Navy Individual Augmentee Combat Training Center NIACT Fort Jackson, South Carolina

2. Disease/Injury Prevention Starts with You! Environmental/occupational health hazards and inadequate personal preparation adversely affect operational readiness Most disease and non-battle injuries occur because preventive techniques were not consistently practiced or personnel were not prepared Know your role in prevention! Preventive Medicine personnel serve as advisors to the commander on individual and unit Preventive Medicine Measures (PMM) that prevent DNBI. To assess the medical threat (disease/illness risk), the team members must be able to perform the following tasks:   Inspect water containers and trailers. Disinfect unit water supplies. Check unit water supply for chlorine. Inspect unit field food service operations. Inspect unit waste disposal operations. Control arthropods, rodents, and other animals in unit area. Train unit personnel in use of individual PMM. Monitor status of PMM in unit. Assist in selection of a unit bivouac site. Supervise the construction of field sanitation devices. Monitor unit personnel in the application of individual PPM.   Preventive Medicine personnel serve as advisors to the commander on individual and unit Preventive Medicine Measures (PMM) that prevent DNBI. To assess the medical threat (disease/illness risk), the team members must be able to perform the following tasks:   Inspect water containers and trailers. Disinfect unit water supplies. Check unit water supply for chlorine. Inspect unit field food service operations. Inspect unit waste disposal operations. Control arthropods, rodents, and other animals in unit area. Train unit personnel in use of individual PMM. Monitor status of PMM in unit. Assist in selection of a unit bivouac site. Supervise the construction of field sanitation devices. Monitor unit personnel in the application of individual PPM.  

3. Module 1 - Pre-deployment Preparation The following presentation consists of four modules to help you prepare for deployment Information in this module addresses pre-deployment preparation and includes Your preventive medicine team Physical fitness, nutrition, medical/dental requirements, travel considerations and stress management Successful completion of each module will allow you to make informed decisions about your health, reducing your risk of injury and disease.

4. Preventive Medicine personnel serve as advisors to the commander on individual and unit Preventive Medicine Measures (PMM) that prevent DNBI. To assess the medical threat (disease/illness risk), the team members must be able to perform the following tasks:   Inspect water containers and trailers. Disinfect unit water supplies. Check unit water supply for chlorine. Inspect unit field food service operations. Inspect unit waste disposal operations. Control arthropods, rodents, and other animals in unit area. Train unit personnel in use of individual PMM. Monitor status of PMM in unit. Assist in selection of a unit bivouac site. Supervise the construction of field sanitation devices. Monitor unit personnel in the application of individual PPM.   Preventive Medicine personnel serve as advisors to the commander on individual and unit Preventive Medicine Measures (PMM) that prevent DNBI. To assess the medical threat (disease/illness risk), the team members must be able to perform the following tasks:   Inspect water containers and trailers. Disinfect unit water supplies. Check unit water supply for chlorine. Inspect unit field food service operations. Inspect unit waste disposal operations. Control arthropods, rodents, and other animals in unit area. Train unit personnel in use of individual PMM. Monitor status of PMM in unit. Assist in selection of a unit bivouac site. Supervise the construction of field sanitation devices. Monitor unit personnel in the application of individual PPM.  

5. Prevention Must Become Part of Your Daily Routine Learning and consistently practicing the following simple techniques will significantly reduce your risk of injury and acquiring disease For example……….

6. Physical Fitness Components of Physical Fitness Muscle Strength Muscle Endurance Cardio-respiratory Endurance Flexibility Physical fitness is essential to reduce the risk of injury during your deployment and a critical component of readiness. Fitness is achievable by everyone despite body type, family history or past habits. The components of fitness include: -Muscle strength: Amount of force a muscle or muscle group can exert against resistance for one maximal effort -Muscle Endurance: ability of a muscle or muscle group to exert force repeatedly without undue fatigue -Cardio respiratory endurance: large muscle group activities that are repetitive and rhythmic in nature and sustainable for long periods of time -Flexibility: Range of motion about a joint Physical fitness is essential to reduce the risk of injury during your deployment and a critical component of readiness. Fitness is achievable by everyone despite body type, family history or past habits. The components of fitness include: -Muscle strength: Amount of force a muscle or muscle group can exert against resistance for one maximal effort -Muscle Endurance: ability of a muscle or muscle group to exert force repeatedly without undue fatigue -Cardio respiratory endurance: large muscle group activities that are repetitive and rhythmic in nature and sustainable for long periods of time -Flexibility: Range of motion about a joint

