U.S. Army Center for Health Promotion 

and Preventive Medicine 

Guide for Deployed Preventive Medicine 

Personnel on Health Risk Management 

Technical Guide 248 

August 2001 

LOCAL REPRODUCTION IS AUTHORIZED AND ENCOURAGED 
Acknowledgements 

A multi-disciplinary workgroup participated in assembling this technical guide at the U.S. 

Army Center for Health Promotion and Preventive Medicine: 

Technical Authors: Mr. Tony Pitrat 

 LTC Ken Wiggans 

 Ms. Veronique Hauschild 

 Mr. Matt McAtee 

 LTC Richard Kramp, MD 

 Mr. Jim Mullikin* 

 LTC Bruno P. Petruccelli, MD 

 MAJ Tamra Barker, MD 

 CPT Steve Richards 

 Ms. Irene Richardson 

 MAJ Aaron Silver 

 Ms. Kelly Spearman 

 Mr. Jesse J. Barkley, Jr. 

 Mr. Richard Wells 

 Mr. Donald Wood* 

Editor Ms. Gail Gibson 

*This effort was supported in part by the Henry M. Jackson Foundation for the advancement 

of military medicine through a grant from the Uniformed Services University of the Health 

Sciences and the U.S. Army Center for Health Promotion and Preventive Medicine. 
TG 248 

Table of Contents 

Page

Chapter 1 – Introduction..............................................................................................................................1 

 1-1. Purpose and Scope...........................................................................................................................1 

 1-2. Background ......................................................................................................................................1 

Chapter 2 – Preventive Medicine Risk Management Concepts ...............................................................3 

 2-1. Doctrine ............................................................................................................................................3 

 2-2. Health Threats and Medical Threats...............................................................................................4 

Chapter 3 – Occupational and Environmental Health and Endemic Disease Surveillance 

 and Risk Assessment During Operational Planning ..............................................................................6

 3-1. Step 1 – Identify Hazards ................................................................................................................6 

 3-2. Step 2 – Assess Hazards................................................................................................................16 

 3-3. Step 3 – Develop Controls.............................................................................................................24 

 3-4. Step 4 – Implement Controls.........................................................................................................25 

 3-5. Step 5 – Supervise and Evaluate...................................................................................................26 

 3-6. Tools and Pitfalls............................................................................................................................27 

Chapter 4 – Phases of Deployment...........................................................................................................28 

 4-1. Phase I – Pre-Deployment.............................................................................................................28 

 4-2. Phase II – During Deployment......................................................................................................31 

 4-3. Phase III – Post-Deployment ........................................................................................................34 

Chapter 5 – Communicating Health Risks While Deployed..................................................................36 

Appendix A – References ...................................................................................................................... A-1 

Appendix B – Operational and Occupational and Environmental Health and 

 Endemic Disease Surveillance Responsibilities.................................................................................B-1 

Appendix C – Public Information Sources ............................................................................................C-1 

Appendix D – Sample Preventive Medicine Estimate......................................................................... D-1 

Appendix E – Preventive Medicine Officer Planning Considerations.................................................E-1 

Appendix F – Infectious Disease Information.......................................................................................F-1 

Appendix G – Health Risk Communication......................................................................................... G-1 

Appendix H – Acronyms ....................................................................................................................... H-1 
TG 248 

List of Tables and Figures 

Page

Table 2-1 – Complementary Aspects of the Operational Risk Management and 

 the Military Decision-Making Process....................................................................................................5 

Table 3-1 – Hazard Probability Ranking Chart for Military Deployments ...........................................18 

Table 3-2 – Hazard Severity Ranking Chart for Military Deployments................................................20 

Table 3-3 – Risk Assessment Matrix........................................................................................................21 

Table 3-4 – Risk Level Definitions...........................................................................................................22 

Table 3-5 – Example Criteria for Assigning Confidence Levels............................................................23 

Table F-1 – Arthropod Vectors Associated With Specific Diseases....................................................F-1 

Table F-2 – Diseases Associated with Disease Pathogens....................................................................F-5 

Table G-1 – Health Risk Communication Guidelines ......................................................................... G-3 

Figure 2-1 – Risk Management Cycle........................................................................................................3 

Figure 3-1 – Intelligence Preparation of the Battlefield............................................................................7 

Figure 3-2 – METT-TC Considerations.....................................................................................................8 

Figure 3-3 – Hierarchy of Health Threats ................................................................................................17 

Figure 4-1 – Assessing Low-Level Radiation Hazards...........................................................................33
TG 248 

1 

Chapter 1 

Introduction 

1-1. Purpose and Scope 

Occupational and environmental health and endemic disease (OEH/ED) threats can seriously impact a 

commander’s mission and affect short- and long-term military operations. Traditionally, they have 

been both separately assessed and independently managed. As a result, they can be misunderstood as 

unrelated aspects of the battlefield – both in doctrine and policy. This document considers these 

hazards to be integrally related and attempts to manage them consistently. However, in order to be 

consistent with current policy, OEH and ED will be referred to throughout using combined OEH/ED 

terminology. 

This technical guide (TG) introduces the processes and tools that can be used to make appropriate 

decisions based on the medical threat. It is written for preventive medicine personnel who are 

assigned the task of providing health risk assessments to the commander based on OEH/ED 

surveillance for deployments. It is directed at the Corps/Joint Task Force (JTF) medical staff-level 

personnel who will be identifying, assessing, and communicating OEH/ED hazards in the operational 

risk management (ORM) process. The objectives of the Army OEH/ED surveillance and risk 

assessment process are to—

a. Document OEH/ED hazards and exposures to soldiers and the force. 

b. Characterize the risks of OEH/ED hazards during all phases of deployment. 

c. Communicate risks in understandable terms to the commander and operational planners. 

d. Allow the commander’s staff to develop courses of action (COA) that consider and/or 

minimize OEH/ED risks to the force. 

e. Provide OEH/ED data to assist in post-deployment health assessments and evaluations of 

OEH/ED ORM processes. 

This TG will provide a general overview of how these hazards can be evaluated within the context of 

Field Manual (FM) 100-14, Risk Management, and how to communicate these risks to the 

commander. For the convenience of the reader, required and related publications are listed in 

Appendix A. 

1-2. Background 

When evaluating these OEH/ED risks, commanders must balance the effects of casualties, impact on 

civilians, the damage to the environment, the loss of equipment, and the level of public reaction 

against the value of [their] objectives (see FM 100-14). Presidential Review Directive (PRD)-5, 

Force Health Protection Concept of Operations, directs the Department of Defense (DOD) to 

“identify and minimize or eliminate the short- and long-term effects of military service, especially 
TG 248 

2 

during deployments (including war), on the physical and mental health of veterans.” OEH/ED 

hazards may include the following: 

a. Chemical hazards include toxic industrial chemicals (TIC) and toxic industrial materials (TIM). 

b. Radiological contamination. 

c. Physical. 

d. Endemic disease. 

DOD Instruction (DODI) 6055.1, DOD Safety and Occupational Health Program, describes the risk 

management process that should be incorporated into all military operations to address safety and 

OEH/ED risks. This process is similar to that described in FM 100-14. DODI 6055.1 requires that 

the assessment of OEH/ED hazards when U.S. forces are deployed outside the continental United 

States (OCONUS). Assessments are performed to support DODI 6050.5, DOD Hazard 

Communication Program, and DODI 6490.3, Implementation and Application of Joint Medical 

Surveillance for Deployments. 

Under the current Force Health Protection (FHP) paradigm, military responsibilities include the 

monitoring and surveillance of all environmental exposures, and the assessment and management of 

the associated health risks. Managing the health risks associated with these OEH/ED hazards is 

important in conserving combat power and resources, thereby promoting FHP. This TG attempts to 

identify those preventive medicine tasks that support OEH/ED surveillance and the responsibilities for 

various assets within the preventive medicine hierarchy. (See Appendix B, Operational and 

Occupational and Environmental Health and Endemic Disease Surveillance Responsibilities.) 

Deployment of military personnel, under any conditions, will result in exposure to hazards other than 

those resulting from combatant operations. These personnel can be incidentally or deliberately 

exposed to harmful levels of environmental contaminants such as toxic chemicals, radiation, or 

biological agents. “Harmful levels” include high-level exposures that result in immediate health 

effects and/or significant impacts to mission capabilities. It also may include low-level exposures that 

may result in delayed and/or long-term health effects that would not ordinarily have a significant, 

immediate impact on the specific deployment mission. 
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3 

Chapter 2 

Preventive Medicine Risk Management Concepts 

2-1. Doctrine 

Army risk management doctrine, as detailed in FM 100-14, provides commanders with methods to 

evaluate and manage the risks posed by operational hazards to the force. In addition, FM 3-100.4, 

Environmental Considerations in Military Operations, provides doctrine for managing environmental 

risks. These two documents provide an initial framework for characterizing environmental hazards. 

This framework is an iterative process that is integrated into operational planning and decision-making 

at all levels. Leaders manage risk by evaluating hazards and implementing ORM options during COA 

development (see Figure 2-1). 

 *FM 100-14 

Preventive medicine personnel will participate in the ORM process by identifying OEH/ED hazards, 

assessing the threat associated with these hazards, characterizing the risks in context of the proposed 

COA, effectively transmitting the risk assessments, and recommending appropriate control measure 

options to the commander. Commanders will then be able to make informed decisions by evaluating 

the OEH/ED risks with other operational risks against mission expectations. 

Risk Management 

Cycle 

Figure 2-1 
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4 

2-2. Health Threats and Medical Threats 

The distinction between the terms health threat and medical threat is very important to operational risk 

assessment and management of OEH/ED hazards. The significant difference in these terms lies with 

the effects on the capability of a military unit to successfully execute its mission. These terms are 

defined in FM 4-02.17, Preventive Medicine Services, as follows: 

 a. Health threat refers to an individual soldier’s health. The term can include hereditary conditions 

that manifest themselves in adulthood, individual exposure to an industrial chemical or toxin where 

others are not exposed, or [conditions that can result in] other injuries and traumas that affect an 

individual’s health but may not affect the health of the unit. On the other hand, if 40 to 50 percent of 

the personnel in a unit exhibit a debilitating condition (e.g., salmonella poisoning), the unit can no 

longer complete its mission. 

 b. Medical threat refers to all “potential or continuing enemy actions and environmental situations 

that could adversely affect the combat effectiveness of friendly forces, to include wounds, injuries, or 

sickness incurred while engaged in a joint operation” (see Joint Publication 4-02, Doctrine for Health 

Services Support in Joint Operations). In Army and multi-service publications, the term is defined as 

a composite of all ongoing potential enemy actions and environmental conditions and disease and 

non-battle injuries [DNBI] that may degrade a unit’s combat effectiveness. Commanders and unit 

leaders are responsible for protecting and preserving Army personnel and equipment against injury, 

damage, or loss that may result from food-, water-, and arthropod-borne diseases, as well as 

environmental injuries (e.g., heat and cold injuries) and occupational hazards. 

Medical threats are a sub-set of health threats that have the potential to degrade a unit’s combat (or 

mission) effectiveness. 

The design of the ORM framework intends to consider both kinds of threats; however, medical threats 

are more important to possible mission failure than non-medical threats. On the other hand, 

controlling unit health threats in toto would be the focus of FHP and maintaining unit readiness. 

The risk management approach, as described in FM 100-14 and FM 3-100.4, is a process for 

identifying, assessing, and controlling risks as well as evaluating the effectiveness of risk control 

measures. This TG addresses OEH/ED hazards that pose health threats to individual troops. These 

can ultimately be expressed as medical threats to the force and the mission. The components of the 

risk management process have been translated into operational principles for assessing medical and 

health threats arising from OEH/ED hazards. The Army OEH/ED surveillance and risk assessment 

EXAMPLE 

During a mission lasting two weeks at most, a health threat to the unit

exists that will result in illness to a portion of the unit if the unit is

exposed. The etiology of the illness is such that symptoms do not

begin to occur until 20-30 days after exposure. In this case, the 

latency period of the health threat might not be classified as a

medical threat. 
TG 248 

5 

system is designed to identify, assess, and recommend control measures for health and medical threats 

to deployed U.S. forces from OEH/ED hazards. The goal of the surveillance and risk assessment 

mission is to assist field commanders in making informed ORM decisions that consider OEH/ED 

hazards. 

As shown in Figure 2-1, the Risk Management Cycle is an iterative five-step process. This approach 

complements the military decision-making process (MDMP) described in FM 101-5, Staff 

Organization and Operations, Appendix J. The integration of the ORM process with the MDMP is 

illustrated in Table 2-1. 

Table 2-1. Complementary Aspects of the Operational Risk Management and the 

Military Decision-Making Process 

ORM Steps 

MDMP Identify 

Hazards 

Assess 

Hazards 

Develop 

Controls and 

Make Risk 

Decisions 

Implement 

Controls 

Supervise and 

Evaluate 

Mission Receipt × 

Mission 

Analysis × × 

COA 

Development × × × 

COA Analysis × × × 

COA 

Comparison × 

COA Approval × 

Orders 

Production × 

Rehearsal × × 

Execution and 

Assessment × × 

*FM 100-14 

While FM 3-100.4 provides some very useful discussions on general environmental considerations, 

current doctrine for managing OEH/ED hazards within the context of FM 100-14 and the MDMP is 

limited. This TG provides an expanded framework that can be used for this purpose. The U.S. Army 

Center for Health Promotion and Preventive Medicine (USACHPPM) guides are currently available 

for assisting preventive medicine personnel in the application of this framework for ambient 

chemicals (USACHPPM TG 230, Chemical Exposure Guidelines for Deployed Military Personnel 

(Draft)) and radiological hazards (USACHPPM TG 238, Radiological Sources of Potential Exposure 

and/or Contamination) in the environment. 
TG 248 

6 

Chapter 3 

Occupational and Environmental Health and Endemic Disease Surveillance and Risk 

Assessment During Operational Planning 

During mission analysis, the commander defines the tactical problem and begins the process of 

determining feasible solutions. The staff then brings their expertise to the analysis. They begin to 

define those things that will affect their particular support mission, the mission of the other staff 

sections, and the mission of the subordinate units. This occurs during the Intelligence Preparation of 

the Battlefield (IPB) process of developing an operations order (OPORD). Information and 

requirements to support the mission are cross-leveled between staff sections at this time. 

OEH/ED hazards are systematically identified, located, and assessed as a result of the information 

from other staff sections and an analysis of the specific missions, implied missions, and the COA. 

Appendix C contains a list of public information sources that can be used to identify and describe 

potential OEH/ED hazards. OEH/ED hazards are identified during the medical planning phase of the 

IPB. Documentation begins during the preparation of the initial preventive medicine estimate. (See 

Appendix D, Sample Preventive Medicine Estimate.) 

3-1. Step 1 - Identify Hazards 

 a. Background. 

OEH/ED hazards are identified during the first four steps of the MDMP: mission receipt, mission 

analysis, COA development, and COA analysis (see Table 2-1). 

Specific OEH/ED hazards can be classified as: no health threat, health threats, health threats of 

concern by the command, and medical threats. These hazards are any harmful occupational or 

environmental condition that may cause injury, illness, disease, adverse health conditions, or death for 

personnel (a health threat). Such conditions may also affect the overall health status of the command 

(a medical threat). 

Deployed personnel may be exposed to such harmful conditions in the ambient environment as a 

result of uncontrolled industrial releases, sabotage, or from the intentional or unintentional actions of 

enemy or friendly forces. They may also be exposed to these materials during the routine daily 

operations associated with their jobs. Exposure will occur from air, water, soil, or a combination of 

these sources. Exposure can also occur through single (e.g., inhalation from air) or multiple routes of 

exposure (e.g., both dermal absorption from soil, inhalation exposure from air and whole-body 

irradiation). The degree with which exposure to one or more materials will result in harm to the 

soldier and/or the mission will depend on many things, but primary considerations include—

(1) Types of hazard (chemical, radiological, physical, or endemic disease). 

