Operational Risk Assessment Training ENTOMOLOGICAL HAZARD

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Operational Risk Assessment Training
ENTOMOLOGICAL HAZARD
Richard D. Wells ENTOMOLOGICAL SCIENCES
PROGRAM US ARMY CENTER FOR HEALTH PROMOTION AND
PREVENTIVE MEDICINE
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Entomological Hazard

• Historical Importance of Vector-borne disease
• "This will be a long war, if for every division
  I have fighting the enemy, I must count on a
  second division in the hospital with malaria and
  a third division convalescing from this
  debilitating disease. - General Douglas
  MacArthur

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Entomological Hazard

• Vector-borne disease risk in context with other
  communicable diseases
• Person to person
• Food/Water-borne

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AFMIC Infectious Disease Risk
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Military Entomology

• Entomological hazard encompasses not only vector-
  borne disease but also includes pesticide
  exposure, medically important arthropods,
  medically important animals, and poisonous plants.

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Entomological Hazard Risk Assessment Process

• Hazard Identification
• Hazard Assessment
• Develop Implement Controls
• Individual Force Health Protection
• Unit Force Health Protection
• Supervise and Evaluate

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Hazard Identification

• What military entomological hazards are endemic
  to this area?
• What is the prevalence of human cases in civilian
  population?

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Hazard Identification What military
entomological hazards are endemic to this area?

• First stop AFMIC web site

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Hazard Identification Information Resources

• MEDIC CD

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Hazard Identification Information Resources

• Armed Forces Pest Management Board (AFPMB)
• DVEPs
• -Focus
• Militarily Important Diseases
• Vectors and their Control
• -Includes
• Country Profiles
• Noxious/Venomous Animals
• Plants

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DVEPS Currently Available

• Central Europe (2001)
• East Asia (2002)
• Middle East (1999)
• North Africa (2000)
• South Central Asia (2001)

Bolivia (1998) Colombia (1998) Ecuador
(1998) Haiti (1994) Honduras (1992) Peru
(1998) Somalia (1993) Thailand (1993)
AFPMB Web Page http//www.afpmb.org/pubs/dveps/d
veps.htm
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Hazard Identification Information Resources

• CHPPM Deployment Pest Management
• http//chppm-www.apgea.army.mil/ento/Deployme
  nt/

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Hazard Identification Information Resources

• Travel Health Web Sites
• CDC, WHO, State Department
• http//www.who.int/home-page/
• http//www.cdc.gov/travel/
• http//travel.state.gov/travel_warnings.html

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Hazard Identification What is the prevalence
of human cases in the civilian population?

• Endemicity Included in AFMIC Analysis
• Information Sources
• AFMIC Disease Occurrence Worldwide (DOWW)
• ProMed-mail
• www. isd.org
• CDC, WHO
• http//www.cdc.gov/travel/
• http//www.who.int/home-page/
• DVEPs

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Hazard Identification What is the prevalence
of human cases in the civilian population?

• Caution
• Third world and recently disrupted populations
  may have significantly more human disease.

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Hazard Assessment

• Impact of vector borne disease hazard on the
  operation.
• Operational Risk Assessment Matrix
• Diseases of Greatest Risk - All
• Diseases of Potential Risk - As many as time
  permits

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Risk Assessment Matrix
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Hazard Severity
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Vector-borne Disease Hazard Severity
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Risk Assessment Matrix
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Hazard Probability
Force Protection Measures
Impact of Vector-borne Disease
Low
High
Occasional
Occasional
Likely
Frequent
Frequent
Low
Seldom
Occasional
Likely
Likely
Frequent

Seldom
Occasional
Occasional
Likely
Likely
Unlikely
Seldom
Occasional
Occasional
Occasional
Unlikely
Unlikely
Seldom
Seldom
Occasional
High
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Hazard Assessment Impact of vector borne
disease on the operation

• Will mission put personnel into close contact
  with vectors?
• Will conditions during deployment be favorable
  for disease transmission?
• What is the Incubation Period?

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Hazard Assessment Will mission put soldiers
into close contact with vectors?

• Vector Habits
• Vector Habitat

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Hazard Identification Disease Vector
Appendix F, TG 248
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Africa Malaria Climate Suitability Model
http//www.mara.org.za/
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Hazard Assessment Will conditions during
deployment be favorable for disease
transmission?

• Seasonality
• Recent Weather
• Density of Vector
• Infection Rate

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Malaria Transmission Season
http//www.mara.org.za/
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Hazard Assessment What is the Incubation
Period?

