The commanding officer of the transferring (parent) command will ensure each family member is screened within how many days of receipt of transfer orders?
Screening supports what by ensuring the service member can execute his or her military duties associated with their military occupation assignment?
What is the term for a family member with an identified special need, which requires special health care or educational services?
Exceptional Family Member (EFM)
Which system adjudicates a service member's "fitness for continued service."?
Disability Evaluation System (DES)
Duty performed in overseas land-based activities, which does not require the service member to be absent more than 150 days per year, but is credited as sea duty due to the relative undesirability of the geographic area is what type of duty?
Type 3 - Overseas remote land-based sea duty
Duty performed in commissioned vessels and deployable squadrons homeported in the US or duty performed in US land based activity and embarked staffs, which require service members to operate away from their duty stations in excess of 150 days per year is what type of duty?
Type 2 - Sea Duty
At an overseas or remote MTF ensure the SSC and MTR providers respond within how many working days of receipt of screening inquiries?
What is the computer-based medical management system used in DOD health care facilities?
Composite Health Care System (CHCS)
Temporary Limited Duty is a term applied when a MEB places a service member in a medically restricted duty status as a result of illness, injury, or disease, TLD occurs in periods not to exceed 6 months with a cumulative per career total of how long?
Duty performed in US land-based activities where service members are not required to be absent from their duty station in excess of 150 days per year is what type of duty?
Type 1 - Shore Duty
What is a public law that required the provision of EIS to infants and toddlers with disabilities (birth - 2 years, inclusive) and their families and a free appropriate public education, to include special education and related services, to preschool and school-age children with disabilities (ages 3-21 years, inclusive)?
IDEA (Individuals with Disabilities Education Act)
Family members require screening when a sailor is serving an unaccompanied tour for how many months or more?
The term Operational Assignment is used in this instruction to designate an assignment to an DON unit which can be expected to deploy from its home base or port for a period of more than how many days?
Duty performed in commissioned vessels and deployable squadrons homeported overseas; or duty performed in overseas land-based activities and embarked staffs, which require service members to operate away from their duty stations in excess of 150 days per year is what type of duty?
Type 4 - Overseas sea duty
What is a data repository containing all active and retired military members and their family members?
DEERS (Defense Enrollment Eligibility Reporting System)
What ensures a productive tour for the service member, family, and command and reduces cost?
The CO of the transferring (parent) command will ensure service members complete medical assignment screening not later than how many days after returning to duty following a period of medically restricted duty or finding of "fit for continued Naval service?"
What is a blood enzyme used to test for tolerance to certain medications such as anti-malarial medication?
Timely access for remote duty designation purposes is defined as how many hours of driving time under normal conditions?
Duty performed in overseas land-based activities, which are credited as shore duty for rotational purposes, where service members are not required to be absent from their duty station in excess of 150 days per year is what type of duty?
Type 6 - Overseas Shore Duty
Unaccompanied service members may request an accompanied tour and command sponsorship for family members. Whose approval is required for navy personnel?
What is the prerequisite for participation in the TRICARE Extended Care Health Option (ECHO) program?
Service members in the HIV program are governed under what series and are not included in medical assignment screening?
In order to protect sensitive medical information, forward the suitability inquiry to the gaining MTF via only which method?
Naval message traffic
All requests for early returns/reassignment (humanitarian reassignment in the Marine Corps) are submitted as what type of report by the parent command?
Overseas Screening deficiency
Treatment is not considered significant if taking medications of low toxicity (e.g., Prozac, Zoloft, or Paxil) for less than how many days?
The service member must be informed of their responsibility to inform his/her command and the SSC at the intermediate MTF of any change in special needs status. Changes include pregnancy, illness, or injury requiring treatment or rehabilitation for longer than how many days, additions or changes to medication, or any other satiation or condition which might alter the initial screening?
Servicewomen who suspect pregnancy must obtain prompt confirmation and inform their CO within how long of pregnancy confirmation?
You need to allow how many working days from receipt of the suitability inquiry for a response and immediately follow-up if the reply is not received by the due date?
Any family member who has not received ACIP recommended immunizations is medically unsuitable to accompany an active duty member to an overseas assignment. Annotate Part 1 of which form, and inform the active duty member, PSD, and the transferring command that this is a disqualifying medical requirement?
NAVMED Form 1300/1
The screening MTF supporting the initial duty station will conduct an initial suitability screening for service and family members before a service member is assigned to intermediate duty assignment. The initial screening is valid for how many months?
Upon receipt of the completed NAVMED 1300/3, the SSC/LIMDU coordinator will retain an audit copy. The retention period is how many ears after which the record is destroyed?
If command sponsored, suitability screening is required for each family member. Screening conducted within the past how many months meets this requirement?
The pharmacy department will assist in determining the availability of required medications at the gaining MTF or operational pharmacy and will dispense, by prescription, sufficient quantities for the en route period of transfer or period needed by the gaining pharmacy to obtain the required meds (up to how many days)?
Post pregnancy suitability screening is conducted approximately how long after post delivery, when the infant is immunized and the mother and infant can be safely screened?
For those service members failing suitability screening, attending physicians will conduct follow-up evaluations how often?
Every 2 months
Dental examinations of family members performed by civilian providers within the past how many months are considered concurrent?
what is Ionizing radiation?
Ionizing radiation is simply nuclear radiation in the form of particles or electromagnetic waves (photons) that, as it passes through matter, causes atoms to become electrically charged or ionized
How many types of ionizing radiation are there?
There are only four types of ionizing radiation of biological significance. These four types of radiation are classified into two categories—particulate and nonparticulate.
What are the types of particulating ionizing radiation?
Particulate ionizing radiation types are alpha particles, beta particles, and neutrons.
what are nonparticulate radiation types?
The nonparticulate radiation type is electromagnetic radiation (photons of x-rays and gamma rays
what is alpha radiation?
Alpha radiation. An alpha particle is a helium nucleus consisting of two protons and two neutrons all strongly bound together by nuclear forces
what is beta radiation?
Beta radiation. Beta particles are identical to atomic electrons but, like alpha particles, they are ejected from a nucleus when the nucleus rearranges itself into a more stable configuration
What is neutron radiation?
Neutron radiation. Neutrons are electrically neutral, yet because of their relatively large mass, they can severely disrupt atomic structures
What is electromagnetic radiation?