(2) Sources of exposure (air, water, soil). 

(3) Source concentrations. 
TG 248 

7 

Intelligence Preparation of The Battlefield 

 Define the Battlefield Environment 

 Describe the Battlefield Effects 

 Evaluate the Threat 

 Determine the Threat COAs

Figure 3-1 

(4) Frequency and duration of exposure. 

 (5) Natural human variability in susceptibility to these conditions. 

 b. Identification of OEH/ED Hazards. 

The assessment begins with the identification of a “hazard” through presumption or detection of a 

harmful portion. This is refined through the second step of the ORM process (by assessing the 

severity and probability of the hazard). Increasing the level of information about the five primary 

considerations listed above results in an increasingly accurate/defensible estimate of the severity of the 

health risk posed. OEH/ED hazards are defined as—

 

 (1) Chemical hazards are any non-radioactive chemical or material to which exposure may cause 

an adverse reaction. These hazards arise from excessive airborne concentrations of mists, vapors, 

gases or solids (fumes or dusts), as well as from contaminated soil or direct exposure to liquid 

chemicals. Exposure routes include inhalation, injection, ingestion, or dermal exposure through the 

skin and mucous membranes. 

 (2) Radiological hazards are those materials that emit energy in the form of waves or particles. 

This includes ionizing and non-ionizing radiation and excessive infrared or ultraviolet light. 

 (3) Physical hazards include excessive noise, vibration, temperature extremes, excessive infrared 

or ultraviolet light (e.g., welding arc), ergonomic hazards, etc. 

 (4) Endemic disease hazards are defined as any living organism that, upon exposure, may cause 

adverse reactions in humans. 

 c. Intelligence Preparation of the Battlefield (IPB). 

Hazards are evaluated during the initial phases of the development of the OPORD. During this time, 

the preventive medicine staff must dissect each COA as it is being developed and, using both 

intelligence information and reconnaissance data (when available), should look for potential hazards 

within each COA. This process should be framed in the context of the mission, enemy, terrain, troops, 

time, and civilian (METT-TC) analysis performed during the medical IPB process. Figure 3-1 

outlines the IPB process. 
TG 248 

8 

The factors of METT-TC provide a framework for identifying hazards when planning, preparing, and 

executing operations. When performing the METT-TC and during mission planning, leaders and 

staffs should look for hazards that affect both tactical and accidental risks. Later discussions in this 

TG will identify and expand on the METT-TC analysis of these hazards within the IPB process. 

The required information to further evaluate the hazard (and ultimately determine risk) must be 

gathered from the METT-TC analysis. The following is a discussion of these steps. 

During the battlefield environment definition process, all members of the staff evaluate the proposed 

area of operation (AO) and the area of interest (AI). The AO is the geographical area where the 

commander conducts the operation, while the AI is the area from which information and intelligence 

are required to permit planning and to conduct the operation. The preventive medicine personnel 

focus on those things in the AO and the AI that may pose a health threat to the deployed forces. The 

preventive medicine observations and input are an integral part of the IPB process for other staff 

sections, as well as for the medical section. Early identification and communication of hazards to 

other staff sections result in the integration of preventive medicine countermeasures during the 

planning stages of the operation. 

This guide will assist the staff in identifying hazards during this process. The preventive medicine 

staff identifies hazards by analyzing the METT-TC considerations (see Figure 3-2) as a part of the IPB 

process. 

Information concerning the battlefield environment comes from strategic assets, experience, and 

reconnaissance. This becomes another layer of information that provides the preventive medicine 

planner with operationally relevant information, resulting in better, health-informed decisions. An 

analysis of the battlefield environment allows planners to identify health-related battlefield effects on 

friendly and threat capabilities. Because the operations plan (OPLAN) has not been produced yet, the 

risk may not be self-evident. However, as the staff develops the COA, the variables are quantified, 

and the risk estimate is refined for each option. 

Once hazards are identified during pre-deployment planning, they should be evaluated to identify the 

risk level associated with the hazards present. These risk levels will depend upon several factors that 

must be identified during the COA development process. 

METT-TC Considerations 

 MISSION 

 ENEMY 

 TERRAIN 

 TROOPS 

 TIME 

 CIVILIAN

Figure 3-2 
TG 248 

9 

During a deployment, hazards are further identified during follow-on mission planning and normal 

operations. Hazards identified during mission planning are identified in much the same way as during 

pre-deployment planning, although there is a greater chance for reconnaissance to occur. 

 d. METT-TC and Hazards Identification in the IPB Process. 

The IPB process analyzes the battlefield environment in order to identify friendly and threat 

capabilities that may influence the operations. Identification of hazards and solutions is an integral 

part of the process regardless of whether they are tactical, accidental, medical, occupational, or 

environmental. For operational risks, FM 100-14 recommends using the normal METT-TC analysis 

process. The METT-TC process focuses on the specific areas defined in Figure 3-2. It uses the 

information to clarify potential hazards and threat COA. Discussion of METT-TC considerations for 

OEH/ED surveillance in hazard identification follows. These sections are not all-inclusive and should 

be tailored to the situation before being used as a complete checklist. 

 e. Mission. 

The mission statement will dictate the scenario requiring evaluation. Unit leaders and staff officers 

typically break the mission down into specified and implied tasks. These specified and implied tasks 

give information on— 

 (1) Who will be involved in the task; what will they be doing? 

 (2) What will be the overall expectations of the command? 

 (3) When will the operation occur, and how long will it last? 

 (4) Where will the operation occur? 

 (5) Why is the operation being conducted and what level of risk is the commander willing to 

accept? 

 (a) As the plan develops—

 

• What tasks will be performed? 

• How many personnel will perform the task? 

• Will the task be continuous or intermittent? 

 (b) Will the task be conducted— 

• Indoors or outdoors? 

• Under nuclear, biological, and chemical (NBC)-protective conditions (mission-oriented 

protective posture gear, NBC-protective shelter, or in a vehicle with NBC-protective capability)? 
TG 248 

10 

• Where climate is a factor (extreme heat or cold, high elevation)? 

• In or around a confined space? 

 (c) Can disease be a factor? 

• Under what conditions or in what types of areas are personnel likely to encounter the 

vectors? 

• What are the potential communicable diseases and vectors associated with the operational 

area? (See Section 4.1 for more information.) 

• What is the prevalence of disease? 

• Under what conditions or habitats are personnel likely to encounter the vectors? 

 f. Enemy. 

An evaluation of the enemy forces’ composition, organization, tactical doctrine, weapons, 

equipment, and supporting systems allows preventive medicine personnel to draw conclusions 

about enemy capabilities, limitations, and potential actions. It is very important to evaluate 

probable or historical enemy actions. When evaluating the enemy threat, the ability of the 

enemy to use existing OEH/ED conditions to his advantage must be considered. This analysis 

must occur with input from the G/J/S-2. Intelligence and preventive medicine personnel must 

consider five questions— 

(1) What is the most likely type of operation? 

(2) When is the action likely to cause the most damage? 

(3) Where will the actions occur? 

(4) How can the enemy accomplish the task? 

(5) Why is the objective or end state important to the enemy? This should include— 

 (a) Terrorist/enemy special operation target information—

• Potential targets such as a TIC manufacturing facilities, water treatment facilities, 

laboratories or research facilities. 

• Residual contamination from historical enemy or industrial activity. 

• Potential targeting of civilians to influence battlefield events or operations. 
TG 248 

11 

 (b) Information about the enemy capabilities—

• Is the threat credible? 

• Do they have the means to precipitate an environmental event? 

 (3) Historical information about enemy’s willingness to create environmental hazards. 

 g. Terrain and Weather. 

The terrain and weather will also affect the identification of potential hazards as they will affect the 

location of employed units; this will also affect how, when, and where exposures may occur. 

 (1) Location of employed units. The location of the units will affect their physical relationship 

with a potential hazard contamination. 

 (2) Geography. In addition to topographical factors that may impact environmental conditions, 

geography will be important. Military units often require suitable facilities located in urban areas to 

accomplish their missions (maintenance, transportation and storage of equipment). Soldiers who are 

located next to urban/industrial areas may be exposed to more hazards because of the current or 

previous uses of the AO. The following are some things to consider when identifying hazards 

associated with an area: 

 (a) Pollution sources. What type and quantity of potential pollution sources exist in or adjacent 

to living or work areas? 

 (b) Pollution transport. How will the terrain or weather affect pollutant transport in air, soil, and 

water? 

 (c) What is the past land use? 

• Will it be industrial land uses involving chemical, biological or nuclear contaminants? 

• Will it be farmland where pesticides might have been used? 

 (d) What is the current land use? 

 (e) What are the potential sources of radiation? 

 (f) What is the entomologic history? 

• How prevalent will the endemic diseases be? 

• What will be the associated competent vectors? 
TG 248 

12 

• What type of terrain or habitat do the vectors inhabit? 

• Where is this terrain in relationship to U.S. personnel? 

 (3) Exposure Considerations. 

 (a) Precipitation patterns. How will precipitation affect exposure? 

 (b) Heat/humidity— 

• Will hot weather increase soldier water intake, require modification of the work uniform, or 

require modification of work hours? 

• Will weather conditions increase exposure (e.g., will inversions and night-time conditions 

increase the potential effects from releases of TICs)? 

 (c) Cold. What cold weather conditions will increase the likelihood of exposure? 

• Will inadequate ventilation of tent heaters result in carbon monoxide exposure? 

• Will sleeping facilities have adequate ventilation to reduce the spread of common cold and 

upper respiratory disorders? 

• Could contaminated soil, when heated, become an inhalation hazard? 

 (d) Specific local climate conditions. Will the local climate be conducive to vector-borne disease 

(e.g., adequate rainfall for mosquitoes or tall grass, brush for ticks)? 

 (e) Logistics. Will local purchase issues result in unforeseen occupational exposures? (How will 

the logistics of any local purchase plan affect the types of chemicals soldiers will use, as well as any 

personal protection equipment (PPE) obtained locally?) 

 (f) Water conditions. What harmful agents (chemical/biological) exist in the water that could 

increase exposure due to the operations (e.g., vehicle washing, laundry, or showers)? 

 h. Troops. 

The type of unit and its activities will also be important when conducting the hazard identification. 

 (1) Types. The type of unit is important in considering hazards because different types of soldiers 

will have different exposure patterns. Administrative duties do not require that soldiers spend as much 

time in contact with soil as a dismounted infantry soldier. Different types of soldiers will experience 

different exposure frequency and duration considerations. 

 (2) Condition. The condition of solders will also affect— 
TG 248 

13 

 (a) Water-intake requirements. 

 (b) Susceptibility to some disease and chemicals. 

 (c) Ability to sustain health through prolonged exposure. 

 (3) Training. Examples of troop preparation prior to deployment— 

 (a) Will the soldiers be prepared for entomologic hazards? Will uniforms be treated? Will field 

sanitation teams be trained and equipped? 

 (b) Will commanders be aware of the need for the following? 

• Engineering controls for routine operations (e.g., ventilation systems, shielding, isolation, 

etc.)? 

• Administrative controls in place for routine operations (limited work shifts, shifts worked 

only during warmer or cooler parts of the day, etc.)? 

 (c) Have personnel been trained on— 

• How to conduct the operation safely? 

• How to safely handle any hazardous materials associated with the operation? 

• How to use any PPE correctly and safely? 

 (4) Operational activities to consider— 

 (a) Will hazardous materials be used or generated as part of the operation? 

 

• Will material safety data sheets be available for all chemicals being used on-site? 

• How toxic will the materials be that are being used? 

• Will there be a published exposure limit such as Occupational Safety and Health 

Administration (OSHA) Permissible Exposure Limit (PEL); American Conference of Governmental 

Industrial Hygienists (ACGIH) Threshold Limit Value (TLV); or Chemical Exposure Guidelines 

(USACHPPM TG 230). 

__________ 

TLV is a registered trademark of the American Conference of Governmental Industrial Hygienists, 

Cincinnati, Ohio. Use of the trademarked name does not imply endorsement by the U.S. Army but is 

intended only to assist in identification of a specific product. 
TG 248 

14 

• How and where will hazardous materials be stored? 

• What physical form will they be in (solid, liquid, vapor, compressed gas)? 

• Will the containers have warning labels (i.e., corrosive, flammable, poison, etc.)? 

• Will personnel be dealing with compressed gas cylinders? 

• Will personnel conduct any sampling of that chemical or by-product? If so, what are the 

results? 

• Are engineering controls present to help minimize exposure to the chemicals? 

• If engineering controls are not present (or are inadequate), do personnel have proper PPE 

issued and fitted? Are there adequate replacement supplies of PPE available in theater (especially if 

disposable PPE is used)? 

 (b) Will there be physical hazards that can be quantified with equipment on-hand (i.e., noise, 

heat stress, ionizing radiation, etc.)? 

 i. Time. 

The health risk from any of the hazards discussed in this document is integrally related to the 

frequency and duration of exposure. Soldiers exposed above a threshold level to an identified hazard 

are generally at increased risk for an adverse outcome as the period of exposure becomes longer, and 

the frequency of exposure increases. Exposure to most chemicals and radiation for a longer duration 

as well as exposures that are more frequent are associated with increased risk, particularly if the 

hazard accumulates in the body. 

With regard to OEH/ED exposure, duration will be a key factor as risks will depend upon the duration 

of the work shift. However, frequency will be key in that the number of shifts worked in a hazardous 

environment will also increase the probability of overexposure or contamination. Detrimental effects 

will then depend upon—

 (1) Exposure Duration (i.e., how long will this exposure occur?). 

 (2) Exposure Frequency (i.e., how frequently will the exposure occur?). 

 (a) Number of shifts per week. 

 (b) Duty day length. 

 j. Civilian 

This analysis will include an in-depth evaluation of how the local population and its dynamics will 

indicate whether hazards are present. Civilians are identified as non-governmental organizations, 
TG 248 

15 

private voluntary organizations, U.S. Government civilians, foreign national civilians, the media, and 

dislocated civilians put at risk by military operations. OEH/ED threats are associated with the 

population density, the countries’ developmental status, and the attitudes of the population toward 

OEH/ED sanitation in general. The following categories are specific items that will be investigated 

during the hazard identification process: 

 (1) Local Population Information—

 (a) Demographics— 

• Population density. 

• Urbanization level. 

• Educational level. 

• Relative income level. 

 (b) Sanitation standards— 

• Waste disposal practices. 

• Sanitation infrastructure condition. 

 (c) Lifestyle— 

• Mobile/non-mobile. 

• Traffic density. 

• Home owners/squatters. 

 (d) Pollution attitudes— 

• Public awareness of hazards. 

• Public use of sanitation structure. 

• Risk perception (cultural priorities – an oil-burning car is better than not driving). 

 (e) Health of the population— 

• Communicable diseases endemic to the area/population. 
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• Control measures for these diseases present. 

• Vaccination programs. 

 (f) Relative income level. 

 (g) Religious or political factions and boundaries. 

 (h) Organization and stability of the government. 

 (i) Public communication systems. 

 (2) Industry Information—

 (a) The types of industry present will govern what type of environmental hazards will be present. 

 (b) The relationship of industry to geography may indicate potential contamination locations and 

hazards.

 (c) Industry attitudes toward contamination may indicate probability and extent of pollution. 

 (d) Will there be any pollution controls or maintenance of pollution controls? 