• Short Incubation (lt15 days)
• Long Incubation (gt15 days)

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Develop Implement Controls

• Individual Force Health Protection
• Unit Force Health Protection

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Develop Implement Controls Individual Force
Health Protection

• Personal Protective Measures
• Chemoprophylaxis/Vaccination

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Individual Force Health Protection Personal
Protective Measures
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Individual Force Health Protection Skin and
Clothing Repellents
DEET Lotion
Permethrin

• Individual Dynamic Absorption Kit (IDA)
• Treatment lasts for life of the uniform
• NSN 6840-01-345-0237

• Apply to EXPOSED skin
• One application lasts up to 12 hours
• NSN 6840-01-284-3982

• Aerosol spray can
• Treatment lasts through 5-6 washes
• NSN 6840-01-278-1336

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Personal Protective Measures Skin and Clothing
Repellents

• Do the units have an adequate supply of DEET skin
  repellent?
• Have uniforms been treated with permethrin?
• Are bed nets on-hand, issued with poles, and
  treated with permethrin?
• Contact the Defense Supply Center Richmond (DSCR)
  Emergency Supply Operations Center (ESOC) at DSN
  695-4865 commercial [phone]. This ESOC
  is staffed 24 hours, 7 days per week.

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Develop Implement Controls Individual Force
Health Protection

• Are service members being vaccinated for endemic
  vector borne diseases?
• Has chemoprophylaxis been initiated if there is a
  malaria threat?

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Develop Implement Controls Unit Force Health
Protection

• Preventive Medicine Assets
• Vector surveillance and control

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Unit Force Health Protection Preventive
Medicine Assets

• Field Sanitation Team
• Brigade/Division PM Sections
• Corps Assets
• Area Support Medical Battalion
• Medical Brigade/Command
• Preventive Medicine Detachments
• FORSCOM Regulation 700-2, FORSCOM Standing
  Logistics Instructions

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Unit Force Health Protection Are field
sanitation teams ready?

• Training
• As Trainee
• As Trainer
• Train unit personnel in PPM
• Uniform Treatment

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Unit Force Health Protection Vector
Surveillance/Control

• Requires pre-deployment planning
• Have supporting medical assets been identified?
• Will the medical support be able to provide
  surveillance and control of the hazards
  identified?

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Unit Force Health Protection Vector
Surveillance/Control

• Verify the initial threat assessment(s)
• Initiate control measures

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Hazard Probability
Force Protection Measures
Impact of Vector-borne Disease
Low
High
Occasional
Occasional
Likely
Frequent
Frequent
Low
Seldom
Occasional
Likely
Likely
Frequent

Seldom
Occasional
Occasional
Likely
Likely
Unlikely
Seldom
Occasional
Occasional
Occasional
Unlikely
Unlikely
Seldom
Seldom
Occasional
High
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Supervise Evaluate

• Vector Surveillance
• Assess Unit Field Sanitation

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Supervise Evaluate

• Reevaluate risk
• Recommend revised individual and unit force
  health protection measures as appropriate

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Humanitarian Mission Considerations

• Contact with high risk population
• Diseases associated with displaced people
• Cholera Filth Flies
• Typhus Lice
• Leptospirosis Rodents

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Entomological Operational Risk Assessment
Afghanistan
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Afghanistan Malaria Distribution
2001 WHO AIMS - www.hicfa.itos.uga.edu
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Afghanistan Relief Map
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Afghanistan Elevation Below 2000 Meters with
Malaria Distribution
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Afghanistan Agricultural Areas
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Afghanistan Agricultural Areas
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Afghanistan Agricultural Areas with Malaria
Distribution
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Bamyan Province Cluster of Malaria Cases
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Afghanistan Leishmaniasis Distribution
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Hazard Probability
Force Protection Measures
Impact of Vector-borne Disease
Low
High
Occasional
Occasional
Likely
Frequent
Frequent
Low
Seldom
Occasional
Likely
Likely
Frequent

Seldom
Occasional
Occasional
Likely
Likely
Unlikely
Seldom
Occasional
Occasional
Occasional
Unlikely
Unlikely
Seldom
Seldom
Occasional
High
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AfghanistanEntomological Risk Assessment
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Entomological Hazard Operational Risk Assessment
Any army that does not suffer from 100 diseases
is said to be of certain victory. -Sun Tzu (BC
400-320)