Operational Preventive Medicine – Flashcards
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Organized political violence
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Conflict is distinguished from peace by the introduction of...
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Stability and Supportt Operations can include
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Noncombatant evacuation operations(NEO) Foreign Humanitarian assistance and disaster relief Combating terrorism Nation Assistance Security Assistance Counter-drug operations Show of Force....etc
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Combat Health Support is defined as: CHS
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those actions encompassing all military health-related activities taken or programs established to further US national goals, objectives and missions.
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CHS plays a significant role in nation assistance by:
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1. Assisting with the development and refinement of the host-nation HN medical infrastructure 2. Providing and maintaining the basic necessities of life for the general population through HN civilian medical programs. 3. Providing assistance in establishing, repairing, or improving basic health and sanitation services.
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the role of the CHS commander is to
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direct every CHS operation towards a clearly defined, decisive and attainable objective. there must be UNITY.
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the Principles of war that apply in stability and support operations are...
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Unity of Effort, Legitimacy, Perseverance, Restraint, and Security.
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Legitimacy
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involves sustaining the peoples willingness to accept the right of the government to govern or of a group or agency to make and carry out decisions.
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Perseverance
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in stability and support operations, strategic goals may be accomplished by long term involvement, plans, and programs. Short-duration operations will occur, but these operations must also be viewed as to their impact on the long-term strategic goals.
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Restraint
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stability and support operations place constraints on the potential actions that can be accomplished and the rules of engagement (ROE) governing these actions. Imprudent action outside the ROE may in fact have a detrimental effect on the attainment of strategic goals and objectives.
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Security
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the security of US forces abroad is PARAMOUNT. Commanders and planners must be aware of the ever-present danger that can exist from the various groups, factions or other governments.
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CHS personnel must be prepared to:
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defend themselves and their patients should the need arise.
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Battlefield Rules in order of precedence are to:
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1. maintain a PRESENCE with the service member ( BE THERE) 2. Maintain the health of the command. 3. Save LIVES 4. Clear the battlefield 5. Provide state-of the art care. 6. Ensure the early return to duty (RTD) of sick, injured, or wounded service members.
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DNBI
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is the major cause of service member ineffectiveness in this environment.
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before combat and combat suppport troops
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CHS personnel will arive in the AO...
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NEO are conducted to
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evacuate civilian noncombatants and nonessential military personnel from locations in a foreign host nation suring time of endangerment to a designated safe haven.
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NEO
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these operations are of short duration and consist of rapidly inserting a force, occupying an objective, and withdrawing as planned.
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Preventive medicine support provided to NEO consists of:
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-Assessment of the medical threat during planning phase and during operation. -Assessment of potential for transferring diseases back to the US. -Assist in the determination of potential sources of food and water.
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the three basic categories of Domestic support activities.
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1. Disaster assistance 2. Community assistance 3. Environmental assistance
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Preventive medicine support provided for disaster operations includes
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1. Assessment of endemic diseases prevalent in the AO( even those considered to be at a low epidemiological level.) 2. Determination of the state of the public works and services (sanitation, water sources, and garbage pickup) 3. and support to temporary camps to reduce rodent and arthropod breeding grounds; establish sanitation facilities; provide training ( education) in field sanitation, personal hygiene and preventive medicine measures PMM, and inspect water supplies, ice etc
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the US military strategy rests on the four pillars of.. in regards to Environmental Assistance.
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1. Compliance 2. Restoration 3. Prevention 4. Conservation.
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Compliance
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includes responding to small-scale hazardous material spills and regulatory support to other government agencies.
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Restoration
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involves cleaning up contamination from past operations.
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Prevention
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is developing and sharing new technologies that reduce pollution generation.
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Conversation
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focuses on the preservation of natural and cultural resources such as wetlands preservation and fighting wildland fires.
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Foreign Humanitarian Assistance programs
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relieve or reduce the results of natural or man-made disasters or other conditions such as human pain, disease, hunger, or deprivation that present a serious threat to life or result in great property damage or loss.
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Disaster relief operations provide
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emergency assistance to victims of natural or man-made disasters abroad. these operations are responses to requests for immediate help and rehabilitation from foreign governments or international agencies.
