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Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction (1999)

Chapter:Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998

« Previous: Appendix I: Department of Defense Instruction 6490.3, Implementation and Applicaton of Joint Medical Surveilance Deployments
Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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Suggested Citation:"Appendix J: Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998." Institute of Medicine. 1999. Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction. Washington, DC: The National Academies Press. doi: 10.17226/9711.
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APPENDIX J Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998 Available on line at: www.amsa.army.mil. 263

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266 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES CNCLOSI}EtE A O~EE"1 G1lmAlV~E 1. Deplo~t De~. P`or the purpose of Clot health su~i31~nce. ~ detIo~ent is ~ieE1n`:0 as it troop movement resulting from ~ J~5,{urL3fmd And deplo~rr~t Aver for SO ~on~i~Uou~ Libya or Beater ~ ~ I~-1~ location outside the United States that does not have ~ pcm~aner~t ~ Wiling medical treatment Facility Lo c., funded by the Dense Health Arm. Routine shipboard operating ~.t arc not anticipated to inane find apportions ashore lair over 30 ~ntinucu$ da~ are At from the reguire~nent~ for pap- ~ pOSt-~tptO~t 11~lt~ asse~m~. a. Weekly DELI reporting in strongly en~urag~i oil ~ routirle basin. s~het}~er in godson or deployed. ~ famlit~ ~ seamless tension to]~t operations b. If teat duration of deployment is ur`~n~ teen the surveillance requirements des~:d ire this e',olosure (pro and post-~plo~rlent he~ltl, as$~srner~ts health reed mess, and ~T rep owns ~11~ adhere to c. ~e b - eline surveillance req~itelnents des~ibeci In thIs encI~Llrc Should the augmented as necessary based upon }realty threat ~essrrwrlts 2. P=~.p~ym~. The panicled command, through d~p~merlL o~s Nor separate in$t.~tio~ Gil] tOq~3~ ~ 5~d,5 ~ supporting CINCH to ace4mpli~ ~e following at the hosts A. or proccssing station ~ We deploying 5~nrj~e member it. Health ~Threat! Countermeas~ rim Inform berg ice mergers o~ all known potential hearth threats. lo include ~r~mic ~ise,~cs; injuries nuclear. bi~o~cal or chemical (~' co.~r~inan~ the tndus~1 CO3~pOUD8~; combM and cieployment-rela~d stress; clirnatic cowmen: Phi other enviror~me~1 heath throws Such as use ~or~-~.pp=~ pesticide]. Gwen preventive medicine countermeasures ~11 be employed. to inclllde apprc~ria~ pe=~nal pro measurer an~ usc cfger~onal pro,t=tive eguipment. ~ Heals Re~di~. Complete ~nriiviciua1 filth Madison" prime - rim tncludlng the ~]lourir. { ~ ~ {m~urliz~tiD

APPENDIX J ~) D0D h~in~murn E~3~er~. ~vlu~ be ~ u~t in tela~- dipht.herE.a ir id. hcpatiti.s A Al~hlMR Phi polio. 1~:1 Scrvice-spe~iic Reg ~ I. Add. F:e fel ~ A1~31 48- 1 ~ O. 40-562 E; UhlEDINST 62313 1 ~ . am, ~ ~ COhl~IN' ~1623 ~ . iEr Immur~lzatian.s and Chca`oprophvI~.~. 1 i4~emoer 1995 1~mPI~.S ~1~C 7e110= [arm. ~ ht pair ~ typhoid. art pa gu~ ) D6ipl~r~~$p0~.;ii~t R~c,uirctne~ts Based upon the ~phim.l location. the un3iiec-3 c4.~.~.~3 ~[! dete;~eir~e addition! immiu~li~ti~l~ ~ b0~0 p=ph~]i~ Otis Ills i~i~i0~ ~ allied other individual al per~na1 ptomaine me a.~ures (.~h as i1epeller't. ber3~g r ~d ~i~if~rm iIIlpr~,~tiOTe) (~) h<.c filial Scam Update the So rviee.$peeiiic medley record din :F Mood typc; ) ~,'icdicatiO;.,fal~i,~s Special du~ q~raliRc~tions (Li) titian FCC~rli Pro- diploma at healt~i a$$~e nt ~ m, (E) Surnmaw sheet of past me<3ica1 emblems ~) HIV within p=vi0~3 19: Creche brim d.~.t p~:~O$~: HE Preening and pr~leployrnent scram sample). (~) Wt~F~1~5 eked t=t writhe ~4 month. For previous PPo erter~. hand1c JAW Serial= pulley. (~ USA sample on file To ~Rr~rL the unitfi~35vidual Millers o:F0I4A specirncres Art file. contact the DOD ADA S~cLmen Repository (UL.3iC,~ 30 1 -~95- 4379. fax 301~95-~. or e-~.il afrss~afio os~ mi1) (~ Current ph~LesI exam or =~rn~nt IAW Same polisher. [~ ~ ent~ C1~s ~ ~ it. 1:~ DO-day s~ppl.>r Hi- pr~cnpt:Eon medtcation=. 267

