Instructions for protecting detainees and soldiers from lice, ticks, etc.
?MO 'JOT-THE -PgoPoa/or
DEPARTMENT OF THE ARMY
THIRD MEDICAL COMMAND (FORWARD)
MEDICAL SUPPORT OPERATIONS
CAMP DOHA, KUWAIT
AFRC-MCGA-FWD
MEMORANDUM FOR: ARCENT Force Health Protection Officer
THRU: DCS Med Spt Ops, 3d MedCom
SUBJECT: Inspection and Treatment of Detainees for Lice
1. References:
a. Technical Information Manual No. 6, Armed Forces Pest
Management Board, Delousing Procedures for the Control of
Louse-borne Disease During Contingency Operations
(http://www.acq.osd.mil/afpmb/coweb/guidance targets/tech pest
guide s/TIM6/TIM6.pdf ).
b. AR 190-8, Enemy Prisoners of War, Retained Personnel, Civilian Internees and Other Detainees, 1 Nov 1997. (Paragraph 66 relates to civilian internees and states that the medical officer is responsible for detecting vermin infestation and controlling communicable diseases.)
2. Background: Lice are a common problem among displaced persons and detainees. Two of the kinds of lice, head lice and crab lice, are significant nuisances because of their bites and the consequent itching, but they do not transmit any infectious diseases. These species easily move from infested to non-infested people during direct contact or when articles of clothing are exchanged. The third species of human louse, the body louse, is much more dangerous. It transmits three significant diseases: epidemic typhus, relapsing fever, and trench fever. Epidemic Bypithesalsliefit eainfla tesla liaft Irma yelat etci eaartd di psi tin lricsinone ofi al precciarritrsgclirspreopiasilbey eaphalcaiibca.1 professional (head and crab louse treatment is a medical, not entomological, function). InfesLed individuals should be isolated from the rest of the detained population until they are free from lice. Otherwise, there is the danger that the infestation will spread while detainees are awaiting treatment.
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4. Unlike the other two species of human lice, the body louse spends most of its time in the patient's clothing. It lays eggs in seams. As a result, treatment of the human body does not end an
infestation.
5. If possible, a non-governmental organization (NGO) should be used to delouse detainees. If this task cannot be performed by an NGO, the procedure for controlling body lice in a population of detainees is as follows:
a. STEP 1: Screen detainees for lice before they enter the
facility. (Initial instruction may require the services of a
professional entomologist).
b.
STEP 2: Without separating family members, isolate infested individuals.
c.
STEP 3: Evaluate infested individuals for disease, including designating them for 30 days
of observation. People may show no signs or symptoms of louse-borne disease for 30 days afterinitial infection.
d.
STEP 4: Have the infested detainees strip, placing all clothing and bedding in their possession in a labeled bag. The detainees should then bathe thoroughly with soap and shampoo. When bathing is completed, they should be given fresh, clean clothes or a disposable coverall.
e.
STEP 5: Lice in the clothing and bedding must be killed. This may be accomplished by
any of the following methods:
(1)
Treatment of outer clothing with permethrin, only if the outer clothing is field
clothing worn over undershirt and underwear (ENC).
(2)
Wash bedding and clothing at least 15 minutes at a temperature of at least 130 °F (54°C). This temperature may not be suitable for woolen clothing, which should be washed at a lower temperature not lethal to lice. Lice in woolen clothing should be killed with method (4) or (5).
(3) Dry clothing for 15 minutes at a temperature of at least 140 °F (60°C).
(4)
Place in heated room for at least one hour at 158 °F (70°C). Clothing and bedding must be hung up and not packed tightly so that hot air can circulate freely through the cloth.
(5) Dry clean.
(6)
Immerse clothing and bedding in water at a temperature of at least 130 °F (54°C),agitating for 15 minutes.
(7)
Return louse-free clothing to detainees and direct them to an area of the facility with no louse-infested individuals. Louse-borne infections are not directly contagious between people except when lice are present, therefore it is safe for those under medical treatment to return to areas with other detainees.
6. Safety measures for personnel exposed to louse-infested detainees. Personnel examining detainees for lice or working with infested clothing need to protect themselves from louse infestation and typhus infection (possible from direct inhalation of louse parts or louse feces). The
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following safety measures should be used: wear latex gloves, wear a disposable respirator (surgical mask), use the DoD repellent system (topical DEET repellent on exposed skin and permethrin treated clothing, ENC), perform self checks for lice, and be alert for febrile symptoms typical of louse-borne diseases.
