Operational Medicine 2001
Field Medical Service School
Student Handbook

Field Food Service

FMST 0601

17 Dec 99

TERMINAL LEARNING OBJECTIVES:

1.      Given a field environment (day and night), perform field food sanitation per the references.  (FMST.06.01)

ENABLING LEARNING OBJECTIVES:

1.      Without the aid of reference materials and given a random listing, identify the proper procedures involved in field sanitation preparation, prior to movement to the field, per the student handbook. (FMST.06.01a)

2.      Without the aid of reference materials and given a random listing of procedures, select the proper storage and handling procedures for food in the field, per the student handbook.  (FMST.06.01b)

3.      Without the aid of reference materials and given a list of food borne illnesses and symptoms, match the disease to the symptoms, per the student handbook. (FMST.06.01c)

OUTLINE:

A.     PROCEDURES FOR PREPARING PROPER FIELD FOOD SERVICE SANITATION

1. GAIN KNOWLEDGE OF OPERATIONAL AREA

a.       Medical intelligence reports (see FMST 0607)

b.      Naval Environmental and Preventive Medicine Units (NEPMU)

1)      Provide location and phone number for area Army Veterinarians

2)      Provide sources of approved food vendor

3)      Provide training for Food Service Instructors

c.        Disease Vector Ecology and Control Centers (DVECC)

1)      Will identify vectors collected on operations by submitting a DD 1222 form

d.      Local Preventive Medicine Services

1)   Provide training for Food Service Workers

e.       Army Veterinarians

1)      Inspect prospective food vendors

2)      Provide up-to-date list of approved food sources

3)      Extend shelf life for tray rations (T-rats) and Meals Ready to Eat (MREs)

2. Plan field sanitation for particular operation

a.       Select supplies and materials for setting up a field kitchen

b.      Designate personnel to perform sanitary duties, provide current training and

food service physicals

c.       Ensure current immunizations and any additional vaccines for specific operation

for the food service workers

3. EDUCATE PERSONNEL

a.        Information on food sources

1.      Meals Ready to Eat (MRE), Field Mess, Tray Rations

2.      Identify what is safe to eat from local population including street vendors

3.      Wild animals (in cases of emergency)

b.        Disease prevention

1.        Food borne - Personal hygiene is paramount

a.  Hand washing station (with soap and water) for patrons and messman.  See Figure - 1

2.        Water borne - source must be approved by Preventive Medicine prior to consumption

3.        Respiratory - all food service workers must have a current skin test using

Purified Protein Derivative (PPD) to test for tuberculosis infection/disease.

B.     FOOD STORAGE

1. FREEZER/REFRIGERATOR

a.       Required temperatures are as follows:

1.       Refrigerators are maintained at 32-41 degrees F

2.       Freezers are maintained at 0 degrees F, or below

b.      One internal and one external thermometer required for refrigerators and freezers

c.       Temperature readings must be taken and accurately logged at least once per meal period (3X/day)

d.      Freezer spaces should be emptied and cleaned once per week

e.       Frost or glaze ice must not accumulate to more than 1/4 inch on the cooling coils or interior surfaces

2. SEMIPERISHABLE

a.       Items such as potatoes, onions, carrots, and other raw vegetables must be stored on pallets to allow for air circulation and to protect them from decay, spoilage, and vermin infestation

3. NONPERISHABLE/CANNED FOODS

a.       Store off ground using pallets

b.      Rotate stock (First in, first out)

c.       Maintain storage area clean and orderly to facilitate access

d.      Maintain good air circulation to minimize deterioration from moisture

e.       Inspect regularly for vermin infestation

f.        Canned goods inspection

1. Condition: Severely Dented

                      a) Appearance:

1) End seam forced out of position so that it very noticable and that there was

     enough pressure to break the hermetic seal

  2) Very sharp angular dent with acute crimping

   b) Cause:  Puncture from forklift, dropping of cans

   c) Action:  Discard

                 2. Condition: Leakers / Pinholers

                           a)  Appearance:

 1) Can with incomplete closure of the seam

 2) A puncture

 3) Rust spots that have perforated the can and ruptured the hermetic seal.

