3. BUMEDINST 6224.8D; EMERGENCY WAR SURGERY; OPNAVINST 5100.19E; OPNAVINST 6100.3A Flashcards
Which instruction provides policy and guidance for controlling tuberculosis (TB) among Department of the Navy (DON) military personnel and Military Sealift Command (MSC) civilian mariners (CIVMAR)?
BUMEDINST 6224.8B, Tuberculosis Control Program
What form is the Initial Tuberculosis Exposure Risk Assessment?
NAVMED 6224/7
What form is the Interim Tuberculosis Exposure Risk Assessment?
NAVMED 6224/8
What form is the Monthly Evaluation for Patients receiving Treatment for Latent Tuberculosis Infection?
NAVMED 6224/9
What form is the Adult Immunizations Record?
NAVMED 6230/4
What form is the Child Immunizations Record?
NAVMED 6230/5
Records created as a result of BUMEDINST 6224.8B, Tuberculosis Control Program, regardless of media and format shall be managed per what instruction?
SEVNAV-M 5210.1
What needs to occur to significantly reduce the spread of Tuberculosis (TB)?
Early detection and respiratory isolation of persons infected with TB
What is the strategy to control tuberculosis?
a. To promptly detect, treat and report persons who have contracted clinically active TB
b. To protect persons in close contact with patients with active TB
c. To prevent TB in DON MSC and CIVMAR through early detection and treatment of latent TBd. Assessment of DON contract workers and contract healthcare workers
Pertaining to TB the navy is only required to adhere to federal regulations , but not state and local law if they conflict with federal law. T or F?
TRUE
The skin and blood test required for entry into Naval service, identifies individuals asymptomatically infected whith what complex bacteria known to cause Tuberculosis (TB)?
Mycobacterium Tuberculosis
Appropriate TB testing, identifies Individuals that are at increased risk for developing active TB, but are not infectious. What are they diagnoised with?
Latent Tuberculosis Infection (LTBI)
All Navy and Marine Corps accessions, and all individuals beginning employment as Civilian Mariners (CIVMARs) for the Military Sealift Command (MSC) must be screened for what?
Latent Tuberculosis Infection (LTBI) unless previously documented of TB Infection
What must all personnel be screened for during their operational suitability screening?
Latent Tuberculosis Infection (LTBI)
Documented screening or testing for LTBI within what time frame of reporting aboard a commissioned vessel is acceptable?
6 months
Which form should be used to screen all Active duty and Reserve personnel during the PHA to determine their TB exposure history and risk of acquiring TB?
NAVMED 6224/8, Interim Tuberculosis Exposure Risk Assessment
CIVMARs will be screened or tested _______ or during their periodic physical examination at the direction of MSC Fleet Surgeon based on their different risk profile in comparison to uniformed service members
Annually
TB screening must be performed on all personnel prior to or within how many months of arrival on a commissioned vessel?
6 months
It is no longer required that all personnel must have Latent Tuberculosis Infection (LTBI) test results documented within the 6 months prior to separation or retirement. T or F?
TRUE
What is the approved tuberculin routine skin test?
Mantoux test
Tuberculosis Skin Test (TST) test results can be entered into AHLTA, MRRS, or which other authorized electronic medical information system?
Shipboard Non-Tactical ADP Program (SNAP) Automated Medical System (SAMS)
What information is included when documenting a Tuberculosis Skin Test (TST)?
NAME?
Within how many hours after Purified Protein Derivative (PPD) administration must the TST reaction be read?
48-72 hours
If person, returns more than 72 hours after the Tuberculosis Skin Test (TST) placement, what is the next process?
Record results as “Not Read” and thenapply a TST on the opposite forearm
Measurement of the TST reaction is to the nearest whole millimeter (mm). How would a no induration be documented?
“0 mm” or “zero mm”
When should additional LTBI screening and subsequent testing be done?
- date
- type
- strength of tuberculin
- manufacturer
- lot number
- route
What is the normal rate of newly-identified LTBI converters to personnel tested per year in most Navy and Marine Corps settings based on historical TST results associated with routine (non-targeted) screening?
1-2 percent
If the rate of newly identified converters is two times greater than the expected baseline conversion rate of the command among any group tested, who needs to be contacted for specific guidance?
the cognizant Navy Environmental Preventative Medicine Unit (NAVENPVNTMEDU)
A TST may be placed on the same day parenteral live-attenuated virus vaccines are given or at least how many weeks later?