7. Physical Fitness Develop a personal exercise plan, use it and make it a routine (before, during and after deployment) Warm-up (light aerobic activity) Progressive Stretching Physical Activity Sport training (sport specific activity) Muscular strength/Endurance training (resistance training) Aerobic/Anaerobic training (running, swimming, circuits) Cool down (light aerobic activity) Stretch (cool down stretch to aid recovery) Exercise is critical in keeping your body and mind healthy. Exercising at least 1 hour a day, 3-5 times a week will maintain a high level of physical fitness and reduce the risk of injury. Warm up/cool down: 5-10 minutes of low intensity aerobic activity such as brisk walking, slow jogging or stationary cycling Flexibility training: Stretch each body part 1-2 times Hold each stretch 10-30 sec Stretch slowly and in control Do not bounce or jerk Go to the point of tension but not pain Breathe normally Resistance training: A consistent resistance conditioning program will result in (1) reducing high blood pressure, (2) reduce cholesterol levels, (3) increased body awareness, balance, and coordination, (4) assist in injury prevention, (5) decrease fatigue Aerobic Conditioning: A consistent aerobic conditioning program will result in (1) increased physical capacity to meet mission demands, (2) reduce fatigue, (3)improve overall health and well-being, (4) improve immune system, (5) increase muscle endurance, (6) promote relaxation and sleep, (6) promote positive change in cardiovascular health, (7) promote positive change in blood pressure and cholesterol Exercise is critical in keeping your body and mind healthy. Exercising at least 1 hour a day, 3-5 times a week will maintain a high level of physical fitness and reduce the risk of injury. Warm up/cool down: 5-10 minutes of low intensity aerobic activity such as brisk walking, slow jogging or stationary cycling Flexibility training: Stretch each body part 1-2 times Hold each stretch 10-30 sec Stretch slowly and in control Do not bounce or jerk Go to the point of tension but not pain Breathe normally Resistance training: A consistent resistance conditioning program will result in (1) reducing high blood pressure, (2) reduce cholesterol levels, (3) increased body awareness, balance, and coordination, (4) assist in injury prevention, (5) decrease fatigue Aerobic Conditioning: A consistent aerobic conditioning program will result in (1) increased physical capacity to meet mission demands, (2) reduce fatigue, (3)improve overall health and well-being, (4) improve immune system, (5) increase muscle endurance, (6) promote relaxation and sleep, (6) promote positive change in cardiovascular health, (7) promote positive change in blood pressure and cholesterol

8. Physical Fitness Injury prevention Always warm-up and cool down properly Progress slowly Strengthen the musculature around joints to protect them Run on softer flat surfaces when possible Alternate weight bearing and non-weight bearing aerobic activities Rest and eat well Participation in exercise offers many benefits that far exceed the potential risk of injury. When exercising, it is common to feel minor aches and soreness as the body adapts. While injury is possible, following safety guidelines and participating in a strengthening and flexibility program generally decreases this risk. Studies indicate that being well conditioned prior to training and changing exercise routines greatly decreases the chance of injury. Participation in exercise offers many benefits that far exceed the potential risk of injury. When exercising, it is common to feel minor aches and soreness as the body adapts. While injury is possible, following safety guidelines and participating in a strengthening and flexibility program generally decreases this risk. Studies indicate that being well conditioned prior to training and changing exercise routines greatly decreases the chance of injury.

9. Nutrition Nutrition Eating a balanced diet is essential for good health Muscle strength Muscle endurance Flexibility Cardiovascular endurance Body composition Mental acuity/awareness Eating correctly is essential for good health and optimum performance. For each individual, optimal performance may mean something different, such as improvement at work, energy for daily activity or feeling better. A health diet helps prepare the body with proper nutrients and energy to be at its best throughout the day in order to have energy, strength and endurance for: exercise, competition, work, to remain health and resist disease. Eating correctly is essential for good health and optimum performance. For each individual, optimal performance may mean something different, such as improvement at work, energy for daily activity or feeling better. A health diet helps prepare the body with proper nutrients and energy to be at its best throughout the day in order to have energy, strength and endurance for: exercise, competition, work, to remain health and resist disease.

