(Corrected 2 October 1998)
TRAINING SUPPORT PACKAGE (TSP)
TSP Number
081-P-9023
Title
Enforce Preventive Medicine Measures for Protection Against Disease and Nonbattle
Injuries.
Task Number(s)
/Title(s)
081-831-9023, Enforce Preventive Medicine Measures for Protection Against Disease
and Nonbattle Injuries.
Effective
Date
2 October 1998
Supersedes
TSP(s)
None
TSP User
Officer Advanced Course, Warrant Officer Advanced Course
Proponent
The proponent for this document is the U.S. Army Medical Department Center and
School.
Comments/
Recommendations
Users are invited to send comments and suggested improvements on DA Form 2028
(Recommended Changes to Publication and Blank Forms) to Commandant, Academy
of Health Sciences. ATTN: MCCS-HTI (TLS) Fort Sam Houston, Texas 78234-6122
Foreign
Disclosure
Restrictions
This publication contains technical or operational information that is for official
Government use only. Distribution is limited to U.S. Government agencies. Requests
from outside the U.S. Government for release of this publication under the freedom of
Information Act or the Foreign Military Sales Program must be made to Commander,
U.S. Army Medical Department Center and School. Fort Sam Houston, Texas 782346100.
1
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PREFACE
Purpose
This training support package provides the instructor with a standardized lesson plan
for presenting instruction for:
081-831-9023
Task number:
Enforce Preventive Medicine Measures Against Disease and
Task title:
Nonbattle Injuries.
You are a company commander or leader of a unit deployed to the
Conditions:
field. Given equipment authorized by your table of organization and
equipment (TOE) and field sanitation equipment and supplies, AR 405; AR 600-63; FM 21-10; FM 21-10-1.
Enforce the preventive medicine measures against the seven
Standards:
components of the medical threat. Apply the Army’s tobacco use
policies IAW AR 600-63. Identify specific responsibilities of key
personnel for preventing disease and nonbattle injuries. Identify
capabilities of preventive medicine assets in a theater of operations.
Identify preventive medicine information and possible sources to use
for planning for disease and nonbattle injuries (DNBI) where your unit
will deploy. IAW AR 40-5; FM 21-10, and FM 21-10-1.
This TSP
contains
TABLE OF CONTENTS
Preface
Section I - Administrative Data
Section II - Introduction
Terminal Learning Objective - Plan Unit Preventive Medicine and
field Sanitation Procedures.
Section III - Presentation
A - Enabling Learning Objective - Identify reasons soldiers in
the field have increased vulnerability to disease.
B - Enabling Learning Objective - Identify major components of
the medical threat to field forces and their preventive medicine
measures.
C - Enabling Learning Objective - Identify the measures to
protect soldiers from disease and nonbattle injuries (DNBI).
Appendices
D - Enabling Learning Objective - Identify Army tobacco use
policies.
E - Enabling Learning Objective - Identify specific
responsibilities of key individuals within your unit for protecting
soldiers from DNBIs.
F - Enabling Learning Objective - Identify capabilities of
preventive medicine assets in a theater of operations.
Section IV - Summary
Section V - Student Evaluation
A - Viewgraph Masters
B - Test and Test Solutions
C - Practical Exercises and Solutions
D - Student Handouts
2
Page
2
3
6
6
8
8
9
10
14
20
21
23
27
A-1
B-1
N/A
D-1
Enforce Preventive Medicine Measures for Protection Against
Disease and Nonbattle Injuries
23 Sep 1998
SECTION I.
ADMINISTRATIVE DATA
All Courses
Including This
Lesson
COURSE NUMBER
COURSE TITLE
______________
Officer Advance Course
______________
Warrant Officer Course
______________
Task(s)
Taught or
Supported
Reinforced
Task(s)
Academic
Hours
TASK NUMBER
TASK TITLE
081-831-9023
Enforce Preventive Medicine Measures for Protection Against
Disease and Nonbattle Injuries.
TASK NUMBER
TASK TITLE
081-831-9000
Implement Preventive Medicine Measures.
081-831-1047
Supervise the Implementation of Preventive Medicine Policies
The academic hours required to teach this course are as follows:
PEACETIME
HOURS/ METHODS
MOBILIZATION
HOURS/METHODS
:77/CO
:77/CO
*Test
:17/TE
:17/TE
*Test Review
:11/R
:11/TR
*Total Hours
1:45
1:45
Prerequisite
LESSON NUMBER
LESSON TITLE
Lesson(s) Clearance 153-123-2020
Identify Future Threats
and Access
There are no clearance or access requirements for this lesson.
References
NUMBER
TITLE
DATE
PARA. NO
AR 40-5
Preventive Medicine
Oct 90
Para 14-2, 3a, 3b.
AR 600-63
Army Health Promotion
Nov 88
Para 2-2 & Chap 5
FM 8-10
March 91
Chap 10
FM 21-10
Health Service Support in a
Theater of Operations
Field Hygiene and Sanitation
Nov 88
Pages 3 thru 36
FM 21-10-1
Unit Field Sanitation Team
Oct 89
Para 2-2b, 2c.
Appendix D & E
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NOTE: Make assignments so as to allow sufficient time for the students to complete the assignments by the
desired due date. Explain assignments and provide due date and arrangements for collecting and
providing feedback on the assignments.
Student
Study
Assignments
Instructor
Requirements
Read the handout HO 081-P9023, prior to class.
One primary instructor.
Additional
Personnel
Requirements
None.
Equipment
Required
For Instruction
Viewgraph projector for classroom.
Materials
Required
INSTRUCTOR MATERIALS: 9023-1 through 9023-25.
STUDENT MATERIALS: Pen or Pencil, paper and Handout 081-P9023.
Classroom,
Training Area,
and Range
Requirements
Ammunition
Requirements
Classroom with audiovisual support of sufficient size to hold the number of students in
the course.
None
NOTE: Before presenting this lesson, thoroughly prepare by studying this lesson and identified reference
material.
Instructional
Guidance
The use of the AR 40-5, AR 600-63, FM 8-10, FM 21-10 and FM 21-10-1 references is
not necessary to successfully complete the lesson but will be used in the field.
The use of the word unit is as it is presented in AR 40-5 para 14-3 and field
sanitation equipment is as listed in AR 40-5 table 14-1.
Information in this TSP is not limited to the references given above, it also includes
information derived from experience by the medical staff and numerous references
some of which are the following:
Guide to Clinical Preventive Services, Report of the U.S.
Preventive Services Task Force, Williams & Wilkins, 2nd
edition, 1996,
Unpublished presentation at AMEDDC&S by COL J.
Picariello, Commandant, Army Physical Fitness School,
November 1994,
Monthly Vital Statistics Report, Centers for Disease Control
4
and Prevention, National Center for Health Statistics, Vol. 46,
No. 6, January 28, 1998, US DOD Office of Health Affairs,
Survey of Health Related Behaviors Among Military
Personnel, Research Triangle Institute, (1992 & 1995),
Morbidity & Mortality Weekly Report (MMWR), December 26,
1997, Vol. 46, No. 51, pp. 1217-1220 and April 3, 1998, Vol.
47, No. 12, pp. 229-233,
Information compiled by Americans for Nonsmokers Rights,
1995/1996.
Proponent
Lesson
Plan
Approvals
NAME
Oats
Rank
SFC
Position
Dept. of Preventive Health
Services
Date
5/15/97
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SECTION II
INTRODUCTION
Method of instruction: CO
Instructor to student ratio is: 1:25
Time of instruction: 03
Media: VGT 9023-1.
NOTE: Show VGT 9023-1, Enforce Preventive Medicine Measures for Protection Against Disease and
Nonbattle Injuries.
Motivator
Throughout history, armies have had tremendous problems with heat, cold, and disease.
Diseases and nonbattle injuries (DNBIs) have caused the greatest wartime loss of human
resources. If we truly expect to fight the next war outmanned and outgunned, leaders at
all levels will find it more important than ever before our fighting strength.