3-2. Step 2 - Assess Hazards 

This ORM step examines each OEH/ED hazard in terms of probability and severity to characterize 

risks of health threats and medical threats posed by OEH/ED hazards. Risk characterization is the 

process for estimating risk levels and describing their role in context with mission attributes. This step 

is conducted during mission analysis, COA development, and COA analysis of the MDMP process, 

both before and after hazard controls are developed. The following are substeps of this task— 

 a. OEH/ED Hazard Classification (Preliminary Threat Analysis). 

 (1) Determine which of the identified OEH/ED hazards (which, by definition, are health threats) 

have a credible potential to become medical threats to the operation. In addition, identify non-medical 

threat OEH/ED hazards that are of importance to the command. Once additional data have been 

obtained and the risk assessment completed, this preliminary threat analysis should be 

reevaluated in as stated in Section 3.2, d (2), Determine Threat Category, in order to provide the 

commander with an accurate perspective of the type of impact the hazard poses to the unit and 

mission. 
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17 

 (2) An OEH/ED is any substance or organism that may cause injury, illness, disease, adverse 

health conditions, or death for personnel (health threats). Such conditions may also affect the health 

status of the command (medical threats). The four types of threat classifications for these health 

hazards are— 

 (a) No Health Threat. This classification can be assigned to a hazard only when there is no 

evidence to indicate its presence in the environment, if there is enough data to know that the 

concentration and extent of its presence would not pose a credible health threat. 

 (b) Health Threats. This classification consists of all 

identified hazards which, under the right circumstances, 

could result in adverse health effects to certain individuals 

but are not expected to have immediate medical impacts on 

overall mission effectiveness. 

 (c) Health Threats of Concern to the Command. This 

classification consists of those health threats that are of 

immediate importance to the commander based on the 

nature of the operation and/or related (i.e., political) 

considerations. For instance, some hazards may pose health 

effects with delayed onset (e.g., chronic diseases like cancer 

or impaired liver and kidney function) but no immediate, 

mission-impacting effect. 

 (d) Medical Threats. This classification is a subset of 

health threats that have the potential to render a field unit combat 

or mission ineffective. Depending on the mission, such hazards 

include those that can result in effects such as severe eye irritation/blurred vision, severe 

dizziness/confusion, seizures, death, or would otherwise result in sick calls or medical interventions. 

 b. Evaluate Hazard Probabilities. 

 (1) Determine hazard probabilities for all selected OEH/ED hazards (FM 100-14, Substep A). The 

Army definition of hazard probability and the OEH/ED operational definition are— 

 (a) Hazard probability: The likelihood that a hazardous incident will occur. Probability levels 

estimated for each hazard may be based on the mission, COA being developed and analyzed, or 

frequency of a similar event. 

 (b) OEH/ED hazard probability: The magnitude, frequency, and duration of exposure of unit 

personnel to health threats integrated with the expected incidence of exposure within the unit relative 

to established exposure effect levels. 

 (2) Determining OEH/ED hazard probability is a subjective evaluation where information on unit 

and mission attributes (e.g., deployment duration and the unit’s exposure profile) and OEH/ED

Hierarchy of Health Threats 

Figure 3-3 
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18 

information are assessed to determine the degree of exposure to the hazard. The estimation of hazard 

probability involves three primary considerations—

 (a) Comparability of the field unit’s exposure profile (i.e., exposure factors, frequencies, and 

durations) to the standard exposure profile used in the derivation of the exposure guideline(s) of 

concern. 

 (b) Proportion of the field unit that is likely to experience exposures relative to the specific 

exposure guidelines. 

 (c) Confidence in the available data given the sources of uncertainty and variability. 

When these determinations are made, a hazard probability category must be selected for each 

OEH/ED. FM 100-14 provides the following hazard probability categories; these categories should 

be evaluated within the context of the considerations as previously mentioned—

• FREQUENT - occurs very often, continuously experienced. 

• LIKELY - occurs several times. 

• OCCASIONAL - occurs sporadically. 

• SELDOM - remotely possible; could occur at some time. 

• UNLIKELY - can assume will not occur, but not impossible. 

 (3) A Probability Ranking Chart (Table 3-1) can be used to integrate this information to make a 

probability estimate for the hazard. The design of this chart is only a recommendation and should be 

altered as the situation dictates. It is expected that additional investigation into hazard probability 

ranking methods will occur on a routine basis. 

Table 3-1. Hazard Probability Ranking Chart for Military Deployments 

Percent of Exposed Personnel with Exposures Estimated to be Greater Than Specified 

Effect Level Percent of Field 

Unit Exposed < 20 % 20 – 50 % 51 – 70 % 71 – 90 % > 90 % 

> 90 % Occasional Occasional Likely Frequent Frequent 

71 – 90 % Seldom Occasional Likely Likely Frequent 

51 – 70 % Unlikely Occasional Occasional Likely Likely 

20 – 50 % Unlikely Seldom Occasional Occasional Occasional 

< 20 % Unlikely Unlikely Seldom Seldom Seldom 

*Select the proper row and then follow across until the proper column is reached. The qualitative probability 

categories correspond to FM 100-14.
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c. Evaluate Hazard Severities. 

 (1) Determine hazard severities for all selected OEH/ED hazards (FM 100-14 Substep B). The 

Army definition of hazard severity and the OEH/ED operational definition are— 

 (a) Hazard severity: The expected consequence of an event (hazardous incident) in terms of 

degree of injury, property damage, or other mission-impairing factors (loss of combat power) that 

could occur. 

 (b) OEH/ED hazard severity: The potency of the hazard to cause injury, illness, disease, adverse 

health conditions, or death integrated with the significance of the health consequences for personnel 

relative to the ability of the field unit to complete the mission or maintain readiness. 

 (2) OEH/ED hazard severity is a function of the consequence of exposure (e.g., nature of probable 

effect) for any given soldier in the unit and the predicted distribution of that impact within the field 

unit. The estimation of the hazard severity involves three primary judgments— 

 (a) Proportion of the field unit that is likely to exhibit effects relative to the specific exposure 

guidelines. 

 (b) Nature of the health effect(s) associated with exposures at or above the guideline level. 

 (c) Confidence in the available data, given the sources of uncertainty and variability. 

When these determinations are made, a hazard severity category must be selected for each hazard. 

FM 100-14 provides the following hazard severity categories; they should be evaluated within the 

context of the considerations above: 

• CATASTROPHIC - loss of ability to accomplish the mission or mission failure. 

• CRITICAL - significantly (severely) degraded mission capability or unit readiness. 

• MARGINAL - degraded mission capability or unit readiness. 

• NEGLIGIBLE - little or no adverse impact on mission capability. 

 (3) A Severity Ranking Chart (Table 3-2) can be used to integrate this information to make a 

severity estimate for the hazard. 
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Table 3-2. Hazard Severity Ranking Chart For Military Deployments 

Nature of Individual’s Health Effect(s) Associated with Exposures Near the Guideline 

Symptoms 

occurring after the 

mission 

Percent of Exposed Symptoms occurring during the mission 

Persons to Exhibit 

Symptoms 

(ATTACK RATE) Chronic/permanent 

injury or disease 

(e.g. Cancer) 

Mild illness or 

temporary 

irritation 

(reversible, shortterm, nuisance) 

Injury or illness 

that impairs 

functional abilities 

Incapacitation or 

Death 

>50 % Marginal Critical Catastrophic Catastrophic 

31 – 50 % Negligible Marginal Critical Catastrophic 

10 – 30 % Negligible Marginal Marginal Critical 

< 10 % Negligible Negligible Marginal Critical 

 d. Risk Characterization. 

Synthesize the estimates of hazard probabilities and severities. Risk levels for all OEH/ED hazards 

and the overall mission are determined and described in a mission-oriented context. 

This step is continued for each hazard until risk levels are determined for all of the hazards. Risks are 

ranked, and preventive medicine personnel should communicate the risk level to the commander. The 

remaining steps are the follow-through actions to effectively manage risk through the COA 

development process. For a more detailed discussion see FM 100-14 and FM 101-5, Appendix J.

Preventive medicine personnel must characterize the risks of health threats and medical threats posed 

by OEH/ED hazards to the commander. Assessing hazards and characterizing risks involves 

estimating risk levels and describing the hazards and risks in context with mission attributes. The 

major emphasis here is the application of the Risk Assessment Matrix described in FM 100-14. 

The risk of a health threat becoming a medical threat is a function of the probability of the hazard 

occurring and the severity (of exposure) to that hazard by the unit. OEH/ED hazards are characterized 

by determining the degree of exposure and the impact of the exposure on the unit. The determination 

of these variables is subjective, and the uncertainty in the assessment will be a function of the level of 

information available. Characterizing risks involves categorizing OEH/ED hazards as either health 

threats or medical threats; assigning hazard probability, severity, and risk estimates to specific threats 

of concern; and determining if those threats are medical threats to a mission or can be otherwise 

controlled. 

Once the hazard probability and severity estimates are determined, they are synthesized in this step. 

Risk levels for all selected hazards and the overall risk for each COA are determined and described in 

a mission-oriented context. The risk level is defined using the probability and severity information 
TG 248 

21 

from the previous sections combined with command judgments regarding acceptable risk levels for 

the mission. 

The primary objective is to apply the FM 100-14 Risk Assessment Matrix (see Table 3-3) in a way 

that is consistent with operational guidance so that risks can be put in the same context as other 

operational risks. This idea must remain central to the medical planning perspective that threats must 

be compared and communicated to the commander and the staff as transparently as possible. This 

must occur so that the commander will be able to make decisions based on credible information. The 

commander must give this information equal weight with the other risks present on the battlefield. 

Table 3-3. Risk Assessment Matrix 

HAZARD PROBABILITY 

HAZARD 

SEVERITY 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 

Risk characterization should be designed to facilitate the selection of risk control strategies that are 

associated with risk levels that are greater than a readiness- or mission-specified rate (most often 

expressed as a percent of the unit, and a decision of the commander). 

Table 3-4 presents the ORM risk levels defined in FM 100-14 compared with unit status suggestions 

from FM 101-5-1, Appendix D. These sets of definitions were combined to create a risk 

characterization paradigm that is consistent with current operational guidance and the preventive 

medicine approach to assessing health and medical threat risks. 
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Table 3-4. Risk Level Definitions 

Risk Level Defined Consequence 

(FM 100-14) 

Unit Status 

(FM 101-5-1) 

 

Extreme Expected loss of ability to accomplish the 

mission. 

Black (Unit Requires Reconstitution). 

Unit below 50% strength. 

High Expected significant degradation of mission 

capabilities in terms of the required mission 

standard, inability to accomplish all parts of 

the mission, or inability to complete the 

mission to standard if hazards occur during 

the mission. 

Red (Combat Ineffective). 

Unit at 50 – 69 % strength. 

Moderate Expected degraded mission capabilities in 

terms of the required mission standard will 

reduce mission capability if hazards occur 

during mission. 

Amber (Mission Capable, with minor 

deficiencies). Unit at 70 - 84% strength. 

Low Expected losses have little or no impact on 

accomplishing the mission. 

Green (Mission Capable). 

Unit at 85% strength or better. 

*The unit rates provided under unit status are to be determined by the commander. Charts similar to the 

example OEH/ED Hazard Probability and Severity Ranking Charts presented above earlier be aligned with the 

acceptable risk levels provided by the commander. 

(1) Determine Confidence in Risk Estimate. A confidence level should be assigned following the 

derivation of the risk estimate. The degree of confidence in the risk estimate will be particularly 

important when determining a COA. Confidence levels should be simple categories that can be 

rationally explained (e.g., high, medium, low). The confidence level assigned to a risk estimate 

should integrate uncertainty associated with each of the elements of the risk assessment. Key areas of 

uncertainty that should be considered include— 

 (a) Sampling or field data quality. 

 (b) Actual exposures of field personnel. 

 (c) Field unit attributes (e.g., demographics, activity patterns). 

 (d) Comparability of standard guideline assumptions (e.g., exposure duration and frequency) to 

expected field exposure patterns. 

 (e) Expected symptoms of exposure (i.e., hazard severity), including consideration of exposure 

to multiple hazards. 

 (f) Other uncertain or missing information relevant to the process. 
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 (g) Whether the predicted health outcome is plausible, given weight of evidence or real-world 

experiences. 

Table 3-5 provides example criteria for determining a risk estimate confidence level. The final 

determination of confidence must be based on the well-reasoned judgment of the preventive medicine 

officer conducting the risk assessment. 

Table 3-5. Example Criteria for Assigning Confidence Levels 

Confidence Level Criteria 

High 

Sampling data quality is good. 

Field activity patterns are well known. 

True exposures are reasonably approximated. 

Knowledge of the symptoms of hazard exposure relative to 

guideline is well known. 

No important missing information. 

The predicted health outcome is plausible or already 

demonstrated. 

Medium 

Field data quality is good. 

Field exposures are likely to be overestimates of true 

exposures due to incomplete data coverage relative to 

actual exposure durations. 

Detailed information is lacking regarding true personnel 

activity patterns in the field. 

Symptoms are well known for each individual hazard, but 

some scientific evidence suggests that the combined 

effects of all hazards may exacerbate symptoms. 

Predicted health outcome is plausible. 

Low 

Important data gaps and/or inconsistencies exist. 

Exposure conditions are not well defined. 

Field personnel activity patterns are basically unknown. 

Predicted health outcome is not plausible because it is not 

consistent with real-world events/experience. 

 (2) Determine Threat Category. During Step 1 (Hazard Identification), a preliminary threat 

analysis is conducted for each of the identified chemical hazards. The goal is to determine which have 

a credible potential to become “medical threats” or “health threats of concern to the command” in 

order to focus additional data collection and risk characterization efforts. At this point in the process, 

the preliminary analysis should be reevaluated based on the more complete assessment of the nature 

of the hazards and the conditions of exposure. The placement of the hazards into health threat 

categories (i.e., no threat, health threat, health threat of concern to the command, and medical threat) is 

the last step in risk characterization. It is important for the command to understand that some hazards 

pose a greater threat potential to operations than others, even though the risk estimates may be similar. 

The command will have a preference to control medical threats and other health threats of concern 

over other threats. This step is designed to provide the command with an accurate perspective of the 

type of impact the hazard poses to the unit and mission. 
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3-3. Step 3 - Develop Controls 

Implementing this ORM task involves developing one or more controls to minimize or eliminate the 

risks of the evaluated health threats and medical threats posed by OEH/ED hazards. Risks are also 

compared and balanced against mission expectations. Determinations are made whether developed 

controls are sufficient and acceptable. Residual risks are characterized using the same process 

described previously. 

The information is communicated to the commander and risk decisions are then made. These tasks 

are completed as part of the MDMP process: COA development, COA analysis, COA comparison, 

and COA approval. 

Risks are managed during the development of the OPLAN/OPORD by incorporating risk 

management controls and decisions into the plan. OEH/ED hazard control measures are described 

below. 

a. Substep A – Develop Controls (from FM 100-14). 

Hazard control measures, as specified in FM 100-14, fall into three basic categories: educational 

controls, physical controls, and avoidance. Specific control measures for OEH/ED threats include, but 

are not limited to— 

 (1) Educational controls— 

 (a) Enforcing correct wear of the uniform to minimize heat. 

 (b) Enforcing correct use of the DOD Arthropod Repellent System. 

 (c) Enforcing good basic housekeeping. 

 (d) Enforcing personal hygiene standards. 

 (2) Physical controls— 

 (a) Completing active dust suppression measures. 

 (b) Completing entomological measures. 

 (c) Using less hazardous materials in place of more toxic ones. 

 

 (d) Using ventilation to minimize the dispersion of airborne contaminants. 

 (e) Isolating an operation by means of barriers or enclosures (such as welding screens). 

 (f) Shielding a radiation source. 
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25 

NOTE: The military protective mask (M-40, M-17, etc) is only officially approved for use against

military NBC-warfare agents; it may not offer adequate protection against industrial chemicals.