4 weeks
Are TST considered safe for pregnant women?
They are both safe and reliable and should be performed if needed
If they are undergoing further evaluation, what should the service members with positive TST do?
They should not deploy until the evaluations are complete. (i.e. Chest X-rays & mycobacterium cultures)
All individuals with a TST induration that is greater than or equal to how many mm must be evaluated to determine if their test is positive base on risk factors?
5 mm
An increase in reaction size of how many mm or more, within a three-year period is also considered a skin test conversion or positive test indicative of a recent infection with TB?
10 mm
Service members and individuals assigned to operational military forces, including shipboard personnel, without risk factors for acquiring TB are in what risk group? What is their TST induration?
Low Risk
Greater than or equal to 15 mm
Recent immigrants (within the last 5 years) from high TB prevalence countries, Myobacteriology laboratory personnel, and persons with clinical conditions that place them at increased risk are designated what risk group?
Medium Risk
Greater than or equal to 10 mm
Recent close contacts of active TB disease patients, persons with fibrotic or other changed on chest radiograph consistent with prior TB, and patients suspected of having active TB diseas are designated as what risk group?
High Risk
Greater than or equal to 5 mm
To determine if all persons have active TB disease, ensure all persons newly identified as having a positive TST are evaluated by who?
MO, Nurse Practitioner, PA, or IDC
Chest x-rays should be examined for _______ changes consistent with old TB infectionand for any signs of active TB.
Fibrotic
_______ women also should have active TB ruled out with chest x-ray using appropriate shielding.
Pregnant
A person with suspected active TB disease should immediately be what?
Masked, Isolated, and reffered to an appropriate MTF provider
What is the preferred isoniazed (INH) treatment regimen?
INH 5 mg/kg (300 mg max) daily for 9 months
What is the alternate isoniazed (INH) treatment regimen?
INH 15mg/kg (900 mg max) bi-weekly for 9 months with directly observed theraphy (DOT)
How often must follow ups be conducted for individuals receiving therapy for LTBI until treatment is completed?
Monthly
What is the recommended mechanism to assure LTBI treatment compliance whenever feasible?
directly observed theraphy (DOT)
Which form should be used to document patient education and counseling?
SF 600, Medical Record Chronological Record of Medical Treatment
Persons on treatment for LTBI often miss doses. The 9-month daily Isoniazid (INH) regimen should not be restarted if at least how many doses of INH can be administered within a 12-month period?
270 doses
Patients must be examined to exclude active TB disease, if the treatment has been interrupted for more than how many months ?
2 months
What is the ICD 9 code that you should use when evaluating a patient in AHLTA for TB?
ICD9M code v74.1
“Screening exam for pulmonary TB”
What should you do if you suspect a patient has a strain of Tb that is resistant to INH?
Consult Navy Environmental Preventive Medicine Unit (NAVENPVNTMEDU) for treatment plan
Do you need to do baseline lab testing for someone starting INH therapy?
No you do not need to routinely do base line labs prior to treatment
Only do a LFT for those at risk of liver disease
Which form must be used to document the need for continued LTBI treatment for all naval service beneficiaries who transfer from the treating health care facility or leave the military service before completing a course of treatment for LTBI?
NAVMED 6224/9, Monthly Evaluation of Patients Receiving Theraphy for Latent Tuberculosis Infection (LTBI)
Where can members members leaving active service eligible for continued TB treatment and follow up care?
Veteran’s Administration (VA)
Upon discoveray of suspected or confirmed case of active tuberculosis (TB) in a service member assigned to Navy or Marine Corps operating forces, the CO ir OIC must notify who?
Cognizant Navy Enviromental Preventative Medicine Unit (NAVENPVTMEDU) and local health department
Upon completion of the cognizant NAVENPVTMEDU TB contact investigation, assited by command medical personnel, the NAVENPVTMEDU will provide an investigation report to the Command, cognizant Fleet.Type Commander Surgeon, and who?
Navy and Marine Corps Public Health Center (NMCPHC)
Who will conduct the TB contact investigation on persons not assigned to naval operational forces?The MTF will notify the cognizant NAVENPVTMEDU upon initiating a contact investigation and will submit the completed investigation report to who?
Servicing MTFNavy Medicine Region and Navy and Marine Corps Public Health Center (NMCPHC)
Which reference contains the guidance that should be employed when conducting TB contact investigations with suspected transmission within aircraft cabins?