ENC PPM Guidance. COL, MS Theater Entomologist
ENC 1
Guidance for Personal Protective Measures Against Arthropods in Enduring Freedom Theater
General
Individual soldiers can avoid most bites from mosquitoes, sand flies, ticks, and other biting arthropods by using a combination of four techniques: application of topical repellent on exposed skin, application of permethrin on fabric, wearing thquniform properly (sleeves down, trousers bloused into boots), an sleeping under a bed net. See Guide to Staying Healthy, CHPPM GTA 03-05-062 ReUtvo/rhylwIti °Eta WI Nax hate. aisiti/rcensi-Itioi fin Eli .Mg ta/D &-nlE-0)1512dg t a08-05-016f21thicbf Military Significance, AFPMB Technical Information Memorandum #36 (http://www.acq.osd.mil/afpmb/coweb/guidance targets/ppms/TIM36/DoD Ins Repel Sys).
Products
Topical repellent:
Insect Repellent, personal application (3M7/EPA 58007-1), 33% DEET, 12 2-oz, NSN 6840-01-284-3982
Permethrin for fabric:
Insect repellent, clothing application, 40% permethrin (IDA), 12 kits/box, NSN 6840-01-345-0237 Insect repellent, clothing application, aerosol, 0.5% permethrin (Permethrin Arthropod Repellent), 12 6-oz cans/box, NSN Facto6)S-40(901e2713elsI16 Battle Dress Uniforms:
R
4 . Al5 9
TIM No. 36
October 10. 2c0 1
BDU Type XI: Insect Repellent Treated De:seri Cumuttliage BDIJs
.
TROUSERS C0.4 7'
SIZE-LENGTII NSN XS-XS 8415-01-453-2860 XS-XS 8415-01-453-1348 XS-S 8415-01-453-3008 XS-S
8415-01453-1393 XS-R 8415-01453-3035 XS-R
8415.01-453-1435 XS-L 8415-01453-3045 XS-L
8415-01-453-1454 S-XS 8415-01453-3209 S-XXS 8415-01-453.1478 S-S 8415-01453-3219
S-XS 8415-01-453-1496 S-R
8415-01453-3226 S-S 8415-01-453-2034 S-L
8415-01453-3239 S-R 8415-01-453-2036 M-XS 8415-01-453-3290 S-I. 8415-01-453-2047 M-S 8415-01-453-3306 S-XL
8415-01-453-2054 M-R 8415-01-453-3313
3r1-XXS 8415-01453-2128 M-L 8415.01-453-3318 M-XS 8415-01-453-2135 M-XL
8415-01453-3322 M-S 8415-01-453-2153 M-XXL 8415-01-453-3333 1+1-R 8415-01-453-2179
L-S 8415-01453-3340 M-L 8415-01-453.2298 L-1 8415-01453-3347 i-XL 8415-01-453-2301 L-L 8415-01-453-3354
'4-XXL 841 5-01 453-24 72 L-XL 8415-01-453-3762
L-XS 8415-01453-2482 L-XXL 8415-01453-3824
L-S 8415-01-453-2547 XL-S 8415-01.453-3863
L-R 8415-01-453-2577 XL-R 8415-01453-3869 14, 8415-01453-2619 XL-L 8415-01453-3873 L-XL
8415-01-453-2628 XL-XL 8415-01-453-3998 L-X XL
8415.01-453-2636 XL-XXL 8415-01453-4024
XL-S 8415-01-453-2821 XL-R 8415-01453-2832 XL-L 8415-01-453-2855
Bed net
Insect net protector, cot type, EA, NSN 7210-00-266-9736 Poles, folding cot, insect net protector, 4 poles/set, NSN 7210-00267-5641
Product Use
Topical repellent: To be used on exposed skin according to label instructions when there is a danger of insect, chigger, or
Permetliciii 1bl-1:fabric: To repel flying insects from the uniform and to prevent ticks and chiggers from biting. Duration of permethrin in the BDU is greatest for factory-treated uniforms (six months), next best for Individual Dynamic Absorption (IDA) treated uniforms (three to six months), and least for spray-can treated uniforms (three to six launderings). Before entering tick or chigger-infested areas, the outer part of the boot, socks, and lower trousers may be sprayed lightly with permethrin to provide extra protection.
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Bed nets: To be used when sleeping to prevent bites from flying insects. On a cot, the net may be supported by poles and tucked under the sleeping bag to provide a complete barrier. On the ground or in a bed, the net may be suspended from its four corners using string attached to trees or household objects. The bottom of the net must be tucked under bedclothes, mattress or sleeping bag to
Distriblirttomv6airuniiieosirpiaittih dleivkimEnt)
In CONUS prior to deployment
For each soldier Procure factory-treated uniforms or treat all uniforms with IDA Issuelgit.least one tube of topical repellent to each soldier. Issue additional tube of topical repellent for each month that
soldier will be deployed in an area with mean monthly Issue tlrenipteetltarrd p6161 °F or greater.
In EF Theater
For each soldier deployed without repellent, permethrin-treated Treat tudifonifernas lmidlinIEDA kits
OR treat all uniforms with permethrin spray-can, once each IssuetaNtdernehtinse tube of topical repellent to each soldier. Issue additional tube of topical repellent for each month that
soldier will be deployed in an area with mean monthly Issuethrettlpteetitami pifilfeGe.F or greater.
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