January – March 2013 

Perspectives 1 

MG Philip Volpe; COL Mustapha Debboun; Richard Burton 

The US Army Veterinary Service 2020: Knowledge and Integrity 5 

BG John L. Poppe 

The Army Animal Care Specialist; Past, Present, and Future 11 

LTC Boris Brglez; LTC James Giles; COL Kelly Mann 

The Effects of Environmental Extremes on Working Dogs: A Collaborative Initiative 22

LTC Janice Baker; MSG Laura Miller 

Pit Viper Envenomation in a Military Working Dog 28

CPT Curtis R. Cline; MAJ Michelle E. Goodnight

Heatstroke in a Military Working Dog 34 

CPT Miranda Andress; MAJ Michelle E. Goodnight 

Veterinary Diseases Review for Mainland Japan, 2000-2010 38

Will K. Reeves, PhD; MAJ Kimberly Yore; MAJ Robert Paul; Laurel Lloyd 

A Review of Influenza Viruses in Seals and the Implications for Public Health 45 

CPT Virginia White 

Communicating Local Food Risk During Counterinsurgency Operations: 51 

Development and Evaluation of a Risk Communication Campaign 

Esther J. Pfau; LTC Jerrod W. Killian; Carrie A. Kilby; Karen D. Deaver 

Food and Water Risk Assessments: Empowering Commanders and 63

Protecting Service Members

LTC Jerrod W. Killian; MAJ Ronald L. Burke; James E. Westover, Jr. 

The Role of the US Army Veterinary Corps in Military Family Pet Health 69

LTC (Ret) Nancy A. Vincent-Johnson 

One Health and Force Health Protection During Foreign Humanitarian Assistance 81 

Operations: 2010 Pakistan Flood Relief

MAJ Ronald L. Burke 

US Veterinary Support to Standardization of Food and Water Safety and Animal 86 

Care and Use Within NATO

MAJ Ronald L. Burke; COL Kelly A. Mann; et al 

Also in this Issue

Winning Poster of the 2nd Annual Research Day at the Graduate School, 92 

Academy of Health Sciences, US Army Medical Department Center & School

LTC Reva Rodgers; MAJ Renee E. Cole 

The US Army Veterinary Service: 

a national defense resource for health 
January – March 2013 The Army Medical Department Center & School PB 8-13-1/2/3 

By Order of the Secretary of the Army: 

Official: 

1229301 

RAYMOND T. ODIERNO 

General, United States Army 

Chief of Staff

DISTRIBUTION: Special 

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Secretary of the Army 

JOYCE E. MORROW 

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of the AMEDD Community 

The Army Medical Department Journal [ISSN 1524-0436] is published quarterly for 

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DISCLAIMER: The AMEDD Journal presents clinical and nonclinical professional 

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Appearance or use of a commercial product name in an article published in the 

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Views expressed are those of the author(s) and do not necessarily reflect official US 

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LTG Patricia D. Horoho 

The Surgeon General 

Commander, US Army Medical Command 

MG Philip Volpe 

Commanding General 

US Army Medical Department Center & School 
 January – March 2013 1

Perspectives

COMMANDER’S INTRODUCTION

MG Philip Volpe

EDITOR’S PERSPECTIVE

This issue of the AMEDD Journal is the fi rst to feature 

the work of Army veterinary professionals since the 

establishment of the Army Public Health Command, 

which absorbed the resources and functions of the now 

closed Army Veterinary Command. In his article, BG 

Poppe introduces the Veterinary Service, which, as the 

only US military veterinary asset, has both Army and 

Department of Defense missions. As an Army Medical 

Department organization, it supports The Surgeon General’s concepts, initiatives, and plans, while meeting the 

veterinary support demands of the entire US military, 

both in garrison and deployed. The article also details all 

the professional specialties represented in the Veterinary 

Service, including the Veterinary Corps offi cers and the 

enlisted and civilian professionals, providing a complete, 

concise description of their functions and qualifi cation 

requirements. Finally, BG Poppe presents his ideas and 

vision to ensure that support for the constantly evolving requirements facing the Army’s unique resource 

will continue uninterrupted, while always maintaining 

the highest standards expected of military professionals. 

This is an excellent overview of the Army’s veterinary 

capabilities and those dedicated individuals working in 

locations around the world who provide them.

Certainly, Army veterinarians represent “the best of the 

best” in education, skills, and training. However, even 

Veterinarians were fi rst brought into US military service 

in 1776 by General George Washington to care for the 

horses of his Revolutionary Army. As the US military 

grew along with the expanding nation, veterinarians became even more important in caring for the numerous 

draft and cavalry horses and cattle required for armies to 

move and survive during campaigns. During the last half 

of the 19th century, veterinarians became increasingly in 

demand within the Army as their academic and scientifi c 

educations were recognized as valuable for functions beyond the care of animals. In 1916, the Veterinary Corps 

became part of the regular US Army, and veterinarians 

entered the service as commissioned offi cers.

The US Army Veterinary Corps has been featured in 

past issues of the AMEDD Journal. However, for this 

issue dedicated to military veterinary topics, BG John 

Poppe, the 25th Chief of the Army Veterinary Corps, has 

instituted a shift of focus. As a result, this issue expands 

the perspective with articles demonstrating the variety 

and importance of the Army Veterinary Service’s responsibilities as a vital component of US military readiness and capability.

The veterinary medicine component of the Army Medical Department has undergone signifi cant changes over 

the last few years, as the Army Veterinary Command 

was disestablished, and its resources, functions, and responsibilities became the province of the newly established US Army Public Health Command. BG Poppe 

opens this issue with a clear statement of his vision for 

Army Veterinary Services role in The Surgeon General’s strategic initiatives for Army medicine and how it 

will be achieved, as well as an overview of the Services’ 

organizational responsibilities and structure. 

Most people who directly benefi t from the work of the 

Army Veterinary Service have no idea that their good 

health is in many ways directly dependent on the education, training, skills, and motivation of these dedicated 

professionals. Although the articles in this issue provide 

considerable insight into the variety of capabilities and 

responsibilities of the Veterinary Service, the full extent 

of what they do every day far exceeds a single AMEDD 

Journal’s capacity for presentation.

A number of readers will no doubt be surprised to learn 

of the scope of the Service’s work, as well as the high 

levels of qualifi cation and education that are found 

among its professionals. Each day they are hard at work 

in the fi eld and laboratories, conducting research on 

communicable diseases and biological weapons, protecting our food and water supplies, and caring for the 

military working dogs that are vital contributors to front 

line combat operations. Further, the dynamic character 

of the current confl icts has presented an entirely new set 

of previously undefi ned operational and support challenges and responsibilities. Army Veterinary Service 

personnel have repeatedly risen to the occasion, adapting, innovating, and doing what is necessary to protect 

the health and wellness of US citizens, our Warriors, and 

our invaluable military working dogs.
2 http://www.cs.amedd.army.mil/amedd_journal.aspx

they cannot make optimal use of those attributes without 

the services of skilled and dedicated assistants to complement and expand their capabilities. LTC Boris Brglez, 

LTC James Giles, and COL Kelly Mann have contributed an excellent, well-written article that chronicles the 

history of those assistants in Army service, describes 

the current status of their training, responsibilities, and 

assignments, and projects the logical course to address 

future animal care requirements. Today, those assistants 

are the Army Animal Care Specialists (military occupational specialty 68T) who are trained and assigned to 

provide the fi rst level of animal care directly and independently, as well as provide assistance to veterinarians 

and more advanced animal care under their supervision. 

This article is a comprehensive, well-researched, and detailed look at this critically important personnel resource 

without which military veterinary medical care simply 

could not function. It should become an important source 

of information for anyone interested in the history not 

only of the animal care specialists, but also in the evolution of US Army veterinary medical care in general.

Veterinarians were engaged by the Army beginning in 

1776 to provide care for the large animals which were 

vital for transport, and in some cases food. Today, of 

course, the military owns only a few horses, but military 

working dogs (MWDs) have become an increasingly 

important asset, especially in the nonlinear combat environments which have evolved since the Korean War. 

Those dogs are now the focus of the animal care specialties in the Veterinary Service, and in many ways present 

more complex concerns than did horses and cattle. In 

their article, LTC Janice Baker and MSG Laura Miller discuss an area of physiologic concern that must be 

addressed by military veterinarians because dogs now 

accompany human Warfi ghters into virtually every climatic environment. Military veterinarians in the Special 

Operating Forces are driving a collaborative initiative to 

investigate the physiologic capabilities of working dogs 

in order to defi ne their limits for safe and effective use 

in extreme environments, which are currently grouped 

into 4 broad areas: extreme heat, extreme cold, maritime, and high altitude. This article’s descriptions of the 

sophisticated research and analysis involved in this effort are excellent examples of the high levels of sophisticated technical and scientifi c skills that today’s Veterinary Service professionals bring to work every day.

CPT Miranda Andress and MAJ Michelle Goodnight 

continue the topic of environmental concerns for 

MWDs in their article describing recognition and treatment of heatstroke. To underscore the potential seriousness of the problem, they open the article with a detailed 

clinical vignette of an incident involving an MWD who 

developed and subsequently succumbed to heatstroke 

in the summer of 2012, even with the immediate availability and application of veterinary care. They then 

provide a comprehensive, well-referenced description 

of the pathophysiology of veterinary heatstroke, its risk 

factors, and diagnosis and treatment of the condition. 

Their article is an excellent tutorial (or refresher) on this 

serious but highly preventable environmental threat to 

our valiant 4-legged Warriors.

CPT Curtis Cline also collaborates with MAJ Goodnight 

to contribute an article dealing with another environmental threat that our MWDs share with us, that posed 

by venomous reptiles. Their article centers around an 

MWD’s encounter with a pit viper and the subsequent 

treatment of the resulting envenomation. Veterinary 

care was quickly obtained, but unfortunately there was 

no antivenin locally available with which to treat the 

dog. A quick assessment of the alternatives and rapid 

action allowed the MWD to be moved by air to another 

military veterinary treatment facility where the appropriate antivenin was available, resulting in a complete 

recovery. This article presents a textbook example of the 

application of clinical skills, initiative, resourcefulness, 

and quick coordination by which the veterinary staff 

successfully saved a valuable animal. Again, similar to 

the earlier article, CPT Cline and MAJ Goodnight have 

provided a comprehensive tutorial/refresher (and some 

lessons learned) concerning this very real and not uncommon threat to our MWDs.

Public health professionals have worked for years to establish surveillance systems and databases for communicable diseases over as much of the world as possible. 

Such systems are invaluable for spotting outbreaks, disease migrations, trends, etc, and for predicting disease 

incidents based on past data and current occurrences. 

However, as Dr Will Reeves and colleagues point out 

in their article, such surveillance systems do not capture data on zoonotic pathogens from veterinary clinics. Since a number of zoonotic diseases and parasites 

fi rst present in animals that share human living spaces, 

the presence of such organisms in those animals would 

likely be detected before infections in the human population became evident. Dr Reeves and his team studied 

the records of veterinary care facilities on US military 

bases on the home islands of Japan from the past 10 

years to evaluate the potential threat posed by zoonotic 

organisms to US military personnel and families. The 

article is a detailed, thoroughly referenced synopsis of 

their fi ndings. The wide range of zoonotic parasites and 

pathogens found among the relatively small bases in an 

advanced country such as Japan should interest public 

health researchers in the potential value of veterinary 

PERSPECTIVES
 January – March 2013 3

THE ARMY MEDICAL DEPARTMENT JOURNAL

clinic surveillance data within their existing data structures and algorithms.

In addition to zoonotic diseases and parasites, veterinary 

and other public health professionals are concerned with 

reservoirs and vectors of infectious diseases, especially 

communicable viruses. Although most people are familiar with insect disease vectors such as the mosquito, there 

are animal vectors as well, including human beings. In 

her excellent, extremely interesting article, CPT Virginia White reviews infl uenza viruses that infect humans 

and pinnipeds, the species that includes seals, walruses, 

and sea lions. Surprisingly, mass mortality in pinniped 

populations infected with infl uenza has been observed 

for decades. CPT White’s article is a compendium of detailed information about the various infl uenza viruses 

that infect pinnipeds, including etiology, epidemiology, 

pathology, diagnosis, and control, as well as transmission to humans. Especially interesting and concerning is 

her discussion of the presence of avian infl uenza strains 

in almost every analysis of pinniped infl uenza infection. 

This well-organized and extensively referenced article 

is a valuable introduction to the presence and pandemic 

potential of pinniped-borne infl uenza, as well as providing a virtual directory of information sources contained 

within its reference list.

For many decades, US travelers to undeveloped areas 

in the world have faced the possibility of developing digestive distress and illness from consumption of local 

foods. Indeed, most of us are familiar with semihumorous clichés coined for regularly visited areas, such as 

“Montezuma’s revenge.” Unfortunately, for a military 

force operating in undeveloped areas, such food-derived 

illnesses are absolutely not humorous—incapacitated 

military personnel can seriously degrade readiness, 

as has been demonstrated time and again throughout 

military history. Today’s US military personnel receive 

some predeployment training in food choices, however, 

gastrointestinal illness still is in the top 5 diagnosed diseases among deployed personnel. In their article, Esther 

Pfau and her coauthors describe a joint initiative by the 

Army Public Health Command and the Army Medical 

Department Center and School to develop a different approach to predeployment training regarding food-borne 

hazards, and measure the effectiveness of that approach 

in comparison to existing training packages. The new 

training is designed to educate individuals on the hazards represented by different types of local foods they 

will encounter throughout the deployment area, not just 

about the foods available from “approved” sources. Ideally, such training would allow them to make informed 

decisions about which foods are safer than others simply based on the food itself, no matter where they are 

located. While not eliminating it altogether, informed 

choices should signifi cantly reduce the incidence of gastrointestinal illness while deployed. This article is an excellent example of a carefully designed and implemented study, with meticulous attention to the determination 

of statistically valid effectiveness. The fi nal product of 

such efforts is meaningful, effective training, actually 

of value to all who receive it.

Although the Department of Defense (DoD) conducts 

audits of food production facilities worldwide and maintains a directory of those that have met the inspection 

standards, it is unrealistic to think that an approved establishment will be available in every area, especially 

in remote locations, into which our Warriors are sent. 

Therefore, as discussed in the previous article, the risk of 

gastrointestinal disease is signifi cant in such areas. LTC 

Jerrod Killian and his coauthors have contributed an article concerning an additional tool for US military commanders’ efforts to provide safe food and water to US 

personnel working in or deployed to foreign countries. 

The Food and Water Risk Assessment (FWRA) program is designed to allow trained assessors to evaluate 

and communicate food-borne risks on a local, situational basis, allowing commanders to determine the level of 

acceptable risk in conjunction with the assessor who has 

veterinary risk mitigation expertise. The FWRA allows 

consideration of higher risk food operations than does 

the DoD audit and is therefore more dependent on local 

focus on mitigation. However, there are many situations 

in which a commander may have few options for feeding the force (at least in the short term), so the FWRA is 

a tool to help reduce the risk to manageable levels. This 

interesting and informative article is a tutorial for anyone planning for visits or deployments, operational or 

training, to less developed areas of the world.

As LTC (Ret) Nancy Vincent-Johnson explains in her 

article, until relatively recently, veterinary facilities on 

military bases within the continental United States were 

restricted, as a matter of policy, from providing more 

than the most basic of animal care services to non–government-owned animals. This limitation was imposed 

partly from tradition, partly from limited availability 

of veterinary personnel beyond their primary missions, 

and partly from political concerns regarding civilian 

practices in the areas of military installations. Such limitations were not imposed on remote installations where 

civilian veterinary care was not locally available, nor on 

overseas bases because of language barriers and the lack 

of equivalent standards of care. Eventually, the Army 

Veterinary Corps realized that these limitations were 

increasingly harmful to both recruiting and retaining 

high-quality veterinarians, as they saw their profi ciency 
4 http://www.cs.amedd.army.mil/amedd_journal.aspx

in animal care skills atrophy from lack of application, 

thus depreciating the value of the considerable investments of time and money they had committed to their 

educations. The professional environment and policies 

had to change. LTC (Ret) Vincent-Johnson’s interesting 

and very informative article describes the evolution of 

policies and standards that created a clinical credentialing program for new Army veterinarians, established 

an Army veterinary medical standardization board, and 

put in place the funding mechanism and structure to enable military veterinary clinical care of privately-owned 

animals on military installations. This is an excellent 

overview of positive, proactive actions by the Army Veterinary Service to ensure critical veterinary resources 

are available both now and in future years.

Among the many responsibilities and missions of the 

US military are those of Foreign Humanitarian Assistance (FHA), the most visible of which are disaster 

relief. Obviously, disaster relief missions must include 

military medical personnel, whose fi rst responsibility is 

the health and well-being of the US personnel deployed, 

and who secondarily may be called upon to provide 

medical care to sick and injured local nationals, as well 

as to other foreign relief personnel. By their very nature, 

disasters usually provide minimal notice and preparation time, and sometimes achieving the optimum mix 

of skilled personnel may not be possible. MAJ Ronald 

Burke’s article describes one such scenario for Army 

medicine’s participation in relief operations for the 

devastating fl oods in Pakistan during 2010. This FHA 

was primarily transportation and logistics support, and 

as such only included medical support for the US contingent. However, because of political concerns, the US 

strength was limited to approximately 600 total, which 

meant that the organization was truly “contingency,” as 

portions of units were mixed and matched to optimize capabilities with minimal personnel. The medical support 

contingent was likewise very basic, and included only 

a single veterinarian without enlisted preventive medicine or veterinary personnel. Of course the environment 

was austere, unsanitary, and remote, presenting a major 

threat of disease. MAJ Burke points out that a number of 

factors combined to allow the AMEDD professionals to 

successfully protect the deployed personnel, perhaps the 

most important of which was propitious cross-training 

within the 30th Medical Brigade of a year earlier which 

exposed the healthcare practitioners to preventive medicine tasks and procedures. Under the guidance of the 

veterinarian, the bare bones medical staff was therefore 

able to minimize the incidence of sickness among US 

personnel, especially achieving no cases of malaria or 

other arthropod-borne diseases. This article is an excellent lessons learned for AMEDD personnel who may 

fi nd themselves attempting to assemble an austere but 

fully capable medical detachment with only immediately available personnel. The overall lesson: plan ahead for 

fl exibility and shared responsibilities.

Throughout military history, interoperability among 

forces has simultaneously been a cherished goal and 

frustratingly diffi cult to achieve. The majority of experienced military personnel have likely dealt with challenges of operating with other services, and sometimes with 

diverse units within their own service. Communications, 

equipment, parts, and terminology are only a few of the 

areas of potential diffi culty. The challenges become exponentially more numerous and complicated when operations involving multinational forces are considered. 

There are 28 nations in the NATO alliance, each one 

bringing a different perspective and capability into any 

discussion. It is, therefore, not surprising that achieving agreements involves considerable bureaucracy and 

negotiation, as well as a multilayered documentation 

scheme designed to address the concerns of all allies. In 

their article, MAJ Burke and his coauthors clearly illustrate the complexities involved in defi ning and adopting 

meaningful standardization across the NATO structure. 

Their article deals strictly with the areas of food, water, and animal use and care standardization, presenting 

them within the framework of NATO documentation 

and organization. This is an eye-opening look at the inner workings of NATO that work endlessly in efforts 

to achieve alliance-wide standards and understandings. 

NATO forces must deploy quickly and effectively when 

required, and there may not be time to worry about the 

source and quality of the food and water provided until 

you need it. Alliance-wide standardization is intended to 

allay those concerns and allow commanders to focus on 

the combat missions ahead.

PERSPECTIVES
January – March 2013 5

As the 25th Chief of the US Army Veterinary Corps, I 

am honored to dedicate this issue of the Army Medical 

Department Journal to the US Army Veterinary Service. 

Although two previous issues focused on the US Army 

Veterinary Corps in 2007 and 2009 respectively, this is the fi rst issue dedicated to the 

US Army Veterinary Service. The Army 

Veterinary Corps, represented by the caduceus with a black V, is comprised of offi cers, 

both veterinarians and warrant offi cers. 

The Army Veterinary Service includes 

those offi cers along with the outstanding 

enlisted Soldiers, both animal care specialists and veterinary food inspection specialists, and civilian professionals who span 

the spectrum from administrators to veterinarians. The 

Veterinary Service is represented by a distinctive insignia with a banner foundation of “Knowledge and Integrity,” crowned by a unicorn. That insignia is featured as 

the background for the cover of this issue of the AMEDD 

Journal. It is a powerful image that will continue to represent our unique organization and remain the symbolic 

cornerstone of our Veterinary Service culture.

My specifi ed role as Chief of the Veterinary Corps has 

the additional implied task of representing the entire 

Veterinary Service.1

 The Veterinary Service has a Department of Defense (DoD) mission delegated from the 

Secretary of the Army through The Army Surgeon General. It is important that we remember that the center of 

gravity for the Veterinary Service is our deployable veterinary forces,2

 which are represented by a guidon with 

a green cross on a fi eld of white.3

 These units and all 

Veterinary Service personnel support The Surgeon General’s 3 strategic imperatives of creating capacity, enhancing diplomacy, and improving stamina4

 which similarly follows the 

Chief of Staff of the Army’s imperatives of 

prevent, shape, and win.5

 Soldiers and their 

Families benefi t daily from the Veterinary 

Service’s installation support activities and 

research and development work, both of 

which contribute directly to the health and 

wellness of the Army.

The US Army Veterinary Service is the undisputed 

world leader in the provision of military veterinary services, and has continued to grow with the demands of 

supporting an Army and nation at war in multiple theaters of operations over the last decade of 

confl ict. In the future, we will continue to 

set the example for the nation in animal 

health, food protection, and research. As 

an integral component of Army medicine, 

it is imperative that the Veterinary Service 

continues to have a signifi cant, positive effect on the health and readiness of the nation’s Warriors. In accomplishing this, we 

follow the guidelines prescribed by The 

Surgeon General in Army Medicine 2020 

Strategy.4

 We must create capacity to infl uence and enable individual, unit, and organizational health; enhance 

diplomacy by strengthening existing partnerships while 

building new ones to promote unity of effort in the pursuit of health; and improve organizational and individual stamina, an essential element in our transition to a 

system of health that will increase organizational depth, 

resilience, and endurance.

CREATE CAPACITY

The Veterinary Service must maintain its collective 

ability to develop the capabilities and core competencies 

necessary to deliver services and programs that infl uence overall health, and enhance Army Medicine’s role 

as a strategic enabler for both the Army and the DoD 

as a whole. This includes optimization, innovation, and 

organizational learning. Creating capacity is about increasing the ability to infl uence health and readiness. It 

includes the delivery of animal health programs, food 

protection, biosurveillance, research, and 

the development of new methods to positively affect our benefi ciaries’ lives.

We must leverage technology through information management systems for animal 

health, food protection, and biosurveillance. 

We are currently in our second iteration of 

animal health electronic records that will 

replace our legacy systems and be 

The US Army Veterinary Service 2020:

Knowledge and Integrity

BG John L. Poppe, VC, USA

The insignia of the US Army 

Veterinary Corps.

The guidon of deployed

military veterinary units.3
6 http://www.cs.amedd.army.mil/amedd_journal.aspx

the link between our animal health and human health 

responsibilities. We continue to explore food protection 

solutions to enhance the ability to report those programs 

within the Defense Occupational Environmental and 

Health Readiness System to replace our legacy food audit and inspection programs. We must continue to seek 

solutions in biosurveillance that support the Army’s and 

the nation’s strategic defense priorities.

ENHANCE DIPLOMACY

The Veterinary Service leads the way with veterinary 

diplomacy, shaping dialogue on veterinary services 

within DoD, national, and international communities 

to build enduring relationships in line with Army values, interests, and objectives. Diplomacy begins with 

enlisted Soldiers, who provide the fi rst line of defense 

in food protection and Role 1 veterinary care6

 to DoD 

military working dogs. Veterinary Service diplomacy is 

exemplifi ed in 58 years of sponsoring the International 

Military Veterinary Medical Symposium, the 5 years of 

veterinary sessions of the Asia Pacifi c Military Medicine 

Conference, and the dedicated veterinary support of the 

series of training courses focused on stability operations. 

However, there is always more to be accomplished. For 

example, Veterinary Service personnel in the combatant 

commands must be proactive to identify military veterinary personnel in each of the countries in their respective areas of responsibilities, and seek venues within 

which to engage and build enduring relationships.

The US Army Veterinary Service continues to lead the 

way in the education and training of stability operations 

by developing the Veterinary Support of Stability Operations series of courses: Assessment and Production 

Systems, Global Veterinary Medicine, and Production 

Medicine Profi ciency.

These courses, in conjunction with the Foreign Animal 

Disease Diagnosticians and the Medical Stability Operations courses, will ensure that Veterinary Services 

continues as the medical force of choice for the Army, 

DoD, and the nation in building partner capacities.

IMPROVE STAMINA

Recognizing that health is an integral component of 

readiness, the Veterinary Service will continue to improve organizational depth, resiliency, and endurance 

in order to withstand periods of intense change and 

unexpected challenges, and help ensure that the Army 

Medicine System for Health is supportable over the long 

term. The Veterinary Service supports the focus on 

health through food protection programs targeting both 

food safety and food defense, animal health programs 

which affect public health, and support of research that 

benefi ts all military personnel, both Warfi ghters and civilians, as well as their families. The Veterinary Service must increase both organizational and individual 

stamina throughout this intense period of institutional 

transformation, and then sustain the system for health 

for years to come.

CONTINUING 96 YEARS OF EXCELLENCE

Veterinary Corps

Veterinary Corps offi cers (VCOs) have supported virtually every US military involvement since World War I. 

They are not only skilled veterinary professionals, but 

also adaptive leaders trained for full spectrum military 

operations. Comprised of approximately 800 veterinarians and warrant offi cers, the Corps’ expansive breadth of 

knowledge, training, and expertise in veterinary preventive medicine, laboratory animal medicine, veterinary 

pathology, veterinary comparative medicine, and a wide 

spectrum of animal health fi elds including surgery, internal medicine, and critical care medicine is an exceptional, 

invaluable resource, both nationally and internationally.

The Army Veterinary Corps is an invaluable resource of 

diverse veterinary experience and talent, sourced from 

an array of veterinary academic environments. Among 

its veterinarians are graduates from all 28 colleges of 

veterinary medicine in the United States, as well as from 

international veterinary colleges in Canada, the United 

Kingdom, Australia, the West Indies, Korea, and Mexico. 

The Corps is focused on the professional growth of its 

offi cers, who learn and train throughout their careers. In 

fact, postgraduate education or training is a requirement 

for career progression for VCOs. They have many options, including the pursuit of masters, PhD, and DrPH 

degrees in fi elds such as public health, epidemiology, or 

toxicology. They can also enter residency programs in 

laboratory animal medicine, pathology, clinical medicine, and other areas. Army veterinarians continue to 

achieve the highest rate of board certifi cation of veterinary organizations of similar size worldwide.

In addition to the caliber and spectrum of talent among 

VCOs, the training and skills they acquire while serving 

strengthens the Corps’ leadership position in the world. 

The Veterinary Corps maintains its level of professional 

excellence by providing Army veterinarians the training and skill sets needed to fulfi ll the Corps’ crucial role 

within the defense structure of this nation. In this spirit, the Corps developed and implemented a First Year 

Graduate Veterinary Education program which aligns 

with similar existing programs for Army physicians 

and nurses. In the future, all new VCOs will start their 

Army careers at one of 8 projected veterinary centers of 

excellence throughout the United States. For their fi rst 

THE US ARMY VETERINARY SERVICE 2020:

KNOWLEDGE AND INTEGRITY
 January – March 2013 7

THE ARMY MEDICAL DEPARTMENT JOURNAL

year, VCOs will acquire, develop, and refi ne the animal 

health, food protection, and leadership skills necessary 

to be a successful veterinarian, Army offi cer, and adaptive leader. Then, typically following 2 tours of duty, a 

VCO may choose to specialize in one of the following 5 

areas of concentration:

Veterinary Preventive Medicine

Veterinary preventive medicine offi cers are leaders in 

public health functions and responsibilities at DoD installations throughout the world, as well as the austere 

operating environments of operational deployments. At 

the core of this specialty are the 5 core competency areas 

of the American College of Veterinary Preventive Medicine: epidemiology, infectious disease, food safety, environmental health, and public health. Through diverse 

education programs, they may add additional areas of 

expertise including human-animal bond, agricultural 

development, equine medicine, food laboratory diagnostics, wildlife management, humanitarian assistance, 

disaster response, and fellowships with the Centers for 

Disease Control and Prevention Epidemic Intelligence 

Service.7

 With the establishment of the US Army Public 

Health Command, veterinary preventive medicine offi -

cers will continue to be leaders in military medicine in 

the collaborative One Health Initiative, a global strategy 

to link animal, human and environmental health.*

Laboratory Animal Medicine

Laboratory animal medicine offi cers perform missions 

in animal care and use in research, development, training, and evaluation activities across DoD. They provide 

key oversight in DoD-funded animal care and use programs, both intramural and extramural, to safeguard animal welfare. They are skilled clinicians and surgeons, 

and are leading experts in animal facility management 

and animal husbandry. They collaborate closely with researchers. The US Army Laboratory Animal Medicine 

Residency Program is the nation’s premier training program for laboratory animal veterinarians. Offi cers completing the program are eligible to sit for examination 

to achieve board-certifi cation by the American College 

of Laboratory Animal Medicine. Select students may 

complete a one year master of public health program 

combined with a 2-year residency in laboratory animal 

medicine. The Army’s program is the largest and most 

successful in the United States, with usual pass rates of 

over 90% compared to overall pass rates which typically 

range from 35% to 45%.

Veterinary Pathology

Veterinary pathologists serve as integral members of 

DoD animal medicine programs and public health missions of the US Army Veterinary Service. They provide 

and manage comprehensive veterinary pathology training, consultation, education, and support for DoD diagnostic requirements and animal-use medical research 

and development programs. They train and educate 

VCOs in the specialty of veterinary pathology for fi eld 

deployments and rapid assimilation into the research 

and development environment, and provide consultation 

and support to public health efforts in the diagnosis, surveillance, monitoring, and control of emerging, zoonotic, and foreign animal diseases in various operational 

settings. Veterinary pathologists are experts in diagnostic; toxicological; chemical, biological, radiological, and 

nuclear (CBRN); and comparative medical pathology. 

Such expertise is critical for medical countermeasure development, disease pathogenesis support, animal model 

development, research protocol design, ultrastructural 

and molecular pathology, and current and emerging infectious disease surveillance. The veterinary pathologist 

training program is a structured, proven training and 

education program.

Veterinary Comparative Medicine

Veterinary comparative medicine offi cers are the intellectual center of the Veterinary Corps. They are research principle investigators for CBRN, infectious and 

emerging infectious diseases, and environmental and 

toxicological studies. They are also program managers for CBRN programs and provide scientifi c management of the research disciplines. These highly specialized veterinary research offi cers are key contributors to 

developing countermeasures against biological agents. 

These include diagnostics, vaccines, therapeutic agents, 

and operational practices. They are highly skilled in 

complex study design, critical analysis, and decisionmaking, and are called upon as subject matter experts 

in the areas of DoD medical research and translational 

medicine.

Veterinary Clinical Medicine

Veterinary clinical medicine offi cers are highly skilled 

animal healthcare providers, trained in surgery, internal 

medicine, emergency/critical care, diagnostic imaging, 

canine sports medicine and rehabilitation, and animal 

behavior. They play an indispensable role in the medical care of military working dogs (MWDs) and provide 

deployment Role 1-3 MWD care in austere environments and at DoD installations throughout the United 

States. They provide Role 4 MWD consultation and 

referral care at the world-renowned Holland DoD Military Working Dog Hospital at Lackland Air Force Base, 

*The One Health Concept, fi rst articulated by early scientists such 

as Rudolph Virchow, recognizes the intimate relationship between 

human health, animal health and the environment, and calls for 

an integrative, synergistic approach to health by encouraging collaboration among experts of diverse fi elds of study.8
8 http://www.cs.amedd.army.mil/amedd_journal.aspx

Texas. They have an outstanding reputation throughout not only the Army Medical Department (AMEDD), 

but also the veterinary medical community at large as 

champions of MWDs and their well-being. In the future, 

this specialty will focus on a more generalized skill set 

to sustain MWD populations and to better support the 

requirements of deployable forces and units.

Other Veterinary Service Professionals

Veterinary Service warrant offi cers, noncommissioned 

offi cers, enlisted Soldiers, and civilians are essential in 

the execution of the full spectrum of our veterinary service mission.

Veterinary Corps Food Safety Offi cers are highly specialized in the area of food protection. They are selected 

from the noncommissioned offi cer ranks by a competitive application process. After completing the Warrant 

Offi cer Candidate Course, the basic course, and several 

assignments, most are selected to further their food protection education in bachelors or masters programs in 

civilian institutions.

Veterinary Food Inspection Specialists inspect foods of 

both animal and nonanimal origin, as well as operational rations at depots, supply points, and on military 

installations to assure a safe, high quality food supply 

for DoD personnel. We encourage them to broaden their 

expertise by continuing their civilian education. One 

avenue is a bachelor of science degree program in food 

science available through DoD’s Servicemembers Opportunity Colleges.*

Animal Care Specialists provide the care, management, 

and treatment for animals, as well as ensuring sanitary 

conditions in their environments. Their primary responsibility is comprehensive care for government-owned 

animals and the prevention and/or control of diseases 

transmitted from animal to man. Animal care specialists 

are encouraged to advance their professional education 

by pursuing an associate of arts in veterinary technology degree through the Servicemembers Opportunity 

Colleges.

Veterinary Service Civilians are veterinarians, animal care 

technicians, receptionists, secretaries, laboratory technicians, instructors, and other administrative and technical support in the ever-expanding Veterinary Service 

mission. We encourage them to continue their civilian 

leader development with courses available through the 

AMEDD Civilian Corps.

THE WAY AHEAD

The US Army Veterinary Service will continue to man, 

equip, and train the best military veterinary force in history. The leader development of our Veterinary Corps 

offi cers, which ensures mission excellence, will continue to produce a range of experts from generalists to 

specialists while maintaining a core set of competencies. 

We choose to promote veterinarians not by specialty, but 

with the understanding that no matter what specialty a 

veterinarian may choose, at some point he or she may be 

asked to take leadership positions outside that specialty 

area.

Training

The Veterinary Service must continue its training excellence by standardizing terminology. To fulfi ll that need, 

an impending DoD directive will codify the Service’s 

primary mission as food protection, animal health, veterinary public health, and support of research, development, test, and evaluation. We must continue to develop 

the doctrine that supports recent changes to force structure that require updated manuals and combined arms 

training strategy as well as supporting our new relationship within the Public Health Command. In order to better prepare our enlisted Soldiers, especially for service 

within deployable formations, we may want to consider 

developing phase 2 training sites for veterinary food inspection and animal care specialists in conjunction with 

our First Year Graduate Veterinary Education locations. 

We must prepare the leaders of veterinary support deployable units in the lost art of training management for 

full spectrum operations, and ensure each veterinary 

Soldier receives appropriate profi ciency training by leveraging installation veterinary support opportunities.

Organization

The Corps Chief’s offi ce consists of the Deputy Chief, 

who also serves as the Director of the Department of 

Defense Veterinary Service Activity, who is responsible 

for policy, coordination, and the primary staff offi cers 

for the Offi ce of The Surgeon General; two Assistant 

Corps Chiefs, one for Human Resources who also 

serves as the Corps Specifi c Branch Proponency Offi -

cer (CSBPO) and the other for Reserve Affairs. Two of 

the primary responsibilities of the CSBPO are the Long 

Term Health Education and Training (LTHET) program 

and the Post Professional Short Course Program (PPSCP). A unique characteristic of the Veterinary Corps 

LTHET programs is that all who complete the program 

are qualifi ed for a specifi c Army area concentration of 

THE US ARMY VETERINARY SERVICE 2020:

KNOWLEDGE AND INTEGRITY

*A DoD sponsored association representing a consortium of approximately 1900 institutions of higher learning which works to 

make educational opportunities available to servicemembers 

and their families, despite the frequent relocations and disruptions demanded by their military service. Information available at 

http://www.soc.aascu.org/.
 January – March 2013 9

THE ARMY MEDICAL DEPARTMENT JOURNAL

veterinary medicine. The focus of the Corps Chief’s offi ce is refl ected in PPSCP courses such as the Veterinary 

Support of Stability Operations. The Corps Assistant 

Chief for Mobilization and Reserve Affairs coordinates 

the activities of our Army Reserve and National Guard 

veterinary personnel.

Governance of the Veterinary Service is executed through 

the Veterinary Executive Council, which includes the 

previously mentioned offi cers from the Corps Chiefs offi ce and consultants for each of Veterinary Corps areas 

of concentration, as well as the senior warrant offi cer 

and enlisted consultants. Rounding out the group is the 

chief of the AMEDD Center and School Department of 

Veterinary Science as the primary educator and trainer, 

the Veterinary Corps offi cer at the AMEDD Personnel 

Proponency Directorate as the personnel life-cycle designer, our offi cer at the Directorate of Combat Development and Doctrine (DCDD) as the developer of force 

structure and doctrine, and the Deputy Commander for 

Veterinary Services, US Army Public Health Command.

Veterinary support is one of the 10 functional areas 

within the AMEDD. The coordination and synchronization of Veterinary Service personnel—the family of 

veterinarians, warrant offi cers, enlisted Soldiers, and 

civilians—is unique within AMEDD, the Army, DoD, 

and the nation. The special skill sets and expertise of the 

US Army Veterinary Service are needed by many federal and other agencies, and make it a distinct national 

treasure. It is this culture that we have developed, started 

long before the 1916 inception of the Veterinary Corps, 

which must be maintained, no matter the changes made 

in the constant structural adjustments and transitions of 

the Army.

Leadership

The Veterinary Service will continue to embrace leadership that recognizes that we are Soldiers fi rst; offi cers, 

warrant offi cers, noncommissioned offi cers, or enlisted 

second; and veterinary medicine specialists third. We 

will continue to foster the culture of integrity—one that 

plans to not just meet the standard but to exceed it, each 

and every day, even when no one is watching. We will 

continue to seek leaders that lead by example, recognizing that you cannot ask anyone to do anything that you 

would not do yourself.

CONCLUSION

After more than 10 years at war with an all-volunteer 

force, we are stronger and in a better position to support 

the nation. The Army Veterinary Corps is supported by 

an exceptional team of 2,100 enlisted Soldiers and noncommissioned offi cers, and nearly 600 Army Veterinary 

Service civilian personnel. They are instrumental in the 

provision of outstanding veterinary support to almost 

500 installations, a multitude of deployable units, and 

research laboratories across the DoD. Veterinary Service offi cers, warrant offi cers, noncommissioned offi -

cers, Soldiers, and civilians are guardians of the DoD 

food supply, leaders in animal health, and provide critical support to research. They are a highly skilled, adaptive, and empowered veterinary team in support of full 

spectrum operations for the DoD. What truly makes our 

organization unique is the wide spectrum of professionals and their breadth of knowledge and experience. As 

we approach the US Army Veterinary Corps’ centennial anniversary, it is clear that the Veterinary Corps and 

Service are resilient organizations and together form a 

crucial part of the Army Medicine team in support of 

our nation’s security and safety.

Knowledge and Integrity!

ACKNOWLEDGEMENT

I thank LTC Chad Weddell for his assistance in compiling and assembling this article. 

REFERENCES

1. MEDCOM Regulation 10-2/OTSG Regulation 10-

32: Organization and Functions; Headquarters, 

United States Army Medical Command. Fort Sam 

Houston, TX: Headquarters, US Army Medical 

Command; September 29, 2010:11.

2. Department of the Army Pamphlet 600-4: Army 

Medical Department Offi cer Development and Career Management. Washington, DC: US Dept of 

the Army; June 27, 2007:129.

3. Army Regulation 840-10: Flags, Guidons, Streamers, Tabards, and Automobile and Aircraft Plates.

Washington, DC: US Dept of the Army; December 

1, 1998:49.

4. Army Medicine 2020 Strategy. Army Medicine 

Website. August 22, 2012: Available at: http://

www.armymedicine.army.mil/assets/home/Army_

Medicine_2020_Strategy.pdf. Accessed November 

1, 2012.

5. Odierno RT. Marching Orders, 38th Chief of Staff, 

U.S. Army. Washington, DC: Headquarters, US 

Army; January 2012. Available at: https://akocert.

us.army.mil/suite/doc/34721213. Accessed November 1, 2012.

6. Army Tactics, Techniques, and Procedures No. 4-02: 

Army Health System. Washington, DC: US Dept of 

the Army; October 7, 2011:2-16,2-17,2-18. Available 

at: http://armypubs.army.mil/doctrine/DR_pubs/dr

_a/pdf/attp4_02.pdf. Accessed October 23, 2012.
10 http://www.cs.amedd.army.mil/amedd_journal.aspx

7. McElroy K. Opportunities for military medical offi cers: the Epidemic Intelligence Service at the Centers for Disease Control and Prevention. US Army Med Dep J. January-March 2009:57-58.

8. King LJ, Anderson LR, Blackmore CG, et al. Executive summary of the AVMA One Health Initiative Task Force 

report. J Am Vet Med Assoc. 2008;233(2):259-261.

AUTHOR

BG Poppe is the 25th Chief of the US Army Veterinary Corps and Assistant Surgeon General of the Army (Force 

Projection).

THE US ARMY VETERINARY SERVICE 2020:

KNOWLEDGE AND INTEGRITY
 January – March 2013 11

This article reviews the history of the Animal Care Specialist, military occupational specialty (MOS) 91T; summarizes recent innovations in the Animal Care Specialist, 

MOS 68T; and discusses future trends in military veterinary medical care affecting these Soldiers and the Army, 

Navy, Marine Corps, and Air Force units they support.

HISTORICAL BACKGROUND

The US Army Veterinary Corps was established in 1916. 

The 1926 Army Medical Bulletin indicates that Veterinary Corps offi cers of 1926 trained enlisted specialists 

in the Veterinary Service in the following areas:

 Veterinary Technician, General (dealing principally 

with the duties of animal nursing)

 Veterinary Laboratory Technician

 Veterinary Pharmacy Technician

 Veterinary Sanitary Technician

 Veterinary Surgical Technician

 Veterinary Hygienist, Meat and Dairy

 Veterinary Clinical Horseshoer

The 1926 Army Medical Bulletin defi ned the responsibility of the veterinary technician as:

...an assistant to the veterinary offi cer who must learn 

to appreciate the seriousness of any communicable disease and to thoroughly acquaint [themselves] with the 

cause and details of control and eradication in order that 

he may be entrusted with routine procedures. The senior 

veterinary technician must be competent to prepare and 

keep up to date all the required records.

Field Manual 8-5: Mobile Units of the Medical Army

(1945)* defi ned the veterinary technician as:

...specially trained in the following procedures as they 

pertain to animals: practical nursing under the restricted 

conditions obtained in the fi eld; in taking and recording 

temperature, pulse, and respiration; in catheterization; in 

giving of enemas and irrigations; in the administration 

of medicines; in the application of special dressings and 

bandages; in the application of blisters† and their aftercare; in the handling of cases of communicable diseases; 

and in the preparation of veterinary records, reports, and 

returns.

In 1941, the Army published Technical Manual (TM) 

8-450: Veterinary Administration,* a 28-page administrative technical manual for veterinarians and technicians that emphasized the care of horses and food inspection. A year later, change 1 expanded TM 8-450 to 

39 pages. The 1951 edition of TM 8-450 for the fi rst time 

included a 16-page chapter on dogs called “Canine Management” which discussed canine anatomy, physiology, 

and medicine. In the March 1966 Monthly Memorandum (MEDVS) published by the Offi ce of The Surgeon 

General, TM 8-450 was not listed as a study guide for 

the Animal Care Specialist, MOS 91T. The manual had 

become outdated and was discontinued until an update 

was published in July 1968. The updated TM 8-450 (Animal Specialist)* manual had grown to more than 200 

pages and was intended for use as a training aid and reference study guide for the MOS 91T Soldier. It was the 

fi rst Army technical manual specifi cally addressing canine care for the animal care specialist and was the forerunner of the MOS 91T Soldier’s Manual. After updates 

in 1972 and 1977, this manual was replaced in 1985 by 

the current Soldier’s Manual and Trainer’s Guide: MOS 

91T, Animal Care Specialist.