NOTE: Tell the students that leaders will find information on this subject in the following literature: AR 40-5,
Preventive Medicine; FM 8-10, Health Service Support in a Theater of Operations; FM 21-10, Field
Hygiene and Sanitation; and FM 21-10-1, Unit Field Sanitation Team and AR600-63, Army Health
Promotion.
NOTE: Inform the students of the following terminal learning objective requirements.
Terminal
Learning
Objective
Safety
Requirements
Risk
Assessment
Level
Environmental
Considerations
At the completion of this lesson you [the student] will:
Action:
Identify actions performed to enforce preventive medicine measures
for protection against disease and nonbattle injuries when deployed.
Conditions:
In a classroom environment and given, HO 081-P-9023 and access
to AR 40-5, FM 8-10, FM21-10, FM 21-10-1 and Ar600-63.
Standard:
Identify measures to take to protect soldiers from DNBIs. Identify the
Army’s tobacco use policies IAW AR 600-63. Identify the four major
components of the medical threat to field forces and their preventive
medicine measures. Identify four specific responsibilities of key
individuals within your unit for protecting soldiers from DNBIs. Identify
capabilities of preventive medicine assets in a theater of operations.
IAW AR 40-5, FM 8-10 , FM 21-10, FM 21-10-1.
None.
Low
None
6
NOTE: Add considerations that are applicable to your specific training location or installation.
Evaluation:
Students will be tested by means of a written examination covering the objective of this
task. Passing criterion will be 70 percent.
NOTE: Inform the student how, when, and where performance of the TLO will be evaluated. Provide the
length of the test or exercise and identify the minimum passing score.
Instructional
Lead-in
This instruction builds on the preventive medicine tasks taught at PLDC,, Precom,
WOCS; 081-831-9000, Implement Preventive Medicine Measures and ANCOC, OBC,
and WOBC, 081-831-1047, Supervise the Implementation of Preventive Medicine
Policies; respectively. The references AR 40-5, FM 8-10, FM 21-10 and FM 21-10-1
and AR600-63 are not needed to complete this lesson successfully but are needed in
the field.
7
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SECTION III
PRESENTATION
A. ENABLING LEARNING OBJECTIVE A
NOTE: Inform the students of the enabling learning objective requirements.
Action:
Conditions:
Standard:
Identify reasons soldiers in the field have increased vulnerability to
disease.
In a classroom environment and given HO 081-P-9023 IAW FM 2110, FM 21-10-1.
Identify the three reasons soldiers in the field have increased
vulnerability to disease. IAW FM 21-10, FM 21-10-1.
Learning Step/Activity - Students receive instruction on the reason soldiers in the field
have increase vulnerability to disease. (FM 21-10 FM 21-101 para 2-2c)
Method of instruction: CO
Instructor to student ratio is: 1:25
Time of instruction: 7.5 minutes
Media: VGTs 9023-2 through 9023-3.
NOTE: For FSC SGI. Ask the students for input about the reasons soldiers in the field have increase
vulnerability to disease. Provide clarification where needed.
1. Merrills Marauders. Disease was an important factor for the famous unit. The
marauders faced a serious medical threat in the jungles of Burma during World
War II. Everyone was sick, but some had to stay and fight although they were
suffering from diarrhea. Evacuation was limited to those with high fever and severe
illness. After a bold and successful attack on a major airfield, Merrills Marauders
were disbanded partly because of disease.
NOTE: Show VGT 9023-2, Medical Threat.
NOTE: Show VGT 9023-3, Increased Vulnerability. (FM 21-10-1 2-2c) Explain that the slide lists reasons for
a soldier’s increased vulnerability.
2. Environment Extremes. Even superbly conditioned, healthy soldiers are vulnerable
to disease when they deploy to the field. The first factor of concern in the field is
environmental extremes. The tactical situation often requires us to go into places
good sense tells us to avoid: mosquito-infested jungles; sandfly-infested deserts;
and cold, windy plains. As professionals, we must be ready to live and fight in such
places.
3. Reduction of Natural Defenses. The second factor is the reduction of the body’s
natural defenses. The body has an amazing capacity to protect itself against heat,
cold, and disease. But the efficiency of those mechanisms depends on overall well
being. Consider this: first we put soldiers in a loud, vibrating, cramped aircraft and
fly them halfway around the world so their body clocks are out of synchronization
(jet lag). Then we put them deep in the field, keep them soaking wet, add heat or
8
cold, feed them meals at irregular intervals, and fire flares all night while they are
trying to sleep. It is not long before they are totally exhausted. Under these
conditions, soldiers would soon have lowered defenses against disease.
4. Breakdowns in Sanitation. The third and final contributing factor is breakdowns in
sanitation. Actions, which are convenient in peacetime, become a challenge in the
combat zone: using the latrine, getting rid of garbage, or simply taking a shower.
Even changing your underwear is a futile effort when you are living in a muddy
foxhole. During search and destroy missions in Vietnam, it was common for men
to go three or four weeks without shaving or changing clothes. There was nothing
macho about it; such acts were simply inconvenient.
NOTE: Conduct a check on learning and summarize the enabling learning objective.
B. ENABLING LEARNING OBJECTIVE B
NOTE: Inform the students of the enabling learning objective requirements.
Action:
Conditions:
Standards:
Identify the major components of the medical threat to field forces
and their preventive medicine measures.
In a classroom environment given HO 081-P-9023 and access to FM
21-10-1.
Identify the four major components of the medical threat to field
forces and their preventive medicine measures, IAW FM 21-10-1.
Learning Step/Activity - Students receive instruction on the major components of the
medical threat to field forces and their preventive medicine measures. (FM 21-10-1 22b)
Method of instruction: CO
Instructor to student ratio is: 1:25; FSC 1-16.
Time of instruction: 7:5minutes
Media: VGT 9023-4.
NOTE: The following instruction focuses on individual and unit responses to the medical threat to field forces
and its preventive medicine measures.
NOTE: Show VGT 9023-4, Major Components of the Medical Threat to Field Forces. (FM 21-10-1 2-2b).
NOTE: For FSC SGI. Ask the students for input about the major components of the medical threat to field
forces and their preventive medicine measures. Provide clarification where needed.
1. Of the four major components, heat is the most lethal medical threat. Rommel
found this out when he lost more than 10 percent of his force in North Africa to
heat-related deaths or incapacitation . Since heat injury is usually a result of
dehydration and thirst is a poor indicator of a body’s need for water, unit leaders
must regularly enforce the drinking of more than one quart of water an hour when
the heat condition dictates. During operations in Grenada, the fact that soldiers do
not drink hot water was reemphasized. The Army plans to remedy the problem of
portability by introducing water refrigeration units to the inventory. Until then,
however, you, as a leader, must enforce a rigid water consumption policy. Failure
to do so results in lost combat power.
9
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2. The second major component of the medical threat is cold. This threat includes
severely cold climates and those regions, such as the desert, which have drastic
temperature variations. During the day the desert temperature may be hot;
however, at night the temperature may drop drastically. By educating soldiers on
the proper wearing of the uniform and by enforcing the use of the buddy system,
cold injuries can be greatly reduced.
3. The third major component is arthropods. The use of insect repellents and the
proper wearing of the uniform can virtually eliminate the incidence of disease from
biting insects.
4. The fourth major component is diarrheal disease. Diarrhea can be significantly
reduced by ensuring that only potable water is consumed by our soldiers and that
food is prepared under sanitary conditions. Have soldiers purify their drinking water
if treated water is not available (see task 081-831-9000, Implement Preventive
Medicine Measures and 081-831-1047, Supervise the Implementation of Preventive
Medicine Policies). Failure to enforce field sanitation discipline can reduce your
combat power as surely as an artillery barrage.
NOTE: Conduct a check on learning and summarize the enabling learning objective.
C. ENABLING LEARNING OBJECTIVE C
NOTE: Inform the students of the enabling learning objective requirements.
Action:
Conditions:
Standards:
Identify measures to protect soldiers from DNBIs
In a classroom environment given HO 081-P-9023, and access to
AR 40-5, FM 21-10.
Identify three measures to take to protect soldiers from DNBIs.
IAW AR 40-5, FM 21-10.