WHO/HTM/TB/2008.399
Within what time frame must a Medical Event Report be submitted for all new cases of active TB or suspected new cases of active TB by the ship or station?
24 hours
What is the minimum particulate respirator size that medical department personnel must wear when working in rooms or spaces containing a person with known or suspected active TB?
N95 mask
Which type of event overwhelms immediately available medical capabilities to include personnel, supplies, and/or equipment?
Mass Casualty
Which principle is effective mass casualty response founded on?
Triage
Which system sorts and prioritizes casualties based on the tactical situation, mission, and available resources?
Triage
The ultimate goal of combat medicine are the return of the greatest possible number of warfighters to combat and the preservation of what?
Life, Limb, and Eyesight
How many different categories of triage are there?
4; Immediate, delayed, minimal, and expectant
Groups of injured people who require attention within minutes to 2 hours on arrival to avoid death or major disability to life, limb, or eyesight fall under which triage category?
Immediate
Which triage category would a patient be placed into who presents with a head injury requiring emergent decompression?
Immediate
Which triage group includes those wounded who are in need of surgery, but whose general condition permits delay in treatment without unduly endangering life, limb, or eyesight?
Delayed
Which triage category would a patient be placed into who arrives with fractures or soft-tissue injuries without significant bleeding?
Delayed
Which triage group has relatively minor injuries and can effectively care for themselves or with minimal medical care?
Minimal
Which triage group has injuries that overwhelm current medical resources at the expense of treating salvageable patients and should not be abandoned, but separated from the view of other casualties?
Expectant
Prior to entering the treatment facility, Wounded contaminated in a biological and/or a chemical battlefield environment must be?
Decontaminated
Heavy stress patients should be sent to a combat stress control restoration center for up to how many days reconstitution?
3
Which mnemonic should be used where resources/tactical situations allow for combat stress patients?
BICEPS:
Brief - Keep interventions to 3 days or less of rest, food, and conditioning
Immediate - Treat symptoms at recognition (do not delay)
Central - Keep in one area for mutual support and identity as soldiers
Expectant - Reaffirm return to duty after brief rest
Proximal - Keep as close as possible to their unit
Simple - Do not engage in psychotherapy and only address present stress response and situation
What are the external factors of Triage resource constraints?
- Tactical situation and the mission
- Resupply
- Time
What are the internal factors of Triage resource constraints?
- Medical supplies
- Space/capability
- Personnel
- Stress
What has transfusion medicine in the theater of war historically relied on and will probably continue to rely on in the future
Walking blood bank
What information is of critical importance when reaching a decision in triage?
- Initial vital signs
- Pattern of injury
- Response to initial intervention
The majority of combat wounded will suffer nonfatal extremity injuries. How will these be triaged in general?
Non-emergent
All casualties should flow through a single triage area and undergo rapid evaluation by whom?
Initial triage officer
What are the qualities of an ideal initial triage area?
- Proximity
- One-way flow
- Well-lit, covered, climate-controlled
- Casualty recorders
- Litter bearers
Who is responsible for overarching clinical management of the mass casualty response at role 2-4 facilities?
Chief of Trauma
Who must each individual on the resuscitation treatment team coordinate the movement of their patients with?
Chief Surgical Triage Officer
Numerous authors have stated that, after the first 24 hours of a mass casualty ordeal, the activities of the care providers must be decreased by what percentage to allow for participant recovery and rest?
50%
What is defined as the movement of a casualty from the point of injury to medical treatment by nonmedical personnel? (typically involves a helicopter returning from the battlefield)
Casualty Evacuation (CASEVAC)
What is defined as the timely, efficient movement and en route care provided by medical personnel to the wounded being evacuated from the battlefield to MTFs using medically equipped vehicles or aircraft? (e.g., civilian aeromedical helicopter services and Army air ambulances)
Medical Evacuation (MEDEVAC)
Which type of evacuation generally utilizes United States Air Force (USAF) fixed-wing aircraft to move sick or injured personnel within the theater of operations (intratheater) or between two theaters (intertheater)? (e.g., Afghanistan to Germany)
Aeromedical Evacuation (AE)
Which type of care is the maintenance of treatment initiated prior to evacuation and sustainment of the patient’s medical condition during evacuation?
En route care
How many litter straps are used to secure patients to the litter for patients entering the medical evacuation system?