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Disaster relief operations may include
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Refugee assistance Food programs Medical treatment and care Other civilian welfare programs
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Refugee Operations
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may entail the rescue of individuals fleeing a nation and the establishment of temporary safe havens to house and care for these people. PMT support may be required to ensure: sufficient sanitation, disease surveillance, water, and food wholesomeness.
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Peace Support Operations
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Encompass a wide range of activities which establish or sustain peaceful conditions or foster the conditions essential to establishing peace. Include essentially diplomatic activities to support diplomacy in peacekeeping and peace enforcement. Other activities which support peace operations may include humanitarian assistance and nation assistance.
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Peacekeeping Operations
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include such activities as monitoring and supervising truces to facilitate diplomatic efforts to reach a political settlement of the dispute.
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Peace Enforcement Operations
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are a form of combat, armed intervention, or the physical threa of armed intervention. They are used to compel compliance with international sanctions or resolutions and include combat operations to establish or reestablish conditions conducive to peace such as forcible seperation of belligerents. the role of the PMT in this type of operation is Medical Threat and sanitation and disruption of garbage disposal, water and sewer services.
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Most stability and support operations require traditional PVNTMED support which are?
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assess medical threat, disease surveillance/investigation, OEH surveillance, vector control, education in PMM, informing the chain of command.
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The aspects to determine base camp location include:
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1. Identify available land, facilities, and/or equipment 2. Determine if the site meets mission requirements 3. Determine applicable standards: by purpose of camp(refugee camp,base camp)/ by organization establishing camp( us forces, world health)
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Location considerations?
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Primary: position to perform mission and inherent force protection. Secondary: Political and Economic.
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Some areas of consideration in site selection include: ???
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presence of TIC/TIM or HM/HW hazards(including asbestos and PCBs), Industrial facilities in the area that may subject personnel to contaminants, Potential for dust or noise, Landfills and waste dumps, Drainage( both to and from the site), Proximity to civilian populations, Adequate space for HM/HW and POL storage and protection, Adequate space for latrine and gray water facilities. Existing enviromental infrastructure, such as water and sewer, Overall safety of structures on the site, Proximity to areas of standing water that may spread illness, Possible endangered species or critical habitats, Presence of historical, cultural, or religious sites. Interference with the normal routine of the local civilians.
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Planners use environmental surveys to: ???
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ensure that any hazards from HM/HW, POL, CBRN contamination, disease vectors, and other contamination sources( such as open sewers or medical waste) are identified and mitigated, if possible, before the unit occupies the site.
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An EBS environmental baseline survey helps to determine: ???
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determine site condition before occupation, thereby limiting liability to US forces for any damage incurred.
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what is the exact purpose of EBS?
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1. protection of service personnel( eliminating,minimizing, or mitigating environmental health risks to Service members) 2. Sustainability determination of a designated location 3. Sensitivities involved with cultural or archetectural consideration. 4. Minimizing any potential US liability for the condition of a site at the time US forces depart. 5. Used to determine the environmental impact of property use by military forces and the level of environmental restoration needed prior to returning the property upon their departure.
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what is the jist of EBS?
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is conducted to determine whether a parcel of land is acceptable for military use and it documents the proposed sites existing environmental conditions and the likelihood of last or ongoing activities that may have created environmental safety or health problems.
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types of Environmental surveys?
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1. EBS 2. Closure report. 3. ECR enviromental conditions report: which is conducted periodically and is included in the closure report. not less than on a quarterly basis.
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the Three types of Environmental survillance assessments.
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1. EH short term ( phase I) assessment 2. EH long-term ( phase II) assessment 3. Environmental Reconnaissance
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Environmental short-term Assessment (phase I)
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is conducted during initial entry to a site to determine the baseline environmental conditions at a location where US forces will be or are stationed or have a tendency to visit during a deployment for MORE THAN 30 DAYS. base camps, police stations, headquarters, checkpoints, communications points.
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Environmental long-term assessment( phase II)
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is designed as a second step in the characterization of the environment at a base camp, its purpose is to monitor the service members exposure to contaminants in the environment during the length of the deployment. The data collected during this period is used to monitor trends in the contamination of the environment and potential effects on deployment forces.
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Environmental Reconnaissance
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is performed preventive medicine personnel, engineers, civil affairs or special operations personnel to enhance environmental health intelligence estimates
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is the Environmental Reconnaissance checklist
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USACHPPM TG 251 for use in conducting recon.
