INDIAN ARMY

“THE GREEN BOOK”

FOR
NON MEDICAL OFFICERS

PUBLISHED UNDER THE AUTHORITY OF

CHIEF OF ARMY STAFF
 3-\.
MESSAGE

Multiple military campaigns in history have proven that

uncontrolled spread of diseases can adverselv imDact on the
operal,onal eiftctercy of armes Tl.e.elore, prev;nlon of diseases,
oolh rllectioJs and nonrnfectious. ts tmportant to ensure a1 erfrcierr
and robust Army.

In fieJd, soldiers have increased vulnerability to preveniable

diseases due to a multitude of exogeneous environmental factors like
harsh weather, hilly terrain, isolation, stress of insurgency etc.
Endogenous factors like genetic susceptibility and breakdown of
bodys natural defences can further aggravate the situation. Sotdiers
are expected to operate under conditions of siress and stfain. Those
who get affected are mentalty and physica y weak.

Medical officers must remain pro-active and ensure timely advice

lo commanders at all levels to mitigate health retated problems,
particularly when soldiers operate in harsh terrain and climate
conditions.

Commanders at all levels have a verv imDortant role in

urderctanding these laclors and putting prevenlive measures in prace
to reduce casualties due to ill health.

I am ceftain that this "l\ranual of Health tor Non-l\redical Officers

- The Green Book will serve as an excellent readv reckoner for the
Commanders to safeguard the health of troops and keeD them
fighling fit.

'JaiHind
4t7
(Bipin Rawat)
General
b Lt Gen AshwaniKumar, Adjltanr General's Branch
Inreg€red Ho o MoD (Amy)

>< New Delhi 110 011

MESSAGE

1 The Indlan Arny has always aimed at prcvidiig the hghest level oi
promotive, preventive, curative and rehabilitative heath qre to ils sod ers.
In ihis di€ction. lhe€ is a constani endeavoLr to prcvoe resources b
Commanderslo supportlhem in mainlaining a heallhyforce.

2. The [,lanual of Healih for Non Medi€l OfficeB The Green Book' has been
designed as a comp€hensive document covering all aspects of peventive heath
aclions that €n be laken by Commande6. lt has been con@piualized to provide
leady Gtercnce rof common heallh issues being iaced during pertonnance in

3 lam su€rhatrhe bookwillhelp enhancethe awareness ot preventive health

amongst the lsers and facil tate ils app ication for enhancement ot ove€li state of
hea[h or Indian Amy. This book is available in a user friendly e book fo.mat lor
easy undercland ng and prompt reference. lwould like to compliment the
edltorial team forihe excellenl work.

'Jai Hind'

Ll Gen
Dale : dq Jan 2org
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tn 'h'iq, I|dlF :..@ (i{)

ore Gen Med 6 seruces (Amy)

DcdorGens' MedicarssRices (Amy)
hr.Eared Ho or Mdo (Army)
,L Bock, New Derh ri0001

1. The role oi Army requires maintenan@ ol the highest standards or

tEining and phtsi@l fihess of all pe6of nel Everysick individuaL isa losslo
seryie for lhe duralion of illness and convalescence while invalidmenl and
dedlh resJr n oss o'hqn y valJabe rcined adnpow'r

2. The Afined Forces i,,ledical Setoces are deployed ln suppoft ol all

membe6 of the Indian Army and endeavour lo deliver highest standard of
holislicheathcarewhichbeginswilhlheparadigmof prevention.

3 Commanders ai all leves need lo be conve6anl wilh lhe lenets oI

Mil tarv Preventive Med cine and Public Heallh n order lo render ne@ssary
aclonsfor healih relaled maneB in a timely and proactive manner

4. ThisfiBtedltion ot'The Green Book'has been prepared with ihe aim

of povding heallh relaled informaton to Commanders based on exjstirg
policies in Armed Forces incorporating nallonaland internalionalguidelines

5. The manual cove6 varety of toplcs Enging lrom sale water supply.
iood safety, prevenllon of an borne diseases. prolection fiom veclor borne
diseases, proper disposal ol wasle, mmunizalion againsl diseases,
neasures lo Dreveni lilestvle dseases and slress management to heallh
educalion. I am sure lhs manualwill be an invaluable aid and gulde lo lhe

ft-
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"The art of war is of vital importance to the state. It is a matter of life

and death, a road either to safety or to ruin. Hence under no

circumstances can it be neglected. "

"If you know the enemy and know yourself, you need not fear the

results of a hundred battles. If you know yourself but not the enemy,

for every victory gained you will also suffer a defeat. If you know

neither the enemy nor yourself you will succumb in every battle ........ "

Sun Tzu

THE PHILOSOPHY OF SUCCESSFUL LEADERSHIP IS AS APPLICABLE TO

‘THE FIGHT AGAINST DISEASES’ AS IT IS TO ‘WAR’.

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EDITORIAL TEAM

Maj Gen Reena Bharadwaj, VSM, ADGMS (IS, H & PS)

Col Vani Suryam, Col Med (Health)
Lt Col Harpreet Singh, GSO 1, Med (ESM)
Maj Gurpreet Singh, OC SHO (L), Jalandhar Cantt
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E BOOK USER’S GUIDE

Dear Reader,

1. Welcome to the world of most cost effective med interventions – the

prevention of diseases through this e-book “The Green book”. The present “Manual
of Health for Non Medical Officers” has been prepared to sp Cdrs at all levels in
prevention and control of diseases.

2. Efforts have been made to make this e-book user friendly. The reader can
now move to the topic of interest on a click. To elaborate, the moment you reach
links provided in this e-book, the mouse cursor indication will change from routine

symbols to select symbol( ). Clicking on this symbol will help you in the following:-

(a) To open a selected section/ sub section/ appx from the contents page/
list of apendices, click on the section/ sub section/ appx of interest given on
contents page/ list of appendices.

(b) To open contents page from a particular section/ sub section, click on
the title of section/ subsection.

(c) To open list of appendices from a particular appx, click on the title of
the appx.

(d) To open the appx referred in a para, click on the word ‘appx’.

(e) To go back to the para under reference for appx, click on the contents/
table/fig of the appx.

3. Wishing you an enjoyable and learning experience.

Editorial Team
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TABLE OF CONTENTS

Ser No Section Page No

1. Preventable Diseases in Indian Army: Where Are We? 01
(a) Burden of Communicable Diseases
(b) Burden of Lifestyle Diseases
(c) Leading Causes of Hospitalisation and Death
(d) Environment and Terrain Related Diseases - Situational
Analysis
2. Ensuring Safe and Wholesome Water: Prevention and 08
Control of Water Borne Diseases
(a) Diseases Related to Water Supply
(b) Role and Responsibilities in Relation to Water Safety

(c) Establishment of Field Water Point

(d) Water Disinfection
(e) Water Surveillance
(f) Water Safety During Move
(g) Swimming Pool Sanitation
3. Food Safety: Prevention and Control of Food Borne 18
Diseases
(a) Understanding Food-Borne Diseases
(b) Role and Responsibilities in Relation to Food Safety

(c) Ensuring Food Safety in Cook Houses

(d) Hygiene Aspects Related to Food Handlers
(e) Control of Flies, Cockroaches and Rats
(f) Food Safety During Move
4. Prevention and Control of Air Borne Diseases 27
(a) Air Borne Diseases
(b) Prevention of Air Borne Diseases
(c) Actions to be Undertaken in Unit on Occurrence of a Case/
Outbreak of Air Borne Diseases
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TABLE OF CONTENTS

Ser No Section Page No

5. Effective Measures Against Dengue, Malaria and Other 33
Mosquito Borne Diseases
(a) Mosquito Borne Diseases
(b) Role and Responsibilities in Relation to Prevention of
Mosquito Borne Diseases
(c) Measures for Control of Mosquito Breeding
(d) Measures for Control of Adult Mosquitoes
(e) Personal Protective Measures and Discipline
(f) Protection While on Move
(g) Suppressive Treatment for Malaria
(h) Filaria Survey
6. Health Education 44

(a) Principles of Health Education

(b) Fighting HIV/ AIDS on a War Footing: A Template for
Health Education
7. Combating Lifestyle Diseases 48

(a) Lifestyle Diseases

(b) Dietary Recommendations
(c) Physical Activity Recommendations
(d) Prevention of Alcohol Abuse
(e) Reducing Obesity in Indian Army
8. Managing Mental Stress 55

(a) Introduction
(b) Characteristics of a Mentally Healthy Soldier
(c) Stress and Stress Induced Behaviours
(d) Stress Management in Indian Army
(e) Managing Marital Discords
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TABLE OF CONTENTS

Ser No Section Page No

9. Prevention of Snake and Animal Bites 60

(a) Prevention of Snake Bite

(b) Signs and Symptoms of Snake Bite
(c) First Aid Measures: Snake Bite
(d) Prevention of Animal Bite
(e) First Aid Measures: Animal Bite
10. Waste Management 64

(a) Disposal of Human Excreta

(b) Solid Waste Management
(c) Miscellaneous Waste
11. Minimising Terrain and Environment Related Diseases 71
(a) Prevention of Cold Injuries
(b) First Aid: Local Effects of Cold
(c) Prevention of Heat Related Diseases
(d) First Aid: Effects of Heat
(e) Prevention of High Altitude Illnesses
(f) First Aid: High Altitude Illnesses
12. Medical Examination and Medical Boards 79

(a) Medical Examinations

(b) Medical Boards
(c) Injury to a Person Subject to Army Act
(d) Fatal Case Documents
13 Health Education Material 89
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LIST OF APPENDICES

Appendices Page

Section 1. Preventable Diseases in Indian Army: Where Are We?

A Average Duration of Hospital Stay (Communicable Diseases) 04

B Average Duration of Hospital Stay (Non Communicable Diseases) 05

C Leading Causes of Hospital Admissions: All Categories 06

D Top Ten Causes of Mortality : All Categories 07

Section 02. Ensuring Safe and Wholesome Water:

Prevention and Control of Water Borne Diseases
A Diseases Related to Water Supply 13

B Ortho-Toludine (OT) Test to Check Efficiency of Chlorination 14

C Organisation of the Field Water Point 15

D Disinfection of Water 16

E Use of Outfit Water Sterilising Tablets 17

Section 03. Food Safety: Prevention and Control of Food Borne Diseases

A List of Common Food Borne Diseases 22

B Checklist: Receipt, Handling and Storage of Raw Food 23

C Processing and Cooking of Food Items 24

D Daily Food Safety Checklist for Cook Houses 25

E Hygiene Chemicals for Control of Houseflies, Cockroaches and Rats 26

Section 04. Prevention and Control of Air Borne Diseases

A List of Common Air Borne Diseases 31

B Method for Optimising Floor Space Utilisation 32

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LIST OF APPENDICES

Appendices Page

Section 05. Effective Measures Against Mosquito Borne Diseases

A List of Mosquito Borne Diseases 40

B Checklist: Early Identification of Mosquito Breeding 41

C Hygiene Chemicals and Spraying Equipment for Control of Mosquito 42

Borne Diseases
D Treatment of Mosquito Nets 43

Section 07. Combatting Lifestyle Diseases

A Food Pyramid 54

Section 10. Waste Management

A Shallow Trench Latrine 69

B Deep Trench Latrine 70

Section 12. Medical Examination and Medical Boards

A Age Wise Schedule of Medical Examination for Officers 86

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SECTION 01. PREVENTABLE DISEASES IN INDIAN ARMY: WHERE ARE WE?

References: - (a) Annual Health Report 2016. Directorate General Medical

Services (Army).

Appendices: - A: Average Duration of Hospital Stay (Communicable

Diseases).
B: Average Duration of Hospital Stay (Non Communicable
Diseases).
C: Leading Causes of Hospital Admission: All Categories.
D: Top Ten Causes of Death: All Categories.

GENERAL

1. Understanding disease burden is pre-requisite to devp org will among Cdrs at

all levels for prevention and control of preventable diseases.

2. Lifestyle Diseases. More than half of Army str is in the age gp 30-44 yr. This
age gp is known to be at high risk for onset of lifestyle diseases (Heart diseases,
Diabetes, Hypertension, etc). Therefore, Cdrs at all levels are reqd to impl effective
lifestyle interventions to prevent lifestyle diseases.

3. Environment and Terrain Related Diseases. Dply of troops in extreme

climatic conditions (cold, high alt, deserts, etc) necessitates strict impl of accln
schedule and preventive measures among all rks for minimising loss of trained
manpower.

4. Communicable Diseases. The overall admission rate has frequently shown

incr in months of Jul to Oct. These trends imply need for enhancing routine health
and hyg measures during seasonal peak txn pds for prevention and control of
communicable diseases viz. mosquito borne diseases, food and water borne
diseases, etc.

AIM

5. The aim of this section is to discuss burden of preventable diseases in the

Army.

LAYOUT

6. This section is divided into the following parts:-

(a) Part I : Burden of Communicable Diseases.

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(b) Part II : Burden of Lifestyle Diseases.

(c) Part III : Leading Causes of Hospitalisation and Death.

(d) Part IV : Environment and Terrain Related Diseases -

Situational Analysis.

PART – I: BURDEN OF COMMUNICABLE DISEASES

7. Man Days Lost on Occurrence of Communicable Diseases. Review of

communicable diseases leading to hospitalisation in Army is given as appx A to this
section. On an average, more than half a month of trained manpower is lost due to
hospitalisation resulting from preventable diseases such as Viral Hepatitis,
Tuberculosis, Leprosy and Chicken Pox. Instituting preventable measures against
these diseases results in gain of addl manpower as well as maint of high morale of
the troops.

PART – II: BURDEN OF LIFESTYLE DISEASES

8. Man Days Lost on Occurrence of Non Communicable Diseases. Review

of non communicable diseases leading to hospitalisation in Indian Army is given as
appx B to this section. Hospitalisation due to diseases such as Alcohol Dependence
Syndrome, psychiatric disorders, and lifestyle diseases contributes to approx half a
month of manday loss with each hospitalisation. Most of them being preventable,
should be dealt by incr awareness levels among all rks with regard to preventive
actions and should be placed as KRAs by Cdrs at all levels for a fighting fit forces.

PART – III: LEADING CAUSES OF HOSPITALISATION AND DEATH

9. Top Ten Causes of Hospital Admission and Death. Review of top ten
leading causes of hosp admission and death is given as appx C and appx D to this
section respectively. Injury NEA resulting from RTAs, falls, etc is the leading cause
of hospitalisations as well as deaths due to non op causes in the Army. Institution of
adequate and timely preventive and control measures against these diseases can
drastically reduce disease burden in the Army.

PART IV: ENVIRONMENT AND TERRAIN RELATED DISEASES:

SITUATIONAL ANALYSIS

10. Cold Injuries. The decadal trend shows that morbidity due to effects of cold
has remained more or less same. The monthly trend in morbidity due to effects of
cold clearly shows seasonal variation with more cases in winter months.

11. Effects of Heat. Incidence of effects of heat has shown a significant incr in
the cat of cadets. Morbidity due to effects of heat shows seasonal variation with
more number of cases in summer months of May to Sep.

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12. Effects of High Altitude. Percentage of Army str posted to high alt has
shown an incr in the recent years. High alt related illnesses such as High Alt
Pulmonary Oedema (HAPO), High Alt Cerebral Oedema (HACO), etc leads to
hospitalisation as well as death among army pers. Prevention by accln and
subsequently preventive measures against these illnesses will go a long way in
prevention and control of diseases resulting from effect of high alt.

