081-831-1047 (SL4) - Supervise the Implementation of Preventive Medicine Policies

1.   Ensure proper preventive medicine measures (PMM)
are followed for protection against
cold injuries.

a.
Wear layers of loose
clothing.

Note.  Minimize
sweating. 
When clothing becomes wet or
dirty, it loses its ability to provide
warmth.

(1) 
Remove layers of
clothing before doing strenuous
work.

WARNING:Do
not remove protective clothing in a
chemical environment

(2) 
Replace layers of
clothing when your strenuous work
is completed.

(3) 
Launder clothing
regularly.

b.
Exercise to increase
blood circulation.

(1) 
Tighten and relax arm
and leg muscles, fingers, and
toes.

(2) 
Use hands to massage
and warm the face.

WARNING:
Physical and mental weariness
contribute to inactivity, reduced
heat, and increased chance for cold
injury

(3) 
Refrain from smoking.
Smoking decreases blood flow to the
skin.

c.
Change socks.

(1) 
Put on dry socks during
rest breaks to reduce the risk of
frostbite and trench foot.

WARNING:
Severe frostbite and trench foot can
result in the loss of hands or feet

(2) 
Put damp socks inside
your shirt around your waist to
dry.

d.
Prevent dehydration.

(1) 
Drink sufficient fluids
(potable water, juices, and warm
nonalcoholic beverages).

Note.  Drinking a
sufficient amount of potable water in
cold weather is as important as it is
in hot weather. 
In cold weather, you may not
realize that your body is losing
fluids and salt. 
Sweat evaporates rapidly or is
absorbed so completely by the layers
of clothing that it is seldom visible
on the skin.

(2) 
Rest when possible.

e.
Pair with a buddy.

(1) 
Remind each other to do
warming exercises often.

(2) 
Watch for signs of cold
injury such as frostbite, trench
foot, and hypothermia.

2.   Ensure proper PMMs are followed for protection
against heat injuries.

a.
Drink sufficient amounts
of water.

Note.  Your body
needs a minimum amount of water for
cooling, waste elimination, and
metabolism. Any attempt to train the
body to use less water can be harmful
and may lead to heat injuries.

(1) 
Use the fluid
replacement policy for warm
weather table as a guide (see
tables 081-831-1047-1
and 081-831-1047-2).

Table
081-831-1047-1. 
*Fluid Replacement Policy for
Warm Weather
(Average Acclimated Soldier Wearing
BDU, Hot Weather)

Easy
Work

Moderate
Work

Hard
Work

Heat
Category

WBGT
Index, �F

Work/
Rest

Water
Intake, Qt/Hr

Work/
Rest

Water
Intake, Qt/Hr

Work/
Rest

Water
Intake, Qt/Hr

1*

78
– 81.9

NL

½

NL

¾

40/20
min

¾

2 (green)

82
– 84.9

NL

½

50/10
min

¾

30/30
min

1

3
(yellow)

85
– 87.9

NL

¾

40/20
min

¾

30/30

1

4
(red)

88
– 89.9

NL

¾

30/30
min

¾

20/40
min

1

5** (black)

>90

50/10
min

1

20/40
min

1

10/50

1

CAUTION: Hourly Fluid Intake Should Not Exceed 1½ Quarts. 
Daily Fluid Intake Should Not
Exceed 12 Quarts.

*The
work/rest times and fluid replacement
volumes will sustain performance and
hydration for at least 4 hours of work
in the specified heat category. 
Individual water needs will
vary ± ¼ quart per hour.

*NL
= no limit to work time per hour. 
Rest means minimal physical
activity (sitting or standing) and
should be accomplished in shade if
possible.

*Wearing
body armor adds 5° F to WBGT
Index.

Wearing
ALL MOPP overgarments adds 10° F
to WBGT Index.

**Suspend
physical training and strenuous
activity. 
If an operational (nontraining)
mission requires strenuous activity,
enforce water intake to minimize
expected heat injuries.

Table
081-831-1047-2.
Examples of Categories of Work

Easy Work

Moderate Work

Hard Work

• Weapon maintenance.
• Walking on hard surface at 2.5
  mph, �  30-pound load.
• Manual of arms.
  

Marksmanship training.

Drill and ceremony.