Electromagnetic ( nonparticulate photons) ionizing radiation Gamma and x-rays constitute the most abundant form of ionizing radiation associated with a nuclear detonation
What does "exposure" mean?
Exposure is defined for gamma and x-rays in terms of the amount of ionization they produce in air.
What is the "absorb dose"?
Although the concept of exposure provides a measurement standard for electromagnetic radiation in air, additional concepts are needed for all types of radiation and its interaction with other materials, especially living tissue. Absorbed dose is defined as the radiation energy absorbed per unit mass.
What is the activity level of radioactive material?
The activity level of a radioactive material is simply a measure of how many atoms disintegrate (decay) per a unit of time
What is half life activity?
Half life Activity is tied to a physical property of a radionuclide known as the half-life. The half-life of a radionuclide is the amount of time it takes one-half of the nuclei to decay
How does a nuclear det occur?
A nuclear detonation results from the formation of a supercritical mass of fissile material, with a near instantaneous release of nuclear binding energies and large-scale conversion of mass to energy
How is the energy of a nuclear explosion transfer?
The energy of a nuclear explosion is transferred to the environment in three distinct forms—blast, thermal radiation, and nuclear radiation
What is "airburst"?
Airburst. An airburst is an explosion in which a weapon is detonated in air at an altitude of sufficient height that the fireball does not contact the surface of the earth In the vicinity of ground zero, there may be a small area of neutron-induced ground activity (NIGA) that could be hazardous to troops required to pass through the area. The NIGA hazard is temporary, lasting only a few days to a few weeks
What is a "surface burst"
A surface burst is an explosion in which a weapon is detonated on, or slightly above, the surface of the earth so that the fireball actually touches the land or water surface
What is a "subsurface burst"?
A subsurface burst is an explosion in which the point of the detonation is beneath the surface of the land or water.
What is a "high altitude burst"?
A high altitude burst is one in which the weapon is exploded at a high altitude (typically above 50 km) so that it generates an intense electromagnetic pulse (EMP) which can significantly degrade the performance of, or destroy sophisticated electronic equipment.
How many types of blast are there?
There are two basic types of blast forces which occur simultaneously in a nuclear detonation blast wave; these are direct blast wave overpressure forces, measured in terms of atmospheres of overpressure; and indirect blast wind drag forces, normally measured in the velocities of the winds which cause them.
What is the most common injury following a blast?
Thermal burns will be the most common injuries, subsequent to both the thermal pulse, and the fires it ignites. The thermal radiation emitted by a nuclear detonation causes burns in two ways, by direct absorption of the thermal energy through exposed surfaces (flash burns), or by the indirect action of fires caused in the environment (flame burns). The relative importance of these two processes will depend upon the nature of the environment. If a nuclear weapon detonation occurs in easily flammable surroundings, indirect flame burns could possibly outnumber all other types of injury.
Why is a thermal burn extremely difficult to manage?
Because of the complexity of burn treatment and the increased logistical requirements associated with the management of burns, they will constitute the most difficult problem faced by the medical service
What % of energy is released in a nuke airburst?
About 5 percent of the energy released in a nuclear airburst is transmitted in the form of initial neutron and gamma radiation
Should surgical treatment be delayed if patient is radiologically contaminated?
the external contamination hazard to both the patient and attending medical personnel will be so negligible that NECESSARY MEDICAL OR SURGICAL TREATMENT MUST NOT BE DELAYED BECAUSE OF POSSIBLE CONTAMINATION.
What is the reservoir for Q Fever?
sheep, goats, cattle, dogs, cats, some wild mammals, birds, and ticks
What are some neurological complications that can occur with Q FEVER?
aseptic meningitis or encephalitis
Tissue samples obtained during an autopsy need to weigh how much for microbiology and intoxication testing?
How long after a person is recovering for a BW attack should new blood samples be taken from personnel?
If there is a chance that members have been exposed to smallpox how quickly should they be immunized?
Within 1-7 days
What is the treatment for smallpox?
To administer VIG 0.6 ml/kg every 2 to 3 days IM in divided doses at multiple sites over a 24 to 36 hour period until no new lesions appear
What is the preventive measure for viral hemorrhagic fever? .
To ensure all AD members have a yellow fever vaccine
What is the treatment for VENEZUELAN EQUINE ENCEPHALITIS?
Non specific administer anticonvulsive therapy as needed
VENEZUELAN EQUINE ENCEPHALITIS is usually found in what part of the world?
Central/South America and Trinidad
What is the preventive measure for viral hemorrhagic fever?.
To ensure all AD members have a yellow fever vaccine
Each year, approximately how many health care workers become infected with the Hepatitis B virus (HBV)?
The CDC estimates that HBV infection in health care personnel actually results in some 600 hospitalizations and how many deaths annually?
Commanding officers and officers in charge must develop and implement universal protocols of infection control strategies to prevent transmission of HBV and other pathogens of what type?
The ability of HBV to survive in the environment, coupled with its high titers in the blood, makes it an excellent model for which practices?
COs and OICs must appoint who in writing to assist in implementing the infection control program?
Infection Control Office (ICO)
The use of rubber, plastic, paper, foil, or other fluid resistant materials to cover surfaces and protect them from contamination is known as what technique?
What is the number of micro-organisms contaminating an object and is sometimes also known as bioload or microbial load?
What is an unprocessed biological monitor from the same lot as the test monitor and when cultured serves as a control by verifying the viability of the unexposed organisms?
What is a bacterial endospore test designed assess whether sterilization has actually occurred?
What are pathogenic micro-organisms that are present in human blood and capable of causing disease in humans?
What test is a diagnostic test of a prevacuum sterilizer's ability to remove air from the chamber and prevent air reentrant?
What is the destruction of inhibition of most viruses and bacteria while in their active growth phase?
What are chemical dyes used to determine whether the conditions required for sterilization are met?
The presence or reasonably expected presence of blood or other potentially infectious material on an item or surface is said to be what?
What is the propagation and growth of micro-organisms or living tissue cells in or on a nutrient medium?
Dental items are classified in one of three ways, based on the pathways through which cross contamination may occur and the location and technique of instrument use. They are what?
What items are instruments, and materials that penetrate the skin, mucous membranes, or bone?