                           b)  Cause: Acid in the can

   c) Action: Discard

                      3.  Condition: Springers

                           a) Appearance: 

            1) One end of the can is always distended

            2) When this end is pushed in, the opposite end may become distended or the same end may spring back to the distended position when pressure is released. Exception is coffee and molasses

  b) Cause: Natural gas build up 

   c) Action: Discard

4. Condition: Swellers/Swells

a)      Appearance: 

1)      This can has both ends distended at the same time

2)      Swellers are classified as critical defects except when they contain molasses or coffee.

                      b) Cause: Natural gas build up

                      c) Action: Discard

5.  Condition: Flippers

a)      Appearance:

1)      This can has little or no vacuum

2)      It appears normal but when one end is struck on a flat surface, the opposite end will distend and remain distended until forced back into position.

(a)    Cause:  Loss of vacuum by bacterial action or chemical action of the contents of the metal can

(b)   Action: Discard

NOTE:  Never consume canned goods under these conditions.  Do not attempt to taste test.

C.     FOOD HANDLING IN THE FIELD

1. TEMPERATURES

a.       Cold foods prepared for serving shall be rapidly stored at 41 degrees F or below

b.      Hot foods must be held at 140 degrees F or higher

2. TIME

a.       Food held at temperatures between 41 degrees and 140 degrees F for more than four hours shall be destroyed.  This temperature range is optimum for bacteria reproduction.

3. LEFTOVERS

a.        Saving  leftovers is strictly prohibited due to field conditions where holding temperatures and refrigeration are not reliable

b.        All leftovers must be disposed of as garbage

4. PREPARATION AND SERVING OF FOOD IN THE FIELD

a.       Potentially hazardous food (salad type fillings such as egg, tuna, and poultry) are prohibited due to lack of clean prep areas, inadequate space for refrigeration, and unreliable electrical supplies.

b.      Chopping and grinding of meat is prohibited

c.       Frozen food should be thawed under refrigeration

d.      Ice machines must be scrupulously maintained

e.       Condiments will be provided in individual packets

f.        Fruits and vegetables obtained from local economy must be soaked in chlorine solution of 100 parts per million (PPM) and rinsed with potable water prior to serving

     5.  MEALS READY TO EAT (MRE)

a.       Purpose

1.      Replaced the Combat rations (C rations), for troops on the march or when initially setting up camp

b.      Description

1.      Lighter, less bulky and easier for personnel to transport

2.  12 different varieties and Kosher meals

3.  Shelf life is 48 months but may be extended by Army Veterinarians

c.       Storage

1.      Store off the deck on pallets, in shaded area, and stack no more than three pallets high

d.      Inspection of  MRE

1.      Take random sample of oldest stock

2.      Inspect contents on smooth white paper square (36”X36”)

a)      Invert case contents on paper

b)      Rap case sharply to knock out debris or insects

c)      Collect insects for identification

3.      Inspect MRE bag

a)        Check bag for punctures or penetrations

b)        Check bag folds and seams for insect debris or penetration

6. INSULATED FOOD CONTAINERS (VAT CANS)

a.       Purpose:  Used to transport, store, and serve hot and cold foods

b.      Description:

1.      Container made of plastic or metal

2.      Each container has three aluminum inserts with tight fitting covers

c.       Preparation:

1. For hot foods preheat the containers by filling with 2 quarts of water and let stand    

    for 30 minutes

2. For cold foods pre-chill the containers by filling with 2 quarts of ice water or

    crushed ice and let stand for 30 minutes

3. For filling containers, inserts must always be used.  Fill to capacity (5 1/3 liters, 5  

    2/3 quarts).