1

Field Manual 8-5, Medical Service Units Theater of 

Operations (1959),* documented the transition from the 

veterinary troop cavalry hospital to the veterinary small 

animal hospital detachment known as TOE‡

 Team ID. 

This detachment was allocated on the basis of one per 

fi eld army and one per 500 animals in the communications zone. The veterinary small animal hospital detachment had the capacity to treat 50 small animal patients. 

The responsibilities of the veterinary small animal hospital detachment were as follows:

The Army Animal Care Specialist;

 Past, Present, and Future

LTC Boris Brglez, VC, USA

LTC James Giles, VC, USA

COL Kelly Mann, VC, USA

*Obsolete, no longer in effect.

†Blistering was an old and controversial practice of applying an irritating substance to an injured area in order to increase the infl ammatory 

reaction and possibly speed the healing process.

‡Table of Organization and Equipment: Defi nes the structure and equipment for a military organization or unit.
12 http://www.cs.amedd.army.mil/amedd_journal.aspx

 Provide veterinary care and treatment for all 

small animal patients (dogs) evacuated to the 

detachment.

 Restore small animal patients to service as soon 

as possible.

 Dispose of small animals deemed unfi t for further 

service.

 Treat and prepare for further evacuation small animal patients requiring prolonged treatment beyond 

the capabilities of the detachment.

Team ID included 2 veterinarians, one of whom was the 

commander. Twelve enlisted personnel included in this 

detachment were:

 One chief veterinary animal specialist (NCO,* 

MOS 91T/E5)

 One senior veterinary animal specialists (MOS 

91T/E5)

 One veterinary laboratory specialist (MOS 92B/

E5)

 6 veterinary animal assistants (MOS 91T, 2 E4s 

and 4 E3s)

 One clerk (MOS 71A/E3)

 One patient administration clerk (MOS 71G/E4)

 One animal tender (MOS 91T/E2)

In order to provide a country-wide veterinary hospitalization capability, the 936th Medical Detachment (ID), 

Veterinary Small Animal Hospital, was activated on August 19, 1965, at Fort Ord, California.2

 It had 2 offi cers 

and 10 enlisted Soldiers, with Captain Bernard Mistretta commanding and Captain Howard Hamby as deputy 

commander. In December, the detachment embarked 

from Long Beach, California on the USSN Leroy Eltinge. After 3 days at sea, the unit gathered to open their 

classifi ed orders. The envelope only contained 12 pamphlets entitled “Welcome to Vietnam.” CPT Mistretta 

had been in the Army for a few months following his 

college graduation, CPT Hamby had just graduated, and 

the noncommissioned offi cer-in-charge (NCOIC) was a 

young sergeant. The unit arrived in Saigon, Republic of 

South Vietnam on December 23, 1965, and prevailed in 

the task ahead despite the odds.

In 1961, veterinary specialists began receiving more formalized training in canine and laboratory animal medicine at the Walter Reed Army Medical Training Center. 

SGM William Kadic (MOS 91T) and CPT Randy Vanderhurst formalized the 91T training, culminating with 

the fi rst “offi cial” 91T graduation on December 16, 1966. 

The US Army Formal Schools Catalog (DA Pam 350-10, 

1968)†

 contained the fi rst entry for the Veterinary Specialist Course (321-91T 20) to be presented at the Walter Reed Army Institute of Research (WRAIR), Walter 

Reed Army Medical Center, Washington, DC. The Randall Building at WRAIR, which opened on August 10, 

1971, was specifi cally designed to house dogs, monkeys, 

and chimpanzees used in research and in the training of 

Veterinary Specialists, MOS 91T.

While the US Army and the Veterinary Technology 

Schools were credentialing technicians, the American 

Association for Laboratory Animal Science (AALAS) 

was doing the same. In 1966, AALAS formed the Animal Technician Certifi cation Board program to begin the 

certifi cation of laboratory technicians.3

 In 1967, AALAS 

published the fi rst Manual for Laboratory Animal Technicians. One year later SGM Kadic became one of the 

fi rst MOS 91T Soldiers to receive Laboratory Animal 

Technologist certifi cation, followed later in the 1970s by 

SFC William Wade and others. On December 3, 1971, 

the Veterinary Corps announced 3 AALAS certifi cation programs: Assistant Laboratory Animal Technician, 

Laboratory Animal Technician, and Laboratory Animal 

Technologist. The position of licensed veterinary technician had yet to be defi ned. The fi rst Animal Technician 

National Examination was given in 1986 in the state of 

Maine. In 1989, the American Veterinary Medical Association (AVMA) House of Delegates approved the use 

of the term “veterinary technician” to replace “animal 

technician”; ironically, the Army fi rst used the term 

“veterinary technician” in the 1920s.

The creation of civilian veterinary technology programs 

is credited to Dr Walter Collins, a former Air Force veterinary technician (1952-1956) and later Director of Veterinary Technology at the State University of New York 

Agricultural and Technical School in Delhi, NY. Dr 

THE ARMY ANIMAL CARE SPECIALIST; PAST, PRESENT, AND FUTURE

SGM William Kadic CPT Randy Vanderhurst

*Noncommissioned offi cer †Obsolete, no longer in effect.
 January – March 2013 13

THE ARMY MEDICAL DEPARTMENT JOURNAL

Collins and his staff, some of whom had prior military 

backgrounds (Army veterinarians Douglas McBride 

and Randy Vanderhurst; Veterinary Technician Daniel 

Walsh), were instrumental in getting AVMA involvement and accreditation for technician programs. During 

a conversation between author LTC Brglez and Dr Collins (2011), he reminisced:

Everyone must understand, when this program (and 

many like us) fi rst started there were many naysayers and 

practitioners even (not to mention Veterinary Colleges 

and the AVMA) who were very skeptical about the training of veterinary technicians and were worried we might 

be producing charlatans or quacks. This did not deter our 

faculty from its goal of reversing this archaic prevailing 

belief of the 1960s.

Despite initial resistance, veterinary technology became 

AVMA accredited in 1973, beginning at Michigan State 

University and later the Nebraska College of Technical 

Agriculture. Dr Walter Long (University of Nebraska), 

Dr Vanderhurst (Colorado Mountain College), and Dr 

Roger Lukens (Purdue University) were pioneers in 

the establishment of veterinary technology programs 

throughout the United States. By 

the year 2000, 86 programs were 

accredited by the AVMA, including 2 distance learning programs. 

SFC William Wade (1974-1994), 

prior Air Force veterinary technician and later Army 91T, was one 

of the fi rst to become a licensed 

veterinary technician (LVT). Today there are 203 AVMA-accredited veterinary technology 

programs, including 22 four-year 

degree programs and 9 distance 

learning programs.4

FROM CAVALRY TO K-9 CORPS

American Expeditionary Forces of World War I had no 

organized canine units. The French and Belgian armies 

provided US forces with dogs used for casualty, messenger and guard duty. Prior to World War II (WWII), 

the US military had 50 sled dogs in Alaska and 40 dogs 

used in Admiral Byrd’s Antarctic Expedition. Additionally, there were a handful of dogs at Camp Haan and 

Fort MacArthur in California, and local sentry dog programs for the Coastal Artillery. An offi cial, systemic 

dog program did not exist. In January 1942, Congress 

enacted “Dogs for Defense Inc,” and on March 13, 1943, 

the US Quartermaster Corps established the K-9 Corps. 

Of the 20,000 dogs procured throughout WWII, more 

than 11,000 were trained for service as messengers (151), 

scouts (595), mine detectors (140), sled and pack use 

(368), and sentries (9,298). During the Korean War, the 

Army used approximately 1,500 dogs, primarily for sentry duty.5

 About 4,000 dogs were employed during the 

Vietnam War, of which 281 were offi cially designated as 

killed in action.6

The fi rst graduating class of Veterinary Specialist Course (321-91T 20) at the Walter Reed Army Institute of Research. Front row, left to 

right: PVT Kenneth Poston, PVT Kenneth Rosak, PVT Robert Miller, COL Stephen G. Asbill (Director), PVT Leanard J. Berube, PVT Richard 

Bernyk, PVT Jerry Ford, PVT Jerry Ehrhart. Back row: PVT Robert L. Tokin, PVT James Wade, PVT John Redmond, PVT Ike Bootsman, PVT 

Eugene Morris, PVT Erving Gustafson, PVT William Buckman, PVT Gerald Alexander. Photo by PFC Ford, US Army Signal Corps, December 16, 1966.

Airman Walter Collins, 1952 Dr Walter Collins, 1980s 1LT Douglas McBride, 1956
14 http://www.cs.amedd.army.mil/amedd_journal.aspx

The advent of fi ghting with mechanized vehicles during 

WWII greatly reduced the need for horse-mounted cavalry. This transition, coupled with the creation of the K-9 

Corps, transformed Army Veterinary Services. Veterinarians and animal care technicians had to realign doctrine, organization, training, leadership, equipment, and 

personnel to support the European and Pacifi c theaters. 

Horses remained necessary to fi ght on terrain ill-suited 

for vehicles, such as the Italian mountains and dense 

jungles of Burma. However, use of horses was minimal 

compared to that of leashed and unleashed war dogs. 

Prior to 1941, US Army veterinary manuals and medical records for canines were nonexistent, unlike the volumes of regulations and fi eld manuals regarding equine 

care, shoeing, medical equipment, and veterinary cavalry hospitals. For example, Field Manual 8-5: Mobile 

Units of the Medical Army (1945)* described Veterinary 

Services’ role in the horse cavalry and contained no 

mention of supporting roles for canine units.

The US Infantry capitalized on the dogs’ extraordinary 

sensory capabilities, fearless nature, and ability to track 

the enemy. Scout dogs were considered the most critical; their ability to detect the enemy and provide a silent 

warning in semidark, dense, thick jungles was invaluable, 

and could not be duplicated. Although originally trained 

for sentry duty while in Sicily, Chips, the most famous 

dog of WWII, was an excellent scout and attack dog. As 

reported by Company I, 30th Infantry Regiment, 3rd Infantry Division, Chips attacked an enemy machine gun 

crew in a pillbox off-leash, seizing one man and forcing 

the remaining crew of four to surrender.7

Following WWII, the USAF had an increased demand 

for sentry dogs as a result of a lack of personnel to guard 

Strategic Air Command bases. In October 1958, the 

USAF became the executive agent for military working 

dogs (MWDs), and the Sentry Dog Training Branch of 

the Department of Security Police Training was established at Lackland Air Force Base, Texas. 

The fi rst signifi cant Army manual devoted to training and 

care of war dogs was FM 25-6: Dog Team Transportation (1941).* This manual included an additional 70 pages on canine care not found in the fi rst edition published 

in 1926. Field Manual 72-20: Jungle Warfare (1942)* 

discussed working dogs’ valued roles as scouts and messengers with proven value in combat. Jungle warfare 

doctrine anticipated that dogs would be commonly used 

in the future, a prediction that came true, as illustrated 

in today’s special and conventional forces. With the establishment of the K-9 Corps, the Quartermaster Corps 

released Technical Manual 10-396: War Dogs (1943),* 

the fi rst comprehensive manual on dog care, of which 

11 pages were dedicated to canine preventive medicine 

and treatment. Field Manual 70-15: Operations in Snow 

and Extreme Cold (1944),* reiterated canine capability 

for scouting and messaging and as excellent sentinels.

The 91T MOS was changed to 68T in 2006.8

 Today, increased numbers of Soldiers with MOS 68T are being 

permanently slotted in combat organizations without 

the direct supervision of a veterinarian. The increased 

responsibility of those Soldiers requires reassessment 

of the MOS 68T skill set and redefi nition of Veterinary 

medical care Roles 1-4.

FROM ECHELONS TO ROLES OF VETERINARY 

MEDICAL CARE

Army Tactics, Techniques, and Procedures No. 4-029

defi nes Roles 1, 2, 3, and 4 of military veterinary care, 

formerly specifi ed as I through V echelons of care in the 

1942 release of Field Manual 8-10: US Army Medical 

Service Field Units.* In today’s Army, Role 1 veterinary 

medical care is provided by an animal care specialist, 

MOS 68T (who is often referred to simply as 68T), assisted in his/her duties by the handlers of military working dogs (MWD), equestrian, livestock, or Navy marine 

mammals, who provide immediate fi rst aid for animals 

in their charge in the event of injury, with or without a 

Veterinary Corps offi cer (area of concentration (AOC) 

64A) present. The capabilities for Roles 2 and 3 veterinary care are found in the Medical Detachment (Veterinary Service Support) (MD(VSS)). Role 2 is provided by 

5 identical Veterinary Service Support Teams (VSSTs), 

each staffed by one Veterinary Corps offi cer (AOC 64A), 

one 68T, and 5 food inspection specialists (MOS 68R). 

Role 3 veterinary care is provided by a Veterinary Medical Support Team (VMST), consisting of one veterinary 

clinical medicine offi cer (AOC 64F) and 3 animal care 

specialists (MOS 68T).

The treatment goal for each role of medical care is to provide defi nitive treatment for return to duty or evacuation 

to a higher role of care. Veterinary Role 1 medical care 

may be provided by either a 68T or Veterinary Corps 

offi cer (VCO) who is individually assigned to various 

Army, Marine Corps, Navy, or Air Force fi eld units or 

VSSTs. In the event a 68T or VCO cannot provide Role 

1 care at the point of injury/sickness, a handler will perform basic emergency fi rst aid procedures and prepare 

the animal for evacuation to a higher role of veterinary 

medical care. Depending on the type of emergency, the 

68T or VCO will evaluate and stabilize the traumatized 

or ill patient to enable the patient to withstand further 

evacuation for defi nitive treatment at either a forward 

deployed Role 2 VSST or Role 3 VMST.

THE ARMY ANIMAL CARE SPECIALIST; PAST, PRESENT, AND FUTURE

*Obsolete, no longer in effect.
 January – March 2013 15

THE ARMY MEDICAL DEPARTMENT JOURNAL

The VSST Role 2 veterinary medical care includes veterinarian-directed resuscitation and stabilization and may 

include advanced trauma management, emergency medical procedures, and forward emergency resuscitative surgery for dogs, horses, livestock, or Navy marine mammals. This role may provide care for up to 10 MWDs.

Role 3 veterinary medical support by the VMST is designed to care for dogs only. It includes veterinary diagnostic, therapeutic, and surgical procedures. Veterinary 

care administered at this role requires advanced clinical 

capabilities and can provide care for up to 50 MWDs. 

Veterinary Role 3 capability is not routinely provided for 

horses, livestock, or Navy marine mammals. Prior coordination is necessary for any veterinary Role 3 care required for horses, livestock, or Navy marine mammals.

No kennels are provided for Veterinary Role 2 or Role 

3 medical care in the MD(VSS). In common usage, 

the term “kennel” is a fi xed habitat for boarding dogs, 

whereas “crate” refers to a mobile carrier for transporting individual dogs. Crates may be used for temporary 

housing of dogs as necessary. Fixed veterinary treatment 

facilities located on military bases have kennels, and may 

have crates available for transport of dogs. In a deployed 

environment, tents may be used for veterinary surgical 

treatment facilities and crates are used as kennels. Each 

dog has a crate and the handler is expected to remain 

with the animal at the facility. The VMST can provide 

a minimum of 8 crates where dogs may be housed. As 

with dog handlers, horse riders, livestock caretakers, 

and Navy marine mammal handlers must remain with 

animals in their custody while at a treatment facility.

Veterinary Role 4 medical care is provided in the United States by the Department of Defense (DoD) MWD 

Veterinary Service at the LTC Daniel E. Holland MWD 

Hospital located on Lackland Air Force Base, Texas. 

Veterinary Role 4 medical care expands the capabilities 

available at veterinary Roles 1, 2, and 3 medical care 

facilities and provides additional specialized veterinary 

medical and surgical care, rehabilitative therapy, and extended convalescent capability.

Currently, animal care specialists are organic to specifi c 

units, such as Army Engineer and Ranger, the Navy 

Marine Mammal Program, and the Medical Detachment (Veterinary Service Support). The animal care 

specialist supervises or provides the care, management, 

treatment, and sanitary environment for animals. A 

primary responsibility of the 68T is the prevention and 

control of diseases transmitted from animal to human 

and comprehensive care for government-owned animals. 

Nonveterinary personnel, such as handlers, are trained 

to perform lifesaving and fi rst aid procedures until an 

animal care specialist or a veterinarian is available.

ANIMAL CARE SPECIALIST (68T) TRAINING UPDATE

The 68T10 advanced individual training (AIT) program 

is currently an 11-week in-residence training program 

at the Army Medical Department Center and School 

(AMEDDC&S). There are 5 to 6 courses with class sizes ranging from 15 to 30 conducted annually, available 

to both active duty and reserve Soldiers. Eighty-two of 

the 101 68T10 level skills on the critical tasks list are 

addressed during AIT. The skills not trained during AIT 

are primarily laboratory animal and large animal tasks 

designated as on-the-job training for Soldiers assigned 

to units performing those missions. The 68T10 students 

are exposed to a broad range of veterinary topics, some 

of which include basic anatomy and physiology, system diseases and disorders, pharmacology, parasitology, mathematics and dose calculations, hematology, 

radiology, surgery support, anesthesia, dentistry, shock 

management, wound management, initial management 

of various MWD emergencies, canine and feline care 

and management. Approximately 30% of the training 

is classroom environment, the remainder is conducted 

in hands-on demonstrations, exercises, and practical 

examinations. The areas of largest focus include monitoring the anesthesia patient, animal husbandry, and 

MWD emergency management. The training is divided 

between the AMEDDC&S, the Holland MWD Hospital, 

Fort Sam Houston Veterinary Treatment Facility, Camp 

Bullis fi eld training site, and the Fort Sam Houston 

Equestrian Center. The primary goal is to graduate a 

68T10 that is in the “walk” phase of the “crawl, walk, run” 

concept for most of the 68T critical tasks. The majority 

of the 68T critical tasks list trained by AIT is intended 

to maximize the skill set of the junior 68T assigned to 

table of distribution and allowances* and modifi ed table 

of organization and equipment (MTOE) veterinary assets. The 11-week duration of the course, coupled with 

the broad scope of veterinary practice, necessitates that 

many skills will need extensive development at the 68T’s 

fi rst duty station. Without additional training, graduates 

of the 68T10 program are not eligible to take state or national examinations to gain licensure as an AVMA registered (or certifi ed, licensed) veterinary technician. As 

a comparison, the AVMA-accredited residence training 

program for veterinary technicians is 2 years in length.

The next available course in the 68T lifecycle following AIT is the 68T Clinical Profi ciency Course (CPC), 

*Prescribes the organizational structure, personnel and equipment authorizations, and requirements of a military unit to 

perform a specifi c mission for which there is no appropriate 

table of organization and equipment 
16 http://www.cs.amedd.army.mil/amedd_journal.aspx

fi rst offered in 2006. A 5-day residence course at the 

AMEDDC&S offered semiannually to both active duty 

and reservists with at least one year experience in the 

MOS, the CPC has a class size up to 24 students. The 

target rank is E4 and E5, but exceptions are frequently 

granted for Soldiers who are deploying or assigned to an 

independent 68T duty site. There are currently 22 critical tasks for the 68T20, however, the short duration of 

this course requires a number of the tasks to be conducted at unit level or the next phase of residence training. 

The focus of this course is to prepare the 68T to perform advanced technical skills with minimal Veterinary 

Corps offi cer oversight. For that reason, 60% to 70% of 

the material is taught through hands-on exercises, wet 

laboratories, and student-led presentations. Some of the 

topics include the MWD handler training support package, foreign animal disease, rabies management, MWD 

program overview (deployment issues, medical evacuation, physical conditioning, and rehabilitation), canine 

cardiopulmonary resuscitation/basic cardiac life support, advanced hematology, advanced trauma laboratory, 

anesthesia monitoring problems, wound management 

techniques, equine management, necropsy, radiology 

and ultrasound examination. The trauma and wound 

management scenarios are conducted on a combination 

of patient simulators and canine cadavers. The 68T CPC 

is strongly encouraged, but not a mandatory part of the 

68T track.

The next phase in the 68T career track is the 3-week 

technical track of the Advanced Leader Course (ALC), 

which is preceded by 3 weeks at the NCO Academy and 

40 hours of NCO Academy distributed learning. The 

target population is E5 and E6, both active Army and 

reservists. Due to the longer duration of ALC relative 

to the CPC, a number of 68T20 critical tasks in addition 

to the 68T30 tasks are taught in this course. Those tasks 

deal with Occupational Safety and Health Administration rules and requirements, and controlled substance 

management. Approximately 35 hours of the course are 

dedicated to NCOIC duties in the veterinary treatment 

facility (VTF). Formerly, the Army Veterinary Command provided this training in the VTF Management 

Course designed for prospective VTF NCOICs. The inclusion of this content in ALC ensures it is a part of the 

68T education experience. However, some Soldiers may 

attend ALC after they served as a VTF NCOIC, missing the optimal training window. The course content is 

approximately 60% hands-on/demonstration and 40% 

classroom instruction. Sixteen hours of the course are 

student-led foreign animal disease and parasitology research, and papers and presentations in the adult-learning model concept. There is moderate reinforcement of 

topics from the 68T CPC course, although trained to a 

greater depth in areas such as MWD program and issues, advanced laboratory diagnostics, advanced principles of anesthesia, abdominal ultrasonography, triage 

and emergency patient management, veterinary nursing 

management, and critical skills lane training. Both ALC 

and 68T CPC are scheduled to coincide with the Veterinary Support to a Theater of Operations Course or 

the Veterinary Corps Offi cer Basic Offi cer Leadership 

Course, which feature a live-tissue training laboratory 

for Veterinary Corps offi cers and affords the 68T handson opportunity for surgical preparation and support, 

anesthesia induction and maintenance, and emergency 

procedures. Other emergency and nursing care skills 

are reinforced on simulator and cadaver models. In the 

near future, the VTF Management Course will transition to the Army Public Health Command, and the MOS 

portion of the 68T ALC will decrease to 2 weeks.

A 68T30 distributed-learning package is in development 

and pending approval from the Army Learning Management System (ALMS) and US Army Training and Doctrine Command. The online course consists of 5 in-depth 

training and testing modules covering small and large 

animal medicine, diagnostic testing, anesthesia, surgery, 

and offi ce management. The original intent of the 80-

hour distributed-learning product was to serve as a prerequisite for the ALC technical track in order to reduce 

track length and enhance training time for advanced 

tasks. However, the maximum distributed-learning time 

is already in use by the NCO Academy. When approved 

and placed on the ALMS site, the product will be available for unit and individual training, but not included in 

a mandatory component of the 68T lifecycle. To increase 

its use, there is a proposal to designate the distributedlearning package as a prerequisite for the 68T CPC.

Animal Care Specialists assigned to a DoD research institution will undergo an internal training program to 

meet the technical profi ciency standards outlined by the 

animal use program description. While further laboratory animal technical training and certifi cation is not 

a requirement, it is highly encouraged and the institutions generally do pay for the 68T to take certifying 

examinations from AALAS. The 3 levels of certifi cation—Assistant Laboratory Animal Technician (ALAT), 

Laboratory Animal Technician (LAT), and Laboratory 

Animal Technologist (LATG)—correlate with specifi c 

requirements for education and experience. While a 

college degree is not required for the ALAT, LAT, or 

LATG examinations, the on-the-job experience requirement is reduced for college graduates. The AALAS also 

maintains a technician certifi cation registry with the “R” 

designator with those certifi cations for technicians that 

maintain requisite continuing education units.

THE ARMY ANIMAL CARE SPECIALIST; PAST, PRESENT, AND FUTURE
 January – March 2013 17

THE ARMY MEDICAL DEPARTMENT JOURNAL

In 2010, the Army approved a veterinary technology 

associate’s degree in the Servicemembers Opportunity College Army Degree program with the AVMAaccredited online institution, San Juan College (http://

www.sanjuancollege.edu/vettech). The program is 

funded through tuition assistance for eligible Soldiers. 

Graduates of the 68T Animal Care Specialist Course are 

awarded 26 credit hours, and 68T ALC graduates receive an additional 6 credit hours towards the 75 credit 

hour Associates in Applied Sciences degree. Completion of this AVMA-approved program allows a graduate 

to sit for the Veterinary Technician National Examination to become a registered veterinary technician. Historically, veterinary technicians of varying educational 

backgrounds could challenge the certifying examination, 

however, current examinees must be graduates of an approved AVMA program. The credits are fully transferrable to other AVMA-accredited institutions, including 

the 4-year veterinary technology program. This represents an excellent opportunity for the 68T to obtain a degree relevant to their fi eld, improve their skill set, obtain 

national certifi cation, improve the professional standard 

of the Veterinary Corps, and increase their postservice civilian earning potential. The American Animal 

Hospital Association reports that in 2009 the national 

average salary for a registered veterinary technician 

was $32,635, compared to $27,518 for a nonregistered 

technician.10 At the time of this writing, 22 animal care 

specialists are actively enrolled in the San Juan College 

veterinary technology degree program. While there is 

no current requirement for 68Ts to have civilian licensure as a veterinary technician, it is a point of discussion 

as a future lifecycle requirement as we seek to improve 

the professional standards of the Veterinary Corps and 

keep pace with civilian education trends.

CURRENT OPERATIONAL SUPPORT AND FUTURE 

TRENDS

Defense security industries and the MWD community 

experienced exponential growth in their missions after 

the terrorist attacks of September 11, 2001. The expansion is evident in both raw end-strength numbers and the 

increasing variety and specialization of working dog and 

handler programs. Prior to 2001, the majority of MWDs 

were dual-trained (patrol/narcotics and patrol/explosives 

detector dogs). In the years after the terrorist attacks, the 

Army, Marine Corps, Navy, and Air Force MWD program managers researched, developed, and deployed 

working dog and handler teams of combat tracker dogs, 

specialized search dogs, improvised explosive device 

detector dogs, and tactical explosives detector dogs.

Contractors on the battlefi eld are not new to warfare, and 

many forward operating base security contracts include 

detector dogs for entry control point and mine detection operations. The majority of these dogs are found in 

controlled security zones guarding military and civilian assets. For the purposes of this article, those statements are necessarily broad and are not meant to diminish known uses of contract working dogs in other areas. 

However, their typical use is for protection of high-value 

areas so that MWD teams are available for other missions. The history of the mine detection dog (MDD) program provides a good example. Contracted MDD teams 

have performed humanitarian assistance and other mine 

clearance operations for decades, but in 2001 the DoD 

did not have a military MDD program of record. At the 

onset of Operation Enduring Freedom, civilian MDD 

teams were initially contracted for vital inside-the-wire 

mine clearance missions to ensure safety of areas adjacent to seized airfi elds. Combat engineers recognized 

the increasing need for MDDs and developed their own 

military MDD program to directly support engineer operations. In order to ensure veterinary care under early 

entry, austere, and remote operating conditions, the 

newly formed combat engineer mine detection dog unit 

MTOE included one 68T per squad of 6 MDDs plus handler teams. Today, 68Ts also serve in support of medical 

training and canine programs associated with Special 

Operations Forces and Marine Expeditionary Forces.

Perhaps the greatest change in MWD medicine during the past decade has been the emphasis on training 

the MWD handler to act as a fi rst responder for his/her 

MWD. It seems intuitive now, but prior to 2001, handlers 

were taught veterinary medical care and husbandry topics that were informative but did not bring the subjects 

together in a way that maximized their capabilities as the 

earliest responder to every MWD injury. For the past 10 

years, a MWD handler emergency care training support 

package has been available for training all MWD handlers as fi rst responders for their MWDs. The training 

tasks were originally designed by veterinary clinical specialists to fulfi ll 3 purposes: (1) introduce handlers in the 

MWD Basic Handler Course to routine canine care and 

fi rst responder medical tasks, (2) train all handlers on all 

fi rst responder medical tasks in follow-on courses or at 

the handler’s fi rst duty site, and (3) serve as the basis for 

all Veterinary Corps offi cers and kennel masters to use 

as refresher/sustainment training for US MWD handlers 

at all duty sites around the globe. This training package 

was also adopted and modifi ed by the Royal Army Veterinary Corps for British MWD handler deployments.

The latest edition (July 12, 2012) of the MWD Handler 

Training Manual, Medical Care and Management of Military Working Dogs by Handlers, supersedes all previous 

training materials and medical care guidance. The training 
18 http://www.cs.amedd.army.mil/amedd_journal.aspx

manual and PowerPoint presentations covering 36 individual tasks are available for download (restricted access, 

Army Knowledge Online password protected) through: 

http://phc.amedd.army.mil/organization/phcrsouth/do

dmwdvs/Pages/DoDMWDVSHandlerTraining.aspx. 

This revision of training for military MWD handlers 

qualifi ed by MOS, Air Force specialty code, or Navy 

enlisted classifi cation redirects the focus of medical 

care to 3 specifi c areas of concentration: tactical combat 

casualty care, noncombat emergency care, and preventive medical care. The tasks have been revised to refl ect 

current practices based on experience with MWDs injured in combat operations by focusing on procedures 

most critical to preservation of life, limb, and eyesight of 

working dogs. Handlers now provide the most effective 

immediate care to prevent further injury, reduce effects 

of trauma and illness, and stabilize the patient while 

coordinating rapid evacuation. The new MWD Handler 

First Aid Kit has been compartmentalized to ensure the 

exact medical supplies needed to perform every task 

are available, but in a format that maximizes fl exibility in meeting mission requirements. The kit contents 

are linked to the training tasks. Handlers are authorized 

resupply of class VIII items from all supporting veterinary units, including medications that they are trained 

and authorized to administer to their MWD. Similar to 

food and water requirements, handlers will pack fi rst aid 

items essential for urgent or routine care of their MWD 

as appropriate for each mission.

The manual Medical Care and Management of Military 

Working Dogs by Handlers contains important information for combat medics and corpsmen working directly 

with MWD detachments, however, medics and other 

nonveterinary healthcare providers (HCPs) should also 

refer to the updated (February 2012) Joint Trauma System Clinical Practice Guideline, Clinical Management 

of Military Working Dogs.

*

 It contains concise, stepwise instructions and applicable decision-trees, algorithms, tables, charts, photos, and diagrams which assist the HCP in understanding or reviewing the medical 

information provided. The format works well because 

the annexes are mutually supporting with referenced 

and hyperlinked passages throughout the document. 

Clinical Management of Military Working Dogs is the 

culmination of research, review, and collaboration with 

numerous veterinary and human medical professionals 

in the Army Medical Department (AMEDD) and Special Operating Forces, including individuals deployed 

in Operations Iraqi Freedom, New Dawn, and Enduring 

Freedom. This update provides nonveterinary healthcare 

providers with general information concerning handling 

of MWDs and with clinical medical guidance for management of seriously ill or injured MWDs to assist in 

recognition and initial resuscitation and stabilization of 

life- and limb-threatening conditions.

Military working dogs are critical assets in today’s combat environment. Expectations are that injured working 

dogs will receive a high level of resuscitative care as 

far forward as possible. The ideal medical providers for 

MWDs are military veterinarians and animal care specialists supporting the assigned dog handler. However, 

HCPs may be the only medical personnel available for 

gravely ill or injured MWDs. Provision of medical care 

by HCPs should be limited to circumstances in which 

the dog is too unstable to transport or medical evacuation is not possible, or immediate care is necessary to 

preserve life, limb, or eyesight, and veterinary personnel are not available. Healthcare providers should only 

perform medical or surgical procedures commensurate 

with their training and necessary to prepare the dog for 

evacuation to defi nitive veterinary care available at multiple locations throughout the theater. Clinical Management of Military Working Dogs is the standard of care 

for HCPs regarding their scope of practice in the medical treatment of MWDs, and guides the actions of all 

veterinarians and animal care specialists tasked with 

predeployment, deployment, or sustainment training of 

HCPs.

In the current deployed MWD care and referral network 

illustrated in the Figure, the MWD handler is fi rst responder and then transports the MWD to veterinary 

medical care via casualty evacuation or medical evacuation assets, often with the help of a combat medic or 

corpsman. The organization and units providing Roles 1, 

2, 3, and 4 veterinary care were described in detail earlier 

(pages 14, 15). The decision to strategically evacuate or 

return an MWD to duty varies, based on the injury or disease process and operational unit considerations. Every 

effort is made to do what is best for the MWD, as well as 

to support the mission of the operational unit. Dog Center Europe is the strategic evacuation destination for all 

MWDs in the US Central Command area of responsibility. However, there are 19 additional military veterinary 

activities and veterinary centers located throughout the 

world that could provide defi nitive care for an MWD in 

consideration of proximity to the MWD’s home station 

and the availability of clinical specialists.

The DoD MWD Veterinary Service (MWDVS) has 45 

Soldiers and Department of the Army civilian personnel assigned to the Holland MWD Hospital and the Medina MWD Clinic facilities at Lackland Air Force Base, 

THE ARMY ANIMAL CARE SPECIALIST; PAST, PRESENT, AND FUTURE

*http://www.usaisr.amedd.army.mil/assets/cpgs/Clinical_

Mgmt_of_Military_Working_Dogs_Combined_19_Mar_12.

pdf
 January – March 2013 19

THE ARMY MEDICAL DEPARTMENT JOURNAL

Texas. They provide routine and specialized veterinary 

care for up to 1,150 working dogs onsite; conduct basic 

and advanced veterinary medical training for handlers, 

68Ts, and VCOs in partnership with the AMEDDC&S 

Animal Health and Veterinary Specialist Branches and 

the 341st Training Squadron (DoD MWD Training 

Center); and provide global referral and consultation 

support to working dogs throughout the DoD and other 

federal agencies. Recently, the DoDMWDVS achieved 

accreditation by the Association for the Assessment and 

Accreditation of Laboratory Animal Care International 

to comply with new DoD regulations and advance the 

unit’s roles and responsibilities in all areas of MWD 

health, welfare, and operational support. One-half of 

the assigned personnel are 68Ts or civilian registered 

veterinary technicians (RVTs). These facts emphasize 

the expanding roles and importance of veterinary technicians. Without their assistance and advanced training, the DoDMWDVS could not perform its Role 4 

missions.

Current licensure requirements and future trends in 

the profession of veterinary technology are important 

to the AMEDD and the DoD. It is no longer possible 

for 68Ts to challenge board examinations based on 

work experience alone. National and state certifi cation examinations are required for RVT licensure after 

completion of an AVMA-accredited associates degree 

program. The National Association of Veterinary Technicians in America (NAVTA) Committee on Veterinary 

Deployed environment military working dog care and referral network.11

Glossary:

CASEVAC - casualty evacuation (from point of injury) OCONUS - outside of CONUS (overseas)

CONUS - continental United States STRATEVAC - strategic evacuation (from theater)

DODMWDVS - Department of Defense MWD Veterinary Service TF MED - task force, medical

HCP - healthcare provider (nonveterinary) VETAC - veterinary activity

MMB - multifunctional medical battalion VETCEN - veterinary center

MD(VSS) - medical detachment (veterinary service support) VMST - veterinary medical support team

MEDEVAC - medical evacuation (within theater) VSST - veterinary service support team

MWD - military working dog

Role 3

Theater Veterinary Hospital

MD(VM) or VSMT

64F + 64As/68Ts

Medical Brigade

Headquarters

MMB or TF MED

MD(VSMD(VSS) ) + MD(VM)

Role 3

Theater Veterinary Hospital

VMST

64F + three 68Ts

Role 2: VSST

VCO/68T

Role 2: VSST

VCO/68T

Role 2: VSST

VCO/68T

VSST/VSMT

VCO/68T

Role 3

Dog Center Europe: Kaiserslautern, GE

+19 CONUS/OCONUS referral centers

VETAC /VETCEN

() ( )

Future = MD(VSS)

VSST/VSMT

VCO/68T

VSST/VSMT

VCO/68T

VSST/VSMT

MD(VSS)

Headquarters

Role 2: VSST Role 2: VSST R l 2 VSST

64F + three 68Ts

VETACs/VETCENs

Role 4

DODMWDVS MWD Handler

VCO/68T VCO/68T VCO/68T

Healthcare Provider MWD Clinical 

Practice Guidelines

Role 2: VSST

VCO/68T

Role 2: VSST

VCO/68T

Role 2: VSST

64A/68T/68Rs

Independent

Duty

Role 1:

Id d t

MEDEVAC

DODMWDVS Training Package

Procurement, 

Preventive Medicine, 

Duty

68T

Independent

Duty 68T

1 MWD Team Predeployment Training
20 http://www.cs.amedd.army.mil/amedd_journal.aspx

Technician Specialties is recognized by the AVMA and 

sets forth standards for all specialty academies analogous to the American College of Veterinary Specialties. 

There are currently 11 veterinary technician specialties 

and 6 additional certifi cation programs recognized by 

the AVMA and NAVTA12 and, according to the Bureau 

of Labor Statistics, employment of veterinary technologists and technicians is expected to grow 52% during 

the 2010-2020 projection period.13 Today’s Soldier has 

unprecedented access to distance learning opportunities, and there is renewed Army emphasis on the Enlisted Degree Program.14 However, civilian credentialing of Army animal care specialists as RVTs through 

AVMA-accredited degree programs has not been identifi ed as critical to the AMEDD. The new Enlisted Degree Program is not MOS-specifi c and participants are 

still required to use their tuition assistance benefi ts. 

The AMEDD has recognized the advantages of civilian credentialing for the combat medic (MOS 68W) and 

medical laboratory specialist (MOS 68K) and should 

now provide support to the 68T similar to these existing, 

centrally-funded health education training programs. 

These recommendations are in the best interest of the 

Soldier and the Army. Strategic investment in 68T RVT 

licensure engages the Soldier in personal discipline and 

study habits conducive to lifelong learning, which promote professionalism within the MOS and elevated veterinary medical standards of care throughout the DoD. 

In the short term, leaders should encourage their 68Ts 

to become associate members of NAVTA in order to 

raise awareness of licensure and specialty certifi cation 

opportunities. Over the long term, the AMEDD should 

leverage the 32 American Council of Education credits 

already available in the 68T AIT and ALC courses, and 

fund 68T enrollment in AVMA-accredited veterinary 

technology associates degree distance-learning programs leading to RVT licensure. The continued success 

and future advancement of MWD medicine depends on 

the Soldiers’ dedication to lifelong learning, the professionalism of the 68T and civilian RVTs in the Veterinary 

Corps, and AMEDD support of training programs that 

consistently produce and retain credentialed and competent Animal Care Specialists.

REFERENCES

1. Soldier Training Publication 8-91T14-SM-TG: 

Soldier’s Manual and Trainer’s Guide, MOS 91T, 

Animal Care Specialist. Washington DC: US Dept 

of the Army; August 2002. Available at: https://

armypubs.us.army.mil/doctrine/DR_pubs/dr_aa/

pdf/stp8_91t14.pdf. Accessed October 3, 2012.

2. Clark WHH. The History of the US Army Veterinary Corps in Vietnam, 1962-1973. Ringgold, GA: 

W.H. Wolfe Associates; 1991:58.

3. Stephens UK. The development of the technician’s role, technician training and certifi cation. 

In: McPherson CW, Mattingly SF, eds. 50 Years of 

Laboratory Animal Science. Memphis, TN: American Association for Laboratory Animal Science; 

1999:74-79. Available at: http://www.aalas.org/

pdf/50_yrs/ch12.pdf. Accessed October 10, 2012.

4. American Veterinary Medical Association. Programs accredited by the AVMA committee on 

veterinary technician education and activities 

(CVTEA). Available at: https://www.avma.org/

ProfessionalDevelopment/Education/Accredita

tion/Programs/Pages/vettech-programs.aspx. Accessed September 27, 2012.

5. Field Manual 20-20: Military Dog Basic Training 

Care [obsolete]. Washington DC: US Dept of the 

Army; July 14, 1972:4.

6. US Army Quartermaster Foundation. Quartermaster war dog program. Available at: http://www.

qmfound.com/K-9.htm. Accessed March 10, 2011.

7. WWII K-9 Chips. War Dogs pages, Olive-Drab 

website. Available at: http://olive-drab.com/ od_wardogs_famous_chips.php. Accessed 

October 12, 2012.

8. MILPER Message Number 06-118: FY 07 Enlisted 

Military Occupational Classifi cation And Structure (MOCS) Personnel Reclassifi cation Actions. 

Alexandria, Virginia: US Army Human Resources 

Command; April 25, 2006. Available at: https://

www.hrc.army.mil/Milper/06-118. Accessed October 19, 2012.

9. Army Tactics, Techniques, and Procedures No. 

4-02: Army Health System. Washington, DC: US 

Dept of the Army; October 7, 2011:2-16,2-17,2-18. 

Available at: http://armypubs.army.mil/doctrine/

DR_pubs/dr_a/pdf/attp4_02.pdf. Accessed October 23, 2012.

10. Brice C. Compensation and benefi ts. Trends Mag. 

2011;January/February:27-30. Available at: http://

student.aahanet.org/eweb/images/student/pdf/

CompensationandBenefi ts_TrendsJF11.pdf. Accessed October 10, 2012.

11. GTA 90-01-037: Integrating Military Working Dogs 

into Counter-IED and Counterinsurgency Operations. Fort Leonard Wood, MO: US Army Military 

Police School; May 2012: Annex D – Veterinary 

Medicine.

12. Colorado Association of Certifi ed Veterinary Technicians. Technician specialties. Available at: http://

www.cacvt.com/specialties. Accessed September 

27, 2012.

THE ARMY ANIMAL CARE SPECIALIST, PAST, PRESENT, AND FUTURE
 January – March 2013 21

THE ARMY MEDICAL DEPARTMENT JOURNAL

13. Bureau of Labor Statistics Occupational Outlook Handbook, 2012-13 Edition. Veterinary technologists and technicians. US Department of Labor Website. Available at: http://www.bls.gov/oco/ocos183.htm#outlook. Accessed September 27, 2012.

14. Tice J. Enlisted, earn a degree faster. Army Times. 2010;71(18):18.

ACKNOWLEDGEMENT

All photographs appearing in this article were provided by the authors.

AUTHORS

LTC Brglez was formerly the veterinary combat developer for the Force Protection Branch, Concepts and Requirements 

Division, Directorate of Combat Doctrine and Development. Currently, he is Deputy Commanding Offi cer, 248th Medical 

Detachment (Veterinary Service Support), Fort Bragg, North Carolina.

LTC Giles is the Chief of the Advanced Animal Health Branch, Department of Veterinary Science, US Army Medical 

Department Center and School, Fort Sam Houston, Texas.

COL Mann is Director, DoD MWD Veterinary Service, LTC Daniel E. Holland MWD Hospital, Lackland Air Force 

Base, Texas.

Two animal care specialists assist veterinarians performing a surgical procedure on a military 

working dog in Kandahar, Afghanistan.
22 http://www.cs.amedd.army.mil/amedd_journal.aspx

Military working dogs (MWDs) are employed in a 

variety of austere and extreme environments, yet the 

environmental limits in which they can safely and effectively operate have never been thoroughly defi ned. 

A combat unit utilizing canine teams may experience 

an altitude change of 5,000 feet elevation or more for 

a single mission or an elevation change of over 10,000 

feet within a few days of being deployed from its home 

base. Operational needs may dictate a rapid change in 

the footprint of forces on the battlefi eld, requiring movement to a vastly different terrain and environment. Dogs 

deploying in support of combat or other contingency operations where there is little time for acclimation may 

experience rapid changes in altitude, temperature, and 

humidity. A collaborative initiative spearheaded by special operations forces (SOF) veterinary personnel across 

the range of the US Special Operations Command seeks 

to characterize the physiologic capabilities of working 

dogs and advance their safe and effective use in these 

environments.