268 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES fS1 Squired McKee! equipment. ~1~. gas mask X hang aids. denta1 cnhodo~tic cqu~pmcut. at.. { 103 Pow art al ~cupaticnat healt ~ equipment (reap ~raiory prc0~r, I~e ~ Ned pro te cticn. and per$~1 exp churn dos~ mct<:~) . preens new. (1 1 ~ No unrested he al~ p~ ob1~s {P-4 proofs limbed Bum status. c. FIcalth Used. Conduct p~:pl~m~nt heath ass=~ents the (one and orocc~ng instrnetions at Enclo$~ ~- 3. During D~plo~e~t The Amid commar`d u~i31 provit[e guidance a sll~pert, lo: ~ Ensure DNEl suwe111~e da~ i:; ~llecte<1 and MAUI using the for and Instru~s at Enclosur`: C. b. E$~1i~h procedures for documenting anci report~r~g moss reportable medical Ants I,~t~ci at Ex~clo:;~re ~ ~r to ~e US Axmy ~ledical Sorh,eiitar.~e, Actor (balsa] publication. Hi Ser`~= Reportable E~M~ts.'4 version IN ~ ty I996 for gUi j5,13~t,3 and c~e deDnit;ions Upon ~n presumptive as well ~s confirmed reportable me~ilca1 events. c. Ensure, Sie~-spe,~c ~rcceciu~ ale maintained ~r approp~ archiving of health cio~ume~ts (MINI. p~t~cidc~. arid c,rL4ironme,~ sunimI~e ciata) Ad chords Llnrlividuat health treatment prwid 0, Provide troop commanders It, ;`p~f~p~at;e a~d [imply hand Anus in~Om,~tion. e. Base<1 upon the tilF~t as~$mem a~d Acid pro~ide~i ~ the S~ inch ~ oIrlt imp lernentation u~structions ~ ~ OD 1 C4go.~' H Implemen~n and Application oi Spirit NIedica1 Surveillant= Or Deployments. Sandlot systematic anti eomp~hertswe progr~ at ~ eillancc~ ~se~rU ~d prcvention ~ cceupation~ anti en~ro~1 health hey. f Ensure the interim of oce~p~ional health =d safety panty. g. At past C,0~ol operations chief ~e it pest Ant (1P~E} pro grmn de~ccibeci Ix D0D 1 ~ ~ 50.7,. "D OD Pes ~ DIE Sternest Pro~=r~. 22 Abaft lags Her pesticides =e ~r~ploy~ ensure th~ Else of drily D0D hippy] pC5ti~iCiE~. 4 P~-~ent

APPENDIX J at. ~1~ ~,d Ed ~[i~ ~ ~i31 pro ~ =~ ~ =~ ~pp~ ~ 1 } mid - it p ~{ depi~d - ~t health amen us~g ED a, fan processing guetlance aq Ene]~re E. t21 I0q~rlq in Se Reich ~ rrtedn~q~rs ~n ne Ad of T~dqica} - Ed nation upon at Up to hadn't pmoessing station ba3~d on remew ~d. Its trt,~T~t t0~d.~6 t thaws. the p~t-deplo~q.mt health 8~88dT.~q Ott fo1l~q and why pent health ~q~ei31an~ data q5] Not me~q1~1 qri~rief to deployed Service no c'~ al, It I~TB1~ even ~d e~ usurer are un~q~nq -n vi;or~rr`eTr~1 ~s~ s In after Born Upon (~d (51 Develop ~ En. d.~lq~ 1~s 1~d q ~ lo bait ~ Morgan Lessons Lady System atolls) ~ ' ma_ Id ~ $upp~rq ing Em_ =~ Amp t~ =0,0~01~ ~ following at the ~ drone sq.at~n or p=~h,~d~, Aim inn ~[ q Alp Em - ~l0~ng ~d~r~q~ meld_ ~ t 1) Con~nq k tuteroulosiq~ Ring q~i~hin 1 beer LEE r~dq-plo~q or goner IA ~ Se - ~e =~id in requirements 12) ~11~ inhere indicated her Service polio. ~ serum Copy fbq. E1W testing arts storage in to serum ret 13) Conriq~:t adqUit.ona1 healt}~ -~er,1s andfor health dchriel ir'dicate~i by health throws or=onts occurrug .n theater 269