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Appendix ‘A’
(Refer para 07 of Section 01)

AVERAGE DURATION OF HOSPITAL STAY

(COMMUNICABLE DISEASES)

Ser No Disease Days Preventive

measures
1. Viral Hepatitis 17.70 Available

2. Tuberculosis 15.73 Available

3. Leprosy 14.14 Available

4. Chicken Pox 13.54 Available

5. Influenza and Pneumonia 11.62 Available

6. HIV/ AIDS 11.24 Available

7. Zoonotic Diseases 10.75 Available

8. Enteric Gp of Fevers 10.14 Available

9. Malaria 9.80 Available

10. Acute Respiratory Infections 8.32 Available

11. Intestinal Infectious Diseases 8.05 Available

(Excl Salmonella, Cholera &
Food Poisoning)
12. Cholera and Food Poisoning 6.33 Available

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Appendix ‘B’
(Refer para 08 of section 01)

AVERAGE DURATION OF HOSPITAL STAY

(NON COMMUNICABLE DISEASES)

Ser No Causes Days

1. Substance Abuse incl Alcohol Dependence Syndrome 15.13

2. Psychiatric Disorders (Excl Substance Abuse ) 14.40

3. Diabetes Mellitus 12.80

4. Chronic Obstructive Pulmonary Disease 11.26

5. Anemia, Malnutrition, Obesity, Gout (Metabolic) 10.99

6. Hypertensive Diseases 9.83

7. Injuries Due to NEA 9.74

8. Neoplasms 9.63

9. Obesity 8.92

10. Ischemic Heart Diseases 7.11

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Appendix ‘C’
(Refer para 09 of section 01)

LEADING CAUSES OF HOSPITAL ADMISSION: ALL CATEGORIES

Ser No Diagnosis Rate per 1000

1. Injuries Due to NEA 17.77

2. Disease of Musculoskeletal System & 8.45

Connective Tissue
3. Chicken Pox 4.66

4. Diseases of Urinary System 4.29

5. Hypertensive Diseases 2.91

6. Viral Hepatitis 2.78

7. Psychiatric Disorders 2.64

8. Acute Respiratory Infections 2.53

9. Intestinal Infectious Diseases 2.10

10. Infection of Skin & Subcutaneous Tissues 2.05

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Appendix ‘D’
(Refer para 09 of section 01)

TOP TEN CAUSES OF MORTALITY: ALL CATEGORIES

Ser Disease Rate per

No 1000
1. Injuries Due to NEA 0.44
2. Diseases of Heart (Excl IHD) 0.11
3. Ischemic Heart Disease (IHD) 0.10
4. Cause Unknown 0.09
5. Neoplasms 0.09
6. Injuries EA (Incl BC) 0.08
7. Diseases of Liver, Pancreas & Intestine 0.04
8. Cerebrovascular Diseases 0.03
9. Septicemia 0.03
10. Disease of Urinary System 0.01

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SECTION 02. ENSURING SAFE AND WHOLESOME WATER: PREVENTION AND

CONTROL OF WATER BORNE DISEASES

References: - (a) AO 165/79: Duties and Responsibilities in Relation to

Health of Service Personnel and Families
(b) AO 25/2004: Prevention of Food and Water
Borne Diseases
(c) The “Red Book”: Public Health and Preventive Medicine
for the Indian Armed Forces.

Appendices: - A: Diseases Related to Water Supply.

B: Ortho-Toludine (OT) Test to Check Efficiency of
Chlorination.
C: Organisation of the Field Water Point.
D: Disinfection of Water.
E: Use of Outfit Water Sterilising Tab.

GENERAL

1. Enteric Gp of water borne diseases are 12th leading cause of hospitalisations

in Army. Their occurrence, whether as isolated cases or as outbreaks, causes
approx. 10 days of trained manpower loss with every hospitalisation. However,
majority of these illnesses can be prevented. It is, therefore, imperative to obs
meticulous preventive measures to obviate their occurrence.

AIM

2. The aim of this section is to discuss measures which must be undertaken by

Cdrs at all levels for prevention and control of diseases related to water among all
rks and their families.

LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Diseases Related to Water Supply.

(b) Part II : Role and Responsibilities in Relation to Water

Safety.

(c) Part III : Establishment of the Field Water Point.

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(d) Part IV : Water Disinfection.

(e) Part V : Water Surveillance.

(f) Part VI : Water Safety During Move.

(g) Part VIII : Swimming Pool Sanitation.

PART – I: DISEASES RELATED TO WATER SUPPLY

4. Health may be affected either directly by consuming contaminated water or

indirectly through food chain and by use of water for recreational or other purposes.
Detl list of water borne diseases with their common symptoms is given as appx ‘A’ to
this section.

PART – II: ROLE AND RESPONSIBILITIES IN RELATION TO WATER SAFETY

5. The provn of adequate and safe water sup is an imp resp of every Cdr for
maint of health and fighting efficiency of troops. The Engrs/ MES are resp for the sup
of safe and wholesome water. The med auth are resp for the advice wrt safety and
procedure to render water safe for consumption.

6. Duties and Responsibilities of Station Commander. OC Stn is resp for all

measures necessary for maint of health of those in the stn and prevention of
diseases. In addn to duties and resp as laid out in AO 165/79, it is recom that the Stn
Cdr ensure the following for prevention and control of water borne diseases :-

(a) Familiarisation with the existing problems related with water sup in the
stn. Inputs should be obtained from local GE and OC SHO/ FHO/ DADH/
ADH. A vis to the water pts, water treatment plant and sewage treatment plant
along with local GE and OC SHO/ DADH/ ADH should also be undertaken.

(b) Stn Health Committee meetings should be ensured regularly on

monthly basis. These meeting should be attended by Stn Cdr, COs/ OsC
units, SEMO, local GE and the Cantt Executive Offr.

(c) Regular feedback from both local GE and OC SHO/ FHO should be
obtained to assess efficiency of preventive measures in stn.

7. Duties and Responsibilities of COs/ OCs Unit. The overall resp of impl
various instr for prevention of water borne diseases is that of the COs/OCs of the

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10

resp units. Further to AO 165/79 and AO 25/2004, resp of COs/ OCs incl the
following :-

(a) A unit offr should be detl for performing duties as Unit Hyg and San
Offr alongwith Unit Hyg and San Squad. In addn, trg of the squad should be
carried out with asst of SHO/ FHO/ Health Section.

(b) In fd areas, where central water pt has not been est by the Engrs, the
COs should take advice of RMO regarding selection of source and purification
of water.

(c) Feedback on preventive activities carried out by the Unit Hyg and San
Squad should be taken on a regular basis.

8. Duties and Responsibilities of Unit Hygiene & Sanitation Squad. A

dedicated str of 04 NCOs and 06 ORs (major units) or 02 NCOs and 03 ORs (minor
units) with 100% res should be trained in hyg, san and water duties. The same
should wk under unit hyg and san offr, usually being unit QM. This squad should
undertake following activities for ensuring water safety in the unit:-

(a) Daily checking of free chlorine levels using a colour test or OT test in
coord with med auth. Detl of OT test are given as appx ‘B’ to this section.

(b) In case, NIL free chlorine is detected in a water sample, Stn HQ, MES/
Engrs and med auth to be info imdt for corrective measures. Use of
household methods of purification such as boiling and/ or alt sources of water
should be used until water is declared fit for consumption by med auth.

(c) Bacteriological exam of water samples from all loc in AOR carried out
atleast once in a month and record of the same maint.

(d) All troops during ptlg, op mov, ex, mov by rail/ rd, etc should be issued
‘Indl Outfit Water Sterilizing’ (OFWS) tab and its use should be ensured.

(e) No water from unauth sources should be issued/ used in the unit.

(f) Smaller overhead tk in cook houses/ bath houses, water storage ctn,
gharas / chatties, water coolers, etc. should be cleaned under unit arrng, once
a month.

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11

(g) Gharas/ chatties should be kept covered at all times. A suitable dipper
adequately protected from dust and flies should be provided with each
drinking water ctn.

PART III: ESTABLISHMENT OF THE FIELD WATER POINT

9. On active service in the fd, water pts are org under the adm of the Corps of
Engrs. The med services in the fd coord with Engrs in selection of a proper water
source and water collecting pt. A schematic dia of org of field water pt is given as
appx C to this section.

PART IV: WATER DISINFECTION

10. Disinfection of water in fd is usually carried out using water sterilising powder
(WSP). Detl of steps involved in manual disinfection of a water source are given as
appx D to this section.

PART V: WATER SURVEILLANCE

11. Water svl in units should be based on two modalities with good record
keeping. Firstly, daily checking of free residual chlorine should be done in a manner
so as to cover the entire unit area in a week. Secondly, bacteriological exam of water
samples should be carried out once a month.

PART VI: WATER SAFETY DURING MOVE

12. Cdrs at all levels should ensure that bodies of troops mov by rail or rd,
undertake all necessary precautions for prevention of food and water borne
diseases, as laid down in AO 25/2004. In addn, the following specific precautions
should be obs:-

(a) Water from the rly stn should be obtained only from auth sources. Info
regarding safety of water source can be obtained from the local SEMO/ MCO/
Rly auth.

(b) All pers should be issued adequate quantity of OFWS tab. An

endorsement to this effect should be made in the mov order/ leave cert of the
indl. Method of use of OFWS tab is given as appx E to this section.

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12

PART VII: SWIMMING POOL SANITATION

13. Swimming pool is utilised for recreational activity on a seasonal basis.

Chlorination and maint of swimming pool is being carried out by Engrs/ MES in coord
with med auth. A few imp considerations in swimming pool san are as under:-

(a) Before opening of swimming pools for use during season, a thorough
maint should be carried out followed by jt insp by engrs and med auth. The
pool should be declared open only after obtaining a fitness cert from med auth
for public safety.

(b) Free chlorine levels should be checked daily half an hr before opening
of swimming pool to public. A residual free chlorine level of 1 ppm should be
maint.

(c) Chloronome as well as aeration chamber should be checked daily for

its functionality. Further, a min of 15% of water should be replaced on daily
basis.

(d) DOs and DON’Ts for the bathers and swimming pool users should be
ensured in letter and spirit and prominently displayed.

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13

Appendix ‘A’
(Refer para 04 of section 02)

DISEASES RELATED TO WATER SUPPLY

Ser No Disease Common symptoms

1. Cholera Sudden onset of profuse, effortless, watery
diarrhoea followed by vomiting, rapid
dehydration, muscular cramps and
decreased urine.

2. Typhoid (Enteric fever) Initially generalised body weakness, coated

tongue and nausea, often with abdominal
pain and constipation or "pea soup" like
diarrhoea, followed by continuous fever for
3 to 4 weeks.

3. Viral Hepatitis Yellow skin or eyes (jaundice), nausea,

abdominal pain, fatigue and fever.

4. Amoebiasis Symptoms vary from mild abdominal

discomfort and diarrhoea to acute
fulminating dysentery and involvement of
liver (liver abscess).

5. Giardiasis Watery diarrhoea alternating with greasy

stools. Fatigue, cramps and belching wind
may also occur.

6. Diarrhoea Passage of loose, liquid stools, usually

more than three times in a day. However,
stools do not contain blood.

7. Dysentery Presentation similar to diarrhoea, however,

stools are blood stained.

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14

Appendix ‘B’
(Refer para 08 (a) of section 02)

ORTHO-TOLUDINE (OT) TEST TO CHECK EFFICIENCY OF CHLORINATION

Pre-requisites.
1. The test should be performed during active water sup and on taps recieving direct
water sup for best results.
2. In fd conditions, this test should be performed everytime after chlorination process
is carried out. However, it should be performed after atleast half an hr of chlorination.
3. Items reqd for the test include a test tube/ ctn and OT reagent (Ord item).

Select a consumer end or a tap whose water sup is to be tested for safety.

Open tap and let it run for 2-3 min.

Take 10 ml of mid stream running water into a test tube/ beaker/ transparent ctn.

Add 01 ml of OT reagent.

Look for immediate change in color (within 10-15 seconds).

Immediate change of color to yellow suggest safe water.

Change in colour at a later time, and not
No change in colour suggests water as
immediate, does not ensure safety of
UNFIT for use. water.

OT TEST KIT

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Appendix ‘C’

(Refer para 09 of section 02)

ORGANISATION OF THE FIELD WATER POINT

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Appendix ‘D’
(Refer para 10 of section 02)

DISINFECTION OF WATER

STEP 01: ESTIMATE BLEACHING POWDER/ WSP REQD FOR

DISINFECTION (HORROCK’S TEST).

STEP 02: ADD CALCULATED AMOUNT OF BLEACHING POWDER/

WSP IN A BUCKET TO PREPARE STOCK SOLUTION.

STEP 03: WAIT FOR 10-15 MINS FOR SEDIMENT TO SETTLE.

STEP 04: TAKE THE SUPERNATANT FLUID FROM THE STOCK

SOLUTION AND ADD IT TO THE WATER REQUIRING TREATMENT.

STEP 05: WAIT FOR 30 MINS AFTER CHLORINATION. CHECK

EFFICACY OF DISINFECTION BY PERFORMING COLOUR TEST
OR OT TEST.

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Appendix ‘E’
(Refer para 12 (b) of section 02)

USE OF OUTFIT WATER STERILISING TAB

CONTENTS.

In the ctn, there are two bottles. Fifty sterilising white tab are
contained in one bottle and fifty taste removing blue tab in second
bottle.

The bottles should be kept tightly corked when not in use.

On approaching a water source, fill water bottle and add one white
tab.

DO NOT consume the prepared solution before half an hr after

constitution. The longer the time pd, the better it is. The water
bottle should be well shaken two or three times during this pd.

When thirsty, add one blue tab and shake it well.

The water is safe for consumption.

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SECTION 03. FOOD SAFETY: PREVENTION AND CONTROL OF FOOD BORNE

DISEASES

References:- (a) AO 25/2004 : Prevention of Food and Water

Borne Diseases.
(b) The “Red Book” : Public Health and Preventive Medicine
for the Indian Armed Forces.

Appendices:- A: List of Common Food Borne Diseases.

B: Checklist: Receipt, Handling and Storage of Raw Food.
C: Processing and Cooking of Food Items.
D: Hygiene Chemicals for Control of Houseflies,
Cockroaches and Rats.

GENERAL

1. Food-borne diseases are a diverse gp of diseases which are bound together

by the fact that they all are transmitted through a common agency, viz. contaminated
food. Cholera and Food Poisoning lead to hospitalisation of six days on an average.
The occurrence of these diseases can therefore be prevented by ex measures as
regards hyg and san of food.

AIM

2. The aim of this section is to discuss measures which must be undertaken by

Cdrs at all levels for prevention and control of food-borne diseases. These instr will
be applicable to all food service est of the Army, incl various messes and cook
houses, unit wet canteens, and such other eating est.

LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Understanding Food Borne Diseases.

(b) Part II : Role and Responsibilities in Relation to Food

Safety.

(c) Part III : Ensuring Food Safety in Cook Houses.

(d) Part IV : Hygiene Aspects Related to Food Handlers.

(e) Part V : Control of Flies, Cockroaches and Rats.

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(f) Part VI : Food Safety During Move.

PART – I: UNDERSTANDING FOOD-BORNE DISEASES

4. Food-borne diseases usually presents with symptoms related to stomach and

intestines, such as nausea, vomiting, diarrhoea, stomach pain and fever. Detl list of
common food-borne borne diseases is given in appx ‘A’ to this section.

PART – II: ROLE AND RESPONSIBILITIES IN RELATION TO FOOD SAFETY

5. The overall resp of impl of instr for prevention of food-borne diseases is that of
the COs/ OCs of resp units. CO/ OC unit should also provide all asst to inv offrs, in
case of an outbreak/ epidemic. Salient features of resp of CO/ OC unit incl the
following :-

(a) Necessary action to be undertaken at unit level on basis of san insp

findings submitted by RMO/ local med auth. If reqd, Stn HQ/ fmn HQ/ MES
auth should be apch for asst.

(b) San diary to be fwd, after remarks of CO unit, to SEMO/SMO, through

OC SHO or FHO, latest by the tenth day of the next month.

(c) Trg of pers of Unit Hyg and San Squad to be org. Necessary asst from
unit RMO/ local med auth may be taken for the same.

(d) COs/ OCs should ensure that cook house Standing Orders incl provn
of keeping food samples from each meal in refrigerator for upto 24-48 hr after.
These samples are indispensable in finding causative organism and thus
instituting control measures during food-poisoning outbreaks.

