Army Action Plan: Standard Operating Procedures for In-Processing Medical Evaluation

ntrAnaz HOSPITAL
SOP NO: 637. - GUANTANAMO BAY, CUBA
Tithe IN-PROCESSING.MEDICAL EVALUATION
Page lof4 Effective Date: 24 Sep 63 SCOPE: Detsadon" Hospital
End: (1) In-processing Order Short
• (2) Report of Medical E.xamination
.L BACKGROUND. Detainees arrive from highly endemic areas for infectious diseases inchaditignibettadosis, =Ma, and parasitic Infections. This section provides a detailed description of the medical screening and treatment for incoming detainees.
IL POLICY. Treatment add care provided will be limna and will follow the guidelines provided by the articles of the Geneva Convention. Specifically, each detainee will undergo screening and nutmeat fofdiseases common to the Middle East region.
k
[IL GENERAL PROCEDURES:
A. Upon arrival to Camp Delta, each detainee will be searched, showered,
and
administratively processed. Hair may or may not have been cut prior to transfer to Guantanamo Bay, thus a hair inspection for lice will be completed. Treatment for cutaneous infestations will be administered as needed. aodtht& which has beenpre-treated with pennednin, will be issued.
1 t B. Each detainee will be brought into the medical clinic individually accompanied by a security force escort team. The specific order of detainees will be based on triage performed prior to administrative in processing. Detainees will be placed in a higher triage category if their
ii.
condition deteriorates prior to arrival at medical.
I ...
$. C. The detainee will receive a pre-made medical record with the following forms: Report ofMedical Examination (see enclosure I), SF U, SF 508, SF 600, SF 601, SF 603, DA 2664-R,
-,, NAVMED 6150120, and DA
,.. Form 4237-R. A CHCS medical record number will be assignedbeginning with 11118-0X-3000C. The name will be recorded as D, JTF70000C. The patient
..: category will be 1(66.
D. A history and physical examination will be recorded on the Report of Medical Examination on enclosure (1). The physical exam serves both as a general screening exam ends confinement physical. A separate record of body weight including body mass index calculation will also be maintained (DA 2664-R), Please refer to weight management and nutrition program
(SOP 014).
•***.0 S (bI
E. Psychiatric screening during the initial medical examination will include:
t. Previous psychiatric treatment (diagnosis, phermuotherapy, psychotherapy)
2.
Previous suicidal attempts or serious suicidal intention/plan.

3.
Previous self-mutilation/ 'elf-injurious behaviors

4.
Previous homicidal or assaultive behaviors.

5.
History of substance dependence/abuse,

6.
Current suicidal/ homicidal ideation, emotional distress or odd behavior.

7.
A psychiatric team member will immediately triage any detainee Resenting with

suicidal or homicidal ideation, emotional distress or odd behavior during the in-processing evolution.
g.
Detainees who endorse any of the items listed above will be referred to Psychiatric Services via a coosuk for more in depth 'autumnal within the week.

F.
A dental examination form (SF 603) will be kept within the medical record but a detailed dental examination will not be performed at the time of in processing. Those presenting with a dental issue will be added to the dental list and evaluated in a prioritized manner.

G.
Detainees with a visual complaint will be 'created for vis al acuity and referred for optometry consultation. •

H.
Immunizations administered will include Td (tetanus-diphtheria), MMR (measles, mumps, rubella), and influenza vaccines to all detainees. Those with tetanus-prone wounds may also receive 110 (tetanus immunoglobulin) as per SOP # 024.