Learning Step/Activity - Students receive instruction on identifying measures to protect
soldiers from DNBIs. (AR 40-5 1-4g, 14-3b; FM 21-10
chapter 1, section 1)
Method of instruction CO
Instructor to student ratio is 1:25; FSC 1-16.
Time of instruction: 15 minutes
Media Viewgraphs 9023-5 through 9023-9.
NOTE: For FSC SGI. Ask the students for input about measure to protect soldiers from DNBIs. Provide
clarification where needed.
1. The commanding officer of an Army unit, is responsible for enforcing personal
hygiene and individual preventive measures against diseases for all members of
the unit. The commander is also responsible for providing guidance, planning
unit preventive measures, and assigning special tasks to the FST and unit
personnel in order to safely dispose of waste, ensure sanitation of food and
portability of water supplies, and reduce the incidence of injury and diseases
caused by animals and /or insects. (AR 40-5 4-4g, 14-3b)
NOTE: Show VGT 9023-5, Commander/Planner/Leader Role. (AR 40-5 chapter 14)
10
2. The commander and other leaders role in preventive medicine and field
sanitation.
a. Seek advice and guidance.
(1) The commanding officer of an Army organization is responsible for the
health of the organization. To assist in this duty, the commander may
seek advice and guidance of the unit surgeon. The unit dining facility
officer and Field Sanitation Team (FST) members also advise and
assist the commander in matters related to the health of the
organization.
(2) The unit surgeon may seek the advice and assistance of almost every
medical specialty. These specialists include preventive medicine
officers, veterinary officers, environmental science officers, sanitary
engineers, entomologists, preventive dentistry officers, and members of
preventive medicine units.
b. Guard against environmental threats to the health of the unit.
NOTE: Show VGT 9023-6, Environmental Threats to Health. ( FM 21-10 chapter 3)
(1) Insects and animals are important planning considerations because
they may seriously affect the military unit’s preparedness. A soldier in
the hospital with snakebite or malaria is of no more use to the military
unit than the one shot on the field. The soldier who stays awake all
night fighting insects is less effective on the job.
(2) Food and water are important to every soldier. If that food or water is
contaminated supplies may become a casualty.
(3) A military unit generates large quantities of garbage and waste each
day. This waste must be removed promptly and thoroughly. If not, the
camp will soon attract flies and rodents. These pests spread filth-borne
diseases such as dysentery, typhoid, paratyphoid, cholera, and plague.
3. Prepare the camp area for troops. Factors which influence camp area
preparation are the following:
a. Mission. The length of stay in the camp, the tactical situation, and the local
environment affect the comfort and sanitation preparations for the camp.
b. Support facilities. The availability and proximity of support activities such as
field bath units, water supply points, and field kitchens affect preparation.
Other support facilities such as earth-moving, construction, and fabrication
capabilities influence preparation.
c. Other factors. The number of troops using the facilities and the supplies
available influence preparation.
4. Enforce individual preventive medicine measures. Areas which will require the
personal participation of all members of your unit are the following:
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NOTE: Show VGT 9023-7 & 8, Individual Preventive Medicine Measure (I) & (II). (FM 21-10 chapter 2 and
chapter 3)
a. Prevention of insect bites.
1. Proper wear of uniform.
2. Repellent use.
3. Insect net use.
b. Avoiding spoiled food.
c. Avoiding native food (unfamiliar food).
d. Drinking only potable water.
e. Disposing of garbage and waste properly.
f. Practice of personal hygiene.
NOTE: Show VGT 9023-9, Personal Hygiene. (FM 21-10 Section VI)
1. Washing hands after latrine use.
2. Bathing frequently.
3. Changing to a clean uniform whenever possible.
4. Proper care of feet.
5. Brushing teeth after each meal if possible.
g. Protection against sexually transmitted disease.
h. Prevention of heat-related problems.
1. Adequate water consumption. Use the Fluid Replacement Policy for
Warm Weather table and accompanying information as a guide.
NOTE: The students have the following table in their handout.
NOTE: The asterisked (*) fluid retention information is per: “Memorandum, Policy Guidance for Fluid
Replacement During Training, 29/04/98, Office of the Surgeon General.
12
*Fluid Replacement Policy for Warm Weather
(Average acclimated soldier wearing BDU, Hot Weather
Easy Work
Moderate Work
Hard work
Work/Rest
WBGT
Work
Water
Water
Work
Water
INDEX,
/Rest
Intake
Intake,
/Rest
Intake,
1*
F
78 - 81.9
NL
Qt/hr
½
NL
Qt/hr
¾
40/20 min
Qt/hr
¾
2
82 - 84.9
NL
½
50/10 min
¾
30/30 min
1
3
85 - 87.9
NL
¾
40/20 min
¾
30/30 min
1
4
88 - 89.9
NL
¾
30/30 min
¾
20/40 min
1
5**
>90
50/10 min
1
20/40 min
1
10/50 min
1
HEAT
CATEGORY
CAUTION: *Hourly fluid intake should not exceed 1½ quarts. Daily fluid intake should not
exceed 12 quarts.



*The work:rest times and fluid replacement volumes will sustain performance and
hydration for at least 4 hrs of work in the specified heat category. Individual water
needs will vary  ¼ qt/hr.
*NL = no limit to work time per hour. Rest means minimal physical activity (sitting
or standing) and should be accomplished in shade if possible.
*Mission-Oriented Protective Posture (MOPP) gear or body armor adds at least 10
F to the Wet Bulb Globe Temperature (WBGT) Index.
** Suspend physical training and strenuous activity. If an operational (nontraining)
mission requires strenuous activity, enforce water intake to minimize expected heat
injuries.
Easy Work





*Examples of Categories of Work
Moderate Work
Weapon maintenance
Walking on hard surfaces at
2.5 mph,  30 lb. load.
Manual of arms.
Marksmanship training.
Drill and Ceremony





Walking on loose sand at
2.5 mph, no load.
Walking on hard surface
at 3.5 mph,  40 lb. Load.
Calisthenics
Patrolling.
Individual movement.
Hard Work


Walking on loose sand
at 2.5 mph with load.
Walking on hard
surface at 3.5 mph, 
40 lb. Load
techniques. i.e. low
crawl, high crawl.


Defensive position
construction.
Field assaults.
2. Modify uniform as authorized/directed by commander.
i. Prevention of cold-related problems.
1. Proper wear of uniform.
2. Use of the buddy system to spot injuries.
13
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NOTE: Conduct a check on learning and summarize the enabling learning objective.
D.
ENABLING LEARNING OBJECTIVE D
Action:
Conditions:
Standards:
Identify Army tobacco use policies.
In classroom environment with instruction on Army tobacco use
policies.
Army tobacco use policies are identified IAW AR 600-63.
Learning Step/Activity - Students are instructed on the Army tobacco use policies.
Method of instruction: CO
Instructor to student ratio is:1:25, FSC 1:16
Time of instruction: :10
Media: VGTs 9023-10 through 9023-21.
NOTE: Show VGT 9023-10, DA Smoking Policies.
Tobacco use, especially smoking, is becoming less and less socially acceptable. Our
population is beginning to realize the extensive human suffering and real costs of
tobacco use. We can no longer ignore the mounting evidence revealing the harmful
effects of tobacco. Attitudes and behaviors must change now. The DOD has a
smoke-free workplace policy. The Army has the same policy. Programs have
been established to help soldiers and family members become tobacco-free. In this
lesson you will be provided information which will help you to understand current
emphasis on tobacco cessation and the helpful programs available to assist you in
withdrawing from tobacco use.
1. Effects of Tobacco Use
a. Long Term Health Costs of Tobacco Use
QUESTION: What is the leading official cause of death in the United States?
ANSWER: Heart Disease
(1) Leading Cause of Death United States: Heart and blood vessel disease
NOTE: Also referred to as cardiovascular disease.
QUESTION: What is the leading, preventable cause underlying death in the
United States?
ANSWER: Tobacco use.
NOTE: Show VGT 9023-11, Leading Preventable Cause of Death
(2). Leading Preventable Cause of Death: Tobacco Use
NOTE: Tobacco use is responsible for more deaths than all other causes: 450,000 plus deaths per year.
