PREVMED Test 2 Flashcards
1
Q
What is coaming?
A
a raised frame to keep out water
2
Q
What is distillation?
A
total process the distilling plant forms, including evaporation/condensation
3
Q
What is free available chlorine?
A
Chlorine available in the forms of hypochlorus acid and hypochlorite ions
4
Q
What is a micron?
A
A unit of length, one millionth of a meter
5
Q
What is point of use?
A
a treatment device applied to a single tap used for the purpose of reducing contaminants in drinking water
6
Q
WHat is potable water?
A
water is suitable for human consumption, bathing, laundry, personal hygiene
7
Q
What is reverse osmosis?
A
The reverse of the natural osmosis achieved by external application of sufficient reverse pressure to cause the solvent to flow in its unnatural direction
8
Q
What is colilert/colisure?
A
test used to detect total coliform and e-coli in potable water
9
Q
WHat is total coliform?
A
- group of closely related, mostly harmless bacteria that live in soil and water as well as guts of animals
- total coliform = general quality of water, likelihood of fecal matter
- presence/absence is standard for water
10
Q
what is E. coli?
A
Escherichia Coli, fecal coliform bacteria
- commonly found in intestines
- strong indication of sewage/animal waste
11
Q
WHat is the instruction for potable water afloat?
A
NAVMED P-5010-6, appendix B
12
Q
What is the BUMEDINST for potable water?
A
BUMEDINST 6240.10
13
Q
What chemical is used in port and what is used at sea?
A
Chlorine in port
Bromine at sea
14
Q
What are common responsibilities of NAVSEASYSCOM?
A
responsible for shipboard potable water systems
- including treatment facilities/processes to assure safe drinking water
- **a) Design
- **b) Construction
- **c) Maintenance
15
Q
What is NAVFAC responsible for?
A
Promulgating instructions for ship-to-shore potable water connections
- providing potable from approved source at berthed facility
16
Q
What is the Chief of BUMED responsible for?
A
- establishing/promulgating health standards for water quality afloat
- promulgate instructions, notices, other pubs reflecting afloat water quality req’s
- Establish shipboard reqs for med surveillance of potable water systems
17
Q
What is the CO’s responsibilities for water?
A
Promulgating water sanitation bill to ensure:
- receipt
- transfer
- treatment
- storage
- distribution
- surveillance provided and followed
18
Q
Engineering Dept responsibilities with waters?
A
- supply potable water
- potable water system components that:
- Recieve
- store
- distribute
- produce
- treat
- HALOGEN AND pH TESTING
19
Q
What is MED Dept responsible for with potable waters?
A
- Weekly BACTI Testing
- Daily Halogen Testing
- MDR will notify CO of any discrepancies
20
Q
What is the minimum usage requirements for water/person on a ship?
A
50 Gal/person/day
- NAVSEASYSCOM specification
21
Q
What are water hours?
A
Not less than 2 gal/man/day
22
Q
WHat is seawater used for?
A
marine sanitation device systems
23
Q
How many potable water tanks are on a DDG?
A
4 potable water tanks
24
Q
What are the approved water technologies by NAVSEA?
A
Distillation
Reverse Osmosis
other NAVSEA approved water tech
25
What are ship water treatment plants capable of processing?
Potable Water from bacteriologically contaminated water
26
What must potable water go through to be potable?
disinfected to maintain required halogen residual level in potable water tanks
27
What waters should we avoid making potable water?
- harbors or from polluted seawater
- when ships are operated in close formation
- when stripping/discharging waste bilge water forward of saltwater intakes
28
Who is the Ship-to-Shore approved source for water?
Environmental Protection Agency approved public water system
29
What are the US military sources from other established forces?
- British Royal Navy
- Canadian Forces
- Royal Australian Navy
- Other OCONUS US Military reps ashore/Navy Environmental Prev Med Units (NEPMU)
- Shore-to-ship from unapproved source
- Seawater is used aboard ships for: fire mains, decon, marine sanitation devices (MSDs) flushing
30
What are the three types of distillation PLANTS?
Steam - Uses steam from power plant/aux boiler
Waste Heat - heat derived from diesel engine jacket
Vapor Compression type - uses electrical energy
31
What does Reverse Osmosis do?
- Single/triple pass
- removes suspended particles, 1 micron in size
- Through high pressure pump, produces potable water from 20-25% of total
- Single pass RO plants, additional chlorine/bromine required
- Triple pass RO for SUBS, no extra disinfection required, better than distilled
32
What are some specific things to never do with potable water tanks? Exterior coating standard?
- NEVER FILL WITH BALAST WATER!
| - Coating is NSF/ANSI standard
33
Explain specifics about VENTS and Overflow lines?