I.
Laboratories obtained include a Hepatitis A 101, Hepatitis B surface antigen (HbSAg), Hepatitis B surface antibody (HbSAb), Hepatitis B core antibody (HbCAb), Hepatitis C serology. HIV ELISA and malaria smears. The malaria smears will be screened at NH GTMO, and results confirmed at NH Portsmouth. An extra se= sample will be drawn and held for

future me.
J. Each detainee will receive a screening chest X-ray and a PPD to assess for signs of
$ tuberculosis (See SOP's #002 and 031). Repeat positive PPD will not need to be performed if previously documented on the transfer =unary.
f.K. Left hand and wrist radiographs will be obtained after approval by the JTF Surgeon on new detainees meeting the following two criteria:
1. The detainee states his/her age is less than 16 years, end$' 2. Based on the physical examination, the detainee has clinical characteristics that
... suggest that he/she is kiss t han 16 years of age.
3. Regarding the clinical findings, each health care provider performing
.,• * physical examinations will be provided, with a copy of the Tanner staging to animate thedetainee's maturity. It is
recognized chat the Tanner staging provides a clinical measure of age
between
%
9 and 15 years and that clinical finding of sexual maturity are quite uniform above the
..
::. age of 15 years. It is also recognized that Termer staging assumes genetic, raciaLand nutritional background similar to the study group that this staging was based on, and that endocrineabnormalides may influence the time of causation.
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4. Bone radiographs obtained will be digitally forwarded to the AFJP for reading using the Grounds and Pyle standards of bone age determinadon.
L Each detainee will receive empiric treatment for intestinal heiminthes (albendazole 400
mg once) and malaria (melloquine 1250 mg, split into 2 doses). Please refer to SOP 030 for
deans.
M. Upon completion of the above, treat:neat of any condition requiring immediate attention
will be addressed.
A.

0050i.;S

STANDARD OPERATING PROCEDURES Detention Hospital•
Ana Day, Oka
REVIEWED ANAPPRO BY:

'ammulRli)
Officer InChinge .

Date IMPLEMENTED BY: Director for Administration MOW *him,
Oslo
ANNUM REVIEW LOG:
BY:

Dam:

BY:
Date:

Br
Date:By; Dote:

V._

Date:
BY: Date:
BOP REVISION LOG: .
Revision to hoc

Date:Revision to Page: Date:Revision to Page: Date:Revision to Page: Date:Revision to Page: Dale:Revision to Page:"

Date: ENTIRE SOP SUPERSEDED BY:
SOP NO:
Date:

005(ti.46

Ag2, Maim Dapartmwt
(updated 24 September 2003//sed)

AUSUERRIEBOMERSUBRIERIMIDIMmtim
I. Mefloquine 750 mg PO now, SOO mg PO in 12 hours
2.
Albeadole 400mg PO once

3.
Chest Xray: PA

-
4.
Hap A 180
Hep B =Trace Badmen and antibody
Hap El Com antibody
Hap C
HIV

Malaria Smear (poem= NAVHOSP CITMO woo io nal PosomullySarum (draw 1 extra red top)
Immisftdira
I. Td ..5n1 1M once
2.
PPD — read in 4$ to 72 howl

3.
Influenza 0.5 ml IM once

4.
MMR 0.S ml SC once
Cussaks: (cIrcie as needed)
Needs reeling gimes? Y or N
Ootomeoy
General Surgery
Psvehidric Services

Orthopedic-Surgery
Denial

Addltiaaal Orders On* If ladIcated
I. APB Smear O AM x 3
2. If

may be .5 16 years old: confer with JTF Surgeon for approval to
Obtain Left nand i wrist x-rays for bone age determination.

Staff Signature:

Provider:

PATIENT'S IDENTIFICATION /Use this spacefor Mechanical imprint)
'Nod Fors o hoo SI400

NAME:
SSN:
STATUS:
. DOB:

Standing Orders far routine melt all eamplainb at Camp Delta Clinie.
The following medications may be dispensed by MC or HM Corps Staff at Camp Delta Clinic. * ZMPOICAMT. Consult 141 if detainee requires Rom than 4 doses in a 1 meek period.
Complaints of minor aches, plink headache:
*Tylenol (acetaminophen) 650 mg or SOOmg PO q 4.61w PRN
cosaiindigikagfaudint Impaired liver or renal fbnction, caution if O6PD deficiency.