Extensive information is already known about human 

responses to these environments, with subspecialties in 

military medicine such as aviation and dive medicine. Civilian subspecialties such as wilderness medicine focus 

on conditions and treatment associated with exposure 

to the elements in various outdoor environments. These 

subspecialty areas of medicine provide evidence-based 

guidelines to ensure the safety and effectiveness of humans operating in these conditions. In addition, they are 

constantly advancing the ability of our forces to push 

further into new and unique operating environments. 

The Veterinary Corps offi cer (VCO) and Animal Care 

Specialist (military occupational specialty 68T) are in a 

position to assist canine programs in ensuring readiness 

for rapid deployment, or sustained deployment to areas 

of extreme environmental conditions. Canine programs 

look to Veterinary Corps personnel for answers to questions directly affecting combat operating ability:

 Will high altitude will affect his scent detection 

ability?

 When my dog is deployed to the desert, it is better 

to have air conditioning in the kennel to help him 

rest between operations, or no air conditioning to 

help get acclimated to hot weather?

 How high can we (parachute) jump a dog before he 

needs supplemental oxygen?

 What ocean temperature is too cold to use the dogs 

in maritime operations?

 Do nutritional supplements help prevent heat 

injury?

 Does prehydration with subcutaneous fl uids help 

prevent heat injury?

All of these questions were asked of the authors by canine program managers within the past year. It is important for veterinary personnel to remember that canine program managers are looking for facts to aid the 

combatant commanders, who may use this information 

to make high-level decisions on the use of MWDs in 

combat and contingency operations. The responses we 

provide must be accurate, evidence-based, and realistic 

with regard to operational tempo, environment, and operational capabilities and limitations.

Faced with these important questions, the VCO and 

Animal Care Specialist will naturally want to provide 

answers. However, based on the actual evidence in the 

veterinary literature, the correct answer to each of the 

questions above is: we don’t know.

Collectively called “the effects of environmental extremes on military working dogs,” the goal of the initiative is to characterize the normal and abnormal physiologic responses of MWDs to these environments, and 

provide recommendations based on a combination of 

scientifi c evidence, lessons learned, and practical experience of the canine units and veterinary support personnel. The effort includes extensive literature research, 

tracking the work of ongoing research in these areas, 

promoting research and development projects among 

our military and civilian colleagues, and conducting 

original research in the fi eld.

This multifaceted initiative is not a SOF-exclusive endeavor, nor is it a fi nite project. It is a process that will 

evolve, change through research advances as well as 

combat lessons learned, and is expected to continue 

The Effects of Environmental Extremes on

 Working Dogs: A Collaborative Initiative

LTC Janice Baker, VC, USAR

MSG Laura Miller, USA
 January – March 2013 23

indefi nitely. Our approach follows these basic principles 

of the process:

1. Determine what is normal—what are physiologic 

parameters of MWDs in their working state?

2. Defi ne the problem—determine end-user requirements and evaluate the epidemiologic data existing on 

those topics.

3. Critically evaluate the existing evidence to determine current best practices for prevention and treatment 

of adverse reactions to extreme environmental conditions (hyperthermia, hypothermia, etc).

4. Conduct research and development, based on validated requirements, to overcome the defi ned problems and 

increase effective range of MWDs on the battlefi eld.

Current efforts focus on 4 broad operational environments: extreme heat, extreme cold, maritime, and high 

altitude. Within those 4 environments are many subsets, 

such as desert versus tropical heat, and mountain-based 

versus aviation-based altitude. In the following sections, 

we highlight some of the efforts and initial accomplishments of this team, the impact of this initiative on the 

operational canine unit, and discuss the way ahead.

1. Determine what is normal.

The standard range for canine temperature is typically 

stated as between 99°F and 102.5°F, assuming that the 

dog is in a resting, relaxed state when examined. Several studies in canine athletes and working dogs have 

shown rectal temperatures to exceed 108°F during moderate exercise with no adverse effects.1-4 Similarly, Animal Care Specialists serving as SOF Independent Duty 

Veterinary Technicians (IDVTs) have observed for several years that many of their unit’s dogs routinely develop 

temperatures up to or above 107°F during work without 

any adverse effects. Yet, by convention, most veterinary 

personnel learn that any rectal temperature over 106°F 

is a critical temperature indicating heat injury.

Body temperature and physical performance is closely 

monitored in new accession dogs intended for use in 

select SOF multipurpose canine (MPC) programs. This 

monitoring helps assess their physical suitability for the 

program. It is also performed for safety and prevention 

of heat injury while they acclimate to the 20°F or more 

increase in environmental temperature at their new location compared to their countries of origin. Using an ingestible thermistor and radiofrequency reader (CorTemp 

Core Temperature Monitoring Systems, HQ Inc, Palmetto, FL), as well as standard digital rectal thermometers, the Animal Care Specialists noted that all of the 

dogs that were monitored developed rectal temperatures 

of over 108°F during bite and explosive detection work 

of less than 10 minutes duration, despite the relatively 

mild ambient temperatures. In contrast, their core temperatures remained between 103°F-104°F. Fully trained 

and acclimated dogs showed the same patterns of core 

and rectal temperature differential. Their relative tolerance to high rectal temperatures may be explained by 

the lower core temperature readings.

Veterinary personnel who work with canine athletes and 

working dogs are familiar with these high temperatures, 

and tend to rely more on the dog’s physical appearance 

and performance than the thermometer reading when 

assessing the dog’s thermoregulatory status. Subtle 

changes in these factors of performance appear to be 

much more predictive of heat-related illness than rectal 

body temperature alone. 

To truly understand what is “normal” for working dogs, 

the VCO and Animal Care Specialist must move from 

behind the veterinary clinic examination table into the 

working and training environment of MWDs. In dogs 

with intensely high drive, physiologic and behavioral 

response of the dog during a period of recovery may 

be a better predictor of the dog’s physical state. For example, the intensity of a dog’s run toward a decoy or 

reward may not diminish until late in the progression 

of heat stress, due to his high drive. However, during 

the recovery phase after obtaining the reward, the dog 

might show more obvious signs of reaching his limits 

earlier than while in pursuit of a reward. When there 

is no incentive to work for the reward, the dog may focus more on recovery and cooling. Research on associations between subtle canine behavioral changes, body 

Telemetric measurement of body temperature allows a SOF 

Animal Care Specialist IDVT to ensure safety of a dog during 

cold water training.
24 http://www.cs.amedd.army.mil/amedd_journal.aspx

temperature, and heat tolerance may provide insight on 

this topic, and lead to new approaches in educate canine 

handlers on prevention of heat injury in their dogs. 

In humans and other species, changes in metabolic rate 

and peripheral vasoconstriction at various altitudes and 

environmental temperatures affect body heat production and loss.5-7 Considering this model, it is possible 

that changes in core versus rectal temperature may differ between dogs in different states of conditioning, and 

between environmental extremes of heat, humidity, and 

extreme cold or altitude. 

Teaming with researchers from Oklahoma State University and North Carolina State University, the team has 

performed testing to compare core against rectal temperature of canine athletes in a variety of environmental 

conditions, including heat and humidity, extreme cold, 

and high altitude. In addition, they are conducting research and development (R&D) of aids to prevention of 

heat injury, such as cooling mats and muzzles, that allow 

maximum air movement while retaining safety features.

Desert and Tropical Hot Weather Operations

At a fi eld research station in North Carolina, part of the 

SOF veterinary team works with university researchers to characterize the response of heat, humidity, and 

comparative cooling methods in Labrador retriever explosive detection dogs undergoing exercise. As an adjunct to this study, a prototype battery-operated cooling 

blanket designed by a SOF canine program and Army 

Research Offi ce R&D personnel is being evaluated for 

use in the fi eld. The effectiveness of the blanket is being evaluated against other methods of cooling, including immersion in an ambient temperature water trough, 

simulating wading in natural water sources for cooling.

High Altitude Mountain Operations

In Alaska, the SOF veterinary team works with the 

Oklahoma State University researchers in a fi eld station 

to study the effects of extreme cold and altitude on thermoregulation on dogs during exercise and anesthesia. 

Working in an environmentally controlled, low-oxygen 

chamber that simulates up to 15,000 ft altitude and 10°F, 

the VCO and Animal Care Specialist on this project don 

extreme cold weather gear and oxygen masks to monitor 

physiological parameters such as core and rectal temperature changes in Iditarod-proven Alaskan husky sled 

dogs running on a treadmill. This is followed by a fi eld 

anesthesia protocol in a “warm” room at 50°F, simulating a fi eld aid station at a remote mountain forward operating base. In addition, the cold weather team studied 

rapid acclimatization to high altitude in conditioned and 

unconditioned dogs. As part of the project in Alaska, 

the team worked closely with veterinary specialists and 

mushers during the Iditarod dog-sled race. The team 

noted the dogs’ exceptional ability to withstand temperatures as low as -50°F, and tendency for heat intolerance 

in ambient temperatures above only 20°F. This was an 

excellent example of how heat injury or intolerance cannot always be attributed to high ambient temperatures. 

Analysis of the data may lend insight into differences in 

the relation of core and rectal temperature in hot versus 

cold environments. In addition, initial data on maintenance of body temperature during anesthesia in cold 

environments is hoped to aid in the development of safe 

protocols for short-term fi eld anesthesia for working 

dogs in high altitude, cold weather environments.

Maritime Operations

Similar to monitoring the dogs in hot weather, select 

Navy dogs swimming in ocean waters during the winter 

as part of their initial assessment and training are closely monitored for hypothermia and accidental ingestion 

or aspiration of salt water. To ensure the dogs’ safety, 

SOF veterinary personnel and handlers in the water 

with the dogs monitor their core temperatures and other 

measures. Data from this type of preventive monitoring 

is being assessed to design further study, similar to the 

heat, cold, and altitude studies.

2. Defi ne the problem, determine end-user requirements, and evaluate the epidemiologic data.

A combination of evidence and lessons learned from 

practical experience is necessary to drive advances in 

military veterinary medicine. Prevention and treatment 

guidelines for any condition in veterinary medicine 

should be based on the available evidence and end-user 

requirements whenever possible. But as discussed previously, there has been little study into unique conditions 

Core temperature may be a more accurate measure of a 

dog’s temperature while working in extreme environments.

THE EFFECTS OF ENVIRONMENTAL EXTREMES ON WORKING DOGS: A COLLABORATIVE INITIATIVE
 January – March 2013 25

THE ARMY MEDICAL DEPARTMENT JOURNAL

of working dogs on which to base MWD-specifi c guidelines. Two retrospective studies currently provide the 

only statistical analysis of possible risk factors and outcome of heat injury in dogs.8,9

By collecting and analyzing the available epidemiological data, we can validate end-user requirements and focus our efforts in providing accurate guidelines to canine programs that are also relevant to their needs. Retrospective analysis of the available data can determine 

the signifi cance of individual occupational problems 

and hazards for MWDs. 

Before dedication of extensive effort or funds for research and development in prevention of environmentalassociated conditions, we must clearly defi ne the problem. For example, heat injury issues requiring defi ntion 

might include:

 What is the incidence and prevalence of heat injury 

in MWDs?

 Was there any association with the type or use of 

dog and the likelihood of heat injury, or the experience of the handler?

 How many were working in muzzle when injury 

occurred?

 Is heat injury more likely in a deployed environment than a US environment?

 Is it more likely during training than actual 

operations?

 What is the rate of survival versus nonsurvival?

 What treatment measures did the handler or other 

nonveterinary fi rst responders apply prior to arrival 

at veterinary care, and were any of these factors associated with survival or nonsurvival?

In order to provide the most accurate widespread recommendations on prevention or treatment, we need to 

know what risk factors are truly most commonly associated with specifi c conditions, and any factors that infl uence outcome. As there is currently no central database 

for cataloging and retrieving MWD medical data, this 

process will involve an intensive, combined effort of 

conventional and SOF veterinary personnel to retrieve 

and compile the data.

3. Critically evaluate the existing evidence to determine current best practices for prevention 

and treatment.

As discussed above, prevention and treatment guidelines for best practices in veterinary medicine should 

be based on critical evaluation of the available evidence 

whenever possible. A critical review by the SOF team 

of the veterinary literature on canine heat injury found 

that there was very little in the veterinary literature to 

provide evidence-based guidelines on any aspect of canine heat injury for either working or companion dogs.

10

Furthermore, the review revealed that some widelyaccepted guidelines for treatment and long-term management have never been scientifi cally validated, and, 

in some cases, may actually be refuted in the literature. 

For example, most treatment guidelines caution against 

using cold or ice water for cooling dogs with heat stroke, 

claiming that this can slow cooling or lead to complications such as disseminated intravascular coagulopathy 

(DIC). The review found that, according to the available 

veterinary literature, there was no evidence that ice or 

cold water cooling was associated with slower cooling, 

DIC, or worse outcomes in dogs. In fact, ice water immersion was found to be the most rapid method of cooling in hyperthermic human athletes, and is the recommended method of cooling in human medicine.11-14 The 

few canine-specifi c studies on cooling methods were 

conducted 20 to 30 years ago, and involved a very small 

number of animals in experimental studies of induced 

heat stroke models.15-20 Prospective, randomized, controlled clinical trials of different cooling methods would 

be necessary to make defi nite conclusions and provide 

evidence-based guidelines on best practices for cooling.

Along with addressing unanswered questions with research, it is equally important to not propagate guidelines that are not supported by the evidence. If tap water 

and fanning (rather than cold or ice water) is effective 

in cooling dogs with hyperthermia,17 it should be stated 

as no more or less than that when the information is relayed to others. Veterinary personnel should be aware 

that the precept that ice water is contraindicated because 

it leads to DIC is a guideline that is not supported by the 

evidence; it is simply another question that falls into the 

“we don’t know” category of answers.

It is also often asserted that dogs with history of heat 

injury are at more risk for recurrence in the future. In 

actuality, the review found no reports in the literature 

that this had ever actually been studied in canines, and 

that this assertion appears to be extrapolated from the 

human literature. Several human studies have shown evidence of heat intolerance in military recruits for up to 6 

months following an initial occurrence of heat injury,21-24

and standardized heat tolerance tests have been used to 

assess fi tness for return to duty.21,22

Anecdotally, veterinarians may see individual dogs with 

repeated heat injury, apparently confi rming this phenomenon. However, before blaming the recurrence on 

an altered thermoregulatory mechanism from prior heat 

injury, the veterinarian should consider if the repeated 
26 http://www.cs.amedd.army.mil/amedd_journal.aspx

heat injury is due to conditions which can be improved, 

such as decreasing body weight, increased physical conditioning, a surgically repairable upper airway condition, 

or improved handler education. Once these factors have 

been ruled out, then they can consider the concept that 

something within the dog’s thermoregulatory mechanism has been altered, making him more prone to heat 

intolerance. Until there is adequate evidence to support 

it, we cannot make this assertion to canine programs 

with any accuracy.

Fitness for duty following heat injury should be based 

on evaluation of the dog under increasingly strenuous 

conditions of work, similar to heat tolerance testing in 

human service members who have incurred heat injury. 

Veterinary assessments on fi tness for duty based on prior heat injury have the potential to affect management 

decisions regarding individual MWDs within a unit, especially regarding deployment. Finding a scientifi callyvalidated answer to the question of recurrence of heat 

injury could have direct effect on combat units utilizing 

MWDs. Thus, this topic is an excellent example of a valid end-user requirement that warrants further research.

4. Conduct research and development, based 

on validated end-user requirements, to overcome the defi ned problems and increase effective range of military working dogs on 

the battlefi eld.

The fi rst 3 steps discussed above determine normal physiologic reactions, baseline epidemiological evidence, 

and evidence-based best practices. The results of these 

steps drive a focused effort to develop new technologies 

beyond what are already available. Steps in this process 

will also overlap to some degree. The ongoing research 

to determine normal working temperatures and thermoregulatory responses of dogs in environmental extremes 

spans multiple phases of the process. 

It is crucial to the R&D phase in development of new 

methods, equipment, or technologies that these efforts 

are based on validated operational needs of the canine 

unit and the mission requirements of their combat command. To truly serve the Warfi ghter, we must listen to 

what they want from us, and what they regard as an operational problem or obstacle with their dogs. It does 

little good for us to develop a new tool or treatment regimen for their use on the battlefi eld if the data on battlefi eld injuries indicate the tool or treatment has never 

been needed, or they simply will not carry it with them 

due to size, weight, or other inconvenience. Similarly, 

our canine healthcare guidelines must be relevant and 

realistic in their operating environment. The best way to 

determine what they need is to listen, and to ask:

 What does the canine unit want from us?

 What do they view as their most signifi cant canine 

problems?

 What factors of the environment (heat, cold, altitude, etc) are limiting what they can accomplish 

with their dogs?

 What type of solution do they propose, that will fi t 

into their existing operational tactics, techniques, 

and procedures?

CONCLUSION

The Veterinary Corps is in the unique position to facilitate not only the advancement of military working 

dog clinical care, but also extending the effective range 

of this special force protection resource on the battlefi eld. From determining the operational requirements 

through gathering the evidence and creating new and 

advanced capabilities, Veterinary Corps personnel have 

a vital role in advancement of the capabilities of military 

working dogs under environmental extremes. The best 

approach to this effort is ultimately a collaboration between the end-user canine units, the VCOs and Animal 

Care Specialists supporting the canine units, the Veterinary Corps clinical and epidemiology specialists, military R&D specialists, and our civilian veterinary counterparts with the resources and experience in the conduct of basic science and clinical research. Each of these 

collaborators has a vital role in the support of Warfi ghter 

canine programs and their operational requirements.

A SOF Animal Care Specialist IDVT works with racing sled 

dogs during the Iditarod sled dog race in Alaska.

THE EFFECTS OF ENVIRONMENTAL EXTREMES ON WORKING DOGS: A COLLABORATIVE INITIATIVE
 January – March 2013 27

THE ARMY MEDICAL DEPARTMENT JOURNAL

REFERENCES

1. Angle CT, Gillette RL. Telemetric measurement of 

body core temperature in exercising unconditioned 

Labrador retrievers. Can J Vet Res. 2011;75(2):157-

159.

2. Steiss J, Ahmad HA, Cooper P, Ledford C. Physiologic responses in healthy Labrador retrievers during fi eld trail training and competition. J Vet Intern 

Med. 2004;18(2):147-151.

3. Matwichuk CL, Taylor SM, Shmon CL, Kass PH, 

Shelton, GD. Changes in rectal temperature and 

hematologic, biochemical, blood gas, and acid-base 

values in healthy Labrador retrievers before and after strenuous exercise. Am J Vet Res. 1999;60(1):88-

92.

4. Rose RJ, Bloomberg MS. Responses to sprint exercise in the greyhound: effects on hematology, serum biochemistry, and muscle metabolites. Res Vet 

Sci. 1989;47(2):212-218.

5. De Léon AC, Perez Mdel C, González DA, Díaz 

BB, Coello SD, González-Hernández A, AugirreJaime A, CDC of the Canary Islands Group. Hemodynamics and metabolism at low versus moderate 

altitudes. High Alt Med Biol. 2011;12:179-186.

6. Amitabh, Singh VK, Vats P, Kishnani S, Pramanik 

SN, Signh SN, Singg SB, Banjeree PK. Body composition and cardiovascular function in healthy 

males acclimatized to desert and high altitudes. Indian J Med Res. 2009;129(2):138-143.

7. Anufriev AI, Solomonov VF, Isaev AP. Seasonal 

changes in body temperature of medium-sized 

and large mammals in cold climate. Dokl Biol Sci. 

2007;415:317-319.

8. Bruchim Y, Klement E, Saragusty J, Finkeilstein E, 

Kass P, Aroch I. Heat stroke in dogs: a retrospective 

study of 54 cases (1999-2004) and analysis of risk 

factors for death. J Vet Intern Med. 2006;20(1):38-

46.

9. Dobratz KJ, Macintire DK. Heat-induced illness 

in dogs: 42 cases (1976-1993). J Am Vet Med Assn. 

1996;209(11):1894-1899.

10. Baker JL, Hollier PJ, Miller L, Lacy WA. Rethinking heat injury in the SOF multipurpose canine: a 

critical review. J Spec Oper Med. 2012; 12(2):8-15.

11. McDermott BP, Casa DJ, Ganio MS, Lopez RM, 

Yeargin SW, Armstrong LE, Maresh CM. Acute 

whole-body cooling for exercise-induced hyperthermia: a systematic review. J Athl Train. 

2009;44(1):84-93.

12. Armstrong LE, Crago AE, Adams R, Roberts WO, 

Maresh CM. (1996). Whole-body cooling of hyperthermic runners: Comparison of two fi eld therapies. 

Am J Emerg Med. 4:355-358.

13. Clements JM, Casa DJ, Knight JC et al.(2002). Icewater immersion and cold-water immersion provide similar cooling rates in runners with exerciseinduced hyperthermia. J Athl Train. 2:146-150.

14. Proulx CI, Decharme MB, Kenny GP. Effect of water temperature on cooling effi ciency during hyperthermia in humans. J Appl Physiol. 2003;94(4):1317-

1323

15. White JD, Kamath R, Nucci R, Johnson C, Shepherd S. (1993). Evaporation versus Iced peritoneal lavage treatment of heatstroke: comparative 

effi cacy in a canine model. Amer J Emer Med.

1993;11(1):1-3.

AUTHOR

LTC Baker is Command Veterinarian, Naval Warfare 

Development Group, Dam Neck, Virginia.

MSG Miller is assigned to Headquarters, US Special 

Operations Command, Fort Bragg, North Carolina.

Articles published in the Army Medical Department Journal are indexed in MEDLINE, the National 

Library of Medicine’s bibliographic database of life sciences and biomedical information. Inclusion 

in the MEDLINE database ensures that citations to AMEDD Journal content will be identifi ed to 

researchers during searches for relevant information using any of several bibliographic search 

tools, including the National Library of Medicine’s PubMed service.
28 http://www.cs.amedd.army.mil/amedd_journal.aspx

During routine training in a wooded area on Marine 

Corps Air Station Cherry Point, North Carolina, on December 5, 2011, military working dog (MWD) Dingo 

M063 was bitten by a pit viper on the left front limb. 

The MWD handlers rushed the dog to the Cherry Point 

Veterinary Treatment Facility (VTF) for initial stabilization. The dog had profound swelling and bruising of 

the affected limb, along with puncture wounds consistent with a potentially fatal venomous snake bite. The 

patient was assessed and initial stabilization performed 

at the Cherry Point VTF. Based upon consultation and 

Dingo’s clinical condition, administration of antivenin 

was selected as the course of treatment. After initial efforts to obtain the antivenin locally were unsuccessful, 

the decision was made to evacuate Dingo to the Norfolk 

(Virginia) Naval Station VTF for antivenin administration and continued intensive care and monitoring. 

When a snake bite occurs, occasionally the dog handler, 

or owner in the case of a pet, sees the offending snake. 

Often the snake is never seen or identifi ed. The attending veterinarian must use the clinical presentation, patient history, and knowledge of the local fauna to determine the appropriate treatment protocol. Occasionally 

the dog may vocalize, which is followed by lameness, 

swelling, bruising, and sometimes bleeding from the 

bite wounds. Many venomous bites are due to accidental 

contact with the snake. There are 37 species of snakes 

located throughout North Carolina; of those only 6 are 

venomous,1

 and only 5 of the 6 could infl ict a venomous bite consistent with that suffered by Dingo. The 5 

snakes all belong to the family Viperidae, subfamily 

Crotalinae.2

 Specifi cally, they are the Copperhead (Agkistrodon contortrix), Canebrake rattlesnake (Crotalus 

horridus atricaudatus), Eastern Diamondback rattlesnake (Crotalus adamanteus), Pigmy rattlesnake (Sistrurus miliarius), and Cottonmouth or Water Moccasin 

(Agkistrodon piscivorus).1

When the snake bite occurred, the area veterinary clinical medicine offi cer was consulted to provide guidance 

on the immediate treatment of the bite and aid in development of the most appropriate treatment plan. This 

input facilitated prompt decision-making, resulting in 

evacuation of the MWD. The local kennel master at 

Cherry Point reported the incident to his chain of command, and helped coordinate with Marine Transport 

Squadron One to arrange emergency medical evacuation from Cherry Point to the Norfolk Naval Station. 

Dingo M063 was transported to Norfolk in a Marine 

Corps HH-46D Sea Knight search and rescue helicopter. 

The MWD did well during transport and arrived at Norfolk in stable, albeit critical, condition. The antivenin, 

CroFab (BTG International Ltd, London), was provided 

by the Naval Medical Center, Portsmouth, Virginia. The 

MWD was treated with antivenin and received supportive care overnight. Dingo M063 improved signifi cantly 

after antivenin administration and made a full recovery 

with return to duty one week later.

CLINICAL VIGNETTE

At time of initial presentation, the handlers did not report any vocalization or decrease in effort while working, but noticed profound swelling of the left front leg 

after clearing the edge of a wooded area. Dingo M063 

was bright, alert, responsive, and panting heavily upon 

presentation. He had a barely perceptible lameness in 

the left front limb, despite marked swelling in the area 

of the distal elbow. Abnormal physical exam fi ndings 

included an elevated temperature at 106.4°F (99.5°F 

–102°F), tachycardia at 140 beats per minute (bpm) (80 

bpm–100 bpm) with strong synchronous pulses, and a 

small spot of fresh blood on the left dorsal antebrachium. 

He also had moderate to severe fi rm swelling extending 

from the left mid-antebrachium to the region of the elbow. The area of the swelling was gently palpated to rule 

out trauma and/or fracture, and then the skin overlying 

Pit Viper Envenomation in a

 Military Working Dog

CPT Curtis R. Cline, VC, USA

MAJ Michelle E. Goodnight, VC, USA

ABSTRACT

Military working dogs are often trained and/or work in locations where the potential for snake bites is increased. 

Knowledge of the local venomous snakes, the effects of their venom, and appropriate initial stabilization is essential for the US Army Veterinary Corps offi cer (VCO). As military practitioners, VCOs are uniquely situated 

to benefi t from collaboration with other military assets for air evacuation and treatment of their patients. A 

recent clinical case of envenomation is presented, along with a review of the most current literature regarding 

treatment of envenomation in veterinary patients.
 January – March 2013 29

the swelling was shaved (Figure 1). Two small puncture 

wounds (Figure 2) and severe bruising were noted on the 

left dorsal antebrachium. Based on the history, presentation, and initial fi ndings, it was determined the MWD 

had been struck by a venomous pit viper.

A cephalic intravenous catheter was placed, and the 

MWD was given 2 quarter shock doses of intravenous 

crystalloid fl uids (1,500 mL lactated ringers), followed 

by a maintenance fl uid rate. The area of the puncture 

wounds was scrubbed with an antiseptic solution. As 

shown in Figure 1, the margin of the bruising was 

marked with permanent ink to allow monitoring for 

progression of the swelling. The blood pressure was 

normal, and an electrocardiogram (ECG) showed a normal sinus rhythm. A complete blood count and serum 

biochemistry profi le were performed. A mild decrease 

in platelet count was noted (125,000/μl, reference interval 200,000/μl to 400,000/μl), and all other values were 

normal. An intravenous dose of buphrenorphine (0.0075 

mg/kg, 0.0034 mg/lb) was given to relieve discomfort 

associated with the bite. The patient’s temperature 

dropped to 99.1oF within 35 minutes after presentation, 

and the pulse and respiratory rate normalized. The mucous membranes were pink, but tacky. The MWD was 

quiet, alert, and responsive, but clearly uncomfortable. 

The MWD was evacuated to the Norfolk Naval Station 

VTF by helicopter, and arrived in stable condition. The 

swelling and bruising showed signifi cant progression 

since presentation, and a second bite wound was noted 

on the mid-caudal aspect of the antebrachium (Figure 

3). Activated partial thromboplastin time, and prothrombin time were normal upon arrival at the Norfolk VTF. 

After Dingo M063 was reassessed, one vial of intravenous Crotalidae Polyvalent Immune Fab (CroFab) was 

administered. Marked improvement in the swelling and 

bruising (Figure 4) was noted within one hour of beginning administration of the antivenin. The majority of 

the swelling resolved over the next 24 to 48 hours. The 

MWD was bright and alert the next morning, and using the limb with minimal signs of discomfort. He was 

transported back to Cherry Point 72 hours later (Figure 

5), and was returned to work within one week. He went 

on to make a full recovery, with no lasting effects of the 

envenomation.

Figure 1. Marked swelling and bruising of left front limb approximately four hours after snake envenomation.

Figure 2. First bite location noted on dorsal aspect of left 

front leg.
30 http://www.cs.amedd.army.mil/amedd_journal.aspx

CURRENT TREATMENT FOR PIT VIPER 

ENVENOMATION

Background

The name pit viper is derived from the presence of a 

heat sensing pit organ located on the head.3

 Pit viper envonomation occurs throughout the United States, with 

the majority of bites occurring between the months of 

April and October.4

 However, the seasonal occurrence 

can vary signifi cantly depending on location and weather patterns, as was the case with Dingo M063. Approximately 25% of pit viper bites are known as “dry bites,” 

meaning no venom was injected.3-5 As expected, dry 

bites result in a much less severe presentation. In the 

absence of the snake itself, or accurate owner/handler 

identifi cation of the snake, the clinician must use the history and physical examination to rule out other causes 

for the given presentation, such as trauma, other animal 

bites, wounds, or bites from venomous insects.

The severity of the bite can vary considerably between 

patients. Factors such as size and age of the victim, species of snake, size and age of the snake, amount of venom injected, location of bite, number of bites, and depth 

of envenomation can all play a role in the severity of 

clinical signs in the patient.5,6 General location of the 

bite may vary between patients, but bites to the head 

and neck can be particularly serious if swelling causes 

obstruction of airfl ow. Studies have found the majority 

of dog envenomations occur in the head and neck.7

The venom itself is 90% water6 combined with a very stable and complex mix of proteins such as phospholipase, 

hyaluronidase, collagenase, and proteases.3

 These compounds cause various local and systemic effects on the 

victim, including local tissue destruction, and endothelial damage. Endothelial damage results in extravasation 

of fl uid and red blood cells, followed by edema, swelling, 

and potentially reduced circulating blood volume leading to hypotension, hypovolemia, and shock.4

 Pooling of 

blood within the shock organ (liver and spleen in dogs) 

also contributes to hypotension and shock.6

 The venom 

proteins also have a variety of toxic effects on other cells 

throughout the body, including blood cells, myocardium, 

skeletal muscle, soft tissues, and cells of the respiratory 

and nervous systems.5

 Venom characteristics vary signifi cantly across snake species, with some causing more 

Figure 3. A second bite was noted on the medial aspect of 

the left front leg.

Figure 4. Moderate improvement in degree of swelling and 

bruising approximately one hour after intravenous antivenin 

administration.

PIT VIPER ENVENOMATION IN A MILITARY WORKING DOG
 January – March 2013 31

THE ARMY MEDICAL DEPARTMENT JOURNAL

severe and varied damage compared to others.6

 Some pit 

vipers, such as the Mojave rattlesnake and several others, 

possess a neurotoxin containing venom which results in 

ascending fl accid paralysis. These snakes can possess 

only a neurotoxic venom, which would cause neurologic 

dysfunction in the absence of the other clinical signs, or 

a combination of neurotoxic and hematoxic venom.8

The complex venom composition can also have various 

effects on the coagulation system. The venom proteins 

have pro- and anticoagulant properties, and can cause 

fi brin degradation, direct damage to blood vessel walls, 

and impaired platelet function.3

 These changes can result 

in an anticoagulant condition similar to disseminated intravascular coagulation.3

 Therefore, monitoring clotting 

times, (prothrombin time (PT), activated partial thromboplastin time (APTT)), and platelet levels is an important component of patient evaluation and monitoring.

Initial Evaluation

A thorough evaluation and physical examination should 

be performed when a pit viper envenomation is suspected. Signs observed are related to the toxic effects 

of the venom as previously discussed, and vary in onset. 

Most commonly, the fi rst clinical signs appear 30 to 60 

minutes after the bite,4

 but may take up to 24 hours to 

develop in some cases.5

 Due to the wide-ranging effects 

of venom throughout the body, a varying array of both 

local and systemic clinical signs can be observed. These 

clinical signs include hypotension, tachycardia, tachypnea, swelling and bruising in the area of the bite, bleeding/oozing puncture wound, pain, weakness, nausea, 

diarrhea, mental depression, and potentially neurologic 

defi cits.9

 A snake bite severity score is a useful tool for 

determining severity of the bite, and for monitoring progression. This can allow the clinician to make a more 

impartial patient assessment.10

A complete blood count, serum biochemistry profi le, 

and coagulation parameters (PT, APTT, and fi brinogen 

if available) should be checked as soon as possible after 

presentation. Thrombocytopenia and coagulation abnormalities are common with pit viper envenomation, 

and echinocytosis is commonly seen on blood fi lm examination.9

 Other diagnostic tests should include ECG, 

urinalysis, and blood pressure.5

 Repeat tests should be 

conducted as necessary, based on the patient’s clinical 

condition and response to treatment.

Treatment

Signifi cant variation in treatment protocols for pit viper 

envenomation exists in both human11 and veterinary 

medicine.5

 Evidenced-based support in veterinary medicine for therapies commonly used in the past, such as 

glucocorticoids and antihistamines, is not available and 

therefore these therapies are controversial. They are often reserved for treatment of antivenin hypersensitivity 

reactions, as opposed to the envenomation itself. Emergency treatments such as tourniquets, incision and suction, and cryotherapy are not recommended in human11

or veterinary medicine6

 due to lack of effi cacy. Immobilization and timely transport to the nearest veterinary 

treatment facility is the most appropriate emergency 

treatment.4,5 The fundamentals of treatment are fl uid 

therapy, pain management, wound management, and 

antivenin therapy when appropriate and practical.

The area around the envenomation site is clipped and 

scrubbed to allow visualization of the degree of bruising 

and swelling; the area is scrubbed with an antiseptic to 

prevent further infection. It is useful to mark the area of 

swelling and bruising with a marker every 15 minutes, 

and to measure the circumference of the limb. This will 

help determine severity and progression, and aid in determining the need for antivenin administration.3,4

Crystalloid fl uid therapy is administered to correct hypovolemia and treat shock. It is generally administered 

Figure 5. Mild bruising and minimal swelling remaining 3 

days after snake envenomation.
32 http://www.cs.amedd.army.mil/amedd_journal.aspx

in one-quarter shock doses, followed by a maintenance 

rate. Assessment of response to therapy and need for additional boluses is generally done using clinical parameters such as mucous membrane color, capillary refi ll 

time, blood pressure, and urine output.3

Administration of antibiotics is left to the discretion of 

the clinician, but is generally not recommended for prophylactic treatment,5

 but rather if there are signs of an 

actual infection.3,11 Venom can travel in the lymphatics, 

resulting in a lymphadenopathy which may be mistaken 

for secondary infection.9

 The human literature only advocates the use of antimicrobials where there is evidence 

of wound infection, and then the choice should be based 

on culture and sensitivity.4

 There are recommendations 

in the veterinary literature suggesting broad-spectrum 

antibiotics are appropriate due to the degree of tissue 

damage that occurs, and because of the population of 

bacteria found in the mouth of snakes.6,9

Opioids are a good analgesic choice for snakebite envenomation. It is important to avoid high doses of potent 

opioids in the acute treatment phase to prevent masking 

of the patient’s neurologic status. Nonsteroidal anti-infl ammatory drugs (NSAIDs) are generally not recommended due to risk of associated side effects such as 

gastrointestinal ulceration and nephropathy in a compromised patient. The use of NSAIDS can also increase 

the risk of bleeding due to impaired platelet aggregation 

in a coagulopathic patient.5

One of the primary therapies for pit viper envenomation 

is administration of antivenin. Historically, not all studies have supported the use of antivenin in every type 

of pit viper envenomation9,12 and others have found a 

higher survival rate in dogs administered antivenin as 

compared with those that did not receive it.7

 These converging fi ndings from studies of different pit viper species highlights the signifi cant variation in venom composition among species, which infl uences the severity of 

the bite. Indications for use include rapidly advancing 

local swelling and tissue damage, severe and ongoing 

coagulation abnormalities, neurologic signs, and cardiovascular compromise.13 In general, its use in veterinary 

medicine is determined by affordability, availability,5

severity of envenomation, and the clinician’s education 

and experience in treating snake envenomations. It is 

ideally administered within 4 hours of the bite, but may 

be effective up to 24 hours after envenomation.3

 Antivenin administration is known to slow the progression of 

swelling and resolve venom-associated coagulopathies,5

and is the only proven specifi c therapy to treat pit viper 

envenomation.6

There are currently 2 antivenin products available in the 

United States, Antivenin (Crotalidae) Polyvalent (ACP) 

(Boehringer Ingelheim Vetmedica, St Joseph, MO) 

and CroFab. The ACP product has been around much 

longer, contains whole IgG, and is an equine-derived 

product. The CroFab product is ovine-derived. The individual molecules in CroFab are much smaller because 

the antigenic Fc

 portion of the antibody is eliminated, 

and the product contains much less constituent total 

protein than the ACP product.4

 CroFab is more potent 

than ACP (5.2 times),14 but it is also more expensive. A 

recent study found that the CroFab antivenin was effective in treating rattlesnake envenomation in dogs.14 The 

smaller sized Fab molecules are also eliminated much 

faster, and therefore could result in excretion prior to 

neutralization of all venom and recurrence of clinical 

signs, which would necessitate re-dosing. This has been 

observed in humans.14 CroFab antivenin was available at 

the Naval Medical Center, Portsmouth, and was used to 

treat Dingo M063.

The newer ovine-derived product carries a lower risk 

of reaction following administration.3,8 The occurrence 

of adverse reactions following administration is less 

common with CroFab (14.3%) than with ACP (23% to 

56%) in human medicine.4

 The above mentioned study 

using CroFab in dogs showed a 5.2% incidence rate of 

adverse reactions.14 Hypersensitivity reactions can occur, resulting in anaphylaxis (type 1), anaphylactoid 

reactions (complement mediated), or delayed serum 

sickness (type 3), and are treated with a combination 

of diphenhydramine and epinephrine.5

 Anaphylactoid 

reactions are most common,6

 but delayed serum sickness has been reported following ACP administration.15

Antivenin dosing in dogs is based on clinical signs and 

coagulation parameters,3

 and can therefore vary signifi -

cantly between patients. A snake bite severity score can 

also aid in guiding antivenin dosing.14

Even with antivenin administration, signifi cant tissue 

damage can occur. Due to the toxic and complex nature 

of the venom, the damage can occur quickly depending 

on the location of the bite and amount of venom injected. 

Once tissue necrosis has occurred, antivenin administration will not reverse the damage, only prevent further 

damage.3,5 If tissue sloughing occurs, long term wound 

management becomes necessary.

PREVENTION

There is a veterinary-approved rattlesnake vaccine 

available (Red Rock Biologics, Woodland, CA) which 

was developed to provide protection against envenomation by a Western Diamondback Rattlesnake. However, 

PIT VIPER ENVENOMATION IN A MILITARY WORKING DOG
 January – March 2013 33

THE ARMY MEDICAL DEPARTMENT JOURNAL

there are no peer-reviewed canine studies available to 

document its effi cacy. The 2011 American Animal Hospital Association Canine Vaccination Guidelines do not 

make a specifi c recommendation for or against the vaccine due to lack of available data regarding its effi cacy.16

As a practical matter, prevention of the actual bite would 

be very challenging in most dogs because of their curious disposition and the nature of pit vipers.

CONCLUSION

In certain parts of the United States, pit viper envenomation can occur throughout the year, particularly during mild winters when envenomation is unexpected. It 

is useful for veterinary practitioners to be aware of the 

local fauna, and which animals or insects commonly 

cause illness/injury to dogs. This can be challenging for 

Veterinary Corps offi cers who are frequently assigned 

to duty sites in areas with which they are unfamiliar, but 

should be a priority if they are caring for military working dogs. It is also important to know the availability of 

antivenin in the local area. Cornerstones of treatment 

include pain management, intravenous fl uid administration, antivenin administration, and wound management 

as needed. Prompt decision making, use of available resources, and appropriate treatment of clinical signs can 

result in a very positive outcome in these cases.

REFERENCES

1. North Carolina Venomous Snakes. North Carolina State University Cooperative Extension web 

site. Available at: http://www.ces.ncsu.edu/gaston/

Pests/reptiles/venomousnake.htm. Accessed June 

3, 2012.

2. Castoe T, Parkinson C. Bayesian mixed models and 

the phylogeny of pit vipers (Viperidae: Serpentes). 

Mol Phylogenet Evol. 2006;39:91-110.

3. Najman L, Seshadri R. Rattlesnake envenomation. 

Compend Cont Educ Vet. 2007;29(3):166-177.

4. Gold B, Barish R, Dart R. North American snake 

envenomation: diagnosis, treatment, and management. Emerg Med Clin North Am. 2004;22:423-

443.

5. Armentano R, Schaer M. Overview and controversies in the medical management of pit viper 

envenomation in the dog. J Vet Emerg Crit Care. 

2011;21(5):461-470.

6. Peterson M. Snake bite: pit vipers. Clin Tech Small 

Anim Pract. 2006;21:174-182.

7. Willey J, Schaer M. Eastern diamondback rattlesnake (Crotalus adamanteus) envenomation of 

dogs: 31 cases (1982-2002). J Am Anim Hosp Assoc. 

2005;41:22-33.

8. Hoggan S, Carr A, Sausman K. Mojave toxin-type 

ascending fl accid paralysis after an envenomation 

by a southern pacifi c rattlesnake in a dog. J Vet 

Emerg Crit Care. 2011;21(5):558-564.

9. Gilliam L, Brunker J. North American snake envenomation in the dog and cat. Vet Clin North Am 

Small Anim Pract. 2011;41:1239-1259.

10. Peterson M. Snake envenomation. In: Silverstein 

DC, Hopper K. Small Animal Critical Care Medicine. St. Louis: Saunders Elsevier; 2009:399.

11. Lavonas EJ, Ruha AM, Banner W, et al. Unifi ed 

treatment algorithm for the management of crotaline snakebite in the United States: results of an 

evidence-informed consensus workshop. BMC 

Emerg Med. 2011;11(2):1-15.

12. Hackett TB, Wingfi eld WE, Mazzaferro EM, Benedetti JS. Clinical fi ndings associated with prairie 

rattlesnake bites in dogs: 100 cases (1989-1998). J 

Am Vet Med Assoc. 2002;220(11):1675-1680.

13. McCown JL, Cooke KL, Hanel RM, Jones GL, 

Hill RC. Effect of antivenin dose on outcome from 

crotalid envenomation: 218 dogs (1988-2006). J Vet 

Emerg Crit Care. 2009;19(6):603-610.

14. Peterson ME, Matz M, Seibold K, Plunkett S, Johnson S, Fitzgerald K. A randomized multicenter trial 

of Crotalidae polyvalent immune F(ab) antivenom 

for the treatment of rattlesnake envenomation in 

dogs. J Vet Emerg Crit Care. 2011;21(4):335-345.

15. Berdoulay P, Schaer M, Starr J. Serum sickness in 

a dog associated with antivenin therapy for snake 

bite caused by Crotalus adamanteus. J Vet Emerg 

Crit Care. 2005;15(3):206-212.

16. Welborn LV, DeVries JG, Ford R, et al. 2011 AAHA 

Canine Vaccination Guidelines. American Animal 

Hospital Association website. Available at: https://

www.aahanet.org/PublicDocuments/CanineVac

cineGuidelines.pdf. Accessed September 18, 2012. 

AUTHORS

CPT Cline is the Offi cer-in-Charge, Cherry Point 

Veterinary Treatment Facility, Marine Corps Air Station, 

Cherry Point, North Carolina.

MAJ Goodnight is the Chief of Clinical Services, Fort 

Bragg Veterinary Center, Fort Bragg, North Carolina. 

