Table Of Content

MILITARY PREVENTIVE MEDICINE: MOBILIZATION DEPLOYMENT AND VOLUME 2 i FPO The Coat of Arms 1818 Medical Department of the Army A 1976 etching by Vassil Ekimov of an original color print that appeared in The Military Surgeon, Vol XLI, No 2, 1917 ii The first line of medical defense in wartime is the combat medic. Although in ancient times medics carried the caduceus into battle to signify the neutral, humanitarian nature of their tasks, they have never been immune to the perils of war. They have made the highest sacrifices to save the lives of others, and their dedication to the wounded soldier is the foundation of military medical care. iii Textbooks of Military Medicine Published by the Office of The Surgeon General Department of the Army, United States of America Editor in Chief and Director Dave E. Lounsbury, MD, FACP Colonel, MC, US Army Borden Institute Assistant Professor of Medicine F. Edward Hébert School of Medicine Uniformed Services University of the Health Sciences Military Medical Editor Ronald F. Bellamy, MD Colonel, US Army, Retired Borden Institute Associate Professor of Military Medicine Associate Professor of Surgery F. Edward Hébert School of Medicine Uniformed Services University of the Health Sciences iv The TMM Series Published Textbooks Medical Consequences of Nuclear Warfare (1989) Conventional Warfare: Ballistic, Blast, and Burn Injuries (1991) Occupational Health: The Soldier and the Industrial Base (1993) Military Dermatology (1994) Military Psychiatry: Preparing in Peace for War (1994) Anesthesia and Perioperative Care of the Combat Casualty (1995) War Psychiatry (1995) Medical Aspects of Chemical and Biological Warfare (1997) Rehabilitation of the Injured Soldier, Volume 1 (1998) Rehabilitation of the Injured Soldier, Volume 2 (1999) Medical Aspects of Harsh Environments, Volume 1 (2002) Medical Aspects of Harsh Environments, Volume 2 (2002) Ophthalmic Care of the Combat Casualty (2003) Military Medical Ethics, Volume 1 (2003) Military Medical Ethics, Volume 2 (2003) Military Preventive Medicine: Mobilization and Deployment, Volume 1 (2003) Military Preventive Medicine: Mobilization and Deployment, Volume 2 (2005) v Deploying a healthy force at any time to any part of the world requires comprehensive and coordinated preventive medicine services. The challenges and the achievements of military preventive medicine in the US Armed Forces are embodied by these soldiers crossing a river in Haiti in 1995. They represent a carefully screened cadre of young Americans who enter military service and benefit from a scientifically sound program to reduce the threat of infectious diseases and injuries during basic training and deployment. When deployed to a harsh environment such as this one, they are prepared for potential hazardous exposures—infectious diseases, climatic extremes, chemical and nuclear exposures, and mental stressors—by military preventive medicine professionals. Military medical research and development provides their commanders with effective countermeasures. Their health is monitored to detect events that threaten individual health and operational effectiveness both in the field and in garrison. Military preventive medicine has always been a fundamental factor for ensuring operational success, but as US military doctrine shifts to emphasize rapid and relatively smaller deployments of forces accompanied by small medical elements, the preventive medicine mission takes on a new urgency. Department of Defense photograph. DoD Joint Combat Camera Center Reference Number -SPT-95-000922. Photographer: SPC Kyle Davis, US Army vi MILITARY PREVENTIVE MEDICINE MOBILIZATION DEPLOYMENT AND Volume 2 Specialty Editor PATRICK W. KELLEY Colonel, Medical Corps, U.S. Army (Retired) Borden Institute Walter Reed Army Medical Center Washington, D. C. Office of The Surgeon General United States Army Falls Church, Virginia United States Army Medical Department Center and School Fort Sam Houston, Texas United States Army Medical Research and Materiel Command Fort Detrick, Frederick, Maryland Uniformed Services University of the Health Sciences Bethesda, Maryland 2005 vii Editorial Staff: Lorraine B. Davis Kathleen A. Huycke Senior Production Manager Technical Editor Douglas A. Wise Senior Layout Editor Bruce G. Maston Desktop Publishing Editor Andy C. Szul Desktop Publishing Editor This volume was prepared for military medical educational use. The focus of the information is to foster discussion that may form the basis of doctrine and policy. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Dosage Selection: The authors and publisher have made every effort to ensure the accuracy of dosages cited herein. However, it is the responsibility of every practitioner to consult appropriate information sources to ascertain correct dosages for each clinical situation, especially for new or unfamiliar drugs and procedures. The authors, editors, publisher, and the Department of Defense cannot be held responsible for any errors found in this book. Use of Trade or Brand Names: Use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement by the Department of Defense. Neutral Language: Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men. CERTAIN PARTS OF THIS PUBLICATION PERTAIN TO COPYRIGHT RESTRICTIONS. ALL RIGHTS RESERVED. NO COPYRIGHTED PARTS OF THIS PUBLICATION MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM OR BY ANY MEANS, ELECTRONIC OR MECHANICAL (INCLUDING PHOTOCOPY, RECORDING, OR ANY INFORMATION STORAGE AND RETRIEVAL SYSTEM), WITHOUT PERMISSION IN WRITING FROM THE PUBLISHER OR COPYRIGHT OWNER. Published by the Office of The Surgeon General at TMM Publications Borden Institute Walter Reed Army Medical Center Washington, DC 20307-5001 Library of Congress Cataloging-in-Publication Data Military preventive medicine : mobilization and deployment / specialty editor, Patrick W. Kelley. p. ; cm. -- (Textbooks of military medicine) Includes bibliographical references and index. 1. Medicine, Military. 2. Medicine, Preventive. 3. Military hygiene. I. Kelley, Patrick W. II. United States. Dept. of the Army. Office of the Surgeon General. III. Series. [DNLM: 1. Military Medicine. 2. Preventive Medicine. UH 600 M6444 2003] RC971.M64 2003 616.9’8023--dc21 2003048099 PRINTED IN THE UNITED STATES OF AMERICA 10, 09, 08, 07, 06, 05, 04, 03 5 4 3 2 1 viii Contents Foreword by The Surgeon General xvii Preface xix SECTION 5: Epidemiology in the Field 705 31. Disease and Nonbattle Injury Surveillance: Outcome Measure for Force Health Protection 707 32. Outbreak Investigation 723 33. Epidemiologic Measurement: Basic Concepts and Methods 755 34. Laboratory Support for Infectious Disease Investigations in the Field 783 SECTION 6: Infectious Diseases of Concern 801 35. Diseases Transmitted Primarily by Arthropod Vectors 803 36. Diseases Transmitted Primarily from Animals to Humans 937 37. Diseases Transmitted by Food, Water, and Soil 999 38. Diseases Spread by Close Personal Contact 1117 39. Diseases Controlled Primarily by Vaccination 1213 40. Principles of Infection Control and Prevention During Military Deployment 1249 SECTION 7: Preventive Medicine Efforts Following Disasters 1267 41. The Challenge of Humanitarian Assistance in the Aftermath of Disasters 1269 42. Military and Public Health Aspects of Natural Disasters 1289 43. Complex Emergencies 1315 44. Public Health Perspectives Related to Technological Disasters and Terrorism 1337 45. The International Humanitarian Response System and the US Military 1351 46. Domestic Disaster Response: FEMA and Other Governmental Organizations 1363 47. Nutritional Assessment and Nutritional Needs of Refugee or Displaced Populations 1375 SECTION 8: Postdeployment 1393 48. Psychological Aspects of Deployment and Reunion 1395 49. Medical Issues in Redeployment 1425 Abbreviations and Acronyms xxiii Index xxvii ix x