270 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES ENCLOSI=E ~ F~I]EPLOYIVIENT HEALTH ASSE5$S~ EROS P~OCE~q~ GUm~CE : 1. Ser~lce n,embers Abet c~ or re-~lida~ ~e huh ammo Alla at their home motor or promising station ungirt 30 days or their deplo - crib. 2. ~e own must be adm~3~red and ~ irnmc~l,;~tely m~ed hy ~ health ~ are provider. [he pr~icier can be ~ melodic or corpsrrmn for ad~in~ering and initia3Tey re~teu~r~ the que..Stioc~n~ire. Houtev~, positive ~Tspon~.s ~ questions 2-4 ~d 7-8 must be re~rreci ~ ~ phy.sIci~.. physician ~.~ist~t nT~r.$eT or indep~.~ier~t du~ medics techr~icr*n ~ Copies of ~< Impend ~ ~ ust be phased in the Serve e mambos peg medical mr oral Ad. origit`~.3s Grin be immed.atal`- ior~rd~ to BED D0P10YEn~F] ~ SUET ~ ll~nC~ Team Aim. O 1 13 1~urg Fig . ~ bite 701 F~.s CL1U='h.. NFI1 LiHi~ 22041. ~q3N 751-7153 |~,;~. ~r72~T AT 4742) Or CO~Or1~ 7~-~81 71 ~S {~t q727 or de7421. 4. ~e DST provides the ~ ~ Army C; nter for Health F7ro~.otion Ad Pr~r~tive Me~lic,0e (LI=CHP~h4) with ~ preciepl~w~t heath a~$sir.~.t da~e an monthly brig for lui lesion he the Defense ~l~,dic~-e $~ i1Lan~ Sys~rn (DISH, 5 13SACHPP\I provides the Spirit Staff ~r~ifi~ corr~nands. ~d the which with periacidc ~re.~ci ar~al~is r=or~ ~n ~e ~ 4~pEe~d pr~depl~r~< ret heals ~.~.~.b.~ B~ En, ~ ~ [0 ~ ~ ~ ~ ~ ~

APPENDIX -J PRE-DEPLO7hlENT l4~alt3, Assessment I hi ST F\tl ~Tl0~ 5 F RIVACY ACT ~ F ~ B~ Please read am q~r~ti~ ~h,~|cly ra`:d calf DerDre n~arxlr~ yr,~r <;el~tion~. Pr~vir4~ ~ re spouse r.=t~ qu=tiD,n. ,, you uc All understand ~ question, ask ma arimin ;Slrak ~ Locatlo~ bt Operallon ~ Dep3~ment. Eor~ ~ Au. tt~li. Alrica. Sw A~a SE A~ ia LiSL-ue~Lry (IF l~;hlO~rYNy =-- 1 ~. . O r-entral Arncri ~heme ~ ~mLion: ~ia {OI;~rj rD r-~r~ wn 4 South Aru Otisrar Last Heme ~'s U3~ l~rn~o.~; ~ I IJ~ III--I I I ~ Soclal $ocur1~ N.um.bor I I ILI I I i 1 1 1 1 I lJ~1 1 ~ I I l-m-~l ~ I I Flrs! t4arr ~ |-~ I I l-i -: 1 1 ul cos tm~~ ~~ ~| ~I I r I ~- --1 ~ Pay G~nk Gendu ~ er~ice ~F.a. F] r;h 0~mpc ~nt ~ ~-' ~ O1 0 W, O h1 3ir, 0 ~r For ~ Actrv~ Ouly 4 -2 O 02 O W? O FeFna ~ .~rny O Mrat~n al ~uard Ed '0 ~ ~O WA O C=st G48 ~ ~Serves O EE O Q ~O Other ~ Nl~rine CDrps ~ Cilv~li~r, r~o~mFnont ~rnp - ~ ET O O? ~ hl ~O N~n~oveTuner~t |~:on~l ~npl~e L) ED O 06 ~ 0~:, ~ ~th~ 1. Wo ~ you ~ay yc~r ~e~lih in ge~;sral Is 2. 0D ~DU he ~e. an' nnc~iG31 Or de`;1~[ pro414sn~ 3. ArR ~DU a;reenily on a pr~'ile, ~r l.ghL du~, ar are ~DU un~rgoir~ ~ ~1~1 toard? ~ ~eller~t ~ Ve~ ~ 4 ~d O F~;F O `OF O 'f~ai O hir, Air. ~u pregr`gnl~ ~ - LES ORW) ~ Oon't r<F`~~ ~ VcS ~ ~ ~i Oo y0u ha `. ~ [i0~y $up~ ~1 y4~r ~s~ri~¢n ~neei~lic n c,, birlh c~:lr41 pills? ~ ~A ~ Y~ii ~ lIr, 6. O~ ~ have t~ F~;rs c,r pre~ipt~n 91~55~S ~ir ~<r~) an. J~ other p~r~ior~al n~icat c~i~rmnl? O 7. P<ming liaC ~it ~ as,r. ha~e ~u sDugh1 cour~cli~ ar ~r.~ Ior'~r mentat h~lth? -i. ~ >0 cu;renl~ ha`~ ~ny ~;c~lions ar con~rh, ~twe ~F he~lih? PIr~ase Ir$1 ~ur ~n~ms: 0~, 0 ~ Ves ~ hl~ 1 cerdi~ lh~l tti.wnsras on 1hts ~rm OF. tn~ se ~'t'1~ r.~ ~De . ~ ig n~ ~ r~ - Dep~yTnnnt 1l~iig, ~~'~t Ou~i~l~iz. D t - ) APPR~ED S_F'TEM BEFe 1 sei 271 22E19