She is also the Veterinary Clinical Specialist, US Army 

Public Health Command District, Fort Eustis, Virginia.
34 http://www.cs.amedd.army.mil/amedd_journal.aspx

CLINICAL VIGNETTE

Max II F241, an 11-year-old castrated male Dutch shepherd, presented to the Fort Bragg Veterinary Medical 

Center at approximately 1030 on June 7, 2012 for possible bloat. Max II F241 had episode history of bloat 

while deployed to Afghanistan in May 2011, and had 

a gastropexy performed at that time. In July 2011 he 

developed acute hindlimb lameness, which was attributed to severe lumbosacral spondylosis and progressive 

degenerative joint disease (DJD). At that time he was 

prohibited from further bite work and work on the obstacle course. Max II F241 had a history of extreme aggression, with several serious bites to handlers. Prior to 

presentation, he had been receiving Rimadyl (carprofen, 

an nonsteroidal anti-infl ammatory drug) (75 mg orally 

twice a day) and tramadol (50 mg to 100 mg orally 3 

times a day) to control pain associated with DJD. He 

was undergoing disposition due to his inability to function as a military working dog (MWD). To evaluate his 

suitability for adoption, a behavioral assessment termed 

a bite muzzle video (BMV) was required.

The Military Police MWD handlers were fi lming the 

BMV for Max II F241’s disposition packet. He had successfully completed the fi rst section of the video and 

was rested in a shaded area. He was observed to have an 

increased respiratory rate and effort that resolved during the rest period. After completing the second portion 

of the BMV, Max II F241 developed marked respiratory distress, a distended abdomen, and an episode of 

diarrhea. The handlers immediately brought him to the 

Veterinary Medical Center, which is located close to the 

Military Police kennels and training yard, for treatment.

On presentation, Max II F241 was distressed, with a 

temperature of 108.8°F (99.5°F-102.5°F), pulse of 140 

beats per minute (bpm) (70 bpm-120 bpm), markedly 

increased respiratory rate (>100 respirations per minute (rpm) (8 rpm-40 rpm)) with severe distress, and cyanotic, injected mucous membranes. Thoracic auscultation revealed moderate crackles in all lung fi elds, normal 

cardiac sounds, and weak femoral pulses. No gastric 

distension was noted on abdominal palpation, and other 

organs appeared normal. No ping was heard during simultaneous percussion and auscultation of the abdomen, 

and a slight ping was heard in the caudal thorax. The 

presumptive diagnosis for Max II F241 was heatstroke 

with possible gastric distension due to aerophagia.

Flow-by oxygen was provided on presentation, an 18 

gauge intravenous catheter was immediately placed in 

the left cephalic vein, and a 1 liter bolus of lactated ringer’s solution was given rapidly. Active cooling measures 

were initiated immediately following assessment of his 

temperature: soaking with room-temperature water, applying isopropyl alcohol to the pads of his feet, and using fans to provide evaporative cooling. Due to marked 

distress of the patient, Max II F241 was sedated with 1

mg acepromazine and 2 mg hydromorphone injections. 

Max II F241 remained distressed and cyanotic, and was 

given an intravenous (IV) bolus of propofol and then 

intubated, whereupon his color and pulse oximetry improved. A second 18 gauge IV catheter was placed in the 

right cephalic vein. Vital signs were continuously monitored and reassessed. Initial complete blood cell (CBC)/

chemistry panel showed hemoconcentration (packed 

cell volume, total protein, etc.). His blood glucose (BG) 

on presentation was 67 mg/dL, and 30 ml 50% dextrose 

diluted with 30 ml 0.9% NaCl was given IV. After administration of dextrose, his BG increased to 255 mg/

dL. After over an hour of active cooling measures, Max 

II F241’s rectal temperature was 102.7°F. Active cooling 

measures were stopped, and he was dried off.

Heatstroke in a Military Working Dog

CPT Miranda Andress, VC, USA

MAJ Michelle E. Goodnight, VC, USA

ABSTRACT

Military working dogs are often trained and/or worked in locations where the environment is rigorous and 

austere. Knowledge of training conditions, environmental risks, and appropriate treatment of environmental 

injuries is essential for the Veterinary Corps offi cer (VCO). As military practitioners, VCOs are potentially 

placed in situations where quickly recognizing environmental emergencies, such as heatstroke, and initiating 

treatment or evacuation is essential. A recent clinical case of heatstroke is presented, along with a review of the 

most current literature regarding treatment of heat-related injury in veterinary patients.
January – March 2013 35

Radiographs of the thorax and abdomen were obtained 

after he was cardiovascularly stabilized and his temperature had decreased. There was no evidence of bloat 

on abdominal radiographs, and thoracic radiographs 

showed diffuse pulmonary disease, which could have 

been caused by acute respiratory distress syndrome/

acute lung injury, pneumonia, or noncardiogenic pulmonary edema, none of which could be ruled out.

The CBC/chemistry panels were repeated approximately 90 minutes postpresentation. Hemodilution was characterized by a panhypoproteinemia and decreased hematocrit. Ninety minutes after presentation, his BG was 

86 mg/dL. Nasal catheters were placed in both nares for 

oxygen administration. One hundred fi ve minutes after 

presentation, Max II F241’s BG had dropped to 70 mg/

dL, so a 5% dextrose constant rate infusion (75 mL/hr) 

was initiated. Despite additional dextrose support, his 

BG continued to fall, with a maximum value of 69 mg/

dL. Two and a half hours postpresentation, Max II F241 

was extubated and placed on 10 L/min oxygen via nasal 

catheter, maintaining his PAO2

 at 92%. Petechiae developed on mucus membranes, his abdomen, and areas of 

shaved skin, and hemorrhage was noted from IV catheter and nasal catheter sites, as well as venipuncture sites. 

Coagulation testing was performed. Both a PTT and PT 

were within normal limits, although his platelet levels 

dropped markedly from 349 K/μL to 213 K/μL (175 K/

μL-500 K/μL). He developed hypothermia (T=98.2°F) 

3 hours postpresentation.

Due to worsening prognosis for recovery from heatstroke 

and poor prognosis for adoption, euthanasia was elected 

and performed immediately. A complete necropsy was 

performed with tissue samples submitted to the Joint Pathology Center. Notable gross lesions on necropsy were 

hemorrhagic streaks throughout duodenum, jejunum, 

and ileum, enlarged gastric blood vessels, and atelectasis in approximately 25% of lung tissue.

HEATSTROKE IN VETERINARY PATIENTS

Pathophysiology

The development of heat injury is a multifaceted physiological process that encompasses varied cellular and 

systemic responses to heat stress.1-5 Thermoregulatory 

processes initially attempt to control the internal body 

temperature. If the body’s ability to control internal temperature via evaporative (panting, sweating), conductive 

(laying on a cool tile fl oor), or convective (sitting by a 

fan) methods is exceeded, heat illness occurs.2,3 Over 

time, the body can acclimate to environmental temperatures above those found in the dog’s habitual location. 

This acclimatization occurs through the enhancement of 

cardiovascular performance, alterations in kidney salt 

and water processing, plasma volume expansion, and 

mechanisms to resist exertional rhabdomyolysis. This 

process takes several weeks to occur in humans.4

When an animal is rapidly exposed to prolonged, increased body temperatures due to environmental or exertional causes without the ability to acclimate properly, 

heat stress occurs.4,5 The physiologic response to this 

heat stress has 2 components: the acute-phase response 

and the heat-shock response. The acute-phase response 

occurs at the cellular level, primarily involving the leukocytes, while the heat-shock response occurs at the 

gene transcription level in cells throughout the body.1-5

During the acute-phase response, interleukin-1 (IL-1), 

interleukin-6 (IL-6), and various other cytokines are 

produced.4

 These cytokines act to stimulate hepatic 

acute-phase protein synthesis, endothelial cell adhesion, 

and angiogenesis, along with a myriad of other responses.4

 The sequence of leukocyte activation and amplitude 

of the acute-phase response in heat injury is known to 

be similar to that seen in septic patients.4,6 This acutephase response is initially protective, although it becomes detrimental when auto-regulation is lost and the 

response is exaggerated.2

Working in conjunction with a controlled acute-phase 

response, the heat-shock response acts to protect individual cells.4

 When exposed to extreme heat, almost all 

cells in the body have the capability to activate heatshock transcription factors. These bind to the genome 

and upregulate the production of heat-shock proteins.4

These heat-shock proteins then act as chaperones, preserving the conformation and function of enzymes 

throughout the body.2,4,7 Decreases in the levels of heatshock proteins are associated with an increased risk of 

heat injury, and may contribute to the increased risk of 

heat injury in elderly patients.2,4

When the acute-phase and heat-shock responses fail to 

protect the animal from heat stress, heat injury develops. 

Heat injury is a continuum of disease severity, ranging 

from slight physiologic stress (heat cramps) up to severe 

physiologic derangement (heatstroke) and potentially 

death.1-4,8,9 Multiorgan dysfunction in the presence of 

prolonged elevated body temperature is the hallmark of 

heatstroke. Typically, patients suffering from heatstroke 

present in shock secondary to decreased effective circulating volume. They are typically dehydrated, and 

the heat injury compromises vasoconstriction, leading 

to decreased systemic vascular resistance and pooling of blood in the splancnic vasculature.2,3 Altered 
36 http://www.cs.amedd.army.mil/amedd_journal.aspx

cardiovascular function combined with direct cytotoxicity and increased metabolic demand leads to multiorgan failure which, if progressive, can quickly result 

in patient death. Compounding these problems are coagulation abnormalities brought on by the heat injury.2-4

Ultimately, if not controlled by appropriate medical 

treatment, these systemic disruptions lead to multiorgan 

dysfunction, disseminated intravascular coagulation, 

and potentially death.2-4

Risk Factors

There are numerous risk factors for the development of 

heat-related illness in veterinary patients. Exogenous 

factors include lack of acclimation to a new environment, elevated humidity (prevents evaporative cooling), 

lack of access to potable water, confi nement in a poorly 

ventilated space, and some medications.1-3 Endogenous 

factors include laryngeal paralysis or brachycephalic 

syndrome (unable to pant effectively), cardiovascular or 

neurologic disease, advanced age, obesity, and hair coat 

thickness and color.1-3 The risk for development of a heat 

injury can be reduced by controlling some of the predisposing factors, such as obesity and acclimation. There is 

some thought that a previous heat injury may predispose 

veterinary patients to successive heat injuries.1-3 However, this belief is extrapolated from human medicine4

and has yet to be documented in the veterinary literature through a peer-reviewed study.

Diagnosis and Treatment

The diagnosis of a heat-related injury is based largely 

upon the history of the patient, clinical signs on presentation, and potentially the patient’s rectal temperature. 

It is important to remember that during the heat injury 

process, the patient’s ability to thermoregulate is compromised. This may lead to heat injury patients presenting persistently hyperthermic, normothermic, and even 

hypothermic if excessively cooled prior to arrival at the 

treatment facility.1-4 In human medicine, a diagnosis of 

heatstroke requires the presence of central nervous system dysfunction accompanied by hyperthermia.4

 There 

is not a single diagnostic test that can confi rm the presence of heat injury. Thus initial therapy should never be 

delayed while awaiting diagnostic testing results for any 

patient presenting with a potential heat injury.

Current therapy for heat injury in military working dogs 

is initiated by their handlers in the fi eld.8,9 If the rectal 

temperature is above 106°F, handlers are trained to begin 

active cooling measures: removing any muzzle, moving 

the dog to shade, rubbing alcohol to pads of feet and ears, 

soaking the dog in tepid water (no ice or chilled water), 

and placing the dog in a vehicle with the air conditioning 

on full and directed at the MWD. If an air conditioned 

vehicle is not available, the MWD will be transported in 

a vehicle with windows down. If the MWD is showing 

clinical signs of heat injury, such as uncontrollable panting, dyspnea, increased upper airway noise, tachycardia, 

dark mucous membranes, collapse, altered mentation, 

vomiting, or diarrhea, the handlers are trained to place 

an intravenous catheter and adminster room temperature fl uids. All MWDs suffering heat-related injury are 

then immediately transported to a veterinarian.8-9.

Two IV catheters are placed to allow for rapid fl uid therapy. The shock dose of IV fl uids in dogs is 80 mL/kg, 

given at 1⁄4 dose increments with reassessment between 

doses.10 Blood products, such as plasma, are given if indicated. Diazepam or midazolam are used to control seizures if present. Mannitol is administered if increased 

intracranial pressure is suspected. Dextrose is given if 

hypoglycemia is present. Lidocaine is used as a free radical scavenger and for control of arrhythmias, if present. 

Broad spectrum antibiotics are used only if indicated 

(hemorrhagic diarrhea, evidence of infection).1-4 Gastroprotectants, such as famotidine or omeprazole, may also 

be indicated.

The initial minimum database includes CBC, chemistry, electrolytes, and bedside blood glucose assessment, 

and is repeated as often as necessary.1-4 Care should be 

taken in smaller patients to ensure repeated monitoring 

does not exsanguinate the patient. Coagulation tests and 

lactate monitoring can also be useful in these cases, and 

should be performed if available. Electrocardiogram, 

blood pressure, vitals, and blood glucose are continually 

monitored.

Cooling measures are maintained until the MWD’s 

rectal temperature falls to 103°F, at which point all active cooling measures are ceased, and the dog is dried 

completely.1-4 The rectal temperature must be continually monitored for persistent hyperthermia or the development of hypothermia. Once cooled, it is benefi cial to 

maintain the patient in a normal, physiologic temperature range.

Complete blood cell abnormalities associated with heatstroke often include1-4 thrombocytopenia, neutrophilia 

with a left shift, toxic changes in neutrophils, and nucleated red blood cells. Abnormalties in the chemistry panel can include alterations in total protein or electrolytes, 

increases in creatinine kinase, lactate dehydrogenase, 

alanine aminotransferase, aspartate aminotransferase, 

and alkaline phosphatase, azotemia, hypoglycemia, and 

elevated lactate. Coagulation abnormalities can include 

HEATSTROKE IN A MILITARY WORKING DOG
January – March 2013 37

THE ARMY MEDICAL DEPARTMENT JOURNAL

prolonged clotting times, which may progress to disseminated intravascular coagulation.

Respiratory alkalosis can develop as a result of increased 

panting. Metabolic acidosis often develops secondary to 

increased lactate, hypoperfusion, and electrolyte abnormalities. Additionally, the development of confounding 

disease processes, such as acute renal failure, can compound acid-base disturbances. As such, the patient’s 

acid-base status should be closely monitored.3

Negative prognostic indicators include semicoma/

coma, seizures, coagulopathy on presentation (PT>18s, 

PTT>30s), hypoglycemia unresponsive to treatment, elevated creatinine after 24 hours of therapy, hypothermia, 

and greater than 18 nucleated red blood cells per 100 

white blood cells.11

SUMMARY

Heatstroke is an environmental emergency that threatens our MWDs throughout the world. Proper education 

of the handlers, veterinary technicians, and Veterinary 

Corps offi cers is essential to minimize the risk of losing an MWD to this condition. Understanding the risk 

factors, initial therapy, and pathophysiology is key to 

prevention and treatment of heat illnesses regardless of 

location.

Max II F241 had many of the predisposing factors for 

a heat injury. He was an elderly dog (11 years old), was 

obese (body condition score 7/9), had not been worked 

for a few months, so he was not acclimated to the level of 

exercise required for the BMV, and the temperature and 

humidity were both elevated. The personnel involved 

worked to minimize his risk by completing the video in 

the early morning, prior to the day becoming extremely 

hot. Ultimately, Max II F241 died as he lived, happily 

biting anyone who offered an available limb.

REFERENCES

1. Drobatz KJ. Heatstroke. In: Silverstein DC, Hopper K. Small Animal Critical Care Medicine. St. 

Louis, MO: Saunders Elsevier; 2009:723.

2. Johnson SI, McMichael M, White G. Heatstroke 

in small animal medicine: a clinical practice review. J Vet Emerg Crit Care. 2006;16(2):112-119.

3. Flournoy WS, Macintire DK, Wohl JS. Heatstroke in dogs: clinical signs, treatment, prognosis, and prevention. Compend Contin Educ 

Vet. 2003;25(6):422-431.

4. Bouchama A, Knochel JP. Heatstroke. New 

Engl J Med. 2002;346(25):1978-1988.

5. Epstein Y, Druyan A, Heled Y. Heat injury 

prevention-a military perspective. J Strength 

Cond Res. 2012;26(suppl 2):S82-S86.

6. Kurahashi K, Kajikawa O, Sawa T, et al. Pathogenesis of septic shock in pseudomonas aeruginosa pneumonia. J Clin Invest. 1999;104(6):743-

750.

7. Fields PA. Review: protein function at thermal 

extremes: balancing stability and fl exibility. 

Comp Biochem Physiol A Mol Integr Physiol. 

2001;129(2-3):417-431.

8. Army Tactics, Techniques, and Procedures No. 

3-39.34 (FM 3-19.17). Military Working Dogs. 

Washington, DC: US Dept of the Army; May 

10, 2011. Available at: https://armypubs.us.army.

mil/doctrine/DR_pubs/dr_d/pdf/attp3_39x34.

pdf. Accessed July 9, 2012.

9. Vogelsang RL. Care of the military working 

dog by medical providers. J Spec Oper Med.

2007;7(2):33-47.

10. Aldrich J. Shock Fluids and Fluid Challenge. In: 

Silverstein D, Hopper K. Small Animal Critical 

Care Medicine. St. Louis, MO: Saunders Elsevier; 

2009:276.

11. Bruchim Y, Klement E, Saragusty J, Finkeilstein E, 

Kass P, Aroch I. Heat stroke in dogs: a retrospective 

study of 54 cases (1999-2004) and analysis of risk 

factors for death. J Vet Intern Med. 2006;20(1):38-

46.

AUTHORS

CPT Andress is Offi cer-in-Charge, Fort Bragg Veterinary 

Center, Fort Bragg, North Carolina.

MAJ Goodnight is the Chief of Clinical Services, Fort 

Bragg Veterinary Center, Fort Bragg, North Carolina. 

She is also the Veterinary Clinical Specialist, US Army 

Public Health Command District, Fort Eustis, Virginia.
38 http://www.cs.amedd.army.mil/amedd_journal.aspx

Zoonotic diseases and parasites infect animals and 

circulate in animal populations. They do not require a 

human host. Many debilitating and occasionally fatal 

zoonotic diseases are newly recognized threats to humans. Veterinary data are often unavailable for public 

health professionals, and their surveillance systems do 

not capture data from veterinary clinics. However, veterinary practitioners can report zoonotic pathogens to 

public health offi cials. Veterinarians are part of the fi rst 

line of defense and detection1

 for many human pathogens. Veterinary facilities can provide potentially lifesaving data on the prevalence and local transmission of 

pathogens. They also give guidance and training to pet 

owners or public health offi cials on zoonotic diseases 

and risk management.

As an initial step in improving the surveillance of 

zoonotic diseases for US military bases in Japan, we 

conducted a physical audit and data analysis of all animal records at the US military veterinary care facilities 

in mainland Japan. The following report focuses on the 

major parasitic agents likely to infect humans or cause 

disease in military working dogs (MWDs). Veterinary 

clinic reviews could be useful for civilian public health 

organizations in monitoring zoonotic diseases.

METHODS

Military veterinary clinics in Japan maintain paper records on animals that were owned by both military personnel and civilians. Almost all animals that enter the 

country with incoming personnel are initially quarantined 

and examined by military veterinarians. We visited the 

veterinary care facilities at Camp Zama, Marine Corps 

Air Station (MCAS) Iwakuni, US Fleet Activities Sasebo, 

Misawa Air Base, Yokota Air Base, and Yokosuka Naval 

Base and manually reviewed more than 5,400 animal 

medical fi les to capture all reports of parasitic or pathogen activity reported in the last 10 years (2000 to 2010). 

Paper records were entered into an electronic database, 

and each animal was given a unique identifi cation number not tied to personal clinical records. Each record included species, animal name, arrival date, examination 

dates, and working dog status. All reports of parasites or 

infectious diseases were annotated in the computer database with the date the animal presented at the clinic.

The database was organized by military base. The US 

military bases in Japan with veterinary clinics include 

Camp Zama, Yokota Air Base, and Yokosuka Naval Base 

in the Kanto Plain region near the Tokyo metropolitan 

area. The veterinary clinics on these bases also serve 

neighboring military facilities without clinics. These include base housing areas, Atsugi Naval Air Station, Yokohama North Dock, Sagamihara Army Depot, and the 

US Embassy in Tokyo. Misawa Air Base is in Aomori 

Prefecture, one of the northernmost prefectures on Honshu Island. MCAS Iwakuni is located in southwestern 

Honshu in Yamaguchi Prefecture. US Fleet Activities 

Sasebo is in Nagasaki Prefecture on the southern island 

of Kyushu. Kadena Air Base on the island of Okinawa 

has a large veterinary facility that supports numerous 

military bases in Okinawa Prefecture. We did not review the records from Okinawa.

Data was analyzed using SAS version 9.1 (SAS Institute 

Inc, Cary, NC). Temporal analysis was not possible due 

to insuffi cient date denominator data, ie, when an animal tested negative, only year was available, not month. 

The frequency of positive test results by location and 

host was investigated.

Veterinary Diseases Review for

 Mainland Japan, 2000-2010

Will K. Reeves, PhD

MAJ Kimberly Yore, VC, USA

MAJ Robert Paul, VC, USA

Laurel Lloyd, MPH

ABSTRACT

We reviewed all of the paper records on all of the animals treated at the military veterinary clinics on mainland 

Japan from 2000 to 2010 and present a review of the parasites and pathogens of zoonotic potential. Over 16,764 

veterinary visits from more than 5,400 animals were recorded. Zoonotic protozoa were detected in both military working dogs and pets. Parasitic helminthes included numerous nematodes and tapeworms. We discuss the 

limitations of veterinary records and the relevance of zoonotic disease reporting for public health.
 January – March 2013 39

RESULTS AND DISCUSSION

A total of 5,418 animals, predominately dogs and cats, 

were included in the database during the 10-year period 

for which data are available. Animals were tested 16,764 

times. There were 91 unique working dogs.

The review focused on internal parasites and pathogens. 

While some external parasites such as fl eas, mites, and 

ticks are potential vectors of zoonotic diseases, we do 

not discuss them. The majority of animals were cats and 

dogs, and results are summarized in Tables 1 and 2. The 

majority of parasites were unidentifi ed worms followed 

by “Coccidia” (Figure 1).

Protozoons

Protozoan parasites are diverse and range from intestinal parasites with simple, direct life cycles to vectorborne agents that undergo complex life cycles. Parasitic 

protozoons cause some of the most signifi cant zoonotic 

diseases worldwide. Several parasitic protozoons were 

reported from animals at the military veterinary clinics.

There are case reports of 2 dogs at the Camp Zama veterinary clinic infected with Leishmania infantum Nicolle, a visceral leishmania species.2

 The presence of L. 

infantum in military pets recently imported from southern Europe was not surprising but could be politically 

sensitive if a foreign disease were introduced into Japan. 

A review of the published literature on the phlebotomine sand fl ies in Japan revealed that they do not feed on 

mammals.3

Numerous gastrointestinal protozoan parasites were reported from animals. For example, Giardia lamblia was 

detected by fecal fl otation or with ELISA SNAP tests 

(IDEXX Laboratories, Ontario, Canada) from both cats 

and dogs. Giardia lamblia (Stiles) is one of the more 

common zoonotic protozoa and has a relatively stable 

encysted stage that remains infectious in water or wet 

soil.4

 Both acute and cryptic cases occur in humans and 

animals. The taxonomy of Giardia spp is somewhat convoluted, with a variety of serotypes recognized.

4,5 Not all 

serotypes cause clinical illness in humans, and they are 

indistinguishable in fecal fl otations. G. lambia was the 

most frequently reported parasite of MWDs. The infected MWDs were from Misawa Air Base and Camp Zama. 

The reservoir of the infections remains an unknown potential threat to human health. In addition to dogs and 

cats, several fecal samples from water birds on Camp 

Zama were tested for G. lamblia, but all were negative.

Coccidia, gastrointestinal protozoa, were reported in 

18 animals including dogs, cats, a rabbit, and a military 

working dog from Camp Zama. Unfortunately, the term 

coccidia is inclusive of many parasitic protozoa. Based 

on conversations with veterinary staff, some coccidia 

were Isospora spp. One sample was 

positively identifi ed as an Isospora

sp from a dog at Misawa Air Base. 

In general, Isospora spp do not infect humans. However, several other 

parasitic protozoa such as Cryptosporidium spp and Toxoplasma 

gondii (Nicolle and Manceaux) 

might be mistaken as a “coccidia.” 

One of the animals with coccidia 

was a cat, which could shed T. gondii. Toxoplasma gondii was detected 

by the veterinary staff in some animals from a petting zoo adjacent to 

Camp Zama (unpublished data).

A dog in Sasebo was reported to 

harbor Cryptosporidium canis 

Fayer, Trout, Xiao, Morgan, Lai, 

and Dubey. This gastrointestinal 

protozoon has a wide distribution 

throughout the world,6

 including 

Japan. Like other species of Cryptosporidium, an infected animal can 

present with diarrhea. This parasite 

has some zoonotic potential, but the 

Table 1. Positive results in dogs from all mainland military veterinary clinics in 

Japan 2000-2010.

Parasite

Location

Zama Sasebo Iwakuni Misawa Yokota Yokosuka

Nematode

Dirofi laria immitis 13 6 6 17 3 8

Trichuris vulpis 1* -1 -- 1

Toxocara spp 3 2 - 8 - -

Nematode (no further ID) - 7† - -5 1

Strongyloides stercoralis -1 - - - -

Aelurostrongylus abstrusus -- - - - -

Capillaria/Dioctophyma sp 1‡ -- -- -

Hookworm 5 - - - 1 -

Tapeworm

Unidentifi ed tapeworm 2 3 3 6 3 15

Dipylidium caninum 21 1 - - -

Taneia sp - - - 1 - -

Diphyllobothrium latum -- - - 1 -

Protozoa

Giardia 4** - 2 3† - 3

Coccidia 5** - 1 2 - -

Cryptosporidium canis -1 - - - -

Isospora -- - 1 - -

*Tested positive 4 times.

†Two military working dogs included in the total.

‡Military working dog.

**One military working dog included in the total.
40 http://www.cs.amedd.army.mil/amedd_journal.aspx

taxonomy of Cryptosporidium is 

unclear and humans are not susceptible to all species.7

Nematodes

Nematodes are some of the most 

diverse and common parasites 

throughout the world. These worms 

range from commensal internal 

associates, to near-mutualists, to 

blood-sucking and life-threatening 

parasites. Numerous nematodes 

from veterinary clinics were identifi ed as “worms” and nematodes. 

Based on interviews with the veterinary staff, most of these nematodes were ascarids.

The veterinary clinics captured data on one species of 

fi larial nematode, Dirofi laria immitis (Leidy) (heartworm). Both pet owners and veterinarians are aware of 

the risks of heartworm disease. This explains the frequent sampling and subsequent detection of this parasite. Dirofi laria immitis is transmitted by mosquitoes 

and vector populations on most installations, and are 

signifi cant during the summer and fall.8

 Stray dogs are 

rare on most installations, however, wild tanuki (Nyctereutes procyonoides viverrinus Temminck) 

(Figure 2) are susceptible to D. immitis9

 and 

live on bases. The zoonotic risk of D. immitis

is low, as most human infections do not progress. However, larvae can die in the lungs and 

superfi cially resemble tuberculosis or cancer.10

Heartworm was the most commonly reported 

parasite of dogs seen at US military veterinary 

care facilities in mainland Japan. A single feline case was reported from Yokosuka. There 

were no infections in MWDs, but they are regularly treated with preventive drugs.

The primary diagnostic tests for heartworm 

are serologic and detect adult antigens. Identifi cation of microfi laria in blood smears was 

rare, however, blood smears were performed 

on some animals. Microscopic examination of 

blood smears will detect other fi larial nematodes, Babesia, etc. There are several species 

of Dirofi laria in wildlife, and animals from 

Europe pose the risk of arriving with Dirofi -

laria repens (Railliet and Henry). The serologic ELISA SNAP tests (IDEXX Laboratories, Ontario, Canada) for heartworm will not 

detect infections with species other than D. 

immitis.

There were numerous other species of parasitic worms 

that develop in the gastrointestinal tracts of animals. Unfortunately, the majority of records on parasitic worms 

were recorded as nematodes or worms. Poorly identifi ed 

parasites and recordkeeping present a consistent problem in veterinary data from clinics. Interviews with 

the veterinary staff allowed some to be identifi ed, but 

incomplete data reduce the value of veterinary clinics 

in disease surveillance. We summarize the worms that 

were identifi ed to at least the genus level.

Table 2. Positive results in cats from all mainland military veterinary clinics in 

Japan 2000-2010.

Parasite

Location

Zama Sasebo Iwakuni Misawa Yokota Yokosuka

Nematode

Dirofi laria immitis -- - - - 1

Toxocara spp - - - 1 - -

Nematode (no further ID) - 7 - - 5 1

Aelurostrongylus abstrusus -- 2 - - -

Hookworm - - - - 1 -

Toxascaris leonina -1 1 - - -

Tapeworm

Tapeworm 1 5 2 9 7 9

Dipylidium caninum 21 - 3 - -

Protozoa

Giardia 2- - -- -

Coccidia 2 - - 2 2 2

Figure 1. The overall percentage each taxon contributed to the sum of 

all pathogens reported by veterinary clinics of US military bases in Japan 

from 2000 to 2010.

Dirofilaria immitis (26.3%)

Unidentified Tapeworms

(30.5%)

Dipylidium caniunum

(5.2%)

Ascaridae (7.5%)

Unidentified

Hookworms

(2.8%)

Giardia (6.6%)

Other

Worms

(5.2%)

Coccidia (8.0%)

Unidentified Nematode

(8.0%)

VETERINARY DISEASES REVIEW FOR MAINLAND JAPAN, 2000-2010
 January – March 2013 41

THE ARMY MEDICAL DEPARTMENT JOURNAL

A dog at the Sasebo clinic was diagnosed with Strongyloides stercoralis (Bavay), presumably during a fecal 

analysis. Strongyloidiasis was found throughout Japan, 

and recent data indicate it can be locally common.11

Strongyloides stercoralis, a zoonotic nematode, readily 

infects humans and companion animals, causing strongyloidiasis.12 There are several morphologically similar 

species of Strongyloides in dogs and cats. Humans and 

companion animals are generally infected when nematode larvae in the soil pierce their skin, invade the circulatory system, and move into the body. However, S. 

stercoralis can autoinfect or reinfect a host.13

Eggs of unidentifi ed hookworms were occasionally reported from dogs at Camp Zama but not other veterinary 

clinics. This probably represents a sampling anomaly 

or variation in the diagnostic abilities of the veterinary 

staff. Larval hookworms are infectious as free-living 

worms in the soil. They have a life cycle similar to that 

of S. stercoralis and can penetrate the skin of humans 

and dogs. Humans are accidental hosts to these worms. 

In humans, the larval worms usually die near the point 

of exposure, but occasionally the migration tract of the 

larval worm becomes infected and infl amed.14 The resulting cutaneous larval migrans (usually from Ancylostoma sp) may last weeks to months and at times causes 

intense itching, but the condition is self-limiting.

Both wildlife and cats harbored hookworms. Some tanuki on base were infected with Ancylostoma kusimaense

Nagayosi or a related species. Two were removed from 

the intestine of a dead tanuki on Camp Zama. These 

worms are reported to infect domestic dogs.15 A cat from 

Yokota harbored hookworms. Based on a review of the 

Japanese parasitological literature, this worm was most 

likely Ancylostoma tubaeforme (Zeder), which is the 

primary hookworm of domestic cats reported near this 

region of Japan.16 Exotic worms could be introduced in 

pets, but local acquisition of A. tubaeforme is probable. 

Symptoms from infestations with A. tubaeforme can 

range from asymptomatic to a serious disease in cats.

Trichuris vulpis (Froelich) is a whipworm of canids. It 

infects the intestine, but in humans and aberrant hosts 

it can infect other organs.17 Human infections are rare.17

Adult worms can live for years if an animal is untreated, although most animals with low level infestations 

are asymptomatic. Heavy infestations can cause rectal 

prolapse or bloody diarrhea. Eggs are shed in the feces 

and are somewhat environmentally resistant and remain infectious in the soil, allowing reinfection.18 They 

resemble the eggs of most other whipworms and could 

be misidentifi ed. Eggs from T. vulpis were discovered 

in 3 dogs in the last 10 years, one each at Yokosuka, 

Iwakuni, and Zama veterinary facilities. The one dog 

at Camp Zama was repeatedly seen at the clinic for over 

8 months in 2008 and continued to be actively infected 

despite repeated treatments.

Dog and cat roundworms (Toxocara canis (Werner)/T. 

cati (Zeder)) were occasionally reported in fecal samples. 

In addition, numerous unidentifi ed nematodes from the 

clinics were probably Toxocara spp. Both dog and cat 

roundworms are mildly zoonotic geohelminths.19 The 

eggs are environmentally stable and infectious in soil 

contaminated by animal feces.18 When the eggs are consumed, the infectious larvae invade host tissues and can 

cause visceral larval migrans.19 In rare cases, visceral 

larval migrans is fatal.19

Toxascaris leonina (von Linstow) was reported from 2 

cats at the Sasebo and Iwakuni veterinary facilities. The 

adult worms live in the intestine like other ascarids. Eggs 

are shed in the feces and are infectious to cats.20 This 

worm is not a zoonotic parasite, but it can infect dogs.20

In addition to the Toxocara species found in domestic 

animals, there are numerous species in wildlife. Several feral animals were necropsied at veterinary clinics. 

Two adult T. tanuki Yarnaguti were removed during the 

necropsy of a dead tanuki on Camp Zama. Exotic North 

American raccoons live on base, and these animals can 

harbor other ascarids.

The feline lungworm, Aelurostrongylus abstrusus (Railliet), was reported from 2 cats from the same household 

at MCAS Iwakuni. Lungworms have a wide geographic 

range and occur in up to 22% of cats in some surveys.21

Many cats are asymptomatic when infected. These 

worms are not a zoonotic threat.

Figure 2. The tanuki (Nyctereutes procyonoides viverrinus) 

found on some US military bases in Japan. Photo courtesy of 

663 highland, Wikimedia Commons (Creative Commons Attribution2.5 Generic).
42 http://www.cs.amedd.army.mil/amedd_journal.aspx

One rather cryptic handwritten note in a record of a 

military working dog at Camp Zama seems to imply 

that there were worm eggs in the urine. The notes were 

not complete and cannot be fully interpreted. The only 

worms likely to infect the bladder are Capillaria or Dioctophyma spp.22,23 The notes later mention the presence 

of tapeworm proglottids in the same urine sample. The 

urine sample was probably contaminated with fecal material or with tapeworm proglottids that crawled into the 

wrong orifi ce as they moved out of the anus. Yet, based 

on the incomplete data, there was no way to rule out 

Capillaria or Dioctophyma spp.

Cestodes and Trematodes

Like nematodes, fl atworms are some of the most diverse 

and commonly reported endoparasites of domestic animals. There are 2 primary groups of parasitic fl atworms: 

the fl ukes (trematodes) and tapeworms (cestodes). The 

eggs of most parasitic species are shed in the host’s feces. These are often detected by fecal fl otation and microscopy. Unfortunately, for surveillance purposes, the 

eggs of most fl ukes do not fl oat on the frequently used 

solutions, but tapeworm and nematodes eggs do. There 

were no reports of trematodes in any animals despite 

the fact that the intermediate host snails and crustaceans 

live on several bases.

Although tapeworms were reported at every clinic, the 

vast majority (85%) of them were not identifi ed. Molecular techniques or serologic techniques are required 

for some identifi cations. At least 65 animals were diagnosed with unidentifi ed “tapeworms.” The majority 

were from dogs, however, some cats were infected. One 

case was noted in a military working dog from Camp 

Zama. Based on additional information from the veterinary staff, many of the infections were Dipylidium caninum (Linnaeus), the dog tapeworm.

The most signifi cant tapeworm of public health concern 

in Japan is Echinococcus multilocularis.

24 This worm is 

known to infect dogs in northern Japan, with sporadic 

cases in the Tokyo area.25 Unlike the majority of the detected zoonotic parasites which are mildly debilitating 

and not life threatening, an infection with E. multilocularis is likely to be fatal.26 The eggs of E. multilocularis

are almost impossible to differentiate from Taenia spp.27

The similarity between Taenia and Echinococcus was 

a problem when a dog from Misawa was reported to 

shed eggs from a Taenia sp. However, the eggs are morphologically identical to E. multilocularis (Leuckart).27

Echinococcus multilocularis was reported from pet dogs 

in the Tokyo area in 2005 and 2009 and is regularly reported in Hokkaido near Misawa AB.25 A 2009 survey 

of endoparasites in dogs and cats in Saitama, Japan, indicated that E. multilocularis could be as common as 

D. caninum in some pet populations.16 Identifi cation and 

treatment of E. multilocularis in dogs are critical for 

the prevention of hydatid disease in humans. People are 

infected with larval tapeworms when they accidentally 

consume the eggs26 by allowing their dogs to lick their 

face, which is a route of exposure. The lack of identifi cation of tapeworms in animal feces is a failure to protect 

the public’s health.

Two additional species of zoonotic tapeworms were 

identifi ed from dogs. A dog from Yokota Air Base was 

positive for Diphyllobothrium latum (Linnaeus) in a fecal fl oat. D. latum, the broad fi sh tapeworm, is one of the 

best studied and broadly distributed species in the genus 

throughout Asia.28 These tapeworms use fi sh as intermediate hosts and infect fi sh-eating mammals. Based 

on published surveillance, humans in Japan are infested 

with D. latum from eating fi sh.29 Dogs are susceptible 

to this worm if they eat raw fi sh. This tapeworm does 

not cause major diseases in dogs. However, it can cause 

serious anemia in some humans, and the detection of the 

worm indicates infected fi sh were available to the pet. 

Sushi is a popular food in Japan and could be the source 

of the parasite.

One of the most frequently reported tapeworms was 

D. caninum, the double-pored dog tapeworm. It is a 

zoonotic parasite transmitted by arthropods30 but rarely 

is a serious problem. Tapeworm larvae develop in invertebrates and are not a health threat. Humans are susceptible to infection if they eat infected lice or fl eas. Young 

children are most likely to be infected when playing 

with infected animals.31 Dog tapeworms were reported 

from dogs and cats at almost all installations. In addition, a large proportion of the unidentifi ed tapeworms 

were probably D. caninum.

Veterinary clinics maintain records on zoonotic diseases and parasites. Our review of veterinary data indicates that there is a wide range of zoonotic parasites 

and pathogens circulating in the environment on military bases. This information is helpful for public health 

offi cials and could serve as a model for civilian public 

health agencies to determine which threats are present.

ACKNOWLEDGMENTS

We thank the veterinary staff at the veterinary care 

facilities for their assistance with record reviews and 

SGT D. Lewis, SGT C. Utter, and Mrs J. Spencer for 

assistance with record reviews and database management. A portion of this research was supported 

by the Global Emerging Infections Surveillance and 

VETERINARY DISEASES REVIEW FOR MAINLAND JAPAN, 2000-2010
 January – March 2013 43

THE ARMY MEDICAL DEPARTMENT JOURNAL

Response System Operations Division of the Armed 

Forces Health Surveillance Center. The views expressed in this article are those of the authors and 

do not refl ect the offi cial policy or position of the 

Department of the Air Force, the Department of the 

Army, the Department of Defense, or the US Government. This research was supported in part by 

an appointment to the Postgraduate Research Participation Program at the US Air Force School of 

Aerospace Medicine administered by the Oak Ridge 

Institute for Science and Education through an interagency agreement between the US Department of 

Energy and the School of Aerospace Medicine. Distribution A: Approved for public release; distribution 

is unlimited. Case Number: 88ABW-2012-2210.

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F, Nonaka N, Oku Y. Echinococcosis risk among 

domestic defi nitive hosts, Japan. Emerg Infect Dis. 

2007;13:346-347.

25. Morishima Y, Sugiyama H, Arakawa K, Kawanaka M. Echinococcus multilocularis in dogs, Japan. 

Emerg Infect Dis. 2006;12:1292-1294.

26. Torgerson PR, Keller K, Magnotta M, Ragland N. 

The global burden of aveolar echinococcosis. PLoS 

Negl Trop Dis. 2010;4:e722.

27. Zajac AM, Conboy GA. Veterinary Clinical Parasitology. 7th ed. Ames, IA: Blackwell Publishing; 

2006.
44 http://www.cs.amedd.army.mil/amedd_journal.aspx

28. Lee EB, Song JH, Park NS, et al. A case of Diphyllobothrium latum infection with a brief review of 

diphyllobothriasis in the Republic of Korea. Korean J Parasitol. 2007;45:219-223.

29. Oshima T, Wakai R. Epidemiology of Diphyllobothrium latum infection in Japan, with special reference to infection of cherry salmon [in Japanese]. 

Jpn J Antibiotic. 1983;36:566-572.

30. Melnikow N. Über die Jugendzustände der Taenia cucumerina. Archiv für Naturgeschichte. 

1869;35:62-69.

31. Molina CP, Ogburn J, Adegboyega P. Infection by 

Dipylidium caninum in an infant. Arch Pathol Lab 

Med. 2003;127:e157-e159.

AUTHORS

Dr Reeves is an Entomologist with the Epidemiology 

Consult Service, US Air Force School of Aerospace 

Medicine, Wright-Patterson Air Force Base, Ohio.

MAJ Yore is a graduate student at Colorado State 

University, Fort Collins, Colorado.

MAJ Paul is a Preventive Medicine Instructor, US 

Army Public Health Command District - Fort Belvoir, 

Virginia.

Ms Lloyd is an Oak Ridge Institute for Science and 

Education Fellow at the Epidemiology Consult Service, 

US Air Force School of Aerospace Medicine, WrightPatterson Air Force Base, Ohio.

VETERINARY DISEASES REVIEW FOR MAINLAND JAPAN, 2000-2010
 January – March 2013 45

Infl uenza is a common virus that affects many species 

to varying degrees of severity. Pinnipeds are particularly interesting animal models because both infl uenza 

A and B virus infections have been identifi ed in wild 

populations. This is signifi cant because, before the year 

2000, infl uenza B virus infection had only been reported in primates.1

 Infl uenza virus infections in seals have 

historically caused mass mortality events in affected 

populations.2-6 An infl uenza virus was fi rst isolated from 

harbor seals (Phoca vitulina (Linnaeus)) in 1980; the virus was identifi ed as belonging to the H7N7 subgroup 

and the naturally infected cases were described by Geraci et al and Webster et al.5-7 The fi rst isolation of a seal 

infl uenza virus from a human occurred in a researcher 

studying this fi rst known epizootic, confi rming that infl uenza viruses carried by seals could infect humans.5

Pigs are commonly known to be a species in which genetic reassortment of novel infl uenza viruses can occur because they have receptors that allow attachment 

to both mammalian and avian infl uenza virus strains.8

Receptors that recognize avian sialyloligosaccharide 2,3 

Galactose (SAα2,3Gal), and mammalian sialyloligosaccharide 2,6 Galactose (SAα2,6Gal), infl uenza viruses 

have been identifi ed in seal lung tissue.3,9 The H3N8 

strain isolated from dead seals in the 2011 outbreak was 

found to bind both mammalian and avian infl uenza receptors.3

 Additionally, experimental infections in primates with a 1980 seal infl uenza virus resulted in significant systemic disease.10 These fi ndings demonstrate the 

potential for seals to harbor viruses to which humans 

are susceptible and immunologically naïve.

Shortridge and Stuart-Harris proposed the idea of an 

infl uenza epicenter; a geographical area where birds, 

humans, and other animals live in intimate contact, providing optimal conditions for viruses to cross species.11

Traditionally, research has focused on agricultural 

infl uenza epicenters, that is, where humans, birds, and 

pigs live in close contact. Waterfowl are the natural reservoir for all known subtypes of infl uenza A viruses and 

share many resources with pinnipeds at sea.12,13 Additionally, between subsistence hunting, managed animals, 

and shared shoreline habitat, humans are more likely to 

interact with pinnipeds than any other marine mammal. This article provides a review of infl uenza viruses 

in pinnipeds with the goal of increasing recognition of 

potential wildlife infl uenza epicenters, particularly in 

coastal centers with large pinniped populations.