• Walking on loose sand at 2.5
  mph, no load.
• Walking on hard surface at 3.5
  mph, ³ 40-pound load.
• Calisthenics.
• Patrolling.
• Individual movement techniques,
  i.e. low crawl, high crawl.
• Defensive position
  construction.
• Field assaults.

• Walking on loose sand at 2.5
  mph with load.
• Walking on hard surface at 3.5
  mph,

(2) 
Drink extra water
before combat operations.

(3) 
Maintain excess water
in your system for strength and
alertness.

(4) 
Protect yourself from
dehydration and heat injuries
associated with wearing full
chemical protective gear.

b.
Rest whenever possible.

(1) 
Take rest breaks in
accordance with the heat condition
table as the tactical situation
permits.

(2) 
Use rest breaks to
drink water and to cool off.

c.
Eat meals.

(1) 
Eat regular meals daily
to replace salt lost through heavy
sweating.

(2) 
Eat something at each
meal, even if you are not hungry.

Note.  Usually,
eating field rations or liberal
salting of the garrison diet will
provide enough salt. 
Excess intake of salt should be
avoided.

d.
Protect yourself from
exposure.

(1) 
Wear uniform properly.

(2) 
Provide shade whenever
possible.

(3) 
Use barrier creams and
lotions.

3.   Ensure proper PMMs are followed for protection
against biting insects.

a. Apply extended-duration
repellent lotion-

Note.  Extended-duration repellent lotion is a preparation
that can be used on the skin.

(1) 
On exposed skin except
the eyes, lips, and sensitive
skin.

(2) 
Two inches under edges
of battle dress uniform (BDU).

(3) 
Keep away from flame or
excessive heat.

(4) 
Wipe hands after
application.

Note.  Repeat the
above application every 6 hours during
strenuous activity and soon after any
activity that washes away the
repellent (such as stream crossings).

b.
Apply permethrin aerosol
clothing repellent.

(1) 
Use only on fabric.

(2) 
Do not apply to skin.

(3) 
Do not treat BDUs while
being worn.

(4) 
Treat outside of BDU,
insect head net, and mosquito bed
net.

(5) 
Do not treat underwear
or inside the cap.

(6) 
Avoid breathing vapors.

(7) 
Dry clothing (BDUs)
thoroughly prior to wearing.

c.
Wear uniform properly.

(1) 
Tuck pant legs into
boots, roll sleeves down, and
close collar.

(2) 
Wear uniform loosely.

(3) 
Check clothing
frequently.

(4) 
Use buddy system to
check areas of body not easily
seen during self-examination.

d.
Take malaria pills to
protect against malaria parasites. 
(Use in the manner prescribed
for your unit.)

e.
Clean and inspect
yourself.

(1) 
Wash yourself daily or
as often as the tactical situation
permits.

(2) 
Use the buddy system to
check each other for ticks and for
arthropod bites. 
(If ticks are found
attached or if insect bites are
found, seek medical attention.)

(3) 
Use insecticide powder,
cream, or shampoo when prescribed
by medical personnel.

f. 
Clean and inspect your
clothing.

(1) 
Wash your uniform to
remove arthropods and their eggs.

(2) 
Use available military
laundry service or scrub your
clothing yourself with soap and
water.

g.
Use your bed net when
sleeping.

(1) 
Suspend bed net above
sleeping area.

(2) 
Tuck edges of bed net
under the sleeping pad or bag.

(3) 
Treat the bed net with
permethrin aerosol clothing
repellent.

(4) 
Spray interior space
with resmethrin.

(5) 
Avoid breathing vapors.

(6) 
Do not use permethrin
clothing repellent or resmethrin
on skin.

4.   Ensure proper PMMs are followed for protection
against diarrhea and dysentery.

a.
Identify the indications
of diarrhea and dysentery.

Note.  Diarrhea is
an intestinal disorder characterized
by abnormally frequent and watery
bowel movements.

b.
Purify your drinking
water if treated water is not
available.

Note.  Before
using iodine tablets, check them for
physical change.  If they are old, they can lose their disinfecting ability. 
Tablets that are not uniformly
steel gray or that are stuck together
or crumbled should not be used.

(1) 
Fill your canteen with
the cleanest, clearest water
available.

(2) 
Add iodine tablets.

(a)  
Add two tablets to a
one-quart canteen of water.

(b)  
Double the amount of
tablets if a two-quart canteen
is used.