3
Due to differences in the type of evacuation assets used and their effect on the patient’s medical condition (e.g., flying in the pressurized cabin of an aircraft), requests to transport patients via USAF Aeromedical Evacuation (AE) system must be validated by who?
theater validating flight surgeon
Who determines the evacuation precedence for all patients requiring evacuation from Role 2 MTFs or Forward Surgical Teams (FSTs)?
Brigade Surgeon
What should be contacted at the earliest possible time when a patient is readied for evacuation from the Forward Surgical Team (FST) by United States Air Force (USAF) assets?
Patient Movement Requirements Center (PMRC)
What must be bivalve just in case it is over a surgical wound site and mist have a “window” to allow for tissue expansion and emergency access?
Cast
The volume of a gas bubble in liquid doubles at how many feet above sea level?
18,000 ft
Cabin pressures in most military aircraft are maintained at altitudes between 8,000 and how many feet?
10,000 ft
What should be considered when transporting patients by air who are presenting with severe pulmonary disease?
Cabin Altitude Restriction (CAR)
What amount of oxygen saturation does a healthy patient have at a cabin altitude of 8,000 feet?
90%
How many personnel typically make up the Aeromedical Evacuation Liaison Team (AELT)?
4-6 personnel
For evacuation precedence, what movement classification is immediate aeromedical evacuation (AE) to save life, limb, or eyesight? Within how many hours?
Urgent
MEDEVAC (Navy, Army, Marines) = Within 1 hour
AE (Air Force) = ASAP
For evacuation precedence, what movement classification is prompt medical care not available locally and medical condition could deteriorate, meaning the patient cannot wait for routine AE? Within how many hours?
Priority
MEDEVAC (Navy, Army, Marines) = Within 4 hours
AE (Air Force) = Within 24 hours
For evacuation precedence, what movement classification is conditions not expected to deteriorate significantly while awaiting flight? Within how many hours?
Routine
MEDEVAC (Navy, Army, Marines) = Within 24 hours
AE (Air Force) = Within 72 hours or next available mission
Which facilities manage the administrative processing and staging, providing limited medical care of casualties entering or transiting the Aeromedical Evacuation (AE) system?
Aeromedical Staging Facilities (ASFs)
How many hours are patients typically held at Aeromedical Staging Facilities (ASFs) prior to evacuation?
2-6 hours
Patients should have at least how many hours worth of supplies and medications for intratheater transfer?
24 hours
Patients should have at least how many hours worth of supplies and medications for intertheater transfer?
48 hours
Who at the originating MTFs submits requests for movement, timing, destination, suggested support therapies, etc.?
Physicians
Which type of event is an Aeromedical Evacuation (AE) clearance?
Medical care
Which type of event is an Aeromedical Evacuation (AE) validation?
Logistical
What is a decision the referring physician and the local flight surgeon in regards to USAF Aeromedical Evacuation (AE)?
Clearance
Which type of transport is available for patients in need of intensive nursing care, constant hemodynamic monitoring, mechanical ventilation, frequent therapeutic interventions, or other medical or surgical interventions vital to sustain life, limb, and eyesight during movement of the patient through the aeromedical environment?
Critical Care Air Transport Team (CCATT)
How many or more months can the process take for arranging routine humanitarian evacuations out of theater?
6 months
What medical treatment has the goal to maintain adequate perfusion?
Resuscitation
Which clinical condition is marked by inadequate organ perfusion and tissue oxygenation, manifested by poor skin turgor, pallor, cool extremities, capillary refill greater than 2 seconds, anxiety/confusion/obtundation, tachycardia, weak or thready pulse, and hypotension?
Shock
What is the most common type of shock seen in combat casualties that is results in poor perfusion due to diminished volume from hemorrhage, diarrhea, dehydration, and burns?
Hypovolemic
Hypotension is a late finding in shock, occurring after what percentage of blood volume loss?
30%-40%
Which type of shock is defined as pump failure from intrinsic cardiac failure or obstructive cardiac dysfunction from a tension pneumothorax or cardiac tamponade?
Cardiogenic
Which type of shock is defined is defined as poor perfusion due to loss of vascular tone?
Distributive
What are the two types of distributive shock?
Neurogenic and Septic
Which type of shock is seen with spinal cord injury T6 and above due to loss of sympathetic tone and unopposed parasympathetic stimulation with resultant vasodilation?
Neurogenic
Which type of shock has fever, hypotension, tachycardia, and warm extremities from massive vasodilation related to infection?
