msfsc invoice instructions

DEPARTMENT OF THE NAVY COMMANDER MILITARY SEALIFT COMMAND 914 CHARLES MORRIS CT SE WASHINGTON NAVY YARD DC 20398-5540 REFER TO: COMSCINST 6000.1D N00M 11 October 2006 COMSC INSTRUCTION 6000.1D From: Subj: Commander, Military Sealift Command MILITARY SEALIFT COMMAND MEDICAL MANUAL 1. Purpose. To standardize and consolidate into one publication, directives governing the organization, functions, duties, responsibilities and procedures of the Medical Department of Military Sealift Command (MSC). 2. Cancellation. COMSCINST 6000.1C 3. Policy. It is policy of Commander, Military Sealift Command that all portions of the Manual of the Medical Department, U.S. Navy, and other manuals and directives promulgated by the Bureau of Medicine and Surgery not in conflict with this manual, shall apply to MSC. 4. Applicability. This instruction is applicable to all MSC ships and commands. When the ship’s Medical Department provisions of an operating contract or charter agreement vary from this instruction, the contract or charter agreement will govern. Nothing in this document is construed to be a modification of the contract. 5. Action. Subordinate Commanders, Commanding Officers, Officers-in-Charge of Military Departments and ships’ Masters are directed to carry out the provisions of this instruction. Furthermore, addressees are directed to provide MSFSC Force Medical Offices, as appropriate, with any recommended changes to the manual which result from conflict with current effective medical policies, as well as additions or deletions. Appropriate changes will then be forwarded to Headquarters, COMSC for incorporation in the manual. //S// DAVID K. WRIGHT Chief of Staff COMSCINST 6000.1D 11 October 2006 Distribution: COMSCINST 5215.5 List I (Case A,B,C) SNDL 41A (MSC DEET SURGE) SNDL 41B (COMSEALOGs) 41C (MSFSC) 41D (MSC Offices) 41F (COMSEALOG DET EARL NJ) 41G (MSFSC SSUs) 41J (OICMILDEPTs) 41L (COMPSRONs) 41M (MSC TAGOS Office) T-100 (Masters, civil service-manned ships) T-102 (Masters & operators, contract-operated ships FSS) T-103 (Masters & operators, TAGOS) T-104 (Masters & operators, MPS) T-105 (Masters & operators, LMSR) T-106 (Masters & operators, contract-operated MPF(E)) T-107 (Masters, civil service-manned Fast Combat Support Ships) T-108 (Masters & operators, contract-operated T5 Tankes) 2 COMSCINST 6000.1D 11 October 2006 TABLE OF CONTENTS IDENTIFICATION CHAPTER 1 1.1 1.2 1.3 1.4 1.5 1.6 CHAPTER 2 2.1 2.2 2.3 CHAPTER 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 CHAPTER 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 TITLE MEDICAL ADMINISTRATION PAGE Introduction. . . . . . . . . . . . . . . . . . . . . .1-1 Organization and Responsibilities . . . . . . . . . . .1-2 Medical Administration. . . . . . . . . . . . . . . . .1-11 Procedures for Shipboard Relief. . . . . . . . . . . . 1-13 Special and Surge Operations Preparation. . . . . . . .1-15 Medical Department Automation. . . . . . . . . . . . . 1-15 TRAINING General Medical Training. . . . . . . . . . . . . . . .2-1 General Medical Training, Non-Medical Personnel. . . . 2-1 Medical Personnel Training. . . . . . . . . . . . . . .2-3 FISCAL AND SUPPLY MANAGEMENT Supply Administration. . . . . . . . . . . . . . . . . 3-1 Fiscal Support. . . . . . . . . . . . . . . . . . . . .3-2 Medical Material Management. . . . . . . . . . . . . . 3-3 Requisition Procedures. . . . . . . . . . . . . . . . .3-6 Excess and Surplus Items. . . . . . . . . . . . . . . .3-7 Controlled Substances and Medical Material. . . . . . .3-9 Medical Equipment . . . . . . . . . . . . . . . . . . .3-12 Emergency Supplies and Equipment . . . . . . . . . . . 3-13 HEALTH CARE General . . . . . . . . . . . . . . . . . . . . . . . .4-1 Entitlement to Care . . . . . . . . . . . . . . . . . .4-1 Medical Care Afloat. . . . . . . . . . . . . . . . . . 4-5 Informed Consent and Refusal of Care. . . . . . . . . .4-8 Dental Care Afloat. . . . . . . . . . . . . . . . . . .4-10 Afloat Medical Treatment Facilities . . . . . . . . . .4-10 Special Medical Encounters . . . . . . . . . . . . . . 4-14 Casualty Handling . . . . . . . . . . . . . . . . . . .4-18 Decedent Affairs . . . . . . . . . . . . . . . . . . . 4-19 PHYSICAL STANDARDS General. . . . . . . . . . . . . . . . . . . . . . . . 5-1 Periodic Physical Examinations. . . . . . . . . . . . .5-1 Periodicity of Routine Physical Examinations. . . . . .5-4 General Considerations. . . . . . . . . . . . . . . . .5-4 Interpretation and Application of Physical Standards. .5-6 Physical Standards. . . . . . . . . . . . . . . . . . .5-9 Physical Abnormalities and Waivers. . . . . . . . . . .5-13 i COMSCINST 6000.1D 11 October 2006 TABLE OF CONTENTS (Cont’d) IDENTIFICATION CHAPTER 6 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 TITLE OCCUPATIONAL AND PREVENTIVE MEDICINE PAGE General Administration. . . . . . . . . . . . . . . . .6-1 Health Monitoring Programs. . . . . . . . . . . . . . .6-1 Control of Communicable Disease and Immunizations. . . 6-2 Communicable Disease Program Requirements. . . . . . . 6-7 Public Health and Sanitation. . . . . . . . . . . . . .6-11 Quarantine and Solid Waste Disposal. . . . . . . . . . 6-19 Occupational Health. . . . . . . . . . . . . . . . . . 6-22 Medical Readiness Programs, Surveillance & Assessment. 6-22 CHAPTER 7 7.1 7.2 7.3 CHAPTER 8 8.1 8.2 8.3 8.4 AFLOAT QUALITY IMPROVEMENT General. . . . . . . . . . . . . . . . . . . . . . . . 7-1 Professional Qualifications. . . . . . . . . . . . . . 7-1 Requirements. . . . . . . . . . . . . . . . . . . . . .7-4 SNAP AUTOMATED MEDICAL SYSTEMS (SAMS) General. . . . . . . . . . . . . . . . . . . . . . . . 8-1 SAMS Support. . . . . . . . . . . . . . . . . . . . . .8-2 Systems Security. . . . . . . . . . . . . . . . . . . .8-2 ADP Equipment. . . . . . . . . . . . . . . . . . . . . 8-3 ii COMSCINST 6000.1D 11 October 2006 APPENDICES A B C D E F G H I J K L M N Glossary.............................................. A-1 Medical Training Requirements for First Officer/MDR......................................... B-1 Reports and Forms..................................... C-1 Samples............................................... D-1 Logs.................................................. E-1 Medical Technical Library............................. F-1 Medical Training for Non-Medical Shipboard Personnel........................................... G-1 AMMAL Listing......................................... H-1 Emergency Medical Supply Inventory Requirements. . . . I-1 Contract Medical Advisory Service..................... J-1 Positional Functional Requirements and Environmental Exposure Factors...................... K-1 MSC Medical Surveillance Program Physical by Rating. . L-1 Quality Improvement Review Screening Matrix . . . . . .M-1 MSC Medical Readiness Inspection (MRI) Checklist. . . .N-1 iii COMSCINST 6000.1D 11 October 2006 CHAPTER 1 MEDICAL ADMINISTRATION 1.1 INTRODUCTION a. Purpose. This chapter describes the administrative policies and of the Military Sealift Command (MSC) medical department and defines the responsibilities of Medical Officers, other shore-based medical department personnel, afloat medical personnel, Medical Services Officers (MSOs) and Medical Department Representatives (MDRs). b. Contracted Ships. Will adhere to the provisions of their contracts and applicable sections of this instruction. c. Acronyms. Appendix A contains a list of acronyms and definitions used in this instruction. d. Required References. This Manual is not intended to be an all-inclusive reference. Each Medical Department must maintain a library of reference materials from a variety of sources to be used as guidance in accomplishing departmental business. A complete list of references is provided in Appendix F, Professional Books, Publications, and Instructions. Reference material is to be maintained in computer media (CDROM) format hard copies. The STAT-REF medical reference program is required for all MSC ships with MSO or MDR onboard. Key categories of references include: (1) Navy Regulations, 1993 (2) SECNAV/OPNAV Directives (3) BUPERS Directives – Particularly, the Naval Military Personnel Manual (MILPERSMAN) (4) Fleet Commander Regulations (5) NAVMED Publications – Particularly NAVMED P-117, Manual of the Medical Department and NAVMED P-5010, Manual of Naval Preventive Medicine (6) NAVMEDCOM/BUMED Directives (7) Naval Medical Logistics Command (NAVMEDLOGCOM) Messages. 1- 1 COMSCINST 6000.1D 11 October 2006 (8) Senior Officer Present Afloat (SOPA) Instruction. A copy of the SOPA instruction is delivered to each ship upon arrival in most ports-of-call by the boarding party. Pertinent SOPA guidance is often forwarded via message prior to port calls. This instruction contains valuable information for medical department personnel and should be reviewed as soon as possible upon receipt. 1.2 ORGANIZATION AND RESPONSIBILITIES a. Organizational Responsibilities. The medical department is charged with the responsibility of safeguarding the health of personnel and maintaining emergency medical capability. In order to fulfill this responsibility the medical department makes recommendations and advises all departments on matters that may affect the health and readiness of all personnel. b. The Medical Department is composed of the medical personnel, facilities and administrative structure allocated to oversee acute and emergent healthcare. Its mission is to insure and preserve the operational readiness of personnel afloat and ashore. Medical Department personnel at all organizational levels shall advise Commanders and ships' Masters how best to accomplish the medical mission in view of the command's overall mission. c. General Duties. The general duties of all Medical Department personnel assigned to Commander, Military Sealift Command (COMSC) are outlined in this manual. (1) Fleet Surgeon (FS). The primary duties and responsibilities of the Fleet Surgeon are to advise Commander, Military Sealift Command, on medical and occupational health matters related to the mission and personnel of the organization, to recommend and generate medical policy, and to ensure access to and oversee the quality of medical care and occupational health programs. Additionally, the Fleet Surgeon will coordinate and implement the medical and occupational health readiness of all MSC activities. This manual addresses the specific responsibilities for medical and occupational health programs. The Fleet Surgeon will conduct periodic assessments of MSFSC Medical Offices to assess compliance with this instruction. (a) Policy. To set MSC medical policy for all CIVMAR manned ships, for military personnel, IAW DoD and DoN instructions, and to advise program managers regarding medical 1- 2 COMSCINST 6000.1D 11 October 2006 policy to be included in operating contracts for MSC contract ships. (b) Advise. To provide advice, guidance and direction to all components of MSC for medical and occupational health related matters affecting the health and medical readiness of all MSC personnel (military, civilian mariners, civil service and contractor personnel). (c) Medical Programs. To establish and direct MSC medical programs and to provide oversight at subordinate commands. (d) Health Care. To ensure provision of quality medical support and healthcare to all eligible personnel. (e) Occupational Health. To ensure provision and direction of an occupational health program for all MSC employees. (f) Standards. To establish physical and psychological standards for employment, retention, and assignment of CIVMAR and contractor personnel assigned to COMSC controlled ships. (g) Requirements. To develop and maintain medical equipment, logistics, and training requirements for MSC controlled units. This includes review of all documents related to construction, conversion, or alteration of ships under the COMSC. (h) Inspections. Sets standard for Medical Readiness Inspections, medical portion of SMART Inspection (in consultation with INSURV and head of MSC SMART Team), and for medical portion of CQI inspection (IAW COMSC Instruction 4700.1 series). (i) Administration. To monitor medical administration at the headquarters and subordinate levels and ensure compliance with all medical administrative requirements from COMSC and higher authority. To issue instructions and directives appropriate to the management of medical and occupational healthcare. (j) Liaison. To serve as liaison with other Federal agencies and departments including: the U.S. Navy Bureau of Medicine and Surgery (BUMED), Medical Officers of type commands and other components of the Navy, medical components of the U.S. Public Health Service, U.S. Coast Guard, National Oceanic and Atmospheric Administration (NOAA), the Maritime Administration (MARAD) and other federal agencies and components of the maritime industry. 1- 3 COMSCINST 6000.1D 11 October 2006 (k) Strategic Planning. To liaison with the U.S. Transportation Command (TRANSCOM) with the implementation of MSC strategic mobility medical plans and advise MSC strategic planners on medical matters pertaining to force health protection, contingency planning, evacuations, mobilizations, Navy Reserve unit medical issues and other mobility issues. b. Force Medical Officers, MSFSC HQ/Pacific. The Force Medical Officers will advise Area Commanders and Commander, Military Sealift Fleet Support Command (MSFSC) on medical, environmental, and occupational health matters related to the mission of the organization. Additionally, they will also ensure provision of quality healthcare to MSC personnel ashore and afloat and implementation of all MSC medical, environmental health, and occupational health programs. The Force Medical Officers are charged with the following specific responsibilities: (1) Training. To ensure that Medical Services Officers have completed the medical training requirements. In addition, make recommendations to COMSFSC for health training requirements of all ashore and afloat personnel. (2) Occupational/Environmental Health. To develop, implement and maintain occupational/environmental health programs for MSC personnel ashore and afloat in compliance with current applicable directives in accordance with Chapter 6 of this instruction. (3) Examinations. To ensure compliance with the provisions of Chapter 5 of this instruction and Chapter 15 of the Manual of Medical Department (P-117) for required physical examinations for active duty military personnel and Civilian Mariners (CIVMARs). Contract Mariners (CONMARs) will comply with the applicable sections of this manual in accordance with their individual contract. MSFSC HQ Force Medical Officer has primary responsibility for mariner examination policy enforcement and compliance. (4) Standards. To ensure CIVMARs are qualified in compliance with the physical and psychological standards described in Chapter 5 and 6 of this instruction. Additionally, the MSFSC HQ Force Medical Officer will provide interpretive advice regarding the application of the standards to contract or sponsor personnel aboard MSC ships, within the specifics of each contract/Memorandum of Agreement (MOA)/Memorandum of Understanding (MOU). The MSFSC HQ Force Medical Officer has the primary responsibility for mariner physical standards policy enforcement and compliance. 1- 4 COMSCINST 6000.1D 11 October 2006 (5) Waivers. To ensure waivers to the established physical standards outlined in Chapter 5 of this manual are granted only in clear cases based on the employee's ability to perform his/her duties. (6) Healthcare Services. To ensure provision of acute and emergency health care to all personnel embarked on MSC ships including CIVMARs, active duty, civil service employees, contractor personnel (as required and/or authorized by the contract), sponsor personnel and surge team personnel. Additionally, to make provisions for emergency referral of patients requiring care beyond the skill level of the shipboard MSOs and MDRs. (7) MSO Oversight. To oversee professional performance of duties and training of all MSOs and MDRs in the areas of shipboard clinical practice, environmental and occupational health, and Medical Department administration. The oversight of contract MSOs will be in accordance with individual shipping contract established between the Shipping Company and MSC. (8) Advise. To provide advice and guidance to the Area Commanders and COMSFSC on all medical matters and ensure compliance with all administrative regulations and requirements pertaining to medical care. (9) Personnel. To make recommendations to the Civilian Personnel Officer regarding the recruitment, assignment, and promotion of civilian medical personnel. (10) Privileging/Certification. To manage the MSC Medical Privileging/Certification Program, via the authority delegated from the COMSC Fleet Surgeon, in accordance with this instruction, OPNAVINST 6320.7 series and OPNAVINST 6400.1 series. (11) Snap Automated Medical System (SAMS). To maintain afloat and ashore implementation of SAMS program as outlined in this instruction. c. Independent Duty Corpsman (IDC)/Preventive Medicine Technician (PMT). The duties and responsibilities of the IDCs and PMTs assigned to MSC are to advise and assist the Fleet Surgeon and Force Medical Officers on medical and occupational health matters related to the mission and personnel of the organization. When serving independently, without on-site medical officer supervision, the IDC/PMT shall be responsible for providing medical guidance to the Commander/Commodore/Officer-in-Charge of 1- 5 COMSCINST 6000.1D 11 October 2006 the MSC Area command. following duties: In addition, the IDCs/PMTs will perform the (1) Provide technical supervision to MSOs under their cognizance. (2) Coordinate and monitor shipboard medical training and certification. (3) Coordinate, monitor and assist shipboard medical departments as needed and during routine overhaul (ROH), selected restricted availability (SRA) and similar evolutions. (4) Schedule and conduct Medical Readiness Inspections. Assist in conducting medical inspections for MSC contract ships in accordance with COMSCINST 4700.1 series. Additionally, perform Technical Assist Visits as requested by the ship’s master, MSO or as directed by the Fleet Surgeon. (5) For IDCs only: assist in coordinating replacement, or serve as a short-term TEMMAD assist resource, in the event of an unprogrammed loss of a shipboard MSO or as directed by the MSFSC Force Medical Officers or COMSC Fleet Surgeon. d. Medical Services Officers (MSO). Will provide medical care at the level of a U.S. Navy Independent Duty Hospital Corpsman (see Appendix A) in accordance with OPNAVINST 6320.7 series and OPNAVINST 6400.1 series. When afloat, the MSO reports directly to the Master. For the purposes of this instruction, contract MDRs employed with the PM2 Special Missions Program are interchangeable with MSOs, and will be henceforth be referenced to as Contract MSOs (CMSOs). (1) Advise. The MSO will advise the Master and MilDet Officer in Charge (OIC) of medical matters affecting medical readiness and operational mission requirements. (2) Health Care. The MSO will provide or arrange acute and/or emergent medical care for all embarked personnel. The MSO will make fitness for duty determinations for the CO/Master/OIC and advise physicians in medical treatment/examination facilities of MSC requirements. Chapter 4 of this manual discusses other MSO medical care responsibilities. (3) Medical Liaison. The MSO will establish liaison with medical treatment facilities (military and civilian) ashore that provide medical services to embarked personnel. 1- 6 COMSCINST 6000.1D 11 October 2006 (4) Administration. The MSO is responsible for Medical Department administration as follows: 1. Reports. The MSO will become familiar with the reporting requirements outlined in MANMED Chapter 23 and with situational reports required by higher authority. The cognizant MSC Medical Office will be included as in information addressee on all messages concerning medical problems requiring assistance from any activity outside the ship. The nature of the problem and underlying circumstances will be fully explained. (5) Periodic Reports and Requirements. The following are representative of the periodic requirements for conducting business in the medical department. Requirements should be accomplished and reported as discussed in pertinent articles. 1. Daily a. Potable water halogen residual (when at sea or if water is obtained from an unapproved source). Entries must be maintained in SAMs or in the chronological log for non-SAMs ships. b. Medical Journal entries (in chronological order, for significant events that are not documented elsewhere). c. Sickcall Log (submitted daily to the ship’s Master for review). d. e. f. g. 2. Inspection of food service personnel. Health record maintenance. Walkthrough of messing and berthing spaces. SAMS computer system backup. (Every 7 days) Weekly a. Safety/Sanitation inspection (no formal report required, document in medical journal). b. Bacteriological testing of potable water. Entries must be maintained in SAMs or in the Chronological Log for non-SAMs ships. 1- 7 COMSCINST 6000.1D 11 October 2006 c. Conduct medical training in accordance with current directives. Entries must be maintained in SAMs or in the chronological log for non-SAMs ships. 3. Monthly (Every 30 days) a. Food Service Sanitation Inspection Report (NAVMED 6240/1). These reports must be kept on file for two years. b. Update immunization requirements. c. Verify sexually transmitted disease (STD) and tuberculosis (TB) follow-ups. d. e. f. Verify outstanding supply requisitions. Inspect and sterilize expired surgical packs. Submit required monthly reports (as needed). g. Submit SAMS backup data upload/download to Navy Medicine online (when internet connectivity is present). 4. Quarterly (Every 3 months) a. training. b. Sanitation inspections (i.e. laundry, barbershop, store, storerooms and vending machines.) c. Controlled Substances Inventory and Report. (Required monthly if any transaction has occurred.) 5. Semiannual (Every 6 months) a. b. 6. Deratting/deratting exemption certification. Inventory all emergency gear and equipment. Conduct appropriate Basic Life Support Annual (Every 12 months) a. Inspect and re-sterilize plastic covered autoclaved surgical packs (as needed). b. Retire files per current directive. 1- 8 COMSCINST 6000.1D 11 October 2006 c. Verify medical records per current directives. d. Tuberculosis report (by 28 Feb) to the Environmental Health Officer assigned to MSFSC Force Medical Office, Norfolk, Virginia for review and submission to the cognizant NEPMU. 7. Bi-Annual (every 2 years) a. Request an Industrial Hygiene Survey, to address all changes which may have occurred, with the cognizant NEPMU or Navy Medical Treatment Facility (required per OPNAVINST 5100.19 series). 8. Tri-Annual (every 3 years) a. Request a Shipboard Safety Survey with the Naval Safety Center (required per OPNAVINST 5100.19 series). 9. Situational a. b. c. prevention. d. Pratique). e. Report of heat/cold injury (NAVMED 6500/1). Maritime public health declaration (Free Medical Event Reports (MERS). Letter/message report of TB contact. Letter/message report of malaria control and f. g. h. i. j. facilities. k. Accident Injury Reports. Medical Joining Report. Mass prophylaxis for infectious hepatitis. Personnel casualty report. Report of hospitalization at non-federal Diving Accidents. 1- 9 COMSCINST 6000.1D 11 October 2006 l. m. n. o. Competence for duty exam. Death report. Aviation Accident Report. Heat Stress survey. p. Post deployment critique to the cognizant Force Medical Officer. q. r. (MSO turnover). (7) Safety. The MSO will serve as an assistant to the Safety Officer on MSC ships, as required by COMSCINST 5100.17 series and OPNAVINST 5100.19 series. The MSO will serve as a member of the ship’s Safety Council and assist the Safety Officer with administering the afloat occupational and health elements. (8) Occupational/Environmental Health. The MSO will administer all environmental and occupational health programs onboard MSC ships as prescribed in Chapter 6 of this manual. (9) Orientation and Training. The MSO will conduct medical orientation for newly reporting personnel and training of all crewmembers as described in Chapter 2 of this manual. (10) Certification. The MSO will ensure that he/she maintains certification as outlined in Chapter 7 of this manual. f. Medical Department Representatives (MDR). The operating contractor is responsible for providing a Medical Department Representative onboard each ship, to provide acute and/or emergent health care to all personnel embarked and to stock medical supplies as required by contract and union agreements. MDR’s are to be trained in accordance with current directives and will adhere to the provisions of this instruction and current operating contract. g. Medical Support Personnel. Medical Department personnel are assigned to COMSC, MSFSC HQ, SSU Guam and Singapore offices. They are responsible for coordinating medical surveys, assessments, technical assist visits (TAVs) and Medical Readiness Anthrax/Smallpox reports. Bulkhead to Bulkhead medical supply inventory 1- 10 COMSCINST 6000.1D 11 October 2006 Inspections (MRIs) or any assignment as directed by the COMSC Fleet Surgeon. 1.3 MEDICAL ADMINISTRATION a. Medical Records Administration. accordance with MANMED Chapter 16. Will be maintained in b. Custody. Medical records will remain in the custody of the Medical Department. The records will be available to any healthcare provider to whom the patient is referred to for evaluation or treatment or to any MSC medical representative requiring the record for inspection or clinical performance monitoring purposes. c. Medical Records Administration for CIVMARs. Medical records, including an original and supplemental, will be prepared for every CIVMAR during the initial hiring physical examination. SAMS will be the only authorized ADP system utilized onboard MSC units. All CIVMARs will be entered into and tracked by SAMS and the HRMS database. (1) The original health record will be maintained at MSFSC Medical Office in Norfolk, VA and updated upon return of the supplemental record. (2) The supplemental record will consist of available hard copy records and be accompanied with the 3.5” SAMS master tickler/medical encounters transfer disk. CIVMARs will hand carry these records to every assignment and they will be maintained onboard. The record will include current medical information. At a minimum, there will be a copy of the downloaded SAMS demographic data, the most recent physical examination (including specialty consultations), current laboratory and x-ray results, a baseline and any significant electrocardiogram report, all information regarding allergies, blood typing, sickle cell status, G-6PD status, immunizations, spectacle and pharmaceutical prescriptions, copies of reference and current audiograms, and any current problems and therapies. (3) When a CIVMAR is referred to medical care to a source outside MSC, the supplemental record will accompany the individual to the healthcare provider. The MSFSC Medical Office telephone number will also be provided to facilitate further consultation. Upon completion of the consultation, the original report will be forwarded to the cognizant Force Medical Officer and MSFSC Medical 1- 11 COMSCINST 6000.1D 11 October 2006 Office with copies retained in the supplemental and original records. a. Medical Records Administration for Sponsor/Contractor Personnel. Sponsors and contractors will provide medical records in accordance with this instruction and the provisions of their individual contract/MOA/MOU. b. Temporary Medical Records. The MSO/MDR will establish a temporary medical record for all employees reporting onboard for duty without a record and for visitors who request treatment. The temporary record will be incorporated into the individual’s permanent record at the earliest opportunity. The temporary medical record will be forwarded to the employer (for contractor and other official visitors) or to the medical facility having custody of the individual’s permanent file (for official visitors). c. Medical Reports and Forms. Appendix C lists required reports and forms. Appendix D contains samples of authorized reporting formats. Units that are SAMS capable will maintain records on the SAMS database and in ADP format. d. Medical Department Journal. Shall be maintained to record significant events onboard ship. For example: (1) Reports of infectious diseases. (2) Report of personnel casualties, injuries, or death. (3) Any other occasions of significance or departure from normal. e. Training. Medical training for all shipboard personnel will be documented in SAMS. f. Medical Department Files and Correspondence. General and administrative correspondence files will be organized by Standard Subject Identification Code (SSIC) as outlined in SECNAVINST 5210.11 series. Consistent use of this system will ensure smooth turnover and reduce lost files and information. Correspondence will be prepared in accordance with SECNAVINST 5216.5 series. g. Medical Technical Library. The STAT-REF medical reference program will be utilized in all MSC owned and operated ships. A copy will be provided upon initial set-up and the MSO/MDR’s are responsible for updating thereafter. The MSO/MDR 1- 12 COMSCINST 6000.1D 11 October 2006 will maintain the publications, instructions and references listed in Appendix F. 1.4 PROCEDURES FOR SHIPBOARD RELIEF a. Responsibilities upon Assuming Duty. An MSO reporting to a ship for duty will, in company of the MSO being relieved, be assured of the status of medical department management, equipment, and supply prior to assuming duty. The outgoing MSO, if present, will assist in providing a proper turnover. It is recommended that a representative from MSC Medical be present during turnover, if available to assist the relieving MSO. A Technical Assist Visit (TAV) is most helpful in this regard and can be arranged by contacting the respective MSC Medical Department. At a minimum, turnover will include: (1) All supplies and equipment required by AMMAL are on board and in good operating condition. (2) Ongoing actions affecting the status of medical material (e.g., outstanding requisitions, outstanding surveys, outstanding repair orders, etc) are properly documented and understood by the relieving MSO. (3) Administrative requirements are being met as required by this directive and other applicable guidance. Specifically, ensure all required reports are current and properly submitted. (4) Health surveillance programs are in place and current (immunizations, hearing conservation, physical examinations, and wellness programs). (5) Required training is being conducted and documented. (6) Reviewing SAMS for completeness and accuracy. (7) Completing a Medical Readiness Inspection checklist and attach it to the Letter of Relief. b. Letter of Relief. (1) Within one (1) week of arriving onboard the ship, upon completion of procedures outlined above, the relieving MSO will advise the Master in writing that he/she has relieved the previous MSO and the current conditions of the Medical Department. At the time the letter is presented to the Master, both the Master and incoming MSO will sign the letter. A copy will be sent via mail 1- 13 COMSCINST 6000.1D 11 October 2006 or electronically to the relieved MSO for signature. That copy of the letter will be returned to the ship within 30 days. Appendix D provides a sample relief letter. (2) In addition, a medical journal entry will be made with the following statement: I have this date assumed the duties of Medical Services Officer/Medical Department Representative of the USNS (Name of Ship). I have assured myself that the management and accountability of the medical department on board this ship is in accordance with current directives. Item discrepancies noted: State “None” or list specific discrepancies in the Letter of Relief. (3) Letter of Relief must be kept on file for a period of 2 years onboard. (4) Adjudication of Discrepancies noted upon relief. (a) Adjudication of discrepancies noted upon relief will be handled as a matter of the individual command prerogative. (b) The outgoing MSO will be held accountable for the discrepancies noted at time of the turnover. 1.5 SPECIAL AND SURGE OPERATIONS PREPARATION a. Special medical considerations related to extended underway periods or long term geographic isolation should be considered in preparation for extended deployments. b. Disease Surveillance and Immunization Requirements. The MSO will ensure that he/she obtains situational awareness by consulting with the MSFSC Force Medical Officers and/or the MSC Fleet Surgeon. This will include determination of immunization requirements, malaria prophylaxis, and any other force protection issues applicable to the area of operation. Amplification is included in Chapter 6 of this manual. c. Requirement for Supplies. The MSO will determine the requirement for additional supplies for the underway period. This requirement is described in Chapter 6 of this manual. 1.6 MEDICAL DEPARTMENT AUTOMATION 1- 14 COMSCINST 6000.1D 11 October 2006 a. MSOs are required to utilize the Snap Automated Medical System (SAMS) for the management of shipboard Medical programs. b. Medical Departments without SAMS will utilize a computer based program (ex. EXCEL database) to monitor medical supplies, and will maintain a medical journal with detailed chronological entries. 1- 15 COMSCINST 6000.1D 11 October 2006 CHAPTER 2 TRAINING 2.1 GENERAL MEDICAL TRAINING a. General. Medical training shall generally comply with the standards established by U.S. Navy and the current revision of the International Maritime Organization (IMO) International Convention of Standards for Training, Certification and Watchkeeping for Seafarers, 1995 (STCW 95). CIVMAR or Contract mariners sailing in the capacity of shipboard MSO or MDR are designated as “Person in Charge of Medical Care (PIC). STCW 95 Medical Training Requirements are outlined in Appendix B. b. Responsibilities (1) Fleet Surgeon. The Fleet Surgeon, in accordance with current directives, will establish medical training requirements for all MSC personnel. (2) Force Medical Officer, MSFSC HQ. The MSFSC HQ Force Medical Officer will manage the medical training program in accordance with OPNAVINST 6400.1 series and this instruction. (a) Monitor training of each healthcare provider. (b) Ensure course completion data is included in each healthcare provider’s Individual Certification File (ICF). (c) Approve attendance of courses other than those listed in Appendix B. The healthcare provider must first successfully complete the required courses. The requested training must be directly related to the performance of clinical, administrative or other Medical Department functions. 2.2 GENERAL MEDICAL TRAINING, NON-MEDICAL PERSONNEL a. Basic Safety Training Course: In accordance with STCW 95, all CIVMAR and Contract mariners must initially successfully complete a USCG approved Basic Safety Training Course and every 5 years thereafter. b. Additional Medical Training for Non-Medical Personnel. Medical training requirements exist to support operational readiness by developing individual capability to preserve and maintain health. The MSO or other MSC medical personnel will 2- 1 COMSCINST 6000.1D 11 October 2006 generally provide training. Lessons will be concise, clearly presented and appropriate to the health and safety of the crew and tailored to the operational requirements of the ship. The minimum lesson topics for required crew training are as follows: (1) Basic Cardiac Life Support with AED (2) Sexually Transmitted Disease (STD) (3) Drug/Alcohol (EtOH) Abuse (4) Hearing Conservation (5) Heat Stress (6) Sight Conservation (7) Engineers trained in potable water sanitation (8) Self/Buddy First Aid for burns, shock, fractures, and hemorrhage (9) Blood Borne Pathogen (BBP) transmission and prevention (10) Indoctrinate personnel in the health and sanitation hazards of the MSD system (11) Emergency medical supply training (Stretcher/Litter, First Aid Box (FAB), and Mass Casualty Box (MCB) (12) Cold/Hot weather operations c. Training Program Administration. All shipboard training will be documented using the SAMS training module with the following information included: (1) Date (2) Topic (3) Individual and group receiving the training (4) Instructor’s name (5) Number of personnel present (6) Type of presentation 2- 2 COMSCINST 6000.1D 11 October 2006 d. Indoctrination for Newly Reporting Personnel. The MSO will provide shipboard personnel a general orientation to include: (1) A complete record review with the crewmember. (2) Availability and access to both the ship and local ashore medical services. (3) Location and purpose of shipboard emergency medical equipment. 