272 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES Cat 1251 ~ Ian inli3rvi~rrr.~;3rr~ or p83tj3r~, din .~1~rrir~ pr~t~lr=~ Ore rear. anti rim by ~ of S=~. Ore ~ "9 =Y ~ ¢ mud ~ lh r~u.lip~ preblt~s Furler 4~[r~OlOliGh of ;~Llern lo be 4~ in dice ~rd REFEiR~L INDICATED None Cardiac ~r;~ba~F~r30~1 Walrus n33ctirJn ~ Anal O Or~rm^~ic OE~ ~ ED O Fare by firms Faligu~b, h~l~j.e, &141tis~tram core'~lair~t ~1 O Ou O ~N ~ henna Roth ~urol4g~ OrthrJF - ir Preg~3n~r Pulmonary Other F I hAL 1'LDlOAL DISPOSITI ON Cc~rn~nl$: Itf net rd~loyable. expFain] Indr=te the timers of e¢~h or the Blowing .s )2o t:lA j~ r r,dj=F (hr~t tri~ir~ r>Or~pi~ler-[ 0 ~ ~edical in~m~at~nshr~btdisiri~ O $~num ~ror HlV ~rs~vn wit!~in 12 r~rTh~ Immuei~li~a cun~nt ,q, p~ sr~r~ranir`g ~hia epl~i~lD r,3 ~t Dep[~ahls t ~3rtiFy lhat Ihi' ~ViC~r pFrJOc i~ has bae~ c - ~1~, Pf OV i{1O F ' ~ 5 ign~ ~U. ~ ar.c ~ . 3~: D3te (mmldr~m} 1 ~ 1/~1-Jil:.~ ~ 1 ~ P~e~r~ ~1m ~an~ht Q~5 i~nn~i ~D ~~ ~F~F4~vrFO [i EPTEiLlBER ~ Jg9$ 2~t.

APPENDIX J EN~$URE WEEE;1`Y Orson AND NON-~1~E IMPLY REPOSIT INSTRITOTEONS Dmense nod h~on-~ttle ~ ~s - The VIt~ S - s of to Unit 4e main ce=~n (or A. ~e ~d real battle injury l:~NBI] BEES is that they ~ an implant ~ at }he unit 1~1. The are Me Nital slgrm of isle unit.- an ~,=~ ANTI sys~m ~r kr4~1e Abnormal rates se~ to fame medical attention or' ~ problem area imn,~<iiate~. ~ are the ultimate outcome rne,~e of how me]! ;~ corr'ma~d $ pr - know medici'1e pal - m is wctki~ Ate d~ c~ he use by th~ medical staff ~ identifier and hi~ll~t inedible mew of reriu~ng the inc5rien~ ai pr~venq+^ble ellipse ~d injury lithe d~a must be reported up the my chain so that ~ Big pictured of ci3~ patterns queen 4q~ a.~$~41~ci to la~lise pr~qolq~s and quickly irde;wne With qrppropria~ preq~q~h`-e meq-1icine countennea.ures Addl+~lonallyq thq. Ails must be reported o~ ~ quickly basis 1~ciEng Saturday 2359 hm Ioca1] through q~ommand q-q.aanr~ air the OFF Surg;ean~ C:lNC: Surgeon Joinq S=fI. AIMS Su~s ar`dq the ~ ~ Armor my for Health Promotion qanc3 Prwe~iqve h4~dicirte qiUSAC:HPPhIl. USiAq^~PP~L panics the Spirit Staff. urlilicd corT~m~q0S~ anqi the Services with periodic ANTI trend ana1~s ~q~por~ ior Aunt depl~. Me DNBl report s~q.~3~riq=s Weekly Anal rates and p~qoq~dq~s ta - ~ ryes ace comparison. chit system depends on ~ proper sick call Recook for its electronic ~q~P~lt~' which MUST record a~ ~ minimum ~e foll4~g r~fonnation ran E - - paU~t encounter: Patl~nt'~. ream Sew. Welder. unit, unit id~tlficat~n code 1~. ~d rillty 3~n 0: Spy ci Atom ~ new. follour-upp or a~iministraUm ~ Primary compliant. 4. Find ~ Pimp 5. For Injuries. ~ cla~='iFication into recreation fspo~s. janitor vote ac~derlt (~A). work/~ai~lr,~. or other 273

274 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES 6. F.tna1 ctispo$ition inn one of the foH~wirl~ categories. ~ F~11 duty. PIP light BLIMP testim~d number of cia~`p. rP Stek in quoters lest~ma.~6 number of 6~) rP OF in-i admissions. UP_ ~1 cate~pa~ (~e deFir~i~lor~s =e hi at the end o~ this cnclos~Fol. Sick catI joke IF their alectr~n~e egulvalents chit b~ retuned by medtoa1 unit at the ccr~cl'~.~ior~ o~ the ci~plo~nent Arch fill chill the weedy DOPE reportp [CP11~P these "Pt - -P+ Record the .dP.~is~`i~ fiats in ~e spaces pro~eci ~ the top of the Mom ~ troop sP~er~th refers to Else number of troops being ekes c~e oPE by t}~P~ reporting mcdic;~3 unit. Obtair~ cleric-~p strength for the reporting period from the S-1 f J- L . . He~ew, the sick call log a~d adci up ~e 460ta1 number of new ~=s ~X~44~ 'me seen da~g ~e entire week ire each D~HI catered- ~1t ir1 do- app~,~Late blood ^~d up the ~t4~i [idol and record the nutnbe. in 4~ ~p4~0 prairie. To {~1~1~ GORE r4atear4 divide +~e t~ta1 num+q~r of p4~ticA'ts se~ in even cannery ~ the average troop strength arid Nips ~ 100 For the ~eco1~;ic Ca~60~,rr the FEMALE troop s+~ngth must be used 4~clI1~ the rats noc the to drop Betroth. Chamber to 4ea1enla~ 4~ ~ ~r4~11 ~ ;q BI to+~1 rate . E~nmpl.. aware hers 20 denrmtologico] ma chin Derek in oO0 try the peach= would b~ Cal - as tallow: 20 de~10~31 case~ - ~ ci SOO ~s then 0 ~ ~ 100 - 4% Next adri up he t~t4~1 rlllm45er of It light duty dOYB, lit duty (18755 =15 h~lT JI~I P8t~ClI' 80~45~SiElT~ in each catcgo~r, and ill in apprap~late block.

