First Aid for Soldiers FM 21-11
FM 21-11 First Aid for Soldiers: Appendix C
Common Problems/Conditions
Headquarters, Department of the Army, Washington, D.C., October 27, 1988
Section I. HEALTH MAINTENANCE
C-1. General
History has often demonstrated that the course of battle is influenced more by the
health of the troops than by strategy or tactics. Health is largely a personal
responsibility. Correct cleanliness habits, regular exercise, and good nutrition have much
control over a person's well-being. Good health does not just happen; it comes with
conscious effort and good habits. This appendix outlines some basic principles that
promote good health.
C-2. Personal Hygiene
a. Because of the close living quarters frequently found in an Army
environment, personal hygiene is extremely important. Disease or illness can spread and
rapidly affect an entire group.
b. Uncleanliness or disagreeable odors affect the morale of workmates. A daily
bath or shower assists in preventing body odor and is necessary to maintain cleanliness. A
bath or shower also aids in preventing common skin diseases. Medicated powders and
deodorants help keep the skin dry. Special care of the feet is also important. You should
wash your feet daily and keep them dry.
C-3. Diarrhea and Dysentery
a. Poor sanitation can contribute to conditions which may result in diarrhea
and dysentery (a medical term applied to a number of intestinal disorders
characterized by stomach pain and diarrhea with passage of mucus and blood). Medical
personnel can advise regarding the cause and degree of illness. Remember, however, that
intestinal diseases are usually spread through contact with infectious organisms which can
be spread in human waste, by flies and other insects, or in improperly prepared or
disinfected food and water supplies.
b. Keep in mind the following principles that will assist you in preventing
diarrhea and/or dysentery.
(1) Fill your canteen with treated water at every chance. When treated water
is not available you must disinfect the water in your canteen by boiling it or using
either iodine tablets or chlorine ampules. Iodine tablets or chlorine
ampules can be obtained through your unit supply channels or field sanitation team.
(a) To treat (disinfect) water by boiling, bring water to a rolling boil in
your canteen cup for 5 to 10 minutes. In an emergency, boiling water for even 15 seconds
will help. Allow the water to cool before drinking.
(b) To treat water with iodine--
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Remove the cap from your canteen and fill the canteen with the cleanest water available.
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Put one tablet in clear water or two tablets in very cold or cloudy water. Double
amounts if using a two quart canteen.
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Replace the cap, wait 5 minutes, then shake the canteen. Loosen the cap and tip the
canteen over to allow leakage around the canteen threads. Tighten the cap and wait an
additional 25 minutes before drinking.
(c) To treat water with chlorine--
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Remove the cap from your canteen and fill your canteen with the cleanest water
available.
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Mix one ampule of chlorine with one-half canteen cup of water, stir the mixture with a
mess kit spoon until the contents are dissolved. Take care not to cut your hands when
breaking open the glass ampule.
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Pour one canteen capful of the chlorine solution into your one quart canteen of water.
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Replace the cap and shake the canteen. Loosen the cap and tip the canteen over to allow
leakage around the threads. Tighten the cap and wait 30 minutes before drinking.
(2) DO NOT buy food, drinks, or ice from civilian vendors unless approved by
medical personnel.
(3) Wash your hands for at least 30 seconds after using the latrine or before touching
food.
(4) Wash your mess kit in a mess kit laundry or with treated water.
(5) Food waste should be disposed of properly (covered container, plastic bags or
buried) to prevent flies from using it as a breeding area.
C-4. Dental Hygiene
a. Care of the mouth and teeth by daily use of a toothbrush and dental floss
after meals is essential. This care may prevent gum disease, infection, and tooth decay.
b. One of the major causes of tooth decay and gum disease is plaque. Plaque is
an almost invisible film of decomposed food particles and millions of living bacteria.
To prevent dental diseases, you must effectively remove this destructive plaque.
C-5. Drug (Substance) Abuse
a. Drug abuse is a serious problem in the military. It affects combat
readiness, job performance, and the health of military personnel and their families. More
specifically, drug abuse affects the individual. It costs millions of dollars in lost time
and productivity.
b. The reasons for drug abuse are as different as the people who abuse the use
of them. Generally, people seem to take drugs to change the way they feel. They may want
to feel better or to feel happier. They may want to escape from pain, stress, or
frustration. Some may want to forget. Some may want to be accepted or to be sociable. Some
people take drugs to escape boredom; some take drugs because they are curious. Peer
pressure can also be a very strong reason to use drugs.
c. People often feel better about themselves when they use drugs or alcohol,
but the effects do not last. Drugs never solve problems; they just postpone or compound
them. People who abuse alcohol or drugs to solve one problem run the risk of continued
drug use that creates new problems and makes old problems worse.
d. Drug abuse is very serious and may cause serious health problems.