2.3 MEDICAL PERSONNEL TRAINING a. Medical Department Personnel Training. The goal of medical training is to ensure competence in the performance of assigned duties providing quality medical care to all personnel. Training requirements for MSOs/MDRs are contained in Appendix B. b. Person-In-Charge (PIC) of Medical Care. MDRs designated as PIC of Medical Care will successfully complete an USCG approved PIC-Medical course and all prerequisite training prior to assuming the duties as MDR. The periodicity of this course is every 5 years and must be kept current whenever sailing in the capacity of MDR. c. Additional Training. Completion of additional training contained in Appendix B is required prior to assignment afloat. These required courses contain most information required in the performance of the healthcare providers' duties. Only the MSFSC HQ Medical Officer or the MSC Fleet Surgeon can grant assignment in lieu of completion of required training. d. Re-certification Training. Periodic re-certification training for MSOs will be coordinated through the MSFSC Medical Training Specialist upon the request of the cognizant MSC Force Medical Officer, the ship's Master or other competent authority. The individual MSO is responsible for maintaining all certifications necessary for employment. e. MSO Refresher Training. Completion of the Basic MSO Refresher Training Course is required every 3 years, in lieu of the USCG approved PIC-medical course. f. Continuing Medical Education Requirements. All MSOs must complete 12 approved continuing medical education units 2- 3 COMSCINST 6000.1D 11 October 2006 (CME's/CEU's) each calendar year to maintain certification. Through delegated authority from the Fleet Surgeon, the MSFSC HQ Force Medical Officer must approve CME/CEU and copies kept in the ICF for two years. All non-Navy sponsored CME/CEU resources are subject to review and approval by MSFSC HQ Force Medical Officer. 2- 4 COMSCINST 6000.1D 11 October 2006 CHAPTER 3 FISCAL AND SUPPLY MANAGEMENT 3.1 SUPPLY ADMINISTRATION a. General. The purpose of this chapter is to prescribe policy and procedures for the fiscal administration of afloat Medical Departments in all government owned MSC ships. SAMS program is required for the utilization of supply administration on all MSC ships with MSOs onboard (with the addition of T-ATF/ T-ARS ships). For non-SAMS equipped MSC ships, a working computer based program is required to monitor ship’s medical supplies. b. Responsibilities (1) Fleet Surgeon. The Fleet Surgeon is responsible for the establishment of fiscal and supply management policies for MSC Medical Departments ashore and afloat. Specific responsibilities include: (a) Approving of Authorized Minimum Medical Allowance Lists (AMMALs). (b) Designating ship's AMMALs. (c) Approving of installed medical equipment configuration change requests. (d) Reviewing operating schedules, Required Operational Capabilities (ROCs), Projected Operational Environments (POEs) and any other documents which may influence onboard medical supply requirements. (e) Reviewing costs associated with medical equipment and supplies. (f) Review and approval for use of all supply maintenance computer programs and systems. (2) Force Medical Officer, MSFSC HQ/Pacific. Medical Officers are responsible for: The Force (a) Implementing policies established by the Fleet Surgeon. (b) Making policy recommendations to the Fleet Surgeon. 3- 1 COMSCINST 6000.1D 11 October 2006 (c) Reviewing requests/recommendations for AMMAL changes and forwarding, with endorsement, to the Fleet Surgeon. (d) Reviewing space and installed equipment configuration change recommendations. (e) Overseeing of MSOs in fiscal and supply management. (f) Reviewing requests for inventory changes on ships as detailed in paragraph 3.3 of this chapter. (3) Commander/Master/OIC. The Commander/Master/OIC will exercise oversight to ensure the operational readiness of the Medical Department. (4) Medical Services Officer (MSO)/Medical Department Representative (MDR). The MSO/MDR is responsible and accountable for the management of shipboard medical fiscal and supply programs. Specific responsibilities are detailed in the remainder of this chapter. 3.2 FISCAL SUPPORT a. Allocation of Funds. The Project Manager’s Comptroller distributes funding for the projected annual operating costs for each ship and is broken down into departmental funding codes. The master has final authority for budget executions and redistribution of funds as necessary. Medical department funding is based on analysis of historical fiscal data requests for fiscal support provided MSO/MDR, or input from the MSFSC Force Medical Officers to the Fleet Surgeon, and on formal recommendations of policy changes by the COMSC Fleet Surgeon. b. Projections. As required by the cognizant Force Medical Officer, the MSO/MDR will submit projected additional operating costs. This projection will be based on current re-supply needs and anticipated operational requirements including extended underway periods, geographical isolation or large quantities of expiring medical shelf-life items. c. OPTARs. The MSO/MDR will develop a local OPTAR log to facilitate management of the Medical Department. The MSO/MDR will ensure that the proper debit entries are made in either the OPTAR log or an automated system. The MSO/MDR should anticipate quarterly funding. The MSO/MDR is responsible for management of 3- 2 COMSCINST 6000.1D 11 October 2006 Navy funds as described in NAVCOMPT 3013-2 or NAVSO 3073 and will maintain authorized AMMALs. d. Accountability of Funds. SAMS installed units is the required automated system program to monitor medical supply funds. This documentation for future funding adjustments. The MSO/MDR will completeness and accuracy all records including: (1) Posting of requisitions and receipts. (2) Posting of obligations and cost adjustments. (3) Maintaining files of outstanding and filled requisitions within the confines of the Medical Department. 3.3 MEDICAL MATERIEL MANAGEMENT a. Medical Materiel Management. The quality and availability of medical care is dependent upon the appropriate medical supplies being onboard and in the proper place. The following sections provide guidance for the MSO/MDR in the performance of medical materiel management. b. Authorized Minimum Medical Allowance List (AMMAL). MSC ships utilize standard AMMALs similar to those of U.S. Navy surface ships having similar medical care, deployment lengths and crew complements. The approved AMMALs contain required consumable medical supplies, durable medical equipment and emergency medical supplies (i.e., First Aid Boxes). Appendix H of this manual lists the AMMALs authorized for each class of ship. c. AMMAL Modification Requests. Modifications to AMMALs by additions/deletions of line items or increases/decreases of authorized quantities may be requested by MSO/MDR. Requests for modification will be forwarded via the cognizant Force Medical Officer to COMSC Fleet Surgeon. Appendix D contains a sample AMMAL change request. d. Ship Specific Requirements. Upon the written approval of the COMSC Fleet Surgeon, the MSO/MDR may supplement their AMMAL with items specific to the needs of their vessel. e. Extended Voyage/Specific Mission Requirements. Medical materials necessary to support specific needs related to special missions, extended voyages or geographical isolation may not be included in the ship's AMMAL. Recommendations for additional onboard MSC track and provides support ensure the 3- 3 COMSCINST 6000.1D 11 October 2006 medical supplies may be received from local military medical facilities, regional environmental health authorities or other medical facilities. In all instances, the cognizant Force Medical Officer will be notified of these recommendations. Upon his/her discretion, the cognizant Force Medical Officer will authorize, in writing, the purchase of additional items not contained within the AMMAL (at no time will any additions, deletions, or modifications to the controlled medicinals be authorized without specific approval of COMSC Fleet Surgeon via the cognizant Force Medical Officer). MSO/MDR may increase AMMAL stocking levels to meet operational requirements. f. Custody of Medical Materiel. The MSO/MDR is responsible and accountable for all medical materiel onboard. Stringent controls to prevent the waste, loss or abuse of medical equipment and supplies will be established. Items with potential for drug abuse (needles, syringes, etc.) will be inspected in accordance with DLAMINST 4155.5 series (Para M118), secured and inventoried at each turnover between MSOs. g. Inventory Management. are: (1) Bulk Stock. Inventory that has been received into a medical storage area and not yet expended to working stock. A bulk storage area may be located within the hospital space. However, to alleviate confusion, bulk and working stock should be separated. If this is not possible, SAMS should be clearly annotated to indicate which items are in the bulk stock category and which are in the working stock category. (2) Reserve Stock. That portion of the inventory, contained within the bulk stock that is distributed throughout the ship for emergencies. Reserve stock includes the inventories of first aid boxes, mass casualty boxes and any other emergency stocks such as stretchers. Reserve stocks are maintained at the prescribed levels throughout the life of the ship. (3) Working Stock. Items expended from bulk stock for use aboard the ship and not classified as reserve stock (i.e., Sick Call supplies). (4) Low Limit. The minimum requirement of any item as prescribed by the currently authorized AMMAL. Any additional items required by the cognizant Force Medical Officer will also be maintained as part of the low limit. The low limit is considered to be the reorder point for medical material. Inventory stock level definitions 3- 4 COMSCINST 6000.1D 11 October 2006 (5) High Limit. Equal to the low limit plus additional quantities historically required to sustain operations for 30 days. Amounts exceeding the high limit are considered excess. (6) Reorder Point. The reorder point is the low limit plus any amount necessary to sustain operations during the interval between ordering and receiving supplies. Logistic considerations (i.e., long lead times for receipt of material), will dictate the actual reorder point, however, bulk stock may not fall below 90% of prescribed levels. h. Inventory Schedules. Inventories will be completed in compliance with the following schedules: (1) General Supply Items. Bulkhead to bulkhead inventories of all onboard medical supplies will be conducted during MSO turnover or at the assumption of MSO duties. At a minimum, semiannual inventory to coincide with MSO/MDR turnovers is highly recommended. (2) Emergency Equipment. Inventory of emergency medical supplies (reserve stocks) and other medical equipment or supplies dispersed throughout the ship will be completed semi-annually, after use or after evidence of break-in (i.e., broken seals). (3) Suspected Loss. Medical storage areas, first aid boxes and other medical supply containers will be inventoried immediately upon discovery of a broken or tampered seal or other evidence of unauthorized entry. (4) Controlled Substances. Controlled substances will be inventoried quarterly. If a transaction occurred (use, survey, or supply changes), a monthly inventory will be required. Procedures for this inventory are contained in NAVMED P-117 and paragraph 3.6 of this chapter. i. Turnover Inventory Requirements. A written report summarizing medical supply readiness will be included in the turnover letter submitted to the Commander/Master/OIC prior to transfer of custodial responsibilities. The following inventories are required: (1) All controlled substances (bulk and working stock) (2) All controlled equipage 3- 5 COMSCINST 6000.1D 11 October 2006 (3) All reserve stock including first aid boxes, mass caualty boxes and any other first aid kits and supplies (meets semi-annual requirement) (4) Medical Technical Library (see Appendix F) (5) All repair parts held (if applicable) (6) Other Responsibilities. The relieving MSO/MDR will: (a) Insure that the SAMS Database accurately reflects current inventories and are prepared for all items of medical supply. (b) Insure that all ongoing actions for medical stocks are properly documented. (c) Upon completion of the inventory, an entry must be documented in the Medical Journal as described in Chapter 1. 3.4 REQUISITION PROCEDURE a. Requisition/Receipt Procedures. Guidance for preparation of requisition forms is contained in NAVSUP P-485 and COMSCINST 4000.2 series. b. Standard Stock Material. Every effort has been made to develop medical equipment and supply requirements that are supported by the Naval Supply System. The use of other sources is discouraged except in cases of extreme need or unforeseen circumstances due to the disruption of the normal acquisition process. c. Log Entries. The MSO will order, track, inventory, and maintain all medical supplies and equipage in the supply module of SAMS as outlined in chapter 8 of this instruction. d. FSC 6000 Items. When requesting medical material (FSC 6505, 6510, 6515 etc. items), MSOs/MDRs are advised to insert the following information: (1) Use document identifier Code "AO5" or "AOE" in card column 1-3 to indicate exception type requisition. (2) Use advise code "2-G" in card column 65-66 to indicate that the anticipated usage rate requires latest expiration date only. 3- 6 COMSCINST 6000.1D 11 October 2006 (3) In the "Remarks" space, enter the following: "ADVICE CODE 2-D ALSO APPLIES. FURNISH EXACT QUANTITY REQUESTED, DO NOT ADJUST TO UNIT PACK QUANTITY." NOTE: If packaging is such that a unit of issue may be split, less than the unit of issue may be requested. Because of the possibility of requisition cancellation, use of this code should be discussed with the Supply Officer. e. Non-Standard Stock Material. Procurement of medical supplies outside of the Federal Supply System through open purchase program is strongly encouraged whenever feasible to facilitate delivery of medical supplies. 3.5 EXCESS AND SURPLUS ITEMS a. Excess. Excess items are those items that are included in the AMMAL by written authority of the COMSC Fleet Surgeon, the cognizant Force Medical Officer, or are in excess of the high allowable limit (30 day supply for consumable). Excess items will be reported to the cognizant Force Medical Officer for possible redistribution. Excess consumable supplies, excluding controlled medicinals, may be evaluated by the MSO/MDR and retained onboard if their use prior to expiration is probable. MSOs/MDRs are strongly discouraged from maintaining excess consumables. b. Surplus. Surplus items are those items that are not included on the ship's AMMALs or authorized by the cognizant Force Medical Officer. Surplus items will be returned to the Navy supply system for redistribution. The Supply Officer will provide guidance for the preparation of the required paperwork. Inspection codes used to describe equipment conditions are found in Appendix M of DLAMINST 4155.5 series. c. Transfer of Equipment. Transfer of installed equipment or controlled equipage will take place only with the prior written approval of the COMSC Fleet Surgeon. d. Quality Control for Medical Supplies and Equipment. The MSO is responsible for maintaining quality control surveillance over all medical supplies and equipment. Appendix M to DLAMINST 4155.5 provides a listing of potency dated material, estimated 3- 7 COMSCINST 6000.1D 11 October 2006 storage life and inspection and testing criteria for all medical material. e. Review. Reviewing the Naval Medical Logistics Command’s message traffic forwarded by the cognizant Force Medical Officer for guidance affecting quality control of onboard medical material. f. Surveillance. Items having an "estimated storage life" will be monitored on a routine basis, during issue and inventories. Expiration dates and extensions will be recorded in SAMS and screened regularly for expired items. All expired Type 1 potency dated items will be removed from stock, surveyed and reordered. Accounting and inventory records will be promptly adjusted to reflect the disposition of items removed from stock. g. Reporting Unsatisfactory or Defective Material. Upon receipt or discovery of unsatisfactory, expired or defective material, a report will be made promptly in accordance with the procedures contained in BUMEDINST 6710.63 series. The suspected item will be suspended from use pending direction for use or survey from higher authority. h. Survey. Losses of COMSC property due to damage or exceeding of service life will be documented in accordance with NAVSUP P-485, Revision 2, paragraphs 5127 and 5128. 3.6 CONTROLLED SUBSTANCES AND MEDICAL MATERIAL a. Controlled Substances. Specific policy and procedures for the management of controlled substances are found in Chapter 21 of NAVMED P-117. b. Definition. Controlled substances are identified as narcotics, alcohol, barbiturates, tranquilizers and other items requiring special custodial care that are designated by the symbols "C," "Q" or "R" in the "Notes" column of the Identification Lists in the Federal Supply Catalog. The Fleet Surgeon and MSFSC Force Medical Officers may designate other drugs as "abuse drugs" requiring security measures similar to controlled substances. c. Requisition Procedures. NAVSUP P-485, NAVSUPINST 6710.1 series and NAVMED P-117 provide guidance for the preparation of requisitions for controlled substances. Requisitions for controlled substances are reported to the Naval Medical Logistics Command (NAVMEDLOGCOM) where the issue is validated against the 3- 8 COMSCINST 6000.1D 11 October 2006 AMMAL for the particular ships. If a conflict exists, a request for justification of the requisition is forwarded to the ship with information copies to COMSC and the Area Commander. Masters will ensure a response to NAVMEDLOGCOM within 10 working days of receipt of the request. d. Non-AMMAL Controlled Substances. Controlled substances not included on the AMMAL for the ship will not be ordered without prior written approval from the MSC Fleet Surgeon and the cognizant Force Medical Officer. Requisitions forwarded for controlled substances not listed on the AMMAL may be canceled at the stock point. e. Appointment of Custodians. The Master will appoint, in writing, a Bulk Custodian and a Working Stock Custodian. The Bulk Custodian will normally be the Supply Officer or another officer with access to a safe. The Working Stock Custodian will normally be the MSO or MDR. The same person cannot perform these Bulk and Working Stock Custodian duties. Sample appointment letters are provided in Appendix D. f. Storage. AMMAL limits of controlled substances can be divided into Working Stock (no more than 1 Unit of Issue); and Bulk Stock (the remainder of the amount authorized if an MSO is assigned). Otherwise, due to the minimal quantities authorized, the Master will have custody of the controlled substances. g. Bulk Stock. The Bulk Stock will be stored in a separate safe located in the Master’s or Supply Department safe. The contents will be noted on the Medical Department NAVSUP 1114M. All quality surveillance will be the responsibility of the MSO. A Bulk Custodian will be appointed and control access to the safe (see para 3.6e and 3.6k). h. Working Stock. The Working Stock will be stored in a separate safe located in the Medical Department. Access will be limited to the MSO or MDR only. i. Security of Needles and Syringes. As with controlled substances, certain security precautions must be exercised for the use and storage of needles, syringes and other items with potential for abuse. At a minimum, these items will be kept under lock and key, with the MSO or MDR having responsibility for security and accounting of reserve stock, working stock and expended (used) items. 3- 9 COMSCINST 6000.1D 11 October 2006 j. Security of Controlled Substances. Regulations, potential for theft, and the possibility of abuse mandate storage, handling, and use of security precautions above those for other drugs. Only the appointed Bulk Custodian will have the combination for the bulk safe and only the Working Stock Custodian will have the combination for the working safe. The combinations will be recorded and placed in a Security Container Information Envelope (SF 700, Pt. 2A), and held by the Communications Materials Security (CMS) Custodian or the Master. Changes to the combinations will be made at change of custody or when compromise of the combinations occurs, but not less frequently than every 12 months. k. Bulk Custodian. The Bulk Custodian is responsible for custody of all unissued controlled substances. The Bulk Custodian must personally maintain the necessary accounting records and documents necessary to substantiate proper receipt and expenditure of controlled substances in his/her custody and will ensure that required inventories of all controlled substances are conducted in accordance with the provisions in Chapter 21 of NAVMED P-117. l. Working Stock Custodian. The Working Stock Custodian is responsible for custody of all controlled substances issued by the Bulk Custodian to working stock but not yet prescribed to a specific patient. The Working Stock Custodian will be guided in his/her duties by the provisions in Chapter 21 of NAVMED P-117, and must personally maintain the accounting records and documents necessary to substantiate proper receipt and expenditure of the controlled substances in their custody. The Working Stock Custodian will ensure that required inventories of working stock controlled substances are held in accordance with Chapter 21 of NAVMED P-117. m. Controlled Substances Inventory Board (CSIB). The Master/Commander/OIC will appoint, in writing, a Controlled Substances Inventory Board consisting of a Senior Member, one additional member and one alternate member. Sample letters are contained in Appendix D. These members will become familiar with their duties as prescribed in Chapter 21 of NAVMED P-117. Although prohibited from being a member of the board, the MSO will provide guidance to the Master and the Controlled Substances Inventory Board in the performance of their duties. n. CSIB Inventory. The Board will conduct a quarterly (unless changes in inventory occurs), surprise inventory of all bulk and working stock controlled substances. The inventory will include: 3- 10 COMSCINST 6000.1D 11 October 2006 (1) A review of all requisition, receipt, transfer and dispensing documents. (2) Ensuring a complete audit trail is accurately reflected in the supporting documents. (3) An audit of all transactions completed during the inventory period. o. Thefts or Loss of Controlled Substances. The Board will also conduct a complete inventory upon discovery of loss or theft of controlled substances, immediately notifying the Master, the Area Commander, COMSC Fleet Surgeon and cognizant MSFSC Force Medical Officer as required in NAVMED P-117. p. Reporting Requirements. The senior member is responsible for submitting to the Master, for approval, a written report of all inventories conducted. Appendix D contains a sample report containing the minimum requirements. q. Destruction/Survey. Destruction or survey of controlled substances will be accomplished only with the concurrence of the Master. At least one Board member will witness the destruction of controlled substances and verify, in writing, the destruction. The destruction documents will be retained in the Medical Department files. Appendix D contains a sample report. 3.7 MEDICAL EQUIPMENT a. Medical Equipment. MSC Medical Departments will comply as much as practical with the provisions in Chapter 8 of NAVMED P5132 (Equipment Management Manual). b. Maintenance. The MSO/MDR is responsible for the maintenance of Medical Department equipment. Specific duties include: (1) Spare Parts. MSOs/MDRs will ensure copies of NAVMED 6700/3 are prepared and forwarded to NAVMEDLOGCOM. NAVMEDLOGCOM will determine the spare parts requirements and forward a listing to each ship. The MSO/MDR will maintain the required spare parts onboard. The parts identified by NAVMEDLOGCOM are considered to have a high rate of failure and may have to be replaced during routine operator maintenance. 3- 11 COMSCINST 6000.1D 11 October 2006 NOTE: The spare parts list is not a part of any AMMAL. (2) Performance of Maintenance. The MSO/MDR will perform recurring maintenance specified in NAVMED P-5009 and the manufacturer's literature. Maintenance that is beyond shipboard capabilities will be requested from the nearest Navy medical repair facility or as specified by equipment’s warranty requirements. (3) Controlled Equipage. For shipboard Medical Departments, the term "controlled equipage" will include those items prescribed by the ship's Master, all equipment costing in excess of $250.00 and all medical reference manuals. The MSC Fleet Surgeon may include specific items at his/her discretion. Controlled equipage will be inventoried annually and/or upon relief of the custodian in compliance with COMSCINST 4000.2 series. 3.8 EMERGENCY SUPPLIES AND EQUIPMENT a. Medical Emergency Supplies and Equipment. Appendix I of this manual provide a comprehensive listing of emergency supplies and equipment required on MSC ships. Additional guidance is contained below. b. Hospital Supplies. The ship’s hospital or sickbay will be stocked with sufficient quantities of medical supplies necessary to ensure that the MSO/MDR will be able to provide emergency treatment without undue delay. Prescribed sterile surgical packs will be readily available as needed. c. First Aid Boxes. All MSC ships will have first aid supplies dispersed throughout the ship. GENSPECS for T-SHIPS 652 and Appendix I of this manual provide for location of first aid boxes onboard MSC ships. AMMAL 0927 list contents of first aid boxes. d. Mass Casualty Boxes. (Formerly known as Portable Medical Lockers (PML)). The placement of Mass Casualty Boxes onboard ships is outlined in GENSPECS for T-SHIPS 652 and Appendix I of this manual. AMMAL 0964 list contents of the Mass Casualty Boxes. e. Stretchers. The approximate number and location of stretchers is contained generically in GENSPEC for T-SHIPS 652 and Appendix I of this manual. Differences in design and conversion of MSC ships negate concrete location requirements. Additional 3- 12 COMSCINST 6000.1D 11 October 2006 guidance can be obtained from the COMSC Fleet Surgeon’s Office at MSC Headquarters. f. MSO Response Kit. The minimum requirements for the MSO Response Kit are contained in AMMAL 0924. The COMSC Fleet Surgeon may specify additional requirements. g. CBR Decontamination Equipment. CBR decontamination equipment and supplies are the responsibility of the shipboard CBRD Officer. Although FSC 6505 items (i.e., Atropine Auto injectors, Doxycycline, Ciprofloxin) are required in the Decontamination Lockers, these items are not part of the AMMAL. Although not technically responsible for procurement, maintenance or replacement, the MSO/MDR will monitor all Shelf Life Extension Program (SLEP) and Quality Assurance messages generated by NAVMEDLOGCOM and will provide such support to the CBRD Officer. h. Oxygen. The hospital will have “H” and “D” size oxygen cylinders in accordance with the AMMAL requirements and secured/mounted in the hospital spaces as specified by T-SPECS and ready readily available for use. In general, the hospital will have two size "H" cylinders (1500 pounds) installed convenient to the treatment table. Wards will have one size "H" cylinder installed convenient to one bed. All medical spaces with Oxygen on hand shall prominently display “NO SMOKING” signs. i. Other. Other emergency medical supplies may be dispersed throughout the ship at the discretion of the MSO/MDR. All equipment will be maintained and inventoried as applicable. 3- 13 COMSCINST 6000.1D 11 October 2006 CHAPTER 4 HEALTHCARE 4.1 GENERAL a. General. This chapter provides guidance for healthcare issues including entitlement to healthcare, accessing healthcare systems, facility requirements, special medical encounters and emergency medical readiness. b. Guidance. 5 U.S. Code 8101 at sea, 5 U.S. Code 8901 et seq and Public Law 97-35 of 13 August 1981 are the source documents for this entitlement. NAVMEDCOMINST 6320.3 series provides amplifying information regarding eligibility in Navy medical treatment facilities (MTFs). Other DOD agencies have similar directives. 4.2 ENTITLEMENT TO CARE a. Entitlements. Each employee category (active duty, civil servant, civilian employee and contractor) is eligible for medical care from government sources. However, the level, source and cost assignment of such care is different for each category. b. Active Duty Military Personnel. Active duty military personnel assigned to MSC ships/units are entitled to the same benefits provided all military personnel. If medical care is received from non-federal sources, guidance for claim submission is provided in NAVMEDCOMINST 6320.18 series. c. Availability of Civil Service Health Insurance. All MSC employees, ashore and afloat, are entitled to enroll in civil service health insurance plans per 5 U.S. Code 8901 et seq. All employees are strongly encouraged to take full advantage of this entitlement. d. Civilian Marine (CIVMAR) Employees Afloat. CIVMARs are entitled to receive medical care for occupationally related conditions from federal and civilian sources. (1) Duration of Entitlement. Entitlement for occupationally related care begins when the CIVMAR commences travel to the ship (unless the ship is within normal commuting distance of the CIVMAR’s home), continues during the shipboard assignment and ends when the CIVMAR returns to his home (unless the ship is within normal commuting distance of the CIVMAR’s home). 4- 1 COMSCINST 6000.1D 11 October 2006 (2) Scope. The entitlement for occupationally related medical care includes the following: (a) Periodic physical examinations. (b) Medical Surveillance elements (i.e. HCP, AMSP, forklift MSP). (c) Treatment for occupational illness or injury. (d) Referrals to specialists for occupational illness or injury. (e) Medical consultations from MSC contract advisory physicians that are available to the shipboard healthcare provider. (f) Required Immunizations will be administered in accordance with BUMEDINST 6230.15 series, BUMEDNOTE 6230, COCOM requirements for his/her AOR, or other guidance set forth by higher authority. Modifications of the aforementioned references for the mariner population are as detailed in Chapter 6 of this instruction. (g) Chemoprophylaxis for communicable diseases (i.e., tuberculosis or malaria) is considered required treatment. NOTE: Immunizations are provided to CIVMARs on a non-reimbursable basis. Contract operators are required by contractual agreement to comply with all Navy immunization requirements including Anthrax and Smallpox. (3) Referral. If an occupationally related injury or illness occurs requiring care beyond the capabilities of the MSC provider, the MSO will ensure a completed CA-16, Authorization for Examination and/or Treatment, or CA-17, Duty Status Report, is forwarded with the CIVMAR to authorize treatment at a federal MTF. The MSO must ensure that an appropriate S.O.A.P. note is incorporated in medical record prior to referral. (4) Rehn Reporting. To recoup costs, the federal treatment facility is required to submit the charges for all occupationally related injury or illness to the Office of Worker Compensation (OWC), Department of Labor (DOL), in accordance with NAVMEDCOMINST 6320.3 series. Specific instructions for the submission of bills 4- 2 COMSCINST 6000.1D 11 October 2006 for payment are also contained in COMSCINST 12810.1 series. MSO/MDR will provide any assistance the MTF requires. The e. Non-Occupationally Related Conditions Afloat. CIVMARs are entitled to receive care for non-occupationally related acute or emergent conditions within the capabilities of the MSO/MDR onboard the ship to which the CIVMAR is assigned. No charge will be made for any acute or emergent medical care rendered aboard MSC ships, regardless of the extent of care received or the value of the supplies used in its provision. f. Non-Occupationally Related Care Ashore (1) CIVMARs are not generally entitled to treatment of nonoccupational illnesses and injuries in federal MTFs (including MSC medical facilities ashore). Paragraph 4.2i of this chapter is applicable. When such care is received from federal medical facilities, costs are the responsibility of the CIVMAR. The Federal Employees Health Benefit program requires that the employee be referred to a non-federal source of care at the employee's expense. (2) If referral to a non-federal source of healthcare for a non-occupational condition is not possible because of medical reasons, unavailability or inadequacy of care, the CIVMAR may be retained in the federal healthcare system at the CIVMAR’s personal expense (or that of the insurer) only until such time as the CIVMAR is able to be referred. g. Resolution of Disputes. If a question of whether an injury or illness is occupationally related cannot be resolved locally, copies of the medical record, accident reports and all other documents will be forwarded to OWC, DOL, for a determination. Should OWC make the determination that a condition is not occupationally related, the cost for the care will be the responsibility of the CIVMAR, effective on the date of determination. Charges prior to the determination date will be paid by OWC, DOL. h. Foreign Non-Federal Care. In extreme cases, where the overseas healthcare provider will not accept the CIVMAR’s insurance and the CIVMAR is unable to pay in cash, the Master of the ship is authorized by the COMSC Comptroller to pay for the medical services provided. This procedure renders the CIVMAR personally indebted to and financially responsible for reimbursement to the government. 