That’s equivalent to two fully loaded jumbo jetliners colliding in mid-air, each day, with no survivors.
b. Diseases/Conditions Related to Tobacco Use
14
QUESTION: What are the diseases caused by using tobacco?
ANSWER: Heart disease, cancer, emphysema, stroke.
(1) Heart Disease: Leading risk for heart attack..
NOTE: Promotes atherosclerosis, the laying down of fatty deposits which leads to blockage of arteries in
the heart.
(2) Contributes to strokes and poor circulation.
NOTE: Poor circulation may lead to gangrene of limbs and amputations.
(3) Chronic lung diseases: emphysema, bronchitis.
(4) Cancers: lung, throat, mouth, bladder, possibly cervix.
(5) Osteoporosis (brittle bones).
(6) Increases risk of surgery and prolongs healing
process.
(7) May decrease male fertility.
NOTE: Show VGT 9023-12, Affects on Nonsmokers.
(8) Affects health of nonsmokers.
 Second hand smoke linked to lung cancer,
asthma attacks.
Children have more middle ear and lower
respiratory infections.
 Infants born to women who smoke have more:
Low birth weight babies, premature births, miscarriages.
 May increase risk of Sudden Infant Death
Syndrome (SIDS).
2. Soldiers & Tobacco
NOTE: Most of the previously mentioned unhealthy effects take many years to develop. But, there are
some ways tobacco use impacts upon soldiers’ performance immediately. These are especially important
considerations for soldiers and you, their leaders.
QUESTION: What are some examples of how smoking or smokeless tobacco use
may detract from soldiers’ performance and health after only a short period of time?
ANSWER: Tobacco use increases the likelihood of cold weather injuries, more
respiratory infections, to include pneumonia, and smokers tend to be in the hospital
15
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longer after surgery.
NOTE: Show VGT 9023-13, Increased # sick call visits.
a. Increases number of sick call visits.
NOTE: Smoking makes it far more likely that soldiers will be susceptible to upper respiratory infections
(colds and flu), which may progress to pneumonia. The healing time from pneumonia can be significant.
And, as mentioned earlier when discussing general effects of tobacco use, smokers are more likely to
develop chronic bronchitis and emphysema, both which are debilitating and often progress to pneumonia.
NOTE: Show VGT 9023-14, Decreases Readiness
b. Decreases readiness
NOTE: The bottom line is that tobacco use decreases readiness. The less time soldiers train for their
wartime mission, the less prepared they will be for deployment and the subsequent conflict, whatever and
wherever it may be. In addition to this significantly detrimental effect on ultimate readiness, tobacco use
also leads to other physical responses that are of great consequence when they occur during battle.
NOTE: Show VGT 9023-15, Adverse Impact on Soldiers
c. Decreases night vision
d. Decreases hand-eye coordination
e. Decreases stamina
f. Increases cold weather injuries
g. Increases overall number of injuries
NOTE: Soldiers who can’t distinguish the outline of an enemy tank or other vehicles from various terrain
features or vegetation put everyone at risk. And, soldiers who can’t site as well with their weapon are
certainly more likely to miss their target. Even during training missions decreased night vision, stamina,
and an increased number of injuries, be they cold weather or otherwise, decrease the number of hours
some soldiers can train. This certainly affects both individual and unit readiness.
h. Leads to addiction
NOTE: Show VGT 9023-16, Addiction.
NOTE: There are far more smoking-related deaths every year than deaths due to illicit drug use. Despite
the fact that people know tobacco is bad for their health and longevity, and want to give it up, it is very
difficult for most to do so. The physical and emotional dependence developed with tobacco use is very
great. Withdrawal symptoms are unpleasant. Often tobacco users feel jittery and irritable after a certain
period of time without nicotine. These are symptoms of withdrawal! We need soldiers who are alert, can
concentrate on the task at hand, and who are team players, not individuals who are easily aggravated by
other people or stressful situations due to their bodies’ reaction to not having tobacco.
3. Tobacco use in the US Army
a. Army Cigarette smoking vs US Adult Population
16
 Army: 43% in '87, 34.9% in '95
 U.S. Teenagers (High School)
27.5% in ’91, 36.4% in 1997
 United States: 25% in ‘91, 25,5% in ’94
NOTE: Per the Centers for Disease Control & Prevention (CDC), in 1994 smoking increased for the first
time in a decade in US adults (from 25 to 25.5%). Despite this small increase in our country’s adult
population use, note the significantly higher smoking rate in our troops versus the country as a whole. The
teenage smoking rate has gone up greatly in only 6 years. What does this mean for the Army? Soldiers
learn about smoking at a young age and may be even more likely, due to the increases we’re seeing in
both teenage and adult use, to come to the Army already addicted to the substance of tobacco.
b. DOD Smoking by Age (1995)
 20 or younger: 40.8%
 21-25: 35%
 26-34: 29.2%
 35 or older: 26.9%
c. DOD Smoking by Rank (1995)
 E1-E3: 40.8%
O1-O3: 9.5%
 E4-E6: 34.8%
O4-O10: 7.1%
 E7-E9: 32.6%
W1-W5: 22.4%
NOTE: 1/3rd of both officers and enlisted begin smoking after entering the Army (1992).
NOTE: Young soldiers are very impressionable. Thus, as might be expected, the youngest soldiers are
more likely to smoke. This is where the bulk of our force strength is. The base of the Army’s pyramid is
made up of soldiers 17-25 years of age. Many young troops are likely to have already taken up the
smoking habit before enlisting, and may already be exhibiting adverse health and performance effects. As
Army leaders it is your responsibility to act as role models for soldiers, and to assist them in becoming the
best soldier they can. If you use tobacco yourself, consider the message this conveys to those around
you. And, all leaders, at whatever rank or position, should be encouraging all soldiers to “kick the habit” so
they can “be all they can be”.
NOTE: Show VGT 9023-17, Army’s #1 Healthy People 2000 Goal.
NOTE: These trends are of great concern to DOD. In 1987 the U.S. Department of Health and Human
Services identified health priorities for our entire country. The objective was to achieve them by the year
2000. This plan was named Healthy People 2000. DOD, in turn, chose 45 particular goals from this plan
for its population. And, the Army ultimately ranked these and selected the 5 top goals for its population.
These are commonly referred to as the Top 5 Healthy People 2000 Priorities. Number one is to reduce
military smokers to 20%. Look where we are at (nearly 35%) versus where we want to be.
17
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d. Smokeless Tobacco
By Service Branch (males)
 Army: 17.4%
 Air Force: 9.3%
 Marines: 25.1%
 Navy: 13.4%
 U.S. Civilians: 11.4%
*Only about 1% of DOD females use smokeless tobacco
NOTE: Contrast the Army’s smokeless use to that of the civilian population overall. Again, we have a
higher rate than the U.S. as a whole. Often troops switch from cigarettes to smokeless in a field setting, if
the smoking area is too far from their work-site, or, when they’re in an academic setting where smoking is
prohibited. And, for young soldiers it seems to have a particularly macho image attached to its use:
cowboys, race car drivers, baseball players. Many people believe smokeless is safer than smoking. But,
smokeless tobacco is a factor in the development of heart disease, and various cancers. Cancers of the
mouth and throat are particularly deforming and deadly. It is well established that smokeless tobacco of
all types (chew, snuff, bandits) lead to these heart-breaking diseases. Again, all military members who
are in official or unofficial roles as leaders need to be part of the effort to educate and assist others in
becoming tobacco free, as well as looking at their own behavior and potential need for self change.
NOTE: 36% of both enlisted and officers begin use of smokeless tobacco after entering the Army (1992).
Thus, entry training for both enlisted personnel and officers is an ideal time to inform people they may be
at risk for starting both smoking, as discussed earlier, and smokeless tobacco use. It is also prime time to
provide the education and programs to keep soldiers tobacco-free. And, of course, those who currently
use tobacco should be informed they may not be able to perform at their best, today, or in the future due
to this habit.
NOTE: Show VGT 9023-18, Army’s #2 Healthy People 2000 Goal
NOTE: The Army’s immediate goal (based on our second Healthy People 2000 Priority) is to reduce use
of smokeless tobacco to 4% or less in those 12-24 years of age. Again, we have a long way to go.