- located to reduce accidental contamination
- screened openings w/18guage or finer; non-corrosive mesh
Unauthorized termination points:
- food service space
- medical
- toilets
- electrical/electronics room
- exterior of ship
34
Explain Water Level measurements?
```
Automatic Level guage
- DIRECT READ GUAGE
Petcocks
- VALVES AT VARIOUS INTERVALS
Sounding Tubes
- 100ppm FAC for 2 min
Must be labeled "POTABLE WATER USE ONLY"
```
35
What are requirements for water filling connections?
- Clearly labeled
- Color coded DARK BLUE
- 18 inches from deck
- turned face downward
- screw caps with keeper chains
36
How must potable water lines/piping be connected?
NEVER BE CROSS CONNECTED TO ANY NON-POTABLE SYSTEM
37
Why is an air gap important?
Allows potable water to be distributed to non-potable water tanks and appropriate backflow device
38
For Sanitary requirements: What are Potable Water Hose Lockers?
- Vermin Proof
- Locked
- 18 inches off the deck
- Printed, step-by-step instructions for disinfection
39
For Sanitary Requirements: What is important about the Potable water hose?
- examined routinely
- Removed from use when cracks develop in lining or leaks occur
- shall not be used for any other purpose
40
How are potable water hoses supposed to be?
- Clearly Labeled "POTABLE WATER ONLY"
- Labeled every 10 ft
- Coupling is color coded DARK BLUE
41
How should the Potable Water Hose Locker be labeled?
Potable Water Hose
42
For potable water transfer: What should be tested prior to initial transfer of water?
Halogen
- residual should be a minimum standard 0.2 ppm, boost if not at standards
- if within standards (0.2) nothing else is required
43
Who needs to make shore to ship potable water connections?
- Supervised by authorized shore station/ship personnel
44
WHo notifies MDR prior to making potable water hose connection?
Engineering
45
WHo makes recommendations to ENG about halogen residual?
MDR
46
Can potable water hoses be submerged?
NO, never, keep dry
47
Who must be advised to relative necessary procedures, safeguards, and disinfection of potable water from DOUBTFUL sources?
CO
| - minimum halogen residual for DOUBTFUL WATER is 2.0
48
Who approves of FDA approved use for surface disinfection such as iodine for food contact surfaces on a ship?
MDR
49
WHat is Halogen residual?
Chlorine/Bromine
- quick indication if water has been improperly treated
- absence may = contamination
50
What is Bacteriological testing of water?
- ensure fitness for human consumption
| - assess adequacy of disinfection process
51
WHat happens when potable water with sufficient halogen residual is warmed?
Chlorine evaporates
52
For Halogen residual: what must the ship maintain at?
0.2ppm FAC or TABR after Tx
53
When is Halogen residual testing done?
- Daily
- In conjunction with Bacterial testing
- prior to receipt of potable water
54
When is ENG Dept required to check Halogen level of potable water tanks?
30min after contact with receiving entity
55
For Microbiology quality: What are the sample ratios with number of personnel on the vessel?
```
400 or less
- no less than 4 samples
400-800
- 8 samples
800+
- 12 samples
```
56
For Microbiology Quality: How many of the ships ice machines and potable water tanks are tested?
1/4 of Ice machines
| 1/4 of potable water tanks
57
When is the Emergency Potable Water Tank tested?
Monthly
58
For Repeat monitoring: Regarding positive samples, how many repeat samples are required and from where?
- Original Service Connection source
- one upstream
- One Downstream
- Collect samples within 24hrs of pos sample
59
Potable water testing procedures: What do you use to determine Chlorine/Bromine?
- DPD #1 = Test for FAC(free available chlorine)/TBR(total bromine residual)
- DPD #4 = test for chloramines (total chlorine) residual
60
Potable water testing procedures: Color Comparator test kit accuracy?
+/- 10%
| - human error will be the major flaw
61
Potable Water Testing Procedures: Portable Spectrophotometer accuracy?
+/- 2%
- more accurate because no human error
- machine does all the work
62
What are source contamination?
- Cross connections with non-potable water
- leaks in bulkheads between potable water/fuel/ballast/wastewater tanks, bilges
- leaks in non-potable piping through water tanks
- excessive storage time of water in tanks
- improper disposal of chems/liquids through potable water-sounding tubes
- potable hoses for non-potable water
63
For water disinfecting procedures what are approved methods for disinfecting shipboard potable water?
Chlorine and Bromine
64
What are automatic chlorine disinfectants?
In-line chlorinators
| - injects hypochlorite into system proportionately to flow of water
65
How is Bromine dispensed in potable water?
via resin impregnated cartridge
66
What are the two types of brominators?