4- 3 COMSCINST 6000.1D 11 October 2006 i. Civil Service Employees Ashore. Civil service employees are eligible for care for occupationally related injury or illness from federal sources if services are available. Otherwise, nonfederal care for occupationally related illness/injury will be from civilian sources at the expense of OWC, DOL. (1) Federal Military Treatment Facilities. NAVMEDCOMINST 6320.3 series and the Federal Employees Compensation Act, 5 U.S. Code 8101, et seq. provides policy for care received in federal facilities. j. Civilian Personnel. Civilians may be provided emergency care in a federal treatment facility to prevent undue suffering or loss of life or limb. Care will be limited to emergency care and if further treatment is required/recommended, the patient will be transferred/referred to a non-federal source as soon as practical. k. Contractor/Subcontractor Personnel (1) Government contractor and subcontractor personnel are authorized by 32 CFR 72821.81 to receive healthcare from federal sources, on a reimbursable basis, for illnesses and injuries occurring at work in and outside the United States. Non-federal sources must be unavailable or inadequate. Personnel will be referred to a non-federal source as soon as practical. (2) Prepositioning Forces (PF), Diego Garcia. The Naval Support Facility Clinic and the MSO assigned to MPSRONs are authorized to screen and provide acute and emergent medical care to contractor personnel assigned to the PF, Diego Garcia. The contract personnel must maintain their own primary care managers. They are responsible for obtaining all of their own chronic medical care and follow up for all chronic medical conditions. NAVMED P-117 and NAVMEDCOMINST 6320.3 series authorizes care on a reimbursable basis. l. Dual Entitlement. Employees, whether CIVMAR, civil service, contractor personnel or civilian, who are otherwise entitled to federal medical care benefits are not restricted from seeking care under that entitlement. CIVMARs and MSC civil service employees who have occupationally related illnesses or injuries will notify the local healthcare administrator of the dual entitlement and will follow the administrator's direction in the submission of appropriate documents to OWC, DOL. m. Dental Entitlements. Employees, whether CIVMAR, civil service, contractor personnel or civilian, are entitled to dental 4- 4 COMSCINST 6000.1D 11 October 2006 treatment in MTFs only as an adjunct treatment to inpatient hospital care. This care will not include dental prostheses or orthodontia. Limited care to provide short-term relief from pain and suffering is authorized. Paragraph 4.5 of this chapter amplifies. 4.3 MEDICAL CARE AFLOAT a. Level of Medical Care Onboard MSC Ships. The size of the crew, the mission of the vessel, the adequacy of medical facilities, and the availability of physician referral service determine the level of professional training of the healthcare provider assigned to MSC ships. (1) Medical Services Officer (MSO). The training and level of care provided by an MSO onboard MSC ships will be equivalent to that of a U.S. Navy Independent Duty Hospital Corpsmen (see Appendix A). Although generally lacking preventive medicine and shipboard experience, licensed Physicians Assistants and Registered Nurses with emergency medicine/occupational health/primary care experience will be considered on a case-bycase basis for employment as MSOs, practicing within the MSO scope of practice. (2) Contract Medical Services Officer (CMSO). Similar to MSO in duties, training and medical experience. Hired and assigned by the Shipping Line Company operating MSC-owned ships (primarily on PM2 Special Mission Program ships). The training and level of care provided by a CMSO onboard MSC ships will be equivalent to that of a U.S. Navy Independent Duty Hospital Corpsmen (see Appendix A). Although generally lacking preventive medicine and shipboard experience, licensed Physicians Assistants and Registered Nurses with emergency medicine/ occupational health/primary care experience will be considered on a case-bycase basis for employment as contract MSOs, practicing with the MSO scope of practice. (3) Medical Department Representative (MDR). The Master, Chief Mate or First Officer will normally be assigned as an MDR and designated “Person In Charge of Medical Care (PIC)” IAW STCW 95 standards when the ship is not assigned an MSO. They will have successfully complete a USCG approved PIC-Medical Care course and all prerequisite training prior to assuming the duties as MDR. MDRs are authorized to provide care at the level of Advanced First Aid Provider. Only the COMSC Fleet Surgeon and the COMSC Contracting Officer (N10) may lessen the requirement for contractor-operated ships. 4- 5 COMSCINST 6000.1D 11 October 2006 b. Access to Medical Care. Access to medical care, regardless of the level of care required, will begin with the MSO/MDR when assigned. (1) Sick Call. Sick Call will be held at a time designated by the Master and adjusted to fit the ship's work schedule to make the service available to each watch section. (2) Referrals. MSOs/MDRs will refer any patient to a General Medical Officer or a Primary Care Provider (on a space available basis) at a Military Treatment Facility or to a civilian Primary Care Provider when the condition is beyond the level of training of the MSO/MDR or if the patient requests evaluation at a higher level. The MSO/MDR will ensure an appropriate medical entry (in SOAP format) is completed, logged into SAMS (if applicable), and filed in the individual’s medical record. (3) Specialty Referrals. Except in emergencies, patients should not be referred for consultation with a specialist without first being seen by a Primary Care physician. (4) Medical and Surgical Procedures. MSOs/MDRs will not perform surgical procedures except as directed by the cognizant MSC Physician Supervisor or the contract medical advisory service physician. This does not preclude closure of wounds, drainage and debridement of infected skin lesions or the removal of foreign bodies. All excised tissues (except debridement tissue) will be submitted to a pathology laboratory for analysis. Paragraph 4.4a of this manual discusses informed consent. (5) Consultations. At a minimum, MSO/MDRs will seek consultation with a Medical Officer (or contract physician medical advisor, when a Medical Officer is unavailable) whenever they are in doubt about a patient's condition or when any of the following condition exists: (a) A patient has an oral temperature of 102o F or above or a persistent (longer than 48 hours) condition. (b) Fever (oral thermometer) equal or greater than 103 F, unresponsive to treatment after 12 hours. (c) Return visit to Sick Call before assigned follow-up appointment because the condition has not improved or has worsened. 4- 6 COMSCINST 6000.1D 11 October 2006 (d) The patient cannot be returned to full duty after 72 hours duration because of unresolved illness. (e) Unexplained pulse rate above 120 per minute. (f) Unexplained respiratory rate above 28 per minute or less than 12 per minute. (g) The medical/dental problem is beyond the level of training of the provider. (h) Medical evacuations, medical diversions or medical repatriations are initiated/anticipated. (i) The ship's Master or sponsor requests the utilization of a consultant. c. Off-Ship Healthcare Facilities. Personnel requiring medical care should request evaluation and treatment from the shipboard MSO/MDR. The MSO/MDR will ensure proper referral to a federal or civilian healthcare facilities, as appropriate, and track the patient’s care. d. Contract Medical Advisory Service. MSC ships do not normally sail with a task force, or with other ships where a physician is available for immediate referral. However, when a MSC ship is sailing with a task force or replenishing a ship with a medical officer, the MSO/MDR may seek advise from that medical officer. Otherwise, access to immediate medical advice is available to the shipboard healthcare provider from the cognizant MSFSC Force Medical Officer or from a contract physician specializing in emergency care with experience in the maritime environment. Appendix J provides guidance for the use of MSC’s contracted medical advisory service. e. Medications. The MSO/MDR may prescribe only those medications listed in the ship's AMMAL or those approved for use by the cognizant MSC Physician Supervisor. f. Prescriptions and Labeling. All prescription medications issued onboard COMSC ships will be dispensed in properly labeled containers in compliance with Chapter 21 of NAVMED P-117. The label will include the following: (1) Name of the ship (2) Date of prescription 4- 7 COMSCINST 6000.1D 11 October 2006 (3) Patient's name (4) Name, strength and amount of the drug prescribed (5) All directions for use, precautions and expiration date (6) Prescription number (Controlled Substances only) The name of the manufacturer and the lot/control number will be recorded on the prescription form to assure proper identification in the event of an adverse reaction or product recall. (7) Prescriber's name/number of refills 4.4 INFORMED CONSENT AND REFUSAL OF CARE a. Informed Consent. Prior to any invasive procedure (i.e., suturing), the MSO/MDR will inform the patient of the procedure, alternatives, including doing nothing, possible side affects, and the expected outcome of treatment. An SF 522, Request for Administration of Anesthesia and For Performance of Operations and Other Procedures will be used. b. Treatment Rendered Without Consent. Medical treatment may be given without the consent of the patient ONLY UNDER THE FOLLOWING CIRCUMSTANCES: (1) Emergency care to preserve the life or health of an unconscious patient. (2) Care necessary to preserve the life or health of a patient who is considered to be mentally incompetent by a physician or MSO/MDR, until the patient is transferred to a medical treatment facility. This transfer will be accomplished in the most expeditious manner. c. Right to Refuse Care. The right to refuse medical care is affirmed. This right may be exercised at any point during the delivery of healthcare. Employees will be counseled, in writing, that a one-time refusal of care will not result in a permanent ineligibility for care. Refusal of care will be documented for each individual occurrence. Each refusal of care will be documented in the medical record and witnessed by one other person. Refusal to take a required immunization is NOT covered under the right to refuse care, but rather is disobedience of a direct order. Appendix D contains a sample form. At a minimum, the refusal documentation will include: 4- 8 COMSCINST 6000.1D 11 October 2006 (1) Date and time (2) Ship’s location and approximate geographic location (3) Healthcare provider's name and social security number (4) Description of the condition/illness or injury (5) Eligibility for care explanation (6) List of the specific consequences discussed (7) Signature of the patient (or noted refusal of patient to sign) (8) Signature of witness (9) Signature of MSO/MDR (10) Signature of the Master 4.5 DENTAL CARE AFLOAT a. Dental Care. Dental care aboard MSC ships will be limited to emergency treatment necessary to alleviate pain that affects the mariner’s ability to function. b. Procedures. Personnel requiring emergency dental care will normally be sent to the nearest dental facility for treatment. After working hours, emergency dental services are available from the ship assigned the dental guard or from a nearby dental facility ashore. c. Request Form. A completed Consultation Request (SF 513), indicating the primary complaint, will be appended to the medical record and accompany the patient. d. Emergency Palliative Care. When referral of a patient for emergency dental treatment is not possible, palliative therapy should be rendered by the MSO until a Dental Officer can see the patient. Procedures for rendering emergency care are found in the Dental Emergencies CD-ROM (803675). Documentation will include the SOAP format on a SF-600 and appropriate data recorded in the Sick Call Log in SAMS. 4- 9 COMSCINST 6000.1D 11 October 2006 e. Supplies. The supplies/instruments required for emergency dental treatment are provided in ADAL 210. f. Training. Initial training will include a U.S. Navy Fleet Dental Refresher, 2-day, course (or equivalent) and must be renewed every three years. The course curriculum must include one day of didactic and one day of clinical (hands on) experience. 4.6 AFLOAT MEDICAL TREATMENT FACILITIES a. Afloat Medical Treatment Facilities. GENSPECS for T-SHIPS and COMSCINST 9330.6 series, Section 24, provide specific guidance for these facilities. b. Lighting. A permanently mounted, castle-type, surgical light is required for all COMSC ships. All hospital and emergency treatment spaces will be equipped with a primary and secondary fixed-mounting brackets (with power source), located above the treatment table. Four relay-type battle lanterns will be installed surrounding the treatment table. c. Sterilizer. One sterilizer will be installed in the treatment area of each MSC ship. The unit will be mounted securely and will be maintained in operating order at all times. d. Markings. Directional markings (an interrupted arrow having a red cross in the center) will be mounted on interior bulkheads, 60-70" from the deck, indicating the route to the hospital. Sufficient decals will be mounted to ensure visibility from one arrow to the next mounted in either direction. Selfadhering decals (COG CG NSN 7690-01-032-1177, Decal, Red Cross, Arrow, U/I EA, approximate cost $0.69) are recommended. e. Resuscitation Posters. Up-to-date Resuscitation posters, that demonstrate CPR and Airway Management, will be conspicuously displayed in all areas that have a high risk for high voltage electric shock. f. First Aid Boxes and Mass Casualty Boxes. Location requirements are contained in Appendix I of this manual. g. Resuscitator, Hand Operated. A hand operated "AMBU" type resuscitator will be maintained in the hospital/treatment room spaces and equipped to deliver oxygen. h. Oxygen. Oxygen tanks will be located and stowed according to GENSPECS Section 652 and OPNAVINST 5100.19 series. Sufficient 4- 10 COMSCINST 6000.1D 11 October 2006 quantities to deliver 6 hours of continuous oxygen at 2 liters a minute will be available in the hospital spaces. To the extent possible, all oxygen cylinders required by the AMMAL will be mounted in the hospital/treatment room spaces. Cylinders will be filled to capacity at the beginning of each voyage and those used will either be refilled at the earliest opportunity or traded to military treatment facilities for full cylinders. All cylinders will be tagged with DD 1191, Warning Tag for Medical Oxygen. Cylinders in use will be inspected weekly. Unused cylinders in storage will be capped and inspected quarterly. Ensure oxygenhandling storage precautions are posted next to all oxygen tanks on board. i. Litters. Appendix I of this manual contains location requirements for locations of litters. (1) Litters will be inspected quarterly to include the serviceability of the litter, general condition, and the patient securing straps. (2) A minimum of two (2) handling lines with quick connecting hardware must be available for each litter (21 thread or larger manila line or nylon equivalent). (3) Lines used will be of sufficient length to allow litters to be lowered into the required space or down a ladder with enough line remaining to pass through a pad eye or block over the hatch and take three turns around a stanchion. The line at the lower end will be long enough to reach the deck below the deep trunk hatch to ensure stability during casualty transport. (4) All lines will be inside the litter when it is rolled and stored to enhance a smart appearance and discourage pilferage. It is no longer required to permanently attach handling lines to the stretchers. (5) The litters will be mounted off the deck. j. Sterile Surgical Packs and Supplies. The MSO will ensure the hospital and emergency treatment areas are stocked with sufficient sterile surgical supplies to provide emergent care without leaving the area for additional equipment or supplies. The surgical packs described in Appendix I of this manual will be inspected quarterly and their sterility will be maintained. (1) Specific trays or sets will be prepared and maintained sterile. Surgical knife blades with the foil wrapping intact and 4- 11 COMSCINST 6000.1D 11 October 2006 sutures packed in plastic packets are NOT to be steam sterilized due to the deteriorative effect of heat on these items. Armedtype suture material will be used in all surgical packs/trays/ kits. All disposable items required for each pack (i.e. needles, blades) will be affixed to the outer most wrapper of the individual pack. (2) All surgical packs/trays/kits will be plainly marked on the outside of the pack with the name of the pack, sterilization date, expiration date, and the initials of the individual who prepared the pack/trays/kits. (3) It is imperative that all emergency trays be of such size that they can be re-sterilized in the ship’s sterilizer. These sterilizer is to be tested according to current manufacturer’s specifications. k. Sterilization Procedures and Periods (1) Steam Method. Proven through extensive research, steam sterilization is as effective as gas sterilization and is more cost effective. Shipboard sterilizers are sufficient to perform steam-claving of all required surgical packs, therefore shipboard sterilization is encouraged. (2) Procedures (a) Cloth or disposable paper wrapper may be used. (b) All linen products must be freshly laundered before sterilization or re-sterilization. (c) All dressing materials will be renewed (i.e. 4x4s and 4x8s), and all surgical instruments visually inspected and cleaned as needed. (d) Instruments will be sterilized in the open position. (e) The center of all packs will contain an Internal Indicator. The pack will then be taped closed with the correct sterilization indicator tape. (f) Sterilize at a minimum of 250 degrees Fahrenheit, 15 PSI for 15 minutes. 4- 12 COMSCINST 6000.1D 11 October 2006 (g) A plastic dust cover (at least 3 mils thick) may be used to extend the shelf life to 6 months if it is properly applied. (h) Pack must be allowed to cool and dry completely (approximately one (1) hour). (j) Dust cover may be heat-sealed or the end(s) folded over at least four times and taped. (k) Shelf Life. 1) Thirty Days (no dust cover). 2) With intact, heat or tape sealed dust cover - 180 days. l. Event Sterilization. When performed properly (requires MTF Level Control Sterilization Room (CSR), there is no expiration date assigned unless the package is compromised, it is considered sterile. These packs shall be inspected for integrity during routine inventories. Documentation of inspections must be recorded and maintained with the sterile packs. 4.7 SPECIAL MEDICAL ENCOUNTERS a. Special Medical Encounters. This section discusses medical encounters outside of routine Sick Call visits. While it provides guidelines for handling difficult cases, it is not intended to be a substitute for prior preparation by the MSO/MDR or as a reference document in lieu of books contained in Appendix F of this manual, Required Medical Reference Library. MSOs/MDRs are responsible for preparing themselves for medical situations that have a likelihood of occurring aboard their ships. b. Substance Abuse. Substance abuse is normally discussed in terms of use, abuse, or addiction to alcohol or drugs. MSOs should be alert to signs of abuse of both legal and illegal drugs or pharmaceutical preparations. The legal principle of privileged communication or confidentiality does not apply in cases of substance abuse. MSOs/MDRs are required to report all cases of suspected substance abuse to the Master. c. Alcoholism. Alcoholism is a disease involving excessive use, abuse and/or physical or psychological addiction to alcohol. Denial is a key indicator. The diagnosis and treatment of the illness can only be accomplished through physicians and/or 4- 13 COMSCINST 6000.1D 11 October 2006 counselors trained in substance abuse. The role of the MSO/MDR is the recognition of the indicators of the disease and prompt referral to care. Command cooperation leading to accurate diagnosis will prevent alcohol related injuries and aid successful rehabilitation. The following guidelines outline MSO/MDR responsibilities: (1) Referral. Referral for evaluation of alcoholism will be considered when the use of alcohol appears to be a factor to one or more of the following: (a) Impaired performance of duty or Alcohol-related injury (b) Impaired physical or mental health (c) Impaired personal relationships (d) Socially unacceptable behavior (e) Violations of civil, military or maritime law NOTE: Conviction for infractions is not necessary for referral. The role of the MSO/ MDR is as a healthcare provider. (2) Confrontation. Individuals displaying indications of alcohol abuse or addiction should be confronted and encouraged to seek counseling prior to the occurrence of any alcohol related incident or accidents. (3) Abuse of Controlled Substances, Illegal Drugs and Other Substances. Unauthorized use of controlled substances, illegal drugs and/or other substances will not be tolerated aboard MSC controlled ships. While substance abuse treatment is beyond the scope and authorization the Medical Department, MSOs/MDRs will be knowledgeable concerning symptoms, referral sources, the CMPI 792, OPNAVINST 5350.4 series and other COMSC policies regarding substance abuse. d. Competency for Duty Examinations. A Competency for Duty Examination is a medical determination of the physical and mental capability of an individual to perform his/her duties. A Competency for Duty Exam may be warranted when the supervisor observes behavior which places doubt on the employee’s ability to perform assigned work. BUMEDINST 6120.20 series provides detailed instructions on procedures and required forms. 4- 14 COMSCINST 6000.1D 11 October 2006 (1) Requests. Examinations will be conducted only on the written request of the Master, his duly designated representative or the OICMILDEPT. NAVMED 6120/1, Competency for Duty Examination, will be used in all incidences. CMPI 792 applies in all cases of suspected alcohol or substance abuse; CMPI 790 applies for all suspected alcohol abuse. (2) Examination. A physician will normally conduct the examination. If a physician is unavailable, at the Master's discretion, the MSO may conduct the examination. The MSO will consult with the cognizant MSC Physician Supervisor or the contract medical advisory service. A MDR cannot conduct a competency for Duty Examination. (3) Legal Implications. Although the Competence for Duty Examination is primarily a medical determination of competency, its findings may be used in later administrative proceedings. All Competencies for Duty Examinations will be carefully conducted with all observations recorded and confidentiality maintained. (4) Bodily Fluids. If the MSO/MDR has reasonable suspicion that an individual is incompetent to perform his/her duties due to substance use, testing in compliance with Section 4 of CMPI 792, and/or Section 3 of CMPI 790, may be done. Specimens of body fluids (i.e., blood or urine) will be subject to a strict chain of custody and documented on DD Form 1323. e. Altered State of Consciousness. Altered states of consciousness, whether depressed or hyperactive, may be induced by many causes. The danger of death from a compromised airway or respiratory depression is very real. Additional injuries or illness can compound the threat. (1) Observation. Once consciousness becomes so altered that protective reflexes are impaired, the patient will be continually monitored. Treatment for shock and maintenance of the airway are minimum requirements. (2) Evaluation. Examination by the MSO/MDR, in consultation with the cognizant MSFSC Force Medical Officer, Afloat Military Medical Officer or medical advisory service physician will be completed expeditiously. (a) Notify the Master, Task Force Commander (if applicable) and the cognizant MSC Physician Supervisor of the circumstances and request advice. 4- 15 COMSCINST 6000.1D 11 October 2006 (b) Maintain the patient's ABC's and Vital Signs. (3) Use of Restraints. If the altered state of consciousness includes violent, confused or hyperactive behavior that endangers the life or limb of the patient or others, the patient may be restrained using humane methods. The restrained individual will be constantly monitored by one of the ship's officers until the patient can be safely transferred to a MTF. (4) Chemical Restraints. Use of chemical sedation or restraint may be utilized only upon the permission of the cognizant MSFSC Force Medical Officer, afloat Military Medical Officer, or the medical advisory service physician. f. Rape. The evaluation and treatment of a victim of rape includes both a concern for the well-being and medical condition of the individual and sensitivity to the legal issues of gathering evidence in a precise, documented manner. The medical care provided should not, in any way, taint evidence necessary for future legal proceedings. NOTE: After taking care of conditions that affect Life or Limb, prior to beginning any further rape investigation, physical examination or administrative action, notification by confidential immediate naval message to the cognizant Area Commander, Task Commander and the Naval Criminal Investigative Service (NCIS) is required. (1) Examination. Rape victims will normally be examined and treated only by a physician. If a physician is not available or the patient's condition requires immediate intervention, the MSO will contact the cognizant MSFSC Force Medical Officer, Afloat Military Medical Officer, or the medical advisory service physician for guidance. (2) Sexual Assault Determination Kits. A separate kit (NSN 6640-01-423-9132) is required for each patient. A minimum of one kit should be maintained on each ship. Additionally, NCIS usually has kits available for replacement. Supplies, forms and instructions for completion of an investigative examination are included. (3) Specimens/Documents. Specimens and documents obtained during the examination are considered legal evidence and will be accorded chain-of-custody treatment to ensure the evidence is 4- 16 COMSCINST 6000.1D 11 October 2006 admissible in any subsequent legal proceeding action. custody will be documented on DD Form 1323. Chain-of- g. Chemical, Biological Radiological, Nuclear and High-Yield (CBRNE) Exposives. Treatment of CBRNE patients will be in accordance with NAVMED P-5041 and NAVMED P-5046 and other medical publications included in Appendix F of this manual. BUMED special or modified treatment regimens will be transmitted to MSC ships via routine message or SIPRNET e-mail. (1) MSO will assist the ship’s CBRD officer in monitoring Shelf Life Extension Program (SLEP) for CBRD medicinals. h. Repatriations. The medical repatriation of CIVMARs to the continental United States is costly and negatively affects the mission of the ship. Repatriation of a CIVMAR should be initiated only if the medical condition of the individual precludes return to work within 5-7 days or is of a chronic nature where the likelihood of recurrence is high. Repatriation of CIVMARs will be reported to the cognizant MSFSC Force Medical Officer and COMSC via routine message or e-mail. Radio message is no longer required. In extenuating circumstances, a radio message may be sent, and is assigned RCS MSC 6320-1. NOTE: Appendix D of this manual contains a sample of MEDEVAC and Repatriation message. 4.8 CASUALTY HANDLING a. Casualty Handling. The MSO will ensure the ship has a Medical Department Emergency Response Plan that is current and crewmembers are trained to accomplish their assigned responsibilities. Appendix D of this manual contains a sample Medical Response Plan. b. Mishap Reports. Fatalities, injuries and occupational illnesses degrade operational readiness. Hazard awareness and mishap prevention programs depend on accurate, timely mishap investigations and reports identifying the cause of a mishap. Guidance for conducting and reporting mishap investigations is found in OPNAVINST 5102.1 series. c. Serious Illness/Injury. Any embarked personnel with illness or injury threatening to life or limb will be identified immediately to the Master. The Force Commander, cognizant MSFSC Force Medical Officer, Senior Military Medical Officer Afloat, and 4- 17 COMSCINST 6000.1D 11 October 2006 COMSC will be notified via message. The appropriate authority will notify the next-of-kin listed on the emergency data record, as well as other individuals requested by the patient. If able, the patient may make the notification via telephone him/herself. Additionally, the patient may request that no next-of-kin notifications be made. 4.9 DECEDENT AFFAIRS a. NAVMEDCOMINST 5360.1 series, MILPERSMAN 4210100, and COMSCINST 1770.1 provide guidance for administrative requirements upon the death of active duty military, retired military, and CIVMAR personnel as well as other personnel embarked upon COMSC controlled ships. The following guidelines will be observed following any death. (1) Initial Report. When a death occurs on a MSC ship, the Master and MSO/MDR will ensure notification of the Area Commander, Cognizant Casualty Assistance Calls Officer (CACO) and COMSC by immediate message and direct telephone call to the MSFSC HQ or Pacific Force Medical Officer. All information required by MILPERSMAN 4210100 for active duty personnel and NAVMEDCOMINST 5360.1 series (Chapter 3, paragraph 3) for other than active duty personnel will be provided. This report is assigned Report Control Symbol MED 5360-11. (2) Medical Department Journal. An entry will be made in the Medical Department Journal documenting all available information concerning the death. (3) Death Certificate. Chapter 17, Sections 4 & 5 of NAVMED P-117, provides information concerning death certificates and their submission. (4) Health Record Entries. Complete the required entries concerning the death, incorporate the death certificate, if available, close and forward the record to the MSC Physician Supervisor or, in the case of active duty military personnel, to the command holding the service record of the deceased. Refer to NAVMED P-117, Chapter 17. (5) Disposition of Remains. Remains shall be transferred as soon as possible to the nearest military medical facility for disposition. When transfer cannot be accomplished immediately, the remains will be: (a) Provided post-mortem care. 4- 18 COMSCINST 6000.1D 11 October 2006 (b) Placed in a body pouch. (c) Refrigerated at a temperature of 36 to 40o F to prevent decomposition. (d) The space utilized must contain no other items and must be cleaned, disinfected, and inspected by the MSO/MDR prior to reuse. (e) Remains shall be identified with waterproof tags, marked with waterproof ink and affixed with wire ties to the right great toe and at each end of the body bag. (f) Minimum identification shall be full name, SSN and rate. (6) Autopsy. The Military Treatment Facility (MTF) accepting the remains will determine the need for an autopsy. Guidelines are contained in the NAVMEDCOMINST 5360.1 series concerning permission requirements. The CACO will provide support for contacting the next-of-kin for permission (no other person will intervene in this process unless directed to do so by the CACO). The MSO/MDR will provide liaison between any local authorities involved and the MSC Physician Supervisor. 4- 19 COMSCINST 6000.1D 11 October 2006 CHAPTER 5 PHYSICAL STANDARDS 5.1 GENERAL a. Physical Standards. Physical standards enable the uniform interpretation of physical qualification parameters for initial entry, retention, assignment to special duty and training programs required for positions at sea with MSC owned or contracted vessels. These standards are subject to change to meet the needs of MSC. b. Purpose. The standards represent the minimum occupational qualifications for employment. Early identification of physical defects and psychological problems which would compromise a mariner’s ability to perform normally assigned duties reduces the potential for personal injury or illness when mariners are operating in remote environments. c. Exclusion. These standards are intended to preclude acceptance of individuals who would be unable to perform assigned tasks or whose conditions are likely to be aggravated by sea service. Applicants must be physically and mentally able to perform their assigned duties without hazard to themselves or others and be able to respond to emergencies at sea. d. Comparability. Because of the operational environment of MSC ships and the critical mission to support U.S. Navy and other agency requirements, these standards are concordant with those established for alert deployable Naval forces within the DOD and are not necessarily equivalent to those of the civilian industry. e. Prescribing Authority. Under the authority of 5 CFR 339, COMSC develops physical requirements through comprehensive review of physical demands and environmental conditions associated with each mariner’s position. 5.2 PERIODIC PHYSICAL EXAMINATIONS a. Examiner Qualifications. Physical examinations will be conducted by licensed physicians, nurse practitioners or physician assistants. For CIVMARs, these examinations will be conducted at DOD or MSC-approved medical facilities. Examiners will be familiar with the functional requirements and environmental factors of the duties as listed in Appendix K. Comment [s2]: 5 CFR 339.101 through 306 Comment [s1]: a. Medical; Standards and Physical Requirements. Physical standards are provided for the uniform interpretation of physical qualification parameters for initial entry, retention, assignment to special duty and training programs required for employment in positions at sea with MSC. These standards are subject to change to meet the needs of MSC. 5- 1 COMSCINST 6000.1D 11 October 2006 b. Final Authority. Complete examinations and supporting documents are required for final determination. Accordingly the final approval authority for physical examinations is the MSFSC HQ Force Medical Officer. In the event of absence of the MSFSC HQ Medical Officer, the Force Medical Officer, Pacific has final review authority. In the unlikely event of absence of both Force Medical Officers, the MSC Fleet Surgeon assumes final review authority. Any CIVMAR appeal of the final decision will be forwarded to COMSC Fleet Surgeon, via MSFSC. The Fleet Surgeon will review the decision and advise COMSC in making a decision regarding the appeal. c. Waivers. Any consideration of waivers to physical or mental qualifications must be requested by the affected mariner and commented upon in writing by the Force Medical Officer MSFSC HQ or Pacific. Waiver processing procedures are found in Section 5.7 of this chapter. d. Documentation. DOD-prescribed Report of Medical Examination/History and appropriate occupational health forms will be used to document all required examinations. All reports of special studies and examination must either be entered on, or appended to, the examination form. All examinations will be permanently filed in the mariner’s health record. Examinations shall be conducted and documented in compliance with NAVMED P-117 (Manual of the Medical Department). e. Examination Requirements. The physical examination will include the following components. (1) DOD-prescribed Report of Medical History (DD Form 2807)and Report of Medical Examination (DD Form 2808). (2) Special Studies. (a) Complete Blood Count (b) Lipid Profile to include cholesterol, HDL, and triglycerides (c) Fasting Blood Glucose (d) Gluscos-6-Phosphatase (G6PD) deficiency and Sickle Cell anemia test results if not previously recorded in health record. 5- 2 COMSCINST 6000.1D 11 October 2006 (e) General assessment of dental health. New hire mariners will have a dentist-performed examination within 6 months prior to hire documenting no significant dental problems requiring resolution. (f) Ocular examination will include the following components: 1. Gross visual acuity testing (using Snellen Chart, Armed Forces Vision Tester, or equivalent) to determine near and far visual acuity, both corrected and uncorrected, in each eye individually and with both eyes together (binocular vision). 2. Measurement of visual fields by confrontation. 3. Color vision test using FALANT (at hire and for those individuals whose duties require color vision). 4. Paragraph 5.6 of this chapter amplifies visual acuity requirements. (g) Audiogram. (h) Electrocardiogram (EKG). A baseline EKG is required as part of the new employee physical examination and with each periodic examination beginning at age 40 or as clinically indicated. (i) Any additional laboratory study or functional testing clinically indicated to determine the physical qualifications and health of the mariner. f. Validity Periods of Medical Examinations. A medical examination is valid until the next required medical examination. To ensure continued suitability for duty, however, every new assignment shall require the mariner to be queried about changes in their health status or physical ability occurring since their previous assignment (hospitalizations, illnesses, change in medications, and new diagnoses). g. Medical Officer Final Review. MSFSC HQ Force Medical Officer will review history and physical findings and make final fitness for duty determination for CIVMAR examinations. The MSFSC HQ Force Medical Officer is available for consultation regarding interpretation of the standards for contractor personnel. The MSC Fleet Surgeon is the authority for organizational policy, setting 5- 3 COMSCINST 6000.1D 11 October 2006 of physical standards, and contract requirements, regarding contract personnel physical standards and requirements. 