What items are instruments, equipment, or materials that frequently contact mucous membrane but cannot be sterilized due to their design or inability to withstand heat?
What items are instruments, equipment, or materials that do not normally penetrate or contact mucous membranes but which are exposed to splatter, spray, or splashing of blood, or are touched by contaminated hands?
What are equipment or methods which isolate or remove bloodborne pathogens from the workplace?
A surgical entry into the tissues, cavities, organs or repair of major traumatic injuries is what type of procedure?
An infection originating in the environment of a hospital or freestanding dental treatment facility is a what?
What is a process which uses steam heat under pressure for sufficient length of time to kill all forms of micro-organisms?
Saturated steam sterilization
The ICO must ensure that infection control functions are addressed at least how often as part of the command quality assurance program?
The ICO must review and revise all infection control policies and procedures at least how often?
The ICO must include a briefing in the command orientation for all new employees and staff on infection control policies and infectious disease hazards in the workplace per what instruction?
Who directs continuous review and upgrade of the sterilization and infection control syllabus at the Naval School of Dental Assisting and Technology (NSDAT) for the dental technician, basic "A" school?
Commands must review and upgrade their staff and new employee orientation presentation as directed. As a minimum, all personnel will receive initial training within how many days of reporting onboard and at least annually thereafter?
All personnel assigned duties in sterilization areas or functioning as surgical assistants will receive additional documented training in sterilization and what other techniques?
Commands must document infection control training sessions with names of persons attending and conducting, dates, and a summary of the contents of the training and mush maintain these records for at least how many years?
Commands must use what, through the appropriate chain of command, to identify total resources required to meet the guidelines of this directive and those of OHSA and EPA?
A period of up to how long often exists between the time a person becomes infected with a virus and the time when laboratory tests can detect the antigens or antibodies to it?
Approximately what percentage of patients with HIV or HBV show no symptoms and may be unaware of their infectious disease state?
The same infection control practices must be used with all patients regardless if they show symptoms or not and this approach is known as what?
Since what infection is presently the standard model for infection control practices and is more infectious than HIV, those established procedures known to prevent the spread of it serve as the basis for universal precautions?
Which instruction mandates that all active duty health care personnel receive HIV testing on an annual basis during each calendar year?
Since washing increases the porosity of gloves up to what percent, repeated use of a single pair of gloves is not permitted?
What particles can remain airborne long after a procedure is completed, making it so staff and patients must not eat or drink in the DTRs?
At the beginning of each work day when preparing the DTR, flush each of the unit water lines and hoses for at least how long, beginning with the cup filler and cuspidor even if their use is not anticipated?
When preparing the DTR after each patient, remove the handpiece, lubricate and run for how long?
When inhaled, particles less than how many microns in diameter can penetrate directly to the terminal bronchioles and alveoli of the lungs?
Having patients brush their teeth or rinse with a mouthwash before treatment reduces the microbial concentration of their oral flora. Three 10 second rinses will temporarily reduce a patient's microbial count by up to what percent?
Use of a chlorhexidine gluconate preoperative rinse of what percentage significantly decreases the infectivity of an aerosol?
Using opened, properly decanted irrigation solutions is acceptable for up to how long when used for nonsurgical use?
Using opened, properly decanted irrigation solutions is acceptable for up to how long when used for surgical procedures?
Never recap a needle using a two-handed technique. Instead, use one of the commercially available sheath holders or what technique
Sterilizable or disposable syringe tips are recommended. For nonsterilizable tips, flush water syringe for 30 seconds. Disinfect by wiping with a high-level disinfectant to clean, then wrap with disinfectant saturated gauze for how long?
When securing a DTR at the end of the work day you must flush each unit water line and hose for how long?
To clean uncarpeted floors and other horizontal surfaces regularly and when spills occur use launderable mops with a detergent and an EPA-registered disinfectant or a detergent with sodium hypocholorite at what dilution?
Contaminated laundry may be laundered on-site if OSHA and CDC guidelines are followed. A wash cycle must be of at least 25 minutes duration with a water temperature of at least what?
160 degrees F
Infectous waste must be placed in closable, leak-proof containers or bags that are labeled as what?
What is one of the most important procedures in preventing the transfer of micro-organisms from one person to another?
What can survive and multiply on the skin, can be cultured repeatedly from the skin, are usually of low virulence and are not easily removed?
The mere mechanical action of rubbing the hands together and rinsing them under running water is effective in removing what?
What are water soluble complexes of iodine with organic compounds which are effective against all gram positive and gram negative bacteria and viruses?
Chlorhexidine gluconate antiseptic is an effective antiseptic for reducing transient and resident microbial hand flora, has a sustained antimicrobial effect and does not appear to affect what adversely?
Seventy percent isopropyl alcohol also known as waterless handwashing agents virtually disinfects the skin in how long?
Personnel should empty, disassemble, and clean all refillable hand cleansing agents dispensers at what interval?
What sterilization is preferable for all equipment and materials that can withstand high temperatures?
What is the most effective means of sterilization for almost all items used in dentistry?
Steam under pressure
A typical dry heat cycle is how many minutes at 320-345 degrees F, plus the time required to bring the load up to sterilization temperature?
A mixture of alcohols, formaldehyde, water, and other chemicals heated under pressure forms a gas that can achieve sterilization, also known as what type of sterilization?
Using a heated unit, ethylene oxide sterilization can be achieved in how long at 120 degrees F?
COs should not purchase new ethylene oxide equipment, it may not survive in today's dental health care environment because ethylene oxide is a serious problem of what sort?
EPA classifies disinfectants as what, based on the contact time of the solution and the biocidal activity of an agent against bacterial spores, mycobacterium tuberculosis, lipid and non-lipid viruses, and vegetative bacteria?
High, intermediate, or low level
Iodophors are classified as what level disinfectants if the product label claims tuberculodical activity?
Infection control in prosthodontics and orthodontics is divided into two distinctly different areas, what are they?
DTR and the dental laboratory
You should soak reusable impression trays in an EPA-registered disinfectant for how long, scrub in soapy water, and seal in peel packs before autoclaving?
You should consider all prosthetic devices received contaminated and scrub them with a brush using a bacteriocidal soap. Store the brush in a glutaraldehyd solution of what percentage between uses?