PART III: ENSURING FOOD SAFETY IN COOK HOUSES

6. Receipt and Storage of Raw Food Items. Procurement of the correct type
of raw food items and their hyg storage is one of the essential steps in ensuring food
safety and prevention of food-borne diseases. Checklist for measures to ensure safe
and hyg receipt, handling and storage of food items is given in appx ‘B’ to this
section.

7. Processing and Cooking of Food Items. Detl process to be undertaken for

processing and cooking of raw food items is given as appx ‘C’ to this section. In
addn, spl emphasis on the following pts should be undertaken.

(a) Cooking for the next meal should start only after the last serving of
previous meal.

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(b) The total time from end of cooking process to its last serving should not
be more than one and a half hr in summers and not more than two hr in
winters.

(c) Meat, egg and rice dishes should be the last ones to be cooked for any
meal.

(d) No food items left-over be carried over to the next meal.

(e) Meat, chopping block should be cleaned thoroughly with soln of

bleaching powder (made by dissolving 5 g/ one teaspoon of bleaching
powder in 5 ltr of water) followed by rubbing of salt on top surface. Meat
chopper/ knives should not be used for preparing other food items and
should be cleaned by boiling for 15 min or soaking in bleaching powder soln
for half an hr.

8. Storage of Cooked Food Items. Cooked food, as mentioned above, should

not be stored for more than one to two hr. However, if for unavoidable reasons, it has
to be stored for longer duration, the storage should be done in refrigerator. Further,
any such food item should be thoroughly re-heated before consumption (same as
initial cooking process). No cooked food item should be re-stored again as it poses
threat for food poisoning.

9. Items like curds, raita, vegetable salads, ice creams etc which do not need
cooking, should be processed hygienically and stored in a cool place, such as
refrigerator.

10. Sweet dishes which can be served hot (e.g. Halwa, Kheer, Custards, Gulab-
Jamun, etc) should be served hot and fresh.

PART IV: HYGIENE ASPECTS RELATED TO FOOD HANDLERS

11. The term “food handler” includes NCOs i/c cook house, store keeper, chefs,
mess keeper, stewards, bar-men, all indl working in wet canteens and aerated water
factories, and all civ working in cook houses/ messes.

12. All food handlers should undergo med exam by RMO/ AMA once monthly and
the records (incl immunisation) should be prominently displayed in cook houses.

13. No pers should be emp as food handler if he/she has suffered from: -

(a) Viral hepatitis. Till a pd of 3 months from recovery.

(b) Typhoid/ Enteric Fever/ Dysentery. Till 6 negative stool cultures

performed at wkly intervals.

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(c) Diarrhoea/ Vomiting/ Fever/ Sore Throat/ Cold/ Boils/ Furuncles/

Infected Cuts, Abrasion or Wounds/ Jaundice/ Ear Discharge/ Abrasion
or Wounds on Hands or Forearms. Till certified as ‘Free From Infection’
(FFI).

14. The NCO I/C cook house/ wet canteen should undertake visual insp of all
food handlers, every morning and refer suspected cases to RMO/ AMA. Checklist for
food safety is given as appx D to this section.

15. Adequate facilities for washing hands (incl adequate water sup, a basin, soap,
nail brush and clean towels) should be available at entrance of cook houses

16. All food handlers should wash their hands with soap and water on first time
entry into cook house in the day, after use of toilet and after handling refuse,
garbage, left-over food, or raw food items.

17. Food handlers should put on auth cap/ pugree, apron and other protective clo.

PART V: CONTROL OF FLIES, COCKROACHES AND RATS

18. Adequate housekeeping, general cleanliness, proper storage and covering of

raw and cooked food items, proper disposal of kitchen waste, fly proofing and use of
fly swatters/electric insect killers should be ensured to prevent transmission of food
borne diseases.

19. Advice of RMO/local med auth to be obtained and compliance ensured by the
units, as regards use of hyg chem. Hyg chem and their uses for control of flies,
cockroaches and rats is given as appx E to this section.

PART VI: FOOD SAFETY DURING MOVE

20. Cdrs at all levels should ensure that troops mov by rail or rd undertake
necessary precautions for prevention of food borne diseases. A few imp
considerations are as under:-

(a) Procurement of fresh rations during mov should be made only through
the auth ASC sources.

(b) Halts for cooking and serving of meals should be made at places
where safe water sup is available.

(c) Hot meals should always be served.

(d) No leftover cooked item should be carried fwd for the next meal.

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Appendix ‘A’
(Refer para 04 of section 03)

LIST OF COMMON FOOD BORNE DISEASES

Ser No Disease Symptoms Remarks

1. Viral Hepatitis Yellow skin or eyes It may occur due to
(jaundice), nausea, consumption of
abdominal pain, fatigue contaminated food as well
and fever. as contaminated water.
2. Diarrhoea Passage of loose, liquid It can be transmitted from
stools, usually more than one person to another due
three times in a day. to contaminated food,
However, stools do not fingers, flies and fluids.
contain blood.
3. Dysentery Presentation similar to -
diarrhoea, however, stools
are blood stained.
4. Cholera Sudden onset of profuse, Transmission of Cholera is
effortless, watery readily possible at places
diarrhoea followed by with poor environmental
vomiting, rapid san.
dehydration, muscular
cramps and decreased
urine.
5. Typhoid Initially generalised body If not adequately treated,
aches, coated tongue and person can infect others for
nausea, often with long pd of time, despite
abdominal pain and looking apparently healthy.
constipation or "pea soup"
like diarrhoea., followed
by continuous fever for 3
to 4 weeks.
6. Food Sudden onset diarrhoea, Occurs among a number of
Poisoning or vomiting, or both troops who have shared a
accompanied with/without common meal.
stomach pain with or
without fever.

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Appendix ‘B’
(Refer para 06 of section 03)

CHECKLIST: RECEIPT AND STORAGE OF RAW FOOD

PROCUREMENT OF RAW FOOD ITEMS

• From auth sources only.

• LP:- shops/ traders approved by local med auth.
• Prlim exam: Appearance, physical condition, taste and smell.

STORAGE AREA

• Separate, fly proof, cool, dry and spacious with racks and fly proof
almirahs.
• No cooking/ food preparation/ cleaning in storage area.

STORAGE OF DRY RATIONS

• Inside labelled and covered bins.

• Bins kept inside almirahs having 15 mesh wire gauze.
• No item to be stored on the ground or in gunny sacks.

STORAGE OF FRESH ITEMS

• Raw vegetables and fruits:- In containers with open top and sides
with mesh like structure for passage of air.
• Milk, milk products and eggs:- in refrigerator.
• No item to be stored on the ground or in gunny sacks.

SEPARATE MEAT ROOM

• Made of impervious, easily cleanable floor and walls, drainage

present, presence of meat hook, chopping block, chopper and sink
with water sup.
• Raw meat:- In meat chests with zinc sheeting on inside and fly
proof lid of 15 mesh size wire gauge.

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Appendix ‘C’
(Refer para 07 of section 03)

PROCESSING AND COOKING OF FOOD ITEMS

Processing and cooking of food items.

Items eaten without cooking

(e.g., onions, radish, carrots,
tomatoes, coriander / mint Food items eaten after cooking.
leaves, green chilies,
cucumbers, etc).

Scrub food items with both Scrub food items with both hands
hands under running tap water under running tap water or in a large
or in a large basin containing basin containing water.
water.

Peeling/chopping on clean, zinc topped

Keep them soaked in solution table, or such other smooth and
of chlorine for half an hour impervious platform. Never to be
(Prepared by adding one undertaken on the floor or on gunny
teaspoon of bleaching powder sacks.
in 10 litres of water).

Mixing of ingredients, prior to cooking/

Wash under running tap water, kneading of dough on zinc topped table,
to remove chlorinous smell. or platform.

Cooked for atleast five minutes after

Hygienic for consumption. boiling point is reached. Most hygienic
when cooked in pressure cooker,
roasting/baking in hot air oven, or grilling.

Hygienic for consumption.

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Appendix ‘D’
(Refer para 14 of section 03)

FOOD SAFETY FIRST - DAILY CHECKLIST

Any of the following questions answered NO should ensure corrective action.

Food Safety Checklist YES NO

1. Running water available from all sinks?
2. All hand washing pts have soap and towels?
3. Dustbin emptied from previous day food waste/ garbage?
4. Refrigerator/ deep freezer working properly?
5. Items stored in refrigerator hyg and fit for consumption?
6. Adequate soap/ detergent available for dish washing?
Cooking utensils clean, well maintained, and free of physical
7.
defects?
Food prep area thoroughly cleaned with soap, water and bleaching
8.
powder (work surfaces, equipment, utensils etc).
9. Floors of cook houses cleaned with cresol/ disinfectant?
10. No visible spoiled or tainted raw food.
No evidence of insects/ cockroaches/ rats in storage, cooking, and
11.
dining areas.
No pers with ill health on cook house duty (diarrhea, vomiting,
12. jaundice, fever), and Food handlers free of cuts/ wounds on
hands?
All pers working in cook house have med exam done and certified
13.
FFI by med offr?
14. All pers working in cook house have clean clo and short nails.
15. Handwashing practices observed.
16. Cooked food stored in food warmer.
17. No left over food stored for next meal.
18. Sample of all the food items stored for next 48 hr?
Previous samples of food items that have been stored for 48 hr
19.
discarded?
20. Record of daily inspection of food handlers maint?

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Appendix ‘E’
(Refer para 19 of section 03)

HYGIENE CHEMICALS FOR CONTROL OF HOUSEFLIES, COCKROACHES

AND RATS

Ser No Indication Hyg Chem options Instr for Use

1. Housefly Cyphenothrin Solution - 10 ml in 990 ml of water.
breeding
spots Sprayed @ 500ml/m2 surface area.
(eg. Garbage
bins) Diflubenzuron 2.5% Solution - 8g in 1L of water.
WP
Sprayed @ 500 ml/m2 surface area.

2. Imdt destr of Pyrethrum solution Solution:- Recd from

houseflies (0.1%) SHO/FHO/local med units.

Sprayed @ space spray in cook

houses and dining halls, half an hr
after breakfast and at least half an
hr before preparations for lunch
have started.

All food items to be meticulously

covered before spraying.

All doors and windows to be kept

closed before, during, and till half
an hr after spraying.

3. Cockroach Propoxur 2.5% Solution:- Used without dilution.

control solution
Sprayed in moist and dark places.

Boric Acid Baits/sprinkle along corners.

Cyphenothrin Sprayed in moist and dark places.

(0.1-0.5%)
4. Rat control Bromidilone baits To be used under supervision of
RMO/local med auth only.

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SECTION 04. PREVENTION AND CONTROL OF AIR BORNE DISEASES

References:- (a) The “Red Book” : Public Health and Preventive Medicine
for the Indian Armed Forces.
(b) Textbook of Public Health and Community Medicine.
Published by Department of Community Medicine, Armed
Forces Medical College in Collaboration with World
Health Organisation, India Office, New Delhi.

Appendices:- A: List of Common Air Borne Diseases.

B: Method for Optimising Floor Space Utilisation.

GENERAL

1. During ops/ ex/ mov etc, priority is given to safety of troops. Improvisations
for comfort only follow after ascertaining the safety from op pt of view. However, little
realised, that common protection also enhance the exch and proliferation of airborne
diseases. Thus, it is imperative that preventive measures be emphasised and
followed to prevent occurrence as well as for efficient control of outbreaks resulting
from air-borne diseases.

AIM

2. The aim of this section is to discuss measures which must be undertaken by

Cdrs at all levels, for prevention and control of air-borne diseases.

LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Air Borne Diseases.

(b) Part II : Prevention of Air Borne Diseases.

(c) Part III : Actions to be Undertaken in Unit on Occurrence of

a Case/ Outbreak of Air Borne Diseases.

PART – I: AIR BORNE DISEASES

4. Air-borne diseases are those diseases in which infectious organism enters the
body through the respiratory passage. List of common air-borne diseases occurring
in the Army with their symptoms is given as appx A to this section.

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PART – II: PREVENTION OF AIR BORNE DISEASES

5. Maintenance of Ventilation. Since txn of organisms through the air can be

widely dispersed, specific air ventilation is reqd to manage their dispersion and
control outbreaks of airborne infections. Subjectively, it is said that at 0300 hr in the
morning, if no musty or unpleasant odour is perceived inside the bk/ room, the
ventilation is satisfactory.

(a) In routine areas of wk, married accn and OTM accn, adequacy of
ventilation can be ensured by provn of atleast two windows per room (window
area of about 10 percent of the floor space). The windows should be arranged
so as to provide cross ventilation.

(b) In loc where due to shortage of married accn, outliving or living under
own arng is usually resorted to, the CO/ OC unit should ensure hyg, san and
other aspects of the accn.

6. Prevention of Overcrowding. As far as possible, only auth str of pers

should use the accn structure, perm or temp.

(a) The space recom per indl in a bk is min 2 metre of linear wall space or
5 metre² of floor area or 18 m3 of air space, excl any ht above 3.6 metre.
Method of optimising floor space utilisation is given as appx B to this section.

(b) Beds/bunks must be spaced with an interval of atleast 2 metre betn

centres of two adjacent beds. The greater the interval, the better it is.
However, during exigencies of service, these scales may be reduced after a
med review.

7. Personal Hygiene and Etiquettes. A collective effort from each and every
indl is reqd for prevention of diseases. All troops should be educated regarding pers
hyg and etiquettes for prevention and control of air-borne diseases.

(a) Patients suffering from cold, cough, etc should cover their mouth while
coughing and use handkerchief for nasal secretions. The handkerchief should
be washed and dried in sunlight on daily basis, or better still, secretions
should be recd in destroyable paper napkin or tissue paper which should be
burnt. Spitting in open should be strongly discouraged.

(b) Regular handwashing using soap and water is the single most effective
measure against txn of diseases. It should be encouraged among pers for
prevention of air-borne diseases.

(c) Use of common personal items such as towel, handkerchief, combs,

etc should be discouraged.

(d) Prac of keeping the doors and windows closed to keep out heat and
cold should be discouraged. The glass windows should be kept open and wire
mesh windows closed at all times.

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(e) Hanging clo on wiring made for mosquito nets across bks interferes
with exch of air and promotes disease txn. Such prac must be discouraged.
Adequate furniture must be provided as per the scales of accn to keep clo
inside.

(f) Adequate sunlight inside bks and offices is desirable.

8. Avoidance of Dust. All sweeping and dusting must be carried out when the
bldg is unoccupied. Wet mopping of the floors is much better method to prevent air
borne diseases.

9. State of Repairs. Dilapidated floors and walls provide a harbour for dust and
germs. Moist patches and seepage along the walls attend to incr life of germs and
therefore risk of infection.

10. Provision of Charpoy and Use of Mosquito Nets. Provn of charpoy and
use of mosquito nets helps in keeping sleeping pers adequately separated, decr
dissemination of air-borne diseases and incr insulation against cold, either from the
grnd or the atmosphere.

PART III: ACTIONS TO BE UNDERTAKEN ON OCCURRENCE OF A CASE/

OUTBREAK OF AIR BORNE DISEASES

11. The foremost and most imp step to be carried out in the unit on occurrence of
case/outbreak of air-borne diseases is to ensure that a/m routine measures are in
place. Further, specific actions reqd at unit/ sub unit level are as under:-

(a) Measures for adequate ventilation and prevention of overcrowding

should be ensured.

(b) Untreated cases are the most potent source of infection. Therefore,
early diagnosis and treatment/ isolation/ hospitalisation should be carried out
as per advice of local med auth.

(c) The contacts of the patient viz buddy, pers staying in same bk, pers
sharing same room/ gd post, pers dining together, etc should be examined on
daily basis.

(d) System for early iden of cases such as buddy system, daily parade
checks, etc should be developed to minimise duration of outbreak. The time
duration for such activities should be discussed with and adhered to according
to dirns recd from local med auth.

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(e) Mopping of floors using cresol black (Phenyl) to be instituted until the
area is declared outbreak free by local med auth.

(f) Addl measures such as use of facemasks, vaccines, drugs, etc for
curtailing the outbreak should be undertaken according to the advice rendered
by local med auth only.

