tbmed577.pdf

TB MED 577

TECHNICAL BULLETIN

SANITARY CONTROL AND SURVEILLANCE

OF FIELD WATER SUPPLIES

APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED.

HEADQUARTERS, DEPARTMENT OF THE ARMY

December 2005

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TECHNICAL BULLETIN HEADQUARTERS

MEDICAL 577* DEPARTMENT OF THE ARMY

Washington, DC, 15 December 2005

SANITARY CONTROL AND SURVEILLANCE OF FIELD WATER SUPPLIES

Paragraph Page Chapter 1 INTRODUCTION Purpose 1–1 1 References 1–2 1 Explanation of abbreviations and terms 1–3 1 Applicability 1–4 1 Technical assistance 1–5 1 Provisions 1–6 3

Chapter 2 ROLES AND PROCEDURES Overview 2–1 5 Background 2–2 5 Roles 2–3 6 Preventive medicine levels of field water support 2–4 8 Preventive medicine support to field water mission through the operational cycle 2–5 8

*This bulletin supersedes TB MED 577, dated 9 November 2005.

You can help to improve this bulletin. If you find any mistakes or have a recommendation to improve procedures, please let us know. Mail a memorandum or DA Form 2028 (Recommended Changes to Publication and Blank Forms) directly to Office of The Surgeon General, ATTN: DASG-PPM-NC, 5111 Leesburg Pike, Falls Church, VA 22041-3258.

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Chapter 3 INTRODUCTION TO FIELD DRINKING WATER General 3–1 13 Field water terms and concepts 3–2 13 Field water sources 3–3 14 Field water discipline 3–4 16 Uses for potable and nonpotable water 3–5 17

Chapter 4 PREDEPLOYMENT PLANNING AND

PREPARATION

General 4–1 19 Predeployment planning 4–2 19 Predeployment preparation 4–3 20

Chapter 5 WATER SOURCE SELECTION AND BASIC

TESTING FOR POTABILITY

General 5–1 23 Water source reconnaissance surveys 5–2 23 Raw water source—basic characterization testing 5–3 25 Treated water—basic potability testing 5–4 26 Chemical agent testing 5–5 27 Documenting, reporting, and archiving 5–6 28

Chapter 6 ADVANCED WATER SURVEILLANCE

AND TESTING

General 6–1 29 Environmental baseline survey 6–2 29 Environmental health site assessment 6–3 30 Advanced water surveillance monitoring and advanced water testing 6–4 31 Advanced water testing procedures 6–5 31 Use of advanced water testing results 6–6 33

Chapter 7 EVALUATION OF FIELD TESTS AND

ANALYTICAL RESULTS (HEALTH

GUIDELINES)

General 7–1 35 Department of Defense tri-Service field water standards 7–2 35 Other standards 7–3 36 Military exposure guidelines 7–4 37 iii

Force health protection and operational risk management 7–5 38 Risk management options 7-6 39 Documentation and reporting of risk assessments 7-7 40

Chapter 8 PREVENTIVE MEDICINE INSPECTIONS

AND REPORTING

Section I Preventive Medicine Inspection Program General 8-1 43 Garrison inspections 8-2 43 Field inspections 8-3 43 Section II Preventive Medicine Inspection Criteria General 8-4 44 Site conditions 8-5 44 Reverse osmosis-based water purification system operations inspections 8-6 45 Monitoring, storage, and distribution inspections 8-7 45 Potable water containers 8-8 46 Water trailer inspections 8-9 47 Tank truck inspections 8-10 47 Fabric water tank and drum inspections 8-11 48 Water trailer location and dry distribution point inspections 8-12 48 Shower and decontamination point inspections 8-13 48 Recordkeeping and supply storage 8-14 49

Chapter 9 WATER TREATMENT AND DISINFECTION Section I Water Treatment General 9-1 51 Overview 9-2 51 Reverse osmosis-based water purification systems 9-3 51 Emergency water treatment—individual devices 9-4 55 Section II Disinfection General 9-5 55 Disinfectants and disinfection procedures 9-6 56 Chlorine residual requirements 9-7 57 Chlorine residual measurements frequencies 9-8 58 Section III Individual/Emergency Disinfectants General 9-9 58 iv

Chapter 10 DISTRIBUTION AND STORAGE EQUIPMENT

OPERATION AND MAINTENANCE

Storage and distribution 10-1 63 Equipment cleaning, sanitizing, and decontamination 10-2 65 Chemical, biological, radiological, nuclear, and explosives decontamination of equipment 10-3 68

Chapter 11 MANAGEMENT OF WASTE FROM FIELD

WATER OPERATIONS

General 11-1 71 Disposal of wastewater 11-2 72 Disposal of solid wastes, spent ultra filter, micro filter, and reverse osmosis membranes, and cartridge filters in a non-chemical, biological, radiological, nuclear, and explosives environment 11-3 76 Disposal of chemical, biological, radiological, nuclear, and explosives-contaminated wastes 11-4 76