In-line Brominator
- preset to 0.7ppm bromine to water normally
- can deliver 2.0ppm when necessary
Recirculation Brominator
- draws water, injects into small batch, water recirculated
- delivers 0.7ppm bromine to water
67
What is the BATCH METHOD?
Manual Chlorine disinfection
- may result in over-chlorination
- uses CALCIUM HYPOCHLORITE (HTH)
68
What is the chlorine dosage calculator?
select desired ppm
select strength/type of chlorine used
- 5% Sodium Hypochlorite (liquid measure)
- 10% Sodium Hypochlorite (liquid measure)
- 65-70% Calcium Hypochlorite (dry measure)
69
What is the Chlorine dosage rule of thumb?
One ounce HTH/5,000 gal water = 1.0 ppm
70
What are the required Halogen residuals used for disinfection of potable water?
- Approved source = 0.2 ppm FAC/TBR after 30 min contact time
- Unapproved source = 2.0 ppm FAC/TBR after 30 min contact time
* if brominator cannot get TBR of 2.0 use BATCH METHOD
71
Disinfection Steps: Method 1?
- Add chlorine to achieve 10ppm FAC through tank
- Perform Bacteriological testing
* negative = use water
72
Disinfection steps: Method 2?
- Spray/apply directly 200ppm FAC to all tank surfaces
- flush inlet/outlet pipes with 10ppm
- perform bacteriological testing
* negative = use water
73
Disinfection steps: Method 3?
- fill 5% of tank Vol w/50ppm FAC Solution
- hold for 6 hours
- perform bacteriological testing
* negative = use water
74
How can you control taste/odor problems with potable water?
```
Chlorination method
- Chlorinate to 5.0 ppm FAC
- Distribute at 2.0 ppm FAC
Steam method
- Requires NAVSEA approval
```
75
How do we request outside assistance for potable water issues?
Contact NEPMU via TYCOM Med Officer
76
Storage requirements for potable water water agents?
- 6 ounce bottles
- stow in a locked box mounted on a bulkhead
- Preferred in ENG office space
- Metal Box like first aid locker
* Three 1/4inch holes drilled in bottom to release gas
77
What are the requirements for storing Calcium Hypochlorite?
- No More than 48, 6oz bottles in individual locker/bin
- all lockers/bins/enclosures containing HTH labeled "HAZARDOUS MATERIAL, CALCIUM HYPOCHLORITE"
* RED LETTERS
* WHITE BACKGROUND
78
What is the shelf life of Bromine cartridges in storage?
2 years from date of manufacture
79
What is the water sanitation bill?
posted conspicuously in areas where potable water/associated materials are:
- processed
- treated
- stored
80
Who is ultimately responsible for Water Sanitation bill?
CO
81
How long is the Potable water log kept for?
2-year chronological record
82
WHat must the potable water log include?
- time/date for each sample
- location of ship
- sample site
- source
- halogen residual
- bacteriological test result
* presence/absence
* include +/- controls
* purpose of test
83
What are the medical departments responsibilities with marine sanitation devices?
Conduct visual inspections as part of routine habitability and sanitation inspection
84
What is Medical’s responsibilities regarding prevention of waste water hazards during Indoc?
- potential health hazards associated with human waste
- proper personal hygiene necessary to reduce the risk associated with working with MSD systems
- correct procedures for cleaning and disinfecting contaminated spaces
85
How often are personnel trained on prevention of waste water hazards?
Periodically
86
What cleanups or medical department representative is required to be at regarding waste water hazards?
Food service Spaces
living Spaces
medical Spaces
87
For collection hold and transfer system what are the three modes that it operates in?
Restricted waters
at sea
in Port
88
What is the most common collection hold and transfer system?
Tape II-B marine sanitation device
89
What are the functional elements of the CHT system?
- Soil drains or sewage “from toilets and urinals“
- Gray water drains “ from showers, laundry, and galleys“
- diverter valves which direct the waste water over the side or to the holding tanks
90
How many hours are holding tanks constraints to?
12 hour holding period
91
For transfer elements regarding CHT, what are they?
```
Sewage pumps,
overboard/deck connection discharge,
diverter valves/check valves,
- each tank has two sewage pumps connected to discharge sewage/gray water to receiving facility,
ship waste offloading barge,
directly overboard
```
92
What are the two different modes regarding CHT?
Manual mode - pumps actuated independent, deactivate when liquid reaches 10% of tank volume
Automatic mode - stops pump automatically at 10% capacity, activate signal at 30%, signal standby to activate at 60%, visual/audible high-level alarm activated at 80%
93
For health and safety inspections with CHT systems what is the greatest danger to ships and personnel?
Hydrogen sulfide (H2S)
94
What are health and safety inspection requirements for CHT systems?