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Appendix ‘A’
(Refer para 04 of section 04)

LIST OF AIR BORNE DISEASES

Ser No Disease Common symptoms

1. Chicken Pox Fluid filled rash on body accompanied by fever
and generalised weakness.

2. Pneumonia Fever with cough and difficult breathing.

3. Measles Fever and cough followed by rashes over skin.

4. Rubella Fever, lymph node swelling and rashes.

5. Diphtheria Fever with cough, enlarged tonsils and ill looking.

6. Mumps Painful enlargement of one or both sides of face

glands accompanied with fever.

7. Whooping Cough Fever with cough which is followed by a deep,

high-pitched inspiration.

8. Meningococcal Fever with headache, vomiting with/without

Meningitis change in mental status.

9. Upper Respiratory Cough, sore throat, running nose accompanied

Tract Infection (URTI) with fever.

10. Influenza Fever with chills, generalised weakness,

muscular pains and cough.

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Appendix ‘B’
(Refer para 06 (a) of section 04)

METHOD FOR OPTIMISING FLOOR SPACE UTILISATION

Arrangement 01 Arrangement 02
(Floor space not maximised) (Floor space maximised)
Two man bunk
One man bunk

Greater distance betn bunks

3 ft min betn bunks

Breathing Zone
Breathing Zone

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SECTION 05. EFFECTIVE MEASURES AGAINST MOSQUITO BORNE DISEASES

References: - (a) AO 165/79: Duties and Responsibilities in Relation to

Health of Service Personnel and Families.
(b) AO 27/2004: Prevention of Malaria and Other Mosquito
Borne Diseases.
(c) The “Red Book”: Public Health and Preventive Medicine
for the Indian Armed Forces.
(d) Textbook of Public Health and Community Medicine.
Published by Department of Community Medicine, Armed
Forces Medical College in Collaboration with World
Health Organisation, India Office, New Delhi.

Appendices: - A: List of Mosquito Borne Diseases.

B: Checklist: Early Identification of Mosquito Breeding.
C: Hygiene Chemicals and Spraying Eqpt for Control of
Mosquito Borne Diseases.
D: Treatment of Mosquito Nets.

GENERAL

1. Mosquito borne diseases are leading cause of sickness and death among
highly trained manpower of Indian Army. At the same time, these diseases are quite
amenable to prevention. Preventive measures against mosquitoes will considerably
asst in controlling these diseases as well as their occasional outbreaks.

AIM

2. The aim of this section is to discuss measures which must be undertaken by

Cdrs at all levels for units/ fmns loc upto an alt of 2250 meters (7500 feet), for
prevention and control of mosquito borne diseases. For troops deployed above an alt
of 2250 metres, specific instr are issued by GOsC-in-C Comd/ GOsC Corps on the
advice of med auth.

LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Mosquito Borne Diseases.

(b) Part II : Role and Responsibilities in Relation to

Prevention of Mosquito Borne Diseases.

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(c) Part III : Measures for Control of Mosquito Breeding.

(d) Part IV : Measures for Control of Adult Mosquitoes.

(e) Part V : Personal Protective Measures and Discipline.

(f) Part VI : Protection While on Move.

(g) Part VII : Suppressive Treatment for Malaria.

(h) Part VIII : Filaria Survey.

PART – I: MOSQUITO BORNE DISEASES

4. Mosquito borne diseases are those diseases which are transmitted from one
person to another, or from an animal to human beings, through infective mosquito
bite. Detl list of common mosquito borne diseases in the Army is given as appx A to
this section.

PART II: ROLE AND RESPONSIBILITIES IN RELATION TO PREVENTION OF

MOSQUITO BORNE DISEASES

5. Preventive measures against mosquito borne diseases are to be enforced by

the GOsC-in-C Comd, or GOsC Corps, on the advice of med auth.

6. Duties and Responsibilities of Station Commander. Further to AO

27/2004, fmn Cdrs/ Stn Cdrs are reqd to ensure the following for prevention and
control of mosquito borne diseases:-

(a) Hosp admission rates to be perused and explanation from Cdrs be

obtained for units which show high incidence of mosquito borne diseases.

(b) Stn Orders on anti-malaria and anti-mosquito precautions, insecticide

spraying and trg pgmes for unit anti-malaria squads to be published on advice
by local med auth or as dir by Corps/ Comd orders.

(c) All MES/ Engr wks to incl OC SHO/ FHO/ SEMO rep as board
member.

7. Duties and Responsibilities of COs/ OsC. COs/ OsC units are resp for all
aspects of impl of prevention and control measures against malaria and other
mosquito borne diseases within their AOR. COs/ OCs are reqd to ensure the
following:-

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(a) Unit anti-malaria committee presided by unit 2iC to be constituted. The

members would include the sub unit Cdrs, QM, RMO and any other member
detl by the CO of the unit. Record of proceedings to be maint and submitted
to insp offrs.

(b) Unit offr (usually unit QM) to be detl as “unit anti-malaria offr” for asst in
disch of duties.

(c) Unit anti-malaria squad at scale of 1 x NCO and 2 x OR per Coy (or
equivalent), with 100% res to be made available to RMO/ SEMO/ SMO for
trg. The same should undertake anti-malaria and anti-mosquito activities as
and when advised by med auth.

(d) Anti-malaria discp and pers protective measures are strictly obs by all
pers and families.

(e) Anti-malaria eqpt is available as per auth and the same as well as
mosquito nets are in serviceable state.

(f) Hyg chem are collected and used in correct formulations, as advised
by med auth.

(g) Suppressive treatment, as advised by local med auth is strictly impl.

(h) Take up case with MES/ Cantt Bd/ higher HQ regarding wks for
reduction of mosquito breeding.

(j) All pers and families with fever are promptly referred to RMO/AMA for
treatment.

8. Duties and Responsibilities of ASC. ASC auth are resp for procurement,
stocking and issue of all hyg chem in adequate quantity and well in time, as per
forecast made by med auth. OsC Sup Dep are reqd to ensure the following:-

(a) ”Monthly Off Take” of various hyg chem to be fixed in conslt with med
auth.

(b) Stock posn of hyg chem as on the last date of month to be fwd, so as
to reach SEMO/ SMO/ OC SHO or FHO by 5th day of the next month.

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9. Duties and Responsibility of MES/ Engineers. MES auth/ Engrs are resp
for the following:-

(a) Imdt repair/ rectification of defects which favour mosquito genic

conditions.

(b) Provn of proper, well-fitting covers on all over-head tk and their repair/
replacement, if found defective.

(c) To ensure that following any constr/ repair, no cesspools or

depressions in the grnd or quarries are left over.

(d) To seek advice of OsC SHO or FHO /SEMO/SMO on public health

aspects, starting from the plg stage, whenever any major/ minor/ repair/ maint
wk is being contemplated.

PART III: MEASURES FOR CONTROL OF MOSQUITO BREEDING

10. Identification of Potential Breeding Sites. Unit anti malaria offr and Unit
RMO should undertake detl san rd and indicate potential mosquito breeding areas. A
wkly checklist for early iden of mosquito breeding is given as appx B to this section.

11. Reduction of Mosquito Breeding Sites. Measures for reduction of

mosquito breeding should be undertaken throughout the yr and stepped up
seasonally, as advised by local med auth. Potential breeding sites, as iden, is to be
dealt by resp unit anti malaria pers in their area of jurisdiction. Necessary consv staff
to be provided by Stn HQ. The measures incl the following:-

(a) Empty cans/ bottles, broken crockery, junk items, discarded tyres, etc
should be disposed in an environment friendly manner and littering of same
should be discouraged.

(b) Small pits/ depressions and low-lying patches of grnd should be filled
with mud and levelled off the grnd.

(c) Pukka drains should be de-weeded and cleaned. Repair wks and
clearing of blockages should be undertaken on priority, if reqd.

(d) Kutcha drains around cook houses, bath areas, etc should drain into a
soak pit.

(e) Overhead water reservoirs, water storage tk, man holes and insp
chambers of sewer lines, septic tk and soak pits should be covered with tight
fitting covers.

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(f) Upper opening of vent pipes of septic tk/ sewer lines should be covered
and tied with a piece of mosquito net (nylon clo mtrl).

12. Observance of Dry Days. Units should earmark a particular day of the wk to
be obs as “Dry Day”. On this day, following activities should be carried out:-

(a) All water holding ctn should be emptied and turned upside down.

(b) All desert coolers should be drained off, scrubbed and cleaned.

(c) All ornamental and fire tk should be drained off and cleaned.

(d) All indoor/ outdoor ornamental flower pots should be drained and fresh
water be added.

(e) All fire buckets should be re-filled with fresh water, after thorough
cleaning.

(f) Firefighting tk should not be emptied on dry days. However, they

should be treated with hyg chem such as Baytex granules or Abate. Other
insecticides should not be sprayed on these tk. Larvivorous fishes such as
Gambusia can also be used in these tk depending on the feasibility.

13. Piggeries. Units should not maint any piggeries because of high risk of txn of
Japanese encephalitis besides other health issues.

14. Use of Hygiene Chemicals. All water collections which cannot be addsd
effectively through a/m measures should be sprayed once wkly. Advice of
RMO/AMA/local med auth should be taken for use of hyg chem. List of hyg chem
and spraying eqpt for control of mosquito borne diseases is given as appx C to this
section.

PART IV: MEASURES FOR CONTROL OF ADULT MOSQUITOES

15. Insecticide Residual Spray (IRS). IRS, commonly known as DDT spray
(because of DDT being used earlier) is undertaken in scheduled rds (three rds) in a
yr using Malathion 50% EC. All bldg, incl single living-in accn, married accn, cook
houses, dining halls, toilets, gd posts, tents, bkr and bk, etc should be sprayed.

16. It is imp to note that IRS is done to interrupt txn of mosquito borne diseases
and will not have much effect on either mosquito density, or on mosquito nuisance.
For reducing the mosquito density or nuisance, personal protective measures and

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measures for control of mosquito breeding should be given higher priority. Also,
repeated spraying, more than the scheduled rds will not make any extra contribution
towards prevention; on contrary, it will only lead to toxicity among troops.

17. Indoor Knockdown Space Spraying. Indoor knockdown space spraying

with Pyrethrum (0.1%) should be undertaken, at dusk, if advised by med auth. All
doors and windows should be kept closed before starting the spraying and for 15 min
after spraying.

18. Outdoor Fogging. Outdoor fogging, using the available thermal fogging
machine will be undertaken by SHO/ FHO iaw rulings on the subject. Units may also
consider mod of veh for fogging depending on feasibility.

PART V: PERSONAL PROTECTIVE MEASURES AND DISCIPLINE

19. Pers protective measures backed up with a strict observance of anti-malaria

discp contributes substantially to prevention, even in areas where a/m measures
become difficult. The following measures should be ensured by all rks and frequently
checked by Cdrs at all levels:-

20. Mosquito Nets. All rks should be issued mosquito nets. Families should also
be issued mosquito nets, as per auth, out of stn stores.

21. Every indl should be educated, encouraged and enforced to sleep inside
properly tucked mosquito nets. The mosquito net should be insp from inside for any
mosquitoes before going to sleep.

22. Treatment of Mosquito Nets. In notified areas where treatment of mosquito

nets with “Deltamethrin” is auth, unit anti- malaria squad, under the supervision of
local med auth should treat all mosquito nets before issue. Detl of steps for treatment
of mosquito nets is given as appx D to this section.

23. Mosquito Proofing of Accommodation. Mosquito proofing of doors and

windows of all accn with proper wire gauge, as auth should be ensured through
MES auth.

24. Mosquito proof doors and windows should be kept closed at all times (from
dusk to dawn for prevention of Malaria and at day time for prevention of Dengue/
Chikungunya).

25. Proper Clothing. All rks should put on proper uniform/civ clo, at all times.
This should be in the form of trousers, full sleeve shirts with sleeve rolled down,
shoes, socks and cap, as applicable.

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26. Mosquito Repellents. All pers on duty, at all times, besides using proper clo,
should apply mosquito repellents (DMP / Odomos / DEET (Mosfree) on exposed
parts as hands, face and neck, every four hours.

27. Discipline. Activities like bathing, washing, etc., should be undertaken betn
first and last light. No person should roam around in PT kit or in an ill-clad manner,
betn dusk to dawn.

PART VI: PROTECTION WHILE ON MOVE

28. All troops mov by rd or rail should ensure pers protective measures.

29. If the unit is mov by train, carriage should be sprayed with IRS (as explained
above) prior to entraining. Thereafter, every day at sunset, indoor knockdown space
spraying (as explained above) should be carried out.

30. During journeys by rd, halts at night should not be made within half a mile of
any town or village and mosquito nets will be used during such halts.

31. If considered necessary, GOsC–in–C Comd may order suppressive treatment

for such mov, on the advice of med auth.

PART VII: SUPPRESSIVE TREATMENT FOR MALARIA

32. Suppressive treatment is instituted only on the dir of GOsC-in-C Comd, on the
advice of med auth.

33. It is imp to note by Cdrs at all levels and impressed upon all rks that 100
percent compliance to suppressive treatment is to be achieved in notified areas.
However, alone and by itself, it is no panacea as regards to prevention of malaria. All
a/m measures need to be in place alongwith suppressive treatment for effective
prevention and control of Malaria.

PART VIII: FILARIA SURVEY

34. Annual night blood svy betn 2100 to 2400 hrs covering all rks, cadets, rect,
defence civ and families is conducted by local med auth. All cases found to be
harbouring filarial infection are treated and followed up for 12 months.

35. Units are reqd to maint “Filaria Register” for the same. Also, in case of any
person who is posted out within this pd of follow up, intimation and advice regarding
the remaining pd of follow up should be fwd by the dispatching unit to the new unit.

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Appendix ‘A’
(Refer para 04 of section 05)

LIST OF MOSQUITO BORNE DISEASES

Ser No Disease Remarks

1. Malaria Mosquito species causing Malaria prefer
overhead tanks for breeding.
Biting Time: Dusk to Dawn.

2. Dengue Mosquito species causing these diseases

3. Chikungunya breeds in clean water collections, especially
artificial and discarded ctn.
Biting Time: Day time biter.
Known as Tiger mosquito because of black
coloured body with white stripes in betn.

4. Japanese Encephalitis Breeds in dirty collections of water such as

5. Filariasis blocked drains.
Also known as nuisance mosquito.

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Appendix ‘B’
(Refer para 10 of Section 05)

CHECKLIST: EARLY IDENTIFICATION OF MOSQUITO BREEDING

Have you checked THIS WEEK?

Presence of Breeding in:-

 Air Coolers/Desert coolers

 Water holding buckets for fire fighting

 Unused bottles, ctn and disposable cups

 Ornamental ponds/ Flower vases

 Drums for water storage

 Tyres

 Junk mtrl (for eg: polyethene bags, cans, broken utensils etc)

 Pits/Low lying patches of grnd

 Open drains

 Soakage pits

 Manholes and inspection chambers of sewer lines

 Septic tk

Is overhead tank securely covered?

Have you ensured that line/ unit/ neighbor next to yours are also doing the
same?

Are dry days getting obs?