METHODS

Search Strategy

The PubMed database was searched in July 2007, February 2010, and again in August 2012. The searches were 

performed without language restriction and used the key 

words “seal,” “Phoca,” “phocid,” “pinniped,” “otaria,” 

“otariid,” “otariidae,” “Arctocephalus,” Zalophus,” “Callorhinus,” “fur seal,” “sea lion,” “marine,” or “marine 

mammal,” along with “infl uenza,” “orthomyxovirus,” 

“zoonoses,” “zoonosis,” “zoonotic,” “H1,” “H3,” “H4,” 

“H5,” or “H7” to fi nd reports on cases of infl uenza in 

seals or seal strains found in man. Additional articles 

were located through the reference sections of the selected papers.

Selection of Articles

The title and abstracts of all search results were reviewed 

for inclusion using the following criteria: the article 

mentioned at least one case of infl uenza in pinnipeds, 

a seal infl uenza strain found in humans, or discussion 

of pathology or environmental interaction of infl uenza 

strains found in seals.

RESULTS

The PubMed searches yielded 112 different results. Of 

these, 26 articles, spanning from 1978 to 2012, were 

A Review of Influenza Viruses in Seals

 and the Implications for Public Health

CPT Virginia C. White, VC, USA

ABSTRACT

With the public health community and general population more concerned with infl uenza than ever before, it is 

important to explore all potential vectors for the next pandemic. Potential sources include pinnipeds (seals and 

sea lions). Between subsistence hunting, managed animals, and shared shoreline habitat, humans are more likely 

to interact with pinnipeds than any other marine mammal. This paper summarizes documented infl uenza events 

and research on Phocidae and Otariidae and discusses the potential challenges they present to public health.
46 http://www.cs.amedd.army.mil/amedd_journal.aspx

selected for review because they met the above inclusion 

criteria. The remaining 86 studies were not applicable to 

this review. 

Etiology

Infl uenza viruses belong to the Orthomyxovirus family 

of enveloped viruses with segmented, single-stranded 

negative-sense RNA. Infl uenza viruses are divided 

into 3 types (A, B, and C) based on the 2 major core 

proteins, the nucleoprotein and the matrix protein.14

Of these types, only infl uenza A and B viruses tend 

to cause epidemics in humans and are the main focus 

of this review. Each infl uenza A virion consists of a 

host-derived lipid bilayer envelope and an 8-segmented 

genome, which codes for the 11 virion proteins. These 

proteins are the 3 transmembrane glycoprotein spikes 

(hemagglutinin (HA), neuraminidase (NA), and matrix 

protein 2 (M2)), a nucleocapsid (matrix protein 1 (M1)), 

a nucleoprotein (NP), 3 polymerase proteins (PA, PB1, 

and PB2), an apoptosis-inducing protein (PB1-F2), and 

2 nonstructural proteins (NS1 and NS2). The segmentation of the genome allows for genetic reassortment 

within and between viruses, readily creating new phenotypes (antigenic shift).15 Additionally, mutations may 

occur, especially in the H region, creating an antigenic 

drift.15 M1 and M2 are involved in virion coating and 

uncoating.15 Nucleoprotein and polymerases aid in transcription. Hemagglutinin and NA are responsible for 

viral attachment and release and are also the antigens 

involved in host immunity.2

 Additionally, HA plays a 

role in determining host range, since membrane fusion 

and genome penetration only occur if the proper cellular 

proteases are present to cleave the HA into the disulfi delinked polypeptides HA1 and HA2

.

16 Currently, 16 HA 

and 9 NA serotypes have been recognized for infl uenza 

A viruses, all of which have been isolated from birds.12,13

Each virus has one HA and one NA subtype, which theoretically may occur in any combination. Specifi c infl uenza strains are identifi ed by a standard nomenclature 

specifying virus type, host, geographic origin, sequential number of isolation, and HA and NA serotype, for 

example: A/Seal/Mass/1/80/(H7N7).

Transmission and Epidemiology

Waterfowl, particularly of the orders Anseriformes and 

Charadriiformes, are the natural reservoir for all known 

subtypes of infl uenza A viruses.12,13 Avian infl uenza 

viruses replicate mainly in the birds’ intestinal tract 

and are spread from bird to bird by a fecal-oral route.17

Spread of avian infl uenza viruses to seals may occur 

through direct contact, such as predation on birds, inhalation of aerosolized virus, or indirect contact with 

bird feces through contaminated food or water.17 Avian 

infl uenza viruses have been shown to be most stable in 

fresh to brackish water (0-20,000 ppm) with colder temperatures (4°C-17°C), and a slightly basic pH (7.4-8.2).18

In seals, infl uenza binds to the same type of sialyloligosaccharide receptors, SAα2,3Gal, as birds, but the 

receptors are located in their lungs instead of in their 

intestinal tract, making inhalation the most likely route 

of transmission.9,19

The fi rst recorded epizootic of infl uenza in seals occurred from 1979-1980 on the New England coast. An 

H7N7 infl uenza virus was repeatedly isolated from 

the lungs, brain, and hilar lymph nodes of dead seals.20

Approximately 600 seals died; an estimated mortality 

of 20%.5,6 From 1982-1983, an H4N5 infl uenza virus 

caused a 2% to 4% mortality of harbor seals on Cape 

Cod.2

 H4N6 and 3 strains of H3N3 were isolated from 

harbor seals in another Cape Cod epizootic in 1991 and 

1992.21 In 2011, again on the New England coast, 162 

harbor seals died in an outbreak of pneumonia lasting 

less than 4 months. This was 4 times greater than the 

expected mortality rate in a healthy, wild seal population.3

 An H3N8 strain was isolated from several of the 

seals.3

 Antigenic and genetic analyses showed that all 

genes from each of the epizootic strains were of avian 

origin.3-6,9,21,22 Furthermore, a study by Mandler et al 

demonstrated that the closest-matching avian strains to 

the 1980 H7N7 virus were from the same geographic 

region as the seal isolate.23

Evidence of infl uenza virus infection by many different 

infl uenza serotypes has been found through antibody 

and virus isolation from seals around the world. Serotypes H7N7, H4N5, H4N6, H3N8, and H3N3 have been 

found in harbor seals (Phoca vitulina) on the New England coast of the United States.3-7,21,22 De Boer et al found 

antibodies to H1, H3, H4, H7, and H12 in sera from 

seals from the Bering Sea.24 Interestingly, all NP-ELISA 

positive sea lions were negative in Hemagglutinin inhibition tests, suggesting the sea lions carried antibodies 

to a then unknown hemagglutanin serotype.24 Danner 

and McGregor found H3 and H7 antibodies in a ringed 

seal (Phoca hispida) in Alaska.25 In contrast, Calle et al 

did not fi nd antibodies to infl uenza A in sera from the 

6 bearded seals (Erignathus barbatus) sampled near St. 

Lawrence Island, Alaska.26 Austin and Webster did not 

fi nd antibodies to infl uenza A or B virus in sera from 

the 237 Weddell seals (Leptonychotes weddelli) sampled near Cape Armitage, Antarctica.27 In Arctic Canada, 2.5% of the ringed seals that were tested by Nielsen 

et al were seropositive for infl uenza A, but were not 

tested for serotype.28 Antibodies from H3 and H6 were 

found in sera from Kuril harbor seals (Phoca vitulina 

stejnegeri) in Hokkaido,

 Japan.29 Ohishi et al reported 

evidence of H3N2 in Baikal (Pusa sibirica) and ringed 

A REVIEW OF INFLUENZA VIRUSES IN SEALS AND THE IMPLICATIONS FOR PUBLIC HEALTH
 January – March 2013 47

THE ARMY MEDICAL DEPARTMENT JOURNAL

seals from Lake Baikal and the Kara Sea in Russia.22

Researchers believe seals caught this serotype from 

humans.1,13,22 Additionally, in 2002, Ohishi et al found 

antibodies to H3N2, H2N2, H3N8, and infl uenza B in 

Caspian seals (Pusa caspica) from the Caspian Sea.30

Until Osterhaus et al identifi ed antibodies to an infl uenza B virus in 2000 from a harbor seal in Pieterburen, 

Netherlands, infl uenza B was thought to be a strictly 

human virus.1

 More recently, antibodies to infl uenza B 

virus and to H1N1 have been isolated in fur seals (Arctocephalus australis) from Lobos Island, Uruguay.31 It 

appears that severe infl uenza virus infection is sporadic 

in seals and, fortunately, does not usually lead to a mass 

die-off. More research is needed to explore the cause, 

likely multifactorial, for such epizootics and the role 

of evolving infl uenza viruses and infl uenza-associated 

mortality events in pinnipeds.

Clinical Signs and Pathology

Clinically affected seals appear weak and may exhibit 

respiratory distress and ataxia. Additional clinical signs 

include a frothy white or blood-tinged nasal discharge, 

mild cough, pneumonia, conjunctivitis, and swollen, 

emphysematous necks.3,5-7 Affected seals are often in 

good body condition due to the rapid course of disease. 

Experimental infection of harbor seals induced clinical signs in as little as 24 hours and naturally infected 

seals were observed to have died just hours after feeding 

normally.5-7 Cause of death is acute hemorrhagic pneumonia. Postmortem lesions include necrotizing bronchitis and bronchiolitis and hemorrhagic alveolitis.5-7

Diagnosis

Virus isolation from culture of nasal or pharyngeal swabs 

or enzyme-linked immunosorbent assay (ELISA) can be 

used to test for infl uenza antibodies in serum.5-7,21,22,24,28-

32,33 Hemagglutinin inhibition and Neuraminidase inhibition tests are necessary for subtyping isolates.24 Differential diagnoses include phocine and canine distemper viruses, phocine herpesvirus-1, and Mycoplasma.7

Treatment and Control

Due to the viral etiology, there is no specifi c treatment 

for infl uenza virus infection in seals. Supportive care 

may be helpful in rehabilitation, though may not be feasible in the case of an epizootic event. The development 

of antibodies in naturally and experimentally infected 

seals suggest that immunity through vaccination is possible, but this would be impractical and cost prohibitive 

in wild pinniped populations.4

 Measures to prevent infl uenza transmission to captive pinnipeds include covering pens to minimize exposure to bird feces and designing enclosures to prevent direct contact with feral pinnipeds. Additionally, in zoo settings, vaccination of birds 

in conjunction with strict biosecurity measures and viral 

monitoring can reduce the amount of infl uenza virus 

present in the environment, decreasing the likelihood of 

viral transfer to other species in the collection.34

Human Cases

The fi rst recorded cases of infl uenza transfer from seals to 

humans were during the study of the 1979-1980 epizootic on Cape Cod. Within 2 days of known contamination 

of the eyes during seal necropsies, 4 people developed 

purulent conjunctivitis with intense periorbital swelling 

and pain. Recovery was uneventful and complete in 4 to 

5 days.6

 Another case occurred during a study of experimental infection of harbor seals with A/Seal/Mass/1/80 

(H7N7) when an infected seal sneezed into the face and 

right eye of an investigator. A severe conjunctivitis developed in the person’s right eye within 40 hours and the 

periauricular lymph nodes were enlarged by 96 hours 

postexposure. High levels of the virus, confi rmed as A/

Seal/Mass/1/80 (H7N7), were recovered in conjunctival 

swabs from the infected eye. The conjunctivitis resolved 

by the fourth day.6

 Antibodies to the seal virus were not 

detected in sera from any of the human cases, but this is 

not unusual since a blood-ocular barrier exists, preventing induction of a systemic immune response when only 

the eye has been exposed.6

COMMENT

The subject of infl uenza in seals raises many questions. 

There appears to be several ways in which seal-human 

interactions, both direct and indirect, could contribute 

to the development, spread, or exacerbation of infl uenza 

outbreaks.

Are infl uenza outbreaks in seals more prevalent than 

realized?

Harkonen et al investigated a 2007 epizootic of harbor seals from the Danish island of Anholt and along 

the Swedish coast.35 Thousands of seals were reported to have perished in the outbreak. Observation and 

necropsy of affected seals revealed weakness, swollen, 

emphysematous necks, dyspnea, hemoptysis, interstitial pneumonia, and necrotizing tracheitis and bronchitis.35 Additionally, an increase in stranded harbor porpoise (Phocoena phocoena) carcasses, also exhibiting 

emphysema, was found in the same area.35 Bacteriology and PCR for phocine distemper virus performed 

on seal and porpoise samples yielded no answers as to 

the cause of the mass mortality.35 Agreeably, due to the 

lack of recovery of pathogenic bacteria in combination 

with the histpathological fi ndings, Harkonen et al suggested the etiology was viral.35 It is possible this was 

an infl uenza mortality event. Infl uenza infection causes 

similar symptoms and pathology as those described by 
48 http://www.cs.amedd.army.mil/amedd_journal.aspx

Harkonen et al, and has also been reported in cetaceans, 

who also have SAα2,3Gal infl uenza receptors in their 

lungs.5-7,9,17,19,28,35-37 This, however, would be the fi rst recorded infl uenza epizootic affecting both pinnipeds and 

cetaceans and could indicate either an independent, yet 

simultaneous, introduction of novel infl uenza virus into 

both species or an important cross-species transmission. 

ELISA for infl uenza virus could be performed on remaining samples to rule this out as a cause.

Can marine mammals act as an intermediary species in 

the spread of avian infl uenza from birds to humans?

Antigenic and genetic analyses of epizootic strains from 

seals revealed that all genes from each of the epizootic 

strains were of avian origin.3-7,9,22 Additionally, researchers believe that seals acquired, and may be reservoirs for, 

human H3N2 and infl uenza B viruses.1,13,22,30 A study by 

Scheiblauer et al demonstrated that a variant of A/Seal/

Massachusetts/1/80 adapted to cause severe systemic 

disease in mice, ferrets, and rats, all commonly used 

animal models for human infl uenza studies.38 It has already been shown that infl uenza virus from seals can 

replicate in human tissue and that seal infl uenza viruses 

can be systemically virulent in primates.5,10 Perhaps 

most concerning is the fact that the H3N8 virus isolated 

from carcasses in the 2011 seal outbreak has the ability 

to transmit between seals, which may become infected 

with multiple infl uenza virus subtypes.3

 It is probable 

that seals could act as a “mixing vessel” for creating 

pandemic strains by mixing genes from avian and mammalian viruses.3,30

Can marine mammals spread avian infl uenza viruses 

through their migrations?

Little is known about the role of migratory patterns of and 

interactions between the various species of pinnipeds in 

the spread of disease. Harris et al used an individualbased model of seal movement to evaluate the infl uence 

of epidemiological parameters and host ecology on the 

spread of phocine distemper virus through populations 

of harbor seals.39 It was determined that short foraging 

trips with short haulout durations or long infectious 

periods allowed for more traveling by the seals and increased the likelihood that disease would spread between 

haulouts.39 Since phocine distemper virus, a morbillivirus, has a similar mode of transmission and pathology as 

infl uenza virus in seals, this model might be useful in 

predicting the spread of infl uenza infections in seals as 

well.7

 More research is needed to better understand the 

behavior of seals and its effect on epidemiology.

Do fi sh and sediment harbor infl uenza?

Little is known about the infl uence of abiotic or biotic 

environmental factors on the persistence and spread of 

infl uenza virus. Brown et al reported that water is intimately connected with the transmission of avian infl uenza viruses and that these viruses can remain infective 

in this medium for months under natural conditions.18

Infl uenza virus can also be preserved in environmental ice or concentrated in fi lter-feeding invertebrates.40,41

Fish feed on many things, including sediment, bird feces, and detritus, which could potentially contain large 

quantities of infl uenza virus.11 Piscivorous birds, such as 

those in the order Charadriiformes, who ate these virusladen fi sh would have the virus in their gastrointestinal tract, where infl uenza virus receptors are concentrated.17 In addition to sharing shoreline habitats, seals 

and seabirds may also feed on the same fi sh species.17

Thanawongnuwech et al proposed an oral route of transmission for avian infl uenza virus infection for tigers 

feeding on H5N1 infected bird carcasses.42 The virus 

may enter the gastrointestinal tract of carnivorous mammals and infect the liver through the portal system.17,42

The demonstration of avian infl uenza virus receptors 

(SAα2,3Gal) in the liver, kidney, spleen, brain, intestine, 

and endothelium of humans supports this theory, but it 

has not been investigated in pinnipeds.43

Can marine mammals be sentinels for the presence of 

highly pathogenic avian infl uenza (HPAI)?

Because of seals’ increased risk of acquiring avian infl uenzas due to their intimate association with seabirds, 

and their possible role as “mixing vessels” for pandemic 

strains, they could be used as sentinels for HPAI. Wildlife rehabilitation centers could opportunistically monitor seal populations through their stranded patients’ serology. In addition to HPAI surveillance, this data could 

also be used in marine mammal conservation efforts. 

Admittedly, since the prevalence of infl uenza in seals is 

suspected to be low, waterfowl would be more sensitive 

sentinels.28

Can indigenous peoples involved in the hunting or consumption of marine mammals be at greater risk for 

transfer of avian infl uenza?

This has been suggested by multiple researchers.22,28

Seals are still commonly hunted in the Arctic Ocean 

for food and fur.22,28 Since human endothelial cells have 

avian infl uenza virus receptors (SAα2,3Gal), knife injuries during processing of seal carcasses could potentially cause vasculitis or systemic infection.43 These carcasses undergo no offi cial inspection and are sometimes 

consumed raw, presenting the opportunity for oral virus 

transmission as well.28,42 To date, no such infections have 

been reported. This may be due to a lack of recognition, 

reporting, or incidence. A study by Siembieda et al reported that waterfowl hunters were 8 times more likely 

to be exposed to avian infl uenza-infected wildlife than 

A REVIEW OF INFLUENZA VIRUSES IN SEALS AND THE IMPLICATIONS FOR PUBLIC HEALTH
 January – March 2013 49

THE ARMY MEDICAL DEPARTMENT JOURNAL

were biologists, veterinarians, and the general public.44

It would be reasonable to extrapolate these fi ndings for 

seal subsistence hunters, though their risk may be smaller due to the low prevalence of viral infection in seals.28

Can active metabolites of antivirals, such as oseltamivir 

(Tamifl u®), in wastewater lead to antiviral resistance in 

marine mammals and birds, creating a cycle that breeds 

increasingly virulent strains?

Research has shown that the antiviral Tamifl u is largely 

excreted from the human body in its active form and that 

current methods of wastewater treatment do not remove 

many types of antiviral drugs from effl uent.45,46 A study 

by Ellis reported low risk exposure levels of oseltamivir 

in wastewater and underscored that little is known about 

long term chronic exposure to low-level water and sediment concentrations of antiviral drugs.45 It stands to reason that waterfowl, such as ducks, sifting through antiviral-contaminated sediment would provide a good breeding ground for resistant strains of infl uenza. This would 

increase the risk of both seals, who share haul out sites 

with and predate on waterfowl, and subsistence hunters 

of acquiring antiviral-resistant infl uenza infections.17,28,47

More research is needed on long term effects on wildlife and humans and on the effective removal of antiviral 

drugs and their metabolites from wastewater.

Further research is needed in these areas, including 

whether each potential threat could act in tandem with 

another to produce a greater negative effect than each 

alone. Such research would also be instrumental in allowing public health professionals to form plans of action 

and intercession in the event of an infl uenza outbreak.

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of Arctic Canada. J Wildl Dis. 2001;37(4):820-825.

29. Fujii K, Kakumoto C, Kobayashi M, et al. Serological evidence of infl uenza A virus infection in kuril 

harbor seals (Phoca vitulina stejnegeri) of Hokkaido, Japan. J Vet Med Sci. 2007;69(3):259-263.

30. Ohishi K, Ninomiya A, Kida H, et al. Serological 

evidence of transmission of human infl uenza A and 

B viruses to caspian seals (Phoca caspica). Microbiol Immunol. 2002;46(9):639-644.

31. Blanc A, Ruchansky D, Clara M, Achaval F, Le Bas 

A, Arbiza J. Serologic evidence of infl uenza A and 

B viruses in South American fur seals (Arctocephalus australis). J Wildl Dis. 2009;45(2):519-521.

32. Lang G, Gagnon A, Geraci JR. Isolation of an infl uenza A virus from seals. Arch Virol. 1981;68:189-

195.

33. Stuen S, Have P, Osterhaus ADME, Arnemo JM, 

Moustgaard A. Serological investigation of virus infections in harp seals (Phoca groenlandica) 

and hooded seals (Cystophora cristata). Vet Rec.

1994;134:502-503.

34. Philippa JDW, Munster VJ, van Bolhuis H, et al. 

Highly pathogenic avian infl uenza (H7N7): vaccination of zoo birds and transmission to non-poultry 

species. Vaccine. 2005;23:5743-5750.

35. Harkonen T, Bäcklin BM, Barrett T, et al. Mass mortality in harbor seals and harbor porpoises caused by 

an unknown pathogen. Vet Rec. 2008;162:555-556.

36. Hinshaw VS, Bean WJ, Geraci J, Fiorelli P, Early G, 

Webster RG. Characterization of two infl uenza A 

viruses from a pilot whale. J Virol. 1986;58(2):655-

656.

37. Lvov DK, Zhdanov VM, Sazonov AA, et al. 

Comparison of infl uenza viruses isolated from 

man and from whales. Bull World Health Organ. 

1978;56(6):923-930.

38. Scheiblauer H, Kendal AP, Rott R. Pathogenicity 

of infl uenza A/Seal/Mass/1/80 virus mutants for 

mammalian species. Arch Virol. 1995;140:341-348.

39. Harris CM, Travis JMJ, Harwood J. Evaluating the 

infl uence of epidemiological parameters and host 

ecology on the spread of phocine distemper virus 

through populations of harbour seals. PLoS ONE. 

2008;3(7):e2710.

40. Smith AW, Skilling DE, Castello JD, Rogers SO. 

Ice as a reservoir for pathogenic human viruses: 

specifi cally, caliciviruses, infl uenza viruses, and 

enteroviruses. Med Hypotheses. 2004;63:560-566.

41. Faust C, Stallknecht D, Swayne D, Brown J. Filterfeeding bivalves can remove avian infl uenza viruses from water and reduce infectivity. Proc Biol Sci. 

2009;276:3727-3735.

42. Thanawongnuwech R, Amonsin A, Tantilertcharoen R, et al. Probable tiger-to-tiger transmission of 

avian infl uenza H5N1. Emerging Infectious Diseases. 2005;11(5):699-701.

43. Yao L, Korteweg C, Hsueh W, Gu J. Avian infl uenza receptor expression in H5N1-infected and noninfected human tissues. Journal of the Federation 

of American Societies for Experimental Biology. 

2008;22(3):733-740.

44. Siembieda J, Johnson CK, Boyce W, Sandrock C, 

Cardona C. Risk for avian infl uenza virus exposure at human-wildlife interface. Emerg Infect Dis.

2008;14(7):1151- 1153.

45. Ellis JB. Antiviral pandemic risk assessment 

for urban receiving waters. Water Sci Tech. 

2010;61(4):879-884.

46. Prasse C, Schlüsener MP, Schulz R, Ternes TA. 

Antiviral drugs in wastewater and surface waters: 

a new pharmaceutical class of environmental relevance? Environ Sci Technol. 2010;44(5):1728-1735.

47. Bogomolni A, Gast RJ, Ellis JC, Dennett M, Pugliares KR, Lentell BJ, Moore MJ. Victims or vectors: a survey of marine vertebrate zoonoses from 

coastal waters of the Northwest Atlantic. Dis Aquat 

Organ. 2008;81:13-38.

AUTHOR

CPT White is Chief, Leavenworth Branch Veterinary 

Services, Fort Leavenworth, Kansas.

A REVIEW OF INFLUENZA VIRUSES IN SEALS AND THE IMPLICATIONS FOR PUBLIC HEALTH
 January – March 2013 51

BACKGROUND

There are numerous threats to the health and safety of 

US military members, particularly in areas with signifi -

cant endemic disease and minimal public health infrastructure. Illness prevention is key to ensuring military 

operational readiness. Gastrointestinal illness, such as 

infectious diarrhea, commonly affl icts deployed US 

military personnel and can adversely affect operational 

readiness.1-5 In addition to degrading operational readiness, diarrheal illness in theater may burden available 

healthcare resources.2

 A systematic review of scientifi c 

literature to determine regional estimates of pathogenspecifi c prevalence and incidence from January 1990 to 

June 2005 found that approximately 25% of individuals 

seeking treatment for diarrhea were reported to be incapacitated because of the illness.6

Between 1990 and 2005, infectious gastrointestinal illness was listed as the fourth most commonly reported 

diagnosis during US military deployments, following 

noncombat orthopedic injuries, respiratory infections, 

and skin diseases.2

 According to Sanders et al,2 a survey of military personnel deployed to Afghanistan from 

2003 through 2004 found that 54.4% of respondents reported experiencing diarrhea while deployed. The number of diarrhea cases in theater is likely underreported. 

A 2006 study of US military personnel deployed to the 

Middle East found that while 60% of survey respondents 

reported an episode of diarrhea and/or vomiting during 

their deployment, only 30% reported seeking care.7

A number of infectious agents commonly associated with 

diarrhea and certain food-borne illnesses, such as brucellosis, hepatitis E, leptospirosis, and typhoid fever, are 

present in Afghanistan and can pose a potential threat 

to US forces stationed there.8

 In a summary of pathogen 

prevalence and diarrhea incidence among US military 

and similar populations by region, enterotoxigenic Escherichia coli (28.3%), enteroaggregative Escherichia 

coli (16.8%), norovirus (7.1%), and Shigella (7.1%) were 

listed as the most common infectious agents identifi ed 

in the Middle East and north Africa. Infection with multiple pathogens was also common (9.3%).6

Time spent off base and consumption of local food have 

been identifi ed as important risk factors for diarrhea,4,5

and consumption of local food is strongly associated 

with reports of multiple episodes of diarrhea.4

 According to Putnam et al,4

 a survey of US military personnel 

deployed to Afghanistan found that 52.8% of respondents reported eating local food at least monthly while 

deployed, and some (8.8%) reported eating it daily. Accordingly, food-borne illness has played, and continues 

to play, a role in diarrhea incidence. It is obvious that 

consumption of food from local, unapproved sources is 

a risk behavior for contracting diarrheal illness.

Recent changes in strategy and the importance placed 

on counterinsurgency operations in Afghanistan and 

other areas of the world have increased the amount 

of time certain service members spend off base, immersed in the lives of local populations.9,10 Part of this 

cultural immersion involves participating in local customs, which includes dining with local populations and 

an increased exposure to local Afghan foods. Service 

members throughout Afghanistan are consuming local Afghan foods on and off forward operating bases. 

The magnitude of consumption is unknown but has 

likely increased under the counterinsurgency strategy 

where building relationships with Afghan partners is 

paramount. Sharing local Afghan food is a critical and 

unavoidable culture-bridging activity. Any program to 

mitigate the risk of food-borne illness from consuming 

local foods must take into account that such behaviors 

have become mission-essential.

Historically, predeployment training has focused on the 

consumption only of foods approved by US military 

Communicating Local Food Risk

 During Counterinsurgency Operations:

 Development and Evaluation of a Risk

 Communication Campaign

Esther J. Pfau, MPH

LTC Jerrod W. Killian, VC, USA

Carrie A. Kilby, MSN, RN

Karen D. Deaver, BS
52 http://www.cs.amedd.army.mil/amedd_journal.aspx

preventive medicine and veterinary personnel and does 

not prepare service members to make informed local 

Afghan food choices to decrease the risk of food-borne 

illness. Tailored and targeted communication strategies 

and messages have been associated with changes in various health-related behaviors.11 Thus, development of a 

targeted communication strategy to change local food 

consumption behaviors by service members as a means 

of mitigating a major risk factor for food-borne illness 

in overseas contingency operations is appropriate. Realistic and targeted risk communication can improve service member readiness and empower service members 

to consume lower risk local Afghan foods (eg, bread, hot 

tea, fully cooked meat) in lieu of higher risk foods (eg, 

dairy products, leafy vegetables). This study evaluates 

targeted health information and communication efforts 

to determine the impact of additional training and information on service member knowledge of food safety 

and the food choices they intend to make.

METHODS

The US Army Public Health Command (USAPHC) and 

the US Army Medical Department Center and School 

formed a multidisciplinary food safety communication team (FSCT) comprised of health communication 

specialists/health analysts, epidemiologists, food safety 

and environmental health specialists, statisticians, and 

recently deployed preventive medicine and veterinary 

personnel. The FSCT’s task was to craft a comprehensive health communication package to empower service 

members to make informed food choices and to develop 

the survey and methods to evaluate the communication 

package. The package consisted of a 15-minute predeployment briefi ng, materials that would be available to 

service members during deployment (poster, sticker, 

smart card, reminder e-card), and 2 leader items (toolkit 

and smart card).

Health Communication Message and Product 

Development

Health communication specialists/health analysts from 

USAPHC worked closely with the FSCT to develop the 

health communication package. The team used Rogers’ 

innovation-diffusion theory12 as a framework to develop 

the health communication package messages and products. Rogers’ innovation-diffusion theory has been examined in a variety of studies, has contributed to a greater understanding of behavioral change, and has been 

found to have numerous applications in public health.13,14

In his innovation-diffusion model, Rogers12 describes 

the types of knowledge individuals need to make decisions and identifi es 5 sequential stages through which 

individuals move in the decision-making process. These 

stages are (1) knowing about the behavior, (2) forming 

an attitude toward the behavior, (3) making a decision to 

adopt or reject the behavior, (4) implementing the new 

behavior, and (5) confi rming the decision to implement 

the new behavior.12

The communication to service members was designed to 

assist them in making lower risk food choices by providing information on how to identify the risk level of common local food items and why it is important to avoid 

high risk food items when possible. The communication 

package included 7 products, each designed to address 

various stages in Rogers’ innovation-diffusion theory.12

The predeployment briefi ng addressed stages one and 

two by generating awareness of the risks of eating local foods, providing information on choosing lower risk 

local foods and the importance of making smarter local 

food choices. The food risk smart card, sticker, and poster for service members addressed stage two and served 

as simple, quick references, outlining commonly available lower risk and higher risk local Afghan foods in 

formats that can be used throughout deployment. The ecard for service members was designed for distribution 

midway into deployment, after service members adopt 

local food consumption behaviors, and addressed stage 

fi ve by confi rming or reaffi rming the benefi ts of making 

smart local food choices. Two products were designed 

specifi cally for leaders: a smart card and toolkit that addressed stages one and two and contained information 

on how leaders can communicate with their personnel 

about the risks of eating local foods, choosing lower risk 

local foods and the importance of making smarter local food choices. The development team ensured that 

no communication product compromised the mission or 

superseded command guidance or policy regarding service member interactions with local populations.

Strategies to target communication materials, such as ensuring that characteristics of the intended audience (age, 

gender, other demographic characteristics) are refl ected 

in the materials, allow for enhanced message relevance 

to audience members.11 For this reason, the FSCT incorporated linguistic, imagery, and stylistic components associated with military service, deployment, and service 

member demographics when developing each product. 

Furthermore, tailored messages are more effective in 

stimulating health behavior change than more generic 

messages.15 Although it was not possible to tailor messages to each individual in a unit, stratifying unit members into groups (such as lower enlisted service members, 

noncommissioned offi cers, and other leaders) allowed 

for a degree of customization that would likely enhance 

overall relevance of products to audience members.

COMMUNICATING LOCAL FOOD RISK DURING COUNTERINSURGENCY OPERATIONS:

DEVELOPMENT AND EVALUATION OF A RISK COMMUNICATION CAMPAIGN
 January – March 2013 53

THE ARMY MEDICAL DEPARTMENT JOURNAL

Evaluation Plan

A pretest and posttest design was used to evaluate the 

effectiveness of the briefi ng* and 3 of the communication products (poster, sticker, and service member smart 

card). A unique identifi er was used to ensure pairing of 

each individual respondent’s pretest and posttest. The 

evaluation plan was approved by the USAPHC Public 

Health Review Board prior to implementation. In May 

2012, a group of more than 100 service members was 

given a prebriefi ng survey to evaluate their baseline 

knowledge and perceptions about deployment local 

food safety. Following the pretest, a preventive medicine physician gave the briefi ng and presented the 3 

additional food safety communication materials to the 

group. A posttest was then administered to determine if 

any new knowledge was gained from the material and 

to gauge service members’ perceptions of the products 

themselves. The prebriefi ng questionnaire asked each 

respondent to rate (high, medium, low) the level of risk 

for food-borne illness of 13 different food categories 

and to provide his/her level of agreement to some attitudinal statements. The postbriefi ng questionnaire asked 

the same questions and also collected specifi c feedback 

on 4 campaign materials: the briefi ng, the poster, the 

sticker, and the service member smart card. The e-card 

and leader materials were not evaluated. The content of 

each questionnaire is reproduced in Figures 1 and 2 

respectively. The following explanatory paragraph introduced each questionnaire:

This survey is designed to help us determine your basic 

knowledge of the safety of local foods that you may encounter during deployment. Local foods are those eaten 

on the economy and/or from sources not approved by US 

military preventive medicine and veterinary personnel. 

They are found off the FOB [forward operating base] 

and also on the FOB in host country owned and operated 

food establishments. Your responses to this survey will 

remain anonymous. Thank you for your participation.

RESULTS

Respondent Profile

Of the approximately 115 service members who attended the briefi ng, 106 completed both questionnaires and were included in this analysis. Over 90% 

of respondents were in the Army and were male. Most 

(81%) had never deployed. About 70% were enlisted 

and 24% were noncommissioned offi cers (NCOs). For 

demographic subgroup analysis the NCOs, warrant 

offi cers, and commissioned offi cers were combined to 

form an “offi cer” group. Over half of the respondents 

were younger than 24 years of age, and approximately 

a third were aged 25 to 34 years. The 2 groups were 

included in subgroup analysis. The majority of respondents had education at high school level and another 18% 

had some degree above high school, but not a bachelor’s 

degree. In the demographic subgroup analysis, attempts 

were made to explore differences between the high 

school/below group and the higher educated group, but 

there were not enough respondents in the higher group 

(n=18) to statistically assess the results.

Foodborne Illness Risk for Specific Food Groups

Overall Ending Knowledge

Overall most respondents were knowledgeable about 

the level of risk for food-borne illness for specifi c food 

groups at the conclusion of the briefi ng. In some cases, 

respondents knew the level of risk for food-borne illness 

of a particular group before the briefi ng. In many cases, 

however, they did not; and over 85% of all respondents, 

regardless of their starting knowledge, were able to correctly identify the risk level of each food category after 

the briefi ng.

As shown in Table 1, the food categories that had the 

highest percentage of incorrect answers (over 10%) and 

may represent an opportunity for continuing education 

were generally “low” risk groups. The only “high” risk 

category in that group was locally canned or packaged 

*The briefi ng materials, including pictures of the poster, sticker, and smart card, are available at http://phc.amedd.army.mil/PHC%20Re

source%20Library/Deployment_Food_Risk_Briefi ng.pdf.

Table 1. Ability to identify risk level of specifi c food categories after 

the briefi ng.†

Food “Right”

Risk

Level

Subtotal

“Right”

(%)

Subtotal

“Wrong”

(%)

Bread Low 96.2 3.8

Fully cooked vegetables, beans and 

rice that are kept and served hot Low 96.2 3.8

Milk and other dairy products (eg, 

cheese, ice cream, butter) High 99.0 1.0

Meats such as lamb, beef, poultry and 

fish that are boiled or well done and 

eaten within 2 hours of cooking

Low 89.5 10.5

Partially cooked or raw meats or fish High 99.0 1.0

Raw, leafy vegetables High 95.2 4.8

Locally canned or packaged products High 89.5 10.5

Hard-skin fruits and vegetables that 

you peel yourself before eating (eg, 

bananas, oranges, limes)

Low 88.6 11.4

Hot tea Low 89.4 10.6

Leftovers, take home, “doggie bag” High 93.3 6.7

Ice, iced drinks, frozen desserts and 

juices High 93.3 6.7

Bottled water or canned carbonated 

drinks Low 86.4 13.6

Opened/unsealed beverage 

containers High 95.2 4.8

†N varied by category, values between 103 and 105.
54 http://www.cs.amedd.army.mil/amedd_journal.aspx

COMMUNICATING LOCAL FOOD RISK DURING COUNTERINSURGENCY OPERATIONS:

DEVELOPMENT AND EVALUATION OF A RISK COMMUNICATION CAMPAIGN

1. Please rate each of the below local foods based on your understanding of their level of risk for food-borne illness. For each 

statement below, fi ll in the circle for the most appropriate response.

Don’t Know 

the level of 

risk

High Risk for 

food-borne 

illness

Moderate Risk for 

food-borne illness

Low Risk for 

food-borne 

illness

a. Breads □0 Ο1 Ο2 Ο3

b. Fully cooked vegetables, beans and rice that are kept and served hot □0 Ο1 Ο2 Ο3

c. Milk and other dairy products (eg, cheese, ice cream, butter) □0 Ο1 Ο2 Ο3

d. Meats such as lamb, beef, poultry and fi sh that are boiled or well 

done and eaten within 2 hours of cooking □0 Ο1 Ο2 Ο3

e. Partially cooked or raw meats or fi sh □0 Ο1 Ο2 Ο3

f. Raw, leafy vegetables □0 Ο1 Ο2 Ο3

g. Locally canned or packaged products □0 Ο1 Ο2 Ο3

h. Hard-skin fruits and vegetables that you peel yourself before eating 

(eg, bananas, oranges, limes) □0 Ο1 Ο2 Ο3

i. Hot tea □0 Ο1 Ο2 Ο3

j. Leftovers, take home, “doggie bag” □0 Ο1 Ο2 Ο3

k. Ice, iced drinks, frozen desserts and juices □0 Ο1 Ο2 Ο3

l. Bottled water or canned carbonated drinks □0 Ο1 Ο2 Ο3

m. Opened/unsealed beverage containers □0 Ο1 Ο2 Ο3

3. Current Branch or 

affi liated Service 4. Rank 5. Age (years) 6. Gender 7. Highest level of education 

completed

Ο0 Air Force Ο0 Enlisted Ο0 18-24 Ο0 Male Ο0 Did not complete high school

Ο1 Army Ο1 NCO Ο1 25-34 Ο1 Female Ο1

High school graduation or 

equivalent

Ο2 Coast Guard Ο2 Warrant Offi cer Ο2 35 and older Ο2

Associates/technical/vocational 

degree

Ο3 Marine Corps Ο3 Offi cer Ο3 Bachelor’s degree

Ο4 Navy Ο4 Civilian Ο4 Graduate or professional degree

Ο5 Contractor

2. Please rate your level of agreement with each of the following statements. Fill in the circle for the most appropriate 

response.

Strongly

Agree

Strongly 

Disagree

a. I can identify the symptoms of food-borne illness. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

b. Foodborne illness should be taken seriously. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

c. I need more information to help make less risky food choices 

when eating local foods in Afghanistan. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

d. Local foods available on forward operating bases in 

Afghanistan are from approved sources. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

e. Foodborne illness is an unavoidable occurrence during 

deployment. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

Figure 1. Pretest local foods communication materials questionnaire.
 January – March 2013 55

THE ARMY MEDICAL DEPARTMENT JOURNAL

Figure 2. Posttest local foods communication materials questionnaire (Figure 2 continued on next page).

1. Please rate each of the below local foods based on your understanding of their level of risk for food-borne illness. For each 

statement below, fi ll in the circle for the most appropriate response.

Briefi ng Strongly

Agree

Agree Neither Agree 

nor Disagree

Disagree Strongly 

DIsagree

a. The purpose of the briefi ng is clear. Ο0 Ο1 Ο2 Ο3 Ο4

b. The briefi ng is easy to understand. Ο0 Ο1 Ο2 Ο3 Ο4

c.

The briefi ng provides enough information about the risks of eating 

local foods during deployment. Ο0 Ο1 Ο2 Ο3 Ο4

d. The briefi ng provides enough information for me to make smart local 

food choices during deployment. Ο0 Ο1 Ο2 Ο3 Ο4

e. I would recommend this briefi ng to other deploying service members. Ο0 Ο1 Ο2 Ο3 Ο4

Comments on the briefi ng:

Poster

a. The purpose of the poster is clear. Ο0 Ο1 Ο2 Ο3 Ο4

b. The poster is easy to understand. Ο0 Ο1 Ο2 Ο3 Ο4

c.. The poster provides enough information about the risks of eating 

local foods during deployment. Ο0 Ο1 Ο2 Ο3 Ο4

d. The poster provides enough information for me to make smart local 

food choices during deployment. Ο0 Ο1 Ο2 Ο3 Ο4

e. The poster text is easy to read. Ο0 Ο1 Ο2 Ο3 Ο4

f. The poster grabs my attention. Ο0 Ο1 Ο2 Ο3 Ο4

g. I would read or refer to the poster if deployed or deploying. Ο0 Ο1 Ο2 Ο3 Ο4

h. I would recommend this poster to other deploying service members. Ο0 Ο1 Ο2 Ο3 Ο4

Comments on the poster:

Sticker

a. The purpose of the sticker is clear. Ο1 Ο2 Ο3 Ο4

b. The sticker is easy to understand. Ο0 Ο1 Ο2 Ο3 Ο4

c. The sticker provides enough information about the risks of eating 

local foods during deployment. Ο0 Ο1 Ο2 Ο3 Ο4

d. The sticker provides enough information for me to make smart local 

food choices during deployment. Ο0 Ο1 Ο2 Ο3 Ο4

e. The sticker text is easy to read. Ο0 Ο1 Ο2 Ο3 Ο4

f. The sticker grabs my attention. Ο0 Ο1 Ο2 Ο3 Ο4

g. I would read or refer to the sticker if deployed or deploying. Ο0 Ο1 Ο2 Ο3 Ο4

h. I would recommend this sticker to other deploying service members. Ο0 Ο1 Ο2 Ο3 Ο4

Comments on the sticker:

NOTE: This blank cell was a typographic error on the form used in the survey. The effect 

on data analysis is explained on page 61.
56 http://www.cs.amedd.army.mil/amedd_journal.aspx

COMMUNICATING LOCAL FOOD RISK DURING COUNTERINSURGENCY OPERATIONS:

DEVELOPMENT AND EVALUATION OF A RISK COMMUNICATION CAMPAIGN

Figure 2 (continued). Posttest local foods communication materials questionnaire.

(Figure 2 continued on next page)

Smart Card Strongly

Agree

Agree Neither Agree 

nor Disagree

Disagree Strongly 

DIsagree

a. The purpose of the smart card is clear. Ο0 Ο1 Ο2 Ο3 Ο4

b. The smart card is easy to understand. Ο0 Ο1 Ο2 Ο3 Ο4

c.. The smart card provides enough information about the risks of 

eating local foods during deployment. Ο0 Ο1 Ο2 Ο3 Ο4

d. The smart card provides enough information for me to make smart 

local food choices during deployment. Ο0 Ο1 Ο2 Ο3 Ο4

e. The smart card text is easy to read. Ο0 Ο1 Ο2 Ο3 Ο4

f. The smart card grabs my attention. Ο0 Ο1 Ο2 Ο3 Ο4

g. I would read or refer to the smart card if deployed or deploying. Ο0 Ο1 Ο2 Ο3 Ο4

h. I would recommend this smart card to other deploying service 

members. Ο0 Ο1 Ο2 Ο3 Ο4

Comments on the smart card:

2. Please rate each of the below local foods based on your understanding of their level of risk for food-borne illness. For each 

statement below, fi ll in the circle for the most appropriate response.