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the purpose of Preventive medicine site survey
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- are conducted to evaluate a units preventive medicine status. - conducted periodically as determined by ESO or Surgeon in command to ensure maintenance of a healthy environment.
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sequence of events in preventive medicine site survey :
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1. receipt of mission 2. Research historical data 3. Obtain necessary clearances 4. Gather equipment/ supplies 5. perform introductions to site command/staff 6. Conduct surveillance IAW unit SOPs, references, policies and /or guidance 7. determine units level of PVNTMED compliance 8. Record all data 9. brief site commander or staff 10. guard all data IAW security measures 11 Archive reports/records IAW unit SOP
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the Geneva Conventions rules concern:
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Violence Discrimination children safety, honor, family rights, religious practices, manners and customs.
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The geneva convention purpose is
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to limit and prevent human suffering and it protects people who are not or are no longer participating in hostilities.
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under international humanitarian law, individuals subject to protected status are:
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People not taking part in the fighting are protected: -civilians - Medics -Chaplains -Humanitarian aid workers, and people who can no longer fight: wounded or sick service members and POWs
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2 types of Protection;
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1. Protection from ATTACK 2. Protection upon CAPTURE
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Retained Personnel
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If captured, medical personnel are "_______ ________" not POWs: can only be required to perform medical duties, must receive all benefits that POW recieve and be retained only as long as needed to care for wounded.
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how are MTFs marked.
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All us medical facilities/transports must display the emblem of the Geneva Conventions. the RED CROSS and RED CRESCENT.
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protected medical transports include:
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1. Ambulances 2. Medical Ships 3. Medical Aircraft
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what are the 4 detainee categories:
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1. Enemy prisoner of war EPW 2. Civilian internee CI 3. Retained person RP 4. Other detainees OD
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what are the 5Ss
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Search, segregate, silence, safeguard, speed.
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treatment of Detainees includes.
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1. all detainees are required to be afforded certain rights. 2. Always treat a captured person as a POW initially 3. 5Ss 4. Medical standard of care for detainees is the same as for US Forces. priority is based in severity of injury.
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Actions upon Capture
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Non-injured detainees will be evacuated as quickly as possible Sick and wounded detainees will be evacuated separately. Cavity searches.
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Rules of cavity searches:
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should be performed for valid medical reasons- not part of routine intake PE. are conducted only if there is a reasonable belief detainee is concealing items. and conducted by same gender, if possible.
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detainees should be provided sufficient
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food, water, clothing, shelter and medical attention.
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what can jeopardize the geneva protection for dedicated medical evacuation vehicles?
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mounting of offensive weapons.
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definition of EPW is:
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one who, while engaged in combat under orders of his or her government is captured by the armed forces of the enemy.
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EPWs can be:
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Members of the armed forces, organized militia, or volunteer corps. Person who accompany the armed forces without actually being a member ( mercenaries) Merchant Marines or civilian aircraft crew not qualifying for more favorable treatment. Individuals who, on the approach of the enemy, spontaneously take up arms to resist invading forces.
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RP retained personnel can be defined as:
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Medical personnel who are members of the medical service of their armed forces. Medical personnel exclusively engaged search for, collection, transport or treatment of the wounded or sick, Prevention of Disease, and staff admin of medical units and establishments exclusively. Chaplains attached to enemy armed forces Staff of National Red Cross societies duly recognized and authorized by their governments.
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Civilian internee can be defined as:
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a civilian who is interned during armed conflict or occupation for security reasons or for protection or because he or she has committed an offense against detaining power.
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Other Detainee can be defined as:
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Persons in the custody of US Armed Forces who have not been classified as an EPW, RP or CI. until legal status is ascertained by competent authority.
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Area requirements for 5,000 person EPW Camp
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5 acres total camp space broken in to two categories: 3.6 acres for living spaces 1.4 for latrines and admin spaces.
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how much space is provided for each occupant?
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3.5 square yards of floor space.
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Refuse and Excreta Disposal requirements for detainee
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-Proper disposal of human excreta creates first barrier to excreta related disease. - sanitary supplies, service and facilities necessary for their personal cleanliness and sanitation will be provided. -separate sanitary facilities will be provided for each sex. - Detainees will have at their disposal, day and night, latrine facilities conforming to sanitary rules of the military.
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For Field Expedient 1-3 days holding time what type of latrine is needed?