Complaints of heartburn, indigestion.
'Mylanta (aluminum hydroxide/magnesium hydroxide)l5 — 30 ml PO q 4 hr PRN

Complaints of rhinorrhea , sneezing, watery eyes, itchy rashes.
Benadryl (diphenhydramine) 2S — SO mg PO q 6 hr PRN
CAggiggikolgstszokm acute asthma, CV disease. increased 10P

Complaints of moderate pain, headache:
*Motrin (ibuprofen) 400 mg — SOO tog PO T7D PRN
calgojagglagesaiglagv.fix of ulcers/UOI bleed, HTN, kidney Alain

Complaints of foot tinea pedis (athlete's foot), tines cruris (jock itch)
Tinactin (tohtafate) 1% cream topical AAA BID x 2 weeks do net repeat 2 weeks without
consulting the M. 0.

Complaints of nasal congestion.
*Sudafed (pseudoephedrine) 30 — 60 mg PO QID PRN

rdadatilditakillefillid311: MX CAD, Diabetes.
Complaints of mote throat.
'elma Lozenges dissolve 1 lozenge in mouth q 4.6 howl PRN

Complaints of inflamed itchy rashes, inflamed bug bites:
Hydrocortisone Topical 1% Cream. Apply to affected area 3 times a day, X 2 weeks

Complaints of heanbum, acid indigestion, occasional constipation.
*Milk of Mm pusda As antacid — I — 3 teaspoons (with water) up to 4 times/day

As laxative — 2 — 4 teaspoons (with Boz of water) Complaints of sere muscles/ body aches. *Bengay (Analgesic Bohn) Apply to affected area 3 times a day for 7 days.
Complaints of flaky, itchy scalp.
Seism Shampoo, small amount to hair then rinse after 15 minutes, no more than twice per week.

MO Signature

Staff SignatureDETAINEE IDENTIFICATION:
typed Toes ke lleu of 87...11:4111. PMV4 sol
ISN:

00:50;s 8

DATE OP MAI

MEDICAL RECORD Report of Medical Examination
I. LAST IlA0414113IT NAAISAMIOLII NAAR
3. ISIID111311CA1ION NUMMI

3. COUP/MY Of MTH A ALII I. SIX
0MALE cJ FEMALE

I.•fl.•.•1••/.1..,
-1, —• • , I.•.•1' r•IT•e

History of Present Illness
Currendy haverever had: (pleanr drde, Jean Mai (/eskaown)
Asthma Yee Diabetes Yes Hart Disease Yes Hepatitis Yee HIV Yes Other
No Hyperlipidemia YesNo Hypes nasion Yoe No Weds Yes No Mental Meer Yee No Renal Mame Yee Taboo:Wools Yes

Ever Berm Hospitalised? No Yes_, &phut
Current Health: Good Fir Any special lwahh requirements? No Yea list
Current Medic:Mor(s):
Known allergies $o methendon(s):
Other Alieliost
Chemical Deettodume? (alcohol. drugs)

Tobacco use? No Yes , amount

Do you have any pain? No Yes WY= Where Now ohm does it ma?
No No No . No No
No
Transfer PM) resale: Negative_. Positive
(rlumbly of mat)
Transfer CXR No mate creme . Abnormal
Cameras:
Family Mabry oft (pAsne drde. knee Monk resksems)
Asthma Yes No Queer Yes No Debsies Yes No Hem Dhow Yes No Oder:

Hepatitis Yes No Hyperlipideatia Yes No Hypermodern Yes No Memel Einem Vat No Renal Dimes Yes No
Review of Systems Do you moorhens auy Ode laliewlags (please circle) General: kw chthe night roam weight lose
Skin: rash skin discoloration Reppimoxy: mash duration?
hammy& sputum Cardiovascular cheat pain Ciestrothieinal: naso vomiting abdominal pan diarrhea
Nemeth*: headache edam dizziness Psychidric: suicidablemicidd tendencies hallucinations Commas:

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PHYSICAL EVALUATION
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