5.3 PERIODICITY OF ROUTINE PHYSICAL EXAMINATIONS a. Periodicity. Unless stated otherwise in this chapter or by competent authority, routine physical examinations will be completed as follows: (1) Entry. employment. All mariners will be examined upon initial (2) Age 40, Age 45, Age 50. (3) Beginning at age 50, examinations are required every two years. (4) After age 60, examinations will be conducted annually. b. Scheduling. Examinations will be performed no later than 1 month following the anniversary date (month and year) of the previous examination. Examinations may be performed earlier. When ship’s operating schedules preclude timely examinations, the examination will be performed at the earliest opportunity. 5.4 GENERAL CONSIDERATONS a. General. job positions. Physical standard requirements may vary between b. Initial Employment. The standards contained in this manual apply to determining physical qualification for initial employment. c. Retention. The standards contained in this will be used as a general guide in determining physical qualification for continued employment. d. Promotion or Career Change. Physical requirements may be specific to each afloat position. Prior to an anticipated promotion or change of position, MSFSC HQ Force Medical Officer will determine whether or not previous physical examinations support qualification for the anticipated position. Conditions previously determined to be “Not Considered Disqualifying,” (NCD) for one specific position may be disqualifying for another position. Additional examination may be required. 5- 4 COMSCINST 6000.1D 11 October 2006 e. Accommodation. A physical condition or impairment will not automatically disqualify an applicant for appointment if the condition is compensated for by satisfactory treatment, medication, prostheses or mechanical aid appropriate for duties at sea or by reasonable shipboard accommodation. Reasonable shipboard accommodation may include, but is not limited to, the use of assistance devices, minimal job modification, and/or adjusted work schedules or assignments. The accommodation must be consistent with MSC Safety and U.S. Coast Guard regulations. f. Special Duty. Standards for special duties are established to meet the physical qualification for mariners assigned to duties requiring a level or type of physical ability or capacity different from that required for employment in the average career position with MSC. g. Medical Surveillance Physical Examinations (MSP). Employees exposed to certain categories of occupational hazards require specialized evaluations. These examinations determine the mariner’s fitness for placement and continued employment in these occupations. Additionally, data from such examination assists managers in assessing the effectiveness of hazard-specific protection programs (heat, noise, asbestos, etc.) OPNAVINST 5100.19 series, COMSCINST 5100.17 series, and NAVMED P-117 provide guidance. Appendix K details the specifics of the job-specific MSPs. h. Additional/Special Requirements (1) Pregnancy. There is no prenatal or emergency obstetrical care available onboard MSC ships for pregnant mariners. Additionally, the ships often travel far outside helicopter range for medical evacuation/transport. In the harsh maritime operating environment there is significant potential for severe injury to a pregnant mariner and/or her fetus. It is the responsibility of the pregnant CIVMAR to notify the Medical Department of her pregnancy. Upon disclosure of pregnancy, referral to the MSFSC HQ Force Medical Officer must be made to determine fitness for duty on a case-by-case basis. (2) Functional/Environmental Requirements. Appendix K provides comprehensive physical functional requirements and environmental exposure factors for MSC mariner positions. The examining physician shall review this information prior to making the determination of FFD. In some cases, functional testing may be required before FFD can be determined. 5- 5 COMSCINST 6000.1D 11 October 2006 (3) Chronic Condition Evaluations. Mariners or employees with chronic diseases or conditions must provide documentation of periodic follow-up with their private physician. This documentation will be reviewed by MSFSC Medical Officers to determine continued fitness for duty. An acknowledgment letter (Appendix D) will be signed by and copy provided to the mariner indicating awareness of the chronic conditions and frequency of follow-up as required by MSC Medical Department. (4) Functional Evaluation. A functional evaluation may be performed at the request of the mariner’s supervisor secondary to identification of a specific functional deficiency. MSFSC HQ Medical Office will arrange appropriate functional testing and evaluate whether any identified functional limitations affect fitness for duty. 5.5 INTERPRETATION AND APPLICATION OF PHYSICAL STANDARDS a. Application of Physical Standards. Physical requirements were developed without regard to gender. Minor physical defects in examinees that have demonstrated their ability to fulfill their afloat duties and responsibilities will be considered less significant than when noted upon initial screening. The total fitness of the mariner will be carefully considered in relation to the duties of his/her position. b. Functional Requirements and Environmental Factors. Functional requirements and environmental factors are included in Appendix K of this instruction. All personnel must be able to participate satisfactorily in firefighting, damage control, abandon ship and other shipboard emergency operations. c. Disqualification. The examining physician will evaluate an individual’s health, physical abilities, compatibility of existing medical conditions in an austere shipboard environment, and physical requirements of the position to determine qualification for initial hiring and/or retention. Disqualification is required when physical examination and review of the medical documentation reveals the individual’s health presents an unacceptable likelihood that the following situations may occur: (1) Adverse Impact on Mission. The mariner’s health presents an unacceptable risk when the examining physician has reason to believe that the medical condition may: (a) Present a high probability of repatriation or medical evacuation. 5- 6 COMSCINST 6000.1D 11 October 2006 (b) Cause an emergent disruption of ship’s operating schedule or diversion from ship’s mission. (c) Interfere with safe and efficient job performance of the mariner or other members of the crew, including firefighting, damage control, abandon ship and other shipboard emergency operations. (d) Result in death from conditions at sea. (2) Acute or Subtle Incapacitation. Persons with progressive conditions that require treatment may be denied employment when access to appropriate medical care may not be available. (3) Aggravation of an Existing Condition. If conditions at sea would significantly aggravate an existing mariner medical condition and/or result in further health impairment. (4) Communicable Diseases. The presence of a communicable disease may not, in itself, be disqualifying. The examiner’s determination of the likelihood of the transmission to other crewmembers will govern qualification. d. Not Physically Qualified (NPQ). In the instance of a finding of NPQ, a complete copy of the examination will be maintained at the MSFSC HQ Medical Office for at least 2 years. The rationale for a finding of NPQ will be clearly stated in the medical file. e. Management of Individuals Found Not Fit for Duty (NFFD) (1) An applicant found NPQ for employment may reapply for employment upon submission of clear documentation demonstrating correction, cure, or sufficient stability to allow safe performance of shipboard duty. Final determination will be made by the MSFSC HQ Force Medical Officer. (2) After having been determined Not Fit For Duty by a physician, the CIVMAR must provide a written report from the attending physician that documents sufficient resolution or recovery to warrant consideration for return to duty. This information may be provided on a standard medical summary form, or as a formal narrative summary. The summary must include: diagnosis, treatment, prognosis, need for follow-up, and opinion regarding fitness for isolated, arduous duty remote from Comment [s3]: Get form from PAC 5- 7 COMSCINST 6000.1D 11 October 2006 definitive medical care. The report will be evaluated by the MSFSC Force Medical Officer. Clarifying communication with the attending physician for clarification of medical questions or issues may be necessary. The final authority for determination of Fit For Duty status is the MSFSC HQ Force Medical Officer. f. Permanent Not Fit For Duty Evaluation. CIVMARs will be found Permanently Not Fit for Sea Duty (PNFFD) when in the opinion of the MSFSC HQ Force Medical Officer there is no possibility of a return to work at sea. As the final review authority, the MSFSC HQ Force Medical Officer will consider the current position held, the CIVMAR’s career path and other careers with MSC afloat prior to reaching the determination of PNFFD. As part of the PNFFD process, the following actions will occur: (1) When a CIVMAR is found PNFFD, he/she will be referred to the MSFSC N-1 Employee Relations Specialist for counseling. (2) Formal notification of PNFFD will be forwarded to MSFSC N-1 Employee Relations Division. (3) The mariner will be informed of the process for reevaluation and rebuttal of the findings that led to his/her categorization as PNFFD. Paragraph 5.7c clearly defines the relationship between the condition being considered disqualifying and performance of the mariner’s duties. 5.6 PHYSICAL STANDARDS a. General. This section establishes physical standards for personnel embarked on vessels under the direction of, or contract to, Military Sealift Command as authorized by 5 CFR 339. b. Disqualifying Conditions. The conditions listed in Section III of Chapter 15 of the Manual of the Medical Department (NAVMED P-117) are generally considered disqualifying except as specified in the next paragraph, c. c. Amplifying Guidance on Specific Conditions. While the guidance in NAVMED P-117 generally pertains, there are unique factors inherent to MSC service that warrant the additional considerations listed below. (1) HIV Sero-positivity is not disqualifying in and of itself. Frequency of required follow-ups, tolerance of prescribed medications, and documentation of continued stability from personal physician will determine duty status. Narrative summary 5- 8 COMSCINST 6000.1D 11 October 2006 or medical summary forms are required to be submitted to MSFSC HQ Medical Office at a minimum every six months. Documented clinical stability, in accordance with current practice guidelines, is required following any changes in condition or antiviral treatment regimen. (2) Hepatitis C is not disqualifying in and of itself. Duty status will be determined by frequency of required followups, tolerance of prescribed medications, and documentation of continued stability from personal physician. Narrative summary or medical summary forms are required at a minimum annually. (3) Gastroesophageal Reflux Disease is disqualifying only if severe and not responsive to therapy. (4) Hearing. In addition to the requirements of NAVMED P-117, the provisions of OPNAVINST 5100.19 series apply. Audiology evaluation including speech reception thresholds is warranted for those individuals who do not meet the above requirements. Duty status will be determined by documentation of continued stability and ability to safely perform duties. Noise restriction may be warranted based on this evaluation. (5) Diabetes. Non-insulin dependent diabetes is not disqualifying in and of itself. Duty status will be determined by frequency of required follow-ups and documentation from personal physician of continued stability, adherence to American Diabetes Association management guidelines, and HbA1c < 8.0. Detailed progress notes, narrative summary or medical summary forms are required at a minimum of every six months. (6) Gout. Gout is only disqualifying if it repeatedly precipitates repatriation or frequently interferes with the mariner’s ability to perform duties. (7) Eyes (a) Visual Standards. The following guidelines provide a reference for medical examiners to evaluate an individual mariner’s vision in relation to occupational requirements. The standards are based on the seafarer’s ability to effectively and safely perform the occupational requirements (visual tasks) of his/her position without endangering themselves, the crew or the safety of the ship during routine and emergent conditions. 5- 9 COMSCINST 6000.1D 11 October 2006 1. Licensed Masters, Mates, Operators or Watchstanders must have uncorrected vision of at least 20/200 in each eye and correctable to 20/40 in each. 2. Engineers, Radio Officers, Non-Watchstanders and All Others must have vision correctable to at least 20/50 in one eye and uncorrected vision of at least 20/200 in both eyes, correctable to 20/50 in each eye. 3. Monocular Vision. Mariners with monocular vision must have vision correctable to 20/30, or better, in the good eye. They must undergo a complete ophthalmologic evaluation prior to initial employment and as part of retention physical examinations. Fitness for duty determinations will be made on a case-by-case basis with particular consideration of monocular depth perception as it relates to occupational safety. Waiver submissions for Masters, Mates, or Watchstanders with monocular vision will require additional documentation of their ability to safely perform essential duties. (b) Prescription Safety Glasses. Mariners who require corrective eyeglasses will be required to wear safety glasses issued through MSFSC Medical Office in Norfolk in accordance with COMSCINST 5100.17 series, Afloat Safety and Occupational Health Manual. Deployed mariners may purchase prescription safety glasses labeled “Z87” conforming to MSC standards (ANZI Z87.1), and submit a claim for reimbursement at the predetermined rate. (c) Color Perception. Applicants will be tested for color perception using the Farnsworth Lantern Test. Waivers will not be considered for Masters, Mates, Watchstanders or Engineering Department personnel found to be deficient in color perception. (d) Glaucoma - Primary or Secondary. The suitability of mariners diagnosed with glaucoma will be evaluated on a case-bycase basis. Untreated narrow angle glaucoma is a cause for rejection. (8) Tuberculosis. Active tuberculosis in any form or location and of any degree or extent is disqualifying. A mariner with a history of active tuberculosis or Tuberculosis Skin Test (TST) reactivity must be evaluated and shown to be free of active disease and adequately treated if clinically indicated. Recent TST converters must have completed an evaluation and have been placed on INH or other prophylaxis if clinically indicated. 5- 10 COMSCINST 6000.1D 11 October 2006 (9) Malignancy is not disqualifying in and of itself. Duty status will be determined by frequency of required followups, tolerance of prescribed medications, and documentation of continued stability from personal physician. Narrative summary, detailed progress notes or medical summary forms are required to be submitted to the MSFSC HQ Medical Office at a minimum every six months. (10) Drug or Alcohol Dependence is disqualifying unless there is demonstrated completion of rehabilitation program and a sustained recovery for at least a year. Current mariners may be waived from the one-year requirement provided they remain compliant with the prescribed recovery program. (11) Personality, Conduct, and Behavior Disorders are generally disqualifying for entry unless demonstrated to be sufficiently stabilized to allow reasonable confidence in the ability to safely perform anticipated duties. Disposition of current mariners with disruptive behavior who are unresponsive to treatment is generally administrative. (12) History of DSM IV-R Axis 1 Psychiatric Illness is generally disqualifying. Waivers may be considered upon demonstration of the individual's ability to perform the functions required of their position for those conditions that are nonrecurrent, stable, non-severe, responsive to well-tolerated medications, require follow-up no more frequently than every six months, are unlikely to be exacerbated by isolated sea duty, and do not present a danger to self and others. A current, complete psychiatric assessment is needed for consideration of waiver with periodic updates as determined by the MSFSC HQ Force Medical Officer. (13) Coronary Artery Disease. Coronary disease that is symptomatic or precludes strenuous activity is disqualifying. Individuals with history of acute coronary events may be considered for waiver if a minimum of six months have elapsed since the event and they are symptom free, have a recent normal exercise stress test, and have no activity limitations. Waivers may be considered for mariners with a history of invasive intervention (e.g. angioplasty, stent placement, coronary bypass grafts) if a minimum of eight months has elapsed since the procedure and they are symptom free, have a recent normal exercise stress test, and have no activity limitations. A narrative summary, detailed progress notes or medical summary forms are required to be submitted to MSFSC HQ Medical Office at a minimum of every six months. 5- 11 COMSCINST 6000.1D 11 October 2006 (14) Cardiac Dysrhythmias. Dysrhythmias that are symptomatic or that present an unacceptable risk for progression are disqualifying. Waivers may be considered for those individuals who can demonstrate complete control with medication over a year or following a successful ablation procedure. A narrative summary or medical summary forms are required to be submitted at a minimum, every six months. (15) Hypertension. Controlled hypertension, demonstrated by readings consistently below 140/90 by commonly available medication and no cardiac or renal involvement is not considered disqualifying. A narrative summary, detailed progress notes or medical summary forms are required to be submitted at least annually. (16) Sleep Apnea that is responsive to commonly available treatment (including continuous positive airway pressure devices) is not considered disqualifying. A narrative summary, detailed progress notes or medical summary forms are required to be submitted at a minimum of every year. (17) Chronic Obstructive Pulmonary Disease that precludes strenuous activity required for shipboard emergency response is disqualifying. A narrative summary, detailed progress notes or medical summary forms are required to be submitted at a minimum of every year. (18) Asthma after age 12 is disqualifying. Waivers may be considered for individuals with historically mild disease (no hospital admissions and no requirement for continuous oral or inhaled medication). Bronchoprovocation testing may be warranted to definitively determine the severity of the mariner’s asthma. A narrative summary, detailed progress notes or medical summary forms are should be submitted, at a minimum, every year. (19) Recurrent Ureteral Calculi (i.e. two or more separate episodes) is considered disqualifying. Waivers may be considered for mariners who have undergone a thorough metabolic work-up and reliably adhere to the prescribed treatment regimen. (20) General Disqualifying Conditions. Any chronic condition which effects functional performance, is progressive, or, in the physician’s opinion, may be worsened by the mariner’s employment is considered disqualifying. Any condition, which poses a threat to the health and safety of the mariner, his/her shipmates or the ship, is considered disqualifying. 5- 12 COMSCINST 6000.1D 11 October 2006 5.7 PHYSICAL ABNORMALITIES AND WAIVERS a. Physical Abnormalities. The term physical abnormality includes all defects, disorders, disabilities or conditions that may be of significance in determining a mariner’s physical qualification to perform the duties of his/her position. b. Documentation. All physical abnormalities that have been noted will be recorded on the prescribed DOD physical examination form in sufficient detail to show clearly the character, degree and significance. Abnormalities will be classified as: (1) Not Physically Qualified (NPQ). The condition for which the mariner is found NPQ must be directly related to the performance of the mariner’s assigned duties. Any medical condition may be considered NPQ, which might constitute a menace, jeopardize health, general welfare or safety, pose a significant risk for repatriation, or interfere with ship’s mission. (2) Not Considered Disqualifying (NCD). The medical condition must be well stabilized or static with respect to performance capability and unlikely to be aggravated by work, exposure or activities. The mariner’s medical condition should be considered by his/her physicians, and upheld in review by the MSFSC HQ/Pacific Force Medical Officer, to be unlikely to endanger the individual or others in the performance of, their assigned duties or limit response to emergencies at sea. c. Mariner Notification. The mariner will be notified, in writing, at the time of the physical examination if NPQ and provided an opportunity to rebut the findings. Additional examinations submitted by the applicant for the purpose of rebuttal will be obtained at their own expense. d. MSFSC N-1 Notification. following: MSFSC N-1 will be notified of the (1) Individuals who are NPQ. (2) Recommendations for individuals that are NCD who require accommodation. e. Waiver Recommendation Process. 5- 13 COMSCINST 6000.1D 11 October 2006 (1) Waiver requests may be initiated by applicants, current mariners or the reviewing Force Medical Officer (MSFSC HQ or Pacific). (2) Waivers may be appropriate when an abnormality is considered to be disqualifying but, in the judgment of the reviewing MSFSC Force Medical Officer, is of such nature as not to preclude the safe performance of duty. (3) When preparing waiver requests, sufficient information about the medical condition or abnormality must be provided to permit reviewing officials to make an informed assessment of the condition in the direct context of the duties of the mariner. Since most delays involving waiver requests result from inadequate information, the requestor must ensure that complete documentation is forwarded for review. (4) Force Medical Officer, MSFSC HQ/Pacific will forward waiver recommendations for final determinations to MSFSC N-1. Waiver recommendation will include any position limitations and work restrictions appropriate for each condition. (5) Final waiver determinations (approved or disapproved) will be returned to the MSFSC HQ Force Medical Office, signed by the Mariner, and copies placed in the mariner’s medical record maintained at MSFSC and in his/her personnel file. Any applicable position limitations or work restrictions will be recorded in the automated medical tracking system. 5- 14 COMSCINST 6000.1D 11 October 2006 CHAPTER 6 OCCUPATIONAL HEALTH AND PREVENTIVE MEDICINE 6.1 GENERAL ADMINISTRATION a. Preventive and Occupational Medicine. The Navy Medical Department provides occupational medical support to MSC ships. MSC Preventive Medicine and Occupational Health programs will follow Navy guidelines and policies as modified to meet the requirements for mariner manned ships. Government owned, contract operated MSC ships are addressed where and when applicable. b. Guidance. Basic guidance for occupational health and preventive medicine programs is contained in the following: (1) Manual of the Medical Department (NAVMED P-117), Chapter 22 (2) Manual of Naval Preventive Medicine (NAVMED P-5010) (3) OPNAV, SECNAV and BUMED directives in the 5100 series and 6200 series (4) NEHC 6260 TM Series, Medical Surveillance Procedures Manual & Medical Matrix (5) CDC, USPHS, FDA and USDA quarantine, food safety, prophylaxis and infections disease policies. 6.2 a. HEALTH MONITORING PROGRAMS Health Monitoring and Wellness Programs (1) General. While assigned to COMSC ships, CIVMARs will be afforded health screening services and wellness programs performed by shipboard MSOs. All findings will be recorded in the outpatient medical record. Abnormal or questionable findings will be referred to the Force Medical Officer, MSFSC HQ/Pacific for evaluation. SAMS will be utilized to document all Occupational and Preventive Medicine Program surveillance, screening and reports. (a) Tuberculosis Surveillance. Annual tuberculosis screening will be completed for all MSC CIVMAR and Military personnel using BUMEDINST 6224.8 series, Annual Tuberculosis Screening Program. Paragraph 6.4e of this chapter provides 6- 1 COMSCINST 6000.1D 11 October 2006 additional information about program requirements. Contract mariners (CONMARs) will insure Tuberculosis Screening is completed on an annual basis through their contract medical services. (b) Physical Examinations. Chapter 5 of this manual details physical examination requirements, health maintenance, and wellness programs for CIVMARs and CONMARs (as specified in each contract). (c) Individual Requirements. Illnesses discovered during physical exams, sick-call visits or health maintenance programs will be recorded in the medical record. Mariners will be monitored on an individual basis as determined by the MSC Physician Supervisor. (d) Special Medical Surveillance. Paragraph 6.7 of this chapter details monitoring requirements for environmental and occupational hazards. (e) Health Promotion Program. The Commander’s Annual Health Promotion Unit Award (“Green H”) was initiated to encourage participation in health promotion initiatives and to provide formal recognition to MSC units that have excelled in establishing and promoting a command conducive to health promotion. COMSCINST 6100.3 series provides further guidance on submitting nominations for this award. 6.3 CONTROL OF COMMUNICABLE DISEASE AND IMMUNIZATIONS a. General. Navy and CDC/USPHS disease prevention and control programs provide guidance to the MSO for advising ships' Masters and safeguarding the health of the crew and surrounding communities. Disease surveillance and reporting, workplace monitoring, medical, environmental health and other assessments are preventive medicine tools used to ensure MSC Mission Readiness. b. Disease Surveillance. Current information regarding disease occurrence, preventive measures and recommended treatment for communicable diseases that may adversely affect the ship's mission is readily available through the below listed sources. MSOs/MDRs will contact the local NEPMU prior to deployment to ensure knowledge of current prophylaxis and treatment anticipated for endemic diseases. The cognizant Force Medical Officer and COMSC Environmental Health Officer will keep shipboard MSO/MDRs appraised of disease occurrences and other medical intelligence 6- 2 COMSCINST 6000.1D 11 October 2006 issues that may impact effective mission effectiveness. sources for disease intelligence available to MSOs are: Other (1) Navy Environmental Preventive Medicine Units (NEPMU). (a) NEPMU-2: 1887 Powhatan ST Norfolk, VA 23511-3394. Comm: (757) 444-7671, DSN: 564-7671, FAX: (757) 444-1191, & PLAD NAVENPVNTMEDU TWO NORFOLK VA (b) NEPMU-5: 3235 Albacore Alley Naval Station, San Diego, CA 92136. Comm: (619) 556-7070, DSN: 526-7070, FAX: (619) 556-7071 & PLAD NAVENPVNTMEDU FIVE SAN DIEGO CA (c) NEPMU-6: 1215 North Rd Pearl Harbor, HI 96860. Comm: (808) 473-0555, DSN: 315-473-0555, FAX: (808) 473-2754, & PLAD NAVENPVNTMEDU SIX PEARL HARBOR HI (d) NEPMU-7: PSC 824 Box 2760 FPO AE 09623-2760 Comm: 011-39-95-56-9251, DSN: 314-624-9251, FAX: 011-39-95-569252, & PLAD NAVENPVNTMEDU SEVEN SIGONELLA IT (2) Disease Vector Ecology and Control Centers (DVECCs). (a) DVECC JAX: Box 43, Naval Air Station, Jacksonville, FL 32212-0043. Comm: (904) 542-2424, DSN: 9422424, FAX: (904) 542-4324, & PLAD: NAVDISVECTECOLCONCEN JACKSONVILLE FL (b) DVECC Bangor: 2850 Thresher Ave Silverdale, WA 98315. Comm: (360) 315-4450, DSN: 322-4450, FAX: (360) 315-4455, & PLAD: NAVDISVECECOLCONCEN BANGOR (3) Preventive Medicine Departments at armed forces medical treatment facilities (MTFs). (4) Armed Forces Medical Intelligence Center (AFMIC). (5) Global Disease Surveillance Report. (6) Department of State. (7) Local Health Departments. c. Navy Disease Reporting System (NDRS). The NDRS is incorporated into the SAMS medical program designed to report selected infectious diseases, injuries, or disease outbreaks that effect operational readiness, are internationally quarantinable or 6- 3 COMSCINST 6000.1D 11 October 2006 are unusual in nature. NDRS is part of the SAMS system. The NDRS generates a Medical Event Report (MER), which replaced the Disease Alert Report (DAR). (1) Masters shall ensure that a MER is submitted in accordance with BUMEDINST 6220.12 series, when a reportable illness, injury or condition is suspected or confirmed. MSC Ships’ Medical Departments and Medical Offices in Norfolk and Guam will maintain an effective medical events surveillance program. (2) Timely, accurate reporting is critical in identifying emerging infectious diseases and initiating appropriate action and resources that will protect both MSC personnel and the surrounding communities. Every report is important. Seemingly unrelated cases of disease or injury on different ships may be medically significant when viewed on a regional basis. (3) The MER will be forwarded by electronic mail using the NDRS to the cognizant NEPMU, with informational copies to the Force Medical Officer, MSFSC HQ/Pacific, COMSC Fleet Surgeon and Environmental Health Officer. If the NDRS or SAMS is not available, traditional means will be used to transmit the MER. (4) Routine MERs will be submitted by the 1st day of the month and urgent MERs will be submitted within 24 hours. In addition, any urgent cases will also require a phone call to the cognizant Force Medical Officer and NEPMU. When an MER may attract high level Navy interest or affect operational readiness, an OPREP-3 NAVY Blue message will follow the MER with informational copies to the cognizant NEPMU, NEHC, MSFSC HQ/Pacific Force Medical Officer, COMSC Fleet Surgeon and BUMED (MED-24). d. Disease Prevention. Prior to entering endemic areas, the MSO/MDR will ensure the following: (1) Provide comprehensive training to the crew on the prevalence, recognition and prevention of endemic diseases in the AOR. (2) Initiate appropriate preventive measures, prophylaxis and/or treatment in accordance with current protocols. e. Local Health Authorities. When deployed, the MSO/MDR will maintain direct liaison with local health authorities and/or American Embassies. If prophylaxis is required for certain diseases by local health authorities and differs from that recommended by the cognizant NEPMU, the MSO/MDR will immediately 6- 4 COMSCINST 6000.1D 11 October 2006 notify the cognizant MSFSC Force Medical Officer by routine message or e-mail to resolve conflicts. Informational copies will be sent to the MSC Fleet Surgeon, area NEPMU and NEHC. f. Universal Precautions for Infectious Diseases. Management of any patient by an MSO/MDR is based on a presumptive diagnosis. In the time between diagnosis of a contagious disease and referral to definitive care, healthcare providers must be aware of the communicability of the diseases between themselves and ship’s crew. Isolation will be at the discretion of the MSO with concurrence of the cognizant Force Medical Officer or medical advisory service physician. The dignity and emotional well being of the patient will be respected at all times. All MSC healthcare personnel will take prudent precautions to limit the spread of contagious diseases. Refer to COMSCINST 6230.1 series for guidance and implementation Bloodborne Pathogens Program. g. Immunizations. As previously stated, CIVMARs and CONMARs shall receive current immunizations in accordance with BUMEDINST 6230.15 series, BUMEDNOTE 6230, COCOM requirements and other guidance set forth by higher authority. Modifications of the cited references specifically for the CIVMAR/CONMAR population are as detailed below: (1) All immunizations, except Yellow Fever and Smallpox, may be given at sea or ashore at the discretion of the MSO with concurrence of the ship’s Master. Resuscitative response capabilities will be made available by the MSO before the administration of vaccines. (2) Yellow Fever immunizations shall be administered by the MSO only in port, during normal working hours after prior notification to the local MTF and concurrence of the Master. (3) Deployable Forces Status. BUMEDINST 6230.15 states CIVMARs and CONMARs serving under the auspices of the Military Services have status equivalent to “deployable forces” and are subject to the same immunization requirements as Active Duty and Naval Alert Forces. (4) Immunization Waivers. The COMSC Fleet Surgeon has authority to grant waivers in the case of legitimate religious objections or other mitigating circumstances. It may be revoked if necessary to ensure the accomplishment of the military mission. This keeps with the tenets of involuntary therapeutic care, when the accomplishment of the military mission may be compromised. 