Decisions to use military protective masks for protection against toxic industrial chemicals (in a

deployment situation only) must be made by competent OEH/ED surveillance personnel on a

 (g) Ensuring pre-deployment vaccination and prophylaxis. 

 (h) Ensuring moving operations (e.g., relocating a base camp). 

 (i) Managing deployment length. 

 (j) Managing work schedules and limiting shift duration. 

 (k) Managing personnel rotation on high-risk missions. 

 (3) Avoidance. PPE is applicable when administrative and engineering controls are 

ineffective or not practicable. PPE is used as a last resort because it does not eliminate the 

hazard. These PPE devices include: 

 (a) Commercial respiratory protection. 

 

 (b) Eye protection. 

 

 (c) Hearing protection. 

 (d) Gloves. 

 (e) Chemical protective clothing. 

 (f) Safety boots. 

 (g) Permethrin impregnated clothing. 

 b. Substep B – Make Risk Decisions. 

A key element of risk decision is determining if the risk is justified. The commander must compare 

and balance the risk against mission expectations. He alone decides if controls are sufficient and 

acceptable and whether to accept the resulting residual risk. If he determines the risk level is too high, 

he directs the development of additional controls or alternate controls, or he modifies, changes, or 

rejects the COA. 

3-4. Step 4 - Implement Controls 

Leaders, such as commanders, subordinate leaders, and their staff, ensure that controls are 

implemented at all levels, and as a result must be clear and simple enough to be understood and 
TG 248 

26 

executed by all subordinate units. They ensure that controls are integrated into standing 

operating procedures (SOPs), written and verbal orders, mission briefings, and staff estimates. 

The critical check for this step, with oversight, is to ensure that controls are converted into clear, 

simple execution orders that can be understood at all levels. Leaders must explain how 

supervisors will implement controls. 

Leaders monitor controls and conduct surveillance for new hazards. The staff must continually revise 

their respective estimates and ensure that the risk management process was effective. (All levels of 

the command must understand the information and controls.) Constant surveillance of the situation 

ensures that overlooked hazards as well as new hazards are identified and controlled during the 

operation. 

This step necessarily occurs during mission execution. As the OPORD is executed, the preventive 

medicine personnel observe and evaluate the risk management procedures set in place. This 

information further provides data to follow-on mission planning and the effectiveness of current 

procedures. This allows for constant evaluation of the risk level and the efficacy of the controls in 

place. 

3-5. Step 5 - Supervise and Evaluate 

During mission preparation and execution, leaders must ensure that their subordinates understand how 

to execute risk controls. Leaders continuously assess risks while conducting operations, especially 

during long-term missions. Leaders maintain situational awareness. They guard against complacency 

to ensure that risk control standards are not relaxed or violated. To gain insight into areas needing 

improvement, leaders must continuously evaluate their units’ effectiveness in managing mission risks. 

 a. Supervise. 

Leaders supervise mission rehearsal and execution to ensure standards and controls are enforced. 

Techniques may include spot checks, inspections, situation reports and brief-backs, buddy checks, and 

close supervision. During the mission, leaders continuously monitor controls to ensure they remain 

effective, and they modify them as necessary. Leaders and individuals anticipate, identify, and assess 

new hazards to implement controls. They continuously assess variable hazards such as fatigue, 

equipment serviceability, and the environment. Leaders modify controls to keep risks at an acceptable 

level. During sustained operations, leaders continue planning to ensure that controls emplaced at the 

beginning of the mission apply to changes in the operation’s current situation and to hazardous 

conditions. Leaders must maintain an extraordinary degree of discipline. They must avoid 

complacency, which can result from boredom and overconfidence. Leaders must ensure that soldiers 

do not relax their vigilance due to performing repetitive tasks, despite changing roles and missions, 

unit turbulence and turnover, and declining skills. Leaders maintain a close watch over controls put in 

place to reduce risks over a prolonged period. 

 b. Evaluate. 

After a mission, leaders and individuals evaluate how well the risk management process was 

executed. They will—
TG 248 

27 

(1) Determine how to ensure that successes are continued to the next mission. 

 (2) Capture and disseminate lessons learned so that others may benefit from the experience. 

 (3) Consider the effectiveness of the risk assessment in identifying and accurately assessing the 

probability and severity of hazards that results in mission degradation. 

 (4) Determine whether the levels of residual risk of each hazard and of the overall mission were 

accurately estimated. 

 (5) Evaluate the effectiveness of each control in reducing or removing risk, including whether 

controls were effectively communicated, implemented, and enforced. 

Leaders and individuals determine why some controls were ineffective and what should be done when 

the hazard is encountered again. A control may be altered; the way it is implemented or supervised 

may be changed to make it effective; or a completely different control may be more effective. 

Leaders must energize the system to fix systemic problems that hinder combat effectiveness. 

As can be seen in Figure 2-1, the Risk Management Process continues throughout a mission as well as 

from mission to mission. It is integral to the MDMP. Its application requires good judgment and 

intuitive analysis borne of confidence, experience, and situational awareness. 

3-6. Tools and Pitfalls 

Appendix A of FM 100-14 provides examples of risk management tools to help leaders assess 

identified hazards, develop controls, and make risk decisions. The tools should be tailored to meet 

particular situations and missions. Units train regardless of the degree of difficulty. To reduce risk, 

commanders identify their mission-essential task list and use the risk management process to assess 

the degree of risk related to each mission-essential task. However, problems arise when risk 

management tools are used without adapting the METT-TC factors. Using a checklist may be helpful 

during the initial mission analysis and COA development. 
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28 

Chapter 4 

Phases of Deployment

The following sections discuss some of the available guidance during the different phases of 

deployment. They are subdivided by the major types of OEH/ED hazards (i.e., chemical, radiological, 

physical and endemic disease), and generally discuss and identify references that allow for the 

planning, evaluation and management of these hazards. 

4-1. Phase I - Pre-Deployment 

For deploying soldiers, potential health hazards can come from many sources: those endemic to the 

deployment site where a unit will conduct operations (ambient), and those associated with the 

operations conducted by the unit such as vehicle maintenance, health care functions, or logistical 

supply and warehousing operations. Planners should use the tools presented here to anticipate 

potential hazardous exposures associated with specific deployment sites. 

Military units should already be familiar with the OEH/ED hazards associated with their daily tasks as 

performed in garrison. However, they should anticipate and plan for changes in the severity and/or 

duration of exposures to those hazards when the tasks are performed in the field instead of in a 

controlled garrison environment. 

 a. Chemical Hazards. 

For chemicals hazards, initial assessments and decisions will begin early in the deployment. As with 

any hazard that is identified, good decisions are made with good information (i.e., the better the 

information collected during pre-deployment reconnaissance about what chemicals may be 

encountered, the more confident planners will be in the actual risk level). The degree with which 

exposure to one or more chemicals will result in harm to the soldier and/or the mission will depend on 

many things. Primary considerations include—

 (1) Types of chemicals. 

 (2) Sources of exposure. 

 (3) Job- or task-related activities. 

 (4) Concentrations of chemicals from sources. 

 (5) Duration of exposure to the chemicals at specific concentration(s). 

Initially, identification of a chemical “hazard” involves the detection or presumption (e.g., 

through modeling) that a chemical exposure will occur. This identification will be refined 

through the second step of the ORM process where the hazard severity and probability are 

evaluated. This establishes the level of risk posed to deployed personnel by a chemical in the 

environment. Increasing one’s level of information about the primary considerations listed 
TG 248 

29 

above will result in an increasingly accurate/defensible estimate of the severity of the health risk 

posed. For instance, are there industries in the area that store raw chemical products? These 

chemicals/facilities could be the source of intentional or accidental releases of catastrophic levels 

of chemicals into the environment. On the other hand, poor sanitation and environmental laws in 

an AO could indicate that significant residual contamination is already in the environment. The 

fact that a residential population lives in proximity to such facilities should not lead to the 

assumption that potentially significant health effects are not caused by the existing 

environmental conditions. Therefore, all information related to the environmental and industrial 

status of a country or area of deployment is critical in deciding what type/degree of chemical 

hazards to anticipate. This information will also aid in deciding what resources are required, 

what risks may/will be accepted, what communication should occur, and what mitigations or 

controls are feasible. 

Guidance on determining the risk from chemical exposures can be found in USACHPPM TG 230, 

Chemical Exposure Guidelines for Deployed Military Personnel (Draft), and USACHPPM TG 231, 

Soldiers Guide for Occupational Exposure Risk Assessment During Deployments (Draft). Both 

documents provide processes and exposure guidelines that allow for the evaluation of both long- and 

short-term (TG 230) and job-related (TG 231) chemical exposures. 

 b. Radiological Hazards. 

In order to assess the risk from a potential radiological hazard, one must identify the hazard. 

USACHPPM TG 238, Radiological Sources of Potential Exposure and/or Contamination, is a good 

source to assist personnel in recognizing radiological sources of potential exposure and contamination 

from both civilian and military origins. It identifies potential radiological sources that may pose both 

high- and low-level radiation hazards. It also summarizes the sources of radiation exposure and 

contamination found in nature, in the nuclear fuel cycle, in the biomedical field, in Army commodities 

and foreign materiel, industry, in transportation of radioactive materials, and in the production and use 

of nuclear weapons. 

Once the source has been identified, the risk assessment begins. The assessment of risk in predeployment operations often depends on intelligence information with regard to the presence of 

potential radiation sources. However, pre-deployment assessments can include environmental 

sampling for clearing a proposed operational area or for collecting background measurements. 

The fundamental principles of safety from external radiation exposure are time (i.e., minimizing 

exposure time), distance (i.e., maximizing distance from a radiation source), and shielding (i.e., 

shielding the identified source). These are also applicable in pre-, during-, and post-deployment 

operations. The less time spent within a radiation field, the lower the dose. By having mock-ups and 

trial runs of jobs where the possibility of significant exposures exists, soldiers in pre-deployment 

operations can minimize their doses. Shielding makes use of the different penetration abilities of 

radiation. That is, to properly shield from a radioactive source, one most know the type of radiation 

emanating from the source and, thus, its penetration capabilities. USACHPPM TG 238 can be used as 

a quick reference for the appropriate identification of the potential radiological hazard and associated 

type of radiation in order to properly use the shielding principle. 
TG 248 

30 

USACPPM TG 244, The Medical NBC Battlebook, and USACHPPM TG 236A, Basic Radiological 

Dose Estimation – A Field Guide (Draft), briefly illustrate how to handle risk from a radiological 

hazard and how it is commonly classified in the Army. USACHPPM TG 236A uses the principles in 

the Allied Command Europe (ACE) directive and Standardization Agreement (STANAG) North 

American Treaty Organization (NATO) documents to simply define risk based on cumulative doses 

from radiological sources. A more in-depth process is required to perform a radiological health-risk 

assessment. 

 c. Physical Hazards 

Management of physical hazards generally includes planning for heat and cold weather extremes, as 

well as noise hazards both associated with the ambient environment (locations near airfields and 

generator farms) and job-related actives such as equipment or vehicle operations. The assessment and 

management of heat and cold injuries in the field are fairly well understood. FM 21-10, Field 

Hygiene and Sanitation, discusses planning and management issues for these hazards and should be 

used as the planning document for these hazards. TG 231, Soldiers Guide for Occupational Exposure 

Risk Assessment During Deployments (Draft), provides a process and exposure guidelines that allow 

for the evaluation of these noise hazards and discusses various risk management options. 

 d. Endemic Disease. 

Pre-deployment planning for biological/entomological hazards will, in addition to communicable 

diseases, encompass pesticide exposure, medically important arthropods (e.g., mosquitoes, sand flies, 

ticks, lice, fire ants, spiders, scorpions), medically important animals (e.g., rodents, birds, snakes), and 

poisonous plants (e.g., poison ivy). Communicable diseases are transmitted person-to-person (e.g., 

influenza, pneumonia, tuberculosis, sexually transmitted diseases, chickenpox (varicella), and 

smallpox (variola) among others). Vector-borne diseases include malaria, plague, yellow fever, 

dengue and other diseases. Arthropod vectors associated with specific diseases, food-, and waterborne diseases include those due to exposure to protozoa, bacteria and viruses and may result in 

diarrheas, typhoid and hepatitis A. (See FM 8-33, Control of Communicable Disease Manual.) 

Crowding and close contact with indigent people increase risks of acquiring person-to-person 

communicable diseases. 

 

Person-to-person diseases are prevented or controlled by reducing crowding, and providing 

immunizations, medications, PPE, and blood-borne pathogen control techniques. 

Vector-borne diseases are prevented or controlled by the proper wear of the field uniform, the DOD 

repellent system, the use of bed nets, pest control and, for select diseases, immunizations and 

chemoprophylaxis (e.g., malaria). 

Food-borne/water-borne diseases are prevented or controlled by proper food and water selection, 

preparation and handling, immunizations (e.g., typhoid), and fully functional field sanitation teams. 

Training to standard is a pre-deployment requirement. 

To identify biological hazards, planners must determine what potential and actual communicable 

diseases and other medical entomological hazards exist in the AO. 
TG 248 

31 

 (1) Determine potential risks. This aspect considers the probability of the vector and disease being 

present at the same time and location. It also considers troop contact with the vector and historical 

data relevant to the disease presence. Historical data may provide great insight into the trends of the 

vector and disease in the deployment area. Planners should use this data to help determine if the same 

problems will occur during the time frame of the deployment. Planners should determine if the rodent 

population is at an acceptable level for long-term operations in the area and whether or not the 

increase in food and human activity attract these potential carriers of disease. If the AO has been 

subjected to pesticide applications in the past, there could be pesticide residues present. (See 

Appendix E, Preventive Medicine Officer Planning Considerations, and Appendix F, Infectious 

Disease Information.) 

 (2) Make decisions and implement solutions. Based upon preliminary information, planners 

should identify the resources required to protect soldiers. This may be in the form of assuring 

adequate ventilation, controlling crowding, chemoprophylaxis, immunizations, or ensuring that 

adequate supplies of repellents, permethrin-treated uniforms, and bed nets are available. 

Planners should develop a sampling plan to assess and confirm or discard the potential hazards 

identified. For preventive medicine staff, detachments, and sections, this may mean coordinating 

or bringing additional vector-control and surveillance equipment. For preventive medicine 

physicians, this may mean coordinating with logistical/medical channels to obtain required 

amounts of immunizations or prophylactic drugs. See the following website to complete 

Department of Defense Form 2795, Pre-Deployment Health Assessment: 

http://web1.whs.osd.mil/forms/DD2795.PDF

4-2. Phase II - During Deployment 

Once the unit is deployed and conducting operations in the field, both leaders and preventive medicine 

personnel or other health professionals will need to monitor operations to manage the risks associated 

with OEH/ED hazards. This may require sampling for air, water and soil contaminants, taking noise 

measurements, or ensuring soldiers are properly implementing risk control measures (e.g. correctly 

using assigned PPE). As the deployment progresses, commanders must plan for the changes in 

operational tempo, and the associated changes in their operations to support it. This must include 

logistical issues associated with risk control measures (e.g., PPE resupply). These personnel should 

periodically check the sick-call records for trends of increasing illness/injury, and inform commanders 

if trends that could be associated with OEH/ED hazards are observed. 

In a deployment situation, soldiers may be working longer than eight hours per day, and/or have little 

or no time off from their jobs. As a result, both ambient environment and job or task-related 

exposures must be monitored and the risks associated with those exposures managed to acceptable 

risk levels. A variety of assessment strategies are used to do this and will be discussed in general 

below. 

 a. Chemical Hazards. 

During deployment, reassessments and validation of both ambient and job task-related chemical 

hazards should be performed. Initially, the reassessment may involve a screening of the area through 
TG 248 

32 

a variety of samples from various potential sources of exposure (i.e., air, water - primarily drinking 

water - and soil). 