After scrubbing a prosthetic device, place the prosthesis in a container filled with an EPA-registered disinfectant such as an iodophor, chlorine dioxide, or a synthetic phenol compound. Place the container in an ultrasonic cleaner for how long?
When disposable covers are not available, treat bite blocks as you would a what?
Film holding device
For an X-ray chair you should disinfect at least daily or when visibly contaminated using an EPA-registered disinfectant at what level?
What is the authority that a military commander lawfully exercises over subordinates in assigning missions and expecting accountability to attainment?
Inherent in command
Which board includes BUMED, TMO, OPNAV Flag and senior civilian leadership and Force Master Chief meeting to discuss strategy, policy, resources, performance, and organizational alignment issues?
Corporate Executive Board (CEB)
What meeting forum is used to share current information on upcoming BUMED activities/ responsibilities and policy changes and facilitate timely communication across Codes? Attendees include Code EA and Administrative Assistants.
BUMED Executive Assistant Meeting
Which meeting includes BUMED and Regional Command leadership forum to discuss health care support delivery issues, resources, and business plan performance?
Regional Commander Business Meeting
Corporate Executive Board (CEB) Weekly meetings are chaired by Vice Chief, BUMED, CEB and Regional Commanders comprise the Resource Requirements Review Board per what instruction?
Regional Commander Business Meetings occur how often and are chaired by Vice Chief, BUMED?
Which forum is used to discuss career development, Senior Executive Management, Senior Operational/Major Staff slates, Total Force Integration strategy, cultural diversity strategy, and Navy Medicine leadership competencies?
Council of Corps Chiefs Forum
On behalf of Chief, BUMED, who conducts investigations and organizational assessments of and consultations for Navy Medicine?
Medical Inspector General (MEDIG)
What meeting is Chartered by BUMED Chief of Staff to conduct BUMED headquarters specific business functions? Membership includes Assistant Deputies of the Corporate Executive Board (CEB) members. Routine functions include: Position Management Board; Space Utilization Board; and conducting monthly Informational Forum.
Deputy Chief of Staff Business Meeting
Which changes are only authorized through change transmittals signed by Chief or Vice Chief, BUMED?
The Surgeon General of Chief, Bureau of Medicine and Surgery is the principle advisor to whom on the provision of centralized, coordinated policy development, guidance, and professional advice on health service programs for Department of the Navy?
Who is the principle advisor to Chief, BUMED on internal and external communication requirements for Navy Medicine?
Communications Director, MOOP
Special Assistants report to Chief, BUMED as subject matter experts and to the Chief of Staff for issues involving what?
Who is the principal staff advisor for Navy Medicine health services? Develops health services policy and directs the provision of medical and dental services as authorized by law or regulations for Navy and Marine Corps personnel, other uniformed Services personnel, their family members, retired members and their family members, eligible survivors or deceased members, Federal civilian employees, and other categories of persons?
M3 Deputy Chief of Staff for Operations
The authority and responsibilities of the Surgeon General, as an OPNAV Principal Official, are derived from the statutory authority and responsibilities of CNO and Vice Chief of Naval Operations (VNCO) and such other authority and responsibilities assigned by whom?
Secretary of the Navy (SECNAV)
Per what instruction does Comptroller (M8) reports directly to Chief, BUMED for financial matters and reports to Chief of Staff for administrative purposes?
SECNAVINST 7000.27 CH 1
orders issued by the Surgeon General in performing his assigned duties have the force and effect of orders issued by personally by whom?
Who is the principal staff advisor for Navy Health Services future planning, projects and recommends Navy Medicine requirements to support National Military Strategy, projects and recommends Navy Medicine plans, policies, and requirements supporting joint doctrine?
M5, Deputy Chief of Staff for Future Plans and Strategies
Deputy Chief of Staff Business Meetings occur how often and are chaired by Deputy Chief of Staff, BUMED?
What type of authority is issued to Special Assistants on matters pertaining to their expertise and position?
Which meeting includes BUMED and Regional Chief of Staff leadership forum to discuss health care and support delivery issues, resources, and business plan performance?
Regional Chief of Staff Business
What is the term used to describe the channel by which staff officers contact their counterparts at higher, adjacent, and subordinate headquarters?
Regional Chief of Staff Business Meeting is a bi-weekly meeting chaired by whom?
Chief of Staff, BUMED
Who is the principal staff advisor for Navy Medicine Total Force (AD, RES, CIV, Contractor) manpower, personnel, training, and education (MPT&E) policies, programs, and practices?
M1, Deputy Chief of Staff for Human Resources
Who aligned all Navy Medical and Dental Commands under the military command of the Chief, Bureau of Medicine and Surgery?
Who is the principal advisor for financial resources and fiduciary processes in response to OPNAV, SECNAV, SECDEF, Office of Management and Budget (OMB), and Congress. Develops principles, policies, and procedures ensuring effective financial resource management?
M8, Deputy Chief of Staff for Resource Management/Comptroller
Who serves as the principal advisor to the Chief, BUMED on religious matters and issues pertaining to the spiritual health of Navy Medicine personnel?
Pastoral Care Director, MOOG
Who is the principal legal advisor to Chief, BUMED on medico-legal strategies, fiscal law, military justice and discipline for Navy Medicine?
Staff Judge Advocate (JSA)
Who is the OPNAV Principal official and serves additional duty as Chief, Bureau of Medicine and Surgery?
Navy Surgeon General
Who are charged with governance within their defined geographic or functional areas of responsibility and delegated day-to-day operational control and resource execution authority?
Who is the principal advisor to Chief, BUMED on human and animal research protections?
Research Protections Director, MOOR
Who is the principal advisor to Chief, BUMED on matters pertaining to the Military Health System (MHD) Information Management / Information Technology (IM/IT) strategic initiatives and the resulting impact on the business practices of Navy Medicine?
Chief Information Officer (CIO)
Historically, U.S. military campaigns fought in what environments have been seriously compromised by malaria?
Commanders will ensure what report on any suspected or confirmed malaria case is sent out as soon as possible to all required addresses whenever a malaria threat exists?
Disease Alert Report (DAR)
Individuals who were treated for malaria in the past must wait how long from the date treatment was finished until they are eligible to donate blood?
Individuals who were in a malaria-risk areas and were required to take chemoprophylaxis because of a perceived risk of exposure, must wait how long from the time chemoprophylaxis was finished?