APPENDIX J C=np~rc Pi rates for each category with the sU~tRd reference rate for that category Mere is required Or the On ~Probl~rr~s identified - Corrective Acorns Ebr all categones where r~s are abovs the suggested roar - ~e Intel. Who c4mp~1~g rates keep the following. i~rrrlation in n,irld; a. ^e suggested reference ra~s are on~ truer ~d Would be used as ~ rough guide only. Ah CENG Surgeon or AID Su~n may modify the -~estcd Reference ~- b~d upon theater s`~ctfic ~s b. Exceeding ~ rate by ~ 146 is not necessarily an indicabor: of sigr~flcar~t prowlers. However going from heaths s~$~d rate ~ twice the su~d raw probably indieat~ Tut them is health problem needing immediate att~tior~. ¢e 5~di~1 su~d reierer~ rates a" not int=de.d to ad `1 up ~ the total HEIDI Bud reference ta~ Art ink category could ~e ~ high rate - thout causers the tote mt to exceed t1:e reierren~ rate - ~t~nUort ~ the i,~ciividual c~t~ is appropriate Phi nee,e,~$~ 'n this Vitro. Alle,~tively, the; tool DNSI raw could be high `~t calming ~ndi`~dua1 categories to exe,e,~d their r~er=~ ~s - tte,ntion to systemic problems c,~sir~g genie al sick call Wits ~ rim is appropriate a.r~ci newest In this Aquatic. d. Use cornmor~ sense ire .nte~rct~g the DNBI m~s l=ck Dim! ramp over time ~H c~npa.re cu~t THAI rates Dim yom unit ~ put DELI rams for co~npamble I. 6. Report weekly DN5T ~a to the unit com~n~r and ~ m - ;=l pet at higher echelons (= need ire the first p~aph of those first Lions) 275

276 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES ~ DEEilNl`TIOBIS Notes: 1. Chant only the initial wait. Do not count ~11~-~p Chin 2. All initial sick can visits should te plank in ~ category. ~ if in doubt about which category, necks the best A. 4. Estimate ~ hi 11~ht du~ lost work Ads. or adrr~sI~ results from ,nit$~1 Gaits CombatIOp=~1 Am B.~.~1~s - Acute ree.~ion to sPtr~s~ ~ transient Aiders ~ cceur without any apparent merino di*P0Prd~ in ret to ==pt~na1 physical anti ~n~1 ~Ptr~*Ps. A1~o Sr~lUciesP p~- t~urrmti~ sums ci,~rder which ~s as ~ delayeci ~ Wretch Capons to stressful Writ or mtuatior~ oF ~ ex~ptiorm11y threa~.~g or ca~$~4phm I. 0th~ ={h~ - ~i$<h~6 of tips sk~h.~h ~ s~" Avows t~aPueP incIu~hi~ heat raw h funga1 off thins 001l~litih=P. it ptt;hg0e wnL=t de~.atlUs, tPIistem, An ~ocnailaPh ur,spf - ~iieci ~iermatitls. em. Inc1uci~ P nun ~ 8.P~ht=Pt=~h. ~t~P~. - ~t Ail - ~ consistent him itl~j0[h of the intestinal tract. I~01udes Tiny tom or diarrhea. g~P:roerh~rit1 . stomach flu ~L5'P - Limit F hepat~t'$ of, 0~6 ~0 r i~clu~ non 0~=P~he, itchy; Sips I (Li-'t.~,~i_5 Ohm ch as hoar orrh~' u1~= em. oh - pal abno~`iUes birdies paid, into many Clitic ~ Ace or ~h~F ~0hn~iti=8 ~l8~<i ~ Ohm ~1~ ~p=P(iU~ti~0 ~ h P h P h h h h 'h p h h ~ht='0~14 ~j~P ~10 it r it he_ BP~k~, nh~ht ~h8U~p OF ~t =~hp_P. (i~h>6h~tl~n h hi stem Bench Font+ ~e~h~h ~C a~d chilblairl ~hnip~h~eP, R~r~re.tlon"~po=~ Any ID urn oocU=ih~g ~ ~ ~ dent ~"q`~= oF the pursuiL of per ~ /oPr grollp ii.+ excl~hO in go IBM trap: In]urie~+ ~ Mali-Ac~h4~ht~ ~ 7 injury ~=~ ~ ~ duct cor~h60qll~n~e ~ ~ motor ~ entice fit. Input, Work,/ ~lth, - At {hnj Up fig COP ~ 5~t ~ Of m h 1 I ~ a~ ~ p era ~ ~ a+ $ / d ~ d ~ si ~ ~ ~ f ~ ~ ~ ivi~ ~ acid ~ ~ ~ ~ p art ~ ~ f HI lo; il~,r trellising ~ include Aid Ace Kohl pi fillips pi

