Chapter VII: Section I: Preventive Medicine Services

5-1. General

On the integrated battlefield, PVNTMED services will be in greater demand than at any other time, especially under BW conditions. Preventive medicine personnel will be called upon to assist the commander in determining the health hazards associated with nuclear fallout; the safety of drinking water in an NBC environment; as well as determining when to use prophylaxis, pretreatments, immunizations, and other PVNTMED measures (PMM) associated with NBC warfare. Preventive medicine personnel must be aware of the medical threat in the AO. They must continually update their medical surveillance activities to identify disease trends (endemic and epidemic), potential disease vectors, and the susceptibility of troops to these diseases. Under NBC conditions, diseases may manifest that exist in the area, but were not being transmitted to personnel. However, due to the reduced health status of personnel from exposures to or from stress-related NBC conditions, the troops begin to suffer their effects. The appearance of diseases or arthropods not known to exist in the AO are indicators that BW agents have been used. For details on PVNTMED operations, see FM 4-02.17.

5-2. Disease Incidence Following the Use of Nuclear, Biological, and Chemical Weapons

_a._ _Determining Factors._ Factors of prime importance in determining the nature and severity of the disease effects are--

· Immunization status of personnel.

· Population density.

· Degree of industrialization in the operational area.

· Availability of food supplies.

· Availability of water.

· Climate.

Finally, the manner and situation in which nuclear weapons are used are of importance. A single weapon detonated in a socially stable area will have far less serious effects than a detonation in an area where combat has already disrupted the social stability. At Hiroshima and Nagasaki, Japan (excellent examples of the first type of situation), the survivors who could get away were able to obtain food, shelter, and care from surrounding intact areas. With prolonged combat operations, such intact areas would not be available, resulting in no food, shelter, or care for survivors. There will be a breakdown in social order and there will be a lack of effective medical support; including PVNTMED functions and facilities.

_b._ _Disease Incidence._ Without PVNTMED capabilities, increased incidence and morbidity from diseases will follow. Some diseases will predominate in incidence, depending upon the geographical areas involved and the endemic diseases present.

(1) In urban areas in temperate climates, several diseases are
epidemic threats. These epidemic threats may include--

· Dysentery (due to a variety of pathogens).

· Rickettsial diseases, particularly typhus and scrub typhus.

· Hepatitis.

· Tuberculosis.

· Sexually transmitted diseases.

· Malaria and cholera (in many parts of the world).

(2) There are several reasons for the increased risk of disease
including, but not limited to--

· Crowding of surviving populations with limited sanitary
facilities, such as was seen in Europe at the end of World War
II.

· A lack of prophylaxis and immunizations with resultant
increases in the susceptible faction of a given population.

· A lack of pest management.

· The effect of irradiation on susceptibility to infection.
With the high levels of fallout covering wide areas, a large
number of people will sustain sublethal whole-body doses of
irradiation. The interaction of irradiation with infections
is not clear; but it may be the result of latent infections
manifesting and decreased resistance to infection. The result
is an increased incidence of disease.

· The ecological imbalance and host-parasite relationship
following the use of nuclear weapons. Each class and order of
animals has marked differences in sensitivity to irradiation.
Arthropods, for example, are much more resistant than are
vertebrates. The normal balance between arthropods and
birds that prey upon them in a given area may be severely
upset, producing a marked overgrowth of the arthropods. If
the arthropods include vectors of disease there would be a
serious increase in disease hazards. If there is an increase
in arthropods that destroy vegetation there would be a serious
destruction of food crops.

· The introduction of a BW agent in an AO in which the disease
organism is endemic or epidemic can increase the risk level for
exposed personnel.

5-3. Preventive Medicine Section

The PVNTMED sections of the brigade, divisional, and nondivisional medical companies perform analysis on water sources and supplies to determine the presence or absence of NBC/TIM contamination; see Appendix I for additional information. Based upon their findings, the water is released for consumption, or is restricted from use until it is treated (usually by water production personnel using the reverse osmosis water purification unit [ROWPU]). They also collect water samples for suspect biological agent contamination for supporting medical laboratory analysis (see Appendix B). They conduct medical surveillance activities, to include occupational and environmental health threat surveillance. They conduct limited entomological surveys to determine the existence of disease-vectoring arthropods in the AO. They inspect food service facilities to determine the extent, if any, of NBC contamination. They evaluate the unit's--

· Immunization status.

· Use of prophylaxis for specific diseases (such as
antimalarial tablets) (see FM 4-02.33), for nuclear radiation
exposure (such as granisetron for nausea and vomiting) (see
FM 4-02.283), and for BW agents (such as Ciprofloxacin for
postexposure chemoprophylaxis for Anthrax) (see FM 8-284).

· Use of nerve agent pyridostigmine pretreatment tablets (see
FM 8-285), if warranted.

· Application of personal hygiene and field sanitation
procedures (FM 21-10/MCRP 4-11.1D).

Based upon their findings, they provide recommendations for corrective actions to the commanders. They assist in training US Army unit field sanitation teams (FM 4-25.12); they are not members of the unit field sanitation team. They conduct medical surveillance activities for their command (FM 4-02.17).

5-4. Preventive Medicine Detachment

The PVNTMED detachment provides PVNTMED services on an area support basis to units within their assigned AO. These services include, but are not limited to--

· Conducting water surveillance, including NBC contamination.
Collecting water samples suspected of NBC/TIM contamination for
analysis by supporting medical laboratory (see Appendix B).

· Performing food service sanitary inspections.

· Conducting medical surveillance and providing epidemiological
consultation.

· Conducting pest (arthropod and rodent) surveys and
surveillance.

· Conducting arthropod control operations. The aerial spraying
missions are dependent upon availability of helicopter support.

· Conducting occupational and industrial hygiene surveys.

· Advising commanders on the application of PMM.

· Training the supported units' field sanitation teams.