Don’t Know 

the level of 

risk

High Risk for 

food-borne 

illness

Moderate Risk for 

food-borne illness

Low Risk for 

food-borne 

illness

a. Breads □0 Ο1 Ο2 Ο3

b. Fully cooked vegetables, beans and rice that are kept and served hot □0 Ο1 Ο2 Ο3

c. Milk and other dairy products (eg, cheese, ice cream, butter) □0 Ο1 Ο2 Ο3

d. Meats such as lamb, beef, poultry and fi sh that are boiled or well 

done and eaten within 2 hours of cooking □0 Ο1 Ο2 Ο3

e. Partially cooked or raw meats or fi sh □0 Ο1 Ο2 Ο3

f. Raw, leafy vegetables □0 Ο1 Ο2 Ο3

g. Locally canned or packaged products □0 Ο1 Ο2 Ο3

h. Hard-skin fruits and vegetables that you peel yourself before eating 

(eg, bananas, oranges, limes) □0 Ο1 Ο2 Ο3

i. Hot tea □0 Ο1 Ο2 Ο3

j. Leftovers, take home, “doggie bag” □0 Ο1 Ο2 Ο3

k. Ice, iced drinks, frozen desserts and juices □0 Ο1 Ο2 Ο3

l. Bottled water or canned carbonated drinks □0 Ο1 Ο2 Ο3

m. Opened/unsealed beverage containers □0 Ο1 Ο2 Ο3
 January – March 2013 57

THE ARMY MEDICAL DEPARTMENT JOURNAL

products, with 10.5% incorrect answers. Respondents 

who gave “wrong” answers were often those who had 

been deployed and rated “low” risk categories as moderate risk. Within the demographic subgroups, there were 

no other differences or trends of note either between 

subgroups or pre- or postpattern across subgroups.

Actual Learning

Following the briefi ng, participants had the “right” answer for one of 2 reasons: either they did not know the 

food’s risk level prior to the briefi ng but learned it during 

the briefi ng, or they already knew the risk level prior to 

the meeting. In the former case, the briefi ng was clearly benefi cial; in the latter, the briefi ng did not change 

knowledge but served to reinforce it.

“Learning” was calculated as the number of respondents 

who incorrectly identifi ed the risk level in the prebriefing questionnaire, but correctly identifi ed it in the postbriefi ng questionnaire. As shown in Table 2, the percentage of respondents who learned from the briefi ng varied 

from 6.7% to 80% across the categories. There were no 

differences by demographic subgroup.

The amount of a priori knowledge and learning with regard to the proper risk classifi cation of each food group 

also varied widely among the food groups. The a priori 

knowledge ranged from 13.3% to 92.4%.

No respondent correctly classifi ed all the categories in 

the prebriefi ng. Every respondent learned the correct 

Figure 2 (continued). Posttest local foods communication materials questionnaire.

5. For each question below, fi ll in the circle for the most appropriate response.

YES NO YES NO

Have you ever been deployed to CENTCOM? Ο0 Ο1

If yes, then would the information you’ve just heard 

have been useful for that deployment(s)? Ο0 Ο1

Have you ever been deployed to AFRICOM? Ο0 Ο1

If yes, then would the information you’ve just heard 

have been useful for that deployment(s)? Ο0 Ο1

Have you ever been deployed to PACOM? Ο0 Ο1

If yes, then would the information you’ve just heard 

have been useful for that deployment(s)? Ο0 Ο1

Have you ever been deployed to SOUTHCOM? Ο0 Ο1

If yes, then would the information you’ve just heard 

have been useful for that deployment(s)? Ο0 Ο1

Comments on why these products would/would not have been useful during deployment:

6. Any additional comments about the briefi ng or communication materials that you saw today?

4. Do you think the information you’ve just heard will infl uence the local food choices you will make during your deployment?

Ο0 YES Ο1 NO

Why or why not?

3. Please rate your level of agreement with each of the following statements. Fill in the circle for the most appropriate 

response.

Strongly

Agree

Strongly 

Disagree

a. I can identify the symptoms of food-borne illness. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

b. Foodborne illness should be taken seriously. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

c. I need more information to help make less risky food choices 

when eating local foods in Afghanistan. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

d. Local foods available on forward operating bases in 

Afghanistan are from approved sources. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6

e. Foodborne illness is an unavoidable occurrence during 

deployment. Ο0 Ο1 Ο2 Ο3 Ο4 Ο5 Ο6
58 http://www.cs.amedd.army.mil/amedd_journal.aspx

answer for at least one category during the briefi ng, and, 

on average, changed to the correct answer for 5 of the 

13 categories as shown in Figure 3. There were no demographic distinctions among the top 10% of learners 

(those who changed 8 or more answers) except that all 

were enlisted personnel.

Confusion and Opportunities for Clarity

Both the hot tea and the bottled water or canned carbonated drinks categories confused several respondents. 

They initially had the correct answer but changed to the 

incorrect answer following the briefi ng. Those in the 

“didn’t help or hurt” column gave an incorrect risk level 

before the briefi ng and also gave (the same or different) incorrect answer following the briefi ng. As shown 

in Table 3, the total number of incorrect responses was 

minimal in both of these “wrong risk” categories.

Attitudes Toward Food-borne Illness

Respondents rated their agreement with different statements refl ecting attitudes toward food-borne illness 

both before and after the briefi ng. Overall, they gained 

confi dence in their ability to identify symptoms of foodborne illness. They increasingly agreed that food-borne 

illness should be taken seriously and understood that 

local foods available on forward operating bases were 

not necessarily from approved sources. Respondents did 

not, however, agree that food-borne illness was avoidable during deployment.

All changes were signifi cantly different at the 0.01 level, 

indicating a 99% confi dence that the changes before and 

after the briefi ng refl ected a conscious shift in agreement level. Changes toward the desired direction (agree 

or disagree) ranged from less than one point to almost 2 

points on a zero to 6 point scale.

After the briefi ng, respondents were more likely to agree 

that food-borne illness was unavoidable. The intent of 

the communication materials was just the opposite—to 

help respondents understand that they could avoid illness with good food choices. Respondents may have 

been confused by the phrasing of the question (do you 

disagree that something is unavoidable) or respondents 

may have become discouraged by content of the briefing, which pointed out the likelihood of getting ill during deployment. Those who had been deployed tended 

to believe that illness was not unavoidable both before 

and after the briefi ng. Otherwise, there were no signifi -

cant differences between demographic groups or in the 

pre- or postpatterns across groups. The statistics are 

presented in Table 4.

COMMUNICATING LOCAL FOOD RISK DURING COUNTERINSURGENCY OPERATIONS:

DEVELOPMENT AND EVALUATION OF A RISK COMMUNICATION CAMPAIGN

Table 2. Learning: how respondents came to the “right” 

answer.*

Food Already

Knew

(%)

Learned

(%)

Bread 29.8 66.3

Fully cooked vegetables, beans and 

rice that are kept and served hot 76.2 20.0

Milk and other dairy products (eg, 

cheese, ice cream, butter) 58.3 40.8

Meats such as lamb, beef, poultry and 

fish that are boiled or well done and 

eaten within 2 hours of cooking

35.2 54.3

Partially cooked or raw meats or fish 92.4 6.7

Raw, leafy vegetables 35.6 59.6

Locally canned or packaged products 20.0 69.5

Hard-skin fruits and vegetables that 

you peel yourself before eating (eg, 

bananas, oranges, limes)

51.4 37.1

Hot tea 52.9 36.5

Leftovers, take home, “doggie bag” 54.3 39.0

Ice, iced drinks, frozen desserts and 

juices 13.3 80.0

Bottled water or canned carbonated 

drinks 59.2 27.2

Opened/unsealed beverage 

containers 67.3 27.9

*N varied by category, values between 103 and 105.

Table 3. Confusion and opportunity for clarity.*

Food Neither

Help nor

Hurt

(%)

Confused

(%)

Bread 2.9 1.0

Fully cooked vegetables, beans and 

rice that are kept and served hot 0.0 3.8

Milk and other dairy products (eg, 

cheese, ice cream, butter) 0.0 1.0

Meats such as lamb, beef, poultry and 

fish that are boiled or well done and 

eaten within 2 hours of cooking

9.5 1.0

Partially cooked or raw meats or fish 1.0 0.0

Raw, leafy vegetables 3.8 1.0

Locally canned or packaged products 9.5 1.0

Hard-skin fruits and vegetables that 

you peel yourself before eating (eg, 

bananas, oranges, limes)

7.6 3.8

Hot tea 3.8 6.7

Leftovers, take home, “doggie bag” 5.7 1.0

Ice, iced drinks, frozen desserts and 

juices 5.7 1.0

Bottled water or canned carbonated 

drinks 4.9 8.7

Opened/unsealed beverage 

containers 2.9 1.9

*N varied by category, values between 103 and 105.
 January – March 2013 59

THE ARMY MEDICAL DEPARTMENT JOURNAL

Information Needs

Respondents were asked before and after the briefi ng 

how much they agreed or disagreed with the statement 

“I need more information to help make less risky food 

choices when eating local foods in Afghanistan.” As 

shown in Table 5, over 85% of respondents indicated 

they wanted more information in their prebriefi ng score. 

About one third indicated that they did not need more 

information after receiving the briefi ng; however, nearly half of them still wanted more information after the 

briefi ng.

A paired t test of before and after scores indicated that, 

on average, respondents moved nearly 1 point away 

from the “agree” and toward the “disagree” end of the 

zero to 6 spectrum. This was a signifi cant change with 

a P<.001 and indicated that, overall, respondents did 

not need as much information as they had prior to the 

briefi ng. Eighty-nine individuals had a prebrief score of 

3, 2, 1, or zero, and 29 (31.4%) of those had a postbrief 

score of 4, 5, or 6, indicating a 

change from needing information to not needing more.

Since there was no “right” answer to this question, interpretation of the results is unclear. 

Some respondents could have 

indicated they did not need 

more information because 

the briefi ng was clear. Others 

may have indicated the same 

thing because they were overwhelmed or simply tired of 

hearing the information. Conversely, those who thought 

they did not need information 

before the briefi ng but wanted 

more after the briefi ng could have been confused by the 

information presented, or were genuinely interested in 

learning more about the topic.

Communication Campaign Materials

Overall Material Effectiveness

Most respondents had a positive reaction to each of the 

4 campaign materials presented to them. Virtually all 

respondents agreed that the purpose of the 4 products 

was clear, they were easy to understand, they provided 

enough information about risks, and they enabled smart 

local food choices. The same proportions would recommend these communication products to other deploying 

service members.

The “Top 2 Box” scores, shown in Table 6, represent 

those who said “Strongly Agree” or “Agree” on a 5-point 

agreement scale. Typically, about 75% of respondents 

strongly agreed regarding the briefi ng, and about 55% 

strongly agreed about each of the specifi c materials. 

The briefi ng was the most 

well-received while the 

sticker and smart card 

were slightly less so. This 

could have been the result 

of respondents having less 

exposure to the sticker 

and smart card during the 

briefi ng or not fully understanding the intended 

use for the materials during deployment. Nonetheless, agreement levels regarding these items were 

still nearly 90%.

Table 4. Changes in attitudes toward food-borne illness.

Statement N Ended

in the

“Right”

Place*

(%)

Moved

in the

“Right”

Direction†

(%)

Moved

from

“Wrong”

to “Right”‡

(%)

Average

Point

Change

I can identify the symptoms of foodborne illness. 105 97.1

(Agree) 78.10 23.0 1.82

Foodborne illness should be taken 

seriously. 105 100(Agree) 26.37 5.7 0.36

Local foods available on forward operating bases in Afghanistan are from 

approved sources.

105 69.5

(Disagree) 65.70 32.4 1.34

Foodborne illness is an unavoidable 

occurrence during deployment. 104 64.4

(Disagree) 18.30 3.8

-0.72

(respondents

moved toward

agree)

*Respondent gave 3 or “better” on a 0 to 6 point scale) in their post- score.

†Respondent moved at least 1 point better on the scale.

‡Respondent started worse than midpoint (3 on a 0 to 6 point scale) and changed to midpoint or “better.”

Number of Categories per Respondent

Number of Respondents

Figure 3. Categories changed from “wrong” to “right.”
60 http://www.cs.amedd.army.mil/amedd_journal.aspx

“Bottom 2 Box” analysis showed no signifi cant differences across elements. However, respondents gave more 

disagreement scores for the sticker than for the other elements on virtually every question, reinforcing that the 

sticker was not as well received as the other communication elements.

The results for specifi c print material attributes are presented in Table 7. The majority (85% to 96%) of respondents believed that the poster, sticker, and smart card 

grabbed their attention and were easy to read. Respondents also said they would refer to these products during their deployment. The poster was typically the most 

well received material and the sticker the least, but the 

differences were not statistically signifi cant.

Again, Bottom 2 Box analysis showed no signifi cant 

differences, although, respondents gave more disagreement scores for the sticker than for the other materials 

on virtually every question, reinforcing that the sticker 

was not as well received as the other communication 

elements.

Effect During Deployment

Following the briefi ng, virtually all respondents said 

that information they had just heard would infl uence 

their local food choices during deployment. 

Comments refl ected that respondents felt 

more informed after the briefi ng and would 

make better choices than they would have 

previously. The main reason given for why 

the information would infl uence respondents 

was that they did not want to get sick. A few 

respondents also noted the deleterious effect 

that illness would have on their mission.

COMMUNICATING LOCAL FOOD RISK DURING COUNTERINSURGENCY OPERATIONS:

DEVELOPMENT AND EVALUATION OF A RISK COMMUNICATION CAMPAIGN

Table 6. Top 2 box agreement, overall material effectiveness.

Communication

Element

Purpose 

was clear

(%)

(Material was)

easy to

understand

(%)

Provides enough information

Respondent

would

recommend

(%)

about risks of

eating local foods

during deployment

(%)

for me to make smart

local food choices

during deployment

(%)

Briefing 100 100 100 98.1 97.1

Poster 97.1 98.1 97.1 95.2 91.4

Sticker 84.6* 93.3† 89.5* 88.6† 86.7†

Smart Card 92.4† 92.4† 91.4† 93.3 90.5

N varied by individual question, value either 104 or 105.

*Signifi cantly lower than the poster and the briefi ng, using a Bonferroni correction for multiple comparisons.

†Signifi cantly lower than the briefi ng, using a Bonferroni correction for multiple comparisons.

Table 7. Top 2 box agreement, print material attributes.

Communication

Element

Text was easy

to read. (%)

(Element) grabs

my attention. (%)

I would read or refere to it if 

deployed or deploying. (%)

Poster 96.2 81.0* 90.5

Sticker 91.4 84.8 83.8

Smart Card 93.3 90.5 87.6

N varied by individual question, value either 104 or 105.

*P=.02 vs the smart card—not signifi cant, using a Bonferroni correction for multiple 

comparisons.

Table 5. Information needs of respondents.

Statement: I need more information to help make less risky food choices... 

Rating After Briefi ng

Rating Before Briefi ng

Strongly

Disagree

Strongly

Agree Total

6 54321 0

Strongly Disagree 6 2 11000 0 4

5 2 01110 1 6

4 1 01120 0 5

3 1 7 3 5 4 1 3 24

2 0 6 1 5 2 3 2 19

1 0 2 1 2 9 8 1 23

Strongly Agree 0 1 4 2 7 2 3 4 23

Total 7 20 10 21 20 15 11 104

n=89

(85.6%)

≈31% of “needed more before”

did not need more after

≈47% of “needed more before”

still needed more after
 January – March 2013 61

THE ARMY MEDICAL DEPARTMENT JOURNAL

CONCLUSIONS AND RECOMMENDATIONS

Overall, the materials were well received and the content was “learned.” Respondents were prepared to make 

better local food choices and indicated that this preparation would translate into less risky behavior during their 

deployment. Everyone learned at least something, and 

several respondents indicated they learned a great deal, 

about which food categories are high/low risk. Attitudes 

changed such that respondents became more aware of 

the causes, severity, and impact of food-borne illness.

Evaluation of the communication products enabled 

identifi cation of information gaps and areas needing 

improvement during future risk communication efforts 

to address deployment local food choices. During the 

briefi ng, respondents seemed to become confused about 

the risks of both hot tea and bottled water or canned 

carbonated drinks. These 2 categories need more clarity in future communication. Additional communication should be concentrated on the categories of meats 

such as lamb, beef, poultry, and fi sh that are boiled or 

well done and eaten within 2 hours of cooking; locally 

canned or packaged products; and hard-skin fruits and 

vegetables that you peel yourself before eating (bananas, 

oranges, limes, etc).

The following limitations must be taken into account 

when assessing the impact of the results. Nearly all 

respondents were in the Army and were male. Future 

testing should strive to include other service members 

as well as female service members, as their perceptions 

could differ from male Soldiers. While there were few 

differences noted between the demographic groups, a 

limited number of groups were explored, given the homogeneity of the respondent pool. Besides service and 

gender, which were noted above other demographics 

such as age, offi cer/enlisted status, education, and previous deployment experience could infl uence comprehension of the materials but were not able to be fully assessed in this study. The materials were only tested with 

one group of service members. While this means that 

all respondents were exposed to the exact same presentation (which is good), in real-life situations, the briefing would not always be given by the same individual. 

Therefore, the quality of the briefer could have impacted 

respondent comprehension of the materials. Future work 

should likely have different briefers so that the briefi ng 

itself, rather than the briefer, could be more independently evaluated. The posttest questionnaire was fi elded 

with a typographic error in Q1-Sticker-a (Figure 2, page 

55). Consequently, the coded responses were shifted to 

the right by one category. These answers were correctly 

recoded for analysis. However since respondents could 

not physically check a box for the fi rst category, no differentiation could be made between the fi rst and second 

choice. As is often done with rating scales, a Top 2 Box 

score was used and the fi rst and second choices were 

combined for all analyses. Therefore the impact of the 

typo was negligible to the results.

This effort illustrated the benefi t of not only developing, 

but also testing communication materials that address 

local food safety. As a result of the evaluation, service 

members are now equipped to make better local food 

choices during deployment, and areas of improvement were identifi ed to guide future communication 

development.

ACKNOWLEDGMENT

The authors thank MAJ (Ret) Caroline M. Kalinowski, LTC Laura A. Pacha, Thomas J. McNeil, Shane M. 

Hall, CW5 Ronald Biddle, Nikki N. Jordan, and Eileen 

K. Resta of the US Army Public Health Command, and 

MAJ Kevin M. Taylor of Martin Army Community Hospital for their assistance in preparation of this article.

REFERENCES

1. Riddle MS, Tribble DR, Putnam SD, et al. Past 

trends and current status of self-reported incidence 

and impact of disease and nonbattle injury in military operations in Southwest Asia and the Middle 

East. Am J Public Health. 2008;98(12):2199-2206.

2. Sanders JW, Putnam SD, Frankart C, et al. Impact 

of illness and non-combat injury during Operations 

Iraqi Freedom and Enduring Freedom (Afghanistan). Am J Trop Med Hyg. 2005;73(4):713-719.

3. Sanders JW, Putnam SD, Riddle MS, et al. The epidemiology of self-reported diarrhea in operations 

Iraqi Freedom and Enduring Freedom. Diagn Microbiol Infect Dis. 2004;50(2):89-93.

4. Putnam SD, Sanders JW, Frenck RW, et al. Selfreported description of diarrhea among military 

populations in Operations Iraqi Freedom and Enduring Freedom. J Travel Med. 2006;13(2):92-99.

5. Kasper MR, Lescano AG, Lucas C, et al. Diarrhea 

outbreak during U.S. military training in El Salvador. PLoS ONE. 2012;7:1-8.

6. Riddle MS, Sanders JW, Putnam SD, Tribble DR. 

Incidence, etiology, and impact of diarrhea among 

long-term travelers (US military and similar populations): A systematic review. Am J Trop Med Hyg. 

2006;75(5):891-900.

7. Monteville MR, Riddle MS, Baht U, et al. Incidence, etiology, and impact of diarrhea among deployed US military personnel in support of Operation Iraqi Freedom and Operation Enduring Freedom. Am J Trop Med Hyg. 2006;75(4):762-767.
62 http://www.cs.amedd.army.mil/amedd_journal.aspx

8. Gaydos JC, Tomich N, Russel KL, et al. A roundtable discussion on emerging infectious diseases – 

risks to US service members in Afghanistan and 

Iraq. Mil Med. 2010;175(12):937-938.

9. Cohen E, Crane C, Horvath J, Nagle J. Principles, 

imperatives, and paradoxes of counterinsurgency. 

Mil Rev. March-April 2006:49-53.

10. Lamb CJ, Cinnamond M. Unifi ed effort key to special operations and irregular warfare in Afghanistan. Joint Force Quarterly. 2010;56(1):40-53.

11. Kreuter MW, Wray RJ. Tailored and targeted 

health communication: Strategies for enhancing information relevance. Am J Health Behav. 

2003;27(3):S227-S232.

12. Rogers EM. Diffusion of innovations. 5th ed. New 

York, NY: Free Press; 2003.

13. White C, Kolble R, Carlson R, Lipson N. The impact 

of a health campaign on hand hygiene and upper 

respiratory illness among college students living in 

residence halls. J Am Coll Health. 2005;53(4):175-

181.

14. Haider M, Kreps GL. Forty years of diffusion of 

innovations: utility and value in public health. J 

Health Commun. 2004;9(Suppl1):3-11.

15. Noar SM, Benac CN, Harris MS. Does tailoring matter? meta-analytic review of tailored print 

health behavior change interventions. Psychol Bul. 

2007;133(4):673-693.

AUTHORS

Ms Pfau is a Health Analyst, US Army Public Health 

Command, Aberdeen Proving Ground, Maryland.

LTC Killian is the Command Veterinarian, US Army 

South, Fort Sam Houston, Texas.

Ms Kilby is a Health Analyst, US Army Public Health 

Command, Aberdeen Proving Ground, Maryland.

Ms Deaver is Senior Command Statistician, US Army 

Public Health Command, Aberdeen Proving Ground, 

Maryland.

COMMUNICATING LOCAL FOOD RISK DURING COUNTERINSURGENCY OPERATIONS:

DEVELOPMENT AND EVALUATION OF A RISK COMMUNICATION CAMPAIGN
 January – March 2013 63

THE EMERGENCE OF THE FOOD AND WATER RISK 

ASSESSMENT PROGRAM

There are inherent risks associated with the purchase 

and consumption of subsistence procured in some overseas locations. In many countries, food-borne diseases 

are endemic and exacerbated by poor hygienic practices 

in restaurants and other commercial catering establishments. Sanitation risks include lack of potable water 

and sanitizing supplies, improper sanitizing procedures, 

poor sanitary standards, questionable health standards 

among workers, a poorly trained workforce, and manual 

or hands-on food processing techniques. There are also 

risks unique to particular countries or regions such as 

lack of food sanitation hygiene laws and insuffi cient 

oversight by the local civilian government (regulators), 

lack of animal herd health monitoring programs and associated controls for endemic diseases, inadequate health 

care systems, improper use of pesticides and chemicals, 

and the lack of food vendor accountability in the event of 

food-borne illnesses. To reduce these risks, commercial 

food establishments who sell to the Department of Defense (DoD) are audited by US Army Veterinary Corps 

offi cers, ensuring compliance with regulatory, industry, 

and DoD requirements. When a food production facility 

passes a food protection audit in accordance with Military Standard 3006A1

 (MIL-STD-3006A), it is placed 

on the Worldwide Directory of Sanitarily Approved 

Food Establishments for Armed Forces Procurement.2

The DoD food protection audit assures that set food protection (food safety and defense) benchmarks have been 

achieved for those establishments listed in the directory, 

thus reducing the risk of food-borne disease to service 

members and their families worldwide.

Unfortunately, the ability to purchase food from DoDapproved food sources is limited in more remote locations where US military service members are increasingly engaged. These engagements range from Beyond 

the Horizon exercises in Panama to foreign humanitarian assistance operations in Pakistan. While most major 

exercises are conducted near larger cities where DoDapproved food sources are more readily available and 

logistically feasible, often the main thrust of these exercises and operations is to serve the most in-need populations in rural areas where DoD-approved food sources 

may be unavailable or impractical. Issues surfaced when 

assessors applied MIL-STD-3006A to food operations 

in developing countries, particularly in more rural areas where local food safety practices were less stringent 

and often did not meet the military requirements. This 

resulted in Veterinary Corps offi cers often failing the 

majority of the facilities audited in developing countries, 

leaving commanders without realistic feeding options. 

Over time, this issue eroded the Veterinary Corps ability to support worldwide missions the DoD considers essential. Veterinary Corps leaders recognized that a new 

approach had to be crafted to support the mission and 

commanders while still preventing food-borne disease. 

This new approach is the Food and Water Risk Assessment (FWRA) program which created a framework for 

trained assessors to identify, assess, and communicate 

food-borne illness risks associated with food preparation operations, including hotel kitchens, restaurants, 

caterers, and military feedings operations, such as fi eld 

exercises and host nation dining facilities. 

Both the MIL-STD-3006A and the FWRA program 

are based upon the same federal food safety laws of the 

United States. However, while MIL-STD-3006A is coupled with a “pass/fail” audit, the FWRA program does 

not pass or fail an establishment, but instead identifi es 

the level of risk to commanders. Consequently, leveraging the FWRA program is a double-edged sword that allows higher risk food operations to be considered for use 

but requires an increased focus on food-borne disease 

mitigation. The danger is that some uninformed commanders may assume that food operations contracted 

under the FWRA program are as safe as DoD-approved 

sources. Specifi cally, FWRAs provide commanders 

with the ability to determine the level of acceptable risk 

Food and Water Risk Assessments:

 Empowering Commanders and

 Protecting Service Members

LTC Jerrod W. Killian, VC, USA

MAJ Ronald L. Burke, VC, USA

James E. Westover, Jr
64 http://www.cs.amedd.army.mil/amedd_journal.aspx

and keeps the assessor at the commander’s side with veterinary risk mitigation expertise.

LOCAL FOOD BENEFITS AND RISKS

Service members who have served in Operations Enduring and Iraqi Freedom or other operations and exercises 

understand the importance of building relationships and 

bridging cultures. In fact, successful counterinsurgency 

operations hinge on building trusting relationships, a 

major component of which can be the sharing of local 

foods. While often not offi cially approved, consuming 

local foods is a reality in most deployed locations. This 

reality also brings profound food safety risks. Among 

personnel deployed to Iraq and Afghanistan between 

2003 and 2004, 78.6% of troops in Iraq and 54.4% of 

those in Afghanistan experienced diarrhea, with 80% 

seeking care from their unit medic. The consumption 

of local foods from non-US sources was associated with 

the increased risk of illness.3

Local foods also have an impact on service members 

in South and Central America. A diarrhea outbreak 

occurred during US military training and humanitarian assistance in El Salvador in 2012. While service 

members frequently report getting diarrhea during 

short deployments, in-depth investigations like the one 

conducted by the Naval Medical Research Unit No. 6 

(NAMRU-6) with epidemiological surveys, microscopy, 

and polymerase chain reaction analysis of stool samples 

are rarely performed. This investigation concluded that 

the consumption of food from on-base local vendors 

(relative risk (RR)=4.01 (95% confi dence interval (CI), 

1.53-10.5), P<.001) and arriving on base within the past 

2 weeks (RR=2.79 (95% CI, 1.35-5.76), P<.001) were 

associated with increased risk of developing diarrheal 

disease.3

 Although many exercises are short in duration, local food risks must be still considered by mission 

planners. In these situations, FWRAs may be the most 

effective tool to reduce the local food risks and disease.

FOOD-BORNE ILLNESS PREVENTION CHALLENGES 

WITH LOCAL FOODS

One of the biggest challenges in preventing food-borne 

illness during smaller military operations is demonstrating to medical and nonmedical leaders the importance 

of command involvement in preventing disease. While 

the benefi ts of consuming local foods are visible and 

compelling, commanders and staffs may be unaware of 

objective evidence, such as the NAMRU-6 study, which 

examines the associations between local foods and service member disease. Even though the true burden of 

food-borne diseases from eating local host nation foods 

in unknown, leaders who believe that local food consumption is not a serious mission consideration, fail to 

employ FWRAs, and do not apply their risk mitigation 

recommendations may fi nd their personnel and mission 

seriously impacted by preventable diseases. A study of 

acute diarrhea in US military personnel deployed to Sinai, Egypt described such mission impacts. One of every 5 individuals who became ill with diarrhea while deployed to Egypt reported being unable to work because 

of their illness (missing an average 2 days), and an additional 2 of 5 reported that their work performance was 

decreased because of their illness. Multiple episodes of 

diarrhea during deployment equates to a large number 

of lost and impacted duty days for the Warfi ghter, and is 

legitimate cause for concern.4

INTEGRATING DoD-APPROVED FOOD SOURCES AND 

FWRAs DURING MILITARY EXERCISES

Rarely is there a “silver-bullet” in the prevention of 

food-borne diseases, and demonstrating the effectiveness of a sound food-borne disease prevention strategy 

remains challenging.* Nevertheless, food-borne disease 

prevention through timely interventions provides the 

“biggest bang for the buck” by preventing more disease 

with fewer resources. The goal is to prevent deployed 

personnel from consuming higher risk local foods, if 

possible (Figure 1). Planners supporting service members in these developing areas must construct the safest 

feeding plan possible within the mission requirements. 

Applying an integrated risk-based intervention approach 

to food protection in deployed settings can signifi cantly 

reduce the incidence and impact of food-borne diseases. 

During the August 2012 Operation Martillo in Guatemala, multiple food options were leveraged. Bottled 

water came from a DoD-approved source in Guatemala 

City, fresh fruit and vegetables came from a local supermarket, Unitized Group Rations†

 and Meals Ready 

to Eat†

 were served at operation sites, and occasional 

catered meals were provided by a local hotel restaurant. 

Of all these food and water sources, local restaurants 

FOOD AND WATER RISK ASSESSMENTS:

EMPOWERING COMMANDERS AND PROTECTING SERVICE MEMBERS

*See related article on page 51.

†US military small unit and individual fi eld (operational) rations

Figure 1. Food-borne disease risk curve for local foods.
 January – March 2013 65

THE ARMY MEDICAL DEPARTMENT JOURNAL

(in a hotel or standalone facility) usually 

present the highest risk of food-borne illness. Common risks include unapproved 

raw materials, inadequate refrigerator or 

freezer space, unsanitary food preparation surfaces, and improper handling of 

potentially hazardous foods. Ice is one 

potentially hazardous food for which the 

risk of contributing to food-borne disease 

is commonly underestimated. Food service personnel often fail to recognize ice 

as a ready-to-eat food that is easily contaminated from improper handling (Figure 2), such as in restaurants in developing countries which make their own ice.

DoD-approved food sources provide the 

foundation of food protection and should 

be considered before higher risk local 

food sources. When DoD-approved food 

sources are unavailable, planners may 

turn to operational rations as the next preferred option 

for food safety. When a feeding plan cannot rely solely 

on either DoD-approved food sources or operational rations because of availability or logistic feasibility, exercise planners may request the FWRA for local food 

procurement.

When small numbers of troops are deployed, planners 

may elect to provide per diem (daily allowance for expenses). Service members usually choose where they eat 

(spend their per diem) and contracted 

meals are not required. While placing 

service members on per diem allows 

them to eat at any number of facilities, 

FWRAs should still be considered to 

lower the risk at the food operations 

that will likely be frequented by service 

members. Another option is contracting with local restaurants or caterers to 

provide meals (no per diem). This option 

requires service members to eat local 

foods from the contracted local food operations. Under this scenario, an FWRA 

is required to ensure that food protection 

risks are understood and mitigated.

The FWRA can roughly be divided into 

2 categories: those performed on upscale 

hotels (often large hotel chains) that host 

DoD sponsored conferences in major cities, and those in support of military exercises, often outside urban areas, where 

in-need rural populations are located. 

The bulk of FWRAs currently performed 

are on upscale hotels in major cities. This 

is certainly the case in the US Southern 

Command’s (SOUTHCOM) area of focus where upscale hotels are routinely 

assessed every 6 months and maintain 

food protection practices arguably comparable to similar hotels in the United 

States. These upscale hotel assessments 

are largely facility-based assessments 

that evaluate individual hotel kitchens 

outside the context of larger exercises. 

In contrast to urban assessments, FWRAs 

conducted in support of exercises in less 

developed areas often require assessors 

to evaluate higher risk moderate scale 

hotel kitchens and consider the complete 

(beyond the hotel) exercise feeding plan. 

Heightened water quality concerns in rural areas due to inferior water distribution 

systems and increased agricultural use create a need for 

safe bottled water sources (Figure 3). In addition to bottled water, fresh fruits and vegetables, local restaurants 

and caterers are assessed to build feedings plans.

Assessors who understand how each food operation 

impacts the overall feeding plan remain agile and able 

to advise contractors and commanders on less obvious 

risks. For example, a hotel kitchen with a moderate risk 

of food-borne illness when serving below its maximum 

capacity may present an extremely high 

food-borne illness risk if required to 

double the number of meals served. The 

risks of food-borne illness spikes when 

food operations surge to meet increased 

demand. The challenging task of developing the safest possible feeding plan 

requires assessors to consider both the 

overall feeding plan and the intended 

use of each food operation.

FWRA RISK COMMUNICATION

Unbroken risk communication to supported commanders and service members who may encounter higher risk 

local foods can prevent food-borne 

diseases. Besides commanders and service members, other key stakeholders 

include the assessor and the contractor. 

The assessor evaluates food operation 

risks and assists contractors in embedding food safety requirements into statements of work. This relationship with 

Figure 2. Ice that is used directly in drinks held in unsanitary buckets and plastic bags.

Figure 3. Reverse osmosis water 

purifi cation system in a bottled 

water plant.
66 http://www.cs.amedd.army.mil/amedd_journal.aspx

contractors is crucial to effect 

the most change within the 

food operation. For example, 

statements of work can require 

the replacement of excessively 

worn cutting boards, the purchase of additional freezers 

to ensure ample cold storage, 

building and kitchen improvements, or even direct the use of 

thermometers.

The assessor communicates 

risk using the risk assessment 

matrix (Figure 4) contained in 

Field Manual 5-19.

5

 Since commanders are accustomed to this 

risk communication tool, its 

use allows food-borne illness 

threats to be placed in the same 

context as other operational risks.6

 This concept must 

remain central to the medical planning perspective so 

that threats may be compared and communicated to 

commanders as transparently as possible. A commander 

can then give this information appropriate weight with 

other risks present on the battlefi eld.

FWRAs IN THE US SOUTHERN COMMAND

The US Army South (ARSOUTH) Deputy Chief of Staff, 

Medical administers SOUTHCOM’s FWRA program. 

The program’s success hinges on partnerships between 

the Army Public Health Command (USAPHC) and other SOUTHCOM organizations. Specifi cally, USAPHC 

Region-South plays a critical role not only in executing 

the majority of FWRAs performed, but also in maintaining a FWRA database. This success is maintained 

by clearly delineating roles and responsibilities within 

SOUTHCOM’s FWRA Standard Operating Procedure 

(SOP). This SOP provides guidance to US military 

groups (MILGROUPs) within host countries, FWRA assessors, and contracting offi cers within SOUTHCOM.

The US military groups facilitate FWRAs by coordinating assessment schedules, in-country transportation, 

translators, laboratory sample shipping, and country 

clearance. The assessor’s role is to coordinate FWRAs 

with the military groups, perform assessments, and submit completed documents to the ARSOUTH Command 

Veterinarian. Contracting offi cers are pivotal in ensuring that the statement of work incorporates realistic risk 

mitigation requirements, and supported commanders 

receive the risk mitigation recommendations. While 

other combatant commands may not yet have the mature, 

standardized program found in SOUTHCOM, FWRAs 

are being conducted regularly across the DoD.

FWRAs IN FOREIGN HUMANITARIAN ASSISTANCE 

OPERATIONS

Natural disasters and other humanitarian crises often 

occur in regions of the world where DoD-approved 

sources are not present or are no longer present due to 

the disaster. Because foreign humanitarian assistance 

(FHA) operations often involve a rapid response to address human suffering, establishing a formal supply 

(DoD-approved sources or operational rations) system 

or conducting sanitary food protection audits of suppliers in a timely manner may not be practical. Finally, 

the transient nature of FHAs limit the long-term value 

of the audits as the operation may be over before fi nal 

approval is granted. Consequently, in FHA operations, 

the FWRA offers commanders a valuable alternative 

for providing sustainment to US service members while 

still ensuring force health protection, as was the case 

during the 2010 DoD fl ood relief operations in Pakistan.

FWRAs were conducted at each of 3 US base camps 

in Pakistan. The initial overall risk assessment for all 

locations was “high,” primarily due to the threat of microbial contamination of food and water. However, the 

implementation of recommended control measures reduced the overall risk to “moderate.” Several of the key 

recommendations were:

 Remove all ruminant meat and meat products from 

the menu (due to the potential risk of bovine spongiform encephalopathy).

FOOD AND WATER RISK ASSESSMENTS:

EMPOWERING COMMANDERS AND PROTECTING SERVICE MEMBERS

Figure 4. Risk management matrix.

Hazard

Severity

Hazard Probability

Frequent (A) Likely (B) Occasional (C) Seldom (D) Unlikely (E)

Catastrophic (I) Extremely High Extremely High High High Moderate

Critical (II) Extremely High High High Moderate Low

Marginal (III) High Moderate Moderate Low Low

Negligible (IV) Moderate Low Low Low Low

Risk Estimate

Hazard probability definitions:

Frequent - occurs very often, continuously experienced.

Likely - occurs several times.

Occasionally - occurs sporadically.

Seldom - remotely possible, could occur at some time.

Unlikely - can assume will not occur, but not impossible.

Hazard severity definitions:

Catastrophic - loss of ability to accomplish the mission or mission failure. Example indicators: death or 

widespread severe illness

Critical - significantly (severely) degraded mission capability or unit readiness. Example indicators: 

multiple food-borne illness incidences.

Marginal - degraded mission capability or unit readiness. Example indicators: sporadic food-borne 

illness, loss of confidence in food supply safety.

Neglible - little or no adverse effect on mission capability.

Source: Field Manual 5-19: Composite Risk Management5
 January – March 2013 67

THE ARMY MEDICAL DEPARTMENT JOURNAL

 Increase the cooking times and temperatures to US 

required levels.

 Use bottled water (from a former approved source) 

for cooking.

 Substitution of high-risk food items on the menu 

with lower-risk food items which were exempt from 

requiring approval (for example, replace locally 

manufactured products with imported products 

from Europe).

 Chlorination of bulk water tanks used for washing 

dishes and cookware with monthly testing for residual chlorine (Figure 5).

 Establish mess trailers for food preparation and dining (Figure 6).

While these recommendations did not completely eliminate the risk of food-borne illness, they did reduce the 

overall risk to a level that was acceptable to the commander and did not negatively impact the FHA operations in Pakistan.*

COMMENT

The FWRA program expanded the Veterinary Corps 

offi cers’ toolbox, allowing them to better deliver food 

protection expertise and broadly shape risk in local food 

operations. Actively mitigating risk and guiding commanders to relatively lower-risk food operations has 

created new challenges and opportunities. The FWRA 

program is transitioning to a military standard, handbook, and checklist (see extracted sample on the following page) to be released in 2013. Improvements include a 

consolidated and updated checklist that allows assessors 

to systematically evaluate food operations in the context of exercise feeding plans. Another change provides 

the assessor with the tools to recommend exclusion of 

higher risk food items (for example, unpasteurized dairy 

products that pose a threat of brucellosis) from food operations. These changes will facilitate the evolution of 

this rapidly growing program.

Probably the greatest challenge is effective risk communication. Veterinary Corps offi cers do an excellent job of 

identifying threats and assessing food protection risks, 

but this risk must be communicated effectively to commanders and Warfi ghters who will use these food operations. Additionally, as combatant commands mature 

their FWRA programs, great care should be taken to develop processes that do not sacrifi ce risk communication 

for convenient contracting. Specifi cally, food operations 

should not receive a pass/fail designation based on the 

FWRA. Rather, informed commanders must weigh the 

FWRA risk level assigned against mission requirements 

and accept or reject the risk. Contracts should only be 

formed after risks are accepted by supported commanders. Further, these risks should be fully reevaluated prior 

to any contract renewal.

While challenges exist with the FWRA program, it also 

provides several opportunities to improve food safety, 

including the latitude to provide food operations recommendations and on-site training. These training opportunities create an avenue for skilled assessors to impart 

their expertise. Additionally, the ability to directly engage partner nations and deliver simple and sustainable 

food protection training that directly effects host nation 

health may open the door to exercise-related training engagements apart from the FWRA program.

Even when DoD-approved food sources or operational rations are maximized and FWRAs are leveraged, 

*See related article on page 81.

Figure 5. Bulk water tanks for the kitchen and dining facility.

Figure 6. A portable, commercial kitchen for on-site food preparation.
68 http://www.cs.amedd.army.mil/amedd_journal.aspx

deployed personnel still encounter higher risk local 

foods, often by choice. They must, therefore, be forearmed with enough food protection knowledge to make 

safer choices with local foods. Educational materials 

such as those available online from the USAPHC (http://

phc.amedd.army.mil/topics/foodwater/ifs/Pages/Local

FoodChoicesDuringDeployment.aspx) provide realistic 

guidance on local food consumption to reduce foodborne diseases.2

 These diseases range from acute bouts 

of diarrhea from Campylobacter spp to life-long spondylodiscitis and sacroilitis from diseases such as brucellosis from unpasteurized milk.

CONCLUSION

The FWRA program has experienced rapid growth because it empowers supported commanders and assessors with essential information, meshes with counterinsurgency operations, and is especially applicable to developing countries. This empowerment is accomplished 

by packaging veterinary expertise into realistic risk 

mitigation recommendations. More than ever, assessors 

must understand and assist planners and contractors in 

assembling the safest feeding plan possible. This understanding allows assessors to engage and exercise their 

veterinary technical knowledge, better partner with assessed food operations, and ultimately protect Warfi ghters by reducing the risk of food-borne illness.

REFERENCES

1. Military Standard 3006A: Sanitation Requirements 

for Food Establishments. Washington, DC: US 

Dept of Defense; August 20, 2000.

2. United States Army Public Health Command. 

Worldwide Directory of Sanitarily Approved Food 

Establishments for Armed Forces Procurement. 

Available at: http://phc.amedd.army.mil/topics/food

water/ca/Pages/DoDApprovedFoodSources.aspx. 

Accessed August 12, 2012.

3. Putnam SD, Sanders JW, Frenck RW, et al. Selfreported description of diarrhea among military 

populations in operations Iraqi Freedom and Enduring Freedom. J Travel Med. 2006;13(2):92-99.

4. Riddle MS, Rockabrand DM, Schlett C, et al. A 

prospective study of acute diarrhea in a cohort of 

United States military personnel on deployment to 

the multinational force and observers, Sinai, Egypt. 

Am J Trop Med Hyg. 2011;84:59-64.

5. . Field Manual 5-19: Composite Risk Management

Washington, DC: US Dept of the Army; August 

2006:1-8.

6. Guide for Deployed Preventive Medicine Personnel on Health Risk Management: Technical Guide 

248. Aberdeen Proving Ground, MD: US Army 

Public Health Command; August 2001:21.

AUTHORS

LTC Killian is Chief, Clinical Operations and Command 

Veterinarian, US Army South, Fort Sam Houston, Texas.

MAJ Burke is Assistant Director, Division of GEIS 

Operations, Armed Forces Health Surveillance Center, 

Silver Spring, Maryland.

Mr Westover is Food Defense Specialist, US Army Public 

Health Command Region-South, Fort Sam Houston, 

Texas.

FOOD AND WATER RISK ASSESSMENTS:

EMPOWERING COMMANDERS AND PROTECTING SERVICE MEMBERS

Step-II Risk Description

*Only address items from Step I rated High or Extremely High (Signifi cant Risks).

1st Signifi cant Initial Risk (SIR) – Item #: O5

● High ○ Extremely High 

Describe SIR: Thermometers were not used to verify internal temperatures of 

chicken or beef before serving. While the chefs were very experienced with using 

cooking time / observation to determine when the chicken and beef were ready, using 

thermometers will verify product-specifi c internal temperatures were reached.

Mitigation for SIR: Assessor provided establishment a thermometer and on-site 

training with meals being prepared. Training included recalibrating thermometer in 

ice-water. Lead chef was receptive, engaged, and likely to use thermometer in future. 