NOTE: Show VGT 9023-19, AR 600-63 Army Health Promotion.
4. AR 600-63, Army Health Promotion & Tobacco Use
a. All health care beneficiaries encouraged to become tobacco-free
b. Smoking prohibited during Basic Combat Training
c. Controlled/limited smoking during AIT
d. Cadre and faculty of schools will not use tobacco products in
presence of students when on duty
e. Health education classes on hazards of tobacco use throughout professional
military training
18
f. Installations will provide smoking cessation programs
g. Smoking prohibited in all DA-occupied work places.
NOTE: Recreation facilities may be excepted as determined by installation commander.
h. Smokers are not permitted additional time beyond routine breaks.
i. Designated smoking areas will be outdoors, with reasonable protection from the
elements, at least 50 feet from common points of entrance/exit, and not in areas of
common use.
5. Help Available Now
NOTE: Show VGT 9023-20, Help with Quitting
a. Your doctor, nurse or physician’s assistant (PA)
(Primary Care Provider)
NOTE: Your health care provider may be able to prescribe medication to help with your cessation effort.
b. Local preventive medicine service
c. Self-help materials available from:
Medical Treatment Facility,
d. Preventive Medicine
e. American Cancer Society (800-486-2345)
NOTE: Show VGT 9023-21, Other Assistance
f. Nicotine gum, nicotine patches
NOTE: Nicotine gum and the patches may be available free of charge at some installations. Participation
in a group cessation program may be required to be eligible for them free of charge. Or, other types of
follow-up in individual sessions may be necessary. Both of these aids are also readily available at drug
stores and the PX as it is not necessary to have a prescription to buy them.
g. Family and unit support is critical
Closing Statement: The use of tobacco of all types, cigars, pipes, cigarettes or smokeless, jeopardizes
the health of both our soldiers who use it, and those around them. It also has a significant adverse impact
upon our troops’ performance and availability for duty. The bottom line is tobacco use detracts from
readiness. As a leader it is your responsibility to maintain unit readiness, to act as a role model for your
troops, and to be a source of information. Not everyone will begin using tobacco upon entering the
military, nor are all those who use it in its various forms ready to quit today. But, correctly timed words
from you may help move someone to consider changing their ways. This, along with providing support,
and suggesting sources of help, will go a long way to keeping our force fit to fight and fit to win.
NOTE: Conduct a check on learning and summarize the enabling learning objective.
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E. ENABLING LEARNING OBJECTIVE E
NOTE: Inform the students of the enabling learning objective requirements.
Action:
Conditions:
Standards:
Identify specific responsibilities of key individuals within your unit for
protecting soldiers from disease and climatic injury.
In a classroom environment, given HO 081-P-9023 and access to
AR 40-5, FM 8-10, FM 21-10, FM 21-10-1.
Identify six specific responsibilities of key individuals within you unit
for protecting soldiers from DNBIs according to this objective. IAW
AR 40-5, FM 8-10, FM 21-10, FM 21-10-1.
Learning Step/Activity - Student receive instruction on the responsibilities of key
individuals within a unit for protecting soldiers from disease and climatic injury. (AR 405 14-2, 14-3ab; FM 8-10 10-5; FM 21-10 Chapters 3,4; FM 21-10-1 1-2, 1-3, 2-4)
Method of instruction: CO
Instructor to student ratio is: 1:25; FSC 1-16.
Time of instruction: 10 minutes
Media: VGT 9023-22.
NOTE: For FSC SGI. Ask the students for input about the specific responsibilities of key individuals within
your unit for protecting soldiers from disease and climatic injury. Provide clarification where needed.
1. The medical threat is impartial. It will strike everyone on the battlefield equally. If
one side takes the medical threat seriously while the other does not, there is a
significant advantage to be gained by the side that considers the medical threat.
2. Commanders obtain information prior to deployment to use when planning unit
preventive medicine measures for protection against DNBIs.
3. DNBI information for the deployment area is provided by preventive medicine
support personnel. Knowing the environmental effects will tell you to expect heat,
cold and other types of casualties. Give priority to DNBIs that are more likely to
occur in your theater of operations.
4. Intelligence and casualty reports will give you additional information.
NOTE: Show VGT 9023-22, Field Sanitation Teams. (AR 40-5 14-3b; FM 21-10 chapter 4; FM 21-10-1 2-4)
5. Each company-sized unit is required to have a FST consisting of two soldiers—one
NCO and one enlisted soldier. If the unit has assigned or attached medical
personnel, the medical personnel function as the commander’s field sanitation
advisors. In either case, these soldiers have the capability to protect the health of
the unit unlike anyone else in the unit. They have the ability to—
a. Check water for adequate chlorine.
b. Check the food.
c. Reduce insect and rodent populations through accepted techniques.
20
d. Dust and trap for rats.
e. Provide training in preventive medicine.
f. Advise the commander on unit waste disposal.
g. Most importantly, these soldiers serve as your eyes and ears allowing you to
focus your attention on the hundreds of other tasks involved in managing a field
unit. These soldiers can meet their FST responsibilities and still have time to
perform their primary job as well. If you put incompetent individuals on your
team, you are denying yourself a valuable resource. Pick good people!
NOTE: Conduct a check on learning and summarize the enabling learning objective.
F. ENABLING LEARNING OBJECTIVE F
NOTE: Inform the students of the enabling learning objective requirements.
Action:
Conditions:
Standards:
Identify capabilities of preventive medicine assets in a theater of
operations.
In a classroom environment, given HO 081-P-9023 and access to AR
40-5, FM 8-10.
Identify the capabilities of preventive medicine assets within the
theater of operations. IAW 40-5, FM 8-10.
Learning Step/Activity - Students receive instruction on capabilities of prevent
medicine assets in a theater of operations. (AR 40-5 chap 14; FM 8-10, chapter 10)
Method of instruction: CO
Instructor to student ratio is: 1:25, FSC 1:16.
Time of instruction: :09 minutes
Media: None.
NOTE: For FSC SGI. Ask the students for input about capabilities of preventive medicine assets in a theater
of operations. Provide clarification where needed.
(1)
Capabilities of Preventive Medicine (PM) assets within a theater of operations—
(a) Quality control monitoring and consultation for :
(1) Food Sanitation.
(2) Water and wastewater.
(3) Vector control.
NOTE: Corp level preventive medicine assets have the capability to perform aerial spray missions.
(4) Personal hygiene.
(5) Environmental hazard protection.
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(6) Disease or environmental injury investigation.
(7) Solid waste disposal.
(a) Field Sanitation Team Training (FST) and certification.
(b) Deployment readiness support including:
(1) Medical threat analysis.
(2) Specific disease and non-battle injury (DNBI) preventive measures.
(3) Additional Field Sanitation Team (FST) training.
(4) Chemoprophylaxis and immunization guidance.
NOTE: Conduct a check on learning and summarize the learning activity.
22
SECTION IV
SUMMARY
Method of instruction: Co
Instructor to student ratio is: 1:25; FSC 1-16.
Time of instruction: 13 minutes
Media: VGTs 9023-23,24,25.
Review/
Summarize
Lesson
NOTE: Show VGTs 9023-23, 24, Four Major Components of the Medial Threat to Field Forces and
Increased Vulnerability.
1. During this session we have looked at the medical threat to field forces. We know
there are three reasons why soldiers are so vulnerable to DNBIs when they deploy to
the field and four major components of the medical threat. We have seen that
DNBIs have played a major role in military campaigns and that our FASTS are an
important resource. We have also seen that resources are available to help in
applying preventive medicine actions if unit resources are not able to handle the
magnitude of the problem.
NOTE: Show VGT 9023-25, Success = Discipline
2. The medical threat is impartial; it will strike anyone on the battlefield with equal force.
If one side takes the medical threat seriously while the other does not, there is a
significant advantage to be gained by the one side. In the next major conflict, the
success of a fighting force may depend on how well it exercises preventive medicine
measures.
NOTE: Make sure you repeat the terminal learning objective of the lesson.