ENSURE A MOSQUITO FREE AREA

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Appendix ‘C’
(Refer para 14 of section 05)

HYGIENE CHEMICALS AND SPRAYING EQPT FOR PREVENTION AND

CONTROL OF MOSQUITO BORNE DISEASES

Hyg Chem for Prevention and Control of Mosquito Borne Diseases

Ser Activity Hyg Chem Remarks

No
1. Spraying at Temephos 50% Preparation of Soln:-
places of EC (Abate) 2.5 ml in 10 ltr water (for water collections
mosquito with depth up to 50 cm).
breeding. 5 ml in in 10 L water (for >50 cm depth).
Area in linear metre to be sprayed by 10L
of soln:- 500 metre.
2. Fenthion (Baytex) Preparation of Soln:-
82.5% EC 5 ml in 10 L water (for water collections with
depth upto 50 cm).
25 ml in in 10 L water (for >50 cm depth).
Area in linear metre to be sprayed by 10L
of soln:- 500 metre.
NOT FOR USE IN POTABLE WATER.
3. Fenthion Ready to use.
Granules 2% Sprayed over areas with dense foliage.
4. Insecticide Malathion 50% Preparation of soln:- 1 L in 10 L of water.
Residual EC Technique:- Soln to be sprayed @ 250 m2
Spray (IRS) of wall surface area covering upto 7 feet ht.
5. Deltamethrin Preparation of soln:- 400 g in 10L of water.
2.5% WP Technique:- Soln to be sprayed @ 500 m2
of wall surface area upto 7 feet ht.
6. Indoor Pyrethrum 0.1% Ready to use soln issued by SHO/FHO.
knockdown To be sprayed in air indoors.
space
spray

Spraying Eqpt

Ser No Hyg Chem Remarks

1. K5 / IKE 0376, Sprayer Auth at scale of 0.75% of unit str (or min of
compression hand one for units whose str is more than 50 but
insecticide, complete less than 100).
Used for IRS as well as for spraying on
mosquito breeding areas.
2. K5/IKE 0176 Sprayer Hand Auth:- 2 per cook house and 2 per dining
Anti Insect (MISH) hall.
Use:-: For space spraying, as and when
advised by med auth.

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Appendix ‘D’
(Refer para 22 of Section 05)

TREATMENT OF MOSQUITO NETS

• (2 x length x ht + 2 breadth x ht + length x

breadth) in metres.
Measure total • Average area of a single net is 10 sq metre.
area of the net

• Measure 1 litre of water and take it in a tub.

• Immerse the dry net, when completely wet, take it out by
gently wringing the net to prevent dripping of water.
• Measure the remaining water in the tub. 1 litre - the remaining
Measure water gives us the absorption capacity of the net.
absorption
capacity • Average absorption capacity - 500 ml (Nylon net); 1L (Cotton
net).

• Deltamethrin 2.5% SC - 1ml per m2.

• Cyfluthrin 05% EW- 1ml per m2.
Calculate the • Average doses.
dosage of the • 10 ml in 500 ml of water (Nylon net).
insecticide • 10 ml in 1L of water (Cotton net).
required

• Put the net in the insecticide solution prepared as per the

procedure given above and knead it well to ensure the net is
completely soaked in soln.
• DO NOT treat more than one net in one tub. Use multiple tubs
Treatment if reqd.

• Take out the net and spread it in shade, once semi dry it can
be hung for drying.
Drying

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SECTION 06. HEALTH EDUCATION

References:- (a) The “Red Book” : Public Health and Preventive Medicine
for the Indian Armed Forces.
(b) Commander’s Handbook. AIDS Control Organisation,
Department of Community Medicine, Armed Forces
Medical College.

GENERAL
1. "Hostile armies may face each other for years, striving/ or the victory that is
decided in a single day. This being so, to remain in ignorance of the enemy’s
condition, is the height of inhumanity." Sun Tzu

2. Health education of all rks is of vital imp in fight against diseases. Cdrs at all
levels must therefore ensure dissemination of regular and aprop messages for
prevention and control of diseases.
AIM
3. The aim of this section is to discuss methods of health education which Cdrs
at all levels can adopt and utilise for imparting/ disseminating health education
among all rks.
LAYOUT
4. This section is divided into the following parts:-

(a) Part I : Principles of Health Education.

(b) Part II : Fighting HIV/ AIDS on a War Footing: A Template

for Health Education.

PART I: PRINCIPLES OF HEALTH EDUCATION

5. Health education is a continuous process and requires use of every med of

communication available. Health education is defined as “a process aimed at
encouraging people to want to be healthy, to know how to stay healthy, to do what
they can individually and collectively to maint health and to seek help when needed”.

6. It should be imparted in such a language and with use of such terminology

that is easily understood by the gp to be instructed. It includes wide range of
activities such as formal lectures, orders, instr, Standing Orders, best unit
competitions, healthy baby shows, etc.

7. To achieve success, it is essential to select certain indl in each unit/ sub-unit

who are in better posn to ex social influence. For eg, a talk by one of the pers who
has won org games regarding physical activity will be more fruitful than anyone else.

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8. Org of health education activities will require guidance and sp from adm auth
as well as med auth. It should rightly be considered as among the best welfare
activities.

9. Methods of carrying out health education will differ from stn to stn, unit to unit
and health topic/ disease under consideration. However, certain broad methods are
as under:-

(a) Formal lectures. These should form part of unit routine trg activities
and should be a part of curriculum in trg centres.

(b) Lectures in Central Institutes. SEMO/ OC SHO/FHO/ local med auth

should be apch for delivery of lectures cum exhibitions at central institutes
about prevention of diseases just before the season.

(c) Lectures in Units. Deliberate efforts should be undertaken by unit

Cdrs to org lectures on various health issues. Necessary asst of unit RMOs/
AMAs should be undertaken. Further, sanitary rds/ health vis should be
followed by a lecture on common diseases for max benefits.

(d) Unit and AWWA Welfare Activities. Unit and AWWA welfare
activities should incorporate health education on issues related to women and
children for enhanced awareness and prevention of diseases.

(e) Audio Visual Education. PA eqpt, projection systems, use of posters

and pamphlets, screening of health education videos during interval of
movies, etc should be utilised for health education.

(f) Competitive Events. Health awareness can be incr by bringing in

competitive spirit. Best unit competitions, best coy, healthy baby shows, etc
conducted regularly plays a vital role in maint of hyg and san. The same
should be encouraged by Cdrs at all levels.

10. The process of behaviour change is a seven step process. The same needs
to be familiarised by Cdrs at all levels to assess the stage in which men under his
Comd is in general. The steps are as under:-

(a) Unaware stage.

(b) Awareness.

(c) Concern about ill effects.

(d) Knowledge.

(e) Motivation to change.

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(f) Implementing change.

(g) Sustaining behavior change.

PART II: FIGHTING HIV/ AIDS ON A WAR FOOTING:

A TEMPLATE FOR HEALTH EDUCATION
11. Imparting health education on sensitive topics such as HIV/ AIDS remain a
challenge. Following is a template for process which can be modified and adopted by
Cdrs at all levels for enhancing awareness levels among all rks and making a
change. The template uses terms and jargons easy to understand and is in context
of routine speaking language.

12. Knowing the Enemy: Generating Interest Among Audiences. In the late
1970s, many indl with rare types of cancers and infections started reporting to
doctors in various parts of USA. It was found out that these patients were
homosexuals. Such illnesses were also occurring in those with multiple sex partners,
drug users, and those receiving blood transfusions. The evidence created suspicion
that a germ carried in blood might be causing these diseases. Within a few years,
research for detecting the germ resp for the disease gathered momentum and the
HIV was found to be the disease agent.

13. Low Intensity Conflict! The Modus Operandi of the Enemy: Making
Audiences Understand the Disease Process. Like modern guerrillas, the enemy
(HIV) specializes in Low Intensity Conflict (LIC). Instead of frontal attk, HIV infiltrates
the defence forces of the human body, by entering and replicating within the white
blood cells (the Arms component of our immune system), and insidiously over a pd
of time with falling number of these vital immune cells, the body is left undefended
against a host of bacteria, viruses and parasites present in the environment. These
take advantage of the weakened state of affairs and lodge a frontal attk - causing a
host of infections. It is when these infections occur that a person is said to have
AIDS. This is why many of the illnesses that people with AIDS get are called
opportunistic infections. It is like ravaging and plundering armies entering a country
whose defence forces are in disarray due to unchecked LIC over the years.

14. The LIC Battlefield: Making the Audiences Understand the Signs and
Symptoms of Disease. After the HIV infiltrates the border (enters the human body),
initially there may be symptoms such as fever and body-ache, which resemble an
attk of flu. After this pd, for most of the time, people infected with HIV are without
symptoms and usually unaware that there is anything wrong with them. How similar
to real LIC scenario! – when the majority of the citizens of the country are unaware of
the real threat. The length of time betn infection and the appearance of AIDS can
vary widely in different people (depending on the relative str of their armies i.e. their
immune system). The major signs of AIDS are wt loss, long duration diarrhoea and
fever for more than a month.

15. Cordon and Search - Routinely Used Blood Tests: Making Audiences
Understand Early Detection. Various blood tests are available to detect HIV

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antibodies. Any person who suspects having contracted the disease should report at
the earliest to nearest hosp and get themselves checked.

16. Borders to be Sealed : The Entry Points of the Guerrilla: Making

Audiences Understand Preventive Measures. One can be very close to someone
with AIDS and not catch the virus. This is very imp to understand because as people
begin to see AIDS as a serious problem, they may panic and reject infected people.
They may isolate them and their families. These reactions are deeply upsetting for
people who are already facing the trauma of AIDS, and may be counterproductive to
the war against AIDS -just as rumours in psychological warfare is a setback to any
Cdr fighting a war. HIV is not transmitted by:-

(a) Ordinary social contact such as staying in the same house/ bk,
breathing the same air, coughs and sneezes, at wk, on the bus and while
travelling together in other veh, at the market and other places where people
get together, at school and other places where children get together, playing
together, touching, shaking hands, hugging, kissing on the cheeks, hands or
forehead, etc.

(b) Sharing toilet seats, towels, washing water, bath water, swimming
pools, eating and drinking utensils or wk tools.

(c) By bite of mosquitoes, bed bugs, and other insects.

17. Action to be Taken on Occurrence of Disease. Armed Forces Med

Services are set with the state of the art and top of the line preventive methods. One
should not panic on detection of disease but at the same time, one should report at
earliest for better mgt of the disease condition.

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SECTION 07. COMBATTING LIFESTYLE DISEASES

References:- (a) The “Red Book” : Public Health and Preventive Medicine
for the Indian Armed Forces.
(b) Basic and Battle Physical Training for Trainees Pamphlet
No – 2 Issued by HQ ARTRAC Aug 2008.
(c) IHQ of MoD (Army) Letter No B/32006/Medical/AG/PS-
2(a) dt 24 Mar 2017.

Appendices:- A: Food Pyramid.

GENERAL

1. Lifestyle diseases are among the top leading causes of sudden death and
contributes heavily to loss of trained manpower to Indian Army. However, majority of
these illnesses can be prevented. It is therefore vital for Cdrs at all levels to obs
preventive measures to obviate their occurrence.

AIM

2. The aim of this section is to discuss measures which must be undertaken by

Cdrs at all levels for prevention and control of lifestyle diseases.

LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Lifestyle Diseases.

(b) Part II : Dietary Recommendations.

(c) Part III : Physical Activity Recommendations.

(d) Part IV : Prevention of Alcohol Abuse.

(e) Part V : Reducing Obesity in the Indian Army.

PART – I: LIFESTYLE DISEASES

4. “Lifestyle”, in the context of preventive health care, indicates the behavioural

patterns which we routinely adopt and the way we tend to live our daily life. Lifestyle
is thus mainly dependent on psycho-social and environmental factors.

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5. Major components of unhealthy lifestyle are as under:-

(a) Poor dietary habits.

(b) Lack of physical activity.

(c) Drug abuse (Alcohol, Tobacco, etc).

(d) Mental stress.

6. Major lifestyle diseases are as under:-.

(a) Obesity.

(b) Hypertension.

(c) Heart diseases.

(d) Diabetes.

(e) Cancers.

(f) Osteoarthritis.

(g) Liver diseases.

PART – II: DIETARY RECOMMENDATIONS

7. A balanced diet is defined as one which contains a variety of foods in such

quantities and proportions that the need for energy and other nutrients is adequately
met for maint health, vitality and general well-being. The exact make-up of a
healthy, balanced diet will vary depending on the indl needs (e.g. age, gender,
lifestyle, degree of physical activity). A food pyramid as general guideline for
composition of a healthy diet is given as appx ‘A’ to this section.

8. Cdrs at all levels can achieve the recom dietary patterns for troops by
ensuring the following:-

(a) Adhering to auth ration scales is the single most effective measure to
achieve nutritional reqmt of a sdr. This also applies to troops posted to places
where addl nutritional reqmt need to be fulfilled (eg. high alt areas, trg centres,
warfare schools, etc).

(b) Provn of hot meals should be ensured. It not only raises morale of the
troops but also gives better palatability.

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(c) The following should be ensured in messes and cook houses for
preparation of a healthy meal:-

(i) Wash vegetables and fruits thoroughly before use. However, DO

NOT wash vegetables and fruits after cutting.

(ii) Washing of food-grains such as dals to be done thoroughly

before cooking. However, DO NOT repeatedly wash food-grains
before cooking.

(iii) DO NOT soak the cut vegetables in water for long pds.

(iv) DO NOT discard the excess water left over after cooking. Use
only sufficient water for cooking.

(v) Cooking to be preferably undertaken in ctn covered with lids.

Open ctn cooking to be discouraged.

(vi) Prefer pressure/ steam cooking rather than deep frying.

(vii) Encourage consumption of sprouted grains.

(viii) Avoid use of baking soda while cooking.

(ix) DO NOT re-use cooking oil. Re-use of oils generate trans fats
which are very harmful to health.

(x) Incl green leafy vegetables in daily diet.

(xi) Limit the use of ghee and butter.

(xii) Restrict intake of preserved and processed foods like papads,

pickles, sauces, ketchup, salted biscuits, chips, cheese, etc.

(d) Regular health education activities should be conducted on healthy

dietary practices.

(e) Use of table salt and pickles to be discouraged.

PART III: PHYSICAL ACTIVITY RECOMMENDATIONS

9. One of the most scientific ex pgme is practiced in the Army which is morning
PT. The gen arrng of each table card for conduct of PT is as under: -

(a) Warming Up and Endurance. This gp is of 13 min duration.

Breakdown is as following:-

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(i) Light stretching ex for three min.

(ii) Jogging at slow pace for two min.

(iii) Running for seven min.

(iv) Recovery or breathing ex for one min.

(b) Strength Endurance. This gp is of 20 min duration. For detl

methodology and sequence of the ex, Cdrs at all levels should familiarise
themselves with ‘Basic and Battle Physical Training for Trainees Pamphlet no
-2’ issued by HQ ARTRAC Aug 2008’.

(c) Cooling Down. This gp is of seven min duration. The ex in this gp are
gen stretching ex.

10. Cdrs at all levels should ensure the following to meet the physical activity
guidelines:-

(a) Ensure regular timings of wk in stn/ units to accommodate PT and

games on for atleast 05 days in a week. Routine PT, as designed for all rks in
Indian Army, when conducted regularly, in letter and spirit, is sufficient to
provide recom physical activity levels to all rks.

(b) Availability of qualified trainer for conduct of PT and games is

desirable.

(c) All rks should attend PT on all days, irrespective of being a single
member or family member.

(d) Participation in org games should be encouraged.

(e) All rks working in offices should be provided a comfortable chair with
back sp. The posture of working staff should ensure that the back is straight
(and not bent fwd) while working.

(f) All computer screens in office complexes should be kept at a

comfortable posn in a manner so that the screen is at eye level and elbows
are at 900 posn while working on keypad.

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(g) All rks working in office during sedentary (sitting) job should get up and
walk at frequent intervals.

(h) Ensure functional status of alt places for physical activity and ex such
as palygrounds, gym, volleyball , swimming pool, etc in various est/ institutes
available in mil stns.

(j) Non-veh day(s) in stn/ units to inculcate habit of cycling/ walking to

office from home should be considered.

PART IV: PREVENTION OF ALCOHOL ABUSE

11. The following measures should be undertaken by Cdrs at all levels to prevent
occurrence of acute alcohol intoxication as well as alcohol dependence:-

(a) Consumption of alcohol to be discouraged.

(b) No indl should be issued alcohol apart from issue days. Deliberate
measures should be undertaken to ensure that issue of only auth quantity is
being made.

(c) Ceiling limit of issue of alcohol from CSD facility should be ensured.

(d) Indl with problematic alcohol use should be referred imdt to hosp for
treatment. It will prevent indl from going into chronic stages and also maint
discp in the unit.

(e) For indl diagnosed with alcohol related diseases incl Alcohol
Dependence Syndrome (ADS), timely specialist review and adherence to
medication should be ensured. Supervision by section i/c or by buddy system
may be carried out for the same.

