navmed p-5010, manual of the naval preventive medicine, chapter 9

NAVMED P-5010 CHAPTER 9PREVENTIVE MEDICINE FOR

GROUND FORCES

Presented By:

HM1(SW) Marlene Rivera

WATER SUPPLY SANITATION IN THE FIELD

Engineers are responsible for providing sufficient potable water for the population to be served.

The medical department advises the commanding officer on water quality issues.

Daily Water Requirements: Navy 24.6 gallons per man per day Marines 19.7 gallons per man per day

WATER SUPPLY SANITATION IN THE FIELD

Equipment Used to Purify Water (2):• ROWPU (reverse osmosis water purification unit)

• the most common field purification system in use.• versatile unit will produce potable water from contaminatedsources including fresh, brackish, or sea water.

• Erdalator• Transportable quick-response water

purification system capable of aerating, clarifying, filtering and disinfecting contaminated water

WATER SUPPLY SANITATION IN THE FIELD

Chlorination is the most common method of disinfecting

potable water• Sufficient chlorine is added to the water to achieve

the desired free available chlorine (FAC) residual after a 30 minute contact time.

WATER SUPPLY SANITATION IN THE FIELD

Chlorination is available in several forms: Calcium hypochlorite, 65-70% (HTH)

• This is the preferred agent Sodium hypochlorite (5%) or (10%)

• This is a liquid solution (household bleach) and may be used in lieu of HTH.

Chlorine gas (in compressed gas cylinders)• This is the most common form used by municipal

water treatment plants.

WATER SUPPLY SANITATION IN THE FIELD

Required Chlorine Residuals: Public water supply systems of questionable quality

• 5.0 parts per million (ppm) FAC after a 30 minute contact time and maintain at a minimum of 2.0 ppm FAC throughout distribution system.

Engineering water points• 5.0 ppm FAC at the standpipe or fill-hose.

Water tankers, trailers, bladders and cans• Maintain between 5.0 ppm and 2.0 ppm FAC when filled at an

approved engineering water point. Maintain at 5.0 ppm FAC when used as a “source” for a distribution (piping) system.

Distribution (piping) system• Maintain 5.0 ppm FAC at the source and 2.0 ppm FAC at the spigot.

Lyster bags and canteens• Maintain at 2.0 ppm FAC when filling from an approved water

source. Chlorinate to 5.0 ppm FAC initially and maintain at 2.0 ppm FAC when filling from an unapproved or raw water source.

SUPERCHLORINATION

This process is used to disinfect water containers and distribution systems initially (before they are used) or when they have become contaminated. Used for contaminated water.

Chlorinate water to 100 ppm for 4 hours Should be labeled “POISON DO NOT DRINK”

during this process After 4 hours the FAC must be 50 ppm or

above.

CANTEENS Add 2 iodine tablets to each

full canteen (double for 2 QT canteens)

• Tincture of Iodine 2% may be used in place of tablets. 5 drops per 1 QT/10 drops if cloudy.

Place lid on loosely and wait 5 minutes then shake vigorously allowing leakage around the cap.

Tighten and wait addt’l 30 minutes.

5 Gallon Water Cans

Dissolve 40 Iodine tablets.

Place lid on loosely and wait 5 minutes then shake vigorously allowing leakage around the cap.

Tighten and wait addt’l 30 minutes.

Testing Requirements

FAC (Free Available Chlorine) Testing Determine the FAC residual of all water

supplies at least daily Bacteriological Testing

Field water supplies must be tested bacteriologically at least weekly following the procedures provided in Chapter 6 of this manual

* Recorded in Medical Department Water Log. *

FOOD SERVICE IN THE FIELD

In the field, all the factors which normally contribute to foodborne illness outbreaks, such as improper storage and holding temperatures, inadequate protection of food from contamination, and poor food handler personal hygiene, are exacerbated.

All food should be inspected by the Food Safety Officer

Storage/Preparation of Food

Temperature readings must be taken/logged 3 times daily (during each meal period)

Field reefers: maint at or below 40 deg F Freezers: maint at or below 0 deg F Chopping or grinding of meat in the field is prohibited Frozen foods thawed under refrigeration. Maybe thawed

at room temp not to exceed 80 deg F. Ice scoops washed & sanitized daily. “Four Hour Time Rule”

Potentially hazardous food kept b/t 40 and 140 deg F Keep hot foods hot and cold foods cold

FOOD SERVICE IN THE FIELD

A field dishwashing unit can be set up by using five (5) metal GI cans (1) First GI can is for collecting garbage. (2) Second GI can is for prewash and will contain a hot detergent

solution and a brush. (3) Third GI can is for washing and will contain a hot detergent solution

and a brush. (4) Fourth GI can is for rinsing and will contain clean hot water held at

a rolling boil. (5) Fifth can is for the final sanitizing rinse and will contain clean hot

water held at a rolling boil (212 deg F).

