Do you have a copy of the Entomological and Zoonotic Operational Risk Assessment (EZORA) for the country where you are deploying?
Have you checked out the NCMI IDRA for the country where you are deploying?
Another good source of hazard information is the Armed Forces Pest Management Board (AFPMB) Disease Vector Ecology Profiles (DVEP). Is there a DVEP for the country where you are deploying?
What is the potential impact of each endemic vector-borne and zoonotic disease on the operation?
The EZORAs and NCMI IDRAs include risk assessments. These risk assessment products are on a countrywide basis; therefore, you should consider making an assessment for the specific region within the country of your deployment. As an example, for malaria, examine sources such as the NCMI Malaria Risk map, Walter Reed Biosystematics Unit (WRBU) VectorMap, Centers for Disease Control and Prevention (CDC) interactive malaria map, and World Health Organization (WHO) reports.
In addition, identify other hazards that Soldiers may encounter such as biting and stinging arthropods, venomous snakes and scorpions, poisonous plants, wild and stray animal, and potential pesticide exposure from contaminated industrial and agricultural sites. Therefore, in addition to diseases listed in the EZORA/IDRA, list other potential environmental, entomological and zoological hazards.
Are the Command Surgeon and the medical staff aware of entomological and zoonotic threats and their potential impact on the operation?
Does the current Preventive Medicine (PM) Annex to the Operation Order (OPORD) contain medical threat information, or have PM personnel received a medical threat briefing? Does the medical threat brief include the entomological and zoonotic threats?
Force health protection issues that must be addressed during pre-deployment planning:
Based on the initial hazard assessment and the anticipated exposure during the deployment, formulate pre-deployment Force Health Protection (FHP) recommendations through appropriate medical chain of command to include:
Inclusion of a qualified entomologist, supportive PM personnel and appropriate equipment for surveillance and control measure in support of the deployment.
Procurement and distribution of personal protective equipment (PPE) such as insect repellents, permethrin-treated bed nets and other PPE items as necessary.
Field Sanitation Teams (FSTs): FSTs provide unit level PM support and are responsible for teaching Soldiers how to use protective measures, issue skin and clothing repellents and monitor their use, provide timely feedback to the commander regarding compliance, and coordinate with Division or Corps PM assets.
Are unit FSTs manned?
Each company-sized unit or equivalent is required to have an FST.
Are FSTs ready?
FST personnel must be trained and equipped to handle the identified vector-borne disease threat.
Individual Protection: Individual force protection measures include the use of DoD Insect Repellent System (skin and clothing repellants and proper wearing of uniform), sleeping under treated bed nets, chemoprophylaxis, and vaccination.
Do the units have an adequate supply of DoD approved skin repellents?
FM 4-25.12 (Unit Field Sanitation Team) requires 4 tubes per person be pre-stocked for use by the FST.
Have Soldiers’ issued Army Combat Uniforms (ACUs) that are factory treated with permethrin (ACU Permethrin)?
If not, do units have an adequate supply of IDA kits? FM 4-25.12 requires 4 IDA kits per person be pre-stocked for use by the FST.
Have bed nets been issued to personnel?
If not, do units have an adequate supply on-hand?
Are bed nets treated with permethrin?
If not, do units have an adequate supply of aerosol permethrin spray? FM 4-25.12 requires 1 can of aerosol permethrin spray per person be pre-stocked for use by the FST.
Are Personal Protective Measures (PPM) items taken on all deployments?
Prevention of arthropod vector bites remains the best method to reduce the burden of vector-borne diseases on the military and military health care system. History has shown that disease outbreaks occur when units encounter a highly focal area of vectors/disease during deployments that were not expected. Even in areas relatively free of vector-borne diseases, exposures to biting arthropods have caused many casualties from secondary infections and allergic reactions. Guidance on personal protection from arthropods and other invertebrates can be found in the AFPMB TG 36 (Personal Protective Measures Against Insects and Other Arthropods of Military Significance ; and US Air Force Guide to Operational Surveillance of Medically Important Vectors and Pests "Operational Entomology" .
Prophylactic antimalarial regimens must be started before deployment (up to two weeks) to be effective.
Has "reach back" expertise been identified?
These persons can provide assistance when a problem or unexpected hazard is encountered during the deployment. Contact these persons during pre-deployment planning to help with developing the sampling plan and identifying the supporting PHC region or vector specific sampling equipment requirements.
Has a sampling plan for vector surveillance for each of the identified threats been prepared?
A sampling plan should be developed during pre-deployment planning. If a vector-borne disease hazard/risk has been identified in the IDRA/EZORA, then sampling of the vector must be conducted at the deployment site. Keep in mind that the risk level in the IDRA/EZORA is an ESTIMATE, and the risk level will get impacted by many other factors in any given deployment area. Maintaining the flexibility to collect a wide variety of vectors is a fundamental component of a thorough sampling plan. The PM assets, once on site, will use this plan to confirm or disprove the potential hazards identified during pre-deployment assessment.
After preparing a pre-deployment sampling plan review the list of items in the standard sampling kit to ensure that items needed for planned surveillance are included.
Do the PM Detachments that will be deployed have all their required TOE and basic load of pesticides and pesticide dispersal equipment on hand to control identified pests/vectors?
See Appendix C, FM 4-25.12, Unit Field Sanitation Team, for the list of supply items for control of arthropods/rodents.
Have provisions been made to record and report pesticide use?
The requirement for recording, reporting, and archiving pesticide use during deployment is addressed in DoDI 4150.07 (DoD Pest Management Program), and DA PAM 40-11 (Preventive Medicine)
Deployment Related Training Videos: The following entomological instructional videos are prepared by the USAPHC, and you can find these videos on our PHC YouTube page:
Access the Reporting Pesticide Use for Archiving page.
Malaria Prevention While Staying in a Malarious Area
How to Apply DEET Insect Repellent
Treating Civilian Clothing with Permethrin
Proper Use of a Bed Net with Poles Over a Cot
Safely Deploy and Secure a Pop-Up Bed Net
CDC Miniature Light Trap Setup
Performing a Tick Drag
How to Treat a Bed Net with Permethrin