APPENDIX J 1~, Other - ~y injury not included in Clle prewiousI~ defined theory ribs. Ophth~lTnalogi~ - Any acute riiagnos~ irl~-~ving the eye, including piglet co~ctimris. my. Tomcat abrast~n. loretgn Boise Anon problen~s etc. D=s not brie routine ref~m~1 for g1~s (r~on-=ut~. P~y~a~icq. M~tM Disorders - ~y Con~r~tio~lly derailed ps~hf~c qrliso~LeI ~ qwq~ll as be}~aqvio~ ch - ~e anci qi~q'.~qrb~ ~ nc~al q^on~qu~T which is either on Lit norms If na.r~ Mar, or is coupled is itch ~usu~ Al Symptoms each as parallels -tory - AM ~ila~is of Me lq owed rF-~plra~ At LET as hron~qi~` pnq-,U=Ortia, F-~mph/~en=. reactive 'winy Be. and ply or the dippy m~;lr~ry t.~q~,l. equity ~ "Roman W]<inF tar~tisr Ii. trachMll9. otttl aunt $inusitls. sex row D~ - ,q~r3. ~ ~1 sqraxua~l~r ~_Ilnit~4 Ens ~CluL4ql~g Etch disease a~ q~hl~dia~ H19. gory. syphilis helms ~hr~qtroi~q ~d ,nere,al I;. Few; q'`Iqr~q~l~ined - Temp~q~e of 100.5oF or great~F~r ion 24 hours. or hasty of chills and [queer - rE'~u'' ~ Clear [ii~6Fi5F |thi'~ is ~ s=~en5F~g category for many tropical lioness such as r~=i~. d~ng.Ile fevers anti Aphid f~r). ',,FI,3 0~ four ~t bc expl~5 Nor 0~[ It I pr0~,~ Arch ~ msP~ ini~tior~s hoof mid ov~r~rtlorl. AD othr=, ~I¢dic~f ~1 - ~ medical or surely Merlin not 1~ittlng into any my 4~ ~,~q~re MUFF i~7 i, of the quote and cra1 Stiff anon OF pa ~ i060~l ~& gingi~1 q-lisorOqers, cables and Wilily ar,emalitles. MA He 11 An ~ ~ ~ ~ ~ ~ ~ is ~ R~t i ~ is ~ F OF A11 ~ th ~ r vi ~ I t ~ ~ id q ~ re ~ Emit deciliter not Stuff one of the ab~ Brim 3~ ~ primly ren~sq A, in~muni~ra~r~q prescription refills.. and physic exacts or 19~ tents ~r a~nir~i$tra~ purposes. id. finq~iblq' ~ a~iciltior1al Amp em abI if [or it $p~iGiq ~eplcyment uteri q,tp4r1 p deli' he'~'h q - 0n=,r~F (~.gF. =~F8~. 5~. firm /~ milder. TV.. 277

278 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES jWEE=Y D=l ~0~ It: _ Troop strer`~h: Anus Peered I OO013 brow _ ~u~F ~3~) ln~du~ Pr~=l~ ~port: Phor`~: . _ .. . . . ~i]: =~GORr ~ Isu=~nI - Pa . . ~ . S0~ ~1~. . . 0.196 _ . D*~=3~ - ._ . 0. ~_ m. ~¢l~w ~ ~ ~ C~col~gE~ ~ . F ~_ . O.- _ ecIea~e-~3;5por~ l .. ...... ~0* _ - ' - T Lear - . ~^ 1.0` _ ~u~. ~r~l~ I 1 ~_ . Ceil ,oule ~1.0% _ ._ - ~_ 0-~% ~ lay - it. 85 ~_ " _ . __ On% _ . on , . . . - . o.ESq ~_ Fc~rr ll~lued _ .. _ _ ~t~~, _ _ hk ~. _ T~L P~} , . 4 ~_ . DAYS OF I~T LIOEIT W~C D1 ~DA~ . . 1 ~" _ _ = _= _ .... _ _.. . ...._ . _= ~~1 1 . _ . . 1 ~l . 3 F~P | .. ~_ . ~eRrqbk I . 4. . . D ~1 .. ~_ Problems ~ti5~: C~etive A~; n - I Et~omng p4~ foe ~ol~t Dep}o~e~"

