleaning removes permethrin from the uniform DOD Insect Repellent System + + = MAXIMUM PROTECTION Permethrin On Uniform DEET On Exposed Skin Properly Worn Uniform

INSECT REPELLENTS FOR SKIN AND CLOTHING: 

DEET lotion NSN 6840-01-284-3982 Apply a thin coat to EXPOSED skin One application lasts up to 12 hours INSECT REPELLENTS FOR SKIN AND CLOTHING Individual Dynamic Absorption Kit (IDA) Treatment lasts for for over 50 launderings NSN 6840-01-345-0237 NSN 6840-01-278-1336 Aerosol spray can Treatment lasts through 5-6 washes Permethrin

OTHER INDIVIDUAL COUNTERMEASURES: 

OTHER INDIVIDUAL COUNTERMEASURES Wash and inspect your body for insects/ticks and bites daily Use buddy system to check clothing routinely Launder uniform routinely to remove insects and eggs Order a permethrin-impregnated bed net for use while sleeping Otherwise, treat a bed net before use by spraying the outside of the net with permethrin Tuck edges under cot or sleeping bag Don’t let net touch your skin while you sleep NSN 3740-01-516-4415

TICK REMOVAL PROCEDURES: 

TICK REMOVAL PROCEDURES Use fine-tipped tweezers to grasp mouthparts Grasp mouthparts against skin surface Pull back slowly and steadily with firm tension Avoid squeezing tick Wash wound and apply an antiseptic

Infectious Diseases Cont.: 

Infectious Diseases Cont. Animal-contact Diseases HIGH RISK = Rabies, among the highest in the world INTERMEDIATE RISK = Avian Influenza, Anthrax, Q-fever FHP Priorities Avoid animal contact, especially if the animal exhibits strange behavior No mascots Report all animal bites and scratches

Infectious Diseases Cont.: 

Infectious Diseases Cont. Sexually Transmitted Diseases INTERMEDIATE RISK = gonorrhea, chlamydia, HIV, Hep B FHP Priorities Avoid sexual contact Use latex condoms if sexually active

Infectious Diseases Cont.: 

Infectious Diseases Cont. Water-contact Diseases INTERMEDIATE RISK = leptospirosis FHP Priorities avoid unnecessary contact with lakes, rivers, streams, and other surface water There will not be a sign like this.

Infectious Diseases Cont.: 

Infectious Diseases Cont. Respiratory Diseases INTERMEDIATE RISK = tuberculosis FHP Priorities Tuberculin skin test before and after deployment 72 sqft/person and head-to-toe sleeping arrangement Cough or sneeze into your upper sleeve instead of your hands Wash hands at every opportunity Avoid close contact with local population

Hazardous Animals & Plants: 

Hazardous Animals & Plants Animals Rabid dogs, snakes, centipedes, scorpions, spiders Plants Mexican Poppy, Fetid Nightshade FHP Priorities Do not handle animals Shake out boots, clothing, & bedding Do not touch, chew, eat, or burn unfamiliar plants

CAVES: 

Rabies from bat bites Tick-borne – Relapsing Fever Histoplasmosis from bat guano Confined Space Issues Poor air exchange/ventilation Asphyxiant gasses and/or low oxygen level Ordnance/munitions Other hazardous chemicals and materials stored in the caves CAVES

OCCUPATIONAL HEALTHPRE-DEPLOYMENT: 

OCCUPATIONAL HEALTH PRE-DEPLOYMENT Current Industrial Hygiene review of operations Engineering controls Supply of required Personal Protective Equipment (PPE) Hazard Communication (HAZCOM) training Personal Protective Equipment training Current medical surveillance

OCCUPATIONAL HEALTHDEPLOYMENT: 

OCCUPATIONAL HEALTH DEPLOYMENT Occupational Health Hazards Use your applicable control strategies Elimination or substitution Engineering control Work Practices and administrative controls Personal Protective Equipment Follow the PPE program requirements

FIELD FACILITIESCONTROL OF HAZARDOUS EXPOSURES: 

FIELD FACILITIES CONTROL OF HAZARDOUS EXPOSURES Garrison facilities include engineering controls to control chemical exposures In the field, additional efforts are needed to provide the same level of control for these occupational exposures Install and use safety countermeasures

OCCUPATIONAL HAZARDS: 

OCCUPATIONAL HAZARDS Exhaust from engines and fuel space heaters Gases from weapons firing Solvents used to clean weapons Chemicals and metals from painting vehicles and equipment Greases and oil from vehicle maintenance repair Detergents used to clean equipment Fuels and refueling operations Weapon systems: radiation energy, shock, vibration, noise

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POST -DEPLOYMENT

POST DEPLOYMENT: 

POST DEPLOYMENT Complete Post-Deployment Medical Health Assessment (DD FORM 2796) Receive post-deployment preventive medicine briefing Receive post-deployment screening, testing, and follow-up Continue malaria chemoprophylaxis as directed by your health care provider

POST DEPLOYMENT: 

POST DEPLOYMENT Continue to seek counseling from Chaplain or medical personnel Homecoming Stress Don’t expect things to be exactly the same, especially if long deployment Ease back into roles; don’t rush it Children may be withdrawn Spouse may be moody or depressed Financial and property issues may require immediate attention

SUMMARY: 

SUMMARY Review of Deployment Health Guide Preparation for Deployment Deployment Medical Threat Post Deployment

CONCLUSION: 

CONCLUSION Health threat awareness and implementation of associated countermeasures discussed in the briefing are critical to all military missions (including combat, support, and sustaining base military and civilian forces). Apply this information during all phases of military operations, including training, pre-deployment, deployment, and post-deployment.

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Contact Your Local Preventive Medicine Service or Medical Support Unit for Additional Information Prepared by: U.S. Army Center for Health Promotion and Preventive Medicine (800) 222-9698/ DSN 584-4375/(410) 436-4375 http://usachppm.apgea.army.mil