(f) Health education sessions during sainik samellans, family welfare

meet, etc should be carried out on regular basis.

12. At indl level, following measures should be adopted to avoid alcohol abuse:-

(a) Avoid alcohol. DO NOT start drinking, if you have not started yet.

(b) In case you are an alcohol consumer, consider the following

questionnaire to assess your dependency levels. Any one ‘Yes’ response to
the following questions suggests an alcohol use problem. More than one is a
strong indication that the problem exists.

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(i) Have you ever felt like you should CUT down on your drinking?

(ii) Have people ANNOYED you by criticizing your drinking?

(iii) Have you ever felt bad or GUILTY about your drinking?

(iv) Have you ever had a drink first thing in the morning to steady
your nerves or get rid of a hangover (EYE OPENER)?

(c) In case you have to drink, drink in moderation. No more than one drink
a day for women and no more than two a day for men. When you do drink,
enjoy your drink slowly.

(d) Don't drink on an empty stomach. Having some food in stomach may
help slow alcohol absorption.

(e) Never force a drink. Forcing drinks during social functions is a common
prac. It may be detrimental for the first timer as it may cause acute alcohol
intoxication.

(f) Never mix drinking with driving.

PART V: REDUCING OBESITY IN THE INDIAN ARMY

13. Cdrs at levels should ensure that med exam of troops are conducted iaw
instrs laid down vide AOs and instrs on the subject. This will enable early diagnosis
of lifestyle diseases, if any and thus substantially reduce disease burden.

14. Command Chain. With a view of enabling IOs (at all levels) to curb obesity,
the actions by Cdrs/ COs/ IOs have been laid out in IHQ of MoD (Army) letter no
B/32006/Medical/AG/PS-2(a) dt 24 Mar 2017.

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Appendix ‘A’
(Refer para 07 of Section 07)

FOOD PYRAMID

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SECTION 08. MANAGING MENTAL STRESS

References:- (a) The “Red Book” : Public Health and Preventive Medicine
for the Indian Armed Forces.
(b) Mental Health Programme for the Indian Armed Forces.

GENERAL

1. Mental robustness in a physically sound body is pre-requisite to a well-trained

and operationally efficient sdr. Psychiatric disorders lead to hospitalisation at rate of
2.64 per 1000, thus contributing as seventh leading cause of hospitalisations among
all diseases in Indian Army. It is therefore vital that due imp is given towards mental
health issues of all rks and families.
AIM

2. The aim of this section is to discuss measures which must be undertaken by

Cdrs at all levels for stress mgt.
LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Introduction.

(b) Part II : Characteristics of a Mentally Healthy Soldier.

(c) Part III : Stress and Stress Induced Behaviours.

(d) Part IV : Stress Management in Indian Army.

(e) Part V : Managing Marital Discords.

PART I: INTRODUCTION

4. The resp of ensuring robust mental health of sdr lies on every one those
involved in the rect, trg and leading men in Armed Forces.

5. Stress can be defined as a state of mental or emotional strain or tension

resulting from adverse or demanding circumstances.

6. Work related stress is the response that is generated when indl is presented
with work demands and pressures that are not matched to their knowledge and
abilities and which challenge their ability to cope.

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PART II: CHARACTERISTICS OF A MENTALLY HEALTHY SOLDIER

7. A mentally healthy sdr has the following characteristics:-

(a) Alert and aware of his surroundings.

(b) Shoulders resp willingly.

(c) Accepts orders without resentment.

(d) Gets along with others without undue friction and with mutual pleasure.

(e) Wk with enthusiasm and wants to contribute his bit.

(f) Perseveres in solving problems both at wk and in personal life despite

difficulties and disappointments.

(g) Has high morale.

(h) Has no signs and symptoms of mental disorder.

PART III: STRESS AND STRESS INDUCED BEHAVIOUR

8. Stressors iden in the service conditions are as under:-

(a) Stressors During Training Period.

(i) Loss of emotional sp from family and friends.

(ii) Discp.

(iii) Strenuous physical demands of trg activities.

(iv) Limited scope for privacy.

(v) Competition causing constant pressure to qualify.

(vi) Problems at home - may be in relation to finances, family

members etc.

(b) Stressors in Peace and Family Related Issues.

(i) Improper or poor interpersonal relations.

(ii) Domestic problems related to marital life.

(iii) Health problems of family members.

(iv) Insecurity of family members.

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(v) Children’s education.

(vi) Property disputes.

(vii) Financial problems.

(viii) Inadequate response by civ adm to the problems of service

pers.

(c) Stressors in Field. In addn to the above, following are the specific
stressors in fd:-

(i) Separation from family members.

(ii) Adverse or demanding climatic conditions.

(iii) Isolation.

(iv) Long tenures.

(v) Unknown enemy in CI areas.

(vi) Uncertainty of life.

(vii) Difficult living conditions.

(viii) Fatigue.

9. The response of indl to a stress sit could culminate into positive or negative
stress behaviour. Cdrs should aim to enhance positive stress behaviours and reduce
negative stress behaviours.

(a) Positive Stress Behaviours.

(i) Loyalty to Cdrs, iden with unit tradition and unit cohesion.

(ii) Sense of uniqueness and eliteness.

(iii) Sense of mission.

(iv) Alertness and vigilance.

(v) Str and endurance.

(vi) Tolerance to hardship, discomfort, pain and injury.

(vii) Sense of purpose.

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(viii) Heroic acts of courage and self-sacrifice.

(b) Negative Stress Behaviours.

(i) Misconduct behaviours (self-inflicted wounds, malingering,

Absent Without Leave, desertion, suicide, etc).

(ii) Combat fatigue.

(iii) Post-traumatic stress disorder and other psychiatric conditions.

PART IV: STRESS MANAGEMENT IN INDIAN ARMY

10. Stress mgt incl promotional as well as preventive measures which need to be
undertaken by Cdrs at all levels as under:-

(a) Educate all rks on imp of regular ex, incl yoga and meditation, games,
reading and music etc.

(b) Adoption of healthy lifestyles among all rks.

(c) Effective utilisation of manpower for bonafide wk so as to give them

enough relaxation.

(d) Unit and sub unit Cdrs to ensure better interaction with men at their
place of dply. All rks must be treated well so as not to hurt their sentiment,
pride and dignity under any circumstances.

(e) All pers dply in sensitive/ stressful environment should be granted

regular and frequent spells of leave and should be turned over/ rotated
regularly.

(f) Cdrs should ensure prompt redressal of grievances related to domestic

sphere by timely interaction with the civ adm auth.

(g) All pers returning from leave should be interviewed by the unit offr and
med exam by AMA. Any stress markers be looked for and problems, if any,
should be addsd promptly.

(h) Every effort should be made at stn level for provn of family accn to
married pers serving in peace stn.

(j) Information, education and communication activities (IEC) should be

undertaken at stn level and unit level during sainik samellans, family welfare
meets, etc to remove stigma and discrimination associated with psychiatric
diseases.

(k) Trg courses are being held at Comd Hosp, psychiatric centres and
various fmn HQs by trained psychologists/ counsellors across Indian Army.

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Cdrs should ensure that max number of troops are trained in these courses
and same are utilised as counsellors/ mentors in the unit.

(l) Toll free Mansik Sahayata Helpline numbers are available at various
fmn HQs, psychiatric centres, etc across Indian Army locs. Cdrs at all levels
should encourage all rks to use the same, on as reqd basis, as speaking with
trained counsellors/ psychologists will not only help in reduction of stress
levels but may also prevent a possible loss of life.

PART V: MANAGEMENT OF MARITAL DISCORDS

11. Families should be educated on the topics mentioned below. Necessary asst
from AWWA may be undertaken for the same.
(a) Their role in the org and what is expected out of them in the units.
(b) Finances of the sdr and it’s domestic mgt.
(c) Self-employment opportunities.
(d) Education of children.
(e) General health care of self and care of young children.
(f) Problem solving skills.
(g) When separated, how to keep in touch with her spouse, how to contact
his CO in case of a dispute, how & where to approach a service med
echelon in case of a health problem at home and how to shoulder resp.
12. Voluntary participation in unit activities of AWWA and informal interaction betn
families of Offr’s and PBOR’s should be encouraged.
13. Signs of marital discords arising in the couples should be iden at early stages.
Once detected, the couple should be interviewed and intervention be provided by
unit family welfare or AWWA at the earliest.

14. A troubled marriage which has already adversely affected the

physical/mental/social health of either of the partners should be handled by an expert
only. Refer the couple to AMA/ Psychologist/ Trained Counsellor/ Psychiatrist.

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SECTION 09. PREVENTION OF SNAKE AND ANIMAL BITES

References:- (a) The “Red Book” : Public Health and Preventive Medicine
for the Indian Armed Forces.
(b) Textbook of Public Health and Community Medicine.
Published by Department of Community Medicine, Armed
Forces Medical College in Collaboration with World
Health Organisation, India Office, New Delhi.
(c) DGAFMS Medical Memorandum No 102: Snake Bite.

GENERAL

1. Snake bites and animal bites (dog bite, monkey bite, cat bite, etc) are an imp
cause of preventable hospitalisation as well as loss of trained manpower due to
deaths.
AIM

2. The aim of this section is to discuss measures which must be undertaken by

Cdrs at all levels for prevention of snake bite and animal bite and the immediate first-
aid measures to be adopted.
LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Prevention of Snake Bite.

(b) Part II : Signs and Symptoms of Snake Bite.

(c) Part III : First Aid Measures: Snake Bite.

(d) Part IV : Prevention of Animal Bite.

(e) Part V : First Aid Measures: Animal Bite.

PART I: PREVENTION OF SNAKE BITE

4. Snake bite is an occupational hazard that may be difficult to avoid completely.

However the occurrence can be substantially reduced by adopting the following
measures:-

(a) Sanitation of the Camp. The camp area and its surroundings should
be kept clear of all debris, garbage and rubbish heaps. Avoid having rubble,
termite mounds or domestic animals close to human dwellings.

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(b) Snake Trenches. Trenches 50 cm wide and 60 cm deep with

absolutely vertical sides should be dug around tents/huts. Deeper and wider
trenches further reduce ingress of snakes.

(c) Personal Protection. All rks should be vigilant regarding possibility of

snake bite and ensure preventive and personal protective measures. Cdrs
should ensure that pers obs the following measures:-

(i) Properly tucked mosquito nets must be used while sleeping.

(ii) Lower end of trousers should be properly tucked inside combat

boots while mov outdoors and while ptlg/ marches in vegetated areas.

(iii) A source of light such as torch should always be used while mov
outdoors during dark hr.

(iv) Bk / tentages used for living should be kept well lighted.

(v) Clo, shoes, pillows, blankets, quilts, bedsheets and headwear

should be checked before use, first by gently tapping them and then by
insp the inside surfaces.

(vi) Pers should not be allowed to sleep on the grnd. Efforts should
be made to provide cots to all rks.

(d) Avoid snakes as far as possible. Never handle, threaten or attk a snake
and never intentionally trap or corner a snake in an enclosed space.

PART II: SIGNS AND SYMPTOMS OF SNAKE BITE

5. The symptoms of a snake bite depends upon the type of snake (poisonous/
non-poisonous), amount of venom injected and mental status of patient after the bite.
It varies from no symptoms to death of an indl within seconds. The usual signs and
symptoms of a snake bite are as under:-

(a) A history of being bitten by the snake is most common.

(b) Local pain at the site of bite.

(c) Local swelling at the site of bite.

(d) Presence of fang marks.

(e) Symptoms such as redness of skin, vomiting, abdominal pain,

drowsiness, fainting, uncontrolled bleeding, heavy eyelids, difficulty in opening
mouth, difficulty in breathing, etc depend on multiple factors as explained
above.

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PART III: FIRST AID MEASURES: SNAKE BITE

6. First Aid should be given at the place of occurrence. All rks should be
thoroughly familiar with the first-aid to be given in case of snake bites.

7. DO NOT undertake the following actions:-

(a) DO NOT make local incisions or pricks/punctures at the bite or on the

bitten limb.

(b) DO NOT attempt to suck the venom out of the wound.

(c) DO NOT use potassium permanganate for washing the wound.
(d) DO NOT tie tight bands (tourniquets) around the limb.

(e) DO NOT apply chemicals, antiseptics, herbs, ice, etc to the wound.

(f) DO NOT run after the snake or make attempts to kill it.

(g) DO NOT handle an apparently dead snake with bare hands as it may
still be alive and may bite you.

8. The recom first-aid measures (DO’s) are:-

(a) Reassure the victim who may be very anxious.

(b) Keep the patient at rest.
(c) Immobilize the bitten limb with a splint or sling. Avoid any mov of the
bitten limb.

(d) Avoid any interference with the bite wound as this may introduce
infection, incr absorption of the venom and incr local bleeding/ necrosis.

(e) Gently wipe the wound with sterile cotton gauze once. Wash the area
with plenty of water to wash away unabsorbed venom.

9. Patients with snake bite must be considered as lying cases. They must be
transported to a place quickly using a stretcher where they can receive med care (MI
Room or hospital).

PART IV: PREVENTION OF ANIMAL BITE

10. Control of Stray Dogs. Stray dogs need to be taken care of within the ambit
of existing legal provn on handling of stray dogs which are summarized as under:-

(a) As per Prevention of Cruelty to Animals Act,1960, mutilation or killing

of any animal (incl stray dogs) by using the method of strychnine injections in
the heart or in any other unnecessarily cruel manner is a cognizable offence
under Indian Penal Code.

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(b) There are designated agencies in Government/local self-government

and NGOs like Society for Prevention of Cruelty to Animals (SPCA) that are
auth to deal with stray animals. Stn HQs/Cantt Bds should approach such
recognized associations for redressal of their grievances with regard to stray
dog menace in consultation with local civ Govt agencies.

(c) Sterilization and vaccination of dogs is a scientific and humane

solution to the stray dog menace. ABC (Animal Birth Control) pgme should be
a practical solution to control the stray dog population and eradicate rabies.

(d) Info about incurably ill and mortally wounded dogs should be given
imdt by Stn HQs/Cantt Bd to the Govt/local self-government. Euthanasia, if
reqd, should be in a humane manner by a qualified veterinarian/ RVC offr
using methods approved by Animal Welfare Board of India.

11. Control of Pet Animals. Compulsory registration of all pet dogs and cats
should be impl within cantt. Stn Cdr and unit Cdrs should ensure that these provn
are strictly adhered to in letter and spirit.

12. Vaccination of Pet Dogs and Cats. All pet dogs and cats in stn, besides
being registered and wearing a token, should be vaccinated for Rabies, under the
resp of the owner. A record card of vaccination should be maint by the owner and
produced at Stn HQ, as and when reqd by the Stn Cdr.

13. Control of Monkeys. Offering of food to monkeys on religious grnd should

not be allowed in Cantt/Military stn. The local wildlife department/ forest department
should be apch for rehabilitation of monkeys in their natural surroundings.

14. Proper Disposal of Garbage. Adequate and properly covered bins should
be provided near all cook houses, dining halls, canteens, etc. The same should be
cleared on daily basis. Under no circumstances, stray dogs be offered leftover food
from unit cook houses or by indls residing in family qtrs.

PART V: FIRST AID: ANIMAL BITE

15. Any bite by a dog, cat or a monkey, whether pet or stray, whether previously
vaccinated against Rabies or not and irrespective of whether the bite was provoked
or unprovoked, should be considered as having potential to cause Rabies.

16. Cdrs should ensure that all indls with animal bite are referred to nearest hosp
and treatment started as early as possible after exposure after giving imdt first aid
which includes washing of the bite wound(s) with plenty of soap under running water
for approx 15 min.

17. Pre Exposure Vaccination of Animal Handlers. All indls involved in

handling of animals viz troops working in RVC, AT coys, pet clinics, etc should
receive pre exposure vaccination for prevention of Rabies.

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SECTION 10. WASTE MANAGEMENT

References:- (a) The “Red Book” : Public Health and Preventive Medicine
for the Indian Armed Forces.

Appendices. A: Shallow Trench Latrine.

B: Deep Trench Latrine.