APPENDIX J 13~CLOS~ ~ ~$3DRVICE REPORTS= MEDICS E~NT LIST bi~sLs f~t~rax Bi~gi~3 warf~ want Expo~urc Botuti~h B=~1~1s C~hpyl~ - r CaFb~ ~4n=~e Poisoning C~ tic - ~= ~]~m ~ciritotdom~si~ d Wander Inj~ (ALE, Fr4stl'E~ H"~th~nia Inhere Ape l~ns~cl~d Cr"t-por[di=Es ~14sp~ DIphtl~[a E { 301i 01 o7.H'~' Eh~ic l[~E~ E=e,ph~l[Us Fd3arIasis ~^ttas1s Gon4~rhm H. It~tlu~e, irehrasi~re Har~tavinus ini.'r,~ t l~rl~ Hem It H"t Stroke HE For [lepaUtEs A EIepad~s HepadU 1rz0~ mat Poisoning l~=tlos. is l~ishm~ndasts IAI]) Leish~= C,utaneo~s I~Elrn~0, M~we~tan~ ~i~h~iasis. Unspec lint, mitral L~pr~ LeptospLrosts 279 Ll~lL=io Lame Di~ Claim LAll] heals. FaIcLp~m hams. ILL harm, Ov~e hl~=ia, U~speciFi~i Malaria, bias Meaner. Girl Di~;e hI=i~gitis septicemia Murnps ~ ss~s Plague EM=~aL ~eurn~ia P~LEoIrL~liti~ ~ Finer E~.bi~s, Hutton lap~l:ng For El.hc~rr'atic, l; Ever, ~,~e REtt li'~l]~ F~,~ F<=,~ ~oun~in Sp~ci F=er RUbe,LIa Salmorl,~]l=~s Schists, 5omLa,ois Shi~l]~1 Srn~l~x S - pto~. Group A. Ir~=E" Aphelia (All) S~hilIs4 C~Lt~L Awhile, Intent Swahili. ~m~f8 Swahili. Te ~4s e Shock S~me Tr[chinom T~La - ~10~, ul~r~rli~ ~phO[ci F~,F Typhus F~,r l.Tr.~lritie3. Non-~onoeo~sLL V=,~Ln~,, Aci~rcrse Errant 4r~ri~,r]1~, ~ Duct Or,Ly Yc]1~- Fr,vr,r

280 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES ENCLOSURE E FOST-DEE~ENT ~;ALTE! A5;SESSM3~IT} FORM PROCEE;S=O GIlIDA~E 1 So - ice members meat complete the health smut few or theater, pro Ply Others 5 dam prior to r~epl~ back ~ Amid how ~4n 2. -e form mu" be admir~ist~ed and the i~rnedi~ely r~ed ~ ~ health c~ prmid~r. - ~ prowler con bc ~ Weds or chessman for adnti~Isteri~g and grit ruining the questi4~1r~. ~F~ pCSiti~ IS must b roi=T~d to ~ p}`y~l~ ph~lc3~ ~st~ no. ~: ir`~epender~ cited ne,dic,al ~iCI ~ Copies of the ~n~pleted forte mu" be place{) 3r1 the S~= Ember ~ p~m~ent m~ciic~ rearm Or in the deployed medical sword For ~= to ~ permanent medteal record upon ~i~l~Tr~cnt to whir harm ~on. Snarls ~11 be immediately ~r~rderi ~ 1 he Dep1~ner~t S`2~re'll~" Team 1~= 51 tD L~sburg Pow. Suit 701. Palls {:huteh. Virginla' 2204 I' DS~ 7Bl- PP1 53 [ext. 4;P~ pP or 474~ or c,omme,rciaI Idly SSl-~l53 (ext. 472'iP or 4'i,4~. 4 Pow DE;T provide the- liPS Artery Ce,r~r for ~1~ Pr~notioxt ~ Pmv~tl~ ~Ied~tne (I.F68CHPP~) with ~ pat deploP~T~ent health as~sPmP~nt [~ ~` data b~ on ~ rnonthly basso [or irecl=Pion in ~e Pei"~ns~ Me~1 Su - Mince s~m (DOSS). 5. t1~Pm pm - PUP the ~t Stalk the u~iiieri coln~nds, and APT Serials urith pe~o`.ic ~¢ ar~alyPsie repute on the plow post-~cpIo~nt health ~Pse~mm`t form.