6- 5 COMSCINST 6000.1D 11 October 2006 (5) Geographical Requirements. CIVMARs and CONMARs will adhere to any additional immunization requirements directed by the COMCOMs based on special disease threat assessments within the Area of Operation (AOR). These requirements may be in addition to normal service immunization policy for personnel traveling into that AOR. (6) The MSO and cognizant Force Medical Officer are responsible to ensure compliance with current immunization requirements. Geographical requirements for MSC personnel (Navy Alert Forces) can be obtained from the nearest NEMPU. Each contractor or sponsoring agency will ensure contract mariner/employee compliance with current immunization requirements. (7) Disciplinary Action. Discipline for those who refuse mandatory inoculations is not a medical issue. (a) If a mariner refuses to receive a mandatory immunization, the Master shall give the mariner a "direct order" to be immunized within the limits of current policy and directives. This then becomes an issue of "refusal to obey a direct order". The Master shall handle this action as with any other breach of rules or regulations. (b) The Master should contact the MSFSC N-1 for additional guidance. (8) Tracking Immunizations. All MSC ships giving inoculations will insure each inoculation is entered on the SF 601, DHHS form 731 and the SAMS medical program. This information will be forwarded to the cognizant Force Medical Officer, for tracking and reporting as designated by higher authority. h. Anthrax and Smallpox. Guidance for these programs can be found in the DOD Anthrax Vaccine Immunization Program (AVIP) and DOD Smallpox Vaccination Program (SVP) website. Additional guidance can be found on the Center for Disease Control website and DOD immunization websites. (1) Smallpox vaccinations are administered in port by medical personnel who meet DOD and SECNAV requirements, have completed required training and have been successfully vaccinated against smallpox. (2) Smallpox and Anthrax immunizations are authorized only by direction of the MSC Fleet Surgeon as required by higher 6- 6 COMSCINST 6000.1D 11 October 2006 authority. All personnel receiving these vaccines must receive CDC/DOD approved training in both the benefits and risks of the vaccine and be entered in the training record. Additionally, all personnel will be pre-screened for medical contradictions using screening forms approved by the MSC Fleet Surgeon. HIV screening is mandatory prior to receiving either immunization. The Fleet Surgeon has final authority for granting exemptions or medical waivers. i. Hepatitis. For guidance on the use of Hepatitis vaccines, the cognizant NEPMU should be contacted for current information. Refer to the following directives for guidance and instructions: (1) NAVMEDCOMINST 6230.1 series, Viral Hepatitis Prevention. (2) NAVMED P-5038 – Control of Communicable Diseases in Man. 6.4 COMMUNICABLE DISEASE PROGRAM REQUIREMENTS a. Communicable Disease Program Requirements. The following diseases require monitoring, prophylaxis and treatment. This section is intended as a quick reference. MSOs/MDRs faced with these conditions will use the U.S. Navy directives specified as well as consulting with the cognizant Force Medical Officer and NEPMU. b. Malaria. Malaria is one of the most prevalent diseases on earth. Its prevalence, distribution and disabling effects make it a significant concern to the operational forces. (1) Prevention and Control. Refer to Navy Environmental Health Center (NEHC) Technical Manual (NEHC-TM) 6250.1 Navy Medical Department Guide to Malaria Prevention and Control) for guidance. The MSO will ensure the following. (a) Ensure all embarked personnel are thoroughly instructed in malaria prevention and control, with emphasis on “personal protection” when operating in a malaria endemic area. (b) Ensure all embarked personnel have documented proof of G6PD/Sickle Cell Anemia testing in their health records. (c) Contact the cognizant NEPMU or cognizant MSFSC Force Medical Officer for prophylaxis guidance prior to deployment to any malaria endemic area. 6- 7 COMSCINST 6000.1D 11 October 2006 (d) In accordance with Navy directives, all MSC ships which travel to malaria endemic areas will maintain sufficient supplies of malaria chemoprophylaxis onboard to provide all embarked personnel treatment as directed by the cognizant NEPMU, Force Medical Officer or medical advisory service physician. (2) Documentation and Reporting Requirement. document: The MSO will (a) G6PD Screening Results, should be recorded as deficient or normal in the individual’s health record along with an entry documenting counseling the mariner if he/she is found to have a deficiency. Additionally, the “Sensitivities” block in the Alert Box on the Medical Treatment Cover must be checked. Refer to NEHC TM-6250, seek advice and approval from cognizant Force Medical Officer or medical advisory service physician prior to administering any malaria prophylaxis to G6PD deficient personnel. (b) Chemoprophylaxis drug type, dosage, and the dates chemoprophylaxis began and ended must be documented into Chronological Record of Medical Care (SF 600) form and filed in the individuals health record. Any adverse or unusual reactions to the chemoprophylaxis therapy will be reported promptly to the MSFSC HQ/Pacific Force Medical Officer with information copies sent to the MSC Fleet Surgeon, the cognizant NEPMU and NEHC. (c) A Medical Event Report will be generated by the MSO in accordance with BUMEDINST 6220.12 series if malaria is suspected or confirmed. c. Hepatitis. Hepatitis is a viral disease of military importance. Infectious Hepatitis, or Hepatitis A, is transmitted via food and water and is common in every major seaport in the world. Hepatitis B and C (HBV and HCV) are bloodborne pathogens. HBV is a sexually transmitted disease. d. Sexually Transmitted Diseases (STD). BUMEDINST 6222.10 series and the CDC MMWR Guidelines for Treatment of Sexually Transmitted Diseases provide basic guidance for the management of STDs. (1) HIV & HBV Testing for STD Patients. HIV testing is mandatory for all military personnel diagnosed with an STD. HIV and HBV testing for CIVMAR/CONMAR personnel is not mandatory but highly recommended because of the high prevalence of these diseases associated with other STDs. The CIVMAR/CONMAR diagnosed 6- 8 COMSCINST 6000.1D 11 October 2006 with a STD will be counseled on the risks and offered an HIV and HBV test. (a) If consent for HIV testing is granted, it must be documented with a witness’ signed consent. The BBP Consent Form, COMSC Form 6231/4 must be signed, witnessed, and maintained in the mariner’s health record. (b) HIV testing for STD patients will be conducted at the time of diagnosis and at three (3) and six (6) month intervals. HIV test results will be maintained as confidential information in accordance with the Privacy Act of 1974. (2) Training. MSOs will provide training in the prevention of sexually transmitted disease and blood-borne pathogens precautions as a part the ship's training plan. Preventive and educational health brochures will be made readily available for ship’s company. Brochures can be obtained from NEPMUs and MSFSC HQ/Pacific Force Medical Officer. (3) Education. MSOs will maintain proficiency in the diagnosis, treatment and management of sexually transmitted diseases through triennial (every 3 years) refresher training, courses offered by the cognizant NEPMU. The MSO will be thoroughly indoctrinated as to the risks, complications, symptoms and preventive measures for STDs including HIV. Prior to any deployment, the MSO will contact the local NEPMU for information on the STDs endemic to the ship’s AOR. (4) Treatment. Treatment for STD patients will follow the regimens recommended by the Center for Disease Control (CDC) in the “Morbidity and Mortality Weekly Report (MMWR) Guidelines for Treatment of Sexually Transmitted Diseases.” The current treatment guidelines are available on the CDC website (http://www.cdc.gov/mmwr). The MSO/MDR must review the current MMWR guidelines on the website before initiating any patient treatment, as a patient safety precaution, since new drugresistant STD strains continue to evolve. (5) Hepatitis B Vaccine. Hepatitis B series Vaccine is required for STD patients as an integral part of the treatment regimen unless medically contradicted. (6) Contact Interviews. MSOs will conduct a Contact Interview in compliance with BUMEDINST 6222.10 series. Guidance and assistance may be obtained from the cognizant NEPMU, a MTF Preventive Medicine Department, or the local health department. 6- 9 COMSCINST 6000.1D 11 October 2006 The Contact Interview Report will be forwarded to the cognizant NEPMU and local health department where the sexual contact resides. (7) Management of Sex Partners. The management of sexual partners is disease-specific. The MSO should review the CDC website for the current, disease-specific management of sexual partners. (8) Documentation. The diagnosis and treatment of any STD will be documented in the health record including follow-ups and "test-of-cure" results. Syphilis cases require a NDRS and a SF 602, Report of Syphilis entry. (9) HIV/AIDS. Management of HIV/AIDS cases will be in accordance with current OPM policies, BUMEDINST 6220.10 series, DODI 6485.1 and the NEHC Sexual and Responsibility Program (SHARP) for CIVMAR and military personnel assigned to MSC. (NOTE) HIV screening is only mandatory for CIVMARs as prescreening tool for medical contradictions prior to receiving Anthrax or Smallpox vaccines. e. Tuberculosis (TB) Control Program (1) All MSC ships will conduct a Tuberculosis Control Program in accordance with BUMEDINST 6224.8 Tuberculosis Control Program. The MSO/MDR will operate, maintain, and monitor the program. For medical readiness purposes, PPD/Tuberculin Skin Test (TST) converters evolution must be 100 percent. Compliance with the TB Control Program is a critical element in the MSC Medical Readiness Inspection. (2) Annual Summary Record. The MSFSC Environmental Health Officer (EHO) will prepare the MSC Fleet Annual Summary Record, covering the period of 1 January through 31 December each year. The MSFSC EHO will submit the record by 28 February the following year to the cognizant NEPMU and send copies to the MSC Fleet Surgeon and MSFSC Force Medical Officers. The Annual Summary Record will be kept on file at MSFSC HQ medical office for at least three years. f. Medical Intelligence Program. medical intelligence in ports outside communicable disease and availability enhance operational medical support. Collection of current the U.S., with emphasis on of medical care, will MSOs will report any 6- 10 COMSCINST 6000.1D 11 October 2006 significant medical intelligence gathered during port visits, hospital visits, or gained through other sources, to the cognizant Force Medical Officer. The cognizant Force Medical Officer will relay significant information to COMSC Environmental Health Officer and the Armed Forces Medical Intelligence Command, Ft. Detrick MD. 6.5 PUBLIC HEALTH AND SANITATION a. Environmental Health. Good public health management practices and high sanitary standards are primary factors in the prevention of communicable disease and directly contribute to the health, morale and well being of the crew. NAVMED P-5010, USDA and USPHS Food Code, and NAVSUP PUBS 421 and 486 provide guidance. The Master will ensure that the ship has a systematic ongoing inspection program. NAVMED P-5010 and COMSCINST 9330.6 series provide guidance. The Master, or his/her representative, usually the MSO, will conduct daily shipboard inspections. (1) General Habitability. The MSO shall monitor cleanliness of the ship as a whole, adequacy of ventilation, heating and lighting, cleanliness of bedding, living spaces and heads and the identification and correction of safety deficiencies in all living and working spaces. Deficiency reports will be made to the Master as necessary. (2) Personal Hygiene. Personal hygiene and sanitation of the crewmembers will be monitored. (3) Pest Control. Effective control of insects, pests and rodents aboard ship shall be in compliance with NAVMED P-5010, Chapter 8 and the Navy Shipboard Pest Control Manual. Pest Control Surveys and pesticide application will be recorded in SAMS. (a) Pesticide Application. Prudent pest control measures remain the responsibility of MSC shipboard Medical Supply Departments. Routine surveys of stores for the presence of insects during receipt, transfer, storage or food preparation is paramount for good control. When actual infestation is determined, preventive measures will be employed by certified personnel per the Navy Shipboard Pest Control Manual. Only MSC Medical Department personnel (MSO/MDR) will be certified in shipboard pest control and responsible for the application of pesticides. Steward personnel are highly encouraged to attend Shipboard Pest Control classes for sanitation control measures, but will not be certified to handle pesticides. 6- 11 COMSCINST 6000.1D 11 October 2006 (4) Food Safety (a) General. Food service facilities will be monitored daily by the MSO/MDR. The MSO will conduct formal, unannounced Food Safety Inspections at least on a monthly basis in accordance with NAVMED P-5010, Chapter 1. The MSO will: 1. Conduct surveillance of the storage, preparation, and serving of food, and the disposal of food residues. Surveillance of food service space sanitation includes proper cleaning of equipment and utensils. 2. Conduct food service sanitation inspection at least monthly utilizing NAVMED Form 6240/1. The report will be forwarded to the Master. Discrepancies will be corrected in a timely manner and reported to the medical department. Upon the recommendation of the MSO, the frequency of formal inspections may be decreased to quarterly. However, only the most exemplary departments should consider changing the monthly requirements. 3. Inspect subsistence items for fitness for human consumption; ensuring that subsistence items are received from approved sources (see Article 1-5, NAVMED P-5010 for limitations of this requirement). 4. Conduct initial screening of food service personnel newly reporting onboard for detection of disease or unclean habits that could result in food-borne illnesses. The health screening does not need to include a physical examination but is should be sufficient to detect evidence of diseases that may be transmitted by food. Subsequent health screenings, e.g., annual evaluation, are not routinely required but may be conducted at the discretion of the MSO. It is advisable to re-screen food service personnel who have been away from their duties for extended periods, especially those who have traveled to foreign countries, before resumption of food service duty. 5. Provide technical guidance and assistance in the presentation of food service training programs. (b) Food Safety Training. All food service personnel will have a minimum of four hours training. Food service personnel will posses a current Food Safety Training Certificate in accordance with BUMEDINST 4061.1 series and NAVMED P-5010. MSOs and Chief Stewards will be certified as Food Safety Instructors. 6- 12 COMSCINST 6000.1D 11 October 2006 1. Food Safety Instructor refers to a person either military or civilian who has successfully completed either the Catalog of the Navy Training Course (CANTRAC) B-322-2101, “Food Safety Manager’s/Supervisor’s Course”, or alternatively successfully demonstrated food safety core competency knowledge by obtainment of a Food Protection Manager Certification via a Conference for Food Protection/American National Standards Institute (CFP/ANSI) accredited program/examination as set forth by the CFP/ANSI Food Protection Manager Certification Program. All Food Safety Instructors and persons in charge shall maintain a current certification in order to comply with food safety training requirements as set forth by this instruction. (c) Documentation. Food Safety inspections will be documented using NAVMED 6240/1 (Rev. 12/97), Food Establishment Inspection Form found in Appendix C of NAVMED-P-5010, Chapter 1. b. Potable Water (1) General. Each MSO/MDR will be thoroughly familiar with the standards listed in NAVMED P-5010, 1-61 and Chapter 6, and will ensure that monitoring of the ship’s potable water is included in the preventive medicine program. Pertinent aspects are included in this chapter for ready reference. The medical department will make monthly inspections of the potable water system and report adverse conditions that potentially affect the health of the crew to the Master. (2) Water Sanitation Bill. Each ship must develop a water sanitation bill either as part of the SORM or as a separate instruction to meet the specific needs and conditions of the ship. This bill will be posted conspicuously in areas where potable water and associated materials are processed, treated, or stored. NAVMED P-5010, Chapter 6, contains a sample water sanitation bill that can be adapted to meet the needs of any ship. (3) Water Treatment and Halogen Testing. Water from approved sources will be routinely treated by adding enough halogen to provide a residual at the end of a 30-minute contact time. The NAVMED P-5010 requires a 0.2 part per million (ppm) residual throughout the distribution system. However, due to distance of the terminal ends of the distribution system from the potable water tank, 0.2 ppm throughout the system may not be reachable without excessively halogenating water in the tanks. Assuming bacteriological monitoring has shown consistently negative results, a trace reading at terminal ends is acceptable. 6- 13 COMSCINST 6000.1D 11 October 2006 The ship’s potable water system will be super-halogenated whenever contamination exists as defined by NAVMED P-5010, Chapter 6. (a) Water Production. Distillation of harbor water is strictly prohibited except for extreme emergencies. “Emergencies” exist when vital requirements for potable water cannot be fulfilled from other sources. If an emergency exists and harbor water is distilled, sufficient halogen compound should be used to produce 2.0 ppm residual after 30 minutes at the tap. Halogenating to 5.0 ppm at the tank should produce this residual. If this halogenation does not produce the required 2.0 ppm residual, it should be increased until the required level is reached. When steaming in close proximity to other ships, precautions should likewise be taken in distilling potable water. (b) Testing for Halogen Residuals. Testing will be accomplished using the color comparator test kits or portable spectrophotometer. Testing will be accomplished before receiving water on board from any source (either shore hook-up or barge transfer) and a minimum of 30 minutes after any initial halogenation has been accomplished. Daily residual testing is mandatory while the ship is deployed or underway. Testing will be accomplished by monitoring a minimum of four sampling points that are representative of the ship’s distribution system (i.e., forward, aft, mid-ships, and as far above the 0-1 level as possible). Due to the routine testing conducted by preventative medicine personnel at all U.S. Naval Stations, daily testing is not required in these ports. However, if there is any reason to believe contamination may occur, such as work being conducted on the ship’s potable water system, daily testing should be accomplished. All testing will be documented using the SAMS environmental surveillance module. (c) Potable Water Connections, Hoses and Lockers 1. Potable water fill connections are 2-1/2 inch hose valves for large ships and 1-1/2 inches for smaller ships. Fill lines for potable water will not be cross-connected with any non-potable waterline or system. When not in use, filling connections will be closed with screw caps attached with keeper chains. Connections will be at least 18 inches above the deck with the receiving connection turned down to protect it from contamination. A warning plate bearing the inscription “POTABLE WATER ONLY” in one-inch letters will conspicuously designate filling connections. Each valve hand wheel and coupling will be color-coded dark blue in accordance with GENSPECS section 507 (Color No. 15044). 6- 14 COMSCINST 6000.1D 11 October 2006 2. Potable water hoses will be used to transfer potable water only, and for no other purpose. Hoses will be stenciled with the inscription “POTABLE WATER ONLY” at 10-foot intervals. Hoses will be kept in good condition at all times, examined monthly and removed from service when cracks develop in the lining. Cracks in lining are usually caused by normal deterioration and stress. Hoses will be stored with the ends coupled or closed with screw-type caps in pad-locked, vermin proof lockers. 3. Lockers will be identified and labeled “POTABLE WATER ONLY.” Lockers will be located out of the weather, if practical, and at least 18 inches off the deck, padlocked and vermin proof. Printed step-by-step instructions for disinfecting of potable water hoses will be conspicuously posted in the hose storage area. (d) Sounding Rods and Tapes. The sounding rods and tapes used to measure the potable water in the storage tanks must be color-coded dark blue, labeled, or otherwise identified “POTABLE WATER USE ONLY.” These tapes will be disinfected using 100-ppm free available halogen solution before each use. (4) Bacteriological Testing (a) Testing will be accomplished using the Colilert method; the required supplies are listed in the AMMAL. Samples for bacteriological analysis will be collected from representative points throughout the distribution system (i.e. forward, midships, aft, as far above the 0-1 level as possible) as well as from the potable water tanks. In no case should less than four samples be taken weekly. The number of samples collected should be based on the size of the distribution system and the number of tanks. Sampling points will be varied from week to week. Sample of ice must be collected from one quarter of the ice machines weekly. (b) Testing will be documented using the SAMS environmental surveillance module. Halogen residual readings will be included with the results. Positive and negative “control test samples” will be tested each time that the bacteriological test are performed. (c) The control tests are essential to ensure quality of the test procedure. A positive control may be obtained by testing 100 ml of water that has been lightly inoculated with 6- 15 COMSCINST 6000.1D 11 October 2006 feces; a rectal swab is recommended. The control tests are processed in the same manner as the routine water samples. No growth should result from the negative control test; the positive control should demonstrate numerous typical coliform colonies. (5) Storage of Halogens (a) Calcium Hypochlorite Storage. Calcium Hypochlorite storage lockers are the responsibility of the engineering department, but the medical department must be aware of the location, proper mounting and the contents of the storage locker. Improper stowage, in conditions of dampness or high temperatures may lead to fire or explosion. For proper stowage requirements, refer to NAVSHIPS Technician Manual, Chapter 670 (Stowage, Handling and Disposal of Hazardous General Use Consumables). (b) Bromine Cartridges Storage. Bromine Cartridges are the responsibility of either engineering or supply department. Cartridges must be stowed in clean, dry ventilated storeroom/locker. Refer to NAVSHIPS Technical Manual, Chapter 533 (Potable Water Systems). Cartridges have a shelf life of two (2) years from the manufacturer’s date. (3) Potable Water Log. All monitoring of the potable water system will be documented in SAMS. Entries will include resolutions to any problems noted in the remark section. Non-SAMS equipped ships must maintain entries in Potable Water Log and/or Medical Department Journal. c. Marine Sanitation Device (MSD). The Master will ensure that all components of the MSD are routinely inspected. All personnel operating the system will be trained in the health and safety aspects of operating the MSD. Proper protective equipment and clothing will be maintained for routine work or for use during an emergency sewage spill. (1) Hygienic Procedures. The following hygienic procedures are applicable to all shipboard MSDs. (a) Hose Handling. Personnel disconnecting or connecting sewage transfer hoses will not subsequently handle potable water hoses without a thorough wash-up (hands, lower arms and face in that order) with hot soap and water. 6- 16 COMSCINST 6000.1D 11 October 2006 (b) Protective Clothing. Personnel connecting or disconnecting sewage hoses will wear rubber gloves, rubber boots, faceshield and coveralls. (c) Food/Drink in MSD Spaces. Eating, drinking or smoking is prohibited in all MSD spaces and while handling any component of the MSD system. (d) Warnings. Health warning placards will be posted at the entry to all MSD spaces identifying safety procedures, location of spill cleanup kits, and prohibition on eating, drinking and smoking. (e) Labeling. MSD valve handles and operating levers must be color-coded gold in accordance with GENSPECS 593 (Color Number 17043). (f) Maintenance. All MSD systems will be maintained in compliance with Chapter 7 of NAVMED P-5010 and the manufacturer's instructions. The MSO will incorporate inspection of MSDs into the habitability inspection. (g) Leak or Spill Clean-up Procedures. In the event spaces become contaminated with sewage as a result of leaks, spills or sewage system backflow, the space will immediately be evacuated and the Master, First Mate and MSO will be notified. The area will be isolated and disinfected in compliance with NAVMED P-5010. (h) Emergency Escape Breathing Devices (EEBDs). Two EEBDs will be mounted in CHT pump rooms and MSD work areas. (2) Contaminated Bilges. If a potable water tank forms the deck or any boundary of the bilge contaminated with sewage, daily bacteriological monitoring of the water from the tank will be conducted until such a time that the likelihood of contamination of the water tank is negligible. (3) Contaminated Potable Water Tanks. If any portion of the potable water system is suspected of being contaminated, the system will be secured, cleaned and disinfected in compliance with Chapter 6 of NAVMED P-5010. (4) Gas Free Engineering for MSD Systems. Compliance with COMSCINST 5100.17 series, chapter 593 of NSTM 59086-T8-STM-010/CH593R4 Pollution Control Gas Free Engineering and OPNAVINST 5100.19 series is required prior to entering or breaching any component of a sewage disposal system for repair or inspection. 6- 17 COMSCINST 6000.1D 11 October 2006 6.6 QUARANTINE AND SOLID WASTE DISPOSAL a. Quarantine. U.S. Government ships including MSC ships have the full panoply of rights of sovereign immunity. They will meet the quarantine requirements published by proper authority of individual countries. However, they will not be subject to search or inspections by officials of those countries for any reason. Masters may certify compliance with quarantine regulations and restrictions to foreign health officials. Chapter 22 of NAVMED P117 and SECNAVINST 6210.2 series detail quarantine regulations. The Master will prohibit interchange with port areas or with other ships until consultation with local health authorities when: (1) Quarantinable conditions exist aboard the ship. (2) Arriving from a quarantined port. (3) Doubt exists regarding the health conditions of the port or area. b. Certificate of Compliance. At the discretion of the Master, foreign health officials may be welcomed aboard to receive a quarantine declaration or certificate of compliance. The foreign host may require a description of measures taken by ship's company to insure compliance with local health regulations. In some countries, a declaration of certain infectious diseases (see SECNAVINST 6210.2 series) known to be aboard, including HIV is required. If a mariner is known to be HIV positive, only a declaration of the disease will be given and no further information. The infected person/s or entire crew may be quarantined aboard ship for the duration of the port visit if mandated by foreign health authorities. c. U.S. Quarantine Declaration. Public health quarantine procedures are required for ships that, in the last 15 days prior to arrival into the U.S. ports, Territories or Commonwealths or departure from the last U.S. port, Territories or Commonwealths (whichever is shorter) have or have had any crewmembers aboard with the following illnesses: (1) Persistent fever of 100 degrees F. (38 C.) or above for more than 48 hours with a rash, glandular swelling or jaundice. 6- 18 COMSCINST 6000.1D 11 October 2006 (2) Diarrhea, defined as three loose stools in a 24-hour period or as a greater than normal stool frequency for that person. (3) Death due to illness other than battle or physical injuries. (4) When one or more of the these conditions exist, the Master will send a priority message or electronic mail detailing the conditions present, between 12 - 72 hours prior to arrival in port, to the senior naval officer in command of the port or local port authority. Copies will be sent to the cognizant preventive medicine authorities. A reply confirming receipt of the message will contain quarantine procedures if required. Otherwise, the ship may proceed directly to berth and resume normal business. This quarantine procedure does not exempt the ship from subsequent health inspections deemed necessary by U.S. port and health officials. d. Deratting Certificate or Deratting Exemption Certificate. Required for all ships before entering most foreign ports or returning to CONUS, U.S. Territories or Commonwealths after visiting foreign ports. SECNAVINST 6210.2 series, BUMEDINST. 6250.14 series and Article 22-37 of NAVMED P-117 detail requirements. Masters and MSO/MDR will ensure renewal of certificates prior to their expiration. Assistance may be requested from the area NEPMU, MSC Medical Office MSFSC HQ/Pacific or Navy MTF Preventive Medicine Services having a USPHS Deratting Exemption Certificate seal. e. Rat Guards. Per BUMEDINST 6250.14 series, all ships are required at least 36 inches in diameter (cone type) on all shore service and mooring lines, weather inport CONUS or overseas. MSC ships will follow these requirements. (1) Rat guards must be affixed to service lines at least 6 feet from the pier or any "potential jumping" surface. Care must be taken to leave no opening between the rat Guard and service lines. f. Disposal of Meat, Fish and Produce from Foreign Countries. Masters will comply with SECNAVINST 6210.2 series, OPNAVINST 5090.1 series, COMSCINST 5090.1 series and U.S. Department of Agriculture (USDA) regulations prohibiting the importation of plant or animal products into the United States, its territories and commonwealths. 6- 19 COMSCINST 6000.1D 11 October 2006 (1) Notification. Upon arrival in CONUS, U.S. Territories or commonwealth, the Master will notify the U.S. Department of Agriculture Quarantine Inspection Division (AQI) of purchases of foreign produced foodstuffs and ensure proper quarantine and disposal procedures are observed. (2) Action. Foreign subsistence is subject to quarantine procedures by the USDA for all MSC ships entering U.S. ports. Masters will ensure the following quarantine procedures are strictly adhered to on all MSC ships. (a) Make all efforts to consume all foreign subsistence before entering U.S. ports. (b) Properly dispose of all garbage produced by both U.S. and foreign subsistence in accordance with SECNAVINST 6210.2 series, OPNAVINST 5090.1 series and COMSCINST 5090.1 series. (c) Ensure foreign subsistence not consumed is kept in its original containers or placed in double bags and segregated from U.S. subsistence. (d) Double bag all garbage produced by foreign subsistence or that which may be mixed with U.S. procured subsistence. (e) Seek USDA guidance for the final disposition of foreign subsistence/garbage. (f) Notify the cognizant Area Commander via message with description and volume of the subsistence disposed. (g) Maintain accurate accounts of foreign subsistence from purchase to final disposal for review of USDA inspectors. g. Shipboard Disposal of Medical Waste. The MSO/MDR is responsible for ensuring that shipboard medical wastes are handled and disposed of in compliance with OPNAV P-45-113-3-99, COMSCINST 5090.1 series and the MSC Environmental Policy Handbook. h. Plastic Medical Waste. All potentially contaminated plastics used in direct patient care will be segregated and stored for proper disposal ashore per COMSCINST 5090.1 series. 6- 20 COMSCINST 6000.1D 11 October 2006 6.7 OCCUPATIONAL HEALTH a. General. The selection of MSC personnel for medical surveillance examinations is primarily based on the results of Industrial Hygiene Surveys (IHS) or history of past exposure to hazardous materials (such as asbestos). Due to USNS manning complexities, some administrative programs may be tailored to the needs of CIVMARs and MSC ships. Additional guidance is contained in the Medical PCMatrix, OPNAVINST 5100.19 series and BUMED directives. b. Heat Stress Surveillance. Heat Stress Surveillance will be conducted IAW OPNAVINST. 5100.19 series, NAVMED P-5010-3 and COMSCINST 5100.17 series. Heat Stress Surveys and Reports will be documented in SAMS. c. MSC Medical Surveillance Program Physical by Rating (Job Description). This tool, Appendix K, is a concise “cook book” of all MSPs required by MSC by job description with periodicity of exams. As mariners gains occupational exposure history with MSC, other MSPs from this list may be required in addition to those listed for his or her present job requirements. d. MSC Specific Medical Surveillance Programs. The Medical Surveillance Programs are based on IHS data from MSC and U.S.Navy fleet units. The MSPs may be modified or discontinued only after analysis of new IHS data and concurrence of the MSC Fleet Surgeon and MSFSC Force Medical Officers. MSP exam criteria in the CD version of PC Matrix may be installed at shoreside MSC Medical facilities only. All MSC personnel will utilize the appropriate Personal Protective Equipment (PPE) as described in the Industrial Hygiene Survey. Job specific Medical Surveillance Exams for civilians are provided in Appendix L. The frequency and contest of Surveillance Exams is published in the NEHC-TM OM 6260, Medical Surveillance Procedures Manual and Medical Matrix. 6.8 MEDICAL READINESS PROGRAMS, SURVEILLANCE AND ASSESSMENT a. Shipboard Medical Inspections Program. Will insure the highest state of readiness by providing comprehensive and standardized medical evaluations throughout the MSC Fleet. Inspectors will receive standardized formal training in the disciplines they evaluate and maintain the highest level of practical knowledge through competency evaluation. (1) The Shipboard Medical Inspections Program is consolidated under the Fleet Surgeon at MSC Headquarters (HQ). The COMSC Environmental Health Officer is “Senior Inspector” and 6- 21 COMSCINST 6000.1D 11 October 2006 works in concert with Medical Afloat Programs Manager (COMSC Fleet Corpsman). The MSC Headquarters Medical Office will have overall program responsibility and oversight. The Senior Inspector will develop policy and provide guidance for the COMSC Medical Readiness Inspection Program. MSFSC HQ Force Medical Officer is delegated oversight responsibilities for the “government-owned, government-operated” (GOGO) ships. (a) The MSC Medical Afloat Programs Manager has operational responsibility for all Shipboard Medical Inspections and is responsible to the Senior Inspector for program elements. The Medical Inspections Branch is co-located in Norfolk, Virginia with MSFSC HQ Medical Office, and also at SSU Guam, Marianas Islands with the Medical Office, Pacific. Shipboard Inspectors are in the direct chain of command under their cognizant MSC Force Medical Officer for all other military administrative and professional responsibilities. Inspectors are located in Norfolk and forward deployed to the Far East/Western Pacific AORs to insure mission accomplishment. (b) The Composite Medical Readiness Inspection Group will: 1. Plan, schedule and execute all TAV/MRIs and other medical evaluations. 2. Provide QA oversight of the program 3. Insure required training and competencies for inspectors are current 4. Collect data from MRIs and other medical inspections as directed 5. Forward required data to the Senior Inspector for analysis as directed 6. a timely manner 7. 8. 