GENERAL

1. Waste is anything which is of no further use to mankind. However, improper

disposal of waste, whether excremental/ generated from MI Rooms, Barber Shops,
etc has enormous potential to cause serious diseases.

AIM

2. The aim of this section is to discuss measures related to mgt of waste

generated at fmn/ unit level.
LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Disposal of Human Excreta.

(b) Part II : Solid Waste Management.

(c) Part III : Miscellaneous Waste.

PART I: DISPOSAL OF HUMAN EXCRETA

4. Temp camps are those loc which are occupied for six days or less. Shallow
Trench Latrines are the most popular method used for excreta disposal during temp
camps. Schematic dia of a Shallow Trench Latrine is given as appx A to this section
and detl is as under:-

(a) Each trench is 90 cm long, 30 cm wide and 60 cm deep.

(b) Trenches are dug in parallel with an interval of at least 60 cm in betn

two trenches.

(c) The earth removed should be neatly piled at its head end.

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(d) The trench is used by squatting astride it, with a foot on either side and
not both feet on the same side.

(e) After defaecation the excreta must be covered by earth with a scoop.

(f) The latrine area must be policed by a member of the unit sanitary
squad to ensure that each user carries out these instr.

(g) After 24 hr, faeces should be covered with a 3 cm layer of slaked lime
and trenches should be filled with earth. A new row of trenches is imdt dug in
front of the previous day's row.

(h) While leaving the camp, the earth should be well butted and the whole
area and the grnd up to 1 metre all round should be sprayed with hyg chem
and suitably marked 'L' so as to indicate the grnd as unusable by any unit
camping thereafter.

5. Semi-permt camps are those which are occupied for more than six days but
less than a yr. Normally five seats per latrine are constr at the scale of 10 percent of
the str of unit/ subunit. Broad detl of the constr of Deep Trench Latrine and its maint
are given hereunder step by step and as appx B to this section. Unit Hyg and San
Squad pers should be trained in proper constr and maint of the DTL with
understanding of the rationale.

(a) The standard trench is 1 metre wide, at least 2½ metre deep and 3
metre in length, or of the length of the superstructure available. If any danger
of sides collapsing is envisaged, they should be riveted with bamboos,
sandbags or wire netting. If sandbags are used the width should be 1.3
metre. It should not reach the subsoil water level for chances of
contamination of subsoil water level. If the subsoil water level is high, an incr
depth may be obtained by building a mud bank upto one metre high all
around the trench. This bank is riveted on both its internal and external faces
with interlaced bamboo.

(b) The grnd upto one metre around the trench is then dug to a depth of 10
cm and the loosened earth is removed. Strips of oil-soaked sacking, each
1½metre wide, are then spread over this dugout area with the inner edges
hanging down to 15 cm over the sides of the trench and secured in posn with
small wooden pegs. The outer edges are sunk into the grnd along the outer
edge of the dugout area.

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(c) Reqd numbers of joists (4 or 5) are placed over the trench, overlapping
its edges by 60 cm to sp the superstructure.

(d) The fly proof wooden superstructure made as described below is then
placed over the joists so as to overlap the edges of the trench by 10 cm.

(e) The squatting type of superstructure should be flat as a table top, made
of tongued and grooved timber, and it’s under surface completely covered by
a double thickness of oiled sacking snugly tucked to the wood, except at the
lidded squatting apertures.

(f) Each aperture should be 36X25 cm, with a distance of 30 cm from the
next one and fitted with a hinged lid.

(g) The lid should overlap the aperture by 5 cm all round. It should be
covered on the under surface with a double layer of oiled sacking. A device
for opening without touching it with hands should be provided.

(h) The loose soil removed from around the trench is then mixed with
heavy oil, replaced in the dug-out area around the trench on the top of the
sacking and joists, and rammed down to form a hard impervious layer.

(j) A flytrap may be constructed at one end of the trench.

(k) A shallow drain with a soak pit at its end to stop storm water from
entering the trench is made all round the latrine.

(l) An overhead shelter must be provided as protection against rain and

the sun. Partitions should be interposed betn seats.

(m) Maint should be carried out as under:-

(i) The superstructure must be maint fly proof by replacing all

wrapped lids, by sealing all cracks with oiled sacking and by replacing
all torn sacking.

(ii) The lids must always be kept closed when the latrine is not in
use.

(iii) It is unnecessary and even harmful to throw any disinfectant into

the trench.

(iv) Oiling of superstructure or seats is unnecessary; they should be

scrubbed daily and washed and always kept dry.

(v) Tins, bottles or other extraneous matter must not be thrown in.

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(vi) Insecticide spray should be carried out on a fixed day once a

week on the superstructures and 2 metre all around the latrine.

PART II: SOLID WASTE MANAGEMENT

6. Solid waste includes all unwanted or discarded mtrl of domestic, street,

commercial, industrial and agricultural origin. It consists of garbage and swill from
cook houses and dining halls; house and street rubbish like waste papers, rags,
glass pieces, dried leaves, pieces of wood, ferrous and nonferrous metals, plastics,
ashes, cinders, brick bats and commercial and industrial wastes of all types.
Generally, wastes of animal and vegetable origin are very attractive to flies,
cockroaches, rodents and other pests and therefore must be disposed off
hygienically, as early as possible. Solid waste should be managed according to Solid
Waste Mgt and Handling Rules 2016.

7. Collection. Suitable receptacles are to be provided at convenient places for

collection of all rubbish awaiting disposal. Metal, fly proof receptacles, big enough to
hold 24 hr collection, must be provided for storage of garbage and swill in the cook
houses and dining halls. General camp refuse and house refuse other than garbage
which is not so attractive to flies may be collected separately. In a permt camp
sanitary bins made of G I sheet are usually provided. In other types of camps
receptacles having well fitted lids may be improvised from empty cresol drums, oil
drums and ghee tins.

8. Methods of Disposal. The recognized methods of disposal of solid wastes

are burial, sanitary land-fill, incineration, composting, salvaging, etc. The choice of a
particular method is governed by factors such as type of camp, cost, availability of
land and labour.

9. Education. Cdrs at all levels must educate all rks on following pts:-

(a) Generate min waste.

(b) Recycle or reuse packing mtrl.

(c) Waste to be disposed in environment friendly manner.

PART III: MISCELLANEOUS WASTE

10. MI Rooms. Biomedical Waste Mgt and Handling of MI Rooms in the units
have to be ensured in accordance with existing rules and regulations. This will
ensure that MI Rooms are institutions intended to provide med treatment and care

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for the ill or the injured and not contrarily, a potential centre for spreading diseases
due to improper biomedical waste mgt.

11. Barber Shops. Following measures should be ensured:-

(a) Combs, razors and clippers should be kept immersed in 2.5 per cent
cresol, Dettol, or chlorosol solution when not in use. Before use they should
be washed with clean water.

(b) The rest of the time they should be cleaned and protected with vaseline
except combs which are to be cleaned and washed with soap and dried.

(c) Shaving brushes after each shave should be washed in a solution of

savlon/ Dettol and then rinsed in clean water.

(d) Razors should be wiped on a clean towel kept for the purpose.

(e) The blade should be used only once and then disposed.

(f) The used blades should be disposed by deep burial after disinfection in
a strong bleach solution (5% str for half an hr).

(g) In general, shaving by barbers should be discouraged where possible

and indl be encouraged to shave themselves.

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Appendix ‘A’
(Refer para 4 of section 10)

SHALLOW TRENCH LATRINE

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Appendix ‘B’
(Refer para 05 of section 10)

DEEP TRENCH LATRINE

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SECTION 11. MINIMISING TERRAIN AND ENVIRONMENT RELATED DISEASES

References:- (a) The “Red Book” : Public Health and Preventive Medicine
for the Indian Armed Forces.
(b) Textbook of Public Health and Community Medicine.
Published by Department of Community Medicine, Armed
Forces Medical College in Collaboration with World
Health Organisation, India Office, New Delhi.
(c) AO 110/80. Effects of High Altitude and their Prevention.

GENERAL
1. A number of troops are dply in extreme climatic conditions. Such extreme
climate is not only detrimental to health but is of considerable imp for the Army since
it may seriously interfere with op preparedness. It is therefore imperative for all
concerned to meticulously obs preventive measures with a view to maint highest
level of op efficiency and morale of troops.

AIM
2. The aim of this section is to discuss measures which must be undertaken by
Cdrs at all levels for prevention of terrain and environment related diseases.

LAYOUT
3. This section is divided into the following parts:-

(a) Part I : Prevention of Cold Injuries.

(b) Part II : First Aid: Local Effects of Cold.

(c) Part III : Prevention of Heat Related Diseases.

(d) Part IV : First Aid: Effects of Heat.

(e) Part V : Prevention of High Altitude Illnesses.

(f) Part VI : First Aid: High Altitude Illnesses.

PART I: PREVENTION OF COLD INJURIES

4. Following preventive measures should be ensured at all levels:-

(a) Shelter. There should be adequate protection from cold and wind in
living areas, as well in the toilets and bathing places.

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(i) Camps should be sited on the slopes of hills, rather than in the
trough.

(ii) Tents and bkr should be so sited that they provide adequate
protection from wind (direct draughts) and snow drifts.

(iii) Tent Arctic should be used for accommodation, when available.

(iv) Mattress Kapok and sleeping bag should be used to keep

oneself warm.

(v) Stoves heating/ bukharis should be used at auth locs. However,

precautions to prevent fire hazard and Carbon Monoxide poisoning
should be ensured.

(b) Protective Clothing.

(i) Clo should be loose and warm. It should be worn in multiple

layers. Outer layer should be impervious to water and wind proof and
the inner layers should be of an insulating mtrl like wool.

(ii) Damp and wet clo should be imdt changed.

(iii) Special care should be taken to adequately cover those parts of

the body which are more susceptible to adverse effects of cold, viz.,
fingers and hands, feet and toes, nose and ears.

(iv) Head should be properly covered with a cap comforter or a

‘balaclava’.

(c) Gloves/ Mittens.

(i) When auth, these should be always used.

(ii) Gloves should be tied at the wrist with a strap to avoid ingress of
snow and water.

(iii) The sleeves of coat parka should cover the ends of the gloves,
and strapped with a button/ strap, so that snowflakes do not find their
way into the gloves.

(d) Boots and Socks.

(i) Every indl should have at least three pairs of woollen socks so
that two pairs of socks are worn at a time and one pair is available for
change.

(ii) Socks should be kept in a proper state of repair as badly darned

socks may cause local injuries.

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(iii) Boot should not be tight fitting, kept soft and water proof, by appl
of special dubbin.

(iv) Boot Combat Rubber Insulated (Boots Arctic) should be used

where auth.

(v) When walking on snow and slush, putties should be used, if

available, but they should not be applied too tightly.

(vi) Sleeping with boots on should be avoided, as it impedes

circulation.

(e) Personal Hygiene.

(i) Feet should be kept dry.

(ii) Feet, hands and face should be insp each night for any sign of
cold injury and washed thoroughly with warm water, dried and smeared
with a little vaseline before sleeping.

(iii) Foot powder may be sprinkled before wearing socks to keep the
feet dry.

(f) Nutrition. Fluids should be taken liberally and food should be

nutritious, hot and appetizing.

(g) Alcohol and Smoking.

(i) Alcohol must be avoided, particularly when the indl is likely to be

exposed to cold. Mov out in the cold after consuming alcohol should be
strictly prohibited.

(ii) Use of tobacco should be discouraged. Use of tobacco in any

form should be definitely prohibited once cold injury occurs.

(h) Exercise.

(i) Regular moderate ex is advised to keep up the circulation and

maint body warmth.

(ii) During the pd of prolonged immobility, there should be frequent

mov of limbs, fingers and toes. However, excessive effort resulting in
sweating must be avoided.

(j) Care in Handling Cold Objects.

(i) Direct contact with cold objects, especially metals such as

triggers etc should be avoided. These may be wrapped with a tape.

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(ii) Metallic forks and spoons should be warmed before use.

(k) Buddy System.

(i) All rks should wk in pairs and be taught to watch each other for
early signs of cold injury.

(ii) If the tip of the nose, earlobes or cheek of one is showing

whitishness, excessive redness, blistering or blackish discoloration, the
other should draw attention, so that first aid can be given.

PART II: FIRST AID: LOCAL EFFECTS OF COLD

5. The following measures should be taken:-

(a) All the cold injury cases should be treated as stretcher/ lying cases.

(b) First Aid at the unit level/ RAP incl gradually increasing body temp of
the indl by providing hot fluids, hot food, extra blankets and sleeping bag.

(c) Patient should be re-assured and mild analgesics such as aspirin may
be given.

(d) Evac to the nearest med unit should be undertaken on priority basis.

(e) Local warming of the parts is not advisable at unit/ RAP level, unless
evac is likely to be delayed. In such cases local warming of the affected parts
should be done with lukewarm water (40º - 42º C) or by wrapping in a warm
cloth. It should not be done using dry heat.

PART III: PREVENTION OF HEAT RELATED ILLNESS

6. For the purpose of preventive measures, hot wx is gen taken as the pd from
01 April to 30 Sep. Cdrs at all levels should ensure that the following preventive
measures are followed:-

(a) Water Intake.

(i) Preferably, cool water should be made available during hot wx.
However, it should be ensured that the ice is used for external cooling
only.

(ii) In hot wx, troops undertaking moderately hard wk may need up

to 10 to 12 ltr of water in 24 hr, while men undertaking strenuous tasks
/ route marches may need up to 16 to 17 ltr in 24 hr.

(iii) Troops must be encouraged to drink plenty of water, at periodic

intervals of every hr or two.

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(iv) Water being an essential physiological requirement, water discp

should not be attempted.

(b) Salt Intake. The quantity of salt auth in rations is considered

adequate. Addl salt may be provided on the dining table for use. There is no
reqmt to give extra salt, over and above auth.

(c) Work.

(i) It is accepted fact that wk performance in hot environment may

not be as much as during cool/moderate conditions.

(ii) The hr of wk and PT/ games should be restricted to the cooler

parts of the day. Troops should not be emp on strenuous tasks or trg in
the open betn 1100 to 1700 h (or timings as recom by local med auth)
but may carry out light wk under shade.

(d) Training Programmes.

(i) During hot season, before conducting endurance tests of

physical performance like BPET, route marches, etc, clearance should
be taken on daily basis from local med auth.

(ii) Even after such clearance has been given, the tests must be
started in such a manner that they are completed before sunrise and
definitely before 0700 hr.

(e) Clothing. Clo should be light and loose. Cdrs may consider allowing
troops to put on PT dress during working time during hot conditions.

(f) Meals. Troops should be provided with wholesome and well cooked
meals. Intake of plenty of water should be encouraged.

(g) Rest. As far as possible, reveille should not be before 0500 hr. If
possible, during conditions of high temperature, troops should be provided
with facilities to have an afternoon rest after meals under shade.

(h) Bathing. Daily bath or as frequent as operationally possible, should be

carried out using soap and water.

(j) Living Accommodation. Bk/ living places should be well ventilated

and overcrowding should be avoided. Use of fans/ natural ventilation/ desert
coolers where available should be made.

(k) Alcohol. During summers, issue of alcohol should be restricted.

Alcohol should not be issued on the evening before strenuous physical test.

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PART IV: FIRST AID: EFFECTS OF HEAT

7. Following measures should be undertaken:-

(a) Mov patient to a cooler, shaded place.

(b) Remove clo.

(c) Spray skin with tap water (at 25° to 30°C) or wrap the patient in a sheet
soaked in water.

(d) Continue fanning manually or with an electrical fan.

(e) Keep vigorously massaging the skin to prevent constriction of blood

vessels during cooling.

(f) Place ice packs or towel soaked in cold water around the neck, axillae
and groin.

(g) Keep the patient in side posn and NOT on back.

(h) Quickly tpt to the Ml Room/Hosp as an emergency.