10. Nutrition Nutrition Guidelines Eat a variety of foods Balance food intake with physical activity Choose a diet With plenty of grain, fruits and vegetables Rich in fiber Low in fat Moderate in sugars Moderate in salt and sodium Stay hydrated! Food and water play a major role in sustaining your health, performance and morale. As little as a 2% decrease in body weight due to water loss can significantly DECREASE performance. You must consume fluids continuously even when you don’t feel thirsty since thirst sensation is a poor indicator of the need for fluids. Energy needs typically increase in the field environment due to higher physical demands. To ensure optimum physical and mission performance, you should consume enough food to relieve hunger and avoid weight loss. Maintain your weight; do not avoid food or attempt weight loss during field operations. Energy needs can vary based on individual body size, weight, and level of fitness. Climate can also affect energy requirements, for example: Work in cold weather can increase energy needs by 10-25% Operations in high-altitude areas can increase energy needs by 50% or more To maximize physical performance and aid your body’s ability to heat/cool, you must consume adequate amounts of food and fluids each day.Food and water play a major role in sustaining your health, performance and morale. As little as a 2% decrease in body weight due to water loss can significantly DECREASE performance. You must consume fluids continuously even when you don’t feel thirsty since thirst sensation is a poor indicator of the need for fluids. Energy needs typically increase in the field environment due to higher physical demands. To ensure optimum physical and mission performance, you should consume enough food to relieve hunger and avoid weight loss. Maintain your weight; do not avoid food or attempt weight loss during field operations. Energy needs can vary based on individual body size, weight, and level of fitness. Climate can also affect energy requirements, for example: Work in cold weather can increase energy needs by 10-25% Operations in high-altitude areas can increase energy needs by 50% or more To maximize physical performance and aid your body’s ability to heat/cool, you must consume adequate amounts of food and fluids each day.

11. Medical/Dental Requirements Medical, Dental & Vision Screening Prescription Medication If you require medication which may not be available through normal supply systems, talk with your provider to obtain a 6-month supply, or enough for the duration of the operation Ensure immunizations are current. Obtain and take chemoprophylaxis as instructed Complete Pre-deployment Health Assessment (DD Form 2795)

12. Personal Gear Assemble appropriate clothing, gear and personal hygiene items Anti-fungal cream/powder and shower shoes Insect repellent, sunscreen, eye and hearing protection, lip balm, skin lotion Cotton underwear (10 changes) Toothbrush, Dental Floss, Fluoride Toothpaste Ensure uniforms are treated with permethrin DEET Become comfortable with your uniform and 782 gear Wear new boots Wear gas mask/MOPP gear Ensure uniforms, chemical protective clothing, 2 pair of prescription military spectacles (if required), protective masks (with prescription lens inserts, if required ), protective eyewear (i.e. Ballistic Laser Protective Spectacles (BLPS) or Special Protective Cylindrical System (SPECS), contact lenses (if operationally required e.g. Apache contact lens program), and other gear are in good condition and fit properly Practice putting on/removing clothing, masks, and gear: ensure clothing items, hair, etc. do not interfere with proper wear Ensure uniforms are treated with insect repellent (permethrin), mark treatment date and method of treatment on the uniform Apply permethrin to uniforms with the Individual Dynamic Absorption (IDA) kit (good for the life of the uniform) or aerosol spray (reapply after sixth wash) Preferred or special types/brands of personal hygiene items may not be available at all locations; if you need medications or hygiene items which may not be available through normal supply systems, obtain a 6-month supply, or enough for the duration of the operation (include pre-/post-deployment) Ensure uniforms, chemical protective clothing, 2 pair of prescription military spectacles (if required), protective masks (with prescription lens inserts, if required ), protective eyewear (i.e. Ballistic Laser Protective Spectacles (BLPS) or Special Protective Cylindrical System (SPECS), contact lenses (if operationally required e.g. Apache contact lens program), and other gear are in good condition and fit properly Practice putting on/removing clothing, masks, and gear: ensure clothing items, hair, etc. do not interfere with proper wear Ensure uniforms are treated with insect repellent (permethrin), mark treatment date and method of treatment on the uniform Apply permethrin to uniforms with the Individual Dynamic Absorption (IDA) kit (good for the life of the uniform) or aerosol spray (reapply after sixth wash) Preferred or special types/brands of personal hygiene items may not be available at all locations; if you need medications or hygiene items which may not be available through normal supply systems, obtain a 6-month supply, or enough for the duration of the operation (include pre-/post-deployment)