9. Master and MSO/MDR Grade all MRIs as: C1 through C4 Brief Masters and MSO/MDR’s of MRI results Provide a working copy of the MRI to the Prioritize and follow-up all discrepancies in 6- 22 COMSCINST 6000.1D 11 October 2006 Provide liaison with other MSC, military or 10. civilian medical facilities (c) The Shipboard Inspections Branch will forward the official TAV/MRI cover letter and MRI report for review and signature by COMSC Fleet Surgeon within 10 working days of the MRI. Headquarters will forward the official MRI to the ship's master with copies to Shipboard Inspections Branch, Norfolk and cognizant MSC Force Medical Office. Additional copies will be forwarded to: 1. Officer b. Medical Readiness Inspection (MRI). The MRI covers medical administration, supply, patient care, facilities, controlled narcotics inventory, potable water surveillance, food service safety, marine sanitation devices, vector control, infectious disease control, hearing conservation, heat stress, occupational health, industrial hygiene, workplace monitoring and medical training. The MRI Checklist is attached as Appendix N of this manual. (1) The MRI will be conducted every 18 months as a minimum. It may be requested in part or in whole as: (a) An external audit or contract turnover by the contractor (b) Quality Assurance (QA) Review by the Master, MSO or Program Manager (c) Pre-deployment assist (2) Only qualified Active Duty Independent Duty Hospital Corpsman (IDC/8425) and Preventive Medicine Technician (PMT/8432) will conduct MRIs/TAVs. c. Technical Assist Visit (TAV). May be conducted when specifically requested by the ship’s Master or MSO/MDR. The MRI form, Appendix M of this manual will be used to conduct the TAV. The Medical Inspections Branch, Norfolk, Virginia, will coordinate all TAVs. TAVs will be not be graded and may be requested in part or whole as: (1) Assist prior to a scheduled MRI. Request should be made +180 days prior and can be upgraded to a MRI. Cognizant Program Manager and/or Contract 6- 23 COMSCINST 6000.1D 11 October 2006 (2) An emergency assist (e.g. an infectious disease outbreak). (3) A specific assist in any medical department areas of responsibility. This is in effect for all T-ATF/T-ARS class ships where a TAV is conducted every 6-8 months to assist the MDR aboard. (4) As directed by the Fleet Surgeon d. MRI Grading Capable (1) C-1: Fully Ready (No unsatisfactory sections. of performing effective in all areas.) (2) C-2: Substantially Ready (No more than one unsatisfactory section. Deficiencies exist which reduce effectiveness but do not cause loss in any one-mission area.) (3) C-3: Marginally Ready (No more than two unsatisfactory sections. Significant deficiencies exist which reduce mission effectiveness.) (4) C-4: Not Ready: (Three or more unsatisfactory sections. Major discrepancies exist that cause a loss to the medical mission capability of the ship.) NOTE: The above MRI/TAV grading is preliminary until final approval by the MSC Fleet Surgeon. The Inspector may assign a C-4 if one critical discrepancy may seriously degrade the ship’s mission, or assign a higher grade than indicated in the guideline due to mitigating circumstances. The Inspector will clearly document reasons for assigning the final grade in the official MRI cover letter and the remarks section of the MRI checklist. (5) Interim Status Report (ISR). An ISR will be submitted to the cognizant MSC Medical Office and COMSC Fleet Surgeon every 30 days until discrepant items have been corrected. e. Medical Ship Material & Readiness Team (SMART). CFR 46, CFR 32-700.321, OPNAVINST 4730.5 series and INSURVINST 1552.1 series are policy instructions for the Board of Inspection and Survey (INSURV). Assisted by other such officers and sub-boards designated by SECNAV, such as SMART, INSURV shall conduct acceptance trials and underway material inspections (UMIs) on 6- 24 COMSCINST 6000.1D 11 October 2006 Naval vessels for acceptance into the Naval service or to determine ships' material condition for further service. (1) COMSC N7 has cognizance over the MSC SMART Program and will conduct (UMIs) on CIVMAR manned MSC ships IAW a MOU with PRESEINSURV. The MSC SMART is a sub-board of and is answerable to the Congress through INSURV. (2) SMART Medical Inspector's qualifications will mirror the Navy's INSURV Program. The preferred experience level for Medical Inspector will be a LCDR 2300 MSC Officer, NOBC 1860E (Surface Warfare Qualified) with previous experience with shipboard Environmental Health Inspections or 1861P (Surface Warfare Medical Department Officer qualified) with previous shipboard and/or Fleet TYCOM/FLEET experience as a Safety Officer. Additionally, the Medical Inspector will be qualified as proficient by the Navy's INSURV board and have comprehensive understanding of the program elements of the Medical SMART. (3) SMART Medical Checklist elements are taken from GENSPECS for T-Ships, NAVMED-P-5010, NAVMED P-117 and other pertinent Navy and USPHS material requirements. The COMSC Fleet Medical Environmental Health Officer will be responsible for writing, maintaining and updating checklists based on current Navy and USPHS standards. f. Environmental Health Assessment (EHA). An EHA is a comprehensive evaluation of Shipboard Preventive Medicine and Occupational Health Programs. The assessment identifies potential health risks and program deficiencies, recommends corrective action, and provides on-site assistance and additional training. The EHA is not mandatory but is highly recommended for preventive medicine program evaluation or pre-deployment preparation. The MSO can request an EHA from the local NEPMU. Assessment results will only be forwarded to the ship requesting assistance. g. Industrial Hygiene Surveys (IHS). OPNAVINST 5100.19 series requires all US Navy ships, including MSC ships to undergo a comprehensive industrial hygiene survey every 2 years. The survey will be performed by an Industrial Hygienist (IH). h. Scheduling (1) Industrial Hygiene Surveys. The Medical Office, MSFSC HQ/Pacific and Program Managers will insure that all ships under their cognizance have a Baseline IHS and coordinate the scheduling of required IHS as needed. The survey should be scheduled well in 6- 25 COMSCINST 6000.1D 11 October 2006 advance and coordinated with the local MTF or NEPMU and Program Manager. The IHS is the basis for MSCs' Occupational Health and Physical Exam Program. (2) Reports and Actions. IHS results and EHAs will be retained aboard ship for review during MSC MRI and SMART Inspections. MSFSC Medical Office (Shipboard Inspections Branch) will maintain a copy of all MRIs, SMART, QAI, TAVs and the IHS. The Shipboard Inspections Branch will insure that the Force Medical Officers, MSFSC HQ/Pacific are provided a copy of any shipboard inspections on ships under their operational command. The Shipboard Medical Inspections Branch, in coordination with the MSC Fleet Surgeon will initiate a plan of action to insure timely follow-up and corrective action is taken. 6- 26 COMSCINST 6000.1D 11 October 2006 CHAPTER 7 AFLOAT QUALITY IMPROVEMENT PROGRAM 7.1 GENERAL a. The purpose of this program is to provide professional review of health care in order to improve the quality of care. It is not meant to punitive in nature, it offers an ideal teaching situation and will be used by both the provider and supervising physician in this spirit. Health care delivery must be reviewed when performed in an independent setting. The Force Medical Officers will perform these reviews and ensure that these reviews are accomplished on time and documented. b. It is the Department of the Navy (DON) policy that all healthcare providers assigned to operational forces participate in an ongoing monitoring and evaluation to identify and resolve problems which impact directly or indirectly on patient care. (1) Medical Services Officer (MSO) Quality Assurance Program. In compliance with OPNAVINST 6320.7, the health care provided for all beneficiaries in MSC afloat medical facilities will be of the highest quality possible. (2) Certification of Health Care Providers. Certification is based on the OPNAVINST 6400.1 series and Quality Assurance Program that reviews MSO/MDR individual training, experience, relevant knowledge and skills as well as treatment modality and outcome. The MSO will be held to the standard of care based on current standard of practice for non-physician health care providers equivalent to the U.S. Navy Independent Duty Corpsman. 7.2 RESPONSIBILITIES a. Fleet Surgeon. The Fleet Surgeon will ensure that a Medical Quality Assurance Program is in place and is effective in its concept and function in all MSC afloat and ashore activities. COMSC Fleet Surgeon and will develop policy based on standards established by COMSC, BUMED and other higher authority. 1. Initial certification for contract MSOs onboard contract-operated PM2 Special Mission ships will be the responsibility of the MSC Fleet Surgeon and will adhere to the requirements of this instruction and the hiring provisions of the current operating contract. The company awarded the operating 7- 1 COMSCINST 6000.1D 11 October 2006 contract or sponsoring agency is responsible for maintaining a quality assistance program for the CMSOs. b. Force Medical Officers, Military Sealift Fleet Support Command (MSFSC) HQ/Pacific. The Force Medical Officers will, through an active Medical Quality Assurance Program, perform ongoing monitoring and evaluation to identify and resolve problems that impact directly or indirectly on patient care. (1) Certification of Medical Services Officers (MSO). The initial certification of MSOs will be the responsibility of the Force Medical Officer, MSFSC HQ. Subsequent required semi-annual medical QA review and recertification will be the responsibility of the cognizant Force Medical Officer supporting the area of operation to which MSO is assigned. (2) Monitoring and Supervision of Clinical Care Delivery. The cognizant Force Medical Officer will monitor and provide supervision for clinical care delivered by MSOs. (3) QA Evaluations. The cognizant Force Medical Officer will conduct comprehensive evaluation of quality, appropriateness and documentation of medical care provided by the MSO shipboard semi-annually. Review will include, but not be limited to, clinical performance in routine and emergency situations, medical record review, medical administration and environmental health programs (see Appendix M - Quality Improvement Review Screening Matrix). (4) Certification File. A certification file will be maintained for each MSO by the Force Medical Officer MSFSC HQ and will contain MSO medical training and CME completion documentation, copies of MSC Officer Evaluations, and QA Review documentation. The certification file should be reviewed by the cognizant Force Medical Officer at least annually at the time of recertification. This file is confidential and is not to be maintained with personnel files. (5) Improper or Substandard Medical Care. The cognizant Force Medical Officer will ensure timely and proper review of all allegations of improper or substandard medical care, therapeutic misadventures, and poor outcome of care where life or limb of the patient was at risk. When investigated and identified as an actual violation of standard of practice, the cognizant Force Medical Officer will document the findings and institute appropriate corrective or disciplinary action in concert with MSFSC N-1. 7- 2 COMSCINST 6000.1D 11 October 2006 (6) Decertification Action. The cognizant Force Medical Officer may decertify a MSO from clinical practice for failure to meet minimum accepted standards of practice. The Force Medical Officer will notify the MSO in writing of such decertification and the basis for the decision. The Force Medical Officer, MSFSC HQ will notify the MSC Fleet Surgeon by phone or email of the decertification. A copy of the decertification action will be forwarded to the COMSC Fleet Surgeon within 14 business days. (a) Appeal of Decertification Action. The MSO may appeal in writing directly to the COMSC Fleet Surgeon. The MSO will be relieved from duties during the course of the appeal and transferred to the area MSFSC Mariner Pool. The Fleet Surgeon’s decision will be based on all available information. The appeal response will be provided in writing to the MSO via the MSFSC within 30 days. The decision of the COMSC Fleet Surgeon is final. (b) Non-Clinical Performance. All instances of poor non-clinical performance or other disciplinary incidents will be administered under applicable Civilian Mariner Personnel Instructions or Civil Service Policies. c. Medical Services Officer (MSO). Individual MSOs will participate in an ongoing Quality Improvement Program. NOTE: This section applies to Medical Department Representatives (MDR) hired for employment onboard by Special Mission Program ships (PM2) operated by shipping line companies. (1) Maintain Training, Certification and Licensing. The MSO will maintain the training, certification, licensing and continuing medical education (CME) requirements applicable to his/her level of professional training. (a) The Force Medical Officer, MSFSC HQ, will be the custodian of all training, certification and licensing for Civil Service MSOs (Not applicable to PM2 contract MSOs). (b) The MSO will ensure certifications records held by the Force Medical Officer, MSFSC HQ are current and complete by forwarding all documentation of required training and continuing medical education for inclusion to the appropriate in the certification file (Not applicable to PM2 MDRs). (c) Maintain Medical Records and Medical 7- 3 COMSCINST 6000.1D 11 October 2006 Administrative Files. The MSO will maintain all medical records and medical administrative files, including SAMS and other computer files and systems, in a high state of readiness and available for review. 7.3 REQUIREMENTS a. Hiring. Only highly qualified personnel with medical experience and training in the maritime industry and/or isolated medicine will be considered for employment by MSC for the position of Medical Services Officer. b. Scope of Employment. The scope of employment mirrors the requirements for U.S. Navy Independent Duty Corpsman (IDC), both Surface and Submarine, or their equivalents (as determined by the COMSC Fleet Surgeon). Individuals possessing licensure, credentials or qualifications above this level are limited to the scope of practice of an IDC. (1) Applications. The applicants for the position of MSO will complete the normal application for CIVMAR employment and ensure that all appropriate military and medical professional documentation is attached for review and consideration. The MSFSC HQ Force Medical Officer or designated representative will advise the Personnel Officer on the suitability of applicant for employment. (2) MSO Professional Qualifications. The following professional qualifications are minimum requirements for employment as MSO. NOTE: This section also applies to Contract Medical Services Officers hired for employment onboard by Special Mission Program ships (PM23) operated by shipping line companies. (a) Former Independent Duty Hospital Corpsman. Applicant must be either a retired or former Independent Duty Hospital Corpsman in good standing, or military equivalent, and hold a valid USCG Certificate of Registry. Shipboard or emergency medical experience within the last three years is desirable. Submission of DD214 is required as proof of prior NEC 8425/8406 designation is required. (b) Physician Assistant. Applicant must hold, or have held in good standing, a valid license as a Physician's Assistant by a state, territory or commonwealth of the United States or the 7- 4 COMSCINST 6000.1D 11 October 2006 District of Columbia or certificate from the National Commission on Certification of Physician Assistants and hold a valid USCG Certificate of Registry as a Physician Assistant. Shipboard emergency medicine, or primary care experience within the last three years is desirable. (c) Registered Nurse. Applicant must hold a valid current license as a Registered Nurse issued by a state, territory or commonwealth of the United States or the District of Columbia and hold a valid USCG Certificate of Registry as a Registered Nurse. Shipboard or emergency medicine, or primary care experience within the last three years is desirable. (d) Medical Department Representative (MDR). When the size of the ship, its crew or the operating environment or tempo are not sufficient to justify the assignment of an MSO, MSFSC or the ship Operating Company will assign a licensed officer, trained to the STCW-PIC standards. 7- 5 COMSCINST 6000.1D 11 October 2006 CHAPTER 8 SHIPBOARD NON-TACTICAL ADP PROGRAM (SNAP) AUTOMATED MEDICAL SYSTEM (SAMS) 8.1 GENERAL a. SNAP Automated Medical System (SAMS) is an automated data processing (ADP) system designed to minimize the administrative burden for Navy Medical Departments. Description of each module is contained in the SAMS User Guide. Installation of version 7.06 (Y2K compliant) or higher is required. SAMS is divided into the following modules: (1) Master Tickler: Contains patient demographic data. Contains data directly related to (2) Medical Encounters: patient care. (3) Radiation Health: Radiation Health Program. Contains data related to the (4) Occupational/Environmental Health: Contains data related to occupational and environmental issues. (5) Supply Management: of medical supplies. Contains data related to management (6) Training Management: Contains data related to management of training for all ships/units. (7) Schedule Management: information. Contains time management (8) Systems Management. Contains information related to the setup of, and access to, the system. b. All MSC (including T-ATF/T-ARS class and PM2 operated) ships with Medical Service Officers assigned are required to have SAMS installed onboard. Additionally, the MSOs are required to complete SAMS training. 8.2 SAMS SUPPORT a. Medical departments are required to back up SAMS on a daily basis. A minimum of five sets of backup disks is required at all SAMS sites. For SAMS sites on a LAN, a local medical 8- 1 COMSCINST 6000.1D 11 October 2006 department server daily backup is still required in addition to the LAN administrator’s backup. When problems arise which cannot be locally corrected, proceed as follows: b. Recheck all hardware connections. c. Print out any error reports for review with SAMS technical support staff. d. Contact SAMS technical support staff by one of the methods outlined below. (1) MSC East units: SPAWAR System Center, Chesapeake, VA (a) By E-mail: samseast@scn.spawar.navy.mil (b) By phone: COMM: (757) 443-0741 DSN: 646-0741 (c) By message: (2) MSC West units: (a) By E-mail: SPAWARSYSCEN CHESAPEAKE VA//94// SPAWAR System Center DET San Diego samswest@scn.spawar.navy.mil (b) By phone: COMM: (619) 556-7714/9092 DSN: 526-7714/9092 (c) By message: SPAWARSYSCEN CHESAPEAKE DET SAN DIEGO CA//623// 8.3 SYSTEM SECURITY a. The MSO acts as the SAMS Manager. All users must be entered into the system using the Systems Management module. Use is password protected and each user should be granted access only to those modules necessary for completion of assigned tasks. Passwords are not to be shared with anyone. When not in use or unattended, workstations should be logged off to avoid unauthorized access to information. The system manager’s password will be provided to the ship’s CMS/Security Manager for emergency use. 8.4 ADP EQUIPMENT a. All ADP equipment will be Information Technology for the Twenty First Century (IT-21) complaint. Hardware replacement or 8- 2 COMSCINST 6000.1D 11 October 2006 upgrade will be the ships responsibility and will be listed on the ship’s ADP inventory. 8- 3 COMSCINST 6000.1D 11 October 2006 APPENDIX A Glossary Action Level - One-half the concentration of chemicals in air allowed by Navy Occupational Health Standards. Afloat Medical Programs Manager – The duties and functions of the Afloat Medical Programs Manager are assigned to the Fleet Corpsman. Assistance Visit - Visits made at the request of the Master or Medical Services Officer (MSO) and conducted to provide assistance to Medical Department personnel in any and all Medical Department functions. Authorized Minimal Medical Allowance List (AMMAL) - Minimum requirements for specific ships by name, class or structural design. AMMALS include consumable medical supplies, durable medical equipment and emergency medical supplies. Certification - The process by which the credentials of prospective healthcare providers are reviewed by a Certification Board for appropriate training, experience, relevant knowledge, and skills to ensure the provision of quality and appropriate care to patients. • Interim Certification - Granted by the MTF or Type Commander as a temporary authorization to provide care until Initial Certification. Initial Certification - Granted by the Certification Board after review of all documentation submitted by employee or applicant. Recertification - Consideration by the Certification Board of updated documentation submitted since Initial Certification adding considerations for QA monitoring and continuing education. Accomplished no less often than every 3 years. • • Certification Board - The non-physician healthcare provider certification authority for MSC. The Board consists of the COMSC Special Assistant N00M/Fleet Surgeon and the MSFSC HQ/Pacific Force Medical Officers. A- 1 COMSCINST 6000.1D 11 October 2006 Controlled Substances - Narcotics, alcohol, barbiturates, tranquilizers and other items requiring special custodial care. These items are designated by the symbols "C," "Q" or "R" in the Notes column of the Identification Lists in the Federal Supply Catalog. Controlled Substances require special storage, security and accounting procedures due to their potential for abuse. Force Medical Officer – Active duty Navy Physicians assigned to MSFSC HQ (located in Norfolk) and Pacific (located in Guam). General Military Training (GMT) - GMT requirements are imposed to support operational readiness by developing individual capability to preserve and maintain health. GMT courses include basic first aid, safety and environmental health. Independent Duty Corpsman (IDC) - A Navy Hospital Corpsman, in paygrades E-6 through E-9, who has successfully completed an advanced Hospital Corps "C" School or sanctioned equivalent training (listed in the CANTRAC) for the NEC. They are trained to perform duties independent of a Medical Officer. The following designations are considered IDCs: • • • • • Submarine Force IDC (HM-8402) Special Amphibious Reconnaissance IDC (HM-8403/5345) Surface Force IDC (HM-8424/8425) Special Operations IDC (HM-8491) Deep Sea Diving IDC (HM-8494) The following are considered equivalent to an IDC: • • USA Field Medical Specialist (MOS 91B30) USCG Health Services Technician (with a 2D designator) Inspection Personnel – These personnel are responsible for ensuring that the health of embarked personnel is not jeopardized by poor safety, habitability, environmental health or industrial hygiene conditions. These personnel must be fully trained and qualified to inspect all functions addressed by the medical inspection checklists (i.e., medical, clinical, Navy Occupational Safety and Health (NAVOSH), environmental health and habitability). Medical Advisory Service - In cases in which a physician may not be available for immediate referral, advice may be received from nearby military Medical Officers, Force Medical Officers or from a contractor service specializing in emergency care. A- 2 COMSCINST 6000.1D 11 October 2006 Medical Event Reports (MERs) – MERs report selected diseases, injuries, and outbreaks which affect operational readiness; present hazards to the military or civilian community; are internationally quarantinable; are unusual in presentation, clinical course, outbreak potential, treatment; or may generate inquiries to the Chief, Bureau of Medicine and Surgery(BUMED) or higher authority. Medical Service Officer (MSO) - The MSO has the basic responsibilities of a Navy Independent Duty Hospital Corpsman, but may be educated at different professional levels (e.g., Physician's Assistant, Registered Nurse or Independent Duty Hospital Corpsman). The MSO’s mission is to advise the Master in all areas affecting the health of embarked personnel, in medical administration, in monitoring environmental health and industrial hygiene, in medical readiness of the ship, and to provide acute and/or emergent medical care to mariners when necessary. Medical Waste – Waste that may be categorized as "potentially infectious waste" if it contains pathogens that could cause disease in a susceptible host. If this harmful potential is not considered to be probable, medical waste is categorized as "other waste." Medical waste may be liquid, paper/cloth or disposable plastic, and must be disposed in accordance with federal, state and local guidelines. MSC Physician Supervisor: Force Medical Officers, MSFSC HQ/ Pacific, as clinical supervisor for MSOs. Morbidity and Mortality Weekly Report (MMWR) – A weekly report published by the Centers for Disease Control (CDC) that contains data on specific diseases as reported by state and territorial health departments and reports on infectious and chronic diseases, environmental hazards, natural or human-generated disasters, occupational diseases and injuries, and intentional and unintentional injuries. Also included are reports on topics of international interest and notices of events of interest to the public health community. Permissible Exposure Limit (PEL) - The concentration of chemicals in air allowed by Navy occupational health standards and are generally the same as specified in 29 CFR 1910. Primary Care - An approach to patient care which emphasizes first contact health assessment, health maintenance and treatment. A- 3 COMSCINST 6000.1D 11 October 2006 Privileging - The granting of authorization by the Fleet Surgeon and Force Medical Officers to a healthcare provider to perform certain duties and procedures. Quality Improvement Program – The program that addresses the commitment to quality medical care for all COMSC employees. Quarantine - Applies to vessels in which doubt exists regarding the sanitary or health conditions existing onboard. Ships under quarantine are not allowed entrance to port areas until the Master has consulted the appropriate health authorities. Repatriation, Medical - The act of removing a CIVMAR from assigned duties aboard ship due to a medical condition which precludes successful performance of required duties. Seaman’s Health Improvement Program (SHIP) - A set of standards, developed by a MARAD sponsored committee and based on an IMO/ILO/WHO Convention, for pre-employment physical examinations and crewmember medical training. SHIP standards are available for all career fields within the maritime industry. Scope of Care - The medical procedures an MSO is qualified to practice by virtue of documented training, certification and observance. Shipboard Non-Tactical ADP Program (SNAP) Automated Medical System (SAMS) - An automated medical administrative management system designed to address the requirements of shipboard Medical Departments. Included in SAMS are features for the management of health care, administration functions, monitoring functions, medical supplies and health protection programs. Special Assistant/N00M - Special Assistant for Medical, Environmental Protection, Safety and Occupational Health (COMSC N00M is the COMSC Fleet Surgeon). ACRONYMS ACDUTRA AFMIC AOR AL APF ADAL AMMAL BUMED Active Duty for Training Armed Forces Medical Intelligence Center Area of Responsibility Action Level Afloat Prepositioning Force Authorized Dental Allowance List Authorized Minimal Medical Allowance List Bureau of Medicine and Surgery, U.S. Navy A- 4 COMSCINST 6000.1D 11 October 2006 CBR CBRNE CHT CINC CIVMAR CME COMSC COMSFSC CONMAR CQI DAR DBOF DC DOD DOL DON EHS FF GMT IHS ILO INSURV IMO IOL ITP MANMED MARAD MDR MEDEVAC MER MMWR MOA MOS MOU MPSRON MSC MSCU MSD MSDS MSFSC MSO NAVMEDLOGCOM NAVMEDCOM Chemical, Biological and Radiological Chemical, Biological, Radiological, Nuclear and High Yield Explosives Collection/Holding Transfer Commander in Chief Civilian Mariner Continuing Medical Education Commander, Military Sealift Command Commander, Military Sealift Fleet Support Command Contract Mariner Contract Quality Assurance Inspection Disease Alert Report Defense Business Operating Funds Damage Control Department of Defense Department of Labor Department of the Navy Environmental Health Survey Fire Fighting General Military Training Industrial Hygiene Survey International Labor Organization The Board of Inspection and Survey International Maritime Organization Initial Outfitting List Individual Training Plan Manual of the Medical Department, P-117 Maritime Administration Medical Department Representative Medical Evacuation Medical Event Report Morbidity and Mortality Weekly Report Memorandum of Agreement Military Occupational Specialty Memorandum of Understanding Maritime Prepositioning Ship Squadron Military Sealift Command Military Sealift Command Unit Marine Sanitation Device Material Safety Data Sheets Military Sealift Fleet Support Command Medical Services Officer Naval Medical Logistics Command Naval Medical Command (previous name of BUMED, interchangeable with current BUMED instructions) A- 5 COMSCINST 6000.1D 11 October 2006 NAVOSH NCIS NCPI NCD NEC NEHC NEPMU NIF NIOSH NIS NMETC N00M NSF NSN NWCF OIC OMB OPTAR OSHA OWC PEL POE PPD PPNG QI ROC SAMS SHIP SMART SNAP SSIC SSU STD STO TST USCG WHO Navy Occupational Safety and Health Naval Criminal Investigative Service Navy Civilian Personnel Instruction Navy unique term for “Not Considered Disqualifying” Navy Enlisted Classification Code Navy Environmental Health Center Navy Environmental Preventive Medicine Unit Navy Industrial Funds (replaced by DBOF) National Institute for Occupational Safety and Health Not in stock Navy Medical Education and Training Command Fleet Surgeon; Special Assistant to COMSC Naval Support Facility National Stock Number Navy Working Capital Fund Officer in Charge Office of Management and Budget Operating Target Occupational Safety and Health Administration Office of Worker Compensation Permissible Exposure Limit Projected Operational Environment Purified Protein Derivative Penicillinase - Producing Neisseria Gonorrhea Quality Improvement Required Operational Capability SNAP Automated Medical System Seafarers Health Improvement Program Shipboard Material Assessment Readiness Team Shipboard Non-Tactical ADP Program Standard Subject Identification Code Ship Support Unit Sexually Transmitted Disease Ship’s Training Officer Tuberculosis Skin Test United States Coast Guard World Health Organization A- 6 COMSCINST 6000.1D 11 October 2006 APPENDIX B Medical Training Requirements for First Officer/MDR 1. Background. The United States Coast Guard approved a curriculum to provide for the training of shipboard personnel in emergency medical care delivery aboard ship. This training program was developed in an effort to establish professional training standards for seafarers with responsibilities for shipboard first aid and advanced medical and practical skills. Medical care, medical aid and first aid requirements are contained in the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1995, (STCW Convention) of the International Maritime Organization (IMO). 2. Training Requirement. In reviewing the USCG recommended training, COMSC considered operational environments and other factors not normally associated with commercial operations. They determined that completing both STCW Standard of competence for seafarers designated to provide Medical First Aid Onboard Ship (MFACP) and seafarers designated to Take Charge of Medical Care Onboard Ship (MPIC) courses was an appropriate level of training for First Officers assigned as MDRs on MSC ships. This is roughly equivalent to an Advanced First Aid Course of 5 - 10 days duration. 3. Periodicity. Mariners assigned medical responsibilities will be provided an initial course of instruction and periodic updates at required intervals. Re-certification of the STCW MFACP and MPIC courses is required every 5 years. 4. Knowledge, Skills and Abilities. Tables I and II are taken from STCW 95 Table A-VI/4-1 and A-VI/4-2 training documents and describe medical functions to be performed and skills necessary for successful performance of medical duties. 5. Training Curriculum Development. Each training facility must submit a training plan to COMSC for approval prior to enrolling MSC mariners. The plan will be reviewed to ensure that all elements are sufficiently developed to provide the skills and abilities outlined in Table I and II. B- 1 COMSCINST 6000.1D 11 October 2006 TABLE I STCW Standard of Competence for Seafarers Designated To Provide Medical First Aid Onboard Ship (MFACP-Level 2) -Three Day CoursePREREQUISITE COURSE (EFA-Level 1) STCW Basic Safety Training Program Module (1 Day Course) First Aid Body Structure and Functions Toxicology hazards on board Examination of casualty or patient Spinal Injuries Burns, Scalds and effects of heat and cold Fractures, dislocations and muscle injuries Medical Care of rescued persons Radio medical advice Pharmacology Sterilization Cardiac Arrest, Drowning and Asphyxia Administrative Duties LEVEL 1 X X X X X X X 2 X X X X X X X X X X X X X X X = Required B- 2 COMSCINST 6000.1D 11 October 2006 TABLE II STCW Standard of Competence for Seafarers Designated To Take Charge of Medical Care Onboard Ship (MPIC-Level 3) -Five Day CoursePREREQUISITE COURSE (MFACP-Level 2) STCW Designated to Provide Medical First Aid Onboard Ship Provide Medical Care to the Sick and Injured while they remain on board including: Head and Spinal Injuries Neurological assessment Injuries of ear, nose, throat and eyes External and Internal bleeding Use of a Tourniquet Burns, Scalds and Frostbite Fractures, dislocations and muscular injuries Splinting and immobilization Wounds, wound healing and infection Techniques of suturing and clamping Management of acute abdominal conditions Minor surgical treatment Treating Abdominal evisceration and Sucking chest wound Dressing and bandaging General Nursing principles and care Medical conditions and emergencies Sexually Transmitted Diseases Tropical and infectious diseases Alcohol and drug abuse Dental Care Gynecology, pregnancy and childbirth Medical care of rescued persons Death at sea Hygiene Disease prevention, disinfestation and de-ratting Vaccinations IV Infusions Managing systemic pain Managing local pain External assistance including: Radio Medical advice Transportation of the ill and injured LEVEL 3 MDR X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X MSO X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X B- 3 COMSCINST 6000.1D 11 October 2006 LEVEL 3 MDR X X X X X MSO X X X X X ADMINISTRATIVE PROCEDURES Keeping records and copies of applicable regulations including: Maintaining Medical Records International and national maritime medical regulations SAMS data entry and tracking Helicopter evacuation Medical care of sick seafarers involving cooperation with port health authorities or outpatient wards in port. Heartsaver AED Instructor Certification CPR Instructor (AHA) Certification X = Required O = Optional X O O X STANDARDS FOR ASSIGNMENT OF MSOs TO MSC In order to practice as an MSO within MSC, the following additional courses must be successfully completed according to the schedule indicated below. *Safety Programs Afloat Course (5 days) *BCLS/AED Provider *BCLS/AED Instructor Communicable Disease for Deployed Forces Initially (As a New Hire) then Q-3 years Initially, then Q-2 years Initially, then Q-2 years Initially, then Q-3 years Hearing Conservation Afloat Heat Stress Afloat Shipboard Pest Management *M-PIC (Level 3 STCW) TB Control Program Viral Hepatitis Initially, Then Q-3 years Initially, Then Q-3 years Initially, Then Q-3 years Initially, then Q-5 years Initially, then Q-3 years Initially, then Q-3 years B- 4 COMSCINST 6000.1D 11 October 2006 *Water Sanitation Afloat *Navy Food Safety/SERVSAFE Instructor *Respiratory Manager Afloat *CBR-E Course *SAMS (2-day trainer) Dental Refresher (2-day) *Drug Coordinator *Q/A Review *CME's *Mandatory/Critical Initially, then Q-3 years Initially, then Q-5 years Initially, then Q-3 years Initially, then Q-3 years Initially, then Q-3 years Initially, then Q-3 years Initially, then Q-5 years Every 6 months 12 per calendar year B- 5 COMSCINST 6000.1D 11 October 2006 APPENDIX C REPORTS AND FORMS REPORTS SUBJECT Report of Tuberculosis Screening Repatriation/Hospitalization Report Medical Event Report Report of Death Report of Heat/Cold Injury REFERENCE FREQUENCY BUMEDINST 6224.8 COMSCINST 6000.1 BUMEDINST 6220.12 NAVMEDCOMINST 5360.1 NAVMED P-5010-3 Annual Situational Situational Situational Situational FORMS NUMBER CA 16 CA 17 DD 1149 MSC 6320/2 NAVCOMPT 2155 NAVMED 6120/1 SF 78 DD DD SF OF FORM 2807 FORM 2808 513 522 SUBJECT Authorization for Examination and/or Treatment Duty Status Report Requisition and Invoice/Shipping Document Refusal of Medical Care Form Requisition/OPTAR Log Competency for Duty Exam U.S. Civil Service Commission Certificate of Medical Examination Report of Medical History Report of Medical Examination Request for Consultation Request for Administration of Anesthesia and for Performance of Operation and Other Procedures (Consent Form) Chronological Record of Medical Care Adult Immunization Record Security Container Information Envelope International Certificate of Vaccination Competency for Duty Examination Toxilogical Specimen Form SF 600 NAVMED 6230/4 SF 700 PHS 731 NAVMED 6120/1 DD Form 1323 C- 1 COMSCINST 6000.1D 11 October 2006 APPENDIX D This appendix includes samples of routine correspondence, reports and forms used by the Medical Services Officer. Included in this appendix are the following: 1. 2. 3. 4. 5. 