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a long slit trench latrine, will be used for urination and defecation. 30 m from natural bodies of water, 100m from messing and 15m from living spaces.
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for longer holding times what type of latrine is needed?
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construction of 100 deep-pit, 4-hole latrines
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how many refuse collection containers are required for camp residents?
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200: 33 gallon refuse collection containers. ( 1/25 camp residents)
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417 refuse collection containers are required:
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if camp residents will be preparing their own food. PM personnel will be required to ensure containers are covered and emptied daily to prevetn overflow.
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what temperatures and length of time is requred to kill all stages of louse on them. WASH
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at least 15 minutes at 130 degrees F ( 54 degrees C)
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when drying what temps and length of time will provide additional assurance that all lice and their nits are killed?
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140 degrees F ( 60 degrees C) and 15 minutes
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Lindane Lotion.
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what can be prescribed by medical staff on-site, for individual treatment for head lice, crab lice, and scabies mites.
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Clothing requirements
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5,000 orange jump suits or other generic coverall if various sizes pre-treated with permethrin are needed to protect EPWs and also control spread of disease.
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Filth Flies
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which type of flies will be a major preventive medicine issue especially during warm weather.
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potable water requirements for EPW
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a minimum of 20,000 gal/day to the camp. residents(4 gal/person/day) if preparing food ( 8 gal/person/day)
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how many water buffaloes are required to be filled daily.
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20, 400-gallon water tanks on trailers, every time the containers are filled , they must be inspected for proper sanitary reqs.
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Humanitarian rations:
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do not contain any meat products and are preferred to MREs if there are any dietary restrictions.
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what are the Three Major Communicable diseases
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Diarrheal diseases, tuberculosis and Malaria.
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DA Form 2664-R is Weight Register(Prisoner of War)
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is used to conduct an initial medical screening and weigh-in of each detainee. Its purpose is to monitor the general state of health, nutrition and cleanliness of prisoners and to detect contagious diseases, esp tuberculosis, veneral disease, lice, louse-borne diseases and HIV.
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what information is collected for a dead EPW,RP,CI.
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Full name of deceased Interment serial number ISN of deceased Date, place, and cause of death Statement that the death was, or was not, result of deceased own misconduct.
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what form is filled out by the attending medical officer and appropriate camp commander as a "certificate of death."
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DA Form 2669-R
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for what reasons may a body be cremated.
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only due to imperative hygiene reasons, the detainee's religion, or the detainees request for cremation. When a body is cremated, this fact together wirh the reasons will be set forth in the death certificate DA Form 2669-R
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All persons will be respected as human beings they will be protected against all acts of violence to include:
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Rape, Forced prostitution, Assault and theft, Insults, Public curiosity, Bodily injury, Reprisals of any kind. No SCIENTIFIC EXPERIEMENTS.
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Which types of detainee deaths require the camp commander to appoint an officer to investigate and report
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1. Each death or serious injury caused by guards or suspected to have been caused by guards or sentries, another detainee, or any other person. 2. Each suicide or death resulting from unnatural or unknown causes.
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Three goals for professional relief agencies
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1. reduce suffering 2. reduce secondary risk and provide security 3. Prepare disaster area to resume full responsibility ASAP
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What is the chronological order of events/ aspects of a disaster.
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1. Initial rescuers are victoms or from the zone of fringe impact 2. Professional relief agencies arrive at Day+2 or Day+3 3. Professional agencies must be requested. 4. Mission of organizied relief is to prepare area for self-care.
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4 types of camps
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1. Reception or transit center 2 Self-settled 3.Planned temporary settlements 4. Extensions to temporary settlements.
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Reception or transit center is defined as:
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where displaced people or refugees stay for short periods. A reception and transit center should be treated in the same way as a planned temporary settlement if it is: Large, having >2,000 people Expected to last a long time.
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Self-settled is defined as
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where people have settled spontaneously, yet require partial relocation, provision of infrastructure and sustainable environmental resources.
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Planned temporary settlements are:
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where settlements are constructed and serviced by physical planners in advance of arrival of people( e.g. from reception or transit centers)
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Extensions to temporary settlements:
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where extension to settlement is required to accomodate new arrivals (e.g. from reception or transit centers.)