4. Labeling – include food item, number of servings, and date/time of preparation

        7.  TRAY RATIONS (T-RATS)

a.       Purpose: 

1.  Serves as storage, heating and serving trays for hot and cold food

b.      Description:

1.      The entire heating and serving equipment is transported in the back of a   

High-Mobility Multipurpose Wheeled Vehicle (HMMWV or HUMVEE) with a water bull and 5 ton truck accompanying to carry the tray rations and water

2.      The heating equipment is a large basin of extremely hot water that can heat up 10 hermetically sealed trays in about 30-40 minutes

3.      Each tray has up to 36 servings, depending on product

4.      Included in the equipment are basic food service items like serving utensils, knives, work table for chow line, and a tool kit for the equipment

             c.   Storage:

1.      Can be stored and transported without refrigeration

c.       Inspection:

1.      Take a random sample of stock

2.      Open contents and visually inspect

D.     ETIOLOGICAL CATEGORIES OF FOOD BORNE ILLNESS

1. FOOD BORNE ILLNESS

a.       Definition- Syndromes acquired by the consumption of food contaminated by disease pathogens, microbial toxins, or poisonous chemical substances

b.      Types:

1.      Food borne intoxication:

a)      Chemical poisonings

1)      Arsenic – residue of spray on fruits and vegetables

2)      Cadmium or zinc – a result of dissolved acid foods (tomates)

3)      Insecticides – exposure to food or equipment after spraying operation

4)      Symptoms - Usually occur shortly (1-2 hours) after ingestion

(a)    Violent nausea

(b)    Vomiting

(c)    Diarrhea

5)      Treatment:

(a) Gastric lavage

(b) Respiratory support

(c) Hydration

b)      Food borne poisoning

1)        Source - Toxins produced by infectious agents present in the ingested food that have short incubation periods

2)        Types:

(a)    Staphylococcal intoxication (Enterotoxin)

(1) Foods most commonly implicated are:

  [a] Potato salad

  [b] Custard

  [c] Pies

  [d] Meats, in particular poultry

(2)   Signs / Symptoms:

[a] Abrupt onset in 2-4 hours

[b] Severe nausea

[c] Projectile vomiting

[d] Diarrhea

[e] Prostration with little or no fever

(b)    Clostridium botulinum (Botulism-exotoxin) – food most commonly implicated are home canned low acid foods such as vegetables and fruits improperly processed.

(1)    Symptoms/signs

[a] Onset usually12-48 hours

[b] Blurred vision

[c] Cranial nerve paralysis

[d] Weakness

[e] Headache

[f] Dizziness

[g] Death resulting from respiratory and/or cardiac failure

c)       Natural poison or intoxicants (Shellfish, fish, mushrooms) – natural poisons

       are found within these foods when harvested

(1)    Signs / Symptoms

(a)    Weakness

(b)   Paralysis

(c)    Numbness and tingling of ears

(d)   Apprehension

(e)    Death

(2)    Treatment

(a)    If nausea and vomiting persist, give IV fluids containing salts and dextrose for dehydration and acid/base imbalance

(b)    Remove poison by gastric lavage

NOTE:  Food borne intoxication usually involves the upper gastrointestinal tract and as an intoxication it usually only affects the stomach.  Symptoms are generally local in nature with a rapid onset from 30 minutes to 7 hours.  Symptoms usually subside within 24-36 hours.

2.      Food borne infection

a)      Source - The ingestion of food containing bacteria, viruses, parasites which must multiply within the gastrointestinal tract before causing symptoms

b)      Types – foods most common are meats like hamburger, hash, turkey and seafood mixtures such as lobster and crab

(1)    Salmonella

(2)    Shigella

(3)    Escherechia coli 0157:H7

c)      Symptoms/signs:

(1)    Onset usually 6-24 hours after ingestion

(2)    Fever

(3)    Abdominal pain or distress

(4)    Prostration

(5)    Diarrhea

(6)    Vomiting

d)      Treatment:

(1)    Electrolyte or IV fluid replacement

(2)    Symptomatic therapy

(3)    Antibiotics for bacterial infections (oral or IV depending on severity of symptoms)

NOTE:  Food borne infections usually involve the lower gastrointestinal tract and as an infection, it incurs total body reaction.  Symptoms are systemic, having an onset time after incubation of pathogenic organism.

REFERENCE (S):                                                             

1.  Manual of Preventive Medicine (NAVMED P-5010-1 & 9)

2.  Field Hygiene and Sanitation (FM 21-10)

Field Medical Service School
Camp Pendleton, California

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Operational Medicine 2001
Health Care in Military Settings

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