6. Turnover Report Controlled Substances Letters/Reports Bulk Stock Custodian Letter Working Stock Custodian Letter Controlled Substance Inventory Board Letter Controlled Substance Inventory Board (Senior Member) Letter Controlled Substance Inventory Report Narcotic Destruction Report AMMAL Change Recommendation Letter Repatriation Message Medical Record Screening Matrix Department Emergency Response Plan Refusal of Medical Care (MSC 6320/2) Six-Nine (6-9) Month Medication Supply Request Not Fit for Hire/Duty Letter Chronic Condition Acknowledgement 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. D- 1 COMSCINST 6000.1D 11 October 2006 SAMPLE BULK STOCK CUSTODIAN LETTER (Date) MEMORANDUM From: To: Subj: Master, USNS XENO Mr. J. J. Holton, Chief Mate APPOINTMENT AS BULK STOCK CUSTODIAN FOR CONTROLLED SUBSTANCES (a) NAVMED P-117, Manual of the Medical Department, Chapter 21 (b) COMSCINST 6000.1 series Ref: 1. You are appointed as Bulk Stock Custodian for controlled substances for the duration of your assignment to this ship or until relieved of these duties in writing. 2. You shall read and become familiar with the parts of references (a) and (b) which concern your duties as Bulk Custodian. 3. You shall maintain the necessary accounting records and documents, as set forth in the references, to show the proper receipt and expenditure of items in your custody. 4. You shall ensure that the proper security is maintained for items in your custody and change the combination of the safe containing the bulk stock items in accordance with existing regulations. You shall ensure that an OPNAV 5511/2 (Combination Change Envelope) has been placed in the custody of the Master or his designee. 5. The Controlled Substances Inventory Board will conduct quarterly inventories of all controlled substances in your custody if no transactions have occurred. If transactions have occurred, the inventory will be required on a monthly basis. 6. You will report directly to the Master in the performance of the above duties. ____________________________ (Signature of Master) D- 2 COMSCINST 6000.1D 11 October 2006 SAMPLE WORKING STOCK CUSTODIAN LETTER (Date) MEMORANDUM From: To: Subj: Master, USNS VIRTUAL Mr. James G. Smith, Medical Services Officer APPOINTMENT AS WORKING STOCK CUSTODIAN FOR CONTROLLED SUBSTANCES (a) NAVMED P-117, Manual of the Medical Department, Chapter 21 (b) COMSCINST 6000.1 series Ref: 1. You are appointed as Working Stock Custodian for controlled substances for the duration of your assignment to this ship or until relieved of these duties in writing. 2. You shall read and become familiar with the parts of references (a) and (b) which concern your duties. 3. You shall maintain the necessary accounting records and documents as set forth in the references, to show the proper receipt and expenditure of items in your custody. 4. You shall ensure that the proper security is maintained for items in your custody and change the combination of the safe containing the working stock items in accordance with existing regulations. You shall ensure that an OPNAV 5511/2 (Combination Change Envelope) has been placed in the custody of the Master or his designee. 5. The Controlled Substances Inventory Board will conduct quarterly inventories of all controlled substances in your custody if no transactions have occurred. If transactions have occurred, the inventory will be required on a monthly basis. 6. You will report directly to the Master in the performance of the above duties. ____________________________ (Signature of Master) D- 3 COMSCINST 6000.1D 11 October 2006 SAMPLE CONTROLLED SUBSTANCE INVENTORY BOARD LETTER (Date) MEMORANDUM From: To: Subj: Master, USNS ORION Ms. Wilma Stevensen, Third Mate APPOINTMENT AS MEMBER OF CONTROLLED SUBSTANCES INVENTORY BOARD (a) NAVMED P-117, Manual of the Medical Department, Articles 21-24 through 21-26 and 21-47 (b) COMSCINST 6000.1 series Ref: 1. You are appointed as a Member of the Controlled Substances Inventory Board. 2. You shall become familiar with the functions of this board as set forth in references (a) and (b). 3. You will assist in the physical inventory of all controlled substances onboard this ship. Quarterly inventories are conducted if no transactions have occurred. If transactions have taken place, the inventories will be conducted on a monthly basis. A Controlled Substances Inventory Report of each inventory shall be made to the Master. 4. In your report to the Master you shall include the following: a. Report of inventory. b. Discrepancies noted in checking all receipt and expenditure vouchers, prescriptions and logs, showing receipt and expenditures of all controlled substance inventories. c. Whether prescribed accounting records were properly prepared as set forth in the references. d. Whether closures of vials, bottles and other containers indicate evidence of tampering. (If so, the contents must be inventoried and checked for quantity or held for CSIB review.) ____________________________ (Signature of Master) D- 4 COMSCINST 6000.1D 11 October 2006 SAMPLE CONTROLLED SUBSTANCE INVENTORY BOARD (SENIOR MEMBER) LETTER (Date) MEMORANDUM From: To: Subj: Master, USNS HIRSUTE Mr. L. T. Adolpho, Chief Mate APPOINTMENT AS SENIOR MEMBER OF CONTROLLED SUBSTANCES INVENTORY BOARD (a) NAVMED P-117, Manual of the Medical Department, Articles 21-24 through 21-16 and 21-47 (b) COMSCINST 6000.1 series Ref: 1. You are hereby appointed as Senior Member of the Controlled Substances Inventory Board as defined in reference (a). In addition, Mr. S. Halifax and Ms. Wilma Stevensen will assist you as members of this board. 2. You shall become familiar with the functions of this board as set forth in references (a) and (b). 3. You will conduct a quarterly inventory of all controlled substances if no transactions have taken place. This inventory will be done monthly if any transactions have occurred. A Controlled Substances Inventory Report shall be made to the Master. 4. In your report to the Master, you shall include the following: a. Report of inventory. b. Discrepancies noted in checking all receipt and expenditure vouchers, prescriptions and logs, showing receipt and expenditures of all controlled substance inventories. c. Whether prescribed accounting records were properly prepared as set forth in the references. d. Whether closures of vials, bottles and other containers indicate evidence of tampering. (If so, the contents must be inventoried and checked for quantity or held for CSIB review.) ____________________________ (Signature of Master) D- 5 COMSCINST 6000.1D 11 October 2006 SAMPLE CONTROLLED SUBSTANCE INVENTORY REPORT (Date) MEMORANDUM From: To: Subj: Senior Member, Controlled Substances Inventory Board Master, USNS JUSTICE CONTROLLED SUBSTANCES INVENTORY REPORT FOR AUGUST 2003 Ref: (a) NAVMED P-117, Manual of the Medical Department, Chapter 21 (b) COMSCINST 6000.1 series 1. In accordance with reference (a) and (b), a controlled substance inventory was conducted with the following results. Name Strength NSN UI Last Report Received Quantity Expended Balance On Hand 2. Discrepancies noted are as follows: (Either state "none" or list each discrepancy with corresponding explanation.) _____________________________ (Senior Member) _____________________________ (Member ) ____________________________ (Member) ____________________________ (Master) Copy to: MSO D- 6 COMSCINST 6000.1D 11 October 2006 SAMPLE NARCOTIC DESTRUCTION REPORT 6710 (Date) From: To: Subj: Ref: Mr. John J. Smith, MSO... Master, USNS VIRTUAL (T-AGOS 42) SURVEY OF CONTROLLED SUBSTANCES (a) Manual of the Medical Department, Article 21-26 1. In accordance with reference (a), authorization to survey and destroy the following substances is requested: Drug 1. 2. 3. 4. 5. __________________ (MSO) – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – FIRST ENDORSEMENT From: To: Master Senior Member, Controlled Substance Inventory Board Lot# Manufacturer Amount Reason 1. I hereby direct the destruction of the controlled substances listed above with documentation of this action in accordance with the requirements of reference (a). ______________________ (MASTER) Action taken by the Controlled Substance Inventory Board: The controlled substances listed above were destroyed on (date) by flushing (or list other means of destruction). List of Medication with Lot numbers ________________________ (Senior Member) __________________________ (Board Member) D- 7 COMSCINST 6000.1D 11 October 2006 SAMPLE AMMAL CHANGE RECOMMENDATION LETTER (Date) From: Medical Services Officer, USNS PLATO T-AXX 1 To: Commander, Military Sealift Command, Code N00M Via: Force Medical Officer, Atlantic / Pacific Region Subj: AUTHORIZED MINUMUM MEDICAL ALLOWANCE LIST (AMMAL) CHANGE RECOMMENDATION Ref: (a) COMSCINST 6000.1 series 1. In accordance with reference (a), the following AMMAL change is recommended: a. Item to be added/deleted to AMMAL #_____: (1) (2) (3) Standard Stock Number Nomenclature Cost/Cube/Weight b. Justification for recommendation: (Examples include cost upgrades, new technology, space limitations, duplication, medical care and medical administrative support.) c. Alternatives and reason for rejection of alternatives: (Alternatives may be non-traditional, e.g., the substitution of lozenges for bottled cough syrup where ship configuration does not allow for the storage of bottles. This may not be the better clinical alternative, but may be superior in terms of overall cost.) d. Estimated cost of change per ship: (Cost projection must include any hull, electrical or installed systems changes, labor and the difference in cost between current AMMAL requirements and recommended AMMAL requirements.) _________________________ (MSO) D- 8 COMSCINST 6000.1D 11 October 2006 SAMPLE REPATRIATION MESSAGE R 111420Z NOV 94 ZYB FM USNS SATURN PSN 873473M32 TO COMSCLANT BAYONNE NJ//NOOM/N1/N3// INFO COMSC WASHINGTON DC//NOOM/N1/N3// UNCLAS //N06000// MSGID/GENADMIN/USNS SATURN// SUBJ/SERIOUS ILLNESS, INJURY, REPATRIATION REPORT// RMKS/1. PERSONAL INFORMATION FOR OFFICIAL USE ONLY IN PERSONNEL ADMINISTRATION. A. LAST, FIRST SSN, AGE, GENDER, POSITION, DEPT B. NOK NAME, ADDRESS, PHONE C. NOK NOTIFIED? D. DATE, TIME, LOCATION OF REPAT/LOCATION REPATED TO/ MEANS OF REPAT E. LEAVE ADDRESS F. NAME OF MASTER/NAME OF MSO G. ICD CODES/CONDITION H. ADMINISTRATIVE COMMENTS I. SHIP STATUS/WAS DIVERSION REQUIRED J. MEDICAL ADVISORY SERVICE CONTACT/MEDICAL OFFICE CONTACT K. DATE REPORTED ABOARD L. DATE HIRED BY MSC M. OVERDUE/NOT OVERDUE FOR RELIEF BT D- 9 COMSCINST 6000.1D 11 October 2006 SAMPLE MEDICAL RECORD SCREENING MATRIX NAME____________________________________________________________ SSN_____________________________________________________________ POSITION________________________________________________________ PROJECTED DUTY ASSIGNMENT______________________________________________________ YOU ARE REQUIRED TO COMPLETE THE FOLLOWING PROCEDURES PRIOR TO YOUR NEXT ASSIGNMENT. Physical Examination (forms attached) Scheduled for _________________________________ (Date/Time/Place) Immunizations: Yellow Fever Smallpox Hepatitis A Typhoid MMR Typhoid Meningoccocal TET/DIPTH Anthrax Hepatitis B Influenza Pneumococcus (Age 65 and older) PPD: Date given: Date read: Results: Occupational Screenings: Audiogram Eye Examination (safety glasses) Pulmonary Function Test EKG AMSP Screening/Chest X-ray G6PD/Sickle Cell Trait Determination Blood Lead Level Other Monitoring Medication Requirements (6 months supply) Environmental Health Interview Date began medical screening/clearance:____________________________________________ Date completed medical screening/clearance:____________________________________________ Cleared by:_____________________________________________________ D- 10 COMSCINST 6000.1D 11 October 2006 SAMPLE MEDICAL DEPARTMENT EMERGENCY RESPONSE PLAN Subj: Ref: MEDICAL DEPARTMENT EMERGENCY RESPONSE PLAN (a) COMSCINST 6000.1 series (b) NAVMED P-117, Manual of the Medical Department, Chap. 2 1. Purpose. To serve as a guide to shipboard personnel on the facilities, material resources, procedures and personnel responsibilities in responding to emergencies at sea. Each emergency is different and the unique nature of MSC crews and ships relies upon the sound judgment of all crewmembers to respond in an appropriate manner. The intent of this instruction is to incorporate judgment and flexibility when responding to emergency situations. 2. Scope a. Location of Emergency Medical Equipment (1) The hospital spaces are located at __________. The Medical Department will be prepared for emergencies at all times. The Medical Services Officer will maintain his/her proficiency and familiarization of prescribed duties. (a) Routes to the Medical Department will be indicated on interior and exterior bulkheads, access doors and hatches by standard U.S.N. routing markers. The markers will be mounted at eye level and be sufficient in number to allow an individual to maintain eye contact when between two markers. (b) The Medical Department supplies and equipment will be maintained in compliance with reference (a). (2) Mass Casualty Boxes are located at: ____________________________ ____________________________ ____________________________ (3) Bulkhead mounted First Aid Boxes are located at: __________________ __________________ __________________ __________________ __________________ __________________ (page 1) D- 11 COMSCINST 6000.1D 11 October 2006 (4) MSO Emergency Response Kit(AMMAL 0924). Maintained in the ship’s Hospital for use by the Medical Services Officer. (5) MDR Emergency Response Kit(AMMAL 0944). Maintained in Hospital for use by the Medical Department Representative. (6) Stretchers. The Medical Services Officer will ensure stretcher bearers are identified by name and receive proper training in compliance with reference (a). A current list of trained stretcher bearers is attached. The following types of stretchers are located in the following areas: (a) Reeves Sleeve/Spine Board _____________________ ______________________ _____________________ ______________________ (b) Stokes Litter(rigid) _____________________ _____________________ ______________________ ______________________ (c) Stokes Litter rigged with floatation devices ____________________ (Note: Maintained by the Deck Department IAW NWP-14.) (d) Sea-Air Rescue Litter _______________________ (e) Water-tight Boat First Aid Boxes _______________ (7) Automated External Defibrillator is located at ____________________________________________________ b. Order of Treatment (1) First aid treatment given by the first personnel responding at the scene of a casualty (Buddy Aid). (2) First aid care provided by Stretcher Bearers. (3) Care provided by the First Officer/MDR (4) Care provided by the Medical Services Officer. (page 2) D- 12 COMSCINST 6000.1D 11 October 2006 REFUSAL OF MEDICAL CARE DIRECTIONS: This form will be used to document the refusal of medical care or treatment by a patient against the advice of the Medical Services Officer, medical advisory service physician or Master. PATIENT’S STATEMENT 1. By this instrument, I, ____________________________________________, hereby certify that _____________________________________ (Name, Health Care Provider) has explained to me that my refusal to receive medical treatment or undergo further diagnostic examination for my condition ________________________________ (include ICD-9 code of presumptive diagnosis) could have a negative impact on my state of health. 2. I certify that I understand the risks involved by my refusal of care. The risks, as explained to me are: 3. I certify that it has been explained to me that my refusal of care in no way prevents me from seeking care at this facility for my current condition or any other in the future. PATIENT’S SIGNATURE: PHYSICIAN, MSO SIGNATURE: WITNESS’ SIGNATURE: NAME: SOCIAL SECURITY NO.: POSITION: MSC 6320/2 (7/06) D- 13 SHIP: LOCATION: DATE/TIME OF TREATMENT: MASTER SIGNATURE: DATE/TIME: DATE/TIME: DATE/TIME: COMSCINST 6000.1D 11 October 2006 SAMPLE 6-9 MONTH MEDICATION SUPPLY REQUEST (Date) FROM: Military Sealift Fleet Support Command Medical Department (Code NO2M) 1283 Tow Way Drive Norfolk, VA 23511-32496 Tel: (866) 827 4955 REQUEST FOR SIX-NINE (6–9) MONTHS SUPPLY OF MEDICATION IN THE CASE OF: (Last Name, First Name MI, last 4 SSN) WHOM IT MAY CONCERN: SUBJ: TO: 1. Subject named Civilian Mariner is being deployed. Because of the probability that his/her ship may be isolated for prolonged periods of time, it is required that he/she has six to nine months supply of his/her medication. 2. Our records show this Mariner is on the following medications: a. _______________________________________________ b. _______________________________________________ c. _______________________________________________ d. ________________________________________________ NOTE: THIS IS NOT A PRESCRIPTION 3. Your cooperation in assisting the Mariner in this matter is most appreciated. Should you have any questions or desire verification, please feel free to call (866) 827-4955 and refer to this memorandum. ___________________________________ (Medical Department Representative) D- 14 COMSCINST 6000.1D 11 October 2006 SAMPLE MARINER NOTIFICATION OF NOT FIT FOR HIRE/DUTY LETTER Medical Officer Military Sealift Fleet Support Command 1283 Tow Way Drive Norfolk, VA 23511-2419 (Date) Name Address Subj: Ref: NOT FIT FOR DUTY, ADDITIONAL INFORMATION REQUIRED (a) COMSCINST 6000.1 series Per reference (a), we are unable to find you Fit For Hire/Duty because there are one or more conditions found on your entry physical examination that require additional information from your physician. This determination may be reconsidered upon receipt of sufficient medical documentation to reliably assess suitability for shipboard duty. The information requested is attached as one or more Medical Summary Forms, which indicate which type of physician is most appropriate to provide the information. The information due dates listed on the Medical Summary Form is based on a reasonable clinical estimate of completion time and does not change the time limit for you to complete all conditions of employment. As indicated previously if you fail to receive medical clearance by the deadline on the original tentative offer of employment letter, the tentative offer of employment may be rescinded, requiring you to reapply once all conditions of employment have been met. Questions concerning this may be directed to this office at (757) 443-5760. Sincerely, W.G. RUDOLPH, MD CAPT, MC, USN Encl: Medical Summary Form Copy to (without attachments): MSFSC Marine Employment Division CIVMAR Support Center D- 15 COMSCINST 6000.1D 11 October 2006 SAMPLE CHRONIC MEDICAL CONDITION LETTER (Date) MEMORANDUM From: To: Force Medical Officer, Medical Office, ___________________ _____________________________________________ (Name of Civmar and Last 4 SSN) FOLLOW-UP CHRONIC MEDICAL CONDITION (S) Subject: 1. A review of your medical record indicates that you have the following chronic medical condition(s): a. b. c. d. _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ 2. In order to ensure that you received adequate follow-up from your private physician and that you are physically qualified for sea duty, it will be necessary for you to see your private physician for follow-up of these conditions at least annually as a minimum. Your physician may recommend more frequent visits. Failure to keep the Medical Office up to date regarding your medical status may result in a finding of not fit for duty. 3. If you have been placed on medication by your physician it is your responsibility to have your medication with you or arrangements to have medication delivered to you for your assignment aboard ship. 4. It will be your responsibility to obtain the written summary from your physician(s) and return it to the Medical Office in Norfolk, VA. If there is any question, please contact that office at 1-866-827-4955 or (757) 443-5760 ______________________________ MSFSC HQ Force Medical Officer I have read and understand the above. _________________________________________ Civmar Signature __________________ Date This form to be placed in Part 1 of Original and Supplemental Record as top sheet above problem sheet. (rev: 8/4/05) D- 16 COMSCINST 6000.1D 11 October 2006 APPENDIX E LOGS REFERENCE PARA PREPARATION INSTRUCTIONS SUBMISSION REQUIREMENTS NAME FORM FREQ MEDICAL DEPT. DAILY JOURNAL SICK CALL LOG PEST CONTROL LOG* POTABLE WATER LOG** HEAT STRESS LOG** 1.3h(1) BOUND LOG DAILY PARA 1.3(6) NONE 1.3h(2) SAMS DAILY PARA 1.3h(2) NAVMED P-5010 NAVMED P-5010 OPNAV 5100.19D COMSC 5100.17B PARA 1.3(7) NONE 1.3h(4) SAMS SITUATIONAL NONE 6.5c(3) SAMS DAILY NONE 6.7a(2) SAMS SITUATIONAL NONE TRAINING LOG 2.2b MSC 12410/5 SITUATIONAL COMSC 3120.2D NOTE: For non-MSO (or Contract MSO) manned MSC operated ships: * can be maintained in the Ship’s log when contract services are obtained and conducted ** can be maintained by the Engineering Department E- 1 COMSCINST 6000.1D 11 October 2006 APPENDIX F Medical Technical Library 1. Purpose. To promulgate the minimum technical resource list for MSC Medical Departments. 2. Background. Medical technical library resources for MSC ships are somewhat unique from those of the Navy and are influenced by several factors. The patient population is generally older and operational commitments often mean ships travel alone, as opposed to traveling in the company of a Task Force or Group. a. To develop the onboard medical resource requirements, COMSC medical personnel reviewed requirements, established in NAVMEDCOMINST 6820.4L, and considered recommendations for other publications made by professionals within the maritime industry and the surface medicine community. b. Ships without Medical Service Officers have a lesser requirement and will stock only those publications and directives indicated by footnotes. 3. Responsibilities It is a. Fleet Surgeon/N00M, Special Assistant to COMSC. the responsibility of N00M to maintain and update the requirements of this appendix as necessary. Updates will generally occur when medical care requirements change, when medical technology changes occur or when medical publications require updating. b. Force Medical Officer, MSFSC HQ/Pacific. It is the responsibility of the FMOs to recommend changes to this appendix to N00M. c. Medical Services Officer (MSO). It is the responsibility of the MSO to recommend changes to this appendix to the FMOs. 4. Required Publications a. CD-ROM Titles: • • STAT-REF, Electronic Medical Library PMT Toolbox F- 1 COMSCINST 6000.1D 11 October 2006 • SAMS User Guide b. Publications • • • • • NAVEDTRA 14295 NAVEDTRA 14274 NAVEDTRA 14275 Hospital Corpsman Dental Technician Vol. 1 Dental Technician Vol. 2 Benenson, Abram S., Control of Communicable Diseases in Man. American Public Health Association Emergency Care and Transportation of the Sick and Injured. American Academy of Orthopedic Surgeons (Committee on Allied Health) Clinically Oriented Anatomy. Moore, K. L., Lippincott Bates, Lippensott • • • Guide to Physical Examination, A. International Classifications of Diseases (ICDA), Clinical Modi-Classification, 9th revision, Volume 1, 2 and 3. U.S. Department of Health and Human Services Publication Number (PHS) 80-1260 Physician's Desk Reference (PDR). Oraville NJ Medical Economics Co., • • Ship's Medicine Chest and Medical Aid at Sea, The. U.S. Public Health Service (DHHS Publication Number (PHS) 84-2024) Required Directives Department of the Navy File Maintenance Procedures and Standard Subject Identification Code (SSIC) Department of the Navy Correspondence Manual Credentials Review and Clinical Privileging of Healthcare Providers Licensure and Certification of Health Care Providers Environmental and Natural Resources Program Manual Navy Occupational Safety and Health (NAVOSH) Program Manual F- 2 5. SECNAVINST 5210.11 series SECNAVINST 5216.5 series SECNAVINST 6320.23 series SECNAVINST 6401.2 series OPNAVINST 5090.1 series OPNAVINST 5100.23 series COMSCINST 6000.1D 11 October 2006 OPNAVINST 5102.1 series OPNAVINST 5350.4 series OPNAVINST 6000.1 series OPNAVINST 6110.1 series OPNAVINST 6320.6 series OPNAVINST 6320.7 series Policies for OPNAVINST 6400.1 series Mishap Investigation and Reporting Drug and Alcohol Abuse Prevention and Control Guidelines Concerning Pregnant Servicewomen Physical Readiness Program Hospitalization of Servicemembers in Foreign Medical Facilities Health Care Quality Assurance Operating Forces Certification, Training, and Use of Independent Duty Hospital Corpsmen (IDCs) Shipboard Habitability Program Food Sanitation Training Program Supply Procedures Manual MSC Command Inspection Program Disposal of Solid Waste in the Marine Environment Drug and Alcohol Abuse Problem Military Sealift Command Medical Physical Readiness Program Precautions for the Transmission of Bloodborne Pathogens (BBPs) Accommodation Standards Military Sealift Command Ships Material Quality Control Storage standards OPNAVINST BUMEDINST COMSCINST COMSCINST COMSCINST COMSCINST COMSCINST Manual COMSCINST COMSCINST 9640.1 4061.1 4000.2 5040.2 5090.2 series series series series series 5350.2 series 6000.1 series 6110.1 series 6230.1 series COMSCINST 9330.6 series DLAM 4155.537 6. Other Required Resources • HMIS (Hazardous Materials Information System) Defense Logistics Agency, Defense General Supply Center, Richmond VA 23297 (microfiche format) CHRIS (Chemical Hazard Response Information System), U.S. Coast Guard Commandant Instruction - M16465.11, U.S. Government Printing Office, Washington DC 20402; Stock Number 050-01200215-1 Online Resources Navy Electronic Directives System, http://doni.daps.dla.mil/ • 7. • F- 3 COMSCINST 6000.1D 11 October 2006 • 8. BUMED Directives System, http://navymedicine.med.navy.mil/instructions/directives/default.asp Naval Medical Education and Training Command. The following optional references are available on CD-ROM from the Naval Medical Education and Training Command: https://nshs.med.navy.mil ADVANCED COMBAT TRAUMA LIFE SUPPORT (504442) CLINICAL APPLICATION OF LABORATORY (803460) DENTAL EMERGENCIES (803673) EMERGENCY MEDICAL CONDITIONS FOR HOSPITAL CORPSMEN (801526) HIV/AIDS TOTAL FORCE TRAINING FOR HEALTH CARE PERSONNEL (503008) MALARIA: DIAGNOSIS, TREATMENT, AND PREVENTION” (805657) MANAGEMENT OF CHEMICAL WARFARE INJURIES (804039) DIFFERENTIATION AMONG CHEMICAL, BIOLOGICAL AND RADIOLOGICAL CASUALTIES (806590) PSYCHIATRY TECHNICIAN: CRISIS INTERVENTION (805221) RECOGNITION AND MANAGEMENT OF ABDOMINAL CONDITIONS (802460) RECOGNITION AND MANAGEMENT OF ACUTE RESPIRATORY CONDITIONS (802458) RECOGNITION AND MANAGEMENT OF CARDIOVASCULAR CONDITIONS (802459) RECOGNITION AND MANAGEMENT OF COMMON DERMATOLOGICAL CONDITIONS (802461) The following CDs are available from the Naval Operational Medical Institute (NOMI) by contacting: www.nomi.med.navy.mil OPERATIONAL MEDICINE 2001 HEALTHCARE IN MILITARY SETTINGS (NAVMEDPU 5139) The following CD is available (for download only) from the Naval Operational Medical Institute (NOMI) by contacting: www.nomi.med.navy.mil OPERATIONAL OBSTETRICS & GYNECOLOGY (NAVMEDPUB 6300-2C) F- 4 COMSCINST 6000.1D 11 October 2006 APPENDIX G MEDICAL TRAINING FOR NON-MEDICAL SHIPBOARD PERSONNEL 1. Below are the minimum training requirements to be covered annually: a. Basic Self and Buddy First Aid: burns, shock, fractures, bandaging, hemorrhage control, hygiene, heat stroke/exhaustion, etc. b. Basic Life Support (with AED) c. Health Hazards of MSD System d. Casualty Transporting e. Potable Water Sanitation (Engineers only) f. Personal Hygiene, STDs, Physical Fitness, Dental Hygiene g. Blood Borne Pathogens h. Heat Stress i. Hearing Conservation j. Sight Conservation k. Substance/EtOH Abuse l. Cold/Hot Weather Operations m. Emergency Medical Supply n. Respiratory Protection G- 1 COMSCINST 6000.1D 11 October 2006 APPENDIX H MILITARY SEALIFT COMMAND AMMALS AMMAL 0730 0731 0732 0733 0734 0734A 0910 7005 0210 0924 0927 0943 0964 SHIP CLASS/UNIT APSRON/MPSRON (DEPLOYMENT AMMAL) T-ATF, T-ARS T-AK, T-AKR (CONTRACTOR OPERATED VESSELS) T-ARC, T-AG, T-AGS, T-AGOS, T-AOT T-AO, T-AE, T-AFS, T-AGM, T-AOE, T-AKE T-AGF/LCC AUGMENT LEVEL ONE LABORATORY (MSO MANNED ONLY) WOMEN AT SEA DENTAL MSO RESPONSE KIT FIRST AID BOX MDR MARINER RESPONSE KIT MASS CASUALTY BOX H- 1 COMSCINST 6000.1D 11 October 2006 APPENDIX I Emergency Medical Supply Inventory Requirements Medical Space and Equipment Requirements 1. First Aid Boxes. Bulkhead mounted first aid boxes, containing the inventory of Authorized Medical Allowance List 927 and sealed to prevent tampering, shall be provided in the following spaces: a. b. c. d. e. f. g. h. Bridge (Ship control spaces) Engine and machinery spaces Galleys Electronic control spaces Communication spaces Air control spaces Laundry spaces Anchor handling areas The following litters shall be provided: 2. Litters. a. Stokes Litters (NSN 6530-00-315-4784), steel, without leg dividers, without plastic coating, will be mounted in the following locations: 1. 2. 3. 4. 5. In an interior passageway near the hospital Near each galley/messing area Near each shop space Near the helicopter platform For transfer-at-sea, rigged with flotation gear b. Sea-Air Rescue (SAR)/Medical Evacuation Litter (NSN 6530-01-187-0104) will be mounted near the VERTREP/hover area. c. Reeves Sleeve (NSN6515-01-477-8525) stretcher is designed for extrication and spinal immobilization by sliding the long spine board ((NSN 7530-01-490-2487) into the sleeve. It also has vertical/horizontal helicopter lift capability will be installed near the top of each vertical trunk rising more than two levels where other means of extrication could not be used. The trunk will also have a steel padeye of sufficient strength to permit vertical lifting of injured personnel. Each ship will have a minimum of one such litter. 3. Eye Wash Stations/Deluge Showers. Eye wash stations shall be provided in the following locations: a. Machinery space I- 1 COMSCINST 6000.1D 11 October 2006 b. Marine sanitation device room or other sewage treatment areas c. Battery lockers d. Lockers containing acids and other caustic substances e. Weather deck over cargo tanks (tank vessels only) f. Flammable liquids storerooms 4. Mass Casualty Box. Mass Casualty Boxes, containing the inventory of Authorized Medical Allowance List 0964, shall be strategically mounted and secured for sea at or near designated DC locker. Mass Casualty Boxes shall not be located in or near medical spaces. The surgical instruments listed on the 964 AMMAL and shown on the list below are to be in a sterilized suture pack, sealed in an appropriate outer wrapping, and placed in the Mass Casualty Box along with an inventory list. For security, Mass Casualty Boxes will be pad locked. I- 2 COMSCINST 6000.1D 11 October 2006 Minor Suture Set NSN NOMENCLATURE U/I ALLOW ON HAND EA EA EA EA EA EA EA EA PG PG EA 1 2 2 1 1 1 1 1 2 2 1 6515-00-299-8736 HOLDER, NEED HEG-MAYO 6" FORCEPS HEMO KELLY 5.25-5.75” LG 6515-00-334-3800 SLGT CRVD JAW FORCEPS HEMO KELLY 5.50” LG 1” LG 6515-00-334-6800 STR JAW FORCEPS TISSUE ADSON 4.50" LG TWZR 6515-00-337-7800 STR & SM FORCEPS TISSUE 5" LG TWZR STR & SM 6515-00-337-9800 JAW SQ TIP HOLDER SUT NEED COLLIER 5" LG 6515-00-341-7200 STRAIGHT JAW HANDLE SURG KNIFE DETACH BLADE SIZE 6515-00-334-7800 3 6515-00-365-1820 SCISSORS, GEN SURG ST 5 1/2" BLADE SURG KNIFE DET NO.11 SM TANG 6515-00-660-0010* 6S BLADE SURG KNIFE DET NO.10 SM TANG 6515-00-660-0011* 6S PROBE GEN OPER 5"LG .062" DIA 6515-01-119-0018 SPATULATE *Taped outside package I- 3 COMSCINST 6000.1D 11 October 2006 APPENDIX J Contract Medical Advisory Service and Emergency Medical Evacuation Assistance 1. Background. a. COMSC contracts for twenty four hour per day, seven day a week (24/7) emergency medical advisory service for CIVMAR manned ships and the Afloat Pre-positioning Squadron staffs. This service provides access to a board certified emergency room physician to assist in medical treatment via multiple methods of communication. Additionally, the contract also provides service to arrange for and manage emergency medical evacuation from CIVMAR manned ships, Afloat Pre-positioning Squadron staffs, and the contract mariners stationed aboard the contract ships ported at Diego Garcia. b. Contract operated ships are required to contract for an equivalent 24/7 emergency medical advisory support from a service of their choosing. 2. Policy. Shipboard medical personnel or Master will first request medical advice from physicians embarked on ships of the accompanying Task Force, from physicians of military medical facilities ashore in the next port, and the Contract Medical Advisory Service. For non-emergency issues, personnel may contact the MSC Physician Supervisor. 3. Definition of Services. a. The contractor provides medical advice to CIVMAR manned ships and to Afloat Pre-positioning Squadron staffs when requested by the MSO/MDR, Master, or Squadron CO/MSCO. The advice includes recommended treatment regimes, recommendations for seeking consultation ashore and advice on repatriation/MEDEVAC. Assistance may be requested on any medical condition or situation. There are no limitations on degree of severity or number of requests. b. The contractor also provides service to arrange for and manage MEDEVAC requirements when other sources/routes are not available. As such, Masters, MSCO Diego Garcia, and MSC Force Medical Officers, should first exhaust the closest and quickest methods for MEDEVAC before requesting assistance from the contract medical advisory service. 3. Communications. The contractor provides a procedure guide outlining communication methods including phone numbers, message J- 1 COMSCINST 6000.1D 11 October 2006 addresses, email addresses, and guidelines for information they need about the patient’s condition when requesting medical assistance. This ensures rapid contact with the ship and expeditious evaluation of the patient’s condition. 