Compliance probable. 

Residual Risk When Mitigated: ● Low ○ Moderate ○ High ○ Extremely High 

Affected Product Exclusions (if not mitigated): ___________________ ●None

Reason for Exclusion: N/A

Extracted portion (Step II) 

from draft Food and Water 

Risk Assesment checklist.
 January – March 2013 69

HISTORY OF PRIVATELY OWNED ANIMAL CARE BY 

MILITARY VETERINARIANS

A major focus of the Veterinary Corps is public health, 

thus the prevention of zoonotic disease transmission to 

service members and their families has been of utmost 

importance throughout its history. Military veterinary 

care of service members’ pets originally focused on prevention of zoonotic diseases, especially rabies, a fatal 

disease in humans. As far back as 1928, Army veterinarians were given the mission of vaccinating pet dogs, 

cats, and other animals against rabies.1

 Prior to World 

War II, military offi cers’ privately-owned horses were 

provided the same veterinary care as that provided for 

Army horses and mules.1

 Although some general veterinary care was provided to privately-owned dogs, cats, 

and other pets of service members, the primary responsibility of the Army Veterinary Corps with regard to pets 

was to prevent disease transmission to military animals, 

humans, and communities, particularly during animal 

movement. In addition to the obligatory rabies vaccination program, Army veterinarians were responsible for 

conducting physical examinations and issuing veterinary 

health certifi cates to pet animals prior to their transportation. Upon arrival at their destination, these animals 

were kept under quarantine or veterinary observation 

until declared free of contagious diseases. On Army installations, the provost marshal required registration of 

pet dogs and cats, and annual rabies vaccinations were 

required to renew the registrations each year. Unregistered animals and strays were subject to impoundment 

and disposal. Later, vaccination programs were expanded to include those diseases that could be transmitted to 

military working dogs, including distemper, adenovirus 

(hepatitis), parainfl uenza, and leptospirosis, followed 

years later by parvovirus. Vaccination programs also 

expanded to provide vaccines to cats for common feline 

viruses.

ADPACS TO VETERINARY TREATMENT FACILITIES

After establishment of the US Air Force Veterinary 

Corps in 1949, the Army Veterinary Corps provided 

veterinary services to Army installations, the Air Force 

Veterinary Corps to Air Force installations, and both 

shared responsibility for provision of veterinary services to Navy and Marine Corps installations. Upon dissolution of the Air Force Veterinary Corps in 1980, the 

Army became the executive agent for all Department 

of Defense (DoD) veterinary services and expanded to 

provide animal health care to all Air Force, Army, Navy, 

and Marine Corps installations.2

 At that time, military 

veterinary facilities were referred to as ADPAC, the acronym for Animal Disease Prevention and Control. This 

terminology emphasized the preventive medicine nature 

of the services offered and downplayed the veterinary 

capabilities of the facility. Although pets presented to 

ADPAC facilities for a variety of clinical complaints, essentially only health certifi cates, vaccinations, deworming, and diagnosis and treatment of potentially zoonotic 

conditions were allowed by policy. All other medical 

and surgical conditions were referred to local civilian 

veterinarians off the installation for workup and treatment. An agreement was established between the US 

Army Veterinary Corps and the American Veterinary 

Medical Association (AVMA) limiting the practice of 

military veterinary medicine for pets to those aforementioned services within the United States. Surgery in pets 

was restricted to those emergency procedures necessary to save life, limb, or eyesight before transportation 

to a civilian veterinarian for further care. Most of the 

impetus behind this policy was to limit competition for 

the civilian veterinarians in the local communities surrounding military installations. It also kept the focus of 

Army veterinarians on their primary missions. Care of 

privately-owned pets was, and remains today, a secondary mission that ranks in priority behind the primary 

missions of veterinary care for military working dogs 

and other government-owned animals, food inspection, 

and public health.

In US military terms, overseas locations are referred to 

as outside the continental United States (the 48 contiguous states), or OCONUS. Due to language barriers and a 

lack of equivalent veterinary standards in several countries where US service members and their families were 

stationed, full service military veterinary clinics were 

established at many OCONUS locations. A wider array 

of veterinary services, including surgery and treatment 

for conditions other than zoonoses, were provided for 

pets of authorized personnel. At some locations, 24-hour 

emergency services were also provided by military veterinarians. This was not against policy since the AVMA 

agreement only applied within the United States. In some 

The Role of the US Army Veterinary Corps in

 Military Family Pet Health

LTC (Ret) Nancy A. Vincent-Johnson, VC, USA
70 http://www.cs.amedd.army.mil/amedd_journal.aspx

remote locations within the United States, exceptions to 

policy were granted to provide full service veterinary 

clinics because there were no civilian veterinary clinics located nearby. These locations included Fort Irwin, 

California, and White Sands Missile Range, New Mexico, both located in the desert a long distance from a city 

or large town. New Veterinary Corps offi cers relished 

being stationed at these full service locations because 

they could perform the full spectrum of veterinary care, 

including surgery, to pets of service members stationed 

there. At OCONUS and some remote US locations, veterinary care for pets of DoD civilians was authorized because those personnel are authorized DoD medical care.

By the early 1990s, the Veterinary Corps realized that 

policy limitations prohibiting Veterinary Corps offi cers 

from practicing surgery and services beyond preventive 

medicine in pets were causing those offi cers to lose some 

of their hard-earned veterinary skills, and perhaps interest in remaining in the Veterinary Corps. The neglected 

skills of military veterinarians were refl ected in a declining quality of care they provided to military working 

dogs. Very slowly things began to change. In the 1994 

version of the triservice veterinary regulation,3

 there 

was a slight easing of the restrictions which allowed establishment of authorized population control and other 

surgical programs within the United States and its territories. The changes meant that, with approval from the 

local chain of command, Army veterinarians could start 

programs to spay and neuter unclaimed, adoptable stray 

dogs and cats from their installations. Around that same 

time, there was also a switch in terminology from ADPAC facility to veterinary treatment facility (VTF). In 

addition to aligning with the new terminology for human 

medical facilities (medical treatment facility), veterinary 

treatment facility represented a major change in philosophy in that the veterinary mission role was no longer 

minimized by withholding the term “veterinary” from 

names of facilities operated by the Veterinary Corps. 

The newly established US Army Veterinary Command 

(VETCOM) united the various veterinary activities scattered across the United States and instituted new common goals and policies. Seeing a strong need for Army 

veterinarians to maintain and develop their clinical 

skills, VETCOM initiated a clinical profi ciency initiative in which each Veterinary Corps offi cer was required 

to perform a small number of surgeries, medical case 

workups, and emergency medicine cases or scenarios 

per quarter. Although there was some initial resistance 

within VETCOM and from civilian veterinarians who 

practiced near military installations, the initiative was 

enthusiastically welcomed by younger military veterinarians who were eager to reinforce and further develop 

their clinical skills. Eventually the required cases within 

each category expanded to 7 and that number, 7-7-7, became a minimum standard with no set limits on the maximum. The AVMA agreement was altered to remove the 

past limitations, and in 2008 was revised to the current 

version which reads in part as follows:

Veterinary services will be provided across the full spectrum of veterinary medicine, as directed by the Department of Defense. These services are an important benefi t 

for the Department of Defense service member and their 

family and also provide a critical training and profi ciency base for the Army Veterinary Service personnel.

The entire text of the AVMA agreement and policy on 

military veterinary treatment facilities is presented on 

the next page.

STRAY ANIMAL FACILITIES

Although collection of stray animals on military reservations is the responsibility of the installation commander, 

the Army Veterinary Corps has traditionally played 

important roles in stray animal control. On many military (mostly Army) installations, the Army Veterinary 

Service traditionally had the responsibility of confi nement of strays, and hence maintained the stray animal 

facility. By regulation, stray animals are required to be 

held for a minimum of 3 working days to provide owners suffi cient time to reclaim their animals. After that 

waiting period, animals with good dispositions are typically put up for adoption while feral animals and those 

with bad temperaments or severe medical problems may 

necessarily be euthanized. Animals in the “stray facility” were cared for by veterinary staff before and after clinical hours, as well as on weekends and holidays. 

The workload took a toll on unit morale and detracted 

from the other veterinary missions. Over the last decade, 

VETCOM moved to ensure responsibility for stray animal confi nement is assumed by the individual installations. As of 2012, most installation veterinary service 

activities no longer have responsibility for a stray animal 

facility. At each military installation with such a facility, 

the Army veterinarian is still responsible for performing 

sanitary inspections of the facility at least quarterly, but 

preferably on a monthly basis to ensure that it meets a 

minimum standard of safety and cleanliness. The Army 

veterinarian also examines injured or ill strays, which 

are considered government-owned animals for the fi rst 

3 working days, and takes the appropriate course of action depending on the nature and severity of the medical 

condition. In addition to providing veterinary care to ill 

or injured animals, the installation’s Army veterinarian 

may manage a population control program which involves neutering stray animals prior to their adoption. 

All expenses for neutering and vaccinating the adoptable strays are recouped through an adoption fee paid by 

the new owner.

THE ROLE OF THE US ARMY VETERINARY CORPS IN MILITARY FAMILY PET HEALTH
January – March 2013 71

THE ARMY MEDICAL DEPARTMENT JOURNAL

ANIMAL BITE/RABIES CONTROL PROGRAM

Of all the missions performed by the Army Veterinary 

Corps, one of the most important is that of preventing 

rabies in humans. Rabies is a viral disease, transmitted through contamination of wounds or mucous membranes by the saliva of an infected animal. Most commonly, this occurs when an individual is bitten by a rabid animal. The rabies virus causes infl ammation of the 

brain known as encephalitis. The infl ammation results 

in severe neurological signs typifi ed by aggression and, 

in wild animals, a loss of fear of humans. The incubation period for rabies is long, usually weeks to months 

after being bitten by a rabid animal. In humans and most 

domestic animals, death occurs within a matter of days 

once neurological signs become apparent. Because of 

this, a 10-day quarantine period is established for dogs 

and cats which bite humans. If the animal does not die 

of rabies during this period, there is virtually no chance 

that rabies has been transmitted to the victim. Veterinary Corps offi cers and their staff are considered the 

subject matter experts in rabies for all branches of the 

US military. Knowing which species of animals possess 

a risk of rabies and which do not, knowing how to manage dogs and cats that may have been exposed to a rabid 

animal, and knowing when and how to test rabies suspects are just a few examples of essential knowledge of 

the Army veterinarian. When a human patient presents 

to a military treatment facility for any animal bite, a DD 

Form 2341 (Animal Bite Report) is generated to record 

all the details about the bite, including a description of 

the biting animal, and if it is a pet, hopefully the name 

and address of its owner. The report is then forwarded 

to the local military veterinary service staff which is 

responsible for investigation of the biting animal to determine risk of exposure to rabies for the patient. This, 

in turn, will assist the attending physician in deciding 

whether or not to vaccinate the patient against rabies. 

Fortunately, rabies postexposure treatment is extremely 

successful as long as it is initiated in a timely manner, 

but it is never undertaken lightly as it is expensive, somewhat painful, and not without risk of adverse effects.

Agreement Between the American Veterinary Medical Association and the 

US Army Veterinary Corps Establishing Policy Regarding Services Provided at 

Military Veterinary Treatment Facilities

Army veterinarians provide health care for government-owned animals and for animals of individuals 

authorized military privileges, with an emphasis on wellness, preventive medicine, and outpatient services. 

Veterinary services will be provided across the full spectrum of veterinary medicine, as directed by the 

Department of Defense. These services are an important benefi t for the Department of Defense service 

member and their family and also provide a critical training and profi ciency base for the Army Veterinary 

Service personnel. Authorized veterinary services, for both active duty and retired personnel, are the same 

for personnel living off post as for those living on post. The military Veterinary Treatment Facility is operated 

by the Veterinary Corps offi cer or designated Veterinary Service civilian veterinarian, and all assistants are 

under their direct supervision. A valid Veterinarian-Client-Patient relationship (VCPR) will be established 

prior to initiating treatment. Veterinary services will not be provided in support of any commercial operations 

raising animals (pet or livestock) for sale or profi t.

Cooperation and referral between civilian and military veterinary personnel are strongly encouraged. 

Participation of military veterinary service personnel in local and state veterinary activities such as 

associations, immunization campaigns, fairs, epizootic control programs, public relations functions, etc. in 

a professionally complementary manner is authorized and encouraged. The vital “One Medicine” human 

and animal health effort may require military and civilian veterinarians to partner in an overwhelming event 

such as natural or man-made disasters or disease outbreaks. Army veterinarians are authorized to assist the 

local veterinary association or other appropriate civilian authority in these situations, upon request and, with 

the approval of their chain of command.

The AVMA recognizes and supports Department of Defense animal medicine and public health programs 

administered by military veterinary personnel. In the event clarifi cation is needed on the activities of a 

particular military Veterinary Treatment Facility, the president of the local veterinary association should fi rst 

contact the local Veterinary Corps Offi cer and his or her chain of command, and, if further clarifi cation is 

needed, the American Veterinary Medical Association.

Approved by the American Veterinary Medical Association Executive Board, April 2008.

Oversight: Council on Veterinary Service
72 http://www.cs.amedd.army.mil/amedd_journal.aspx

The veterinary service staff attempts to locate the biting 

animal. This effort may involve contacting the military 

police, contacting civilian health departments and animal control offi cers, or contacting the animal owner directly if the animal lives on a military installation. If the 

latter is the case with a biting dog or cat, the owner must 

bring the pet to the veterinary treatment facility for the 

veterinarian to review the animal’s record and perform 

an exam to determine whether the animal is current on 

its rabies vaccination, and whether the animal is exhibiting any clinical signs suspicious of rabies. Depending on 

the fi ndings, the pet may be allowed to undergo a home 

quarantine at the owner’s house, or it may be required 

to undergo quarantine in a veterinary facility under the 

observation of a veterinarian. While some military veterinary treatment facilities have the isolation kennels 

necessary to perform rabies quarantine, some do not. In 

the latter case, a civilian veterinary clinic would be used 

to conduct the quarantine at the owner’s expense. If the 

animal is exhibiting neurological signs consistent with 

rabies at either the prequarantine examination, the endof-quarantine examination, or at any time during the 

quarantine, the animal must be euthanized and tested for 

rabies. Feral or wild animal rabies suspects which are 

captured after biting a person must be euthanized and 

tested. On military installations, the Veterinary Corps 

offi cer is responsible for euthanizing and submitting the 

animal for rabies testing and for ensuring that the result 

of the rabies test is immediately communicated to the 

patient’s physician as soon as it becomes available.

TALENTED TANGOs

The role of the Army Animal Care Specialist in the provision of military veterinary care to pets is extremely 

important. The military occupational specialty (MOS) is 

68T, and the specialist is known colloquially as a “Tango.” The skilled Tango is a talented individual because 

the MOS requires the skills of a medic, a laboratory 

technician, an x-ray technician, a nurse anesthetist, an 

operating room technician, a pharmacy technician, a patient administration specialist, and a dental hygienist, all 

combined in one. Amazingly, their Advanced Individual 

Training (AIT) school is shorter than any of those other 

AIT schools, so they must learn many of their skills on 

the job. The Army Animal Care Specialist AIT school 

is also much shorter than that of their civilian counterpart, the veterinary technician. Because of the length and 

scope of their education, graduates of civilian programs 

are eligible to sit for the state veterinary technician licensing examinations, whereas the Tango is not due to 

the brevity of their AIT. (See related article on page 11.)

Since there are relatively few Army veterinarians to 

cover all four of the US military services worldwide, the 

Tangos’ assistance is imperative to the success of the 

mission of the Veterinary Corps. As in civilian practice, 

the Tango assists the veterinarian in seeing sick call appointments. Unlike the veterinary technician in civilian 

practice, after being credentialed by the veterinarian, the 

Tango often sees wellness appointments independently 

of the veterinarian. This is a force multiplier which enables many more pets to be seen than could be seen by 

the veterinarian alone. During these wellness appointments, the Tango performs vital signs, obtains a brief 

health history, performs a screening physical exam, obtains blood for heartworm and feline leukemia tests, performs other laboratory procedures, administers vaccines 

and microchips, and dispenses preventive heartworm 

and fl ea/tick products. The Tango also answers client 

questions regarding health and training, and alerts the 

veterinarian when health problems are identifi ed. When 

the veterinarian is off the premises, the Tango is normally limited to performing noninvasive procedures such as 

fecal examinations. However, an exception to policy has 

occasionally been allowed for select remote OCONUS 

locations, such as the Azores, to allow the Tango to perform vaccinations, heartworm testing, and minor treatment for parasites and ear infections in the absence of 

the veterinarian. These “super techs” enable the provision of increased veterinary services to clients at remote 

locations which have no permanently assigned veterinarian. This allows the veterinarian to concentrate on more 

serious health issues and perform surgical procedures 

during their limited visits. At all duty locations, Tangos 

perform anesthesia, place IV catheters, prep animals for 

surgery, assist the veterinarian in surgery, test blood and 

urine, perform dental cleanings, take x-rays, manage the 

animal bite/rabies control program, and more.

FINANCING VETERINARY CARE FOR

PRIVATELY-OWNED PETS

While funds are appropriated by Congress to provide 

veterinary care to government-owned animals, privately-owned animal veterinary care operations are fi nanced 

through nonappropriated funds, commonly called NAF, 

which are self-supporting funds generated through the 

sale of goods and services to support or provide authorized programs. By law, NAFs are used for the collective benefi t of those who generate them. Examples of 

entities that operate using NAF funds include the base 

exchanges (which generate the bulk of those funds), and 

morale, welfare, and recreation (MWR) facilities such 

as bowling alleys, clubs, child development centers, and 

temporary/visitor lodging facilities.

Veterinary facilities are not considered MWR activities. 

Consequently, the Veterinary Service Fund, a supplemental mission fund, is separate and quite different 

THE ROLE OF THE US ARMY VETERINARY CORPS IN MILITARY FAMILY PET HEALTH
 January – March 2013 73

THE ARMY MEDICAL DEPARTMENT JOURNAL

from funds that support other NAF activities. Operational control of the veterinary facility, including fi scal 

decisions, is exercised by the responsible Veterinary 

Corps offi cer. As a nonprofi t activity, a military veterinary treatment facility charges pet owners for veterinary 

services and products to cover expenses. Any profi ts are 

invested in the veterinary facility for new equipment, 

increased services, facility upgrades, etc. Of course the 

Army Veterinary Corps offi cers and the Army animal 

care specialists are active duty military personnel, but 

the civilian receptionists that work at the veterinary 

facility are paid from the NAF funds generated by the 

facility. The collected funds must also be suffi cient to 

purchase and restock the large inventory of medications 

and supplies that are used in the course of providing 

care to privately-owned animals. In addition to the fees 

collected to cover the actual costs of the products and 

services rendered, a $2.00 user fee is charged with each 

transaction. This mandated fee goes to the US Treasury 

to offset the use of appropriated fund resources, namely 

military personnel, which support the NAF activity.

In most veterinary treatment facilities (VTFs), demand 

for pet appointments usually exceeds the availability. To 

better meet the demand, years ago a number of veterinary facilities began to hire civilian veterinary technicians using NAF funds. These NAF technicians helped 

fi ll the gaps during shortages of Army Tangos, and also 

allowed increased numbers of appointments. However, the civilian technicians could only work when the 

Veterinary Corps offi cer was at the facility to run appointments. Years later, VTFs were given authorization 

to employ civilian veterinarians using NAF to expand 

the number of available appointments when the Veterinary Corps offi cer is absent from the VTF. The NAF 

veterinarians also provide continuity during the gaps 

that sometimes occur when the Army veterinarian must 

attend a lengthy military school, or is transferred. Because military veterinarians spend a signifi cant amount 

of time performing their primary missions of food inspection, military working dog care, and public health 

responsibilities, the use of NAF veterinarians allows an 

increased number of pet care appointments when the 

Veterinary Corps offi cer is working on station. As the 

number of NAF employees increase, the fees charged to 

clients must increase to cover the cost of the additional 

wages. More recently, some Veterinary Corps offi cer authorizations as well as some noncommissioned offi cerin-charge (NCOIC) authorizations have been changed 

from military positions to government civil service (GS) 

employee positions. The new positions retain the same 

spectrum of responsibilities as the Veterinary Corps 

offi cer or NCOIC. All government employees are paid 

with appropriated funds, not NAF.

Although each assigned Veterinary Corps offi cer is responsible for clinical operations of their respective VTF, 

fi scal decisions were reviewed and often infl uenced by 

the local installation’s NAF council which managed the 

individual veterinary NAF fund. Historically, this resulted in large variations between VTFs with regard to the 

scope of services offered and the fees charged. In 2008, 

VETCOM undertook the consolidation of all VTF funding under one central NAF fund, the Veterinary Service 

Central Fund. The goals were to standardize fees, expand 

services, and increase continuity of care by hiring additional NAF veterinarians and technicians where needed. 

In addition, consolidation under a single umbrella account allows price breaks on bulk purchases of drugs 

and supplies, creating cost savings that can be passed to 

clients. By May 2012, VTFs on Army, Navy, and Marine 

Corps installations had been converted from individual 

NAF accounts to the central NAF fund. Operations on 

USAF installations were converted in October 2012.

STANDARDS OF CARE: CLINICAL CREDENTIALING

In 2005, the VETCOM Commander proposed development of a clinical credentialing program to assure that 

all Veterinary Corps offi cers assigned within VETCOM 

meet a set standard of clinical skills. An existing credentialing program in the Southeast Regional Veterinary 

Command was used as a model for the new VETCOM 

credentialing program. A newly created regional clinical 

consultant position within the North Atlantic Regional 

Veterinary Command made that region the logical place 

to develop, test, and refi ne the new VETCOM clinical 

credentialing program.

Clinical credentialing tests a new Veterinary Corps offi cer’s ability to apply his or her knowledge and skills 

in a clinical setting, focusing on critical skills necessary to provide the best veterinary care to the military 

working dog and privately-owned pet populations. It is 

based on a clinical credentialing checklist, reproduced 

in the Figure, that is divided into 4 broad areas of general medicine, anesthesia, radiology, and surgery, plus 

a second page of optional tasks if time permits. During 

credentialing, Veterinary Corps offi cers demonstrate 

that they know how to conduct a comprehensive physical examination, neurologic exam, orthopedic exam, 

and ocular exam, interpret ECGs and radiographs, and 

perform anesthesia and 2 different types of surgery. 

Working in small groups of 2 to 5 offi cers over a period 

of one week, credentialing is normally carried out at the 

various duty sites to evaluate them in their own working environment using their facilities, equipment, and 

clinical staff. The program was highly successful. As a 

result, clinical credentialing is now a VETCOM policy 

which mandates that credentialing be conducted within 
74 http://www.cs.amedd.army.mil/amedd_journal.aspx

THE ROLE OF THE US ARMY VETERINARY CORPS IN MILITARY FAMILY PET HEALTH

General Medicine

Authorized the perform General Medicine without direct supervision*

Perform physical exam on a MWD

Perform orthopedic exam

Perform neurologic exam

Perform ocular examination

Interpret ECG

Manage GDV

MWD Deployment Processing

Properly write a SOAP entry

Maintain a MWD record

Manage the Trauma Patient

Sedation and Anesthesia Initials Date

Authorized the perform Sedation and Anesthesia without direct supervision*

Inhalation anesthesia

Staff safety - initial and annual briefings

Pre-operative equipment check

Determine patient’s physical status risk category

Plan individualized anesthetic protocol

Preparation of patient

Induction

Maintenance and Monitoring (manually; Propaq/equivalent)

Postoperative recovery

Sedation Protocols

Pain control (postoperative and chronic pain)

Anesthetic documentation

Radiology Initials Date

Authorized the perform Radiology without direct supervision*

Radiation safety

Critique standard radiographs and identify features of common MWD disease

Surgery Initials Date

Authorized the perform General Surgery without direct supervision*

Prepare patient for surgery (clip, scrub, position)

Scrub, gown, and glove-in for a surgical procedure

Properly drape a surgical patient

Demonstrate proficiency at the following surgical procedures

Laparotomy (Incisional Gastropexy)

Other Laparotomy procedures (ie, OHE, exploratory)

Neuter/scrotal ablation

* Credentialing certification entered into DTMS.

VETCOM VCO Clinical Credentialing Checklist

ALARA, staff safety briefings (initial and annual), radiation 

badge program, shielding, annual testing of protective equipment

No Go

ETCO2, SpO2, Body temperature, HR/RR, NIBP, 

ECG, Fluids

Go

Proctor's Signature:______________________________

Name:___________________________________

Duty Site:________________________________

Proctor's Name:___________________________

Go No Go

Proctor's

Initials

Primary Tasks

Date

DVC:_________________________________________

Rank:___________

Go No Go

Go No Go

Note: Blue font indicates items taken directly from VETCOM training guidance Attachment 3.

US Army Veterinary Command (now US Army Public Health Command) clinical credentialing checklist for 

Veterinary Corps offi cers (page 1 of 2; checklist continued on next page). 
 January – March 2013 75

THE ARMY MEDICAL DEPARTMENT JOURNAL

US Army Veterinary Command (now US Army Public Health Command) clinical credentialing checklist for 

Veterinary Corps offi cers (page 2 of 2; checklist continued from previous page). 

Initials Date

CPR (Basic and Advanced)

Administer Oxygen Therapy

Manage dermatologic conditions (skin, ears, perianal fistula, etc.)

Manage GI disease (diarrhea, parasites) 

Perform dental notations and prophylaxis

Perform dental x-ray views with proper positioning and technique

Evaluate dental radiographs

Manage anaphylactic shock

Manage heat injury

Total IV Anesthesia (TIVA)

Supervise surgical pack and autoclave maintenance

Evaluate and treat envenomation

Manage toxin exposure/ingestion

Infection control/zoonosis

Perform standard x-ray views with proper positioning and technique

Develop an x-ray with automatic processor or Develop an x-ray with Orex CR

Perform abdominal ultrasound

FAST Exam (Focused Assessment with Sonography for Trauma)

Perform ultrasound-guided percutaneous cystocentesis and aspiration

Properly write a SOAP entry

Maintain a MWD record

Perform fine needle aspirate

Interpret Cytology Specimen

Secondary (Optional) Tasks as Time Permits

Go No Go

Interpret CBC and chemistry results

Review MWD necropsy techniques and specimen submission

Process a blood sample

Prepare and review blood smear slide

Process a urine sample

Examine microscopic urine sediment

Demonstrate bandaging techniques

Perform basic parasitology tests (fecal flotation, skin scraping, HW test)

Perform clinical decision-making; determine when to refer an MWD

Perform root canal

Perform dental extraction

Perform exploratory laparotomy 

Operate and maintain Piccolo or VetScan chemistry analyzer

Operate and maintain I-stat machine

Operate Magellan anesthesia machine and oxygen concentrator

Operate Propaq monitor

Operate IV fluid pump

Operate syringe pump

Italics indicates items that are dependent on having the proper equipment or opportune clinical cases.

Note: Blue font indicates items taken directly from VETCOM training guidance Attachment 3.
76 http://www.cs.amedd.army.mil/amedd_journal.aspx

120 days of arrival of a new Veterinary Corps offi cer 

or GS veterinarian. Tasks are graded as a “go” or “no 

go.” Any tasks that are graded “no go” are trained and 

retested during the same credentialing period, if possible. If still not successful, the veterinarian’s commander 

can set clinical limitations for that person until he or she 

successfully passes the tasks in question. The retesting 

follows additional extensive training in identifi ed weak 

areas. Besides ensuring a minimal level of clinical competency in the new Veterinary Corps offi cer, additional 

benefi ts of clinical credentialing were found to include 

instilling confi dence levels in new Veterinary Corps offi cers, providing an opportunity to ask questions as well 

as gain additional training in weak areas, and developing a rapport with the region’s clinical consultant. The 

benefi ts were also found to facilitate later consultations 

and referrals which resulted in improved veterinary 

care for both government-owned and privately-owned 

animals.

VETERINARY MEDICAL STANDARDIZATION BOARD

In 2006, the VETCOM Commander directed the formation of the VETCOM Veterinary Medical Standardization Board (VMSB), modeled after medical standardization boards from some of the most successful 

health maintenance organizations and medical institutes 

across the country. Bringing together a talented team 

of offi cers from throughout the Veterinary Corps, the 

VMSB members comprised a wide variety of ranks and 

specialties who worked together to create a set of high, 

but practical standards. Three committees were initially 

organized: the Formulary Committee, the Equipment 

Committee, and the Protocol Committee.

Formulary Committee

Veterinary Corps offi cers generally change duty stations 

every 2 to 3 years. A common problem upon arrival at 

the new duty location is that the shelves are stocked with 

different medications than those they typically prescribe. 

Expired items are replaced with slightly different versions of similar medications. The Formulary Committee 

was tasked with creating a standardized formulary similar to that found in military medical treatment facilities. 

Standardization has obvious benefi ts: easier transition 

for military veterinarians from one facility to another 

as inventories are the same or very similar; no change 

of inventory with each incoming Veterinary Corps offi cer; and money saved by the combined purchasing 

power across all facilities. It was also necessary to form 

a standardized formulary in preparation for consolidation of the various individual NAFs into one centralized 

NAF account. Items not used frequently enough to be 

included in the formulary could still be prescribed for an 

individual patient for purchase at an outside pharmacy.

Equipment Committee

When Veterinary Corps offi cers or Tangos moved from 

one veterinary facility to another, they often found either a lack of essential equipment or the presence of 

equipment with which they were unfamiliar. Due to a 

number of factors, there was disparity among the equipment found in different veterinary facilities, some were 

very well equipped while others did not have the items 

necessary to properly conduct some procedures such as 

anesthesia. Learning to use a different piece of equipment could be diffi cult, especially when a veterinarian 

or animal care specialist was working temporarily in the 

facility. Sometimes purchased equipment was incompatible with existing systems or expendable supplies, and 

replacement parts were hard to come by. These factors 

often led to disuse of the item.

The goal of the Equipment Committee was to select one 

brand and model of each equipment item that would 

best serve all of the veterinary facilities. The selection 

was based on a number of factors: functionality, compatibility, reliability, ease of use, maintenance requirements, procurement and operating costs, availability of 

expendable supplies and parts, and others. Standardized 

equipment provides each facility with the same capabilities with respect to performing procedures such as 

anesthesia, x-rays, laboratory testing, and more. Also, 

equipment training can be done once, and Veterinary 

Corps offi cers and Tangos could carry that training with 

them from one facility to the next. As with the standardized formulary, purchasing numerous identical items 

allows better pricing from manufacturers, resulting in 

substantial cost savings to the government. Standardization also ensures that the equipment is ordered with the 

same options rather than different confi gurations as is 

the case with the nonstandard equipment. The Equipment Committee researched numerous manufacturers 

and models before recommending the initial selections. 

The committee reviews new equipment items as well as 

feedback and requests from the fi eld, and adjusts the list 

of standardized equipment accordingly. Rather than automatically replacing functional equipment items with 

the standardized item, existing equipment is kept in 

place until its service life has expired, then it is replaced. 

This avoids waste and excessive expenditures.

Protocol Committee

The Protocol Committee is chartered to establish standards of care predicated on evidence-based medicine 

whenever possible. Rather than forcing veterinarians to 

practice an algorithm style of medicine, the Committee intended to set a minimum bar with parameters on 

the right and left and no ceiling, leaving the practitioner 

with the opportunity to apply experience and skills to 

THE ROLE OF THE US ARMY VETERINARY CORPS IN MILITARY FAMILY PET HEALTH
 January – March 2013 77

THE ARMY MEDICAL DEPARTMENT JOURNAL

the practice. This was to ensure that patients received 

high quality care, although the specifi cs of that care 

could vary depending on the individual veterinarian.

The fi rst product that emerged from the Protocol Committee was the Handbook of Anesthesia/Pain Management Standards. During anesthesia, the patient’s life is 

completely in the hands of the anesthetist and so it is 

extremely important to use safe methods and critically 

monitor the patient. Unfortunately, anesthesia is an area 

in which many new veterinarians lack confi dence. The 

Handbook helps by establishing a specifi c protocol for 

“normal” patients as well as establishing additional protocols for those suffering from various conditions, such 

as heart disease, kidney disease, liver disease, and many 

others. There is also a protocol for emergency procedures 

and another for critically ill patients, as well as recommendations on various methods of controlling pain before, during, and after surgery. The comprehensive document sets minimal standards in such areas as preanesthetic workup, anesthetic monitoring, and postprocedure 

pain management. It offers numerous tips and advice on 

what to do if one encounters abnormal fi ndings on preanesthetic bloodwork or during anesthetic monitoring.

The Protocol Committee also produced the Small Animal Vaccination Guidelines. The Guidelines standardize vaccination protocols and vaccine products so that 

clients will not encounter drastic differences in vaccination schedules or vaccine types when they move from 

one facility to another. It takes into account risk factors 

for specifi c diseases which vary among geographical areas. For instance, Lyme disease vaccine is highly recommended for dogs in northeastern and midwestern states, 

while not advocated for dogs living in the southeast or 

the west. The Protocols Committee continues to work at 

developing additional standards of care documents for 

implementation within Army veterinary facilities.

Business Practices Committee

The Business Practices Committee was later added to 

the VMSB. Its goal is to make best practices decisions 

for the business side of the veterinary facilities and to 

safeguard the fi nancial aspects. A Clinical Operations 

Handbook was developed to standardize the way that 

each Veterinary Facility operates in order to give the 

client a consistently good experience at every facility. 

Today, business practices are largely developed and implemented by the Veterinary Service Central Fund.

The VMSB committees are dynamic entities—committee chairpersons discuss issues with committee members as necessary to consider additions and changes to 

their specifi c areas. Requests for additions or changes to 

the formulary, equipment items, and protocols or business practices can be made by any military, NAF, or GS 

veterinarian at any time using a standard request form. 

Feedback on experiences using the formulary, equipment, and protocols are also welcome and help the committees refi ne and improve their products.

VETERINARY CLINICS, CENTERS, AND ACTIVITIES

As the VMSB began its work, VETCOM leaders acknowledged that not all veterinary facilities would be 

able to offer the full spectrum of veterinary services 

due to size or inadequacy of physical facilities, lack of 

a permanently assigned veterinarian, and other factors. 

In the past, veterinary facilities had been classifi ed into 

3 tier levels. However, the terminology was confusing 

even to those within the Veterinary Corps and certainly 

to clients. New terminology was developed in conjunction with the VMSB standards discussed earlier. The 

majority of veterinary facilities continue to be veterinary treatment facilities. Wellness and sick call appointments continue to be available at VTFs, which also have 

the capability to perform routine surgery (spay/neuter, 

small mass removal, etc), and basic emergency care. The 

smaller VTFs are now veterinary clinics, they do not 

have a full-time assigned veterinarian, but are staffed 

either as an attending site or with a NAF veterinarian. 

Veterinary clinics would primarily offer wellness appointments and basic sick call with no surgery capability. After basic stabilization, emergency patients would 

be transported from a veterinary clinic to an appropriate civilian or military facility. The highest level facility 

is now a veterinary center (VETCEN). The VETCEN 

has a training mission (see section First Year Graduate 

Veterinary Education Program on the following page) 

and is staffed with more than one veterinarian, including a clinical specialist with expertise in surgery, internal medicine, or critical care. In addition to the same 

capabilities for appointments and basic routine surgery 

offered at the VTFs, some advanced procedures and surgeries are available at the VETCEN depending on equipment, staffi ng, and the capabilities of the assigned specialist. VETCENs could also accept referrals from other 

veterinary facilities on a space available basis if time 

and resources permit. A veterinary activity (VETAC) is 

similar in concept to the VETCEN, however, it does not 

have a training mission. Examples of VETACs are the 

facilities in Okinawa and Vogelweh, Germany, which 

have an assigned clinical specialist, increased technical 

staff, and equipment to manage more involved cases.

PRIVATELY-OWNED ANIMAL HEALTH RECORDS

Veterinary medical records are initiated on privatelyowned animals at the time of animal registration or at 

the fi rst visit to the veterinary facility. Traditional hard 
78 http://www.cs.amedd.army.mil/amedd_journal.aspx

copy medical records consist of the green record jacket 

(DD Form 2344) which contains a Veterinary Health 

Record (DD Form 2343) used as a cover sheet to display 

pertinent items such as owner information, animal data, 

immunization data, a master problem list, and a record 

of laboratory tests procedures. The record jacket holds 

the Standard Form 600 containing the doctor’s and technician’s medical notes. There are a number of DoD and 

standard forms used in the pet health record, including 

the rabies vaccination certifi cate, health certifi cates, records of various laboratory results, and much more. For 

years the healthcare industry, military and civilian, has 

worked to develop and implement electronic medical records, with varying levels of success. Within military 

veterinary medicine, individual facilities implemented 

electronic record applications of their choice. As a result, 

there was a large variety of software applications in use 

throughout the facilities. Most applications were used 

only for invoicing and inventory control, not for medical notes or treatment records. The existence of many 

various programs complicated personnel movement between locations because of the learning curve for a different system. Each of the multiple programs generated 

a different style report, making it diffi cult to compare 

data across the facilities. These issues prompted VETCOM to mandate the system-wide implementation of 

the commonly used veterinary medical record software 

application, AVImark (McAllister Software Systems, 

Piedmont, MO). Over time, all facilities have made the 

transition. Veterinary personnel also began to use the 

medical recordkeeping feature to document their medical notes directly into digital format. For obvious reasons, 

the use of a single system has dramatically improved effi ciency across the Army Veterinary Service. However, 

AVImark is an individual device installation that is not 

networked among facilities, so AVImark records and 

data cannot be electronically transferred. Consequently, 

animal data must be completely re-entered when a client changes veterinary facilities. Further, veterinarians 

and staff cannot retrieve records from another facility, 

a problem when proof of a previous vaccination is required. The VETCOM initiated development of a new 

Veterinary Electronic Medical Record (VEMR). The 

VEMR will be built as a web-based system accessible 

by authorized, credentialed personnel from any military 

network location. The VEMR will solve the problems of 

record access and transfer, as well as signifi cantly enhance productivity and patient treatment capabilities.

FIRST YEAR GRADUATE VETERINARY EDUCATION 

PROGRAM

Most veterinarians enter the Army Veterinary Corps 

shortly after graduation and are typically assigned to 

duty sites where they are the only veterinarian. This 

can be somewhat overwhelming to the new graduate 

with much knowledge, but limited experience. Unlike 

most of their civilian counterparts who enter internships or go into private practice under the wing of an 

experienced clinician/practice owner, the new Veterinary Corps offi cers often feel isolated when it comes to 

performing surgery, seeking advice on medical cases, or 

managing a business. Although the issue had been recognized for quite some time, a solution was not simple. 

It took much work and several briefi ngs to the staff of 

The Army Surgeon General, but eventually a First Year 

Graduate Veterinary Education (FYGVE) program was 

approved. The fi rst FYGVE class started in the fall of 

2010 with 5 new graduate veterinarians who reported 

to the Fort Belvoir VETCEN for the fi rst iteration of the 

10-month program. The participants alternated between 

clinical and nonclinical (for example, food protection/

public health) rotations every few weeks. During a typical 3-week clinical rotation, one week is spent with military working dog appointments, another week seeing 

privately-owned pet appointments, and the third week 

performing surgery and other procedures. During the 

week assigned to working dog appointments, the veterinarian is also on call for working dog emergencies. 

Clinical rotations at the VETCEN are supervised by a 

clinical specialist. Learning is supplemented by daily 

group case discussions, critical review of journal articles, 

pathology rounds, topic presentations, outside speakers, 

and more. Participants are also allowed one to 2 weeks 

to perform off-site elective rotations. So far, participants 

have spent time with a veterinary ophthalmologist, a 

veterinary neurologist, a veterinary emergency practice, 

and the equine veterinarian at Fort Myer. At the start of 

the second year, additional FYGVE programs were established at Fort Bragg, North Carolina, and Joint Base 

Lewis-McChord, Washington, allowing approximately 

15 total participants in the program. Additional sites 

will open in the future at Fort Benning, Georgia, Fort 

Campbell, Kentucky, and Camp Pendleton, California. 

Adjustments and refi nements are continuously made to 

improve the program which is beginning its third year 

as of this writing. Eventually, all new Veterinary Corps 

accessions will participate in the FYGVE program.

Veterinarians who decide to stay in the Army after their 

initial 2 tours are encouraged to apply for long-term 

health education training, choosing from several different programs including clinical medicine. Offi cers 

have completed residencies in internal medicine, surgery, emergency medicine/critical care, and radiology. 

Veterinarians who successfully complete their clinical 

residency and become board certifi ed in their specialty 

are given the Area of Concentration designator 64F as 

a Veterinary Clinical Medicine Offi cer. The FYGVE 

THE ROLE OF THE US ARMY VETERINARY CORPS IN MILITARY FAMILY PET HEALTH
 January – March 2013 79

THE ARMY MEDICAL DEPARTMENT JOURNAL

program enables participants to get solid clinical experience which is very benefi cial for those who later decide 

to pursue one of the clinical specialties.

MILITARY INSTALLATION HORSE STABLES

As mentioned earlier, from the beginning of formal 

Army veterinarian services early last century, privatelyowned mounts received the same veterinary care provided by the Army Veterinary Corps as Army horses 

and mules. Not surprisingly, today’s situation with regard to equine care is very different. Although there are 

still a few Army owned horses and mules, primarily for 

ceremonial events, most installation stables have disappeared. Of those boarding stables that still exist, most 

are operated by private clubs. However, the installation 

veterinarian is still responsible for performing sanitary 

inspections of the facilities on a quarterly or monthly 

basis. In recent years, most newly graduated veterinarians are focused on small animals and often are not 

comfortable working with or around horses. For those 

Veterinary Corps offi cers, the sanitary inspections and 

occasional end-of-quarantine examinations are the only 

contact they have with horses. Installations that stable 

government-owned horses such as Fort Myer, Virginia, Fort Sam Houston and Fort Hood, Texas, and Fort 

Huachuca, Arizona, are assignments highly requested 

by those Army veterinarians with an interest in horses. 

Such Army veterinarians often provide some services to 

privately-owned horses stabled on military installations 

for vaccinations and annual Coggins (equine infectious 

anemia) testing. Additional services generally are not 

offered due to limitations in time and resources.

ABOVE AND BEYOND

Each year the Army Public Health Command* reviews 

nominations from military veterinary facilities to select 

one to receive the annual Above and Beyond Award. This 

coveted award recognizes units which go beyond their 

designated functions and duties. The accomplishments 

and generosity of the personnel at the nominated units 

are very impressive, and it has often been diffi cult to narrow the selection to just one. Further, many units which 

are not nominated are also very actively involved in their 

community beyond their required functions. A few examples from the extensive list of accomplishments are:

Pet Fairs: community events which host activities such 

as pet and owner health walks; pet shows; demonstrations from military working dog teams, dog agility clubs, 

and dog obedience clubs; distribution of free samples; 

information booths; tours of the VTF; and more.

Pet Visitation to Hospitals (governed by DoD Technical Bulletin TB MED 44

): after undergoing screening for 

health and temperament, animals can be certifi ed by the 

American Red Cross and other agencies to perform pet 

visitation to patients in military and civilian hospitals. 

Several military veterinarians and technicians participate in this program with their own pets and also provide support to others who participate.

Vaccination Clinics: some VTFs take the clinic on the 

road to neighborhoods in military housing areas so that 

families who cannot transport their animals to the VTF 

can still obtain care. Some VTFs host Saturday or evening clinics for those clients whose schedules will not 

allow them to come during the week.

Visits to Schools and Daycare Centers: many veterinarians and technicians visit elementary and preschool classes to give talks and demonstrations on important topics 

such as prevention of animal bites. These activities are 

always enjoyed by the children who especially look forward to seeing the animals that usually accompany the 

staff, and receiving educational coloring books.