Septic
What are the three fluid resuscitation groups of casualties?
Responders, Transient, Non-Responders
Which types of casualties have a sustained response to fluids, may have had significant blood loss but have stopped bleeding?
Responders
What have no role in the initial treatment of hemorrhagic shock?
Vasopressors
Blood product transfusions should be considered early in the resuscitation, particularly in patients who have lost what percentage or more of their blood volume?
30%
What is a critical early step in the management of trauma?
Vascular access
The first attempt for a vascular access is the peripheral. If unsuccessful what is the next intervention?
Intraosseous (IO)
Which position should the casualty be placed for subclavian vein access or internal jugular venipuncture?
Trendelenburg (15° head down)
What technique is used during subclavian vein or internal jugular vein catheter insertion?
Seldinger Technique
Where must humeral or tibial IO devices not be used?
Sternum
What should be given for all penetrating wounds as soon as possible?
Antibiotics
How many soft-tissue examination may be performed on the initial presentation of a sterile field dressing?
One-look
Within how many hours, preferably, of being wounded should wound debridement take place?
6 hours
Which type of wound incisions allow for proximal and distal extension for more thorough visualization and debridement?
Longitudinal
Which type of wound incisions should be avoided because they do not facilitate subsequent extension if needed?
Transverse
Tissue-sparing debridement is acceptable if follow-on wound surgery will occur within how many hours?
24 hours
What 4 assessments should be used in determining the extent of muscle damage?
Color, Contraction, Consistency, and Circulation
Irrigation volume between 6 and how many L is often utilized for significantly contaminated, large open wound?
12
Which type of irrigation is preferred for acute wounds?
Low-pressure
What may be helpful in extending the period of bacterial growth after initial debridement?
Antibiotic beads
What is normally made using 1g of Vancomycin/ 1.2g of Tobramycin per 40g of poly (methyl methacrylate) (PMMA) cement?
Antibiotic beads
Wounds undergo a planned second debridement and irrigation in how many hours?
24-48 hours
How many hours may the time interval between debridements be extended if Negative Pressure Wound Therapy (NPWT) devices are utilized providing all nonviable tissue has been removed?
48-72 hours
Which syndrome is characterized by ischemia and muscle damage or death (rhabdomyolysis) due to compression of extremities, buttocks, or trunks for a prolonged time?
Crush
Reperfusion injuries can cause up to how many L of third-space fluid loss per limb that can precipitate hypovolemic shock?
10
Combat extremity injuries are at an elevated risk of developing a compartment syndrome within how many hours post injury?
48-72 hours
What are all wounds incurred on the battlefield grossly contaminated with?
Bacteria
What are the 4 things that you are looking for to determine wound infection?
Pain and tenderness, redness, warmth, and swelling (The four “-or’s: dolor, rubor, calor, and tumor)
Pseudomonoas, Enterobacter, Acinetobacter, along with what else are common nosocomial pathogens usually expected among casualties who have been hospitalized for an extended period, not those fresh off the battlefield?
Serratia
Salmonella, Shigella, along with what else should be suspected in cases of bacterial dysentery?
Vibrio
Which fungal species should be suspected in casualties hospitalized for prolonged periods, those malnourished or immunosuppressed, or those who have received broad spectrum antibiotics, adrenocortical steroids, or parenteral nutrition?
Candida
Gram-positive cocci and mouth anaerobes in the orofacial and neck region are generally responsive to surgery along with what else?
Clindamycin
What is often responsible for a potentially severe diarrheal colitis (intra-abdominal) that occurs following the administration of even one dose of antibiotic?
Clostridium difficile
Which syndrome is caused by a bloodborne or severe regional infection resulting in a global inflammatory response (fever, leukocytosis, tachycardia, tachypnea, and possibly hypotension)?
Systemic sepsis
Surgical and antibiotic treatment should begin as early as possible for war wound infections, ideally within how many hours after injury?
3 hours
Optimally, surgical debridement should be achieved within how many hours of injury?
6 hours
Which role of care would self aid, buddy aid, combat lifesaver, Corpsman/Medic aid, BAS, STP, and no patient holding capacity fall under?
Role 1
Which role of care would medical company or expeditionary medical support, holding capacity for blood transfusion, radiology, laboratory, and Field Surgical Team support fall under?