Individuals who visited a malaria-risk area and remained asymptomatic, but were not required to take chemoprophylaxis because of negligible risk of exposure, must wait how long until they are eligible to donate blood?
Any person who is deficient in what has a risk of hemolysis associated with taking primaquine for chemoprophylaxis or treatment?
A Malaria DAR should include the patients itinerary during the what previous time frame and the types and duration of any chemoprophylaxis or treatment medications?
Vector Surveillance and Control Measures consist of effective mosquito control programs of what type?
On an individual basis, what are the most important means, even more so than chemoprophylaxis for an individual to prevent becoming infected with malaria?
Personal Protective Measures
Traditionally, malaria chemoprophylaxis has been effectively accomplished with use of cholorquine and primaquine, however, in the past several years, resistance to what has been demonstrated among malaria parasites in certain areas of hte world into which Navy and Marine Corps personnel deploy or live?
Patterns of resistance and drug requirements can change frequently, therefore, Medical Department representatives of fleet units deploying to malaria-risk areas must contact the what prior to deployment for the latest requirements?
Because malaria, in particular what type of malaria, can progress into a rapidly fatal course, the most important aspect of malaria treatment is suspecting this disease in the differential diagnosis of the patient and beginning immediate treatment?
Parenteral chlorogquine hydrochloried, quinidine gluconate, and quinine dihydrocholoide can be used in the treatment of severe cases of malaria where the patient is exhibiting signs of central nervous system involvement, has a very high and life-threatening parasitemia, or cannot take what type of drugs?
What drugs rapidly schizonticidal and therefore rapidly reduce the level of parasitemia?
The Health Information for International Travel has a comprehensive guidance by the Centers for Disease Control (CDC) and is revised and published how often?
What is a comprehensive hardcover textbook of clinical tropical medicine?
Hunter's Tropical Medicine
What conduct tropical medicine research and can provide information on the epidemiology of malaria, atimalarial drug resistance, and mosquito vectors within their countries or geographic areas of reserach?
Naval Medical Research Units
how often should temperature reading in refrigerators In the field be taken
at least 3 times during meal periods
for a garbage disposal pit how large and how many people does it serve
4 sq feet and 4 feet deep and serves 100 people
Within the DoD, who is eligible for TRICARE?
Army, Navy, Air Force, Marine Corps, Coast Guard, Commissioned Corps of the U.S. Public Health Service, and the Commissioned Corps of the National Oceanic and Atmospheric Administration
When can family members of the National Guard or Reserve Member become eligible for TRICARE?
When called to active duty for more than 30 consecutive days
If you are an active duty service member who lives and works more than 50 miles or an hour's drive from an MTF, what are your program options?
If you are an active duty family member, what are your program options?
US Family Health Plan
If you are an active duty family member with an active duty service member who lives and works more than 50 miles or an hour's drive drive from MTF, what are your program options?
Prime Remote for Active Duty family members
US Family Health Plan
If you are a retiree and have eligible family members who are not eligible for Medicare, what are your program options?
US Family Health Plan
If you are a Medicare-eligible beneficiary under age 65, what your program options?
US Family Health Plan
If you are a Medicare- eligible beneficiary age 65 or over, what are your program options?
US Family Health Plan
If you are a Congressional Medal of Honor recipient or recipient's family member , or a certain former spouse of an active or retired service member, what are your program options?
US Family Health Plan
What is Tricare Prime Split Enrollment?
Allows families living in separate Tricare regions to enroll in Tricare Prime together
What are the Tricare Prime Access Standards?
1. The wait time for an urgent care appointment will not exceed 24 hours
2. The wait time for a routine appointment will not exceed one week
3. The wait time for a specialty care appointment or wellness visit will not exceed four weeks
What is Tricare Prime Travel Entitlement?
Resonable travel expenses may be reimbursed if member is referred by their PCM for a specialty care at a location more than 100 miles (one way) from the PCM
What is the US Family Health Plan?
Is an additional Tricare Prime-like option avaiable to active duty family members, retirees, and their eligible family members through networks of community-based hospitals, and physicians, in six areas of the country
If you are enrolled in the US Family Health Plan, what might you not have access too?
What is Tricare for Life?
Offers Medicare-wraparound coverage to Tricare banaficiaries regardless of age, provided that are entitled to Medicare Part A and also have Medicare Part B
Who is required to pay an annual enrollment fee?
Retired service members and their families
Eligible former spouses
Medal of Honor recipients
What does the catastrophic cap do?
It limits the out-of-pocket expenses on annual deductibles, cost shares, and other costs.
At an MTF, how much medication supply can be filled if the medication is on the MTF formulary?
How long does it take for medications to be delievered after recieving the prescription via the mail order pharmacy?
What is the Tricare Extended Care Health Option
It provides financial assistance to active duty family members who qualify based on specific mental or physical disabilities, and offers an integrated set of services, and supplies not available through the basic Tricare program
How much medical care is offered through the ECHO Respite Care?
16 hours per month when recieving other authorized ECHO benefits
How much medical care is offered through the Tricare ECHO Home Health Care Respite Care?
Up to 40 hours per week, 8 hours per day, 5 days a week... only for those who qualify
What is the Transitional Assistance Management Program?
It provides 180 days of transitional health benefits after leaving active duty.
What is Continued Health Care Benefit Program?
Is a premium-based health care program asministered by Humana Military Healthcare Services, Inc.
What is Tricare Reserve Select?
Is a premium based health plan that National Guard and Reserve members who qualify may purchase
Definition of Beneficiary Counseling and Assistane Coordinator.
Perons at military treatment facilities and Tricare Regional Offices who are available to answer questions, help solve health care related problems, and assist beneficiaries in obtainine medical care through Tricare
What is a cost-share?
The maximum out of pocker expenses for which Tricare beneficiaries will pay for inpatient and outpatient care.
Definition of a Military Treatment Facility.
A medical facility owned and operated but the uniformed services- usuallt locared on or near a military base
What is a network provider?
Have a signed appreement with your regional contractor to provide care at a negotiated rate, handle claims for the patient
What is a non-network provider?