(3) 
Replace the cap.

(4) 
Wait five minutes for
the tablets to dissolve.

(5) 
Shake the canteen to
mix the contents.

(6) 
Disinfect the canteen
cap threads.

(a)  
Loosen the cap.

(b)  
Tip the canteen over
and squeeze to allow leakage
around the canteen threads.

(c)  
Turn the canteen
right side up.

(d)  
Tighten the cap.

(7) 
Wait 30 additional
minutes before drinking.

c.
Obtain food and drink
from an approved source.

(1) 
Obtain food, drink, and
ice only from medically approved
sources.

Note.  Do not
obtain food, drink, and ice from
vendors unless they have been approved
by medical personnel.

(2) 
Obtain food from the
dining facility when possible.

d.
Wash your hands for at
least 30 seconds-

(1) 
After using the
latrine.

(2) 
Before touching eating
utensils or food.

(3) 
After eating.

(4) 
After smoking.

e.
Dispose of food waste
properly.

(1) 
Use covered container
to keep out pests and to prevent
breeding of flies.

(2) 
Use plastic bags in the
event you have dumpster-type
receptacles and regular waste
pick-up.

(3) 
Bury in the event you
are in the field and do not have
waste pick-up or other disposal
methods available.

Note.  Before
burying any waste, obtain prior
approval by contacting either the
logistics or the preventive medicine
section.

5.   Ensure proper PMMs are followed for protection
against hearing loss.

a.
Wear protective devices
such as earplugs, ear canal caps, or
earmuffs.

b.
Wear vehicle headgear
such as helicopter crew helmets and
armored vehicle crew helmets.

c.
Keep hearing protection
devices clean to avoid ear
infections.

d.
Avoid noise and/or limit
the time in noise hazardous areas.

6.   Ensure proper PMMs are followed to prevent skin
infections.

a.
Bathe frequently. 
Take a full bath at least
once every week. 
If showers or baths are not
available, use a washcloth daily to
wash-

(1) 
Your genital area.

(2) 
Your armpits.

(3) 
Your feet.

(4) 
Other areas where you
sweat or that become wet (between
thighs or [for females] under
breasts).

b.
Keep skin dry.

(1) 
Use foot powder on your
feet (especially if you have had
fungal infections in the past).

(2) 
Use talcum powder in
areas where wetness is a problem. 
(Cornstarch may be used as
a substitute for talcum powder.)

c.
Change to clean clothing
after a full bath.

(1) 
Wear loose-fitting
uniforms to allow for better
ventilation and blood circulation.

(2) 
Wear proper clothing.

Note.  Do not wear
nylon or silk-type undergarments. 
Cotton undergarments allow more
evaporation of moisture.

d.
Shave facial hair often
enough to be clean shaven (males
only) to allow a tight fit of the
protective mask.

7.   Ensure proper PMMs are followed for care for the
feet.

a.
Before movement.

(1) 
Wear the proper type of
footgear, correctly fitted and
broken in.

(2) 
Wear clean socks that
are free of holes or knotty darns.

(3) 
Use foot powder and
clean socks.

(4) 
Treat and protect
blisters, pressure spots, and
infections before movement.

b.
During movement.

(1) 
Keep feet as dry as
possible.

(2) 
Change socks (if
possible) for dry ones when they
become damp or wet.

(3) 
Dry socks by putting
them inside your shirt around your
waist.

(4) 
Relieve tender pressure
spots on the feet by adjusting
gear.

(5) 
Dust the feet with foot
powder once or twice daily.

c.
Inspect feet at rest
periods.

(1) 
Wash feet during the
noon break if possible.

(2) 
Raise feet while
resting to help reduce congestion
and swelling.

d.
Take care of blisters.

(1) 
Wash the blister and
the surrounding area with soap and
water.

(2) 
Seek medical treatment
for painful blisters or signs of
infection such as redness,
throbbing, and drainage.

8.   Ensure soldiers practice good oral hygiene.

a.
Brush your teeth after
every meal if possible.

b.
Use dental floss at least
once a day.

c.
Rinse your mouth with
potable water after brushing and
flossing.

9.   Ensure soldiers are informed about protection
against STD.

a.
Use a prophylactic
(condom).

Note.  Individuals
should use a condom during sexual
intercourse when there is a
possibility of acquiring an infection.

b.
Urinate immediately after
intercourse.

c.
Wash well with soap and
water.