- always assume holding tanks contain toxic gases unless engineer says otherwise
- never enter CHT pump room with odor and less supplied airline respirator with full face mask
- Post safety watch, SCBA outside access
- H2S is heavier than air
95
What are things pump rooms should have for CHT?
Two emergency escape breathing devices, EEBD, that are good for 10 minutes of air
96
Who needs to be reported to for all leaks spills or other sources of contamination observed during inspections or any time?
Engineering officer
executive officer
SMDR
97
What are the toxic or explosive gases associated with CHT?
Hydrogen sulfide
methane
ammonia
carbon dioxide
98
What are the basic immunizations that personnel to deal with CHT/waste water need to keep current?
Polio
tetanus
diphtheria
99
What are the required personal protective equipment for CHT workers?
```
Coveralls
rubber boots
rubber gloves
face shields
SCBA, when necessary
```
100
What is the reference for sewage spill cleanup procedures?
NAVships technical manual, chapter 593 “pollution control“
101
What are the approved EPA disinfectants for Medical, food-service, and birthing Spaces?
Germicides:
- phenolic type
- iodine type
102
What is the process for contaminated bilges with sewage?
Must be pumped out
washed down with fire hose
pumped out again
103
What is the process if the potable water tanks formed the floor of the bilge and the ship has a sewage spill in it?
- Daily bacterial logical monitoring of affected potable water tanks until assured potable water not contaminated
104
What are the color coding requirements for CHT systems interior of the ship?
All are gold including:
- valve handles
- operating levers
- exterior deck discharge same color as external structure
105
What are the waste water disposal procedures within US waters and territorial seas?
prohibited within 3 nautical miles of sure
106
CHT systems are designed to operate in three modes, what are they?
At sea - sewage/gray waters, diverted or discharged overboard
in Port - sewage and gray water discharged into sanitary sewer through sewer risers/shipped waste off load barges
in restricted - waters sewage collected/stored in hold tanks, gray water discharged overboard via diverter valves
107
What is the NAV med instruction for a potable water in the field?
NAVmed P-5010-10, chapter 18, section 18-2
108
What are the CO responsibilities for potable water in the field?
- ensure safe water for drinking, cooking and bathing
- water discipline
- dangers of consuming untreated water
- disinfection of personal drinking water
109
What is the ENG O responsibilities for potable water in the field?
- provides sufficient potable water quantities for population
110
WHat is Medical Dept responsibilities for potable water in the field?
- advise CO on water quality issues
- assist engineers with:
* selection of sources
* surveying potable water system
- bacteriological exam
- Halogen levels
- inform ENG of water quality/treatment required
- Chemical analysis of field water supplues
110
WHat is Medical Dept responsibilities for potable water in the field?
- advise CO on water quality issues
| - assist engineers with:
111
What are influences on field water choices?
- Quality
- Quantity
- Accessibility
112
What are potential water sources in the field?
- public water: easy/safe, already treated
- unsafe until approved
- evaluate/treat
113
What are locations to get surface water and things to consider?
- quality may be problem
| - rivers, streams, lakes, ponds, seas, and oceans
114
What are some ground water locations and possible issues?
- wells/springs
- usually less contaminated
- located 30 yards upgradient
115
What is the typical field water treatment process?
- straining
- chemical addition
- coagulation
- sedimentation
- Various kinds of filtration
116
What is the Military Reverse Osmosis Water Purification Unit (ROWPU)?
- most common
- can be used to produce water in:
* fresh water
* brackish water
* sea water
- removes:
* microorganisms, parasites, bacteria, and viruses
117
What is non-reverse osmosis?
Only used in treating fresh water
| - 3000 gal/hr
118
Specifics of the Lightweight water purifier (LWP)?
- small military detachments
| - 125gal/hr
119
Specifics of the Tactical water purification system?
- International Organization for Standardization, palletized load system trucks
- produces 1500gal/hr
- replacing RO unit
120
For disinfection of water what is the most common method?
Chlorination
121
How long after contact time should sufficient chlorine be achieved?
30 min
122
What are the different types of disinfectants for field water?
- Calcium Hypochlorite (HTH), 65-70%
- Sodium Hypochlorite 5% or 10%
- Chlorine dioxide
- chlorine gas
- bromine
- chloramines ozone
- UV radiation
123
What are the required chlorine residuals?
2ppm FAC after 30 min contact time
124
What are the chlorine residuals for secondary STORAGE/unit level STORAGE?
1ppm FAC
- if between 02-1ppm - re-chlorinate
- less than 0.2ppm FAC - re-chlorinate to 2ppm, at least 1ppm after 30 min
125
What uses are natural surface/well water and what ppm's for drinking water?
- EMERGENCY ONLY
| - 5ppm after 30min
126
How many iodine tablets are used in a canteen?