4. Procedural Requirements. The Ship will follow the requirements outlined in the procedure guide provided by the contractor. Generally: a. Before requesting emergency medical advice, the MSO/MDR must fully evaluate the patient to maximize the value of the physician contact; ensuring information being provided to the physician is appropriate and complete. b. The ship will use the most expeditious and available means of communication (e.g. INMARSAT) unless under EMCON, to communicate with the contractor. Collect calls are not authorized. When naval messages are used, addressees will include the cognizant MSC Force Medical Officer and COMSC. c. The ship's ADCON must be kept informed of all ongoing actions when a diversion or medical evacuation is anticipated. d. All requests for assistance will be noted in the Medical Department Log, documented in the health record, and an entry made in the medical encounters module of SAMS. 5. MedAire, Inc. As of the publication of this manual, the emergency medical advisory service contracted by MSC is “MedLink”, a service of MedAire, Inc. A “MedLink Medical Handbook” outlining contact information and procedures was distributed to MSC ships covered by this contract. If necessary, you may request a copy of this handbook from COMSC Fleet Surgeon’s Office. MedLink’s 24 hour emergency telephone number is (602) 239-3627. When contacting MedLink, identify yourself by: “MSC”, vessel name and call sign. Tell the MedLink communications specialist your approximate location, destination, and ETA. Using the MedLink Medical Handbook checklist, describe your medical emergency to the MedLink physician. J- 2 COMSCINST 6000.1D 11 October 2006 APPENDIX K POSITIONAL FUNCTIONAL REQUIREMENTS AND ENVIRONMENTAL EXPOSURE FACTORS TABLE I: Describes the functional requirements of each civilian mariner position, including requirements for standing, walking, lifting, vision, hearing and other categories. TABLE II: Describes the environmental exposure factors of each civilian mariner position, including weather, noise, work environment, explosives, isolation and others. K- 1 COMSCINST 6000.1D 11 October 2006 OS(D), ABM, BOSUM, Carpenter, Carp./Maint. Chief Cook, Asst. Cook, Night Cook (Baker), 2nd Cook (Baker) Oiler, Fireman, Watertender, Wiper, Unlic. Jr. Engr., Engine Utilityman Galleyman, Utilityman and 3rd Pantryman Yeoman Storekeeper/UNREP Chief Chief Engineer Purser/Nurse Radio Officer A. FUNCTIONAL REQUIREMENTS Heavy lifting, 45 pounds and over Moderate lifting, 15-44 pounds Light lifting, under 15 pounds Heavy carrying 45 pounds and over Moderate carrying, 15-44 pounds Light carrying, under 15 pounds Straight pulling ( hours) Pulling hand over hand ( hours) Pushing ( hours) Reaching above shoulder Use of fingers Both hands required Walking ( ) Steel decks Standing ( hours) Steel decks Crawling ( hours) Kneeling ( hours) Repeated bending ( hours) Climbing, legs only ( hours) Climbing, use of legs and arms Both legs required Operation of crane, truck, or motor vehicle OCC OCC OCC X X X X X X X X X X X X X X Electrician Messman OCC - Occasional H - Hour's X - Full time X X OCC OCC OCC X X X X X X X X X X X X X X X X X OCC OCC OCC 2H OCC OCC OCC 2H X X X X 8H 8H OCC OCC 2H X X X 8H 8H X X X 8H 8H X X X 2H 2H X X X X X X 4H 4H OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC X X X 4H 4H X X X 4H 4H X X X 4H 4H X X X 4H 4H X X X 6H 6H OCC OCC OCC X X X 6H 6H X X X 6H 6H OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC X X X 4H 4H X X X 4H 4H 1H X X X 4H 4H 1H X X X 4H 4H 1H X X X 4H 4H 1H X X X 4H 4H 1H X X X X X X X 4H 4H 1H X X X X OCC X X X 4H 4H 1H X OCC X X OCC 1H OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC OCC X X X X X X X X X X OCC X X X X X X X X X X X X X X X X X X X X X X X X K- 2 Machinist, Pumpman, Deck Engr., Machinist, Plumber-Machinist X Third Assistant Engineer (W) (D) Asst. Laundryman, Laundryman Chief Steward & Third Steward AB (Watch), Ordinary Seaman Second Officer, Third Officer Second Assistant Engineer First Assistant Engineer Refrigeration Engineer Masters, First Officers COMSCINST 6000.1D 11 October 2006 OS(D), ABM, BOSUM, Carpenter, Carp./Maint. Oiler, Fireman, Watertender, Wiper, Unlic. Jr. Engr., Engine Utilityman Chief Cook, Asst. Cook, Night Cook (Baker), 2nd Cook (Baker) Galleyman, Utilityman and 3rd Pantryman Yeoman Storekeeper/UNREP Chief A. FUNCTIONAL REQUIREMENTS OCC - Occasional H - Hour's X - Full time Ability for rapid mental & muscular coordination simultaneously X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Ability to use and desirability of using firearms Near vision correctable at 13" to 16" to Jaeger 1 to 4 Far vision correctable in one eye to 20/20 & to 20/40 in the other Far vision correctable in one eye to 20/50 & to 20/100 in the other Specific visual requirement (specify) Both eyes required Depth perception Ability to distinguish basic colors Ability to distinguish shades of colors Hearing (aid permitted) Hearing without aid Specific hearing requirements (specify) Other (specify) X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X K- 3 Machinist, Pumpman, Deck Engr., Machinist, Plumber-Machinist X X X X X X X X Third Assistant Engineer (W) (D) Asst. Laundryman, Laundryman Chief Steward & Third Steward AB (Watch), Ordinary Seaman Second Officer, Third Officer Second Assistant Engineer First Assistant Engineer Refrigeration Engineer Masters, First Officers Chief Engineer Purser/Nurse Radio Officer Electrician Messman COMSCINST 6000.1D 11 October 2006 OS(D), ABM, BOSUM, Carpenter, Carp./Maint. Oiler, Fireman, Watertender, Wiper, Unlic. Jr. Engr., Engine Utilityman Chief Cook, Asst. Cook, Night Cook (Baker), 2nd Cook (Baker) Galleyman, Utilityman and 3rd Pantryman Yeoman Storekeeper/UNREP Chief B. ENVIRONMENTAL FACTORS OCC - Occasional H - Hour's X - Full time Outside X X X X X X X X X X X X X Outside and inside X X X X X X X X X X X X X X X X X X X X Excessive heat X X X OCC X X X X X X X OCC OCC OCC OCC OCC OCC OCC X OCC Excessive cold X X X X X X X X X X X X X X X X X X X X Excessive dampness or chilling Dry atmospheric conditions OCC OCC OCC X OCC OCC OCC OCC OCC OCC OCC OCC OCC Excessive noise, intermittent X X X X X X X Constant noise OCC X X X X X X X X Dust X X X X X X X X Silica, asbestos, etc. X X X X X X X X Fumes, smoke, or gases X X X X X X X X X X X X X X X X X X X X Solvents (degreasing agents) X X X X X X X X X X X X X X X X X X X Grease and oils X X X X X X Radiant energy X X X X X X X X Electrical energy X X X X X X X X X X X X X X X X X X X X Slippery or uneven walking surfaces X X X X X X X X X X X Working around machinery with moving parts OCC OCC OCC X OCC OCC OCC OCC X X X X X X X X X X X X X X X X X X X X X Working around moving objects or vehicle K- 4 Machinist, Pumpman, Deck Engr., Machinist, Plumber-Machinist Third Assistant Engineer (W) (D) Asst. Laundryman, Laundryman Chief Steward & Third Steward AB (Watch), Ordinary Seaman Second Officer, Third Officer Second Assistant Engineer First Assistant Engineer Refrigeration Engineer Masters, First Officers Chief Engineer Purser/Nurse Radio Officer Electrician Messman OCC - Occasional H - Hour's X - Full time Working on ladders or scaffolding Working below ground Unusual fatigue factors (specify) Working with hands in water Explosives Vibration Working closely with others Working alone Protracted or irregular hours of work Other (specify) B. ENVIRONMENTAL FACTORS OCC OCC OCC OCC OCC OCC X X X X X X X X X X X X X X X Masters, First Officers Second Officer, Third Officer Purser/Nurse Yeoman Storekeeper/UNREP Chief X X OS(D), ABM, BOSUM, Carpenter, Carp./Maint. K- 5 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X OCC OCC OCC OCC OCC OCC OCC X X X X OCC X X AB (Watch), Ordinary Seaman Asst. Laundryman, Laundryman Radio Officer Chief Steward & Third Steward Chief Cook, Asst. Cook, Night Cook (Baker), 2nd Cook (Baker) Galleyman, Utilityman and 3rd Pantryman Messman Chief Engineer First Assistant Engineer Second Assistant Engineer Third Assistant Engineer (W) (D) Electrician Refrigeration Engineer Oiler, Fireman, Watertender, Wiper, Unlic. Jr. Engr., Engine Utilityman COMSCINST 6000.1D 11 October 2006 Machinist, Pumpman, Deck Engr., Machinist, Plumber-Machinist COMSCINST 6000.1D 11 October 2006 APPENDIX L MSC MEDICAL SURVEILLANCE PROGRAM PHYSICAL BY RATING (JOB DESCRIPTION) RATING Master st nd 1 , 2 OFFICERS 3rd OFFICERS BOSUN, BOSUNMATE, CARPENTER, ABLE BODIED SEAMAN (AB (M)) * ABLE BODIED SEAMAN (AB (W)) ** ORDINARY SEAMAN (OS (D)) * ORDINARY SEAMAN (OS (W)) ** * = Non-watchstander ** = Watchstander CHIEF ENGINEER; 1st, 2nd, 3rd ASSISTANT ENGINEERS; CHIEF ELECTRICIAN, 2nd ELECTRICIAN, ELECTRONIC TECHNICIAN REFRIGERATION ENGINEER DECK ENGINEER MACHINIST UNLICENSED JR ENGINEER, ENGINE UTILITY, OILER, WIPER PUMPMAN CHIEF STEWARD, CHIEF COOK, NIGHT COOK BAKER, 3rd STEWARD, STEWARD COOK, 2nd COOK, ASSISTANT COOK UTILITYMAN LAUNDRYMAN SUPPLY OFFICER, JR SUPPLY OFFICER STOREKEEPER, ASST. STOREKEEPER PURSER MEDICAL SERVICE OFFICER RADIO ELECTRONICS TECHS MEDICAL SURVEILLANC PROGRAM ASBESTOS SURVEILLANCE PCMATRIX REFERENCE 115 REQUIRED MSP 716 716, 503, 704, 720, 710 716, 503 716, 503, 704, 720, 710 716, 503 716, 716, 716, 716, 503 503, 702 503, 702, 704, 720, 710 503 716, 709 716, 503, 709, 704 716, 503 716 716, 710 716 716, 719 716 FREQUENCY / PERIODICITY OF EXAM Years Since First Exposure: > 10 15 – 35 years old = Every 5 years 36 – 45 years old = Every 2 years > 45 years old = Annually Years Since First Exposure: < 10 Every 5 years regardless of age ANNUALLY EVERY 5 YEARS EVERY 3 YEARS EVERY 2 YEARS BASELINE ONLY (Repeated if out of work for medical reasons or > 30 days) 15 – 34 years old = every 5 yrs 35 – 44 years old = every 2 yrs 45 y.o + = ANNUALLY BASELINE ONLY < 60 years old > 60 years old = every 2 years = ANNUALLY 116 HEARING CONSERVATION WASTE WATER & SEWAGE FORKLIFT OPERATOR WEIGHT HANDLING EQUIPMENT FOOD SERVICE 503 702 710 704 709 RESPIRATOR CERTIFICATION 716 HEALTH CARE WORKER 719 720 EXPLOSIVE HANDLERS AND EXPLOSIVE VEHICLE OPERATORS L- 1 COMSCINST 6000.1D 11 October 2006 APPENDIX M Quality Improvement Review Screening Matrix MSC Semi-Annual MSO Clinical Performance & Medical Readiness Oversight Worksheet Assemble: Labeled folder w/ Ship name and Hull # Copy of most recent MSO QA Report Copy of most recent MSO Training Matrix Copy of most recent MRI Cover Letter SAMS Reports Required from MSO: (note status of life-saving items in table below) Supply: Percentage of Inventory on Board Expiring Shelf Life Report (projected 2 months out) Warning Requirement List Outstanding Requisition Report (compare vs. Exp. Shelf Life & Warning Req. List Reports) FSC 6505 Ad Hoc Report AMMAL 924 Location Inventory Report Master Tickler: Physical Exam Status Report Medical Inquiry, Group Summary, All MSP Report Chronic Medical Condition F/U MILDET Annual PHA Report Crew Roster Summary Staff Analysis SAMS’ Data: Immunizations: Typhoid (All types) __________% Crew Current Tetanus Yellow Fever __________% Crew Current __________% Crew Current Hepatitis A __________% Crew Current PPD __________% Crew Current Lifesaving Items Checklist: AMMAL Item Name Required 734 Naloxone HCl Inj. 1BX 924 Naloxone HCl Inj. 0.2 BX 734 Activated Charcoal 8 BT 734 Insulin 1 VI 924 Dextrose Inj. (50 mL) 0.1 BX 734 Nitroglycerin Tablets 1 BT 924 Nitroglycerin Aerosol 1 EA 734 AED Pads 1 PG 924 Pulse Oximeter 1 EA 734 Epinephrine Inj. 1 PG 924 Epinephrine Inj. 0.2 PG 734 Diphenhydramine HCL Inj. 1 PG 924 Diphenhydramine HCL Inj. 0.1 PG 734 Sodium Chloride Inj. (1000 mL) 2 PG 924 Sodium Chloride Inj. (250 mL) .01 PG 734 Lactated Ringers Inj. (1000 mL) 2 PG 924 Lactated Ringers Inj. (1000 mL) .08 PG 964 Lactated Ringers Inj. (1000 mL) 1 PG 734 Albuterol Aerosol 4 PG 734 Diazepam Inj. 1 PG Summary Rates for Inclusion in Clinical Oversight Report: Immunizations: Completion %’s: Total Immunization Completion: Physicals: Completion %’s: CIVMAR Medical Surveillance Programs CIVMAR Physical Exam CIVMAR Chronic Disease F/U MILDET Preventive Health Assessment Supply: % of Authorized Medical Allowance on board % of Medications on board with current expiration date MSO ___________ # On Board Exp.Date Date On Order _____% _____% _____% _____% _____% _____% _____% Reviewing MO ______________ Date, Ship & Location _________________ M- 1 COMSCINST 6000.1D 11 October 2006 APPENDIX M Quality Improvement Review Screening Matrix MEDICAL RECORDS REVIEW (S.O.A.P. FORMAT) Demographic data correct, current included in the SOAP medical entry VS present, Comment on Abnormal values Follows SOAP or similar format Chief Complaint / Diagnosis (Dx) Review of Systems Appropriate to Chief Complaint PE c/w Chief Complaint & History (Hx) Lab, X-ray, Consults Appropriate Dx c/w Hx, PE & Study Results Treatment (Tx) Plan c/w CC, Hx, PE & Test Results Medication (Rx) Dose, Quantity & Duration Clearly Documented Appropriate & Timely comments on test / consult results Appropriate F/U prescribed Problem Summary Updated w/ Rx’s & Significant Illness Meets Std of Care Comments: Name Last 4 Date Name Last 4 Date Name Last 4 Date Name Last 4 Date Name Last 4 Date Name Last 4 Date Name Last 4 Date Name Last 4 Date MSO_________________ Date, Ship & Location ________________________Reviewing MO ______________ MSO Report Date: _________ Crew Size _______ BLS w/ AED for HCP’s Expire Date: _________ Name Last 4 Date M- 2 Name Last 4 Date COMSCINST 6000.1D 11 October 2006 APPENDIX M Quality Improvement Review Screening Matrix Verify Med Ref Library Status: Recommend Update with Current Edition Edition On-Board Required & Recommended Publications per COMSCINST 6000.1 Current STAT!Ref Electronic Med Library Bates Guide to Physical Examination & History Taking Clinically Oriented Anatomy Control of Communicable Diseases Manual Dermatology Text Current Year Physician’s Desk Reference ICD-9 Clinical Modification Vol’s 1-3 Dorland’s Illustrated Medical Dictionary Operational Dentistry CD-ROM PMT Toolbox CD-ROM Emergency Care & Transportation of the Sick & Injured Hdbk of Poisoning, Prevention, Diagnosis & Treatment Ship’s Medicine Chest & Medical Aid at Sea To order STAT!REF, contact: Steve Campbell STAT!Ref Military/Government Sales 307-733-8231 - direct 307-690-8231 -- cellular 307-733-7131 - fax scampbell@tetondata.com The price for the update is about $1799 which includes shipping. They will accept both charge card and purchase orders (yes, this is something the ship has to buy). THIS IS AN INSPECTABLE ITEM! MSO_______________ Date, Ship & Location ________________ Reviewing MO _________________________ M- 3 COMSCINST 6000.1D 11 October 2006 Crew Survey of Healthcare Satisfaction "To Ensure & Preserve the Operational Readiness of Personnel Afloat" The Military Sealift Command Medical Department strives to provide you the best employee health service possible. We need your help in evaluating our service to you. Please take a moment to complete part 1 of this survey, make any comments that would help us better meet your needs, & return to the Master. Reason for your visit:_______________________________ Date of visit:________________ Optional Information Name: ____________________ Rate: ______ Ship: ___________ E-mail: ______________ Rating Scale 1 Strongly Disagree 1. 2. 3. 4. 5. 6. 7. 2 Disagree 3 Neither Agree Nor Disagree 4 Agree 5 Strongly Agree 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 4 4 4 4 4 4 4 5 5 5 5 5 5 5 Was the MSO courteous and professional? Were you assisted in a timely manner? Did the provider explain all findings on your examination? Were you given clear instructions? Were all your questions answered to your satisfaction? Was the need for follow-up, if any, clearly explained? Overall were you satisfied with the care you received? Please take the time to provide any comments, compliments, complaints, and/or suggestions on how we may serve you better. Feel free to use the back of this form, too. _______________________________________________________________________________________________ _______________________________________________________________________________________________ Thanks for your feedback. Please place in the Captain’s Suggestion Box SHIP’S RESPONSE TO FEEDBACK Comments Given to Patient: ____________________________________________________________________ ______________________________________________________________________________________________ _______________________________________________________________________________________________ Patient Satisfied? _____ Yes _____ No Root Cause Identified: _______________________________________________________________________ ______________________________________________________________________________________________ _______________________________________________________________________________________________ Forward to: _____ Ship’s Master for Information and/or Action Copy to: _____ Medical Service Officer for Information & Quality Improvement _____ MSC Pac Region Med Det for Process Improvement Suggestion _____ No Action Necessary Comments: ____________________________________________________________________________________ _______________________________________________________________________________________________ _________________________ MASTER SIG _______________________ MSO SIG ___________________ MSC PacRegion Med Det M- 4 COMSCINST 6000.1D 11 October 2006 APPENDIX N MSC MEDICAL READINESS INSPECTION (MRI) CHECKLIST Formal MRI TAV Contract Turn-Over DATE:______________ SHIP’S NAME & HULL NUMBER:_____________________________________________ SHIP’S MASTER:__________________________________________________________ SHIP’S MSO/MDR:_________________________________________________________ INSPECTOR:______________________________________________________________ The overall grade for this inspection is: C-1 C-2 C-3 C-4 A grade of C-3 or C-4 will require monthly status reports to the cognizant COMSFSC Force Medical Officer with info copies made to COMSC Fleet Surgeon C-1: Fully Ready (No unsatisfactory sections. Capable of performing effectively in all areas.) C-2: Substantially Ready (No more than one unsatisfactory section. Deficiencies exist which reduce effectiveness but do not cause loss in any one-mission area.) C-3: Marginally Ready (No more than two unsatisfactory sections. Significant deficiencies exist which reduce mission effectiveness.) C-4: Not Ready: (Three or more unsatisfactory sections. Major discrepancies exist that cause a loss to the medical mission capability of the ship.) NOTE: The above MRI/TAV grading is preliminary until final approval by the COMSC Fleet Surgeon. The Inspector may assign a C-4 if one critical discrepancy may seriously degrade the ship’s mission, or assign a higher grade than indicated in the guideline due to mitigating circumstances. The Inspector will clearly document reasons for assigning the final grade in the official MRI/TAV cover letter and the remarks section of the MRI/TAV checklist. Critical areas are identified with bold italic print. Master (Date and sign) REFERENCES: a. COMSCINST 6000.1 Series b. NAVMED P-5010 c. NAVMED P-117 d. BUMEDINST 6220.12 Series e. OPNAVINST 5100.19 Series f. OPNAVINST 6710.3 g. NAVMEDCOMINST 6710.12 h. NAVSUPINST 4440.146 Series i. BUMEDINST 6250.12 Series j. BUMEDINST 6224.8 W. Ch-1 k. BUMEDINST 6230.15 Series Inspector (Date and sign MSO/MDR (Date and sign) l. Asst. SECDEF Memo, HBV Immunization Policy dtd 23 Oct 96 m. GENSPECS for T-Ships n. SECNAVINST 6230.4 Anthrax Vaccine Implementation Program o. NAVSUPPINST 421 p. Navy Medical Department Guide to Malaria Prevention q. COMSCINST 5100.17 Series r. Center for Disease Control (CDC) Guidelines s. 29 CFR 1910.1030 t. OSHA Final Rule, (18/01/00) Needle Stick Safety & Prevention Act u. US Public Health Service (FDA) “Food Code” N- 1 COMSCINST 6000.1D 11 October 2006 PART A: MEDICAL ADMINISTRATION (REF A,B,C,D,E) 1. SAMS Version? 2. Medical Department Journal maintained? 3. MSO/MDR proficient in the use of the Navy Disease Reporting System (NDRS) in SAMS? 4. Sick Call Log maintained in SAMS? (Check health records) 5. Potable Water Log maintained in SAMS for 2 years? 6. Binnacle List/AM report of the sick submitted to Master and copy on file? 7. Serious/Very Serious Illness Reports; Reports of Diversion, Repatriation submitted? 8. Heat Stress Reports/Cold Injury Reports submitted/on file? 9. MSC MRI & SMART on file, documented corrective action taken? 10 Has a comprehensive Industrial Hygiene Survey (IHS) been completed and copy on file. (Required every 2 years) DATE OF LAST IHS: 11. Health Records properly maintained and secured? 12. Turnover letter completed within 7 days of assignment and on file? 13. Current STAT-Ref onboard? Version/Date__________ Installed and Utilized? Requirement Met? Part A Comments: Part B: MEDICAL SUPPLY (REF A, C, H) REQUIRED AMMALS/ADALS Onboard?(YES or NO Percentage of 6505 Class Onboard Percentage of all other AMMAL/ ADAL items Onboard AMMAL 0210 0731 0733 0910 7005 0964 Dental TYPE # REQ #&% ABOARD AMMAL 0730 0732 0734 0924 0927 0944 TYPE APSRON/MPSRON T-AK, T-AKR T-AO, T-AE, TAFS,T-AGM, T-ADC, T-AOE, T-AGF, LCC, T-AKE MSO Response Kit First Aid Boxes MDR Emergency Response Kit # REQ #&% ABOARD T-ATF / T-ARS T-ARC, T-AG, TAGOS, T-AOT, TAGS Level One Medical Lab Women at Sea Mass Casualty Box Part B (Continued) 1. AMMALs verified monthly and SAMS / AMMALs UPDATED (AMMALs can be received via INTERNET through NMO or Email. 2. Supplies correctly entered and maintained in SAMS? 3. Overall percent of AMMAL/ADAL onboard : (90% > SAT, <90% UNSAT 6505 series only) 4. Bulkhead to bulkhead Supply Inventory performed annually and documented (Hard copy on file)? Requirement Met? N- 2 COMSCINST 6000.1D 11 October 2006 5. Stock rotated to preclude expired on-hand consumables: # Items inspected # Items Expired Part B Comments: PART C: NARCOTICS/CONTROLLED SUBSTANCES (REF A, F, G, H) 1. Controlled Substances Inventory Board appointed in writing by Master? 2. Quarterly inventories performed and documented? (Monthly if any activity has occurred) 3. Prescriptions on file and countersigned by patient and Master? 4. Requisition surveys/dispensing properly performed? 5. Secure storage provided for Controlled Medications? 6. Non-AMAL narcotic onboard? 6a. Approved by Force Medical Officer with letter on file? NARCOTICS IN EXCESS OF AMMAL LOCATION QTY EXP DATE REMARKS Requirement Met? CONTROLLED MEDS INVENTORY DRUG Diazepam Inj 5mg/ml 2ml Morphine Sulfate 10mg/ml Acetaminophen w/ Codeine 325mg Diazepam Tablets 5mg CANA Autoinjectors LOCATION QTY EXP DATE REMARKS Part C Comments: PART D CREW TRAINING (REF A, B, E, R, S, T) 1. Training Performed and Correctly Documented in SAMS: 2. Training logs and lesson plans maintained? 3. CPR / AED Training? (Electricians, ET Techs, & Radio Elect Techs must be 100%) 4. Sexually Transmitted Disease (STD)? 5. Hearing conservation? 6. Heat Stress? 7. Sight Conservation? Requirement Met? N- 3 COMSCINST 6000.1D 11 October 2006 8. Engineers trained in potable water sanitation? 9. Self/Buddy First Aid for burns, shock, fractures and hemorrhage? 10. Crew trained in Blood Borne Pathogens transmission and prevention? 11. MSO/MDR indoctrinates personnel in the health and sanitation hazards of the MSD system? 12. Emergency medical supply training (AED, FAB, MCB, Litters, etc) 13. Cold Weather operations training? (Situational) 14. Hot Weather operations training? (Situational) 15 Long Range Training Plan (12 months). Part D Comments: (Must have 75% topic completion rate.) PART E CLINICAL COMPETENCY/ TRAINING (REF A, B, C, E, I, J, K, P, R, U ) 1. MSO/MDR certified by Medical Officer to provide patient care? (Contract MDRs are vetted by Fleet Surgeon prior to employment as MDR) 2. Has MSO completed MSO/IDC competency upon hire or during Refresher Training (REFTRA)? __________ % Completed 3. MSO / MDR attended STCW Medical Person In charge of Care? (M-PIC upon Initial Hire with periodic IDC Refresher after) 4 Completed periodic IDC/MSO Refresher training (Every 3 years). 5. Last MO QA completed Date:__________ 6. Shipboard Pest Control Certification current for MSO/MDR by DVECC/NEPMU? (Every 3 years) 7. SERVSAFE/Navy's Food Safety Manager's/Supervisor's Course certified? 8. Heat Stress Afloat? (Every 3 years) 9. Water Sanitation Afloat? (Every 3 years) 10. Health Aspects of Marine Sanitation Devices? (Every 3 years) 11. Hearing Conservation Afloat? (Every 3 years) 12. Navy Chemical - Biological – Radiological/Nuclear & Explosive (CBRNE) Casualty Care Management Course? (Every 3 years) 13. Respirator Protection (NAVOSH Course A-4J-0082) (Every 3 years)? 14. BCLS Instructor.( w/ AED) (Every 2 years) 15. SAMS Proficiency?. 16. Basic Preventive Medicine & Epidemiology (Immunizations/prophylaxis, STDs, malaria prevention/control, hepatitis and TB surveillance) (Every 3 years) 17. Dental 18. Drug Coordinator 19. Safety Programs Afloat (A-493-2099) (Every 3 years) 20. Obtained 12 Continuing Education Units/Continuing Medical Education (CEU/CME) per calendar year Requirement Met? Part E Comments. N- 4 COMSCINST 6000.1D 11 October 2006 PART F PATIENT CARE (REF A, B, C, J) 1. Evaluation, diagnosis and treatment documented in SAMS on each visit and in SOAP format? 2. Files maintained for physical exams, audiograms. 3. Blood type, Sickle Cell, G6PD, & other special SF600s filed in health record? 4. Number of health records reviewed: Active duty # ___________ CIVMAR # __________ (No Less than 10% of records aboard) 5. What is the number of current physical exams recorded? (Indicate % missing) 6. Blood pressure documented biannually for each CIVMAR? Requirement Met? Part F Comments. PART G: PREVENTIVE MEDICINE/OCCUPATIONAL HEALTH (REF A, C, E, J, N, R, S, T) 1. Immunizations current/documented in health record? a. Yellow Fever (10 Years)? b. Tetanus (10 Years)? c. Typhoid Fever (2 Years Injectable/5 Years orally)? d. Hepatitis A (series)? Record number missing: 1st injection: 2nd injection: e. *Hepatitis B (series)? st nd rd 3 injection: Record number missing 1 injection: 2 injection: * Required for: Medical Personnel, Diagnosed or suspected STD patients, Eng & PCRT (Prim CAS Response Team), and Personnel deploying >30 days to endemic areas as defined by CDC or ordered by COCOM or Fleet Commander responsible for the AOR. f. Influenza (Annually)? g. Anthrax (As required by current directives)? h. Smallpox (As required by current directives)? i. HIV’s collected for all Active Duty. j. Annual Pap smears for all Active Duty females? k. Meningococcal Immunization (If applicable) ....l. Pneumococcal immunization (If applicable) m. MMR (two vaccines-all personnel born after 1957 unless they have positive seriologies) n...Poliomyelitis (all personnel must receive booster vaccine, IPV series for personnel who have not received the primary series.) 2. Tuberculosis Surveillance Program: a. Annual TST documented for each crewmember? Number missing: % of crew tested: b. Annual TB report submitted to MSFSC Environmental Health Officer. c. Active TB case contacts documented with proper follow-up? d. LBTI reactor’s evaluation, treatment, and follow-up documented? 3. Sexually Transmitted Disease Program: a. STD interviews conducted/contact reports submitted as required? b. MER in Record? 4. Established Blood-borne Pathogen Program (BBP) and Infectious Disease Control? (COMSCINST 6230.1 Series) a. Familiar with malarial endemic regions, treatment and prophylaxis? Number missing: Number missing: Requirement Met? N- 5 COMSCINST 6000.1D 11 October 2006 b. MDR thoroughly familiar in BBP Program? c. HBV Immunizations for medical personnel and offered to personnel at risk from infectious medical wastes/BBP? d. Personnel handling potentially infectious medical wastes receive training in prevention of BBP transmission? e. Potentially infectious medical wastes sterilized, double bagged in biohazard bags, labeled and properly stored in a secure area until disposal? f. Medical sharps (needles/scalpels) collected in approved sharps containers, sterilized /properly stored and disposed? Part G Comments. PART H: MEDICAL EQUIPMENT and SPACES (REF A, C, M) 1. Exam/Treatment Room equipment properly installed and operating by GENSPECS for T-Ships Sec. 652-1? 2. Adequate space for medical room storage? 3. Hospital space clean, organized, and in good repair? 4. Are medical facilities/equipment, passageways, 1st Aid Boxes, lockers and litters labeled with red crosses/arrows? 5. Sterilizer installed and operable? 6. Sterile minor surgery packs prepared and ready for use? 7. Oxygen delivery system operable and ready for use? 8. “NO SMOKING” sign posted? 9. Medical Biological Refrigerator installed with High/Low temperature alarms. Requirement Met? Part H Comments. PART I: EMERGENCY MEDICINE (REF A, B, C, D, M) Requirement Met? 1. MSO Emergency Response Kit maintained and inventoried? 2. AED/Suction/Oxygen & AMBU bags: a. Required equipment onboard? b. MSO/MDR familiar with their use? c. Maintained in good repair and properly stowed? d AED PADS and Battery checked? AED expiration date ___________ 3. 50-gallon gravity filled emergency potable water tank or approved alternative source installed in overhead of the Medical Treatment Room/s are fitted with: a. Sight glass level indicator? b. Drain fitted with hose bib? c. Vent overflow with insect screen of 18 gauge or finer non-corrosive mesh? d. Gravity feed connection with gate-valve piped from surgical sink cold potable water service line? e. Gate valve and back-flow preventer installed in service branch upstream of tank connection? 4. Is an approved alternative emergency potable water source available if the 50-gallon tank is not utilized? a. Container is labeled with the word “POTABLE WATER” in at least 1-inch letters? b. Each container is labeled with the date of filling and the source of the potable water? c. Containers are stored in a clean dry place in the immediate vicinity of anticipated use? N- 6 COMSCINST 6000.1D 11 October 2006 d. Containers are emptied, inspected, flushed and refilled with potable water every three months? 5. First Aid Boxes maintained and inventoried as required, sealed, and located IAW with the Ship Specific Design Requirements (SSDR)? 6. First Aid Boxes contain two (2) surgical masks, two (2) pairs of patient examining gloves and packets of antiseptic hand cleaner in addition to normal inventory to limit BBP exposure? 7. Mass Casualty Boxes maintained and inventoried every 6 months? 8. Mass Casualty Boxes properly marked, mounted, locked, and located in or in close proximity to the DC locker 9. Rigid Stokes Litter with flotation for transfer at sea aboard with: a. Minimum of 3 patient security straps permanently attached? b. Appropriate handling lines available? 10. AMMAL approved stretchers/litter onboard, properly stowed and inspected quarterly? 11. Appropriate number of Lifejackets and Survival Suits stowed in medical spaces for each bed and maintained in good repair? 12. Emergency call system located at hospital berths, operating table, baths and heads labeled “EMERGENCY CALL ONLY”? First Aid Boxes: Location Inventory Secured Remarks Litter Information (Locations designated by SSDR) Location Inspected Litters Stokes REEVE Sleeve II and spine board Air/Sea Rescue Secured Remarks Part I Comments. ENVIRONMENTAL HEALTH/PREVENTIVE MEDICINE (REF A, B, I, N, O, P, U) PART J: VECTOR CONTROL (REF B) 1. Only authorized pesticides used and applied by certified personnel? 2. Whitmire system employed for pest control? 3. Surveys conducted to determine program effectiveness and results recorded in SAMS? 4. Rat guards (36/48 inches, 6 feet from jumping surfaces) used & properly installed? 5. Electrical and other lines lighted to deter rodent entry? 6. Derat Certification current? Expires on: 7. False bulkheads, ceilings, stainless steel panels sealed/minimized, harborages eliminated? 8. Pesticides used in accordance with label and directions? 9. Pesticides labeled and stowed in flammable locker? 10. Pest control equipment and PPE stowed separately? Requirement Met? N- 7 COMSCINST 6000.1D 11 October 2006 Part J Comments. PART K: POTABLE WATER (REF B) Requirement Met? 1. Potable Water Sanitation Bill current and posted in Hose Lockers and where water is treated? 2. “Batch “& “Super” chlorination procedures understood and properly performed? Daily halogen (FAC/TBR) residuals performed at no less than four varied locations except if taking on water from: homeport, in CONUS or U.S. Territories? (Note: Halogen residuals must be performed concurrently with weekly bacteriological samples). 4. Are weekly bacteriological samples tested from: a. Four sites representative of ships distribution system? b. 25% of ice machines and water tanks on a rotating basis? c. Positive and negative controls performed? d. Appropriate action taken when coliform bacteria are present? 5. MSO/MDR knowledgeable about procedures for doubtful source treatment? 2.0ppm FAC/TBR maintained in potable water tanks when procured from a contaminated or doubtful source? 6. Potable water connection to the following equipment provided with air gap or properly installed backflow prevention device: a. Chill water expansion tank? b. Diesel engine cooling jacket? c. Garbage disposals? d. Food service equipment? 7. Hose bib faucets with ¾-inch fittings? 8. Sounding tubes/sight glass constructed to preclude contamination of tanks and properly maintained? 9. Screw caps on ships with sounding tubes with keeper chains, pad-locked and color-coded dark blue? 10. Brominators, hypochlorinators, chlorine generators properly installed, maintained and operable? 11. Potable Water equipment painted properly identified: a. Hand wheels, valves handle, risers painted Dark Blue? b. “Potable Water Only” signs posted by risers? c. Hose connections/accessories painted Dark Blue? d Hoses labeled and stenciled in Dark Blue “Potable Water Only” every 10 feet? e. Sounding tubes/tapes labeled/color coded? 12. Deck risers are: a. 18 inches off the deck and turned downward? b. Closed with screw cap and keeper chain? 13. Hoses and potable water equipment: a. Stored in weather and vermin proof lockers? b. Are locked? c. Lockers are ventilated and at least 18 inches off the deck? d. Hoses are in good repair and sanitized prior to use? e. Disinfecting instructions are posted? Part K Comments. N- 8 COMSCINST 6000.1D 11 October 2006 PART L: MARINE SANITATION DEVICES (MSD) SYSTEMS (REF E) 1. Personnel responsible for MSD maintenance knowledgeable of health & sanitation aspects of sewage spill cleanup? a. Area secured/non-essential personnel evacuated? b. MSO/MDR, Bridge/Quarter-deck notified? c. Proper use of Personal Protective Equipment (PPE)? d. Security watch with SCBA posted? e. Proper cleanup completed, area and equipment sanitized? f. Personnel do not leave maintenance/or spill cleanup area while wearing contaminated clothing or without personal hygiene? 2. MSD spaces/system routinely inspected and documented by MSO/MDR? MSO/MDR inspects where components interface with health sensitive areas (food service, medical, berthing, lounges etc.) 3. Hand washing facilities located in MSD spaces and equipped with disposable paper towels/soap? 4. Are warning signs posted prohibiting Eating, Drinking and Smoking? Requirement Met? Part L Comments. PART M: FOOD SAFETY (REF B) Conduct Comprehensive food service inspection and provide report under separate cover using the established food service inspection report form ( NAVMED 6240/1 rev 12/97) 1. Comprehensive, monthly, inspections performed by MSO/MDR to identify significant hazards in employee assessment, management, health, food, storage, procurement, preparation, time and temperature? 2. NAVMED 6240/1 (12/97) on file for 2 years? 3. HACCP Tracking data on file (Acceptance to consumption)? 4. SERVSAFE or equivalent Food Safety Training current and documented for cognizant personnel? 5. Temp logs maintained and temps recorded at least twice daily? Requirement Met? Part M Comments. PART N: INDUSTRIAL HYGIENE ADMINISTRATION (REF E & Q) Requirement Met? 1. Heat Stress: a. Engineering personnel responsible for monitoring are trained and familiar with both operating procedures for WBGT and psychrometer and documentation using Heat Stress Survey Watch Station form 303.? b. Approved WBGT (Model RSS-220) and accessories onboard and operable (two required if MSO aboard)? c. WBGT meter calibration is current? d. Motorized Psychrometer on board and operable? e. Free-hanging alcohol filled dry-bulb thermometers (NSN 9G-6685-243-9964 or equivalent) are properly mounted at watch or workstations where heat stress conditions may exist such as: (1) Machinery spaces, including shops? (2) Scullery and galley? (3) Laundry? f. Thermal insulation intact on hot ductwork? g. Local ventilation at permanently manned workstations provides adequate air movement? N- 9 COMSCINST 6000.1D 11 October 2006 2. Respiratory Protection: a. Users have facial hair that would prevent wearing of respiratory protection? b. Adequate stocks of appropriate air-purifying respirators aboard? c. Respirators stored in clean, dust-free environment? d. Pressure demand respirator, such as SCBA, available for entrance into IDLH spaces? (RAC 1) e. Ship’s personnel are wearing respirators as recommended in ships industrial hygiene survey? 3. Noise Abatement a. Noise hazardous areas/equipment identified and appropriate Hearing Conservation Signs posted IAW with most current IHS such as: (1). Machinery spaces? (2). Workshop? 4. Ventilation a. . Proper exhaust ventilation is provided: (1) At bench(s)? (2) In acid battery recharging area(s)? (3) In flammable liquid dispensing area(s) and paint locker? 5. Sight Conservation a. Plumbed emergency eyewash stations are located where (IAW IHS) eye contact with caustic or corrosive liquids may occur such as: (1) Acid battery recharging area(s) (should also have deluge shower)? (2) Main auxiliary machinery spaces? (3) Where flammable liquid mixed/dispensed? b. Eye hazard areas labeled IAW the IHS? 6. Hydraulic fluids Warning Sign posted where contact is possible with fire resistant hydraulic fluids and/or tube oils? 7 . (RADHAZ) Warning sign posted at eye level outside HF antenna transmitting at 250 watts or higher and between 10 and 30 MHz? (Red danger warning circle should also be painted within a 12-foot radius). Part N Comments. Please note additional comments below N- 10