Role 2
Which role of care would a US Army combat support hospital, Air Force theater hospital, or casualty receiving ships; all with full inpatient capacity with ICUs and operating rooms fall under?
Role 3
Which role of care would a regional hospital or US Naval hospital ships, typically outside of the combat zone; general and specialized inpatient medical and surgical care fall under?
Role 4
Which role of care would care facilities within the United States, typically tertiary care medical centers fall under?
Role 5
Antibiotics should be started as soon as possible after wounding, then continued for how many hours, depending on the size, extent of destruction, and degree of contamination of the wound?
24 hours
Empiric cultures should be performed for empiric treatment of SEPSIS and then antibiotic treatment should be initiated within how many hours?
4 hours
Empiric broad-spectrum antibiotic therapy is initiated against likely pathogens and continued for how many days?
7-10 days
What are battle wounds prone to due to high levels of contamination with Clostridium tetani?
Tetanus
What is manifested by localized skin erythema, heat, tenderness, and swelling or induration?
Cellulitis
What are the most dreaded infections resulting from battlefield wounding?
Necrotizing soft-tissue
About what percentage of all trauma casualties requiring evacuation do not require any blood product transfusion?
75%
What is the leading cause of preventable deaths during war?
Exsanguinating hemorrhage
What percentage of evacuated casualties will lose large volumes of blood during initial care and require “massive transfusion” (10 or more units of red blood cells (RBCs) in 24 hours)?
5%-8%
What should be immediately applied to extremities with potential for life-threatening blood loss?
Tourniquets
Which group of blood products are the predominant type fielded with forward surgical units?
O-stored RBCs and AB plasma
Fresh frozen plasma (FFP) is thawed and stored at what degree Celsius for up to 5 days as thawed plasma?
1-6 degree Celsius
Which type of RBCs are safe for emergency transfusion until the ABO type of the casualty is known?
Type O
What is the only type of plasma considered safe for emergency transfusion?
AB
Only what percentage of the population has AB blood?
4%
Massive transfusion is typically defined as needing how many or more units of blood in 24 hours?
10 Units
Blood products should be transfused with a goal ratio of what?
6 RBCs: 6 FFPs: 1 aPLT
If plasma and platelets are unavailable, what should be collected/transfused?
Type-specific fresh whole blood
What develops in trauma patients from conductive, convective, evaporative, and radiative losses due to environmental and surgical exposure?
Hypothermia
What is caused due to hypoperfusion, but can be exacerbated by crystalloids and stored RBCs?
Acidosis
What is a common complication due to extracellular potassium that increases over time in stored RBCs?
Hyperkalemia
What occurs in massive transfusions that is cause by the citrate (anticoagulant) in plasma and platelet products?
Hypocalcemia
What is Emergency Collection of Fresh Whole Blood in the field known as?
Walking Blood Bank
What should be reserved for when standard blood products are exhausted or unavailable?
Emergency Collection of Fresh Whole Blood (Walking Blood Bank)
How many minutes at best does emergency fresh whole blood collection take from the request to its bedside availability?
30-40 minutes
Approximately what percentage of all transfusions are accompanied by a temperature elevation?
1%
What is manifested by rapid onset of “noncardiogenic” pulmonary edema with dyspnea, hypoxemia, and pulmonary infiltrates within 6 hours after transfusion?
Transfusion-related acute lung injury (TRALI)
What is the estimated mortality rate for recognized Transfusion Related Acute Lung Injury (TRALI)?
5%-8%
What is the only transfusion reaction in which the blood product can be continued?
Urticaria (hives/itching)
The order to activate the walking blood bank must come from who?
medical providers
Which modified form will be used by laboratory personnel to record donor temperature, heart rate, and blood pressure to ensure adequacy for donation?
DD Form 572
How many blood collection tubes are collected for screening blood donors?
6 tubes (3 red/marble top tubes and 3 lavender top tunes)
How are the blood collection tubes labelled?
Full Name, SSN, and date/time of collection
How many hours after the date and time of blood tube collection will it expire?
24 hours
What are being tested when performing a rapid test?
ABO/Rh, HIV, HCV, HBV, Malaria, and RPR for Syphilis
How many hours may fresh whole blood be kept stored at room temperature?
