NAVMED P-5010, Manual of the Naval Preventive Medicine, Chapter 9


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This Power Point is part of an Enlisted Advancement Program training series for US Navy Corpsman rating provided by Naval Medical Center Portsmouth Virginia

Naval Medical Center Portsmouth is a military treatment facility serving active duty service members, their dependents and retirees in the Hampton Roads community of southeastern Virginia and northeastern North Carolina.

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NAVMED P-5010, Manual of the Naval Preventive Medicine, Chapter 9

  2. 2. 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
  3. 3. 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 contaminated sources including fresh, brackish, or sea water. • Erdalator • Transportable quick-response water purification system capable of aerating, clarifying, filtering and disinfecting contaminated water
  4. 4. 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.
  5. 5. 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.
  6. 6. 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.
  7. 7. 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.
  8. 8. 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.
  9. 9. 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.
  10. 10. 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. *
  11. 11. 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
  12. 12. 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
  13. 13. 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).
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. Human Wastes (feces and urine)  Mound Latrines • indicated when higher ground water levels or rock formations prevent the digging of a deep pit
  20. 20. Waste Disposal  Urine soakage pit • Most effective in sandy soils • Six tubes made by PVC piping 1x36” • One pipe for every 20 men
  21. 21. Waste Disposal  Urine Trough • 10 ft long “U” or “V” shaped trough is made of sheet metal or wood • 1 trough per 100 men
  22. 22. 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”.
  23. 23. 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.
  24. 24. 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
  25. 25. 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.
  26. 26. 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
  27. 27. 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
  28. 28. Garbage Disposal: Incineration  Incline plane incinerators  Handle garbage – entire battalion  Barrel incinerator  Made from 55 gallon drum by cutting out both ends
  29. 29. HEAT INJURIES  Types of Heat Injuries  Heat cramps  Heat syncope  Heat exhaustion  Heatstroke • IS A MEDICAL EMERGENCY!
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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
  34. 34. 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
  35. 35. Any Questions?