NOTE: Determine if students have learned the material presented by soliciting student questions and
explanations. Ask the students questions and correct misunderstandings.
Check on
Learning
QUESTIONS
You may ask all or some of the questions that follow (as time permits) and feel free to
create your own questions that will better meet the need of the particular class.
(1) What are the three vulnerability factors pertaining to troops in the field?
(FM 21-10-1, 2-2c)
Ans. (a) Environmental extremes.
(b) Reduction of the body’s defenses.
(c) Breakdowns in sanitation.
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(2) What are the four major components of the medical threat?
(FM 21-10-1 2-2b)
(a) Heat.
(b) Cold.
(c) Arthropods.
(d) Diarrhea.
(3) What is the role of a commander or leader in preventive medicine and field
sanitation? (AR 40-5 1-4g, 14-3b; FM 21-10 chapter 1)
Ans. (a) Seek advice and guidance on preventive medicine issues relevant to his
organization.
(b) Guard against environmental threats to the health of the unit.
(4) What preventive medicine information is obtained prior to deployment to a theater
of operation and how is it used in planning? (AR 40-5, 14-4; FM 8-10, 10)
Ans. (a). Identify DNBIs in the area where you will deploy.
(b). Identify the DNBI that is most likely to occur.
(c). Prioritize the preventive medicine measures your unit will apply upon
deployment
(5). What area of preventive medicine requires personal participation by all members
of the unit? (AR 40-5, 14-2; FM 21-10 , 2)
Ans. (a) Prevention of Insect bites.
(b) Avoiding spoiled food.
(c) Avoiding native food.
(d) Drinking only potable water.
(e) Disposing of waste.
(f) Practice of personal hygiene.
(g) Protect against STD.
(h) Prevention of heat-related problems.
(i) Prevention of cold-related problems.
6. What is the DOD policy on smoking in the workplace?
Ans., The workplace will be smoke free.
24
7. What Army regulation addresses the issue of smoking in DA occupied work places.
Ans., AR 600-63, Army Health Promotion.
8. What are some examples of physical responses of tobacco use soldiers may
experience during combat?
Ans., Decreased night vision; decreased hand-eye coordination; decreased stamina;
Increased cold weather injuries; and increased overall number of injuries.
9. What are some of the responsibilities of a Field Sanitation Team?
(AR 40-5, 14-2, 14-3a, 14-3b; FM 21-10-1, 1-2, 1-3, 2-4)
(a) Check water for adequate chlorine.
(b) Check the food.
(c) Reduce insect and rodent populations.
(d) Dust and trap for rats.
(e) Provide training in preventive medicine.
(f) Advise the commander/leaders on waste disposal.
10. What are some of the capabilities of preventive medicine assets in a theater of
operations? (AR 40-5, 14-4; FM 8-10, 10)
Ans. a. Quality control monitoring and consultation for:
(1) Food Sanitation.
(2) Water and wastewater.
(3) Vector control. Corp level preventive medicine assets have the capability
to perform aerial spray missions.
(4) Personal hygiene.
(5) Environmental hazard protection.
(6) Disease or environmental injury investigation.
(7) Solid waste disposal.
b. Field Sanitation Team (FST) Training and certification.
c. Deployment readiness support including:
(1) Medical threat analysis.
(2) Specific disease and non-battle injury (DNBI) preventive measures.
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(3) Additional Field Sanitation Team (FST) training.
(4) Chemoprophylaxis and immunization guidance.
NOTE: Solicit and answer the student’s questions. This is not a graded activity.
Transition
To Next
Lesson
Tell the students what the next lesson will be.
26
SECTION V
STUDENT EVALUATION
NOTE: Describe how the students will be tested to determine if they can perform the TLO to standard. Refer
student to the Student Evaluation Plan.
Testing
Requirements
a. Performance Exercise: None.
b. Written exam. Students will be tested by means of a multiple choice written
examination covering the objectives of this task. A student must score 70 percent
to pass.
NOTE: Include this information also in the Student Evaluation Plan which documents course graduation
requirements. The using school assigns course weight to the evaluation.
NOTE: Rapid, immediate feedback is essential to effective learning. Schedule and provide feedback on the
evaluation and any information to help answer student’s questions about the test. Provide remedial
training as needed. If a student requires remedial instruction, have that student read FM 21-10.
Feedback
Requirement
When students have completed the test, discuss the solutions. Allow ten minutes for
feedback.
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APPENDIX A
VIEW GRAPH MASTERS
A-1
APPENDIX D
STUDENT HANDOUTS
D-1
(Corrected 2 October1998)
STUDENT HANDOUT
ENFORCE PREVENTIVE MEDICINE MEASURES AGAINST DISEASE
AND NONBATTLE INJURIES.
D-2
Read this handout and be prepared to take part in limited discussion during class. A 15 minute multiple
choice test will be administered at the end of the lesson
OBJECTIVES
1. Terminal Learning Objective:
Action: Identify actions performed to enforce preventive medicine measures for protection against
disease and nonbattle injuries when deployed.
Condition: In a classroom environment given HO 081-P-9023.
STANDARD: Identify measures to take to protect soldiers from DNBIs. Identify the four major
components of the medical threat to field forces and their preventive medicine measures. Identify four
specific responsibilities of key individuals within your unit for protecting soldiers from DNBIs. Identify
capabilities of preventive medicine assets in a theater of operations. IAW AR 40-5; FM 21-10,
FM 21-10-1.
2. Enabling objectives:
a. Identify reasons soldiers in the field have increased vulnerability to disease.
b. Identify major components of the medical threat to field forces and their preventive medicine
measures.
c. Identify the measures to protect soldiers from disease and nonbattle injuries (DNBI).
d. Identify the Army’s tobacco use policies.
e. Identify specific responsibilities of key individuals within your unit for protecting soldiers from DNBIs.
f. Identify capabilities of preventive medicine assets in a theater of operations.
3. Introduction:
Throughout history, armies have had tremendous problems with heat, cold, and disease. Diseases and
nonbattle injuries (DNBIs) have caused the greatest wartime loss of human resources. If we truly expect
to fight the next war outmanned and outgunned, leaders at all levels will find it more important than ever
before our fighting strength.
Leaders will find information on this subject in the following literature: AR 40-5, Preventive Medicine; FM
21-10, Field Hygiene and Sanitation; and FM 21-10-1, Unit Field Sanitation Team.
A. Reasons soldiers in the field have increase vulnerability to disease.
1.
Merrills Marauders. Disease was an important factor for the famous unit. The marauders faced
a serious medical threat in the jungles of Burma during World War II. Everyone was sick, but
some had to stay and fight although they were suffering from diarrhea. Evacuation was limited to
those with high fever and severe illness. After a bold and successful attack on a major airfield,
Merrills Marauders were disbanded partly because of disease.
2. Environment Extremes. Even superbly conditioned, healthy soldiers are vulnerable to disease
when they deploy to the field. The first factor of concern in the field is environmental extremes.
The tactical situation often requires us to go into places good sense tells us to avoid: mosquitoinfested jungles; sandfly-infested deserts; and cold, windy plains. As professionals, we must be
ready to live and fight in such places.
D-3
3. Reduction of Natural Defenses. The second factor is the reduction of the bodys natural defenses.
The body has an amazing capacity to protect itself against heat, cold, and disease. But the efficiency of
those mechanisms depends on overall well-being. Consider this: first we put soldiers in a loud, vibrating,
cramped aircraft and fly them halfway around the world so their body clocks are out of synchronization (jet
lag). Then we put them deep in the field, keep them soaking wet, add heat or cold, feed them meals at
irregular intervals, and fire flares all night while they are trying to sleep. It is not long before they are totally
exhausted. Under these conditions, soldiers would soon have lowered defenses against disease.
4. Breakdowns in Sanitation. The third and final contributing factor is breakdowns in sanitation.
Actions which are convenient in peacetime become a challenge in the combat zone: using the latrine,
getting rid of garbage, or simply taking a shower. Even changing your underwear is a futile effort when
you are living in a muddy foxhole. During search and destroy missions in Vietnam, it was common for
men to go three or four weeks without shaving or changing clothes. There was nothing macho about it;
such acts were simply inconvenient.