13. Oral Hygiene Brush twice-daily Daily in difficult tactical environments Floss daily Seek medical attention at the onset of any dental problems ORAL HEALTH Dental disease is a common problem during deployments due to the challenge of maintaining good oral hygiene. You should deploy with toothbrush, dental floss, and fluoride toothpaste. Daily flossing and twice-daily brushing of teeth is the best way to ensure prevention of periodontal disease and to decrease your risk of problems such as trench mouth and tooth decay. In difficult tactical environments, teeth should be brushed at least once a day. Seek medical attention immediately at the onset of any dental problems. ORAL HEALTH Dental disease is a common problem during deployments due to the challenge of maintaining good oral hygiene. You should deploy with toothbrush, dental floss, and fluoride toothpaste. Daily flossing and twice-daily brushing of teeth is the best way to ensure prevention of periodontal disease and to decrease your risk of problems such as trench mouth and tooth decay. In difficult tactical environments, teeth should be brushed at least once a day. Seek medical attention immediately at the onset of any dental problems.

14. Female Specific Deployment Preparation Feminine Hygiene Products (non-deodorant tampons, sanitary napkins, panty liners; menstrual cramp reliever) Yeast infection medication (two courses of vaginal treatment) Portable Urinary Device For use by female personnel to reduce time needed to urinate and resolve privacy issues when latrines are not available (convoys, field operations) NSN: 8530-01-470-2805 Birth control (condoms, birth control pills) (if using birth control pills, continue as prescribed to regulate menstrual cycles and avoid problems resulting from inconsistent use) Hygiene products include unscented wet wipes, hand sanitizer gel/lotion, and feminine hygiene items Portable Urinary Device (PUD) (optional unit/indiv purchase) PUD NSN is 8530-01-470-2805 PUD is for use by female personnel to reduce time needed to urinate and resolve privacy issues when latrines are not available (convoys, field operations) Birth control (condoms, birth control pills) (if using birth control pills, continue as prescribed to regulate menstrual cycles and avoid problems resulting from inconsistent use) Hygiene products include unscented wet wipes, hand sanitizer gel/lotion, and feminine hygiene items Portable Urinary Device (PUD) (optional unit/indiv purchase) PUD NSN is 8530-01-470-2805 PUD is for use by female personnel to reduce time needed to urinate and resolve privacy issues when latrines are not available (convoys, field operations)

15. Air Travel Air travel can cause certain stresses on the traveler Effects of Altitude Oxygen Gas Expansion Cabin Environment Air Quality Humidity Motion Space Jet Lag The following information will make your travel much easier

16. Altitude Pressurized cabins are analogous to the atmosphere present at 5000-8000ft above sea level Less oxygen available Combination of reduced oxygen, inactivity and lack of sleep can lead to dizziness Practice arm and leg exercises before standing Gas expansion within the body Swallow, chew or yawn during descent Avoid gas forming foods or liquids before flight There is less oxygen absorbed into the blood and circulated throughout the body during flight as compared to ground level due to a decrease in oxygen and an increased cabin altitude. As long as you are in reasonably good health, your body has physiological mechanisms that compensate for this decreased quantity of oxygen. There is less oxygen absorbed into the blood and circulated throughout the body during flight as compared to ground level due to a decrease in oxygen and an increased cabin altitude. As long as you are in reasonably good health, your body has physiological mechanisms that compensate for this decreased quantity of oxygen.