Drug abuse may cause mental incapacitation and even cause death.
C-6. Sexually Transmitted Diseases
Sexually transmitted diseases (STD) formerly known as venereal diseases are caused by
organisms normally transmitted through sexual intercourse. Individuals should use a
prophylactic (condom) during sexual intercourse unless they have sex only within marriage
or with one, steady noninfected person of the opposite sex. Another good habit is to wash
the sexual parts and urinate immediately after sexual intercourse. Some serious STDs
include nonspecific urethritis (chlamydia), gonorrhea, syphilis and Hepatitis B and the
Acquired Immunodeficiency Syndrome (AIDS). Prevention of one type of STD through
responsible sex, protects both partners from all STD. Seek the best medical
attention if any discharge or blisters are found on your sexual parts.
a. Acquired Immunodeficiency Syndrome (AIDS).l
AIDS is the end disease stage of the HIV infection. The HIV infection is contagious, but
it cannot be spread in the same manner as a common cold, measles, or chicken pox. AIDS is
contagious, however, in the same way that sexually transmitted diseases, such as syphilis
and gonorrhea, are contagious. AIDS can also be spread through the sharing of intravenous
drug needles and syringes used for injecting illicit drugs.
b. High Risk Group. Today those practicing high risk behavior who become
infected with the AIDS virus are found mainly among homosexual and bisexual persons and
intravenous drug users. Heterosexual transmission is expected to account for an increasing
proportion of those who become infected with the AIDS virus in the future.
(1) AIDS caused by virus. The letters A-I-D-S stand for Acquired
Immunodeficiency Syndrome. When a person is sick with AIDS, he is in the final stages of a
series of health problems caused by a virus (germ) that can be passed from one person to
another chiefly during sexual contact or through the sharing of intravenous drug needles
and syringes used for "shooting" drugs. Scientists have named the AIDS virus
"HIV." The HIV attacks a person's immune system and damages his ability to fight
other disease. Without a functioning immune system to ward off other germs, he now becomes
vulnerable to becoming infected by bacteria, protozoa, fungi, and other viruses and
malignancies, which may cause life-threatening illness, such as pneumonia, meningitis, and
cancer.
(2) No known cure. There is presently no cure for AIDS. There is presently no
vaccine to prevent AIDS.
(3) Virus invades blood stream. When the AIDS virus enters the blood stream,
it begins to attack certain white blood cells (T-Lymphocytes). Substances called
antibodies are produced by the body. These antibodies can be detected in the blood by a
simple test, usually two weeks to three months after infection. Even before the antibody
test is positive, the victim can pass the virus to others.
(4) Signs and Symptoms.
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Some people remain apparently well after infection with the AIDS virus. They may have no
physically apparent symptom of illness. However, if proper precautions are not used with
sexual contacts and/or intravenous drug use, these infected individuals can spread the
virus to others.
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The AIDS virus may also attack the nervous system and cause delayed damage to the brain.
This damage may take years to develop and the symptoms may show up as memory loss
indifference, loss of coordination, partial paralysis, or mental disorder. These symptoms
may occur alone, or with other symptoms mentioned earlier.
(5) AIDS: the present situation. The number of people estimated to be infected
with the AIDS virus in the United States is over 1.5 million as of April 1988. In certain
parts of central Africa 50% of the sexually active population is infected with HIV. The
number of persons known to have AIDS in the United States to date is over 55,000; of
these, about half have died of the disease. There is no cure. The others will soon die
from their disease. Most scientists predict that all HIV infected persons will develop
AIDS sooner or later, if they don't die of other causes first.
(6) Sex between men. Men who have sexual relations with other men are
especially at risk. About 70% of AIDS victims throughout the country are male homosexuals
and bisexuals. This percentage probably will decline as heterosexual transmission
increases. Infection results from a sexual relationship with an infected
person.
(7) Multiple partners. The risk of infection increases according to the number
of sexual partners one has, male or female. The more partners you have, the
greater the risk of becoming infected with the AIDS virus.
(8) How exposed. Although the AIDS virus is found in several body fluids, a
person acquires the virus during sexual contact with an infected person's blood or semen
and possibly vaginal secretions The virus then enters a person's blood stream through
their rectum vagina or penis. Small (unseen by the naked eye) tears in the surface lining
of the vagina or rectum may occur during insertion of the penis fingers, or other objects,
thus opening an avenue for entrance of the virus directly into the blood stream.
(9) Prevention of sexual transmission--know your partner. Couples who maintain
mutually faithful monogamous relationships (only one continuing sexual partner) are
protected from AIDS through sexual transmission. If you have been faithful for at least
five years and your partner has been faithful too, neither of you is at risk.
(10) Mother can infect newborn. If a woman is infected with the AIDS virus and
becomes pregnant, she has about a 50% chance of passing the AIDS virus to her unborn
child.