8 hours
Ships shall not expose personnel to excessive what and shall provide a shipboard work environment that minimizes the probability of such exposure? (Page B2-1)
Heat stress
What is any combination of air temperature, thermal radiation, humidity, airflow, workload, and health conditions that may stress the body as it attempts to regulate body temperature? ( Page B2-1)
Heat stress
To obtain accurate and reliable data on heat stress conditions, ships shall conduct heat stress surveys to record dry-bulb (DB), wet-bulb (WB), and what other readings? (Page B2-1)
Globe Temperature (GT)
What is calculated using dry-bulb, wet-bulb, and globe Temperature? (Page B2-2)
Wet-Bulb Globe Temperature (WBGT) index
Heat acclimatization occurs gradually, usually requiring how many weeks or more? (Page B2-2)
Three
The Commanding Officer shall report to the what those material deficiencies, beyond ship’s force capability to correct, which contribute to heat stress conditions aboard the ship? (PageB2-3)
Immediate Superior In Command (ISIC)
Who shall provide training to divisions on heat stress health hazards, symptoms, prevention, and first aid procedures, upon request? (Page B2-3)
Medical Department Representative (MDR)
IF maintenance or repair is required, record all heat stress related deficiencies on what? (Page B2-4)
Consolidated Ship’s Maintenance Project (CSMP)
Who shall limit personnel heat exposures per established stay times, except as approved by the commanding officer in an operational emergency? (Page B2-5)
Division Officers
Use a WBGT meter or what to measure DB, WB, and GT, and compute the WBGT index to determine the amount of time it is safe to work in a given space?
Automated Heat Stress System (AHSS)
What shall be permanently mounted at watch and workstations throughout the ship where heat stress conditions may exist? (Page B2-6)
Hanging Dry-Bulb (DB) thermometer
Placement of the DB thermometers may be in or out of the ventilation air stream but must be hung at least how many feet from any supply ventilation terminal/ opening? (Page B2-7)
Two
If the difference between the hanging DB thermometer and the DB temperature measured with the WBGT meter, during a survey, is how many degrees Fahrenheit or greater at any watch or workstation, then the DB thermometer is not representative of the temperature at the workstation? (Page B2-7)
Five
If ventilation is present at the workstation where an Automated Heat Stress System (AHSS) unit will be installed, then the sensor should be located in relation to the ventilation duct such that airflow to the sensor does not exceed what fpm? (Page B2-7)
600
Dry-bulb thermometers must still be mounted on ships with what? (Page B2-8)
Automated Heat Stress System (AHSS)
The surveyor uses the WBGT index, along with the individual’s physical exertion level, to determine the permissible heat exposure limits referred to as the what? (Page B2-9)
Physiological Heat Exposure Limits (PHEL) stay times
The operating range for the RSS-220 and Vista Model 960 WBGT meters is 65 degrees Fahrenheit to how many degrees Fahrenheit? (Page B2-9)
150
The operating range for the Automated Heat Stress System (AHSS) is 32 degrees Fahrenheit to 150 degrees Fahrenheit and 10%to what percent relative humidity? (Page B2-9)
95%
The heat stress surveyors shall conduct the first WBGT measurement in the workspace after the meter has been in the space how many minutes to enable it to equilibrate to the surrounding area? (Page B2-10)
Five
The heat stress surveyor shall record all non automated survey readings to the nearest how many degrees Fahrenheit? (Page B2-10)
0.1
Under normal operations, routine watches in engineering spaces are expected to be how many hours at a Physiological Heat Exposure Limits (PHEL) III or lower? (Page B2-13)
Four
How many options are provided for follow-on-surveys for engineering spaces on non-nuclear, steam-powered ships and for laundries, sculleries, galleys, steam catapult spaces and arresting gear spaces? (Page B2-14)
Two
The WBGT meter, motorized psychrometer, or commercially available what may be used to measure DB and WB temperature? (PAGE B2-15)
Hygrometer
The department head may elect to have more than one stay time rotation in a workspace if permitted by what? (Page B2-15)
Physiological Heat Exposure Limits (PHEL)
What is for use in especially hot environments here reduced stay times have been imposed on watch/work standers? (Page B2-16)
Time Weighted Mean (TWM) WBGT
Supervisors shall direct personnel standing watch or working in spaces in reduced stay times (except in operational emergencies as directed by the CO) to leave the heat stress environment prior to the expiration of the Physiological Heat Exposure Limits (PHEL) stay time. These personnel shall move to a cool, dry area conductive to rapid physiological recovery (an area with a DB temperature of how many degrees Fahrenheit or less)? (Page B2-16)
80
Drink more water than satisfies thirst, but not more than how many liters per hour when working in a heat stress environment? (Page B2–17)
1.5
The use of using cooling vests that contain what-based phase change material is not recommended? (Page B2-18)
Paraffin
What shall provide a fiscal year-end summary of shipboard heat stress cases from the Web Enabled Safety System (WESS) database by type of operation, and ship class to CNO (N09F)? (Page B2-18)
NAVENIRHLTHCEN
What provides a measure of environmental conditions? (Page B2-18)
WBGT index
The Navy has developed how many Physiological Heat Exposure Limits (PHEL) curves? (Page B2-18)
Six
Personnel conducting heavy repairs or other strenuous work shall have their stay time determined by using what? (Page B2-20)
Physiological Heat Exposure Limits (PHEL) curve VI
If someone entering a workspace or area for the first time in approximately how long or more can smell the odor of stack gas and/ or fuel vapors, then a harmful concentration may be present? (Page B2-21)
Four hours
Which instruction establishes policy and procedures to ensure timely and accurate completion of deployment health assessments for Active Component (AC) and Reserve Component (RC) Service members, and to provide the process for reporting compliance to the Chief of Naval Operations (CNO)?