17. Cabin Environment Air Quality Half the air in cabins is fresh/half re-circulated. Total air exchange is 20 to 30 per hour. Air quality normally equals or exceeds standards Humidity Fairly dry <20% Minimize discomfort of dryness by Drink water Limit consumption of caffeinated drinks Wear glasses instead of contact lenses Apply skin moisturizer Half the cabin air is fresh air drawn in via the engines with the other half re-circulated from the cabin. The re-circulated air is ducted through an air filter. There is a total air change every 2-3 minutes. This is more than any home or office building and easily maintains cabin contaminants to low levels.Half the cabin air is fresh air drawn in via the engines with the other half re-circulated from the cabin. The re-circulated air is ducted through an air filter. There is a total air change every 2-3 minutes. This is more than any home or office building and easily maintains cabin contaminants to low levels.

18. Cabin Environment Motion For those susceptible Sit over the wing Sit by a window Keep your seat belt fastened Consult a physician concerning medication Space Crowding in aircraft may result in immobility Risk of blood clots Wear lose clothing Place nothing in the seat in front of you to allow stretching Drink mainly water Walk about the cabin every 60-90 minutes Motion: For those susceptible to motion sickness Sit over the wing Sit by a window Keep your seat belt fastened Consult a physician concerning medication Space: Because of crowding, passengers are frequently uncomfortable and unable to stretch or easily leave their seats. In susceptible individuals, prolonged immobility can increase the risk for blood clots to form in the legs. A few simple tips to reduce the risk: Wear lose clothing Place nothing in the seat in front of you to allow stretching Drink mainly water Walk about the cabin every 60-90 minutesMotion: For those susceptible to motion sickness Sit over the wing Sit by a window Keep your seat belt fastened Consult a physician concerning medication Space: Because of crowding, passengers are frequently uncomfortable and unable to stretch or easily leave their seats. In susceptible individuals, prolonged immobility can increase the risk for blood clots to form in the legs. A few simple tips to reduce the risk: Wear lose clothing Place nothing in the seat in front of you to allow stretching Drink mainly water Walk about the cabin every 60-90 minutes

19. Jet Lag Jet lag is associated with air travel especially when crossing multiple time zones Tips to diminish the effects: Rest well before the flight Try to move 1-2 hours toward the destination time before flight Eat lightly before and during the flight Once departed, reset watches and other activities to the destination time Drink water and fruit juices in-flight Adjusting to jet lag is generally easier when travel is to the west, but most travelers adjust to the new time after a few days. Symptoms are multiple and vary with each individual but result from the internal body clock being out of phase Adjusting to jet lag is generally easier when travel is to the west, but most travelers adjust to the new time after a few days. Symptoms are multiple and vary with each individual but result from the internal body clock being out of phase

20. Jet Lag Tips Continued Consider using caffeinated beverages strategically during the day to mask fatigue but avoid use within 4-6 hours of bedtime Wear loose, comfortable clothing Schedule outdoor activities for the first few days of arrival After arrival, adjust to destination time as soon as possible Limit naps to a single nap of 30-40 minutes or less. At the new destination, go to bed and awaken at the appropriate time for that location

21. Stress Fear and physical signs or symptoms of stress are normal reactions before and during combat or other dangerous/life-threatening situations. You should not let fear or stress keep you from doing your job. Talk about what is happening with your buddies, especially during after-action debriefings. Learn ways to relax quickly. Integrate new replacements into your group and get to know them quickly. If you must join a new group, be active in establishing friendships. Give each other moral support. Care for your buddies and work together to provide everyone food, water, sleep, and shelter, and to protect against heat, cold, poor sanitation, and enemy action. Fear and physical signs or symptoms of stress are normal reactions before and during combat or other dangerous/life-threatening situations. You should not let fear or stress keep you from doing your job. Talk about what is happening with your buddies, especially during after-action debriefings. Learn ways to relax quickly. Integrate new replacements into your group and get to know them quickly. If you must join a new group, be active in establishing friendships. Give each other moral support. Care for your buddies and work together to provide everyone food, water, sleep, and shelter, and to protect against heat, cold, poor sanitation, and enemy action.

22. Acknowledgements U.S. Army Center for Health Promotion & Preventive Medicine, Aberdeen Proving Ground, MD Navy Environmental Health Center, Portsmouth, VA