SUMMARY

Even though privately-owned pet care is a lower priority 

mission than military working dog care, food inspection, 

and the public health mission, it is still very important, 

and the one that many Veterinary Corps offi cers, civilian veterinarians, and technicians enjoy the most. The 

vast majority of veterinarians and technicians went into 

veterinary medicine because of a love for animals. It is 

fulfi lling to offer guidance to a client with a new puppy 

or kitten, see a sick pet improve after treatment, and interact with dozens of animals and clients in a day. The 

services provided by the Army Veterinary Corps in caring for pets has expanded over the years and the standard 

of care has improved as well. It is truly a privilege to 

serve those who dedicate themselves to the protection of 

our Nation. The Army Veterinary Corps is indeed proud 

to provide care to the pets of Warfi ghters of the Army, 

Navy, Marine Corps, Air Force, and Coast Guard; their 

family members; and our military retirees.

REFERENCES

1. Mohri RW. Animal farms, captured animals, and 

privately owned animals. In: Miller EB, ed. United 

States Army Veterinary Service in World War II. 

Fort Sam Houston, TX: Offi ce of Medical History, 

US Army Medical Department; 1961:668. Available at: http://history.amedd.army.mil/booksdocs/

wwii/vetservicewwii/chapter19.htm. Accessed 

September 27, 2010. *In July 2011, the US Army Veterinary Command was merged with the US 

Army Center for Health Promotion and Preventive Medicine to form the 

US Army Public Health Command.
80 http://www.cs.amedd.army.mil/amedd_journal.aspx

2. US Army Veterinary Corps History. US Army 

Medical Department Web site. Available at: http://

veterinarycorps.amedd.army.mil/history.htm. Accessed September 27, 2012.

3. [SECNAVINST 6401.1B, Army Regulation 40-905

AFI 48-131] Veterinary Health Services. Washington, DC: US Dept of the Army; August 29, 2006. 

Available at: http://www.apd.army.mil/pdffi les/

r40_905.pdf. Accessed September 27, 2012.

4. Department of Defense Technical Bulletin TB MED 

4: DoD Human-Animal Bond Principles and Guidelines. Washington, DC: US Dept of the Army; June 

16, 2003. Available at: http://armypubs.army.mil/

med/dr_pubs/dr_a/pdf/tbmed4.pdf.

AUTHOR

LTC (Ret) Vincent-Johnson is a civilian (GS) Veterinary 

Medical Offi cer at the Fort Belvoir Veterinary Center, 

Fort Belvoir, Virginia.

THE ROLE OF THE US ARMY VETERINARY CORPS IN MILITARY FAMILY PET HEALTH
 January – March 2013 81

Army Regulation 40-11 defi nes the duties of the various 

Army Medical Department (AMEDD) Corps. Traditionally, there has been a clear distinction between the 

duties of one Corps and those of the others with little 

overlap, although exceptions do exist, such as food inspections performed by both veterinary and preventive 

medicine personnel. This is largely a result of the specialized training that AMEDD personnel receive. Offi -

cers often require 4 to 8 years or more of formal education prior to entry into military service, which is followed by additional Corps specifi c training within the 

military, and oftentimes annual professional continuing 

education. This training is necessary to ensure offi cers 

possess the knowledge, skills, and profi ciency to carry 

out the demanding requirements of their respective professions. These individuals are subsequently assigned to 

specifi c medical units which have clearly defi ned capabilities that are distinct from the medical units of the 

other AMEDD Corps.2

 Deployment of these units during military operations is generally related to the size of 

the supported force (for example, one medical detachment, veterinary services per 70,000 Army personnel 

in a combat zone). This basis of allocation is intended 

to ensure that adequate numbers of trained individuals 

are present in the theater to carry out the broad range of 

medical missions necessary to protect and promote the 

health of the fi ghting force.

Unfortunately, during foreign humanitarian assistance 

(FHA) operations such as disaster relief, it may not be 

possible to deploy these medical units in their entirety. 

The number of deployed servicemembers in the area of 

operations may not warrant an entire unit, or a complete 

unit may not be readily available for a rapid response 

to an unexpected disaster. In other situations, the existing status of forces agreement, or lack of one, may have 

restrictions which limit the number of US servicemembers that may be present in the country or disaster area. 

Although the US forces supporting FHA operations may 

have some reduced medical requirements, (for example, 

no combat realted trauma care), they are not completely 

eliminated. In some instances, as in the case of preventive medicine, the requirements and workload may actually be increased compared to other military operations.3

In such situations, AMEDD personnel should prepare 

themselves to perform additional duties beyond those 

normally associated with their military specialty.

A CASE EXAMPLE: FORCE HEALTH PROTECTION 

DURING THE 2010 PAKISTAN FLOOD

Sustained, torrential rains beginning in July 2010 resulted in widespread fl ooding of over 795,000 sq km, onefi fth of Pakistan’s total land area, and directly affected 

over 20 million residents (Figure 1).4

 Similar to the 2005 

earthquake response, beginning in August 2010, the US 

Department of Defense (DoD) deployed troops to Pakistan as part of a coordinated US foreign humanitarian 

assistance response. However, unlike the 2005 response, 

the DoD’s 2010 response did not provide direct medical 

care to the local population and instead was primarily 

directed at supporting the movement of people and supplies to and from fl ood affected areas.

One Health and Force Health Protection

 During Foreign Humanitarian Assistance

 Operations: 2010 Pakistan Flood Relief

MAJ Ronald L. Burke, VC, USA

ABSTRACT

Restrictions on the number of troops that could enter Pakistan in support of the 2010 fl ood relief efforts limited the type and number of deployed medical personnel. Although this created the potential for mission gaps, 

the assigned personnel were able to perform additional functions beyond those normally associated with their 

particular health specialty to help close these gaps, which was largely made possible due to prior cross-training 

and predeployment refresher training. Given the rapid and unpredictable nature of disaster response, future 

foreign humanitarian assistance operations may face similar issues with assigned personnel. Promotion of the 

One Health concept through instruction and training will help to increase awareness among US Army Medical 

Department personnel about the roles and functions of health specialties, facilitate the identifi cation of critical 

gaps during deployments, and provide personnel with the knowledge and skills needed to address them.
82 http://www.cs.amedd.army.mil/amedd_journal.aspx

Restrictions on the number of US servicemembers in 

Pakistan limited the in-country FHA force to approximately 600 total personnel.5

 US military helicopters were 

deployed to Ghazi Aviation Base in the north and Pano 

Aqil Army Airfi eld in the south, with a small central hub 

at Chaklala Airbase outside Islamabad for coordination 

of transient fi xed-wing airplanes. Limited medical assets 

consisting of 2 physicians, a physician assistant, a veterinarian, and several medics/corpsmen were deployed to 

help protect and sustain the health of the deployed force. 

Although the risk of combat related injuries was low for 

US personnel in Pakistan (in comparison to neighboring 

Afghanistan), disease and nonbattle injuries remained a 

signifi cant threat which required the continued attention 

of the medical staff, particularly with regards to implementation of preventive medicine measures.6

 In many 

deployments, these measures are implemented by traditional preventive medicine units, but due to the troop 

limitations in Pakistan, they were instead implemented 

by nontraditional medical personnel.

One of the initial preventive medicine issues which required attention was an Occupational and Environmental Health Site Assessment (OEHSA) for each of the 3 

US military base camps to identify health threats and 

develop recommendations to minimize their potential 

impact on US servicemembers. An OEHSA is normally 

conducted by trained preventive medicine personnel 

with specialized equipment which is used to detect and 

measure potential health threats such as exposure to 

contaminated air, soil, and water, excessive noise, nonionizing radiation, and arthropod borne diseases. It was 

not possible to complete an OEHSA in its entirety due 

to a lack of certain equipment, such as a noise dosimeter, 

and properly trained personnel. However, a thorough 

OEHSA was still performed at each base camp thanks to 

previous cross-training and subsequent refresher training of personnel prior to deployment. The cross-training 

was conducted several years prior by members of the 

30th Medical Brigade to improve awareness and coordination of efforts between veterinary and preventive 

medicine personnel and units in the US European Command area of responsibility. This training provided participants with a basic understanding of the roles, responsibilities, and methods of their medical counterparts in 

promoting force health protection through food, water, 

and environmental health safety. The subsequent predeployment training by US Army Public Health Command (USAPHC) personnel was able to rapidly build 

off this basic training so that non-preventive medicine 

personnel were able to competently perform OEHSAs 

for all 3 sites, identify signifi cant health threats, and 

develop mitigative measures which were instrumental 

in reducing incidence of disease and nonbattle injuries, 

and protecting the servicemembers’ health.

A signifi cant health threat identifi ed during the OEHSA 

was the lack of DoD-approved sources for food and water 

within Pakistan. While shipment of operational rations 

and bottled water via military airlift was available, it was 

only possible with a like reduction in the transportation 

of humanitarian goods. Fortunately, trained veterinary 

personnel were available to conduct Food and Water 

Risk Assessments (FWRAs) of local caterers which provided the base camp commanders with an alternative to 

operational rations (see related article on page 63). Like 

the OEHSA, a key principle behind the FWRA is the 

identifi cation of food and water associated health threats 

and development of mitigative measures to reduce the 

overall risk to acceptable limits. A common fi nding 

among all 3 FWRAs was general noncompliance with 

US requirements for cooking/holding times and temperatures, and cleaning and sanitation of food and food 

contact items and surfaces. Noncompliance was largely 

due to the contractor’s unfamiliarity with US requirements which was partially corrected during the FWRA 

inspection and outbrief, as well as subsequent training 

of food service personnel by the contractor. Compliance 

was further improved by deploying US military food 

service personnel to provide oversight of the kitchens 

and dining facilities at the 2 larger US base camps. The 

deployment of these individuals in the face of the restrictions on the number of US servicemembers allowed in 

Pakistan is a testament to the importance that the base 

camp commanders placed on food safety. Neither of the 

2 camps where US food service personnel were deployed 

experienced any signifi cant food borne incidents during 

the deployment. Unfortunately, the third camp which did 

not have a US cook supervising operations experienced a 

ONE HEALTH AND FORCE HEALTH PROTECTION DURING

FOREIGN HUMANITARIAN ASSISTANCE OPERATIONS: 2010 PAKISTAN FLOOD RELIEF

Figure 1. Flooding of the Indus River in Sindh Province, Pakistan as a result of excessive rains in the summer of 2010. 

Photo courtesy of the author.
 January – March 2013 83

THE ARMY MEDICAL DEPARTMENT JOURNAL

food-borne outbreak which affected approximately 50% 

of the US personnel. As a fi nal step towards improving 

safety, medical staff at each of the 3 base camps received 

instruction on basic food sanitation and guidance on 

critical items to look for during food service operations. 

Those personnel then performed local food safety inspections in the absence of formally trained veterinary 

or preventive medicine food inspectors.

Another major challenge facing the medical personnel in 

Pakistan was surveillance and control of arthropod vectors, particularly mosquitoes. Application of most DoD 

approved insecticides, and all ultra-low volume (ULV) 

insecticide applications, requires special training and 

certifi cation due to their potential health risks. In some 

instances, insecticides may not be applied unless warranted by vector surveillance conditions such as confi rmed 

presence of malaria positive mosquitoes. Although the 

force restrictions in Pakistan prevented the deployment 

of traditional DoD vector surveillance and control teams, 

vector surveillance and control was still performed by the 

deployed medical force through coordination with organizations. Part of the rapid predeployment training conducted by the USAPHC included refresher instruction on 

the use of Centers for Disease Control and Prevention 

light traps for mosquito and sand fl y surveillance. Those 

items were shipped to the deployed medical personnel 

in Pakistan, along with shipping material and containers, so that local arthropods could be trapped and sent 

to the laboratory at USAPHC Region Europe for identifi cation and testing. Although Anopheles sp mosquitoes 

(Figure 2) were identifi ed from the samples, none of the 

specimens tested positive for malaria. However, malaria 

was eventually diagnosed in one US servicemember at 

Pano Aqil, at which point the deployed personnel consulted with the Armed Forces Pest Management Board 

(AFPMB) to determine an acceptable insecticide. That 

insecticide was subsequently applied by Pakistani military personnel via ULV application. Additionally, all 

personnel were reminded of the importance of proper 

wear of permethrin treated uniform, daily compliance 

with doxycycline malaria chemoprophylaxis, and the 

proper use of bed-nets. No additional cases of malaria 

among US servicemembers were detected following 

these actions.

Other medical challenges encountered during the Pakistan fl ood relief operations included outbreak investigations and laboratory analysis of food and water samples, 

patient movement within and out of country, and obtaining advanced diagnostics and care. In some of these 

instances, DoD medical personnel were able to make 

arrangements with Department of State medical personnel at the US Embassy in Islamabad. In other cases, 

coordination with DoD assets at sea and in Afghanistan, 

Germany, and the United States facilitated accomplishment of the mission.

LESSONS LEARNED

Although it’s unlikely that any future FHA operation 

will be exactly the same as the 2010 Pakistan Flood 

Relief, similarities are bound to occur, especially with 

regards to the numbers and types of personnel deployed. 

Whether or not the affected country places restrictions 

on the number of US servicemembers which may enter 

the country or disaster area, other factors such as the 

limited availability of qualifi ed personnel during the initial rapid disaster response deployment may exist which 

limit the number of deployed medical personnel. In these 

instances, medical personnel may have to cover gaps 

and mission responsibilities traditionally performed by 

other personnel, including tasks which may fall outside 

of their normal military occupational specialty. 

Fortunately, while Pakistani restrictions limited the number of deployed servicemembers in country, the gradual 

onset of the fl ood disaster, as opposed to an earthquake 

or tsunami, facilitated a more measured deployment 

of troops compared to some previous FHA operations. 

The additional time allowed limited refresher training 

for the deploying medical personnel which aided them 

in their ability to perform additional force health protection duties. However, this refresher training would 

likely have been much less effective, and potentially impossible, if it were not for the previous cross-training 

that had been conducted by the 30th Medical Brigade 

veterinary and preventive medicine units several years 

earlier. This prior training was instrumental in raising 

awareness, not only regarding other military medical 

missions and responsibilities, but also on the availability 

of medical resources such as the AFPMB and its disease 

Figure 2. Anopheles minimus mosquito blood feeding. Photo 

by James Gathany courtesy of the Centers for Disease Control 

and Prevention.
84 http://www.cs.amedd.army.mil/amedd_journal.aspx

vector ecology profi les,7 the Walter Reed Biosystematics Unit vector identifi cation services and tools,8

 and the 

USAPHC’s environmental sampling program.

THE WAY AHEAD

The One Health* mission statement asserts:

Recognizing that human health (including mental health 

via the human-animal bond phenomenon), animal health, 

and ecosystem health are inextricably linked, One Health 

seeks to promote, improve, and defend the health and 

well-being of all species by enhancing cooperation and 

collaboration between physicians, veterinarians, other 

scientifi c health and environmental professionals and by 

promoting strengths in leadership and management to 

achieve these goals.10

The One Health initiative is recognized by over 4 dozen 

health-related organizations, including the American 

Medical Association, the American Nurses Association, the American Veterinary Medical Association, and 

the National Environmental Health Association. The 

US Army is uniquely positioned to implement the One 

Health concept as health personnel from all 3 disciplines (animal, environment, and human) work to protect and promote health. Unfortunately, the current lack 

of awareness of the One Health concept and the current 

structural relationships of professionals across the 3 

healthcare disciplines have resulted in virtual stovepipe 

organizations†

 of efforts and a failure to share information across the health systems. In normal operations, 

such a construct jeopardizes our ability to rapidly detect 

emerging health threats. In operations where limited 

personnel are deployed such as the 2010 Pakistan Flood 

Relief, this lack of awareness and “stovepiping” may 

result in mission failure if deployed medical personnel 

lack the training needed to accomplish missions which 

are nontraditional for their career fi eld. Even worse, the 

deployed personnel may not even be aware of the other 

mission requirements and gaps in responsibilities.

While the recent creation of the USAPHC has brought 

together members from the 3 health professions into a 

single organization, additional efforts are still needed to 

increase awareness of the One Health concept at all levels of the military. Cross-training programs such as the 

one conducted by 30th Medical Brigade units should be 

encouraged, particularly between veterinary and preventive medicine units. Although complete cross-training 

between specialties may not be possible, particularly for 

functions which require special training and certifi cation such as pasteurized milk audits and pest control application, these joint training programs are nonetheless 

valuable. At a minimum, these training programs will 

increase awareness of the roles, responsibilities, methods, and equipment of each health profession. This basic 

understanding can then be rapidly refreshed and expanded as part of predeployment training for FHA and other 

military operations. Perhaps of greatest importance, 

these cross-training exercises can facilitate the identifi -

cation of existing gaps and serve as a platform for developing future collaborations in force health protection.

The AMEDD Basic Offi cers Leaders Course (BOLC) 

is another potential opportunity to promote the One 

Health concept. Students from all 3 health professions 

receive combined training as part of the “All-Corps” 

portion of BOLC. However, while the 3 professions 

train together, little discussion is provided as to how the 

actions of one health profession impact the other two. 

Formal introduction of the One Health concept during 

the All-Corps portion of BOLC would not only increase 

awareness, but also increase information sharing and 

coordination of efforts during the offi cers’ future assignments. It would also improve their knowledge of the 

numerous resources in other health fi elds, both human 

and electronic, which can be readily consulted during 

military deployments.

CONCLUSION

Many of the functions performed by AMEDD personnel require highly specialized training. However, this 

specialization, while necessary, may lead to stovepiping 

of efforts in which many AMEDD personnel may not 

be aware of the other efforts that exist, let alone how 

they are accomplished, particularly if these efforts are 

in different health professions. This may result in ignorance of mission gaps and an inability to deal with them 

during FHA operations where limited medical personnel are deployed. Promotion of the One Health concept 

through instruction and training will help to increase 

awareness of these efforts, facilitate the identifi cation of 

critical gaps during deployments, and provide personnel 

with the knowledge and skills needed to address them.

REFERENCES

1. Army Regulation 40-1: Composition, Mission, and 

Functions of the Army Medical Department. Washington, DC: US Dept of the Army; July 1, 1983. 

Available at: http://www.apd.army.mil/pdffi les/r40

_1.pdf. Accessed October 2, 2012.

ONE HEALTH AND FORCE HEALTH PROTECTION DURING

FOREIGN HUMANITARIAN ASSISTANCE OPERATIONS: 2010 PAKISTAN FLOOD RELIEF

*The One Health Concept, fi rst articulated by early scientists such 

as Rudolph Virchow, recognizes the intimate relationship between 

human health, animal health and the environment, and calls for 

an integrative, collaborative approach to health by encouraging 

collaboration between experts of diverse fi elds of study.

9

†A stovepipe organization is defi ned as a structural model in which 

the management and workers have narrowly and rigidly defi ned 

responsibilities. Projects involving such organizations are characterized by lack of integration and interoperability, and duplication 

of efforts.11
 January – March 2013 85

THE ARMY MEDICAL DEPARTMENT JOURNAL

2. Field Manual 8-55: Planning for Health Service 

Support. Washington, DC: US Dept of the Army; 

September 9, 1994.

3. . Joint Publication 4-02: Health Service Support

Washington, DC: Joint Staff, US Dept of Defense; 

October 31, 2006. Available at: http://www.dtic.

mil/doctrine/new_pubs/jp4_02.pdf. Accessed October 2, 2012.

4. Goodwin L. One-fi fth of Pakistan under water as 

fl ooding disaster continues. Yahoo News. Available 

at: http://news.yahoo.com/blogs/upshot/one-fi fthpakistan-under-water.html. Accessed July 8, 2012.

5. Military reaches Pakistan fl ood relief milestone. 

Armed Forces Press Service. US Dept of Defense 

Web site. http://www.defense.gov/news/newsarticle.

aspx?id=61461. Accessed October 2, 2012.

6. Infectious disease risk assessment for non-indigenous relief personnel [Pakistan]. ReliefWeb Website. August 23, 2010. Available at: http://relief

web.int/sites/reliefweb.int/files/resources/

A79F599D2567314385257788006B32B3-Full_Re

port.pdf. Accessed July 8, 2012.

7. Disease vector ecology profi les. Armed Forces Pest 

Management Board Website. Available at: http://

www.afpmb.org/content/disease-vector-ecologyprofi les. Accessed August 3, 2012.

8. Vector identifi cation resources. Walter Reed Biosystematics Unit Website. Available at: http://www.

wrbu.org/. Accessed August 3, 2012.

9. King LJ, Anderson LR, Blackmore CG, et al. Executive summary of the AVMA One Health Initiative Task Force report. J Am Vet Med Assoc. 

2008;233(2):259-261.

10. One Health mission statement. Available at: http://

onehealthinitiative.com/mission.php. Accessed 

August 3, 2012.

11. Khosrow-Pour M, ed. Dictionary of Information 

Science and Technology. Hershey, Pennsylvania: 

Idea Group Inc; 2007.

AUTHOR

MAJ Burke is the Assistant Director, Division of GEIS 

Operations, Armed Forces Health Surveillance Center, 

Silver Spring, Maryland.

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New publication from Borden Institute

COMBAT CASUALTY CARE

Lessons Learned from OEF and OIF

BORDEN INSTITUTE UNITED STATES ARMY MEDICAL DEPARTMENT

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86 http://www.cs.amedd.army.mil/amedd_journal.aspx

The North Atlantic Treaty Organization (NATO) Standardization Agency was established in 1951 as the 

Military Standardization Agency upon the recognition 

that NATO military effectiveness and effi ciency could 

be greatly enhanced through increased standardization 

and interoperability of the Allied forces (specifi c NATO 

defi nitions of terms are provided in the inset below).1

Through improved standardization, NATO militaries 

and partner forces can optimize their available resources by leveraging and utilizing the capabilities of other 

alliance militaries with the stated assurance that common policies, procedures, and equipment will be used. A 

key component of this assurance is the development and 

ratifi cation of standardization agreements within which 

NATO member nations agree to implement a common 

standard, either in whole or in part. Within NATO, the 

Committee of the Chiefs of Military Medical Services 

(COMEDS) has the authority to develop and maintain 

medically-related standardization agreements. It is assisted by the Military Committee Medical Standardization Board which coordinates the efforts of multiple 

working groups and expert panels dealing with military 

medical structures, operations and procedures, military 

medical healthcare, force health protection, medical 

standardization, and medical issues related to chemical, 

biological, radiological, and nuclear threats (displayed 

in the Figure). One of these expert panels is the Food 

and Water Safety and Veterinary Support Expert Panel 

(FWSVS), which is charged with “initiating and developing common principles, policies, doctrines, concepts, 

procedures, programs and techniques for advice to COMEDS and for standardization and coordination in order 

to enhance interoperability within food and water safety, 

environmental health, and for veterinary medicine aspects, in the operational environment.”2

 The FWSVS, 

which reports to the Force Health Protection Working 

Group, is comprised of military veterinary offi cers (or 

their designated representatives) from the NATO member nations, as well as representatives from NATO Partnership for Peace countries.

The FWSVS has primary responsibility for 8 standardization agreements as shown in the Table. In compliance 

with NATO Standardization Agency requirements, all 

standardization agreements and the associated Allied 

Medical Publications are reviewed every 3 years to ensure the principles, policies, procedures, and techniques 

included in the agreements are consistent with current 

medical standards and technologies and in compliance 

with the doctrine and capabilities of NATO military 

partners. In addition to these 8 primary standardization 

agreements, the FWSVS also provides expert consultation on veterinary and food and water safety related 

issues in several additional standardization agreements 

which are the responsibility of other working groups and 

expert panels within COMEDS and the greater NATO 

Standardization Agency community, such as the recently formed expert panel for the use of military working 

dogs (MWD) in counter-improvised explosive device 

(C-IED) operations.

US Veterinary Support to Standardization

 of Food and Water Safety and Animal

 Care and Use Within NATO

MAJ Ronald L. Burke, VC, USA

COL Kelly A. Mann, VC, USA

Steven Richards, PhD, PE, BCEE

COL Timothy H. Stevenson, VC, USA

Defi nitions of NATO Standardization Agency Terms

Interoperability: The ability to act together coherently, effectively and effi ciently to achieve Allied tactical, operational 

and strategic objectives.

Standardization: The development and implementation of concepts, doctrines, procedures and designs in order to 

achieve and maintain the compatibility, interchangeability or commonality which are necessary to attain the required 

level of interoperability, or to optimize the use of resources, in the fi elds of operations, materiel and administration.

Standardization Agreement: A standardization agreement is a normative document recording an agreement among 

several or all NATO member nations, which has been ratifi ed at the authorized national level, to implement a standard, 

in whole or in part, with or without reservation.

Source: NATO Standardization Organization1
 January – March 2013 87

Military Committee 

Land Standardization 

Board

Military Working 

Dog Expert Panel

Counter-Improvised Explosive 

Device Working Group

Food and Water Safety 

and Veterinary Support 

Expert Panel

Chemical, Biological, 

Radiation, and 

Nuclear Medical 

Working Group

Military Medical 

Standardization 

Working Group

Military Medical 

Healthcare Working 

Group

Medical Structures, 

Operations, and 

Procedures Working 

Group

Force Health 

Protection Working 

Group

Military 

Committee 

Medical 

Standardization 

Board* North

Atlantic

Council

Committee for 

Standardization

Committee of the 

Chiefs of Military 

Medical Services

Conference of 

National Armament 

Directors

Consultation, 

Command and 

Control Board

Logistics 

Committee

Military Committee

Civil Emergency 

Planning 

Committee

Air and Missile 

Defense 

Committee

The positions of the Food and Water Safety and Veterinary Support Panel and the Military Working Dog Expert 

Panel within the NATO hierarchy.

*Offi cially, the Military Committee Medical Standardization Board also reports directly to the Military Committee, as 

the Committee of the Chiefs of Military Medical Service is not a primary NATO tasking authority organization.

Current NATO Standardization Agreements of Responsibility for the Food and Water Safety and Veterinary Support Expert 

Panel. Source: NATO Standardization Document Database (http://nsa.nato.int/nsa/nsdd/ListPromulg.html).

Standardization 

Agreement 

Title and Associated Allied Medical Publication (AMedP) Custodian 

Nation

2136 Minimum Standards of Water Potability During Field Operations and in Emergency Situations 

(AMedP-18) Netherlands

2534a Welfare, Care and Veterinary Support for Deployed Military Working Animals United States

2538 Animal Care and Welfare and Veterinary Support During All Phases of Military Deployments 

(AMedP-19) France

2541 Audit Principles and Risk Assessment of Food Processors and Distributors Associated With Military 

Deployments (AMedP-20) Belgium

2550 Minimum Standards of Food Safety and Hygiene on Operations (AMedP-XZ) United

Kingdom

2556b Food Safety in the Provision of Food and Catering Services Support to Deployed Operations 

(AMedP-25) Canada

2557 Preventing the Transfer of Animal Or Plant Diseases and Pests to Nonindigenous Areas

(AMedP-26) Greece

2937 Survival, Emergency, Individual Combat and Group Rations Nutritional Values and Packaging 

(AMedP-60) Germany

a

Standardization Agreement 2534 is merging with AMedP-19 into a single consolidated document.3

b

Standardization Agreement 2556 will cover AMedP-20, AMedP-25, and AMedP-XZ in the future.3
88 http://www.cs.amedd.army.mil/amedd_journal.aspx

ANIMAL MEDICINE AND USE

The past 18 months have been a time of signifi cant 

change for agreements covering military animal medical 

care and welfare. Military animals are critical assets and 

injured working animals are expected to receive a high 

level of care during military service. National systems of 

military veterinary medical support are well-established, 

but recent reviews by the FWSVS led to the merging of 

Standardization Agreements 2534 and 2538 and a major 

rewrite of Allied Medical Publication 19: Animal Care 

and Welfare and Veterinary Support During All Phases 

of Military Deployments.

4

 The new document retains 

a phased approach and updates some health certifi cate 

and medical data, but the posture of the comments has 

changed from implicit instructions for veterinarians to 

improved education and guidance for commanders and 

staff. New defi nitions for veterinary roles of care were 

also added in order to maximize communication of veterinary medical capabilities and foster greater interoperability of medical assets on deployment.

In support of the NATO C-IED Action Plan, the Allied 

Command Transformation C-IED Integrated Product 

Team leader from the Unites States organized 2 NATO 

C-IED MWD workshops which were conducted at 

the Defense Animal Centre (Melton Mowbray, United 

Kingdom) in May 2011 and the Defense MWD School 

(Madrid, Spain) in January 2012. Both workshops focused on 6 priority areas designed to optimize use of 

MWDs to support defeating the device, countering 

threat networks, and harmonizing MWD activities as a 

C-IED enabler in NATO C-IED strategy. The participating nations and C-IED organizations came to consensus 

on terms of reference for the expert panel which were 

approved by the Military Committee Land Standardization Board, C-IED Working Group, offi cially creating 

an expert panel in May 2012 (shown in the Figure). The 

inaugural meeting for the new NATO Expert Panel on 

MWDs for C-IED was hosted by Italy at the Military 

Veterinary Centre in Grosseto, Italy, in June 2012. The 

Expert Panel chairman from the United Kingdom led 43 

participants in work on developing NATO MWD certifi -

cation standards, measures of performance and effectiveness, and capability matrix and terminology. Although 

interoperability of MWD capabilities must consider the 

personnel and organizational differences across a wide 

group of NATO stakeholders, outstanding advance work 

conducted by the Nordic Defense Cooperation MWD 

Working Group led to agreement on a matrix defi ning 5 

primary MWD C-IED capabilities within NATO. Other 

international products that improve command and staff 

awareness and understanding regarding the operational 

use of MWDs are under review, which may result in 

quick advancement of NATO objectives. Additional 

interests include improved common operational pictures for in-theater MWD capabilities and veterinary 

medical support locations; use of MWD advisory teams 

and program managers in mission planning and deployments; and combining mutually independent methods 

of detecting items of interest with MWD capabilities to 

fi nd personnel and materials to exploit and strengthen 

the intelligence cycle. Future standardization agreement 

and concept of employment considerations regarding 

operational interoperability, synergy, and unifi ed efforts 

of all NATO and partner countries are ongoing.

DRINKING WATER QUALITY ASSURANCE

Drinking water must be readily available and consumed 

in adequate quantities to prevent dehydration. It must be 

potable or otherwise it may have adverse health effects 

on the consumers. It must also be palatable so personnel 

will be willing to drink it in adequate quantities. Standardization Agreement 2136 implements Allied Medical 

Publication 18: Minimum Standards of Water Potability 

during Field Operations and in Emergency Situations 

(AMedP-18),4

 and provides procedures and water quality standards for fi eld water that is shared among nations 

during NATO operations. The documents have undergone many improvements over more than a decade, as 

nations have worked together to ensure the Warriors of 

each nation receive water that is safe and acceptable 

for drinking. The aims or purposes of Standardization 

Agreement 2136 and AMedP-18 include standardizing 

the approach for ensuring the quality of drinking water 

provided to the troops during fi eld operations; establishing the minimum requirements for potable drinking water provided to troops in a theatre of operations during 

emergency situations; and establishing the minimum 

water quality testing capabilities required in the fi eld.

All nations do not have the same water treatment and 

testing capabilities, and may not be able to meet all of 

the standards in AMedP-18. A caveat has been included 

in the document to ensure all participating nations have 

the ability to share drinking water with other nations. A 

nation that produces water which does not comply with 

all the requirements of the Allied Medical Publication 

(AMedP) must maintain a document detailing what procedures or parameters of the AMedP are not met, and 

provide a copy to the nation or nations who would receive the water. The receiving nations can then decide 

to accept the water as is, accept it and provide additional 

treatment and monitoring, or decline to use that nation’s 

water.

AMedP-18 provides agreed-upon defi nitions of all salient water supply terms and phrases used in the publication (from “approved sources” to “water treatment”), to 

US VETERINARY SUPPORT TO STANDARDIZATION OF FOOD AND WATER SAFETY

AND ANIMAL CARE AND USE WITHIN NATO
 January – March 2013 89

THE ARMY MEDICAL DEPARTMENT JOURNAL

ensure that all nations that use the document interpret it 

the same way. It describes the desirable qualities of raw 

water sources, and methods to assess the quality and determine the type of treatment necessary to obtain levels 

required for emergency, short-term, or long-term use. All 

participating nations agree to the following:

 The provision of safe drinking water in the fi eld is 

an operational necessity.

 All health-related risks will be assessed in setting 

criteria for the quality of drinking water during 

operations.

 The minimum criteria for the quality of drinking 

water based on performance-related risks will only 

be applied in emergency situations.

 To follow the procedures of risk management described within the document.

AMedP-18 contains a list of emergency water quality 

standards with maximum allowable concentration levels 

(MCLs) and indicators. Water that contains contaminants at the indicated levels is only to be used for drinking water for 7 days or less. If either the MCLs or the 

usage period is exceeded, the capabilities of some Soldiers to complete their missions could be compromised 

by performance degradation. These standards were developed in the 1980s through a comprehensive study5

 by 

Lawrence Livermore National Laboratories, and are still 

applicable today.

The operational and long-term standards in the current 

AMedP-18 (edition 5) were selected in the early 2000s by 

the executive committee members and included MCLs 

from the European Union Standards, the US Triservice 

Field Water Standards, and the former US Army Center 

for Health Promotion and Preventive Medicine. In order 

to simplify the defense of the long-term standards to all 

participating nations, the draft of edition 6 of AMedP-18 

proposes to replace the current standards with primarily 

standards copied from the World Health Organization’s 

Guidelines for Drinking-water Quality,

6

 with some additional aesthetic standards from the current Army 

Technical Bulletin MED 577.

7

AMedP-18 gives guidance for storage and handling procedures for both commercially bottled and packaged 

fi eld water that will protect them from the weather, sunlight, and potential adversaries, while maximizing their 

shelf life. Commercially bottled and packaged fi eld water are generally considered food products and are handled, stored, and inspected by Quartermaster personnel, 

augmented by veterinary and preventive medicine personnel in a manner similar to other purchased packaged 

food products. This guidance differs somewhat from the 

very robust surveillance system the US Army has for 

its surveillance program, but is considered adequate, 

and the next edition of Technical Bulletin MED 577

will be more in line with the standardization agreement 

procedures.

AMedP-18 also addresses the situation in which a nation’s bulk water may be taken from a local municipal 

water supply or produced by a commercial contractor. It 

requires that water produced by either source must meet 

all the criteria described for military-produced water, and 

that the chemicals, materials, and ultraviolet disinfection 

systems (if used) be tested and certifi ed to meet the applicable NSF International® (Ann Arbor, MI) standards. 

The water purveyors must also provide documentation 

that they meet these requirements together with water 

quality test results to all nations that use the water.

FOOD AND WATER SAFETY

Much of the early work of the FWSVS focused on operational rations, ensuring that rations were prepared 

and stored in a manner to maximize safety and usability 

by NATO forces. This effort continues today, with the 

most recent draft of Standardization Agreement 2937 

and AMedP-60: Survival, Emergency and Individual 

Combat Rations–Nutritional Values and Packaging,

4

 to 

ensure nutritional equivalency so combat rations may be 

shared with other NATO countries.

When combat operations continue beyond the initial 

entry phase, most nations quickly transition from combat rations to catered meals prepared in dining facilities. These catering operations have evolved over the 

past decade from primarily individual national catering 

operations to multinational NATO catering operations. 

The NATO Support Agency (NSPA) provides logistic 

support to NATO operations, much like the Defense 

Logistics Agency does for US forces. In Afghanistan, 

NSPA is the contracting agency that provides most of 

the meals for US and allied forces. This has created a 

demand for a standardization agreement covering all aspects of catering operations from the facility infrastructure to food storage, processing, and service. The current 

Standardization Agreement 2541 and AMedP-20: Audit 

Principles and Risk Assessment of Food Processors and 

Distributors Associated With Military Deployments,

4

 incorporates many of the requirements within the US Military Standard 3006,

8

 and standardizes the auditing of 

commercial food and water facilities by NATO forces.

A revised draft of Standardization Agreement 2541, 

which should be promulgated for ratifi cation this year 

[2012], covers all aspects of the food chain from the audit 

of the food processing establishment to the inspection of 
90 http://www.cs.amedd.army.mil/amedd_journal.aspx

the catering operation on the battlefi eld. The new Standardization Agreement 2556 will replace Standardization Agreements 2541 and 2550, and will cover AMedP25: Food Safety, Defense, and Production Standards 

in Deployed Operations,

4

 and another AMedP which 

has not yet received a numerical designator, “Inspection of Food Services Catering Facilities on Deployed 

Operations,” in addition to AMedP-20. These new documents will standardize the requirements for operation of 

military and commercial dining facilities during NATO 

operations, and also provide guidance for inspection 

of these facilities. Ratifi cation of these new documents 

will help close an existing critical gap in food and water 

safety during NATO military operations, resulting in 

improved force health protection.

PREVENTION OF DISEASE TRANSMISSION

Standardization Agreement 2557 implementing AMedP26: Veterinary Guidelines on Major Transmissible Animal Diseases and Preventing Their Transfer Summary,

4

the newest standardization agreement produced by the 

FWSVS, was ratifi ed and implemented in February 2011. 

A driving force behind its development is the realization 

that NATO forces may be exposed to zoonotic and transboundary animal diseases during combat, foreign humanitarian assistance, or other military operations. These 

diseases may have signifi cant negative effects on military readiness and force health protection in situations 

involving highly pathogenic avian infl uenza, rift valley 

fever, and other zoonoses. Further, some transboundary 

animal diseases could have signifi cant economic effects 

if they are inadvertently transported and introduced into 

a NATO country’s domestic animal population during 

redeployment of personnel and equipment.

In order to address the health threat posed by these animal diseases, AMedP-26 provides NATO personnel with 

a list of important animal diseases, as determined by the 

World Organization for Animal Health, as well as the 

risk factors associated with their transmission and recommendations for controlling or preventing transmission through disinfection of personnel and equipment. 

Included with these recommendations and guidance are 

document templates to rapidly develop notices which 

can be disseminated to military personnel, caterers, or 

transportation personnel to inform them of imminent 

health threats and reduce the likelihood of inadvertent 

disease transmission.

Although Standardization Agreement 2557, implemented in 2011, is less than 3 years old, the FWSVS panel is 

already working on revisions to improve future versions. 

One proposed improvement is additional guidance for 

preventing transmission to or by military personnel 

through avoidance and the use of personal protective 

measures such as gloves or disposable outer garments. 

Another important change is the reporting of confi rmed 

or suspected diseases not only to NATO preventive medicine staff offi cers, but also the host nation’s chief veterinary authority. This latter report is especially important 

as each nation’s chief veterinary authority is responsible 

for reporting new occurrences of domestic transboundary animal diseases to the World Organization for Animal Health so that neighboring countries and trading 

partners can be informed in a timely manner and take 

necessary precautions to prevent the introduction of the 

disease into their own countries. The revised version of 

Standardization Agreement 2557 and AMedP-26 should 

be available for review in 2013, with ratifi cation potentially in 2014.

SUMMARY

NATO requires all standardization agreements and Allied Medical Publications to be reviewed at least once 

every 3 years to ensure they refl ect current technologies 

and national military policies and procedures. This is 

particularly applicable with regard to veterinary medicine and food and water safety where advances in scientifi c knowledge and practices may result in documents 

quickly becoming obsolete. Such is the case with the 8 

standardization agreements for which the FWSVS has 

responsibility; all are currently undergoing major revisions. With each revision, national representatives, including US veterinary and preventive medicine personnel, must review the documents to ensure there are no 

signifi cant issues which would prevent ratifi cation and 

implementation. This improves standardization and enhances interoperability between NATO partners to minimize duplication. This is accomplished by leveraging 

other national military capabilities, while maintaining 

confi dence that the food, water, and veterinary support 

provided to their Warriors, support personnel, and animals in the fi eld is safe and high in quality. Adherence 

to such standards is a major factor in maintaining the 

operational readiness of all alliance armed forces.

REFERENCES

1. . Brussels, NATO Standardization Organization

Belgium: NATO Standardization Agency; 2012. 

Available at: http://nsa.nato.int/nsa/zzMisc/booklets

/NSO_BOOKLET_A4.pdf. Accessed August 2, 2012.

2. Terms of Reference for the Food and Water Safety 

and Veterinary Support Expert Panel. Brussels, Belgium: Military Medical Steering Group, Committee 

of the Chiefs of Military Medical Services in NATO; 

2009:1.

US VETERINARY SUPPORT TO STANDARDIZATION OF FOOD AND WATER SAFETY

AND ANIMAL CARE AND USE WITHIN NATO
 January – March 2013 91

THE ARMY MEDICAL DEPARTMENT JOURNAL

3. Offi cial Minutes of the 32nd Meeting of the Food 

and Water and Veterinary Support Expert Panel 

[NATO Standardization Agency]. 18-20 September 

2012. Ieper, Belgium.

4. STANAG/AMedP Index. NATO Standardization 

Agency Website. Available at: https://nsa.nato.int/

protected/nsdd/_CommonList.html [restricted access].

5. Daniels JI, Gallegos GM, eds. Evaluation of Military Field-Water Quality. Livermore, CA: Lawrence Livermore National Laboratories; 1990.

6. . 4th ed. Guidelines for Drinking-water Quality

Geneva, Switzerland: World Health Organization; 

2011. Available at: http://www.who.int/water_sani

tation_health/publications/2011/dwq_guidelines/

en/. Accessed October 26, 2012.

7. Technical Bulletin MED 577: Sanitary Control 

and Surveillance of Field Water Supplies. Aberdeen Proving Ground, MD: US Army Public 

Health Command; May 1, 2010. Available at: http://

armypubs.army.mil/med/DR_pubs/DR_a/pdf/

tbmed577.pdf. Accessed October 26, 2012.

8. MIL-STD-3006: Sanitation Requirements for Food 

Establishments. Washington, DC: Offi ce of The 

Surgeon General, US Dept of the Army; June 1, 

2008 [revision C].

AUTHORS

MAJ Burke is Assistant Director, Division of GEIS 

Operations, Armed Forces Health Surveillance Center, 

Silver Spring, Maryland. He is the current Secretary 

for the NATO Food and Water Safety and Veterinary 

Support Expert Panel.

COL Mann is Director, Department of Defense Military 

Working Dog Veterinary Service, LTC Daniel E. Holland 

Military Working Dog Hospital, Lackland Air Force 

Base, Texas. He is a member of the NATO Food and 

Water Safety and Veterinary Support Expert Panel and 

the Expert Panel on the use of Military Working Dogs for 

Countering Improvised Explosive Devices.

Dr Richards is the Field Water Section Chief, Water 

Supply Management Program, Army Institute of Public 

Health, US Army Public Health Command, Aberdeen 

Proving, Ground, Maryland. He is a retired Colonel of 

the Army Medical Service Corps.

COL Stevenson is Commander, Public Health Command 

Region-South, Fort Sam Houston, Texas. He is the 

current Chairman of the NATO Food and Water Safety 

and Veterinary Support Expert Panel.

The North Atlantic Treaty Organization The United States Army Veterinary Corps
92 http://www.cs.amedd.army.mil/amedd_journal.aspx The poster selected best of the presentations as part of the 2nd Annual Research Day held October 23, 2012, at the Graduate School, Academy of Health Sciences, AMEDD Center & School, Fort Sam Houston, Texas.

THE ARMY MEDICAL DEPARTMENT JOURNAL
SUBMISSION OF MANUSCRIPTS TO THE ARMY MEDICAL DEPARTMENT JOURNAL

The United States Army Medical Department Journal is published quarterly to expand knowledge of domestic and international 

military medical issues and technological advances; promote collaborative partnerships among the Services, components, Corps, 

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All manuscripts will be reviewed by the AMEDD Journal’s Editorial Review Board and, if required, forwarded to the appropriate 

subject matter expert for further review and assessment. 

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GUIDELINES FOR MANUSCRIPT SUBMISSIONS

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the manuscript. Ideally, a manuscript should be no longer than 24 double-spaced pages. However, exceptions will always be 

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2. The American Medical Association Manual of Style governs formatting in the preparation of text and references. All articles 

should conform to those guidelines as closely as possible. Abbreviations/acronyms should be limited as much as possible. 

Inclusion of a list of article acronyms and abbreviations can be very helpful in the review process and is strongly encouraged.

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