Do not have a signed agreement with your regional contractor and are therefore "out of network"
Part1: Record of Preventive Med
chronological record (HIV)
Part 2: Record of Medical Care
Chronological record of Medical Care
Emergency care and treatment care
Part: 3 physical qualification
report of medical examination
report of medical history
officer physical examination questionaire
record of disclosure
privaacy act statement
What is a pre-exposure prophylaxis for Q fever?
A formalin inactivated whole cell vaccine, which provides exposure for 5 years.
What is a post-exposure medication for Q-fever?
Tetracycline 500 mg PO every 6 hours for 5 days. or doxy 100 mg every 12 hours for 5 day. effective if begun 8-12 days
True or False. Chemoprophylaxis for Q fever is effective if given immeidately within the first 7 days.
What are treatment meds for Q fever?
Administer 100 mg doxycycline orally every 12 hours for atleast 2 days after patient is afebrile or 500 mg tetracycline every 6 hours for atleast 2 days.
How are Tularemia transmitted?
By anthropod vectors such as: ticks and deerflies or direct contact with infected animals.
What are some post-exposure prophylaxis for Tularemia?
Doxycycline 100 mg po every 12 h
Tetracycline 500 mg orally every 6 hours for 2 weeks, or cipro 500 mg every 12 hours for 2 weeks
When administering streptomycin for Tularemia what is the dose?
7.5 to 10mg per kg IM every 12 hours for 10-14 days
When administering Gentamycin for Tularemia, what is the dose?
3 to 5 mg per kg IV daily for 10-14 days
When administering Ciprofloxacin for Tularemia what is the proper dose?
400 mg IV every 12 hours then switch to oral cipro 500 mg every 12 hours after the patient has clinically impoved
How are Anthrax transmitted?
contact with infected animals, ingesting contaminated meat or Inhaling spores during the processing of wool for textiles.
What are the proper dosage for the pre-exposure prophylaxis for Anthrax vaccine?
6 doses at 0,2 and 4th week then 6,12 and 18 months with annual boosting.
What are some post exposure chemoprophylaxis for anthrax?
All personel exposed to aerosolized Anthrax should be administered ciprofloxacin 500mg tabs orally every 12 hours for 60 days
What are some signs and symptoms of Anthrax?
Fever, Malaise, cough,. also improvement for 3 days then acute respiratory symptoms
What are some treatments for anthrax
Ciprofloxacin 400 mg IV every 12 hours.
Doxycycline 200 mg IV loading dose followed by 100mg IV every 12 hours
How are Brucellosis treated?
Doxy 200 mg and Rifampin 600 mg daily for 6 weeks or Doxy 200 mg daily for 6 weeks and streptomycin 1 gm Intramuscularly daily for 2 weeks.
What are the reservoir for Melioidosis?
soil and water throughout the world between 20 degrees north and south latitudes
Signs and symptoms will show how many days after inhalation of melioidosis?
10-14 days after inhalation
What are some signs and symptoms of Melioidosis?
Mild bronchitis or necrotizing pneumonia, headache, anorexia, and a fever of 102 F
What are some medications given to treat Melioidosis?
Augmentin 60 mg per kg per day in 3 divided oral doses or tetracycline 40mg per Kg per day in 3 divided oral doses.
What are some treatments for Glanders?
Augmentin 60mg/kg/day in 3 div oral doses, Tetracycline 40mg/kg/day in 3 divided oral doses
What are some signs and symptoms of plague?
Acute onset of fever and prostration with acute painful lymphadenitis draining the site of the fleabite
Bacillus anthracis appears as what under the microscope during dx?
Encapsulated, aerobic, Gram postive, spore forming, rod shaped bacterium.
what are the four systems that Bacillus Anthracis can effect?
Skin/cutaneous which is most common, Respiratory rare, GI - rare in the rear, and Oropharyngeal which is least common
Cutaneous Anthrax sx
Usually start within 1 day, localized itching followed by 1) papular lesions that turn vesicular 2) subsequent black eschar within 7-10 days.
Rickettsial (spotted & Typhus Fevers) appears as what under the microscope during dx?
gram negative bacteria, pink-red cocci
Transmission of Rickettsial is done by?
ectoparasites such as fleas, lice, mites, and ticks by scratching infected feces into the skin or by inhaling their terd dust. Dont inhale ectoparasite terd dust.
Geographically where is Rickettsial most common?
Mediterranean, Southern Euro, Africa, India, Israel, Thailand, and Australia. HOWEVER ROCKY MOUNTAIN SPOTTED FEVER OR RICKETTISA PARKERI IS FROM THE AMERICAS.
Clinical presentation of Rickettsial?
Common symptoms develop 1-2 weeks into infection and include fever, headache, malaise, and sometimes nausea and vomiting. Rocky mountain fever may be fatal in 20-60% of untreated cases.
Clinical diagnosis of Rickettsial includes?
PCR- Polymerase chain reaction- DNA basically, skin biopsy of rash or eschar, or EDTA - unclotted blood- to identify specific cells.
Treatment of Rickettshial?
Standard CDC regimen consists of 200mg of Doxycycline daily for 3-14 days. For children 2.2 mg/kg body weight per dose admin twice daily orally or IV for children under 100lb. Antibiotics of the tetracycline class have a high degree of efficacy and low toxicity in the tx of Ricketts
PATIENTS SHOULD BE TREATED FOR AT LEAST THREE DAYS AFTER THE FEVER SUBSIDES!!
Ingestion of fecal matter from persons with Hep A. Incubation period is 15-50 days. Rarely fatal. IgM Anti HAV test for acute infection to properly diagnose.
Contact with infectious blood, semen, and other fluids through birth, sexual contact, needles/syringes/or other drug equipment, needlesticks, tattoos. Incubation perioud is 45-160 days. Specific Test include: HBsAg and IgM anti-HBc for acute only.
Contact with blood of an infected person through sharing of contaminated needles, syringes, or other IV drug equipment use. Incubation period is 14-180 days. Specific test are not currently available for acute infection
Symptoms for Hepatitis (ALL) include:
Fever, Fatigue, Loss of appetite, Nausea, Vomiting, Abdominal pain, Gray colored stool, Joint pain, jaundice.
True or False: Hepatitis C vaccine should be given at intervals of 0,1,3
FALSE!! there is no Hep C vaccine
How is Yellow Fever transmitted?