B. Major components of the medical threat to field forces and their preventive medicine measures.
1. Of the four major components, heat is the most lethal medical threat. Rommel found this out when
he lost more than 10 percent of his force in North Africa to heat-related deaths or incapacitation. Since
heat injury is usually a result of dehydration and thirst is a poor indicator of a bodys need for water, unit
leaders must regularly enforce the drinking of more than one quart of water an hour when the heat
condition dictates. During operations in Grenada, the fact that soldiers do not drink hot water was
reemphasized. The Army plans to remedy the problem of potability by introducing water refrigeration units
to the inventory. Until then, however, you, as a leader, must enforce a rigid water consumption policy.
Failure to do so results in lost combat power.
2. The second major components of the medical threat is cold. This threat includes severely cold
climates and those regions, such as the desert, which have drastic temperature variations. During the day
the desert temperature may be hot; however, at night the temperature may drop drastically. By educating
soldiers on the proper wearing of the uniform and by enforcing the use of the buddy system, cold injuries
can be greatly reduced.
3. The third major component is arthropods. The use of insect repellents and the proper wearing of
the uniform can virtually eliminate the incidence of disease from biting insects.
4. The fourth major component is diarrheal disease. Diarrhea can be significantly reduced by ensuring
that only potable water is consumed by our soldiers and that food is prepared under sanitary conditions.
Have soldiers purify their drinking water if treated water is not available (see task 081-831-9000,
Implement Preventive Medicine Measures and 081-831-1047, Supervise the Implementation of Preventive
Medicine Policies). Failure to enforce field sanitation discipline can reduce your combat power as
surely as an artillery barrage.
C. Measures to protect soldiers from disease and nonbattle injuries (DNBIs).
1. The commanding officer of an Army unit, is responsible for enforcing personal hygiene and
individual preventive measures against diseases for all members of the unit. The commander is also
responsible for providing guidance, planning unit preventive measures, and assigning special tasks to the
FST and unit personnel in order to safely dispose of waste, ensure sanitation of food and potability of
water supplies, and reduce the incidence of injury and diseases caused by animals and /or insects.
2. The commander and other leaders role in preventive medicine and field sanitation.
a. Seek advice and guidance.
D-4
(1) The commanding officer of an Army organization is responsible for the health of the
organization. To assist in this duty, the commander may seek advice and guidance of the unit surgeon.
The unit dining facility officer and Field Sanitation Team (FST) members also advise and assist the
commander in matters related to the health of the organization.
(2) The unit surgeon may seek the advice and assistance of almost every medical specialty.
These specialists include preventive medicine officers, veterinary officers, environmental science
officers, sanitary engineers, entomologists, preventive dentistry officers, and members of
preventive medicine units.
b. Guard against environmental threats to the health of the unit.
(1) Insects and animals are important planning considerations because they may seriously affect
the military units preparedness. A soldier in the hospital with snakebite or malaria is of no more use to
the military unit than the one shot on the field. The soldier who stays awake all night fighting insects is
less effective on the job.
(2) Food and water are important to every soldier. If that food or water is contaminated supplies
may become a casualty.
(3) A military unit generates large quantities of garbage and waste each day. This waste must
be removed promptly and thoroughly. If not, the camp will soon attract flies and rodents. These pests
spread filth-borne diseases such as dysentery, typhoid, paratyphoid, cholera, and plague.
3. Prepare the camp area for troops. Factors which influence camp area preparation are the following:
a. Mission. The length of stay in the camp, the tactical situation, and the local environment affect
the comfort and sanitation preparations for the camp.
b. Support facilities. The availability and proximity of support activities such as field bath units,
water supply points, and field kitchens affect preparation. Other support facilities such as earthmoving, construction, and fabrication capabilities influence preparation.
c. Other factors. The number of troops using the facilities and the supplies available influence
preparation.
4. Enforce individual preventive medicine measures. Areas which will require the personal
participation of all members of your unit are the following:
a. Prevention of insect bites.
 Proper wear of uniform.
 Repellent use.
 Insect net use.
b. Avoiding spoiled food.
c. Avoiding native food (unfamiliar food).
d. Drinking only potable water.
e. Disposing of garbage and waste properly.
f. Practice of personal hygiene.
D-5
 Washing hands after latrine use.
 Bathing frequently.
 Changing to a clean uniform whenever possible.
 Proper care of feet.
 Brushing teeth after each meal if possible.
g. Protection against sexually transmitted disease.
h. Prevention of heat-related problems.
 Adequate water consumption. Use the Fluid Replacement Policy for Warm Weather table
and accompanying information as a guide.
NOTE: Students have the following table in their handout.
NOTE: The asterisked (*) fluid retention information is per: “Memorandum, Policy Guidance for Fluid
Replacement During Training, 29/04/98, Office of the Surgeon General.
D-6
*Fluid Replacement Policy for Warm Weather
(Average acclimated soldier wearing BDU, Hot Weather
Easy Work
Moderate Work
Hard work
Work/Rest
WBGT
Work
Water
Water
Work
Water
INDEX,
/Rest
Intake
Intake,
/Rest
Intake,
1*
F
78 - 81.9
NL
Qt/hr
½
NL
Qt/hr
¾
40/20 min
Qt/hr
¾
2
82 - 84.9
NL
½
50/10 min
¾
30/30 min
1
3
85 - 87.9
NL
¾
40/20 min
¾
30/30 min
1
4
88 - 89.9
NL
¾
30/30 min
¾
20/40 min
1
5**
>90
50/10 min
1
20/40 min
1
10/50 min
1
HEAT
CATEGORY
CAUTION: *Hourly fluid intake should not exceed 1½ quarts. Daily fluid intake should not
exceed 12 quarts.

*The work:rest times and fluid replacement volumes will sustain performance and hydration for at
least 4 hrs of work in the specified heat category. Individual water needs will vary  ¼ qt/hr.

*NL = no limit to work time per hour. Rest means minimal physical activity (sitting or standing) and
should be accomplished in shade if possible.

*Mission-Oriented Protective Posture (MOPP) gear or body armor adds at least 10 F to the Wet
Bulb Globe Temperature (WBGT) Index.
** Suspend physical training and strenuous activity. If an operational (nontraining) mission requires
strenuous activity, enforce water intake to minimize expected heat injuries.
Easy Work





*Examples of Categories of Work
Moderate Work

Weapon maintenance
Walking on hard surfaces at
2.5 mph,  30 lb. load.
Manual of arms.
Marksmanship training.
Drill and Ceremony




Walking on loose sand at
2.5 mph, no load.
Walking on hard surface
at 3.5 mph,  40 lb. Load.
Calisthenics
Patrolling.
Individual movement.
techniques. i.e. low
crawl, high crawl.


Defensive position
construction.
Field assaults.
 Modify uniform as authorized/directed by commander.
I. Prevention of cold-related problems.
 Proper wear of uniform.
 Use of the buddy system to spot injuries.
 Exercise body parts.
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Hard Work


Walking on loose sand
at 2.5 mph with load.
Walking on hard
surface at 3.5 mph, 
40 lb. Load
 Avoid smoking because smoking decreases blood flow to the skin.
D. Army tobacco use policies.
1. Effects of Tobacco Use.
a. Long Term Health Costs of Tobacco Use.
(1) Leading Cause of Death in the United States: Heart and blood vessel disease.
(2) Leading Preventable Cause of Death: Tobacco Use
2. Diseases/Conditions Related to Tobacco Use
a. Heart Disease: Leading risk for heart attack..
b. Contributes to strokes and poor circulation.
c. Chronic lung diseases: emphysema, bronchitis.
d. Cancers: lung, throat, mouth, bladder, possibly cervix.
e. Osteoporosis (brittle bones).
f. Increases risk of surgery and prolongs healing process.
g. May decrease male fertility.
h. Affects health of nonsmokers.
 Second hand smoke linked to lung cancer,
asthma attacks.
Children have more middle ear and lower
respiratory infections.
 Infants born to women who smoke have more:
Low birth weight babies, premature births, miscarriages.