OPNAVINST 6100.3A, Deployment Health Assessment Process
What are regularly scheduled DoD-mandated instruments used to screen Service members prior to deployment, to identify health concerns after deployment, and to facilitate appropriate care?
Deployment Health Assessments
What are the 3 components of deployment health assessments?
(1) DD 2795, Pre-deployment Health Assessment;
(2) DD 2796, Post Deployment Health Assessment (PDHA); and
(3) DD 2900, Post Deployment Health Re-assessment (PDHRA)
Deployments, for deployment health assessment purposes is limited to periods of greater than how many days?
30 days
What term describes the return of personnel from deployment to the home or demobilization station for reintegration or out-processing?
Redeployment
The DD 2795 Pre-deployment Health Assessment shall be administered at home station or at a Navy mobilization processing site (NMPS) no earlier than how many days prior to the expected deployment date?
120 days
The DD 2796 Post Deployment Health Assessment (PDHA) shall be completed no earlier than how many days before the expected redeployment date?
30 days
When will the DD 2796 Post Deployment Health Assessment (PDHA) be completed for Reserve Components (RC) Service members?
before they are released from active duty
The DD 2900 Post Deployment Health Re-assessment (PDHRA) shall be administered and completed 90 to how many days after redeployment?
180 days
Service members who deploy for more than one 30 day period in how many months (frequent deployers) shall receive the PDHRA concurrent with their annual periodic health assessment?
12 months
What can’t be completed by service members who are overdue for a periodic health assessment?
NAVPERS 6110/3, Physical Activity Risk Factor Questionnaire
Who is responsible for developing and maintaining the deployment health assessment policy?
Deputy Chief of Naval Operations (Manpower, Personnel, Training, and Education (CNO (N1))
How often at a minimum must the Deputy Chief of Naval Operations (Manpower, Personnel, Training, and Education (CNO (N1)) provide compliance reports to the CNO?
Quarterly
Who is responsible for developing implementing guidance that ensures deploying personnel are briefed on deployment health threats and are trained and equipped with necessary countermeasures as required by DoD Instruction 6490.03?
Commander, U.S. Fleet Forces Command (COMUSFLTFORCOM)
How often at a minimum must the Commander, U.S. Fleet Forces Command (COMUSFLTFORCOM) provide compliance reports to the Office of the Chief of Naval Operations?
Quarterly (the 30th of the month following the end of the quarter)
What is responsible for providing command-level medical-related support services necessary for Service members to complete deployment health assessments?
Navy Bureau of Medicine and Surgery (BUMED)
What is responsible for maintaining the Electronic Deployment Health Assessment (EDHA) database and performing analysis as necessary on deployment health assessments information?
Navy and Marine Corps Public Health Center (NMCPHC)
What should be used to identify service members who require deployment health assessments?
Medical Readiness Reporting System (MRRS)
How often must Echelon 2 commands submit reports to Commander, U.S. Fleet Forces Command (COMUSFLTFORCOM)?
Monthly
How many days from the expected deployment date must service members complete a DD 2795?
120 days
How many days before or after redeployment must service members complete a DD 2796?
30 days
What is the Commanders tool for monitoring deployment health assessment compliance?
Medical Readiness Reporting System (MRRS)