YF is transmitted primarily through the bite of infected Aedes or Haemagogus mosquitoes.
Yellow fever has _____ transmission cycles?
3- Jungle - Sylvatic, Intermediate - Savannah, and urban.
Jungle or Sylvatic transmission of YF:
between nonhuman primates and mosquito in the forest. then from infected mosquito to humans.
Intermediate or Savannah transmission of YF:
transmission of virus from mosquitoes to humans living or working in border areas. again from monkey to mosquito to humans.
Symptoms of Yellow Fever:
Incubation period is usually 3-6 days in which patients have no illness or only mild illness. Initial symptoms include, fever, chills, severe headache, back pain, general body aches, nausea, and vomiting, fatigue, and weakness with initial improvement of symptoms. After brief remission or improvement of hours to days, 15% of cases progress or develop high fever, jaundice, bleeding, and eventually shock and failure of organs.
Treatment of Yellow Fever:
No specific treatments have been found to benefit patients with yellow fever. AVOID ASPIRIN AND NSAIDS!!!
Nerve agents are potent what?
Organophosphates which stimulate muscarinic and nicotinic stimulation.
Symptoms of Nerve Agent Exposure:
Muscanaric and nicotinic overstimulation:
abd pain, diarrhea, vomiting, excessive salivation, sweating, bronchospasms, copious brochial secretions, muscle fasciculations, weakness and respiratory distress. Seizures, tachycardia or bradycardia may be present.
One of the most important treatments in nerve gas exposure is...
to remove the patient from the source of the
. What are the goals of decontamination?
To prevent the absorption of the toxin in the
victim and prevent secondary exposure to
health care providers.
What chemical agent detector paper can be used to detect and identify V- and G-type nerve agents and H type blister agents?
M8 Chemical agent detector paper.
M256 chemical agent detector kit can detect and identify vapor of what agents?
Nerve, Blister, and Blood agents
What kit should be used on the skin to decontaminate?
M291 or M258 skin decon which contains six packets; enough to complete three skin decons.
In place of the M291 what may be used in an emergency or shortage?
A 0.5 percent chlorine solution to wash toxic agent out of cuts or wounds.
GA, GB, GD,VX(US)
ATROPINE (6 MG FOR NON MEDICAL) 2 MG DOSES FOR MEDICAL PERSONNEL TILL ATROPINIZATION. DRY MOUTH AND TACHYCARDIA
Treatment of chemiclal agents casualties and convental military chemical injuries appendix b; Chapter 6
The protective mask with a fresh filter gives protection
against field concentrations of blood agent vapor. For
protection, MOPP 4 is needed when exposed to or
handling liquid AC.
Hydrogen cyanide is a
colorless, highly volatile liquid with a density 30
percent less than water. It boils at 70°F (26.5°C) and
freezes at 7°F (-13.3°C). It is highly soluble and
stable in water.
This is a colorless, highly
volatile liquid with a density 18 percent greater than
water.irritating to the eyes and mucous membrane surfaces.
AC Cyanogen Chloride.
inhaled in a few breaths may be enough to cause immediate death without anatomical changes also causes the skin to have a pink color
similar to that seen in carbon monoxide (CO)
SIgns and sympotoms of AC ( Cyanogen CHoride)
occur after 20 to 30 seconds with cessation of
respiration within one minute.
Ck (cyanogen chloride)
stimulates the respiratory center
and then rapidly paralyzes it.immediate intense irritation of the nose, throat, and
eyes, with coughing, tightness in the chest, and
Usually death occurs
rapidly or there is prompt recovery. smells like bitter
almonds during a chemical attack, put on your musk
In AC or CK
sodium nitrite and sodium thiosulfate by iv--- ONLY be administered by IV. Intravenously inject
10 ml of a 3 percent solution (300 mg) of sodium
nitrite over a period of 3 minutes. Intravenously inject
50 ml of a 25 percent solution (12.5 gm) of sodium
thiosulfate over a 10-minute period. it produces methemoglobin.
Disposition of Contaminated Clothing
overgarments and rubber gloves, are transferred to
this dump as conditions permit
The medical officer should notify the proper
authority of the
Existence of the dump for contaminated
clothing and blankets.
Exact location and size of the dump.
Type of chemical contamination
Disposition of Contaminated Gloves
and Chemical Protective Overgarments
Air, Land, and Naval Operations.
(1) Contaminated gloves and overgarments
are placed in a closed plastic bag and segregated for
operations at sea, contaminated clothing and materials are dumped over the side. In port, store items in metal cans with tight-fitting lids or airtight plastic bags for later disposal
Immerse heavily contaminated articles in hot soapy water at a temperature just below boiling for 1 hour
Decontaminate the mask
using the M291 Skin Decontaminating Kit or the
M258A1 Skin Decontamination Kit
For thorough decontamination, soak shoes, straps, andother leather equipment in water heated to 122F to 131F (50C to 55°C)
Care of Litters
Protection. Provide emergency protection of
canvas litters by covering them with materials such as
ponchos, plastic sheeting, or shelter halves.
immersion in boiling water for 1 hour. If available,
add 4 pounds of sodium carbonate (washing soda) to
each 10 gallons of water.
Verify Completeness of Decontamination
Monitor Decontaminated Equipment. Use the
Chemical Agent Monitor (CAM)
Avoid pregnancy ____ months after varicella and ____ months after all other vaccines
1 month and three month
Commanders, COs, and OICs ensure what
all personnel under their jurisdiction receive required immunizations
Who is resposnible to maintain international, federal, state, and local records of all required immunizations?
Commanders, COs, and OICs
When someone trasnfers the Commander, CO, or OIC ensures what?
The person receieves any appropriate immunizations for the area which assigned
Who ensures that policies and procedures for creating and maintaining immunization record are followed?
MTF Commanders, COs and OICs
Who must be immediately available when immunizations are being given?
any person who is basic cpr certified
If someone presents with a hypersensitivity to an immunization, what is done?
They are deferred, adn then referred to an allergy specialist.
Recruits receive what shots?
-adenovirus types 4 and 7
-oral polio virus
When deploying or traveling to high risk areas personnel may receive?
- JE vaccine
What precautions must a female take if she is given a live virus vaccine?
avoid becoming pregnant for 3 months
what prevention counseling is given about malaria
mosquito avoidance, personal protective measues and chemoprophylaxis
During what period of duty must personnel have documentation of a TST?