2
127
How many iodine tablets for a 5 gal jug?
40
128
How many iodine tablets are for 70-72 ounce personal hydration system? 100-102 ounce reservoir?
4 for 70-72
| 6 for 100-102
129
specifics of the 3000 gal tank?
- onion tank
- highly mobile
- inflatable/collapsible fabric water tank
130
Specifics of the Load Handling system water tank rack?
- Hippo
| - 2000 gal
131
Specifics of the semitrailer-mounted fabric tank?
3000-5000 gal
132
Tactical water distribution system?
10 miles on level terrain
133
What are the three modes of water distribution/waste management system?
- water distribution set
- hospital
- deployable medical system
134
What is the name of the 400-gal trailer?
Water Bull
135
What is the nick-name of the 800 gal unit?
Camel
136
What is DISINFECTION METHOD 1 of potable water containers?
- chlorinate water to 100ppm FAC
- run through valves/spigots
- keep interior surfaces wet for 60min
- drain at approved location
- rinse container/spigots 2x
137
What is DISINFECTION METHOD 2?
- WATER/CHEMICAL in SHORT SUPPLY
- prep 5 gal water w/100ppm chlorine solution
- long handled brush/rod w/cloth, swab for 10 MIN
- keep walls wet 60min
- rinse through valves/spigots
- rinse/drain 2x through valves/spigots
138
Alternative procedure for disinfection of potable water container?
- chlorine water to 10ppm
- hold 24 hrs
- drain
- rinse spigots 2x
139
What is accommodations?
number of personnel permanently supported by:
- habitability spaces
- systems
- fixtures
- equipment
140
what is surge?
personnel embarked aboard ship for short durations of:
- special operations
- exercises
- mobilizations
141
what are transients?
personnel embarked who do not contribute to host ship capability
142
Who are ships company?
- all personnel assigned to a ship
143
what is hot bunking?
- more than one person to a single berth
144
what are habitability factors?
- floor area
- ventilation
- heating
- sanitary fixtures
- water supply
- lighting
- color
145
Where are the intakes for ventilation/air conditioning located?
- topside exhaust
- stacks
- water spray
146
What max temp should berthing be?
80 degrees dry bulb
147
For heating in berthing and messing what should the minimum temp be?
65 degrees dry bulb
148
WHat is ventilation designed to do?
```
minimize humidity/odors
Specific spaces:
- galley
- scullery
- laundry
- shower
- water closet
```
149
Privacy standards in berthing?
- full privacy partitions
- individually controlled vent terminals
- passageways shall not intersect
150
What kind of pillows are prohibited?
polyurethane
151
what are requirements for mattresses?
- low smoke foam
| - hot bunking is prohibited
152
What are requirements for barbershops?
- Crew <100 - portable barber facility
- Crew 100-300 - barbershop with chair
- Crew 300+ - barbershop, +1 chair for each 300+ people
153
Ship's store requirements?
- required on all ships for hygiene/necessity
- snack bar for 500+ personnel
- vending machines in designated areas, secured to deck
154
Laundry facility requirements for <100 people?
- one 16lb washer/dryer
| - three irons/boards
155
Laundry facilities with 100+ personnel?
- facility for 24lbs/week/person
| - ironing board in every berthing
156
Who makes routine sanitary inspections of toilets, lavatories, and berthing?
- XO
- MDR
- OOD
- JOOD
- Chief MA
- Div O
- Div CPO
157
How do we deal with sewage backflows?
- secured immediately
- corrected
- space is cleaned/sanitized
158
What reason would we submit an inspection report to the CO?
- Identify discrepancies
- recommend corrective actions
- onsite training during inspection
159
Barbershop terminology?
- Disinfectant - agent that destroys/removes pathogenic organism
- EPA - Environmental Protection Agency
- FDA - Food and Drug Admin
160
WHat are the barbershop health requirements?
- medically screened/determined free of disease prior to assignment
- screen deep enough to detect locality of diseases
- NO ANNUAL EVAL
161
Can barbers serve patrons with inflamed/infections conditions?
No, unless they have note from medical officer
162
Barbershop requirements?
- NOT IN GALLEY/FOOD SERVICE area
- must have:
* lavatory fixture
* waste disposal
- lighting/ventilation
- FDA/EPA agents for cleaning/disinfecting
- NO derm practices allowed
- NO SHAVES
- Change cover daily
- clean shop
163
WHat types of clippers are authorized? Compressed air limits?
- vacuum equipped clippers
| - Air less than 15 PSI
164
How often must disinfecting solution be changed in a barbershop?
weekly
165
What requirements are there for removable clipper heads?
- remove
- wipe or dust
- wash/rinse
- disinfected using EPA solution
- rinse with water
166
How often are barbershops inspected and by whom?