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Components of Camp Assessment Program
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things to consider: Number of people affected, their current location, Security factors for people affected and relief agencies, current ot threatened water and sanitation related diseases, current water and food distribution, key people, vulnerable population.
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Critical
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in extreme situations, there may not be enough waer available to meet physiological needs, and in these cases a survival level of potable drinking water is ________?
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water requirements for refugee/internally displaced personnel
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15 L/person/day the water point should have a flow of 0.125 L /second and one water collection point for 250 people 500m max distance from shelter two collection/storage containers per household.10-20L and 20L
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Water treatment options
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Chlorination 0.2-0.5 ppm slow sand filtration boiling water( uses the most fuel, not ideal)
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access and number of facilites for excreta
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maximum of 20 people per facility segregated by sex no more than 50m from dwellings, or 1 minutes walk.
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Requirements for internally displaced refugee camps
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Water, Sanitation, Food safety, Shelter, and Control of Communicable Diseases.
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information
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unevaluated material of every description that may be used in production of intelligence.
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Intelligence
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product resulting from collection processing, integration, analysis, evaluation and interpretation of available information concerning foreign countries or areas
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Strategic intelligence
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required by national and allied decision makers to formulate policy and military plans at national and international levels.
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Tactical intelligence
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Required by corps level and below commanders to develop an estimate of situation and to project enemy intentions in sufficient time to select and execute most effective friendly course of action to defeat the enemy.
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Scientific intelligence
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product of collection, evaluation analysis and interpretation of foreign scientific information, applied research and in applied engineering techniques.
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Technical intelligence
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knowledge of foreign technological developments and performance and operational capabilities of foreign material which have or may eventually have a pratical application for military purposes. Communications-electronic, weapons-munitions, nuclear, biological and chemical, medical and mobility.
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why is medical intelligence significant?
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it is critical to strategic and tactical planning and opertaions to conserve fighting stregth.
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at a tactical level, objective of medical intelligence is to provide intelligence evaluation and analyses of following factors in the theater:
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Conditions concerning people or animals Epidemiological information ( incidence, distribution and control of infectious diseases Plants Enemys field health service support New weapons systems or employment methods that could alter health service support planning factors. Medical implications of contamination from NBC weapons based on employment tactics and chemical or biological agents used. Antidotes to protect against the nbc threats Weather and/or terrain implications.
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intelligence preparation of battlefield functions
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-Function one- Battlefield area evaluation -Function 2- Terrain analysis -Function 3- Weather analysis -Function 4- Threat evaluation, how the enemy would fight w/out weather and terrain restrictions -Function 5- Threat integration, how the enemy would actually fight in consideration of weather/terrain.
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HSS health service support must consider the enemys
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-strength, disposition and combat efficiency - ability to generate combat casualties by causing injury or disease -ability to impact the HSS operations of the command -health and fitness -Field HSS system - Attitude towards the Geneva Conventions
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Considerations of the AO
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- terrain -weather -Civilian population and enemy prisoners of war -Disease -Local resources -NBC threat
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for strategic sources, who is the sole producer of required medical scientific and technical intelligence and general medical intelligence for the DoD?
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AFMIC Armed Forces Medical Intelligence Center.
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what is the objective of medical intelligence at a strategic level?
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to contribute to formulation of national and international policy predicted in part on foreign military and civilian capabilities of the medical or biological scientific community.
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Tactical Sources:
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in a theater of operations, intelligence is the staff responsibility of the military intelligence officer( S2 or G2) and those specialized mil intel units in the combat zone.
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the medical staff officer.
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who establishes priority information requirements and information requirements with the supporting intelligence officer?
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what are the types of military briefings
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Information briefs and Decision briefings
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information briefs are:
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presented in order to inform listener, deal primarily with facts, do not involve presenter including his or her conclusion or recommendations and must include orderly, objective, accurate, clear and concise facts.
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Decision briefs are:
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presented in order to obtain a decision from person being briefed, contain essentially same elements of information briefing, but are usually broader and more comprehensive in scope and content. referred to as"oral staff studies"
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Preventive medicine technician conducts:
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-briefings for multiple proponents/echelons -training for deploying soldiers -training for FST certification -training for other PVNTMED measures, food, heat and cold injuries, and other misc training topics (HIV, STDs and Role of 68S)
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what are the four preparation steps for a briefing?
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PLAN PREPARE EXECUTE and ASSESS