 May increase risk of Sudden Infant Death
Syndrome (SIDS).
3. Soldiers & Tobacco
a. Increases number of sick call visits.
b. Decreases readiness
c. Decreases night vision
d. Decreases hand-eye coordination
e. Decreases stamina
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f. Increases cold weather injuries
g. Increases overall number of injuries
h. Leads to addiction
4. Tobacco use in the US Army
a. Army Cigarette smoking vs US Adult Population
 Army: 43% in '87, 34.9% in '95
 U.S. Teenagers (High School)
27.5% in ’91, 36.4% in 1997
 United States: 25% in ‘91, 25,5% in ’94
The Centers for Disease Control & Prevention (CDC), in 1994 smoking increased for the first time in a
decade in US adults (from 25 to 25.5%). Despite this small increase in our country’s adult population use,
note the significantly higher smoking rate in our troops versus the country as a whole. The teenage
smoking rate has gone up greatly in only 6 years. What does this mean for the Army? Soldiers learn
about smoking at a young age and may be even more likely, due to the increases we’re seeing in both
teenage and adult use, to come to the Army already addicted to the substance of tobacco.
b. DOD Smoking by Age (1995)
 20 or younger: 40.8%
 21-25: 35%
 26-34: 29.2%
 35 or older: 26.9%
c. DOD Smoking by Rank (1995)
 E1-E3: 40.8%
O1-O3: 9.5%
 E4-E6: 34.8%
O4-O10: 7.1%
 E7-E9: 32.6%
W1-W5: 22.4%
One third of both officers and enlisted begin smoking after entering the Army (1992).
Young soldiers are very impressionable. Thus, as might be expected, the youngest soldiers are more
likely to smoke. This is where the bulk of our force strength is. The base of the Army’s pyramid is made
up of soldiers 17-25 years of age. Many young troops are likely to have already taken up the smoking
habit before enlisting, and may already be exhibiting adverse health and performance effects. As Army
leaders it is your responsibility to act as role models for soldiers, and to assist them in becoming the best
soldier they can. If you use tobacco yourself, consider the message this conveys to those around you.
And, all leaders, at whatever rank or position, should be encouraging all soldiers to “kick the habit” so they
can “be all they can be”.
d. Smokeless Tobacco
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By Service Branch (males)
 Army: 17.4%
 Air Force: 9.3%
 Marines: 25.1%
 Navy: 13.4%
 U.S. Civilians: 11.4%
*Only about 1% of DOD females use smokeless tobacco
Contrast the Army’s smokeless use to that of the civilian population overall. Again, we have a higher rate
than the U.S. as a whole. Often troops switch from cigarettes to smokeless in a field setting, if the
smoking area is too far from their work-site, or, when they’re in an academic setting where smoking is
prohibited. And, for young soldiers it seems to have a particularly macho image attached to its use:
cowboys, race car drivers, baseball players. Many people believe smokeless is safer than smoking. But,
smokeless tobacco is a factor in the development of heart disease, and various cancers. Cancers of the
mouth and throat are particularly deforming and deadly. It is well established that smokeless tobacco of
all types (chew, snuff, bandits) lead to these heart-breaking diseases. Again, all military members who
are in official or unofficial roles as leaders need to be part of the effort to educate and assist others in
becoming tobacco free, as well as looking at their own behavior and potential need for self change.
Thirty-six percent of both enlisted and officers begin use of smokeless tobacco after entering the Army
(1992). Thus, entry training for both enlisted personnel and officers is an ideal time to inform people they
may be at risk for starting both smoking, as discussed earlier, and smokeless tobacco use. It is also
prime time to provide the education and programs to keep soldiers tobacco-free. And, of course, those
who currently use tobacco should be informed they may not be able to perform at their best, today, or in
the future due to this habit.
The Army’s immediate goal (based on our second Healthy People 2000 Priority) is to reduce use of
smokeless tobacco to 4% or less in those 12-24 years of age. Again, we have a long way to go.
e. AR 600-63, Army Health Promotion & Tobacco Use
(1) All health care beneficiaries encouraged to become tobacco-free
(2) Smoking prohibited during Basic Combat Training
(3) Controlled/limited smoking during AIT
(4) Cadre and faculty of schools will not use tobacco products in
presence of students when on duty
(5) Health education classes on hazards of tobacco use throughout professional military training
(6) Installations will provide smoking cessation programs
(7) Smoking prohibited in all DA-occupied work places.
(8) Smokers are not permitted additional time beyond routine breaks.
(9) Designated smoking areas will be outdoors, with reasonable protection from the elements, at
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least 50 feet from common points of entrance/exit, and not in areas of common use.
f. Help Available Now
(1) Your doctor, nurse or physician’s assistant (PA)
(Primary Care Provider) Your health care provider may be able to prescribe medication to help with
your cessation effort.
(2) Local preventive medicine service
(3) Self-help materials available from:
Medical Treatment Facility,
(4) Preventive Medicine
(5) American Cancer Society (800-486-2345)
(6) Nicotine gum, nicotine patches
Nicotine gum and the patches may be available free of charge at some installations. Participation in a
group cessation program may be required to be eligible for them free of charge. Or, other types of followup in individual sessions may be necessary. Both of these aids are also readily available at drug stores
and the PX as it is not necessary to have a prescription to buy them.
(7) Family and unit support is critical
E. Specific responsibilities of key individuals within your unit for protecting soldiers from disease and
climatic injury.
1. The medical threat is impartial. It will strike everyone on the battlefield equally. If one side takes the
medical threat seriously while the other does not, there is a significant advantage to be gained by the side
that considers the medical threat.
2. Commanders obtain information prior to deployment to use when planning unit preventive medicine
measures for protection against DNBIs.
a. DNBI information for the deployment area is provided by preventive medicine support personnel.
Knowing the environmental effects will tell you to expect heat, cold and other types of casualties. Give
priority to DNBIs that are more likely to occur in your theater of operations.
b. Intelligence and casualty reports will give you additional information.
3. Each company-sized unit is required to have a FST consisting of two soldiers--one NCO and one
enlisted soldier. If the unit has assigned or attached medical personnel, the medical personnel function as
the commanders field sanitation advisors. In either case, these soldiers have the capability to protect the
health of the unit unlike anyone else in the unit. They have the ability to-a. Check water for adequate chlorine.
b. Check the food.
c. Reduce insect and rodent populations through accepted techniques.
d. Dust and trap for rats.
e. Provide training in preventive medicine.
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f. Advise the commander on unit waste disposal.
g. Most importantly, these soldiers serve as your eyes and ears allowing you to focus your attention
on the hundreds of other tasks involved in managing a field unit. These soldiers can meet their FST
responsibilities and still have time to perform their primary job as well. If you put incompetent individuals
on your team, you are denying yourself a valuable resource. Pick good people!
F. Capabilities of preventive medicine assets in a theater of operations.
1. Capabilities of Preventive Medicine (PM) assets within a theater of operations:
a. Quality control monitoring and consultation for :
 Food Sanitation.
 Water and wastewater.
 Vector control. Corp level preventive medicine assets have the capability to perform aerial
spray missions.
 Personal hygiene.
 Environmental hazard protection.
 Disease or environmental injury investigation.
 Solid waste disposal.
b. Field Sanitation Team Training (FST) and certification.
c. Deployment readiness support including:
 Medical threat analysis.
 Specific disease and non-battle injury (DNBI) preventive measures.
 Additional Field Sanitation Team (FST) training.
 Chemoprophylaxis and immunization guidance.
4. Summary.
In this session we have looked at the medical threat to field forces. We know there are three reasons why
soldiers are so vulnerable to DNBIs when they deploy to the field and four major components of the
medical threat. We have seen that DNBIs have played a major role in military campaigns and that our
FASTS are an important resource. We have also seen that resources are available to help in applying
preventive medicine actions if unit resources are not able to handle the magnitude of the problem.
The medical threat is impartial; it will strike anyone on the battlefield with equal force. If one side takes the
medical threat seriously while the other does not, there is a significant advantage to be gained by the one
side. In the next major conflict, the success of a fighting force may depend on how well it exercises
preventive medicine measures.
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