Initial sampling should focus on key locations and sources of exposure (e.g., such as air from areas 

where soldiers spend most of their time); water from primary water sources (even locally supplied 

bottled water has been found to have significant levels of hazardous chemicals); and soil from areas 

where soldiers may be exposed the most through frequency of contact and amount of contact. 

Improved information (e.g., more samples or more analytes measured in initial sampling) and 

improved quality data (higher sensitivity/specificity) will result in less uncertainty about the risk 

estimate. Resources and time afforded to increasing number, type, and sensitivity of analytical 

samples will have to be balanced with the other resource needs and hazards associated with a 

deployment. In addition, continuous and/or repeated sampling during deployments should be 

performed at levels that are appropriate for the mission and associated hazards. In other words, very 

limited monitoring may be performed in scenarios that are more closely associated with “wartime” 

operations. It is assumed, on the other hand, that peacekeeping missions will involve less critical, 

time-sensitive assessments, so additional resources may be appropriately designated to initial 

sampling as well as continuous/repeated monitoring. 

 b. Radiological Hazards. 

Once the radiological sources have been identified in a pre-deployment scenario, the next step is to 

assess the hazard. This can be performed prior to or during deployment operations. USACHPPM 

TG 236A, Basic Radiological Dose Estimation – A Field Guide (Draft), can be used as an assessment 

tool. USACHPPM TG 236A is designed to assess the identified radiological hazard at Level 1 

(i.e., trained inexperienced field personnel or the noncommissioned officer with limited equipment 

capabilities). 

Current low-level radiation (LLR) exposure guidelines are intended to protect personnel during 

military operations while at the same time maintaining the operational capability of the deployed 

force. ACE Directive 80-63, ACE Policy for Defensive Measures Against Low-Level Radiological 

Hazards During Military Operations, introduced the concept of Radiation Exposure Status categories 

that are linked to risk levels and cumulative doses up to 75 cGy. 

Figure 4-1 can be used in the decision-making process when assessing radiological hazards from LLR 

sources. It links risk assessment initiatives in pre- deployment situations and during deployment. 
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33 

 c. Physical Hazards. 

Management of physical hazards during the deployment generally include executing unit SOPs and 

current doctrine. The assessment and management of heat and cold injuries in the field is performed 

using the guidelines in FM 21-10, Field Hygiene and Sanitation. Again, USACHPPM TG 231, 

Soldiers Guide for Occupational Exposure Risk Assessment During Deployments (Draft), provides a 

process and exposure guidelines that allow for the evaluation of noise hazards and discusses various 

risk management options for noise hazards as they arise. 

 

 d. Endemic Disease. 

During a deployment, planners and the preventive medicine staff must reassess the risks associated 

with biological/entomological hazards in the deployment environment. This will involve continuous 

surveys of the sites where troops are located. Collecting quantified data depicting real-time exposures 

is the recommended survey action. This can involve employing various surveillance methods over an 

extended period of time. These can include— 

 (1) Routine medical surveillance. 

(2) Routine arthropod and rodent surveys. 

 (3) Environmental sampling to determine if pesticide residues are present. 

Assessing Low-Level Radiation Hazards 

Figure 4-1 
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34 

During the early stages of deployment, it may be necessary to rely solely on individual prophylactic 

and preventive measures until risk exposure can be reassessed and protective measures implemented. 

Generally, most biological warfare agents are intended for aerosol application. Increasingly biodetectors may be useful in determining biological weapon use. However, a good surveillance system 

to detect outbreaks of unusual diseases continues to be an essential part of any detection system. The 

risk of biological weapons will be assessed through Armed Forces Medical Intelligence Center 

(AFMIC) and intelligence channels with input from the command G2/J2. 

Determining if endemic disease/entomological risks are “acceptable” or establishing control measures 

to minimize the associated risks is a command responsibility. This may mean that subject matter 

experts must participate in determining what disease or pest thresholds are acceptable based on the 

commander’s intent and risk tolerance. (See Appendix E and Appendix F.) 

The commander supervises, the preventive medicine staff officer or JTF surgeon evaluates, and the 

chain-of-command communicates the risks. Step 5 of the Risk Management Process concerns 

reassessing the situation to ensure appropriateness of the decisions and actions, then determines 

whether modifications to the actions are required. This also includes communicating decisions and 

rationale for actions both up and down the chain of command. 

4-3. Phase III - Post-Deployment 

 a. Chemical, Radiological, and Physical Hazards. 

One of the primary purposes of collecting real-time samples during deployments is to allow the 

continued cycle of reassessment and validation even after the deployment is complete. Postdeployment medical surveillance may at some point uncover health effects that are potentially 

associated with environmental exposures that occurred during deployments. Proper analysis of 

anticipated or unanticipated health effects potentially attributable to these exposures is difficult 

without some form of exposure data. It is important to note that the policy on post-deployment is 

being developed, and this TG will be updated accordingly. At this time, the requirements for 

documenting occupational exposures and ambient exposures are different—

 (1) Documenting Occupational Exposures. The preventive medicine officer or other medical 

professionals should maintain any occupational sampling results obtained in theater for inclusion in 

soldiers' permanent health records. For continuity, it is important to track any occupational illness or 

injury through to its final disposition and be vigilant of any chronic or latent illnesses that may appear 

after the unit has returned to garrison. 

 (2) Documenting Ambient Exposures. In addition, the preventive medicine officer or other 

medical professionals should also maintain any other sampling results (i.e., ambient air water or soil 

measurements) and report the results through appropriate medical channels (regardless of whether 

exposures were deemed significant or not) to the USACHPPM (CDR USACHPPM, ATTN: MCHBTS-DESP, APG-EA, MD 21010-5403). 
TG 248 

35 

For example, malaria chemoprophylaxis must continue for four weeks after leaving the malaria 

area. 

 b. Endemic Disease. 

Post-deployment questionnaires are valuable to identify signs and symptoms of infectious diseases. A 

decision must be made concerning the best time to do an initial post-deployment physical exam and 

administer post-deployment questionnaires, as appropriate, to avoid the dispersion of forces to their 

pre-deployment organizations prior to completing these tasks. In some cases, this may be done at the 

troop medical clinic at their home station, or in country prior to leaving a deployment. This 

determination is particularly important for reservists and National Guard troops who may not reside 

near military medical facilities. The commander ensures troops are evaluated post-deployment for 

known exposures to disease and pesticides, and ensures troops continue all medications as required by 

the physician. 

The commander also ensures all actions are appropriately archived for future reference (i.e., all 

pesticide usage must be archived with USACHPPM). Commanders should give all personnel the 

Department of Defense Form 2796, Post-Deployment Health Assessment to complete 

immediately at the end of the deployment not after returning to the staging area. See the 

following website to complete Department of Defense Form 2796:

http://web1.whs.osd.mil/forms/DD2796.PDF 
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36 

Chapter 5 

Communicating Health Risks While Deployed 

For the purpose of this guide, the preventive medicine officer should communicate the OEH/ED 

risk(s) to the commander in the context of the FM 100-14 risk management process. The preventive 

medicine officer will need to communicate the OEH/ED risks accurately and objectively in a credible 

manner. He or she will need to explain the basis for significant assumptions, data, models, and 

inferences used or relied upon. The preventive medicine officer should be prepared to describe the 

sources, extent, and magnitude of significant uncertainties associated with the assessment. The 

preventive medicine officer must be prepared to make appropriate comparisons of OEH/ED risk(s) to 

other operational risks. 

The commander may require the preventive medicine officer to communicate OEH/ED risks to the 

deployed/deploying force. Detailed information on Health Risk Communication can be found in 

Appendix G, Health Risk Communication. 

.
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Appendix A 

References 

Required 

These documents must be available to the intended users of this document. 

Allied Command Europe (ACE) Directive 80-63, Ace Policy For Defensive Measures Against LowLevel Radiological Hazards During Military Operations, 2 August 1996. 

Allied Command Europe (ACE) Directive 80-64, ACE Policy for Defensive Measures Against Toxic 

Industrial Chemical Hazards During Military Operations, 20 December 1996. 

American Conference of Governmental Industrial Hygienists. Threshold Limit Values (TLVs) for 

Chemical Substances and Physical Agents, and Biological Exposure Indices (BEIs). Cincinnati, 

OH: ACGIH, 2001. 

Department of the Army (DA), Environmental Considerations of Military Operations. FM 3-100.4, 

15 June 2000. 

Department of the Army (DA), Preventive Medicine Services. FM 4-02.17, July 2000. 

Department of the Army (DA), Control of Communicable Diseases Manual. FM 8-33, 2000. 

American Public Health Association, 800 I Street, NW, Washington, DC 20001-3710. 

Department of the Army (DA), Combat Health Support in Stability Operations and Support 

Operations. FM 8-42, 27 October 1997. 

Department of the Army (DA), Planning for Health Service Support. FM 8-55, 9 September 1994. 

Department of the Army (DA), Battlefield Technical Intelligence. FM 34-54, 5 April 1990. 

Department of the Army (DA), Risk Management. FM 100-14, 23 April 1998. 

Department of the Army (DA), Staff Organization and Operations. FM 101-5, 31 May 1997. 

Department of the Army (DA), Operational Terms and Graphics. FM 101-5-1, 30 September 1997. 

Department of Defense Instruction (DODI) 6490.3, Implementation and Application of Joint Medical 

Surveillance for Deployments, 1997. 

Department of Defense Instruction (DODI) 6050.5, DOD Hazard Communication Program, 

29 October 1990. 
TG 248 

A-2 

Department of Defense Instruction (DODI) 6055.1, DOD Safety and Occupational Health (SOH) 

Program, 19 August 1998. 

Joint Publication 4-02, Doctrine for Health Services Support in Joint Operations. 28 February 2000. 

Medical Research Institute of Infectious Diseases, Medical Management of Biological Casualties 

Handbook, 1998. 

Presidential Review Directive 5, (PRD 5) Force Health Protection Concept Of Operations, 

August 1998. 

Standardization Agreement (STANAG) 2461, NATO Handbook On The Medical Aspects Of NBC 

Defensive Operations AMEDP-6(C) Volume I- Nuclear, (Draft), 1999. 

Standardization Agreement (STANAG) 2473, Commanders Guide on Low Level Radiation (LLR) 

Exposure in Military Operations, 3 May 2000. 

Standardization Agreement (STANAG) 2500, NATO Handbook On The Medical Aspects Of NBC 

Defensive Operations AMEDP-6(B),(Feb 1996) (FM 8-9). 

U.S. Army Center for Health Promotion and Preventive Medicine TG 230, Chemical Exposure 

Guidelines for Deployed Military Personnel (Draft), 2001. 

U.S. Army Center for Health Promotion and Preventive Medicine TG 231, Soldier Occupational 

Exposure Assessment (Draft), 2001. 

U.S. Army Center for Health Promotion and Preventive Medicine TG 236A, Basic Radiological Dose 

Estimation – A Field Guide (Draft), June 200. 

U.S. Army Center for Health Promotion and Preventive Medicine TG 238, Radiological Sources of 

Potential Exposure and/or Contamination, June 1999. 

U.S. Army Center for Health Promotion and Preventive Medicine TG 244, The Medical NBC 

Battlebook, May 1999. 

U.S. Army Center for Health Promotion and Preventive Medicine TG 251, Occupational and 

Environmental Health Field Sampling Guide for Deployments (Draft), 2001. 

29 Code of Federal Regulations Part 1910.1000, Air Contaminants. July 1999. Washington, D.C.: 

U.S. Government Printing Office. 
TG 248 

A-3 

Related 

These readings contain relevant supplemental information. 

Department of the Air Force, AIR FORCE PAMPHLET 91-215, OPERATIONAL RISK 

MANAGEMENT (ORM) GUIDELINES AND TOOLS. 1 JULY 1998. 

Department of the Army (DA). Hearing Conservation. DA PAM 40-501, 10 December 1998. 

Department of the Army (DA), Industrial Hygiene Program (Draft). DA PAM 40-503, April 1998. 

Department of the Army (DA), Counterintelligence. FM 34-60, 3 October 1995. 

Department of the Army (DA), Intelligence Preparation of the Battlefield. FM 34-130, 8 July 1994. 

Department of the Navy, Operations, OPNAV Instruction 3500.39, Operational Risk Management, 

3 April 1997. 

DiNardi, Salvatore R., ed. The Occupational Environment - Its Evaluation and Control. Fairfax, 

Virginia: American Industrial Hygiene Association, 1997. 

Medical Research Institute of Chemical Defense, Medical Management of Chemical Casualties 

Handbook, 1995. 

National Academy of Sciences, Institute of Medicine. Potential Radiation Exposure In Military 

Operations, 1999. National Academy Press, Washington D.C. 

National Institute for Occupational Safety and Health, et al., Occupational Safety and Health 

Guidance Manual for Hazardous Waste Site Activities. Department of Health and Human 

Services (DHHS) (NIOSH) Publication No. 85-115. October 1985. 

National Institute for Occupational Safety and Health. Pocket Guide to Chemical Hazards. DHHS 

(NIOSH) Publication No. 97-140. Cincinnati, OH: NIOSH, June 1997. 

National Research Council, Strategies to Protect the Health of Deployed U.S. Forces, Analytical 

Framework for Assessing Risks, 1999. National Academy Press, Washington, D.C. 

Plog, Barbara, ed., et al. Fundamentals of Industrial Hygiene, 4th ed. Istaca, Illinois: National Safety 

Council, 1996. 

U.S. Army Center for Health Promotion and Preventive Medicine TG 230A, Short-Term Chemical 

Exposure Guidelines for Deployed Military Personnel, May 1999. 

U.S. Army Center for Health Promotion and Preventive Medicine Reference Document 230A, Short 

Term Exposure Guidelines for Deployed Military Personnel, July 1999. 
TG 248 

A-4 

U.S. Army Center for Health Promotion and Preventive Medicine, Information for Combat 

Developers On Performance Effects From Exposure to Chemical Warfare Agents, March 1999. 

U.S. Army Center for Health Promotion and Preventive Medicine, Medical Issues Information Paper 

No. IP 31-017, Biological Warfare Agents As Potable Water Threats, March 1998. 

U.S. Army Center for Health Promotion and Preventive Medicine, U.S. Army Health Hazard 

Assessor’s Guide, August 1996. 

U.S. Environmental Protection Agency (USEPA), AP42, Compilation of Air Pollutant Emission 

Factors, February 1995. 

Referenced Forms: 

DD Form 1532-1, Pest Management Maintenance Record 

http://www.defenselink.mil/pubs

DD Form 2795, Pre-Deployment Health Assessment

http://web1.whs.osd.mil/forms/DD2795.PDF

DD Form 2796, Post-Deployment Health Assessment

http://web1.whs.osd.mil/forms/DD2796.PDF
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Appendix B 

Operational and Occupational and Environmental Health and Endemic Disease 

Surveillance Responsibilities 

The concept of OEH/ED surveillance represents a paradigm shift in the way preventive medicine 

assets conduct their FHP mission on the battlefield. The planning considerations and responsibilities 

provided are extracted from, and revised to be consistent with, the intent of the Army Medical 

Department preventive medicine mission and FM 8-55, Planning for Health Service Support. 

The Preventive Medicine Staff Section at Command Level (Division - Corps And Joint Task Force)—

1. Characterize the AO for the medical threat. 

2. Prepare the preventive medicine estimate. 

3. Communicate the estimate to the Command surgeon and develop the preventive medicine 

support plan. 

4. Identify OEH/ED surveillance requirements for subunits. 

5. Develop and implement the sample movement plan to conduct OEH/ED surveillance. 

6. Specify missions for Medical Detachment preventive medicine at the Medical Group, Medical 

Brigade and/or Corps level. 