- quarterly
| - Conducted by MDR
167
What things are required to be done for a Barber Shop inspection?
- ensure sanitary regs posted
- visual check for current physical cards
- general cleanliness
- no hair on floor
- trash low or clean
- countertops clean
- check solutions for hair clipping buildup
- personnel have clean smocks/well groomed
168
At what distance at sea can a ship use seawater for laundry?
Outside the 50 fathom curve (25 miles from shore)
169
What are the control measures for AIR DRY CHEMICAL CONCENTRATIONS when they exceed exposure levels?
- engineering
- administrative
- personal protective equipment
170
What noise hazardous levels require hearing protection?
84 decibels
171
The eyewash stations in the laundry spaces need to be capable of providing ____ per minute for ____ minutes?
0.4 gal/min for 15 min
172
What temperature is hygienically safe laundry?
120-140 degrees
173
What is an required by OSHA for emergencies?
First Aid Kits
174
When chlorine bleach is not included in formulation for laundry what us a necessary step?
Hot air dryers
175
What must laundered articles be free of?
- chemicals
| - biological agents
176
What is the instruction for laundry?
NAVMED P-5010-2
177
What are the requirements for handling soiled/contaminated linens?
- impervious laundry bag
- washable carts, remove/replace liner
- sorted in sorting room
- personnel must wear: clean uniforms, masks, gloves
178
How are laundry personnel to handle contaminated laundry?
```
double sealed bag
outer bag must be:
- red
- biohazard label/symbol
hot water soluble inner bag
CONTAMINATED LINENS NOT SORTED
```
179
What is the ships sanitation certificate program?
BUMEDINST 6210.4
180
Quarantine regulations of the Navy?
OPNAVINST 6210.2
181
What are quarantine regulations intended to do?
Prevent introduction/dissemination domestically/internationally of diseases affecting:
- humans/plants/animals
- prohibited/illegal wildlife
- arthropod vectors
- pests of health/agriculture importance
182
What are the quarantinable diseases?
- cholera
- diptheria
- infectious TB
- plague
- smallpox
- yellow fever
- viral hemorrhagic fever
- SARS
- influenza with potential to cause pandemic
183
Facts about Cholera?
bacterium Vibrio Cholerae
- 1/20 sever cases, profuse diarrhea, vomiting, leg cramps
- inadequate Tx of sewage/drinking water
- brackish/coastal drinking water
184
Methods of control for Cholera?
- oral vaccine
- case report required by:
* WHO/Medical Event Report
- Concurrent disinfection of feces/vomitus of linens/clothes of Pt's
185
Facts about plague?
Bacterium, Yersinia pestis
| - rodent flea on rats
186
Clinical forms of plague?
```
Bubonic
- Lymphadenitis in lymph nodes
- site of flea bite
Pneumonic
- lungs with sputum loaded agent
- respiratory droplets
- leads to outbreaks/epidemics
```
187
Methods of control of plague?
- reduce contact with: flea areas, patients with disease
- education
- rat-proofing
- storage/disposal of food/garbage
- patient isolation
- clothing repellant
- case reports to WHO, MER
188
Yellow fever facts?
- rare cause of illness in travelers
| - Transmitted by AEDES Egypti
189
How long does the immunity last for Yellow fever vaccination?
10 years, live virus vaccine
190
What are isolation procedures for Yellow fever?
- blood/body fluid
- clothing/bednet/repellant
* **CASE REPORT TO WHO/MER***
191
What is Smallpox?
Variola Virus
- last natural occurrence OCT 1977, SOMALIA
- all stock held at CDC (Atlanta)/Centre of Virology/Biotechnology (Koltsovo, RUS)
- spreads by droplet
192
Methods of control for Smallpox?
- immunization
| - if suspected, contact local state/health authorities is OBLOGATORY
193
OPNAVINST 6210.2?
Quarantine Regs of Navy
- Navy's responsibilities
- liaisons
- foreign quarantine
- Public Health Service Req's
194
NAVMED P-5010-8
Navy Entomology and Pest Control Tech
195
BUMEDINST 6210.4?
Shipboard Sanitation Cert Program
| - identify PREMED techs IAW OPNAVINST 6210.2
196
What are the three NAVMED 6210/ instructions?
NAVMED 6210/1 - Navy Ship sanitation control Exemption/Control Certificate
NAVMED 6210/2 - Notification of 30 day extension
NAVMED 6210/3 - Declaration of Health Cert
197
In Foreign Ports, what are the limitations of foreign officials?
Cannot conduct inspections of Military vessels
198
What are US port quarantine requirements?
15 days prior to port:
- report crew w/Temp = 100+F
- rash
- glandular swelling
- jaundice
- SX +48 hours
- DIARRHEA +24 HOURS W/3+ LOOSE STOOLS
199
What are the CO timeline of responsibilities prior to port regarding quarantinable illnesses?