MRE’s/T-Rations

MRE’s have a shelf life of 48 months

Can use for 21 days T-Rations provide 36

servings. The tray packs are hermetically-sealed half-size steam table containers in which up to 36 servings of food, depending on product

Waste Disposal in the Field

4 Types of Waste

1. Human Waste

2. Liquid Waste - Bathing and liquid kitchen wastes

3. Garbage- Peelings, slicings, etc from field

service operations

4. Rubbish- Boxes, cans, paper, plastic

WASTE DISPOSAL METHODS

Location for latrines 100 feet from the nearest natural

water source

100 yards from food service

areas

50 feet from berthing areas

Human Wastes (feces and urine): Disposal

Cat Hole• When troops are on the march• It is dug 8 to 12 inches in diameter and 6 to 12 inches deep and is covered and packed down after use

Straddle trench• temporary bivouacs (1 to 3 days)• 4 ft long, 1 ft wide, 2.5 ft deep• Serves 25 people

The devices for disposing of human wastes in the field vary with the tactical situation, soil conditions, water table, weather conditions, availability of materials, and local environmental regulations

Human Wastes (feces and urine)

Deep Pit Latrine• 4 holes (seats), 8 ft L x 2 ½ ft W• One, 4 seat, DPL/50 ppl

Bored Hole Latrine• 8 per 100 ppl• 18 in diameter hole bored to a

Depth of 15-20 ft• Seldom used

Human Wastes (feces and urine)

Mound Latrines• indicated when higher

ground water levels or

rock formations prevent

the digging of a deep pit

Waste Disposal

Urine soakage pit• Most effective in sandy

soils• Six tubes made by

PVC piping 1x36”• One pipe for every 20

men

Waste Disposal

Urine Trough• 10 ft long “U” or “V”

shaped trough is made of sheet metal or wood

• 1 trough per 100 men

Waste Disposal

Burn-Barrel Latrine• Contains 2-4 seats on half a 55 gallon drum.• Will be primed with 3 gallons of diesel fuel and

gasoline, 4 parts to 1.• After burning, bury ashes at least 12”.

Waste Disposal

Urinoils• These permanent type latrines are very sanitary and less

odorous than other urine disposal methods.

Chemical toilets• Chemical Toilet Requirements

# of Personnel # of Chemical Toilets 1 to 15 1 16 to 35 2 36 to 55 3 56 to 80 4 61 to 110 5 111 to 150 6 Over 150 Add 1 toilet for each

additional 40 persons.

Disposal of Liquid Waste

In the field, bathing and liquid field mess wastes are disposed of in the soil by means of either a soakage pit or soakage trench.

Soakage pit 4 feet square, 4 feet deep and filled with a suitable contact medium. Will service a field mess serving 200 people or less

Disposal of Liquid Waste

Soakage trenches used when the groundwater level or a rock formation

prevents the use of a soakage pit Evaporation beds

constructed to allow 3 square feet of evaporation area per person, per day, for field mess wastes and 2 square feet per person, per day, for bathing wastes.

Disposal of Liquid Waste

Grease traps Filter grease trap

• 55 gallon drum with top

removed and bottom

perforated• Covered with burlap• Filled 2/3 full with 3 layers of

material (crushed rock on the

bottom, layered with sand,

ash, charcoal or straw)

Baffle grease trap• most effective device for removing grease

Garbage Disposal Garbage is disposed of by burial or incineration

Burial (must be at least 100 feet away from any natural water source and 100 yds from the field mess)

When troops are on the march or in camps for less than one week garbage is disposed of by burial in pits or trenches

Pits• Pits are preferred for overnight halts• 4 foot square pit that is 4 feet deep and will service 100 people for

one day Continuous trench

• used for stays of 2 days or more• trench is dug 2 feet wide, 4 feet deep and long enough to

accommodate the next day’s garbage Incineration

• garbage disposal method often used in camps that will be used for

1 week or more

Garbage Disposal: Incineration

Incline plane incinerators Handle garbage –

entire battalion

Barrel incinerator Made from 55 gallon

drum by cutting out

both ends

HEAT INJURIES

Types of Heat Injuries Heat cramps Heat syncope Heat exhaustion Heatstroke

• IS A MEDICAL EMERGENCY!

Prevention of Heat Injuries

Acclimatization - 3 weeks is optimal Adequate water intake Salt Intake Proper clothing (field uniforms

should not be starched)

Careful WBGT monitoring

WBGT Monitoring

<80 white flag 80-84.9 green flag 85-87.9 yellow flag 88-89.9 red flag 90> black flag

Wet Bulb, Globe Temperature (WBGT) Index most effective means of assessing the effect of heat stress on the human body

COLD INJURIES

Types of Cold Injuries

Immersion syndrome• Occur in little as 24 hrs; water temp below 50 deg F

Frostbite Hypothermia Snow burn/snow blindness

DISEASE CONTROL

Prevention is the key to a successful disease control program and may mean the difference between success or failure of the mission

Disease occurrence requires a “Chain of Transmission” consisting of four links:

1. Reservoir

2. Means of transmission

3. Portal of entry

4. Susceptible host

Reservoir

Means of transmission

Portal of entry

Susceptible host

DISEASE CONTROL

Diseases of Military Importance Intestinal diseases Diseases of the respiratory tract Vector-borne diseases Parasitic Diseases Zoonotic Diseases (Diseases transmitted from animals)

Sexually Transmitted Diseases

Any Questions?