7. Identify OEH/ED surveillance capability shortfalls and coordinate with preventive medicine 

support agencies for assistance and training. 

8. Conduct OEH/ED risk assessment for the AO. 

9. Coordinate preventive medicine support for the AO. 

10. Advise the Command surgeon on preventive medicine issues. 

11. Serve as the point of contact for all OEH/ED surveillance activities and concerns for the 

command. 

The Medical Detachment, Preventive Medicine— 

1. Conduct OEH/ED surveillance activities in the area of responsibility (AOR), to include 

coordinating, compiling, analyzing, and reporting OEH/ED surveillance data to assist in evaluating 

conditions affecting the health of the supported force. 

2. Collect OEH/ED samples and specimens, and perform selected analyses or evaluations to 

assist in the medical threat risk assessment. 
TG 248 

B-2 

3. Conduct vector and reservoir control in the assigned AOR to include application of pesticides. 

4. Coordinate NBC-related biological specimen collection and evaluation with treatment, NBC, 

laboratory and intelligence units and organizations. (See FM 34-54, Battlefield Technical 

Intelligence.) 

 5. Monitor DNBI surveillance data, hospital admission, and reports of autopsy for signs of 

disease outbreaks and possible exposures to TIMs and NBC agents. 

6. Monitor pest management, field sanitation, water treatment and storage, waste disposal, and 

DNBI control practices of units in AOR. Provide advice and training as necessary. 

7. Conduct epidemiological consultation and disease outbreak investigation activities for the 

Corps Support Area. 

8. Collect population information for troop concentrations and base camps that will help identify 

possible exposure groups (e.g., locations, living conditions, water source, food source, mission and 

activities performed by the unit). 

9. Conduct specialized OEH/ED surveillance missions in the AO. 

10. Conduct additional preventive medicine support as required. 

The Division Preventive Medicine Section (In Addition to the Preventive Medicine Staff Function)— 

1. Monitor pest management, field sanitation, water treatment and storage, waste disposal, and 

DNBI control practices in the divisional area. Provide advice and training as necessary. 

2. Investigate and evaluate pest management, sanitation, water supply, and waste disposal 

practices. Recommend corrective measures. 

3. Conduct epidemiological consultation and disease outbreak investigation activities in the 

division area. 

4. Coordinate and/or conduct OEH/ED surveillance activities in the division AO. 

5. Collect occupational and environmental samples and specimens, and perform selected 

analyses or evaluations to assist in the medical threat risk assessment. 

6. Coordinate NBC-related biological specimen collection and evaluation with treatment, NBC 

laboratory, and intelligence units and organizations (FM 34-54). 

7. Monitor DNBI surveillance data, hospital admission, and reports or autopsy for signs of 

disease outbreaks and possible exposures to TIMs and NBC agents. 
TG 248 

B-3 

Preventive Medicine Section, Area Support Medical Battalion— 

1. Monitor pest management, field sanitation, water treatment and storage, waste disposal, and 

DNBI control practices in the Corps Support Area (CSA). Provide advice and training, as necessary. 

2. Investigate and evaluate pest management, sanitation, water supply, and waste disposal 

practices in the CSA. Recommend corrective measures. 

3. Conduct epidemiological consultation and disease outbreak investigation activities for the CSA. 

4. Conduct additional preventive medicine support as required. 

Area Medical Laboratory— 

1. Area Medical Laboratory (AML) preventive medicine support missions. 

The AML is a field laboratory that provides confirmatory analysis and expert consultation to field 

Preventive Medicine assets and supports FHP. The preventive medicine support missions of the 

AML include—

a. Epidemiological investigations. 

b. Entomological laboratory analysis. 

c. Radiation laboratory analysis and health physics consultation. 

d. Occupational and environmental laboratory analysis and engineering and environmental 

science consultation. 

e. Industrial hygiene laboratory analysis and expert consultation. 

2. The AML will—

a. Analyze food, water, and wastewater samples. 

 b. Identify disease vectors, pests, and assess the efficacy of pesticides. 

 d. Serve as the central receiving facility for all occupational and environmental sampling for 

the theater. 

 d. Conduct field analysis of potentially acute hazards and coordinate the evaluation (including 

collection and shipping of samples) of long-term or low-level hazards by fixed facilities. 

 e. Receive, compile, and analyze theater-wide medical surveillance data and provide DNBI 

trend information and recommendations to Command surgeons and preventive medicine assets 

throughout the theater of operations. 
TG 248 

B-4 

f. Determine the frequency and distribution of infectious agents and diseases. 

 g. Provide technical consultation to supported preventive medicine assets. 

U.S. Army Center For Health Promotion And Preventive Medicine— 

1. Special Medical Augmentation Response Team – Preventive Medicine (SMART-PM): The 

SMART-PM concept identifies the USACHPPM augmentation assets to support deployed forces on 

the ground in the theater of operations (FM 8-42, Combat Health Support in Stability Operations and 

Support Operations). The main focus for support by SMART-PM is the AML OCONUS. The 

SMART-PM should perform the following OEH/ED surveillance tasks: 

a. Provide technical experts for short durations, special equipment, and/or supplies to support 

sustained OEH/ED surveillance. 

b. Initiate longitudinal monitoring programs for bases of operations and installations as part of 

long or open-ended missions. 

c. Conduct new equipment training and tactics employed by preventive medicine 

detachments and division, area support medical battalion preventive medicine sections. 

d. Conduct special surveys that support the OEH/ED surveillance assets in the theater of 

operations. 

e. Provide additional capabilities as necessary to capture the health threat to exposed forces 

caused by OEH/ED hazards. 

2. USACHPPM Fixed Installation Support: There are six USACHPPM unit locations around 

the world. USACHPPM Headquarters is located on Aberdeen Proving Ground, Maryland. The U.S. 

Regional USACHPPM Commands located OCONUS are in Landstuhl, Germany and Camp Zama, 

Japan. The Regional USACHPPM Commands within the continental U.S. are located on Fort G.G. 

Meade, Maryland; Fort McPherson, Georgia; and Fort Lewis, Washington. The Joint Medical 

Surveillance tasks performed by the USACHPPM Fixed Installation Support are— 

a. Provide pre-deployment hazard characterization support. 

b. Provide special sampling and monitoring equipment to identify hazards and document 

exposures beyond deployed units’ capabilities. USACHPPM’s Deployment Environmental 

Surveillance Program serves as the single point of contact for deployment occupational and 

environmental surveillance issues as part of medical surveillance database and deployment 

surveillance analysis. 

c. Conduct technical analysis in support of deployed OEH/ED surveillance operations. 

d. Provide expert consultation to deployed assets in support of OEH/ED surveillance. 
TG 248 

B-5 

e. Develop exposure guidelines for use in Stability and Support Operations and wartime 

versus peacetime standards. 

f. Provide exposure guidelines for low-level chemical agent concentrations and 

nuclear/radiological materials that can be used in both civilian and military arenas. 

g. Conduct special surveys or projects to support OEH/ED surveillance. 

h. Serve as the repository of all OEH/ED surveillance data for the DOD. 

Armed Forces Medical Intelligence Center— 

1. The AFMIC is responsible for producing finished intelligence for— 

 a. Foreign military and civilian medical capabilities. 

 b. Infectious disease and OEH/ED risks. 

 c. Scientific and technical developments in biotechnology and biomedical subjects of military 

importance. 

 2. AFMIC also manages the medical aspects of the DOD Foreign Materiel Program. To ensure 

that personnel get the most up-to-date information on locations that they may deploy to, forward a 

statement of information through the supporting intelligence office (J/G/S-2) to initiate active files for 

requested information. 

Armed Forces Pest Management Board— 

1. The Armed Forces Pest Management Board (AFPMB) recommends policy, provides 

guidance, and coordinates the exchange of information on all matters related to pest management 

throughout the DOD. The AFPMB’s mission is to ensure that environmentally sound and effective 

programs are present to prevent pests and disease vectors from adversely affecting DOD operations. 

2. The AFPMB has a wide variety of contingency-related policy, guidance, and information 

documents available for downloading from its web site at http://www.afpmb.org. 
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Appendix C 

Public Information Sources 

1. The Medical Environmental Disease Intelligence Countermeasures (MEDIC) CD, updated 

semiannually, is produced by AFMIC, Fort Detrick, Frederick, MD 21701 ((310) 619-7574, DSN 

343-7576). The CD is also available through the USACHPPM web site: 

http://chppm-www.apgea.army.mil

 2. Intelligence staff should be able to supply both history and industrial information and 

population attitudes/industrial base information. 

 3. Other staff (engineer and military policy). 

 4. U.S. Environmental Protection Agency (USEPA) AP42, Compilation of Air Pollutant 

Emission Factors, February 1995. 

 5. USEPA Toxic Release Inventory data web site: http://www-epa.gov/tri

 6. Library of Congress: http://lcweb2.loc.gov/frd/cs/

7. Central Intelligence Agency: http://www.cia.gov/cia/publications/factbook/index.html

8. Center for International Health Information: http://www.cihi.com/Statistics.htm

9. Other information: http://www.pitt.edu/HOME/GHNet/GHKR.html

10. Disease Vector Ecology Profiles are available through the AFPMB web page: 

http://www.afpmb.org/pubs/dveps/devps.htm

11. The Armed Forces Pest Management publication, Technical Information Memorandum 

No. 36, Personal Protective Techniques Against Insects and Other Arthropods of Military 

Significance is also available at their website: http://www.afpmb.org/pubs/dveps/devps.htm

12. The Navy Preventive Medicine Information System maintains up-to-date Disease Risk 

Assessment Profiles and Disease Vector Risk Assessment Profiles on most countries of the world. 

They can be obtained by contacting the Navy Occupational and Environmental Health Center 

((804)-444-7575, ext. 456 or DSN 564-7575, ext. 456). 

13. Centers for Disease Control and Prevention: http://www.cdc.gov/health/diseases.htm

14. World Health Organization: http://www.who.int
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15. Information on specific biological warfare agents, to include route of exposure, signs and 

symptoms and control measures/treatment can be found in the Medical Research Institute of 

Infectious Diseases, Medical Management of Biological Casualties Handbook, July 1998, 

Fort Dietrick, Frederick, MD 21701. 
TG 248 

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Appendix D 

Sample Preventive Medicine Estimate 

Headquarters 

Place 

Date, time, and zone

PREVENTIVE MEDICINE ESTIMATE OF THE SITUATION 

References: Maps, overlays, charts, or other documents required to understand the plan. Reference 

to a map will include the map series number and country or geographic area if required; sheet 

number and name, if required; edition; and scale. 

1. MISSION. (Statement of the specific preventive medicine mission) 

2. SITUATION AND CONSIDERATIONS. 

 

 a. Enemy situation. 

(1) Communicable disease. 

(2) Sanitation levels. 

(3) Public health capabilities. 

(4) Immunization status. 

(5) Level of field sanitation training. 

(6) Nuclear, biological, and chemical capabilities. 

(7) Directed energy capabilities. 

 b. Friendly situation. 

(1) Status of preventive medicine individual and unit supplies and PPE. 

(2) Operational situation. 

(3) Types of rations used. 
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D-2 

(4) Unit preventive medicine readiness. 

 (a) Field sanitation team training and equipment (including PPE). 

(b) Individual and unit preventive medicine measures training and enforcement.

(5) Potable water and ice. 

(a) Sufficient production and distribution units. 

(b) Sufficient availability and quantity. 

(6) Availability of aircraft for aerial spray operations. 

 c. Characteristics of the area of operations. Discuss the following: 

(1) Terrain. 

(a) Does AO favor arthropod/rodent populations? 

(b) Is the AO at high altitude? 

(c) Is water available? 

(d) How will the terrain affect pest management operations? 

(e) How does the terrain affect air quality? 

(f) Is there any known chemical or biological soil/water contamination in the AO? 

(2) Climate and weather. Discuss the following: 

(a) Will the season affect disease transmission? 

(b) Will the season affect heat/cold injury? 

(c) Will the season affect disease vectors? 

(d) Will the season affect water supply? 

(e) Will the season affect pest management operations? 

(f) How does the weather affect air quality? 

(g) How will the weather affect soil and water NBC-Environmental contamination levels? 
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D-3 

(3) Civilian population. Discuss the following as needed: 

(a) Endemic disease. 

(b) Epidemic disease. 

(c) Sources of disease on Mission Support Request. 

(d) Disease immunization status. 

(e) Water treatment standards: 

• Biological residual potential 

• Chemical contamination potential 

• Radiological contamination potential 

(f) Waste disposal practices: 

• Solid Waste Disposal 

• Chemical Disposal (including petroleum, oils, and lubricants) 

• Infectious Waste 

• Radiological Waste 

(g) Nutritional standards. 

(h) Civilian medical support/public health system. 

(i) Industry in the AO that may be a source of hazardous chemical air/soil/water contamination. 

(4) Flora and fauna. Discuss the following: 

(a) Arthropod vectors in AO. 

(b) Arthropod vectors resistant to pesticides. 

(c) Venomous animals and arthropods. 

(d) Poisonous plants.

(e) Dead animals or vegetation that may indicate chemical/biological contamination. 
TG 248 

D-4 

(5) Enemy prisoners of war (EPWs). Discuss the following: 

(a) Presence of disease. 

(b) Number EPW public health officers. 

(c) Disease immunization status. 

(d) Nutritional standards. 

(6) Other. 

 d. Strengths to be supported. 

(1) United States Uniformed Services: 

(a) Army. 

(b) Navy. 

(c) Air Force. 

(d) Marines. 

(e) Coast Guard. 

(2) Department of Defense Civilians. 

(3) Allied forces. 

(4) Coalition forces. 

(5) EPWs. 

(6) United States national contract personnel. 

(7) Indigenous and third country civilians. 

(8) Detainees. 

(9) Internees 

(10) Others. 
TG 248 

D-5 

 e. Health status of the command. 

(1) Origin of the troops—

(a) Are they heat acclimated? 

(b) What are endemic diseases? 

(2) Presence of disease. 

(3) Immunization status. 

(4) Status of nutrition. 

(5) Clothing and equipment (including PPE). If commercial respirators are to be used—

 (a) Have soldiers been medically cleared to wear commercial respirators? 

 (b) Have soldiers been fit tested for commercial respirators? 

(6) Fatigue/resistance to disease. 

(7) Other. 

 f. Assumptions. 

 (1) Is the assumption really necessary for the solution? 

 (2) Will the results change if the assumptions are not made? 

 g. Special factors. 

3. ANALYSIS 

 a. Estimates. 

 (1) Tasks involving arthropods/rodents— 

 (a) Disease/injury threat assessment. 

(b) Survey and identification requirements. 

(c) Control requirements. 
TG 248 

D-6 

(2) Tasks involving OEH/ED—

 (a) Heat. 

(b) Cold. 

(c) Water. 

(d) Sanitation. 

(e) Protection from radiological hazards. 

(f) Protection from chemical hazards. 

(g) Protection from physical hazards (e.g., noise, welding arc, respirable dust, confined space, 

etc.). 

 (3) Tasks involving disease: 

(a) Epidemiology. 

(b) Immunizations. 

(c) Prophylaxis. 

 b. Requirements. 

(1) Supplies. 

(2) Equipment/PPE. 

(3) Civil/military support. 

 c. Resources available—

(1) Organic preventive medicine personnel. 

(2) Attached preventive medicine personnel. 

(3) Supporting preventive medicine personnel. 

(4) Status of unit field sanitation teams. 

(5) Civilian public health personnel. 

(6) Captured enemy public health personnel. 
TG 248 

D-7 

(7) Preventive medicine troop ceiling. 