12-72 hours prior to port
- copy to Military Quarantine inspector
- PREVMED in port
200
What are the elements of the TB Control program?
- TB Screening
- Prev Therapy
- TB Case ID
- TB Patient management
- Contact investigation
201
What is the name of the TB skin test?
Mantoux Method
202
What is Tuberculin, PPD?
- Purified Protein derivative
- Tubersol - preferred
- Aplisol - alternate
203
What size needle is the TB skin test injected by?
Disposable 1ml tuberculin syringe
| - fitted w/ 1/4-1/2 inch, 27 gauge short bevel needle
204
What is the QuantiFERON-TB GOld (QFT) for?
used in place of, not in addition to, TST Test
205
What is mycobacterium TB?
- bacteria that cause latent TB/active TB disease
206
What is active TB?
- TB Bactria are multiplying/attacking body, usually lungs
207
What is Latent TB?
- Bacteria alive, inactive in the body
- don't feel sick, cant spread TB
- usually positive skin test
208
TB Skin test?
- tests if you are infected with T Bacteria
209
TB Blood test?
- new test
| - blood sample for TB
210
What is the BCG test?
- named after french scientists, Calmette/Guerin
| - rarely used in US
211
What is directly observed therapy for TB?
- take TB Meds with help from medical
| - meet w/healthcare worker daily/weekly
212
What is LTBI Tx?
- Isoniazid (INH)/Rifapentine (RPT) orally 15mg/week
213
When a patient has past Hx of active TB/skin tests/Hx of INH they must provide:?
- clinical eval
- hospitalization
- diagnosis
- treatments
214
What form do we document LTBI screenings?
NAVMED 6224/8
215
What is Bacillus Calmette Guerin?
vaccine for TB given to INFANTS/Small CHildren where TB IS COMMON
216
What are the Initial Isonazid (INH) prev therapy evaluations?
- High Risk
- Medium Risk
- Low Risk
217
INH eval therapy for HIGH RISK?
- Induration 5mm+
- recent close contact
- fibrotic/other changes on radiograph
- suspect of having TB
218
INH eval therapy for MEDIUM RISK?
- induration of 10mm+
- recent immigrant (-5 years) from T region
- Healthcare worker/at risk
- clinical conditions that place person at risk
219
INH Eval therapy for LOW RISK?
- induration of 15mm+
| - person with no risk factors
220
Eval for TB must be done by and include?
MO, NP, PA, IDC
- appropriate clinical Hx
- physical exam
- chest x-ray
- sputum exam
- liver function test
221
What form are patients with INH Preventative therapy documented on?
NAVMED 6224/9
222
What is directly observed INH treatment regarding NON-COMPLIANCE?
- INH given 2X/Week
| - difficulty with Tx adherence
223
What is one of the problems with INH therapy regarding the liver?
- Serum Glutamic Oxaloacetic Transaminase (SGOT)
- Serum Glutamic-Pyruvic Transaminase (SGPT) blood levels
* * INH Therapy increases liver enzymes **
224
What is the procedure when suspected/confirmed contact with TB?
- MDR notify cognizant NEMPU
NEPMU Conducts investigation
- investigation done by CDC guidelines
225
WHo is responsible for contact investigation of TB?
CO/OIC
226
Who will TB investigation report be provided to?
cognizant FLEET/TYCOM surgeon
- Navy Marine Corps Public Health Center (NMCPHC)
- SUBMITTED WITHIN 24HRS
227
WHat are the Characteristics of patients with Active TB?
Often Asymptomatic
- cough, weight loss, fatigue, fever, loss of appetite, chills, night sweats
- lungs:
* pulmonary TB = bad cough, chest pain, dyspnes, coughing up blood
228
Treatment for patients with active TB?
```
Chemotherapy
- INH 300mg/day for 6-9 mo
- Children = 10-20mg/kg
Anti-TB drugs
- Bactericidal
- bacteriostatic
```
229
Adverse effects of secondary Tx for TB?
- INH Associated Hepatitis
230
what is medical surveillance and medical event reporting form?
NMCPHC-TM-PM 6220.12
231
What does NMCPHD-TM-PM 6220.12 do?
Enables Navy public health experts to be aware of:
- important med events
- prevention/control actions already taken
- impact/potential to affect large # of people
232
What are the uses of Medical Event Reports?
- any diagnosis/case/event that is classified by DON
- findings reported to Navy Environmental and Preventative Medicine Unit (NEPMU)
* primary consultant resource
233
How can the MER be submitted?
Disease Reporting System internet
- official system for RME's
- when internet unavailable use format on:
Appendix D of NMCPHC-TM-PM 6220.12
234
Where are URGENT reports for MER made?