PART V: PREVENTION OF HIGH ALTITUDE ILLNESSES

8. Most cases of adverse effects of high alt tend to devp within the first week of
induction into high alt, or within a few days of mov ahead to the next higher stage of
high alt. Attention should therefore be paid by Cdrs at all levels on accln by troops.
Accln should be carried out in 3 stages, depending on the ht that the indl is finally
going to stay:-

(a) First Stage Acclimatisation. This is applicable to indls posted above

2700 metres and upto a height of 3600 metres. The accln pd is for 6 days as
under:-

(i) First and Second Days. Rest except for short walk in the unit
lines only, not involving any climbs.

(ii) Third and Fourth Days. Walk at slow pace for 1 ½ to 3 Km.
Avoid steep climbs.

(iii) Fifth and Sixth Days. Walk upto 5 Km and climb upto 300
metres at a slow pace.

(b) Second Stage Acclimatisation. (above 3600 metres and upto 4500
metres). This is carried out for 4 days as under:-.

(i) First and Second Days. Slow walk for a distance of 1 ½ - 3

Km. Avoid steep climbs.

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(ii) Third Day. Slow walk and climb upto 300 metres.

(iii) Fourth Day. Climb 300 metres without eqpt.

(c) Third Stage Acclimatisation. (above 4500 metres) . This also lasts
for 4 days and is on the same lines as second stage of accln.

9. The pt which should be noted is that each stage of accln should be

completed. For instance, an indl who is finally going to an alt of 17000 feet, will first
complete the first stage (6 days), followed by second stage (4 days) and finally the
third stage (for another 4 days).

10. Re-Entry to High Altitude. Indls who have left high alt area will require accln
again if they are away for more than 10 days. Indls who are away for more than 4
weeks will require complete accln as per detl above, while those who have been
away for more than 10 days but less than 4 weeks will have accln for 4 days at each
stage like fresh inductees as under:-

(a) First and Second Days. Rest except for short walks.

(b) Third Day. Walk at slow pace for 1 - 2 Km, Avoid steep climbs.

(c) Fourth Day. Walk 1 - 2 Km with climb upto 300 metres.

11. Pre-Induction Medical Examination. OC Transit Camp to ensure that only

those pers who have been medically examined and declared fit by the Med Offr, are
allowed to board the veh / aircraft.

12. Other Precautions

(a) Avoid going too high too fast.

(b) Prompt treatment of respiratory infections.

(c) Use of adequate protective clo and goggles to prevent effects of cold
and snow blindness.

(d) Health education to troops on the ill-effects of high alt.

(e) Avoidance of excessive consumption of alcohol and smoking.

(f) Consuming well cooked, hot and fresh meals and plenty of hot/ warm
fluids orally.

(g) Maintaining a happy and cheerful environment in the unit also helps in
reducing the incidence of psychological problems, often attributed to high alt.

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PART VI: FIRST AID: HIGH ALTITUDE ILLNESSES

13. The imp early symptoms of high alt related diseases are headache, nausea,
vomiting, (often described as a “bad hang-over”), mental irritability, loss of appetite,
lack of sleep, excessive thirst, palpitation, breathlessness, irritable cough and
impaired judgement .

14. The best form of mgt, once a pers develops high alt illness is imdt evac of the
patient to lower alt or treatment at the hosp.

15. All possible efforts should therefore be made for early evac of
cases/suspected cases of high alt illnesses. Till such time evac is possible, the
following first aid measures should be undertaken :-

(a) Complete rest. Avoidance of any exertion.

(b) Try and evacuate to a post at lower alt, avoiding any exertion.

(c) Oxygen administration, at flow rates of 8 ltr per min, using a face
mask under supervision of RMO/ NA/ BFNA.

(d) Place the patient in HAPO bag, if available, under supervision of

RMO.

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SECTION 12. MEDICAL EXAMINATION AND MEDICAL BOARDS

References:- (a) Defence Service Regulations. Revised Edition 1987.

(b) Regulations for the Medical Services of The Armed
Forces 2010 (Revised Version).
(c) AO 9/2011/DGMS. Health Care System in the Army –
Instructions for Medical Examination and Classification of
Serving Officers.
(d) AO 3/2001. Health Care System in the Army –
Examination and Categorisation of Serving JCOs/ ORs.
(e) AO 3/89. Medical Examination of all Ranks Prior to
Release, Retirement, Discharge, Completion of Tenure or
Service Limit.
(f) AO 513/71. Invaliding Medical Board – Officers, Nursing
Officers and Cadets.
(g) Army Headquarters Adjutant General’s Branch DGMS –
5A letter no 11952/Pol/DG MS-5A dt 28 Jan/19 Feb 1988.
(h) IHQ MoD AG’s Branch DGMS (Army) letter no
76086/Policy/DGMS-5A dt 21 Sep 2017.

Appendices. A Age Wise Schedule of Medical Examination for Officers.

GENERAL

1. Med exam and med bd being conducted in Army have financial and legal
implications for the org as well as beneficiaries. It is therefore vital for all rks to be
aware of existing orders and instrs on the subject.

AIM

2. The aim of this section is to discuss existing orders and instrs related to med
exam and med bd being held in Army. This section also provides ready reference for
Cdrs at all levels for actions reqd to be undertaken in fmn/units on occurrence of
injury/ death of any pers subject to Army Act.

LAYOUT

3. This section is divided into the following parts:-

(a) Part I : Medical Examinations.

(b) Part II : Medical Boards.

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(c) Part III : Injury to a Person Subject to Army Act.

(d) Part IV : Fatal Case Documents.

PART I: MEDICAL EXAMINATIONS

4. Annual Medical Examination (AME): Officers.

(a) Auth. AO 9/2011/DGMS.

(b) Form.

(i) Upto 35 Years. Health Record Card (HRC) only.

(ii) More than 35 Years. HRC and AFMSF 3B.

(c) No of Copies. Four.

(d) Schedule. Detl schedule of AME is given as appx A to this section.

Summary of the same is as under:-

(i) Upto 44 Years of Age. 01 Oct to 31st Mar by unit AMA except
for 26 (25 yr 01 day to 26 yr completed), 31st, 38th and 43rd yr of age
th

when it has to be conducted in nearest MH/ Fd Hosp.

(ii) Over 44 Years of Age. 01 Apr to 30 Sep in nearest MH/ Fd

hosp except for 45th (44yr 01 day to 45 yr completed), 47th & 49th yr of
age when it is conducted by unit AMA.

(e) Officers Away on TD / Course/ Posting Abroad. AME of such offr

may be deferred. However, the same will be carried out within three months of
his/her arrival in India. No special sanction will be reqd for such exam.

(f) Officers on Deputation/ Undergoing Courses. Apply to the nearest

Col Med, Div or Brig Med, Corps or MG Med Comd, Area/ Comd for sanction
to undergo their AME/ PME at the nearest Military Hospital.

(g) In Case Officer Fails to Undergo AME During the Scheduled Time.
He/ she will take up a case for delayed AME. The competent auth for delayed
AME will be as laid down in AO 9/2011.

(h) The dates of AME and Annual Confidential Report (ACR) continue to
be delinked in case of offr.

(j) The offr will ensure availability of AFMSF-3 of previous yr AME and
their HRC when they report for AME.

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(k) The officer who is being examined will certify his/ her previous yr med
cl on AFMSF-3B.

5. Annual Medical Examination: JCOs/ OR.

(a) Auth. AO 3/2001.

(b) Form. AME register and HRC.

(c) Schedule. AME for JCOs/OR will be carried out two months before the
initiation of ACR. For those indl for whom there is no ACR, it will be carried out
from Mar to Jun.

(d) A complete clinical exam and relevant investigations as considered

necessary by the AMA will be carried out.

6. Periodic Medical Examination (PME): Officers.

(a) Auth. AO 9/2011.

(b) Form. AFMSF -3A.

(c) No of Copies. Four.

(d) Schedule. During 36th, 41st , 46th , 51st, 54th, and 58th yr of age,
conducted in nearest hosp.

(e) Officers Who are Abroad During the Schedule of PME. He/she will
undergo the same within three months of arrival in India. No sanction will be
reqd for the same.

(f) If For Any Reason the Officer Fails to Undergo PME During
Scheduled Time. He/she will take up a case for delayed PME as laid out in
AO 9/2011. The sanction for delayed PME will be valid for three months.

7. Periodic Medical Examination: JCOs.

(a) Auth. AO 3/2001.

(b) Form. AFMSF 3A.

(c) No of Copies. Three.

(d) Schedule. At the age of 41 yr i.e. on completion of 40 yr of age or

within one yr of promotion to Nb Sub whichever is earlier.

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8. Release Medical Examination: All Ranks. All rks who are in SHAPE 1 at the
time of release will undergo release med exam.

(a) Auth. AO 3/89.

(b) Form. AFMSF 18 (Ver – 2006).

(c) No of Copies. Five.

(d) Schedule. Up to 8 months before due date of disch by AMA.

9. Medical Examination Before Proceeding to HAA and On Return From

HAA. All rks before proceeding to HAA on permt posting will be subjected to med
exam to detect any disease/ disability which might be aggravated in HAA. Similarly,
all rks will be subjected to med exam within two months of their return from HAA.
Their med exam will be carried out by AMA and record maint in HRC.

10. Unscheduled Medical Examination. Any offr wishing to have a med exam at
any time of the yr may request for such an exam at his/ her convenience not more
than once in a yr, provided he is not asking for review of his/ her disease/ disability
for which he/ she is downgraded to LMC temporarily. Permanently placed LMC offr
can ask for a review at any time after at least half of the pd of LMC has elapsed, if
the AMA certifies that the offr’ condition has improved materially.

PART II: MEDICAL BOARDS

11. Classification/ Re-Classification Medical Board: Officers.

(a) Auth. AO 9/2011.

(b) Form. AFMSF 15 (Ver 2006).

(c) No of Copies. Four.

(d) Schedule. As reqd/on due date of review.

(e) Offrs on TD/ Deputation Abroad. Within 3 months of arrival in India.

No prior sanction reqd.

12. Categorisation/ Re-Categorisation Medical Board: PBORs.

(a) Auth. AO 3/2001.

(b) Form. AFMSF 15 (Ver 2006).

(c) No of Copies. Four.

(d) Schedule. As reqd/ on due date of review.

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13. Release Medical Board (RMB): All Ranks. All rks who are either in LMC or
are detected to have disease/disability during release med exam will undergo RMB.

(a) Auth. AO 3/89.

(b) Form. AFMSF 16 (Ver 2006).

(c) No of Copies.

(i) Officers. Seven copies.

(ii) PBORs. Six copies.

(d) Schedule. Up to 8 months before due date of disch at dependent

hosp.

14. Invalidment Medical Board: Officers.

(a) Auth. AO 513/71.

(b) Form. AFMSF 16 (Ver 2006).

(c) No of Copies. Seven.

(d) Schedule. As reqd at designated hospitals.

15. Invalidment Medical Board: PBORs.

(a) Auth. AO 3/2001.

(b) Form. AFMSF 16 (Ver 2006).

(c) No of Copies. Four.

(d) Schedule. As reqd at designated hosp.

16. Promotion Med Bd for offr have been dispensed with. If an offr has not
undergone a Periodic Med Bd when it was due, he/ she shall undergo a delayed
Periodic Med Bd as explained above, before he/ she can be promoted to the next
higher rank.

PART III: INJURY TO A PERSON SUBJECT TO ARMY ACT

17. The detl of conduct of inquiry, bd, etc in case of injury to a person subject to
army act is given under para 520, page 177 of Defence Service Regulations,
Revised 1987. It is recom that Fmn/unit Cdrs familiarise themselves with the
regulation while handling injury cases in the fmn/unit. A few imp considerations on
occurrence of injury case in fmn/unit are as under:-

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(a) When an offr, JCO, WO, OR or MNS, whether on or off duty, is injured
(except by wounds recd in action), a certificate on IAFY-2006 is to be fwd by
the med offr in charge of the case to the injured person’s CO as soon as
possible.

(b) In case of injuries which are imdt fatal, a report of the C of I

proceedings will take the place of IAFY-2006 (injury report).

(c) If the injury is certified by the med offr to be of serious nature, a C of I

will be held. Where an inquest is held, a copy of the coroner’s report of the
proceedings will be attached to the C of I proceedings.

(d) If the med offr certifies that the injury is of a trivial character, unlikely to
cause permt ill effects, no C of I need be held, unless considered necessary
as under:-

(i) If, in the opinion of the CO, doubt exists as to the cause of the
injury.

(ii) If, in the opinion of the CO, doubt exists as to whether the
injured person was on or off duty at the time he or she recd injury.

(iii) If, for any reason, it is desirable thoroughly to investigate the

cause of the injury.

(iv) If the injury was caused through the fault of some other person.

(e) The injury report will be submitted to the brigade Cdr or the offr who
has been auth to ex the legal and disciplinary powers of a brigade Cdr only if
the injury is severe or moderately severe or if a C of I to enquire into the
causes of injury has been held. He will record on the form his decision
whether or not the injury was attributable to mil service and whether it
occurred on field service. In all other cases, CO will record his opinion.

PART IV: FATAL CASE DOCUMENTS

18. The detl of instr to be followed for disposal of med case sheets and connected
documents in respect of all fatal and non-fatal cases If patients admitted to or of pers
Found Dead to Military Hospitals is provided in DGMS 5A letter no
11952/Pol/DGMS-5A dt 28 Jan/19 Feb 1988. The same is available at DGMS 5A
website. All Cdrs are recom to familiarise themselves with the instrs on the subject
while handling fatal case documents. Imp considerations for unit and fmn Cdrs while
handling fatal case documents are as under:-

(a) Fatal case documents will be prepared in duplicate.

(i) Original Set. Original set will comprise of hand written med
case sheets, investigation forms and other relevant documents.

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(ii) Duplicate Set. Duplicate set will comprise of typed copies of all
documents of the Original set.

(b) In cases classified as BCs/Bas, for which no Injury reports are reqd to
be prepared (except in cases of gross negligence or misconduct as specified
in orders) and which end fatally after admission to hospital, duplicate copy of
the case sheets and attributability certificate need not prepared. In such
cases, death certificate and case sheets in original, alongwith Injury report, if
prepared, should be fwd to the Record Office concerned. These documents
should clearly indicate that the death was on account of Battle
Casualty/Accident.

(c) Within 5 days of the occurrence of the casualty, OC hosp will initiate
AFMSF – 81 (revised) in respect of the deceased and forward it to OC
unit/Trg institution concerned under an OP IMMEDIATE letter. The same has
to be acknowledged by the recipient, completed and returned imdt to the hosp
for further processing of documents.

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Appendix ‘A’
(Refer para 4 (d) of section 12)

AGE WISE SCHEDULE OF AME/ PME FOR OFFICERS

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LEGEND

AMA - RMO/MO i/c MI Room or Staff Surgeon.

# - Blood-Hb%, TLC, DLC; Urine RE & Sp Gr.

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## - Blood – Hb%, TLC, DLC; Urine RE & Sp Gr; Blood Sugar – Fasting & PP
Resting ECG.

### - Blood – Hb%, TLC, DLC; Blood Sugar (Fasting & PP), Uric acid, Creatinine,
Cholesterol/Lipid Profile(if cholesterol is more than 200 mg/dl); Urine RE & Sp Gr
Resting ECG; X-Ray chest PA view.

* - By MO deputed by CO, hospital.

@ - By Med Specialist deputed by CO Hosp.

& - During PME all lady offr will be examined by Gynaecologist and findings will be
recorded in AFMSF-3A and HRC.

Note : After the age of 45 yr, some addl tests can also be included, if available, at
place where PME is carried out.

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SECTION 13. HEALTH EDUCATION MATERIAL

List of Health Education Material.

1. Prevention of Mosquito Borne Diseases.

2. How to Handwash.

3. Sanitary Rules for Food Handlers.

4. Five Keys to Food Safety.

5. Prevention of Food and Water Borne Diseases.

6. Awareness on AIDS.

7. Removing Stigma Associated with HIV/ AIDS.

8. Hypertension – Silent Killer.

9. Diabetes Mellitus.

10. Healthy Diet.

11. Benefits of Physical Activity.

12. Say NO to Tobacco.

13. Alcohol – A Disruptive Factor.

14. Swachh Bharat Abhiyan.

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