APPENDIX J 232~T P O ST- D~ PLOYS E ~ Health A~- a~t I NSTRU Trio ~S PRIVACY A~ OF i9" Please read Edith Replica =~ and Drolly merry ma~rq~ Our sr~l~r~ns. Provide a mix Or ~T8<h (luxation If ace dc, not u~ar-~d ~ CIU6PT| I=! Task the ac'~ini~lor. LOr~akl~ a. of Oper~tiot' ~ Ooploynnent E4r~pc ~ Am Felix Asia ~ Africa SE Edits ~ Cer.trat Arr~arica AEis (Other) ~ I~inanr^'n ~ South Linens O Other List =untry (I F IU<~IMI' torla}d~ Deto ~rr~m~ ~ ~ I' I 1/1 i' 1/l. ~ 1 1 1 income At Op~tim pate of arrival in the |~) 1-- -- i ~1~ 1 IlI-~'T I I D~ Or d.~rtu~r from ~I.=TD'{r~ I. n~ll:/l I I ~ ~ T~ ST! g T ~ ~m ~ 0~ T I ~ bC~ ri~ Nu m BT ~ I l ~ ~--1-~ I 1 ~ 1-1 1 1 1 ~i ~ LUt 1 ~1-m-1 I l L} Flirat t lamr! t~ 1 1 ~ I ~1 1 T ~ 7i T ] ~ h11 DOTH (¢T1H~r~y~) Ll lil I lli ~ ~ ~- 1 P-~,r ~rad~ank Gionder S~e Eranch Compor'~nt O Et O O1 ~ W1 ~ N1a ~O Air For~X ~ ACilve Bu~ o Ea ~ ~ ~$ 4~3 ~ Female O ~O ~r~l ~uar~ IC! O ~BO~ 1114~4 ~ ~OTIISI C~3rBI O .F1E5~rV~ EFi ~ gG ~ Otl1er ~ ht8tin~0orps ~rviliaR~o~rph~aTr't~pir~ ~ E? O O] ~ Ha ~ MDr.~04~n~m~nt [cor.~1r~t) ~ - rO ES ~ ~ ~L216r 1 '0uld ~u ~ ~ur twalih in ~ane,r~i iS: O Excr'Lknt ~ Wry r_jo3~ ~ ~ ~ Fair ~ ~r 2. Po ~nu have any unresol~rd raZedirmi Or d.=n~al prchl,sms th~ dcve1~ duriFag ~ deployh~en ~O Ws O j~r Ar~ ~u ~rrc~lly tn a pr~Fil. ar Ir~t duty? ~ Ye5 O 02r, 4, Dud~ Ihl$ ~T-PI~n~ Ik~tibT ~IM $04,~h1, or i',n,~an~ to $~T~_ cc,ll~-ling ~ eam l~r ~hr nn~nl34 I;OTSI ~O Y ~ iNo Oo ~u hav.- cencr~rna at~ possibiaT ex,~sures or a~nts dur~ ,~ tr~rS ceploy~n."rst that ~4 f~el rn~aR;s~ ~ lfe~ O j~04~ P~ ITLI? F'}easo li~ your wnter~: ~, ~ ~nT ~ cTurreT~ 11 h T] ~ ~ ~ rV ~ 4 eS~n ~ ~ r, ~ h e~h, ~ ~ ~ ~ur heal'h F5Ea~a lisl ycur ~nusnns: 1 ~rliFy 1~31 ~T¢~" ~F this ~nT' ~r. Irue Se rv~ crT t1~ml~Te" Si~r atu.e O`fes 0~O Z3 ~sp~yn~L Hes~h ^~=her' ~r~neire ASO (H~ APPROVEI:h SEi~hlDER 1998 281

282 STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES Me1 inlernq~exiar~ OF patent, the ~1~ing Patents Ore Doled arm calcgori:= ~ Revi~v ct S~tcrn~, Mr.~ Man one ~3] tE row for poller let Pith r~ultiple problems Further Costar ~LlalIon far ~rrab[~n ~ be dam in. Away ~ . ,, . . . . _ .. .. REF~=L ~ND10ATED r.D None O Cardiac 4 That f OF~rat'Dnal Strew Resection 4 Dental O Dranina~lc~'ic ~ EAT Awe Framily Pro~rr~s ~ F311g~s, hl~lse, h~lt~r~lem c~mpdair~l A, G1 tar,., Abet ~ raven Flatly 4 Ncur0pj: r~hopedD: P',egn3n~ ~ Pulmran~ ry r.) Either Ampere; EXPOSL]RE COHOEgNS tOurlng dop1~nen~ Frc~ider gee questlon~ ~ ~ ~ on that rearm ret ~ form nvirc~relental r,~=uFaliraem1 ~ cent or Basic rated O Rono Ind=:e ~ straw; ~[ Axe r;! 11m following: Ye s ~o 3 ~ h4~di=Lthrest ~Er.iefing ~np~r~ ~ O O hymnal in~n~al'~n sheet disiribu~ O 0 Fosr.~Ployr~ant serum ~p~ln~ mII=I - , it rewire I Art; that Delis review ~rocr,~s has ~ cornbread, Pee ~ i der ~ ~ ~ igr~i~ture a ad ~ corm: Hale (h~nVU~) mlm/l.l I..L] ~st~Epl~r~nt ~ - ,~c~z'~4 rl=~i~~ha A$4 (1iAlAPPF<WFO SEPTFh4FER 1~8 23204

Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction Get This Book
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Nine years after Operations Desert Shield and Desert Storm (the Gulf War) ended in June 1991, uncertainty and questions remain about illnesses reported in a substantial percentage of the 697,000 service members who were deployed. Even though it was a short conflict with very few battle casualties or immediately recognized disease or non-battle injuries, the events of the Gulf War and the experiences of the ensuing years have made clear many potentially instructive aspects of the deployment and its hazards. Since the Gulf War, several other large deployments have also occurred, including deployments to Haiti and Somalia. Major deployments to Bosnia, Southwest Asia, and, most recently, Kosovo are ongoing as this report is written. This report draws on lessons learned from some of these deployments to consider strategies to protect the health of troops in future deployments. In the spring of 1996, Deputy Secretary of Defense John White met with leadership of the National Research Council and the Institute of Medicine to explore the prospect of an independent, proactive effort to learn from lessons of the Gulf War and to develop a strategy to better protect the health of troops in future deployments.

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