- phone
- priority Naval Message
- encrypted email
235
What are the timelines for MER submissions?
- Urgent - 24hrs
| - Routine - no later than 7 days after ID
236
what kind of diseases are required to be reported within 24 hours?
- Anthrax
- botulism
- diptheria
- hemorrhagic
- influenza a, novel
- malaria
- measles
- meningococcal
- outbreak or disease cluster
- plague
- poliomyelitis
- rabies, human
- severe acute respiratory syndrom
- smallpox
- TB, Pulmonary
- tularemia
237
what are the incidences REQUIRING submission of MER?
- Any diagnosis listed on RME list
| - outbreaks
238
WHat marking should be marked outside of MER's?
For Official Use Only
239
What makes a COMMUNICABLE DISEASE diagnosis, case, or medical event REPORTABLE?
- suspected
- probable
- confirmed
- ALL DIAGNOSIS'S NEED TO BE CONFIRMED IN MER
240
Describe the Adenovirus Type 4/7 vaccination.
admin: Basic Training
dose: 2 tabs (white/peach)
route: oral
241
Anthrax Vaccine
dose: 5 - 0.5ml shots over 18mo
route: IM
booster: annually as needed/required
242
Haemophilus Influenzae Type B
admin: immunocompromised, sickle cell, no spleen function
dose: 1 - 0.5ml
route: IM
243
Hepatitis A
admin: unless seroimmune, give at boot camp
dose 6-18yo: one 720EL.U/(0.5mL)
dose 19yo+: one 1440EL.U/(1.0mL)
interval: 0, 6mo
244
Hepatitis B
Energix-B
dose: 0-19 y/o, 0.5ml, 3 doses
Recombivax HB
dose: 0-19y/o, 0.5mL, 3 doses
route for both: IM
245
Hep A/B (Twinrix)
dose: 3 doses, 1.0mL
246
Influenza
admin: Annually
dose: 1 0.5ml
route: IM
CONTRAINDICATIONS: serious systemic/anaphylactic reaction
247
Measles, Mumps and Rubella
live virus, pregnant women 28 weeks advisory
dose: 0.5ml
route: SQ
248
Meningococcal
All AD Military
Dose: 1 0.5ml
Route: IM
booster: persistent risk, 5 years
249
Pneumococcal
Admin: High risk for ACIP
dose: 0.5mL
route: IM
250
Poliomyelitis
All AD military booster at basic
dose: 0.5ml
Route: SQ, IM
251
Rabies
Considerations: Animal bite, type of bite, non-bite, saliva exposure
dose: 4 1.0mL HDCV, within 14 days, + 1 dose HRIG (20IU/kg
* **immunocompromised 5th dose at 28 days
251
Rabies
Considerations: Animal bite, type of bite, non-bite, saliva exposure
dose: 4 1.0mL HDCV, within 14 days, + 1 dose HRIG (20IU/kg
* **immunocompromised 5th dose at 28 days
252
Smallpox
dose: 15 jabs of bifurcated needle
***Assess 6-8 days "Major reaction"
route: Percutaneous (scarification)
booster q/10years
253
TDAP
dose: 0.5mL
route: IM
booster every 10 years
254
Typhoid
before overseas dep/assignment to typhoid endemic area
dose: 0.5mL
route: IM
booster 2 years
255
Varicella
given at basic training
dose: 2 of 0.5mL
route: SQ
256
Yellow Fever
Dose: 0.5mL
route: SQ
booster 10 years
257
Yellow fever storage
36-46F
| - discarded after 1 hour of reconstitution
258
MMR storage
- 58Deg +/- 5 degrees
- STORE IN DARK PLACE
- discard 8 hours after reconstitution
259
Varicella storage
Ref: 35-46F
Freezer: -58F +/-5
Discard after 30 minutes of reconstitution
260
WHat is a requirement prior to immunizing patients?
ALLERGIES
| Pregnancy
261
What is the equipment necessary for anaphylactic shock Tx?
- ACLS qualified IDC, Dentist, PA, Nurse
Crash cart contents:
- O2
- Admin apparatus
- airways
- IV fluid
- meds for ACLS
- AED/Defibrillator/cardiac monitor
262
Advisory committee on Immunization Practices (ACIP) for Navy IMMS program?
develops recommendations on administration that include:
- age of vaccine admin
- number of doses/interval
- precautions/contraindications
ACIP is only entity in fed gov that makes these recommendations
263
WHat immunizations can be given while underway?
Everything but YELLOW FEVER
264
What are the forms for documenting immunizations?
- NAVMED 6230-4 - adult health record imms rec
- CDC 731 - Intl. Cert of Vaccination
- DD Form 2766