(11) Summary. AIDS affects certain groups of the population. Homosexual and
bisexual persons who have had sexual contact with other homosexual or bisexual persons as
well as those who "shoot" street drugs are at greatest risk of exposure,
infections and eventual death. Sexual partners of these high risk individuals are at risk,
as well as any children born to women who carry the virus. Heterosexual persons are
increasingly at risk.
(12) Donating blood. Donating blood is not risky at all. You
cannot get AIDS by donating blood.
(13) Receiving blood. High risk persons and every blood donation is now tested
for the presence of antibodies to the AIDS virus. Blood that shows exposure to the AIDS
virus by the presence of antibodies is not used either for transfusion or for the
manufacture of blood products. Blood banks are as safe as current technology can make
them. Because antibodies do not form immediately after exposure to the virus, a newly
infected person may unknowingly donate blood after becoming infected but before his
antibody test becomes positive.
(14) Testing of military personnel. You may wonder why the Department of
Defense currently tests its uniformed services personnel for presence of the AIDS virus
antibody. The military feels this procedure is necessary because the uniformed services
act as their own blood bank in a combat situation. They also need to protect new recruits
(who unknowingly may be AIDS virus carriers) from receiving live virus vaccines. HIV
antibody positive soldiers may not be assigned overseas (includes Alaska and Hawaii). They
must be rechecked every six months to determine if the disease has become worse. If the
disease has progressed, they are discharged from the Army (policy per AR 600-110). This
regulation requires that all soldiers receive annual education classes on AIDS.
Section II. FIRST AID FOR COMMON PROBLEMS
C-7. Heat Rash (or Prickly Heat)
a. Description. Heat rash is a skin rash caused by the blockage of the sweat
glands because of hot, humid weather or because of fever. It appears as a rash of patches
of tiny reddish pinpoints that itch.
b. First Aid. Wear clothing that is light and loose and/or uncover the
affected area. Use skin powders or lotion.
C-8. Contact Poisoning (Skin Rashes)
a. General.
(2) Poison Oak grows in shrub or vine form, and has clusters of three leaflets
with wavy edges (Figure C-2).
(3) Poison Sumac grows as a shrub or small tree. Leaflets grow opposite each
other with one at tip (Figure C-3).
b. Signs/Symptoms.
NOTE
Secondary infection may occur when blisters break.
c. First Aid.
(1) Expose the affected area: remove clothing and jewelry.
(2) Cleanse affected area with soap and water.
(3) Apply rubbing alcohol, if available, to the affected areas.
(4) Apply calamine lotion (helps relieve itching and burning).
(5) Avoid dressing the affected area.
(6) Seek medical help, evacuate if necessary. (If rash is severe, or on face or
genitals, seek medical help.)
C-9. Care of the Feet
Proper foot care is essential for all soldiers in order to maintain their optimal
health and physical fitness. To reduce the possibilities of serious foot trouble, observe
the following rules:
a. Foot hygiene is important. Wash and dry feet thoroughly, especially between
the toes. Soldiers who perspire freely should apply powder lightly and evenly twice a day.
b. Properly fitted shoes/boots should be the only ones issued. There should be
no binding or pressure spots.
c. Clean, properly fitting socks should be changed and washed daily. Avoid
socks with holes or poorly darned areas; they may cause blisters.
d. Attend promptly to common medical problems such as blisters, ingrown
toenails, and fungus infections (like athlete's foot).
e. Foot marches are a severe test for the feet. Use only properly fitted
footgear and socks. Footgear should be completely broken-in. DO NOT break-in new footgear
on a long march. Any blisters, sores, and so forth, should be treated promptly. Keep the
feet as dry as possible on the march; carry extra socks and change if feet get
wet (socks can be dried by putting them under your shirt, around your waist or hanging on
a rack). Inspect feet during rest breaks. Bring persistent complaints to the attention of
medical personnel.
*C-10. Blisters
Blisters are a common problem caused by friction. They may appear on such areas as the
toes, heels, or the palm of the hand (anywhere friction may occur). Unless treated
promptly and correctly, they may become infected. PREVENTION is the best solution
to AVOID blisters and subsequent infection. For example, ensure boots
are prepared properly for a good fit, whenever possible always keep feet clean and dry;
and, wear clean socks that also fit properly. Gloves should be worn whenever extensive
manual work is done.
NOTE
Keep blisters clean. Care should be taken to keep the feet as clean as possible at all
times. Use soap and water for cleansing. Painful blisters and/or signs of infection, such
as redness, throbbing, drainage, and so forth, are reasons for seeking medical treatment.
Seek medical treatment only from qualified medical personnel.
1. The Surgeon General's Report on Acquired Immunodeficiency Syndrome (U.S.
Public Health Service, 1986).
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