Excess of 30 days when first entering duty.
Whom do screenings into the Naval Service apply to?
Navy, Naval Reserve, Marine Corps, Marine Corps Reserve, and CIVMARs for Military Sealift Command.
Which personnel are required to have annual screenings?
Personnel in operational units that may have high risk of TB exposure.
For periodic screenings, to whom screenings do NOT apply to?
A)Active Duty and Civil Service
C)Health Care Workers
D)Medical/Dental facility workers(not MEDICAL staff)
B) Ready Reservists
For Triennial Screening, which personnel only need a screening every 3 years.
Active Duty and Reserve shore based personnel in the U.S. that are in low risk areas.
During which appropriate times should periodic testing be done?
2)Receipt of PCS orders
3)Review of medical records
4)Reporting for A.D. training
When entering/separating from Naval Service, when should a chest x-ray be done for TB screening?
When diagnosis or evaluation of suspected TB.
When are chest x-rays indicated?
A)Newly identified TB reactor
B)Active disease is suspected
C)Previous TB reactor with known contact with disease
D)All of the above
D)All of the above
When are chest x-ray not indicated?
When previous known TB reactor have annual evaluations and are asymptomatic or if they're TB non reactors.
When should there be screenings for dependents?
When there are dependents living in high risk areas of TB.
What are the strengths for PPD injections?
Premixed Tween-80-stabilized intermediate strength(5 TU) and low strength(1 TU).
What procedure is not used except on the specific recommendation from NAVENPVNTMEDU due to it's high numbers of false-positive/negative results?
Multiple puncture TB tests (Tine or Monovac tests)
What type of syringe and size of needle should be used for administration?
1 ml TB syringe with .1ml intervals and fitted with a 25-gauge 5/8in needle.
For PPD administration, what is NOT to be used as a form of administration?
hypodermic jet injector.
What is the preferred dose and strength used for a PPD administration?
.1ml of intermediate strength (5 TU)
After PPD administration into the forearm and no wheal appears on skin can indicate_____
PPD was injected subcutaneously. Another PPD test should be administered on the second arm.
What form should results be recorded on and what information is needed?
SF 601 under Sensativity Tests with Date, Type and strength, and diameter of induration.
What should NOT be entered if measurements are less than 5mm?
"nonsignificant" or "zero" or similar phrases. "zero mm" is what needs to be entered if no induration.
If a measurement is between zero and 14mm after 72hrs, what should be documented?
"not read" on SF 601
If measurement is greater than 15mm after 72hrs, but before or on the 10th day, what actions must be done?
Manage person as a TB reactor since results are significant.
If person reports back more than 10 days, what should be documented?
"not read" on SF 601 regardless of size of measurement. Apply another PPD test on opposite arm.
What should be done if the rate of newly identified reactors are greater than 2.5% among any group tested?
Consider searching for an active case of TB in the command.
What is the meaning when a significant reaction is reported with a 5 TU PPD test for a person with a history of a BCG vaccine?
Infection with Mycobacterium Tuberculosis
When should a low strength PPD(1 TU) be administered?
Person gives history of significant or severe reaction.
When administering a low strength PPD(1 TU), what measurement is considered significant?
Greater than 5mm.
What should be done when a measurement is less than 5mm for a low strength PPD?
Immediately apply an intermediate strength (5 TU)
What is the procedure for two step testing to reduce the likelihood of a boosted response?
Apply a first test, if results are not significant apply a second test a week later. If second test is significant, manage person as infected.
What is ESSENCE?
Early Notification of Community based epidemics- is a tool for local use to ascertain growth and spread of particular syndromes.
Importance of Med surveillance
Surveillance information is critical in both preparing for and responding to public health emergencies.
is critical in identifying emerging or re-emerging infectious diseases that pose a substantial risk of a significant number of human fatalities or severe disabilities.
Who ensures MTFs maintain an effective command medical surveillance program?
Pertaining Navy Medical regional Commands
What is the minimum staffing for ESSENCE monitoring?
ESSENCE monitoring requires a min of two MTF staff members to check ESSENCE at least once each routine workday.
Navy Marine Corps Public Health Center (NMCPHC) conducts analysis of ESSENCE how often?
Shall conduct quarterly analysis of ESSENCE data to maintain situational awareness of long term trends and identify areas for improvement.
NMCPHC shall provide reports to Navy Medicine Regional Commanders when?
NMCPHC shall provide reports monthly describing MTF monitoring compliance.
MER analysis is performed when?
Annually and published quarterly to examine navy and marine corps trends.
Definition of "outbreak"
An outbreak is defined as the occurrence, in a community or region, of cases of an illness or other health related events in excess of normal expectancy.
How long must routine QA program related documents be maintained in a secure location?
Five (5) years before disposal
How long must QA program related documents related to a potentially compensable event and JAG investigation be maintained in a secure location?
Minimum of two (2) years or as long as needed thereafter.
What are the eight (8) program objectives in summary?
1) Systematically monitor services 2) Identify, assess, and decrease risk. 3) Justify resources needed to exceed acceptable standards of PT care. 4) Communicate important QA info to effect clinical decision making at all levels. 5) Integrate, track, and trend QA information. 6) Support credentials review and privileging activities. 7) ID edu and training needs. 8) Gain and sustain compliance with Joint Commission accreditation standards.
Program minimums include:
1) Program objectives 2) Organization and responsibilities. 3) Scope of QA program and customer input. 4) required QA functions including what is to be done by whom and when. 5) Information flow and review needs. 6) Annual review of program. 7) Methodology by which data is generated.
When is a record considered delinquent following discharge from inpatient care?
If all required record components are not completed within 30 days of PT discharge it is considered delinquent.
What is considered a deficiency?
The state in which there is a variance from preestablished minimally acceptable standards of care.
what is a Nosocomial Infection?
An inpatient acquired infection not present or incubating at the time of admission. It is considered Nosocomial if the infection becomes apparent 72 or more hours after admission.
What is a potentially compensable event? (PCE)
An event or outcome during the process of med or dental care in which the pt suffers lack of improvement, injury, illness of severity greater than ordinarily experienced by pt with similar proc or illness.
Example includes falls with lacerations or fractures with a delayed union of fracture. DELAY