(8) Preventive medicine supply status. 

 d. Preventive medicine COAs. (Determine, as a result of the above analysis, all logical 

COAs that will support the Commander’s OPLAN and accomplish the Health Service Support 

mission. Expressed in terms of what, when, where, how, and why.) 

4. EVALUATION AND COMPARISON OF PREVENTIVE MEDICINE COURSES OF 

ACTION. (Compare each COA against the obstacles that will be encountered and against the 

casualties which could result from inaction.) 

5. CONCLUSION. (Decide which COA will best fulfill the mission. List the major advantages and 

disadvantages of the selected COA.) 

/s/ 

Preventive Medicine 

Staff Officer 

Annexes (as required) 

Distribution: 
TG 248 

E-1 

Appendix E 

Preventive Medicine Officer Planning Considerations 

ISSUES THAT MUST BE ADDRESSED DURING THE PRE-DEPLOYMENT PHASE— 

Is the current threat assessment information on hand from AFMIC’s Medical Environmental Disease 

Intelligence Countermeasures CD-ROM, the AFPMB Disease Vector Ecology Profiles, the U.S. 

Navy’s Vector Risk Assessment Profiles, etc.? 

 

 1. What diseases are endemic to this area? Have personnel received a medical threat briefing? By 

whom and when? 

 2. Have action thresholds, based on the medical threat, been developed to guide initiation of pest 

control operations? 

 3. Do the preventive medicine detachments that will be deployed have all their required table of 

organization and equipment and pesticides on hand? 

 4. Are Unit Field Sanitation Teams that will be deployed manned, trained, and equipped? 

 5. Was the deployment site used for any previous industrial or agricultural activity? If yes, detail 

what these activities were. 

 6. Have soldiers’ uniforms been treated with Permethrin? Is an adequate supply of Permethrin onhand? 

 7. Are bed nets on-hand, issued, treated with Permethrin, and prepared to be used by the soldiers 

and in the hospitals? 

 8. Prepare a Sampling Plan to assess the risk when units are on site. 

ISSUES THAT MUST BE ADDRESSED DURING THE DEPLOYMENT PHASE— 

Food and Water 

 1. Are adequate food storage facilities provided or available? 

 2. How often are food service facilities inspected? 

 3. Are wastes disposed of in an environmentally sound manner that protects human health and does 

not provide access for flies, roaches and vertebrate pests? 

 4. Are there any locations where wastes have been disposed of incorrectly and may cause a hazard 

to soldiers? 
TG 248 

E-2 

Soldier Protection 

 1. Are the medical community and the Command surgeon aware of arthropod threats? 

 2. Are the medical community and the Command surgeon communicating with the entomologist? 

 3. Has education on avoiding pests and pest habitats been conducted? 

 4. Are individuals practicing good personal and unit area sanitation? 

 a. Are arthropod repellents on-hand, and are they being used? 

 b. Is an adequate supply of DEET-based lotion on hand? 

 c. Have any individual training materials, such as Tick and Rodents Cards, been issued to the 

soldiers informing them of the hazards? 

 d. Are the soldiers aware of and conducting tick checks using the buddy system? 

 e. Is an Arthropod and Rodent Surveillance Program in place? The type of sampling necessary 

and the sampling frequency for each type of vector or nuisance animal can be found in USACHPPM 

TG 251, Environmental and Occupational Sampling Guide for Military Deployments (Draft). 

 f. The sampling methods include— 

 (1) Larval mosquito surveillance (dip sampling). 

 (2) Adult mosquito surveillance (light traps, resting boxes, etc). 

 

 (3) Biting flies surveillance (sticky traps). 

 

 (4) Filth flies (fly sticky strips). 

 

 (5) Fleas and lice (complaints; sick call records). 

 

 (6) Cockroaches (sticky trap surveillance). 

 

 (7) Ticks and mites (skin rashes, tick drags, complaints). 

 

 (8) Stored product pests (rations infested/destroyed). 

 

 (9) Venomous Arthropods (scorpions, centipedes, ants, etc.). 

 
TG 248 

E-3 

 (10) Commensal rodents (traps, glue boards, droppings, burrows). 

 (11) Venomous animals (poisonous snakes collected or seen). 

 

 g. Is an Arthropod and Rodent Control Program for disease vectors being used? 

 h. Is there an attempt to reduce the number of food sources and breeding habitats? 

 i. Are control personnel properly trained? 

 j. Is there an established Respiratory Protection Program for the pest control personnel? 

 k. Is the PPE for the pest control personnel adequate? 

 l. Are pesticides being used? 

 m. Are the pesticides being used USEPA and DOD approved? 

 n. Is pesticide usage recorded on a DD Form 1532-1, Pest Management Maintenance Record, or 

equivalent? 

 o. Are pesticides stored in an appropriate facility? 

 p. Is a list of pesticides currently used present and up to date? 

 q. Are pesticide labels and material safety data sheets on hand? Are there bilingual labels for the 

protection of civilians? 

 r. Are bilingual pesticide-warning signs posted at the pesticide storage facility? 

 s. Is an eyewash kit available? 

 t. Is spill control equipment and supplies on hand?

 u. Is pesticide application equipment calibrated and working properly?
TG 248 

F-1 

Appendix F 

Infectious Disease Information 

Table F-1. Arthropod Vectors Associated With Specific Diseases

DISEASE PATHOGEN VECTOR SPECIFIC VECTOR(S) 

Anthrax Bacillus anthracis DEER FLIES 

 Family Tabanidae 

Babesiosis Babesia microti HARD TICKS 

 Family Ixodidae 

Bartonellosis Bartonella bacilliformis SAND FLIES Phlebotomus verrucarum 

 (only occurs in Western Andes) Family Psychodidae 

Bed Bugs Parasitism BED BUGS Cimex lectularius 

 Family Cimicidae Cimex hemipterus 

Body Lice Parasitism SUCKING LICE Pediculus humanus humanus 

 Family Pediculidae 

Boutonneuse Fever Rickettsia conori HARD TICKS 

 Family Ixodidae 

California Encephalitis Bunyaviridae, Bunyavirus MOSQUITOES Aedes mosquitoes

 Family Culicidae 

Chikungunya Togoviridae, Alphavirus MOSQUITOES Aedes and Culex spp. 

 Family Culicidae 

Colorado Tick Fever Reoviridae, Orbivirus HARD TICKS 

 Family Ixodidae 

Crimean-Congo Hemorrhagic Fever Bunyaviridae, Nairovirus HARD TICKS 

Family Ixodidae 

Hyalomma spp.

Dengue Flaviviridae, Flavivirus MOSQUITOES Aedes aegypti, 

 Family Culicidae Aedes spp. in tropics

Eastern Equine Encephalitis Togoviridae, Alphavirus MOSQUITOES Aedes and Culex spp.

 Family Culicidae 

Ehrlichiosis, Human Granulocytic Ehrlichia phagocytophila HARD TICKS Ixodes scapularis 

 Family Ixodidae 

Ehrlichiosis, Human Monocytic Ehrlichia chaffeensis HARD TICKS Amblyomma americanum 

 Family Ixodidae 

Epidemic Relapsing Fever Borrelia recurrentis SUCKING LICE Pediculus humanus humanus 

 Family Pediculidae 

 SOFT TICKS Ornithodoros spp.

 Family Argasidae 
TG 248 

F-2 

DISEASE PATHOGEN VECTOR SPECIFIC VECTOR(S) 

Filariasis Wuchereria bancrofti MOSQUITOES Culex fatigans 

 Family Culicidae Anopheles gambiae 

 Anopheles sinenis 

 

 Brugia malayi Mansonia uniformis 

 Mansonia longipalpa 

Anopheles sinenis 

Hantaviral Disease Bunyaviridae RODENTS 

Head Lice Parasitism SUCKING LICE Pediculus humanus capitis 

 Family Pediculidae 

Japanese Encephalitis Flaviviridae, Flavivirus MOSQUITOES Aedes and Culex spp.

 Family Culicidae 

Leishmaniasis Leishmania spp. SAND FLIES Phlebotomus spp.

 Family Psychodidae Lutzomyia spp.

Leptospirosis Leptospira interrogans RODENTS 

Loiasis Loa loa DEER FLIES Chrysops silacea 

(Tropical West and Central Africa 

only) 

 Family Tabanidae Chrysops dimidiata 

Chrysops distinctipennis 

Louse-borne (epidemic) Typhus Rickettsia prowazekii SUCKING LICE Pediculus humanus humanus 

 Family Pediculidae 

Lyme Disease Borrelia burgdorferi HARD TICKS Ixodes spp.

 Family Ixodidae 

Malaria Plasmodium falciparum MOSQUITOES Anopheles spp.

 Plasmodium vivax Family Culicidae 

 Plasmodium ovale 

 Plasmodium malariae 

Mansonellosis Mansonella ozzardi BLACK FLIES Simulium rugglesi 

 Family Simuliidae Simulium anatinum 

Murine (endemic) Typhus Rickettsia typhi FLEAS Xenopsylla cheopis 

 (= Rickettsia mooseri) Family Pulicidae Leptopsylla segnis 

 Polyplax spinulosa 

Murray Valley Encephalitis Flaviviridae, Flavivirus MOSQUITOES Aedes and Culex spp. 

 Family Culicidae 

Nairobi Sheep Disease Bunyaviridae, Nairovirus TSETSE FLIES Culicoides tororensis 

 Family Glossinidae 

 Genus Glossina 

Onchocerciasis Onchocerca volvulus BLACK FLIES Tropical African

 Family Simuliidae Simulium damnosum

 Simulium naevi 

 Central and South America

 Simulium ochraceum
TG 248 

F-3 

DISEASE PATHOGEN VECTOR SPECIFIC VECTOR(S) 

O’nyong-nyong MOSQUITOES Anopheles gambiae only

 Family Culicidae 

Pinkeye Streptococcus pyogenes HIPPILATES 

FLIES 

 

Plague Yersinia pestis FLEAS Xenopsylla cheopis 

 Family Pulicidae 

Queensland Tick Typhus Rickettsia australis HARD TICKS Ixodes holocyclus 

 Family Ixodidae 

Query “Q” Fever Coxiella burnetii HARD TICKS 

 Family Ixodidae 

 SOFT TICKS 

 Family Argasidae 

 MITES Trombicula? spp.

 RODENTS 

Rickettsial Pox Rickettsia akari MITES 

Rift Valley Fever Bunyavriridae, Phlebovirus MOSQUITOES Mosquitoes and Phlebotomus spp.

 Family Culicidae 

Rift Valley Fever Bunyavriridae, Phlebovirus TSETSE FLIES 

Family GLossinidae

Culicoides spp.

Rocky Mountain Spotted Fever Rickettsia rickettsii HARD TICKS Dermacentor spp.

 Family Ixodidae 

Ross River Fever Togoviridae, Alphavirus MOSQUITOES Aedes and Culex spp.

 Family Culicidae 

Salmonellosis Salmonella spp. RODENTS 

Sand Fly Fever Bunyaviridae, Phlebovirus SAND FLIES 

Family Psychodidae

Phlebotomus spp. 

Lutzomyia spp.

Scabies Parasitism MITES Sarcoptes scabiei 

Schistosomiasis Schistosoma mansoni TREMATODES 

 Schistosoma haematobium 

 Schistosoma mekongi 

 Schistosoma japonicum 

 Schistosoma intercalatum 

Scrub Typhus Rickettsia tsutsugamushi MITES Leptotrombidium spp.

 SOFT TICKS 

 Family Argasidae 

Siberian Tick Typhus Rickettsia sibirica HARD TICKS 

 Family Ixodidae 

Sindbis Virus Togoviridae, Alphavirus MOSQUITOES Aedes and Culex spp.

 Family Culicidae 
TG 248 

F-4 

DISEASE PATHOGEN VECTOR SPECIFIC VECTOR(S) 

St. Louis Encephalitis Flaviviridae, Flavivirus MOSQUITOES Aedes and Culex spp.

 Family Culicidae 

Tickborne Encephalitis Flaviviridae, Flavivirus HARD TICKS 

Kyasanur Forest Encephalitis Family Ixodidae 

Louping-Ill Disease 

Omsk Hemorrhagic Fever 

Powassan Encephalitis 

Russian Spring-Summer Encephalitis 

Tickborne Relapsing Fever Borrelia duttoni (Africa) SOFT TICKS 

 Borrelia sp. (Middle East) Family Argasidae 

 Borrelia hermsi (US) 

 Borrelia turicatae (US) 

 Borrelia parkeri (US) 

Trench Fever Rochalimaea quintana SUCKING LICE Pediculus humanus humanus 

 Family Pediculidae 

Trypanosomiasis, African Trypanomoma brucei TSETSE FLIES West Africa

 gambiense Family Glossinidae Glossina palpalis 

Glossina tachinoides 

 Trypanomoma brucei East Africa

 rhodesiense Glossina morsitans 

 Glossina swynnertoni 

Trypanosomiasis, American, Trypanosoma cruzi KISSING BUGS Rhodinius prolixus 

 Chagas Disease Family Reduviidae Triatoma infestans 

 Panstrongulus megsitus 

Tularemia Francisella tularensis HARD TICKS 

 Family Ixodidae 

 DEER FLIES 

 Family Tabanidae 

Tungiasis FLEAS Tunga penetrans 

 Family Pulicidae 

Venezuelan Equine Encephalitis Togoviridae, Alphavirus MOSQUITOES Aedes and Culex spp.

 Family Culicidae 

Western Equine Encephalitis Togoviridae, Alphavirus MOSQUITOES Aedes and Culex spp.

 Family Culicidae 

West Nile Virus Flaviviridae, Flavivirus MOSQUITOES Aedes and Culex spp.

 Family Culicidae 

Yellow Fever Flaviviridae, Flavivirus MOSQUITOES Urban

 Family Culicidae Aedes aegypti 

 Sylvatic

 Aedes simpsoni

Aedes africanus 

Haemogogus spp.

Sabethes spp.
TG 248 

F-5 

Table F-2. Diseases Associated with Disease Pathogens 

Diseases Pathogens 

Specific Vectors, 

Intermediate Hosts, 

or Reservoirs 

PERSON TO PERSON: 

Airborne Droplet or Direct Contact with Respiratory or Ocular Secretions 

Acute Respiratory Disease (Coryza, 

Sinusitis, Otitis Media, Rhinitis, 

Pharyngitis, Laryngitis), Conjunctivitis, 

Viral Pneumonia 

Adenoviruses 

Chlamydia pneumoniae 

Chlamydia trachomatis

Coronaviruses 

Coxsackie virus groups A & B 

Echoviruses 

Haemophilus influenzae

Respiratory Syncytial Virus 

Rhinoviruses 

[Pharyngitis pathogen may 

also be transmitted by food 

contamination.] 

Influenza Influenza A, B & C viruses 

Streptococcal Diseases (Pharyngitis, 

Rheumatic and Scarlet Fevers, 

Impetigo, Erysipelas) 

Streptococcus pyogenes 

Bacterial Pneumonia, Bronchitis 

Meningitis, Septicemia 

Chlamydia pneumoniae 

Chlamydia trachomatis 

Haemophilus influenzae 

Neisseria meningitidis 

Streptococcus pneumoniae 

Streptococcus pyogenes

Legionnaires’ Disease, Pontiac Fever Legionella spp. 

Tuberculosis Mycobacterium tuberculosis 

Pertussis Bordetella pertussis 

Diphtheria Corynebacterium diphtheriae 

Mumps Mumps virus 

Mononucleosus, Burkitt Lymphoma, 

Nasopharyngeal Carcinoma 

Epstein-Barr virus 

Cytomegalovirus Disease Cytomegalovirus 

Viral Exanthema: 

Measles Measles virus 

German Measles Rubella virus 

Chickenpox Varicella-zoster virus [Transmission may also occur 

by person to person direct 

non-sexual contact with skin 

lesions or exudates.] 