Note.  Females
should not douche unless directed to
do so by medical personnel.

10. Ensure soldiers are informed about protection against AIDS.

Note.  AIDS is
contagious in the same way as STDs are
contagious.  Infection can result from a sexual relationship with an
infected person. 
Sexual contact is not the only
way to contract AIDS but is a major
contributor.

a.
Prevent sexual
transmission-know your partner.

(1) 
Avoid having sex with
multiple partners.

(2) 
Avoid having sex with
persons who might be carriers of
the AIDS virus (high-risk groups
include homosexual and bisexual
persons and intravenous drug
users).

b.
Prevent transmission
through shared needles or
syringes-do not inject illicit
drugs.

Note.  There is
presently no cure for AIDS and no
vaccine to prevent AIDS.

11. Ensure proper PMMs are followed for disposal of waste.

a.
For human waste-

(1) 
Use unit latrine.

(2) 
Use cat-hole latrine.

(a)  
Use only on the
march.

(b)  
Cover immediately
after use.

(3) 
Use a straddle trench
for 1 to 3 day bivouac.

b.
For other waste-

(1) 
Bury-less than one
week in the field.

(2) 
Incinerate-longer
than one week in the field.

12. Apply Army tobacco use policies.

a.
Long term and immediate
adverse effects of tobacco use.

(1) 
Leading preventable
cause underlying death in the
United States is tobacco use.

(2) 
Heart disease, cancer,
emphysema, stroke.

b.
Tobacco use in the
military.

(1) 
Decreases readiness,
night vision, hand-eye
coordination, and stamina.

(2) 
Increases cold weather
injuries and number of injuries.

(3) 
Leads to addiction.

c.
Army tobacco use policy.

(1) 
AR 600-63.

(2) 
Smoking is not
permitted in DA-space except in
designated areas.

(3) 
Healthy People 2000
priorities-

(a)  
Reduce military
smokers to 20 percent.

(b)  
Reduce smokeless
tobacco use to 4 percent for age
groups between 12 and 24.

d.
Sources to help soldiers
become tobacco-free.

(1) 
Medical professionals.

(2) 
Local preventive
medicine service.

(3) 
American Cancer
Society.

(4) 
Nicotine gum, nicotine
patches.

(5) 
Family and unit
support.

13. Identify division PM section missions to support field forces.

a.
Identify breakdowns in
PMM (individual and leader/unit).

b.
Inform commanders on
specific measures to repair the
breakdowns.

c.
Provide technical
assistance for training the unit
FSTs.

d.
Monitor training of
individual and unit PMM.

e.
Perform limited
sanitation and vector control work.

14. Identify corps-level PM missions to support field forces.

a.
Corps PM detachments.

(1) 
Provide PM support to
deployed forces in the corps/COMMZ
in a direct support role or a
general support role.

(2) 
Transport organic
personnel and equipment with
logistical support from a unit in
the geographic area.

(3) 
Perform area and aerial
spraying missions, medical
detachment, PM (ENTO) only.

b.
Armored cavalry regiment
(ACR). 
Provide the same type of
support to the regiment as the
division PM section provides to the
division.

c.
Separate brigades
(separate infantry brigade [SIB] and
heavy separate brigade [HSB]).  Provide the same type of support to the SIB/HSB that the
division PM section provides to the
division.

d.
Civil affairs (CA) units. 
Provide support for displaced
persons, refugees, and evacuees. 
Re-establish essential public
health services.

1.   Ensured soldiers protected against cold.

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2.   Ensured soldiers protected against heat.

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3.   Ensured soldiers protected against biting insects.

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4.   Ensured soldiers protected against diarrhea and
dysentery.

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5.   Ensured soldiers protected against hearing loss.

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6.   Ensured soldiers protected against skin infections.

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7.   Ensured soldiers provided care for the feet.

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8.   Ensured soldiers practiced good oral hygiene.

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9.   Ensured soldiers understood PMM to protect against
sexually transmitted diseases.

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10. Ensured soldiers understood PMM to protect against AIDS.

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11. Ensured soldiers disposed of waste properly.

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12. Applied the Army’s policies on tobacco use.

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13. Identified division and corps level PMs and their mission.

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AR
40-5

AR
600-63

FM
4-25.11

FM
21-10