Hand, Foot, and Mouth Disease Coxsackie virus groups A & B [Transmission may also occur 

by enteral (fecal-oral) route.] 

Erythema Infectiosum Parvovirus B19 

Smallpox, Monkeypox Orthopoxviruses 
TG 248 

F-6 

Diseases Pathogens 

Specific Vectors, 

Intermediate Hosts, 

or Reservoirs 

PERSON TO PERSON: 

Mucous Membrane Contact, Sexual Transmission 

Venereal Warts, Cervical Cancer Human Papilloma Virus 

Herpes Simplex Herpes Simplex Virus 

Syphilis Treponema pallidum 

Chancroid Hemophilus ducreyi 

Granuloma Inguinale Calymmatobacterium granulomatis 

Lymphogranuloma Venereum Chlamydia trachomatis 

Urethritis, Cervicitis, Pelvic 

Inflammatory Disease 

Chlamydia trachomatis 

Mycoplasma spp.

Neisseria gonorrhoea 

Ureaplasma urealyticum

Trichomoniasis Trichomonas vaginalis 

Bloodborne Viral Infections: [Transmission may also occur 

by blood product transfusion 

or by inoculation with sharp 

items contaminated with 

blood or serous body fluids.] 

HIV Disease, AIDS Human Immunodeficiency Virus 

Acute and Chronic Hepatitis, 

Hepatocellular Cancer 

Hepatitis B virus 

Hepatitis C virus 

Adult T-Cell Leukemia, Spastic 

Paraparesis 

Human T-cell Lymphotrophic Virus 1 

PERSON TO PERSON: 

Direct, Non-Sexual Contact With Skin Lesions, Exudates, Mucous Membranes 

Hansen’s Disease (Leprosy) Mycobacterium leprae 

Non-Venereal Treponematoses 

(Endemic Syphilis, Pinta, Yaws) 

Treponema carateum

Treponema pallidum subspecies 

PERSON TO PERSON: 

Fecal-Oral (Including Food and Water As Possible Vectors) 

Poliomyelitis Poliovirus 

Acute Hepatitis Hepatitis A virus 

Hepatitis E virus 

Typhoid Fever Salmonella typhi 

Amebiasis Entamoeba histolytica 

Pinworm Enterobius vermicularis 
TG 248 

F-7 

Diseases Pathogens 

Specific Vectors, 

Intermediate Hosts, 

or Reservoirs 

FOOD, WATER, OR SOIL INGESTION: 

Contamination From Animal or Human Feces, or From Foodhandlers’ Skin (S. aureus) 

Enteritis (Acute Food Poisoning, 

Secretory Diarrhea, Dysentery) 

Bacillus cereus 

Campylobacter spp. 

Clostridia perfringens 

Cryptosporidium parvum 

Escherichia coli 

Giardia lamblia 

Salmonella spp. 

Shigella spp. 

Staphylococcus aureus 

Vibrio cholerae 

Yersinia spp. 

Listeriosis Listeria monocytogenes 

Roundworm Infection Ascaris lumbricoides 

Whipworm Disease Trichuris trichura 

Pulmonary Capillariasis Capillaria aerophila 

Guinea Worm Infection Dracunculus medinensis Copepods (Cyclops spp) in 

drinking water 

Hydatid Disease Echinococcus spp. Primarily canids (dogs) 

[Transmission may also 

occur by direct or indirect 

animal contact.] 

Toxoplasmosis Toxoplasma gondii Primarily felines (cats) 

[Transmission may also 

occur by eating infected 

meat.] 
TG 248 

F-8 

Diseases Pathogens 

Specific Vectors, 

Intermediate Hosts, 

or Reservoirs 

FOOD INGESTION: 

Agent Contained Within Food Source 

Marine Biotoxin Poisoning: 

Scombroid Fish Poisoning (Histamine from fish decomposition) Scombroid fish, mahimahi, bluefish, salmon 

Puffer Fish Poisoning (Tetrodotoxin produced by puffer fish) Puffer fish 

Ciguatera Fish Poisoning Gambierdiscus toxicus Reef fish 

Shellfish Poisoning (paralytic, 

neurotoxic, diarrhetic, amnesic) 

Alexandrium spp. 

Dinophysis spp. 

Gymnodinium breve

Pseudonitzschia pungens

Shellfish 

Anisakiasis Anisakis spp. 

Pseudoterranova spp. 

Fish 

Intestinal Fluke Infection Echinostoma spp. 

Fasciolopsis buski 

Gastrodiscoides hominis

Heterophyes heterophyes

Metagonimus yokogawai 

Fish, aquatic plants (snail 

intermed.) 

Liver Fluke Iinfection, 

Cholangiocarcinoma 

Clonorchis sinensis 

Fasciola spp.

Opisthorchis spp. 

Fish (snail intermed.) 

Lung Fluke Infection Paragonimus spp. Crabs or Crayfish 

Capillariasis Capillaria hepatica Mammalian liver 

Capillaria philippinensis Fish 

Trichinosis Trichinella spiralis Pork 

Diphyllobothrium spp. Fish 

Taenia saginata Beef 

Tapeworm Diseases 

Taenia soleum Pork 

Dwarf, Rat, and Dog Tapeworms Dipylidium caninum

Hymenolepis spp. 

Insects 

[Transmission may also 

occur by direct or indirect 

animal contact, the enteral 

(fecal-oral) route, or food 

contamination.] 

Spongiform Encephalopathy 

(Creutzfeldt-Jakob and related dis.) 

vCJD (a prion or virus-like agent) Beef products 
TG 248 

F-9 

Diseases Pathogens 

Specific Vectors, 

Intermediate Hosts, 

or Reservoirs 

CONTACT WITH ANIMALS OR THEIR TISSUES, SECRETIONS, OR WASTE 

Psittacosis Chlamydia psittaci Parakeets, parrots, 

lovebirds 

Q fever [See Table 7] Coxiella burnetii Sheep, cattle, goats, dogs, 

cats, birds 

Anthrax [See Table 7] Bacillus anthracis Mammals (esp. grazing) 

Brucellosis Brucella spp. Cattle, swine, goats, sheep

Leptospirosis Leptospira interrogans Rats, swine, cattle, dogs, 

raccoons 

Pasteurellosis Pasteurella. haemolytica 

Pasteurella multocida

Dogs, cats 

Tularemia [See Table 7] Francisella tularensis Rabbits, hares, voles, 

muskrats, beavers 

Relapsing Fever [See Table 7] Borrelia recurrentis Wild rodents 

Rat Bite Fever Spirillum minus 

Streptobacillus moniliformis 

Rats 

Cat-Scratch Fever Bartonella henselae Domestic cats 

Rabies Rabies virus Dogs (wild & domestic), 

cats, skunks, raccoons, 

mongoose 

Hantaviral Diseases (Hemorrhagic 

Fever, Nephropathy, Pulmonary 

Syndrome) 

Hantaviruses Wild rodents 

Arenaviral Diseases (Hemorrhagic 

Fever, Lassa Fever, Lymphocytic 

Choriomeningitis) 

Guanarito, Junin, Lassa, LCM, 

Machupo, and Sabia` viruses 

Wild rodents, house mice 

(LCM) 

Filoviral Hemorrhagic Fevers Ebola, Marburg viruses (not identified) 

Meningoencephalitis Simian B virus Monkeys 
TG 248 

F-10 

Diseases Pathogens 

Specific Vectors, 

Intermediate Hosts, 

or Reservoirs 

SOIL OR WATER CONTACT: 

Direct Skin or Mucous Membrane Penetration by Infective Parasites 

Hookworm Disease Ancylostoma duodenale 

Necatur americanus

Soil 

Strongyloidiasis Strongyloides stercoralis Soil 

Schistosomiasis (Bilharziasis) Schistosoma spp. Water (snail intermed.) 

SOIL OR WATER CONTACT: 

Contact With Free-Living Organisms in Soil or Water 

Melioidosis (Whitmore Disease) Pseudomonas pseudomallei 

Amebic Encephalitis, 

Meningoencephalitis, Conjunctivitis 

Acanthamoeba spp. 

Balamuthia mandrillaris

Naegleria fowleri

SOIL OR WATER CONTACT:

Inhalation of Free-Living Organisms From Soil

Pulmonary and Systemic Mycoses Blastomyces dermatidis 

Coccidioides immitis 

Histoplasma capsulatum 

Paracoccidioides brasiliensis

Sporotrichosis Sporothrix shenckii [Transmission may also 

occur by dermal 

inoculation with decaying 

vegetation.] 

Diseases Pathogens 

Specific Vectors, 

Intermediate Hosts, 

or Reservoirs 

OPPORTUNISTIC: 

Ubiquitous Organisms Causing Disease in Individuals Where 

Immune Function is Locally or Systemically Compromised 

Dermal, Mucous Membrane, 

Pulmonary, and Systemic Infections 

Aspergillus 

Candida spp. 

Cryptococcus neoformans 

Fusarium 

Melassezia furfur 

Pneumocystis carinii 

Trichophyton 

Zygomycetes 
TG 248 

G-1 

Appendix G 

Health Risk Communication 

General 

 1. Health risk communication is the exchange of information between interested stakeholders such 

as commanders or deploying personnel about the nature, magnitude, significance, and/or control of 

health risks during deployment. The effectiveness of this health risk communication will rely on the 

communicator’s responsibility to— 

 a. Develop key messages. 

 b. Know the audience. 

 c. Be prepared. 

 d. Believe in the topic. 

Soldiers will be preoccupied with both professional and personal issues, such as separation from 

family and financial obligations. These worries will distract soldiers from the message and might 

prevent them from paying full attention to the communicator. It is crucial during deployments that the 

communicator speaks and acts with integrity and believes in the message. If unit leadership does not 

communicate that it is doing everything possible to protect the service members, then trust and 

credibility will be lost and morale will suffer. 

 2. To successfully accomplish the task of OEH/ED risk communication to the deployed/deploying 

force, the preventive medicine officer must be thoroughly grounded in the following elements: 

 a. The communication should be clear, understandable, informative, accurate, and concrete. 

 b. The source of the communication should be perceived as credible and reliable. 

 c. When the target population is not homogeneous, the message should be presented in several 

ways, each specifically designed for one segment of the target population. 

 d. Whenever possible, the target population or representatives of it should be closely involved in 

planning and implementing the program. The earlier the involvement the better. 

 e. Multi-mode presentation is considered to be more effective than single-mode presentation. 

This applies both to mass-media programs and to programs designed for smaller target populations. 

In the latter situation, face-to-face, two-way communication is also advocated. 

 f. Feedback about the behavior change and its consequences in lowering risk is highly effective, 

and should be used whenever possible. 
TG 248 

G-2 

 g. Repetitions of the message are desirable to a point; too many repetitions are ineffective or even 

deleterious. 

 h. Certainly, the message should be interesting and vivid. 

Soldiers will be preoccupied with both professional and personal issues, such as separation from 

family and financial obligations. These worries will distract soldiers from the message and might 

prevent them from paying full attention to the communicator. 

Guidelines 

Regardless of the audience, several facets of the health risk communication research should be 

considered to ensure the effective exchange of health risk information. Following a health risk 

communication program can aid in building and maintaining relationships, establishing trust and 

credibility, and effectively exchanging technical/scientific/medical information. Table G-1 provides 

detailed information on the health risk communication guidelines. 
TG 248 

G-3 

Table G-1. Health Risk Communication Guidelines 

Simplify language and 

presentation, not 

content: 

When trying to communicate the complex issues behind a health risk, it is 

easy to leave out information that seems to be overly technical. Risk 

communication research and studies have proven that all audience members 

can understand any technical subject if it is presented properly. 

This can be done, for example, through the use of visuals and diagrams and 

by defining all technical/medical/scientific jargon and acronyms. 

Be objective, not 

subjective: 

It is often very easy to differentiate between opinions and facts. It can be 

difficult, however, to respond credibly to opinions without substantiating them 

or offending the individual asking the question. 

In order to maintain credibility, respond to both opinions and facts in the same 

manner. 

Communicate clearly 

and honestly: 

To communicate clearly, present information at the audience’s level of 

understanding. People can reject information that is too difficult for them, or 

they can reject a communicator who is perceived to be dishonest or 

untrustworthy. As a result, they may refuse to acknowledge the information or 

become hostile. On the other hand, they may become hostile if they feel 

patronized. The bottom line is – know the audience! 

In addition, whenever possible, provide familiar examples and concrete 

information that can help put the risk in perspective. 

Deal with uncertainty: When communicating health risks, results are not definitive. 

Discuss sources of uncertainty, such as how the data were gathered, how 

they were analyzed, and how the results were interpreted. This demonstrates 

that the uncertainties are recognized, which can lead to an increase in trust 

and credibility. However, when discussing uncertainty, the communicator 

should stress his/her expertise and knowledge of the subject. This will 

reinforce the leadership’s ability to handle the situation and could allay 

concerns and fears regarding the risk and the risk-management decision. 

Be cautious when 

using risk 

comparisons: 

In order to put risks in perspective, comparing an unfamiliar risk to a familiar 

one can be helpful. However, some types of comparisons can alienate 

audience members. 

Avoid comparing unrelated risks, such as the risks associated with smoking 

versus those associated with air contamination. People rarely accept the 

comparison of unrelated risks. 

Develop key 

messages: 

Key messages are those items of importance, the health risk information that 

needs to be communicated. They must be clear, concise, and to the point. 

No more than three messages should be communicated at one time. Repeat 

key messages as often as possible to ensure they are not misunderstood or 

misinterpreted. 

Be prepared: When either presenting health risk information or answering questions 

regarding an individual’s concerns, be prepared. Most questions and 

concerns can be anticipated if the audience is known. In fact, the 

communicator should know 70 percent of the possible questions that could be 

asked. Consider how to answer general questions and how to respond to 

specific inquiries. 
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H-1 

Appendix H 

Acronyms 

ACE Allied Command Europe 

ACGIH American Conference of Governmental Industrial 

Hygienists 

AFMIC Armed Forces Medical Intelligence Center 

AFPMB Armed Forces Pest Management Board 

AI Area of Interest 

AMEDD Army Medical Department 

AML Area Medical Laboratory 

AO Area of Operation 

AOR Area of Responsibility 

COA Course of Action 

CSA Corps Support Area 

DHHS Department of Health and Human Services 

DNBI Disease and Non-Battle Injury 

DOD Department of Defense 

DODI Department of Defense Instruction 

ED Endemic Disease 

EPWs Enemy Prisoners of War 

FHP Force Health Protection 

FM Field Manual 

IPB Intelligence-preparation-of-the-battlefield 

JTF Joint Task Force 

LLR Low-Level Radiation 

MDMP Military Decision-Making Process 

MEDIC Medical Environmental Disease Intelligence 

Countermeasures 

METT-TC Mission, Enemy, Terrain, Troops, Time, and Civilian 

NATO North American Treaty Organization 

NBC Nuclear, biological, chemical 

NIOSH National Institute for Occupational Safety and Health 

OCONUS Outside the Continental United States 
TG 248 

H-2 

OEH Occupational and Environmental Health 

OPLAN Operations Plan 

OPORD Operations Order 

ORM Operational Risk Management 

OSHA Occupational Safety and Health Administration 

PEL Permissible Exposure Limit 

PPE Personal Protective Equipment 

PRD Presidential Review Directive 

SMART-PM Special Medical Augmentation Response Team – 

Preventive Medicine 

SOPs Standing Operating Procedures 

STANAG Standardization Agreement 

TG Technical Guide 

TIC Toxic Industrial Chemical 

TIM Toxic Industrial Material 

TLV Threshold Limit Value 

USACHPPM U.S. Army Center for Health Promotion and 

Preventive Medicine 

USEPA U.S. Environmental Protection Agency