Appendix A. References 79 Appendix B. Drinking Water Standards and Recommended Monitoring Frequencies 89 Appendix C. Use of Bottled and Packaged Water for Deployment 93 Appendix D. Predeployment Planning: Preventive Medicine Estimate Checklist for Drinking Water 103 Appendix E. Field Water System Vulnerability Assessments 107 Appendix F. Field Water Quality Test Kits, Sampling Procedures, and Documentation 125 Appendix G. Water Quality Information and Health Effects 129 Appendix H. Reverse Osmosis Membrane Removal Capabilities 157 Appendix I. Chlorine Dosage Calculations and Measurements 163

Glossary 167 v

List of Tables

Number Title Page

1-1 Support labs and consultative resources 2 2-1 Levels of PVNTMED support to field water operations 10 3-1 Acceptable uses for different quality water 18 5-1 Water source reconnaissance considerations 25 5-2 Frequency of chemical warfare agent and radioactivity testing according to threat and MOPP levels 28 7-1 Risk assessment matrix 39 7-2 Example criteria for assigning confidence levels 40 7-3 Risk management strategies 41 10-1 Requirements to make 5 gal of water with an FAC of approximately 100 mg/L (assuming no chlorine demand) 67 10-2 Requirements to make 400 gal of water with an FAC of approximately 100 mg/L (assuming no chlorine demand) 67 10-3 Nomenclature for ordering equipment cleaning and sanitizing supplies 68 10-4 Surface areas of selected equipment 69 10-5 Volume of dry HTH required to make a 5 percent (50,000 mg/L) bleach solution in different volumes of water, and the area each volume will decontaminate 70 11-1 Wastewater production guidelines for various RO water treatment systems 73 B-1 Basic water quality surveillance parameters and field equipment capabilities 90 B-2 DOD and international military potable field water quality standards 91 B-3 Water surveillance monitoring parameters and recommended frequencies 92 C-1 Evaluation of the risk of soldier illnesses from ingesting microbiologically contaminated bottled drinking water 101 E-1 Typical target field water system components 110 E-2 Examples of physical and operational security measures that may be employed at various locations in field and semifixed water systems 112 E-3 Hazard probability estimates 115 E-4 Severity rating table 116 G-1 Recommended standards for radionuclides in military field water supplies for wartime or emergency operations 153 G-2 Recommended standards for only tritium (H-3) in military field water supplies for wartime or emergency operations 154 G-3 Recommended standards for radionuclides in military field water supplies for support and stability operations regardless of consumption rate 155 vi

G-4 Committed effective dose as a function of consumption rate at the concentrations listed in table G-3 155 H-1 Rejection of salts by a typical ROM 158 H-2 Rejection of heavy metal salts by typical ROMs 159 H-3 Rejection of some organic chemicals by typical ROMs 160 H-4 Rejection of CBRNE agents by RO 161 I-1 Rounded-up volumes of 5 percent liquid bleach that will provide approximately the indicated chlorine dose when added to the listed volume of water 163 I-2 Volumes of 70 percent available chlorine HTH (or solution concentrate) that will provide approximately the indicated chlorine dose when added to the listed volume of water 164 I-3 Equivalent volumes 165 I-4 Common fractions and their decimal equivalents 165

List of Figures

2-1 Levels of PVNTMED support 9 9-1 Lightweight water purifier or TWPS water flow diagram 53 9-2 600-gph ROWPU water flow diagram 54 C-1 Risk levels associated with the factors involved in a bottled water microbiological contamination event 101 E-1 DA Form 7575, FWSVA Worksheet 113 E-2 Relating hazard probability and severity to overall risk 117 E-3 DA Form 7576, FWSVA Summary Data Sheet 118 G-1 Health-effects summary for turbidity with color absent (= zero) and threshold odor number equal to three 130 G-2 Health-effects summary for color with turbidity absent (= zero) and threshold odor number equal to three 132 G-3 Health-effects summary for TDS 133 G-4 Health effects summary for BZ 140 G-5 Health-effects summary for chloride 141 G-6 Health-effects summary for cyanide and hydrogen cyanide 143 G-7 Health-effects summary for arsenic 144 G-8 Health-effects summary for lewisite 145 vii

G-9 Health-effects summary for lindane 147 G-10 Health-effects summary for magnesium 148 G-11 Health-effects summary for organophosphorus (OP) nerve agents 150 G-12 Health-effects summary for sulfate 151 G-13 Health-effects summary for trichothecene mycotoxin, T-2 152 viii

CHAPTER 1

INTRODUCTION

1-1. Purpose

a. This publication provides detailed technical guidance and recommendations for the sanitary control and surveillance of land-based field water support. The guidance and recommendations will help ensure field water supplies are potable in order to protect and enhance the health and performance of the warfighter.

b. This publication—

(1) Establishes field water quality standards.

(2) Describes the process for water potability certification.

(3) Describes water quality surveillance requirements.

(4) Defines preventive medicine (PVNTMED) roles and actions in field water support.

(5) Defines additional non-PVNTMED roles and actions related to the sanitary control and surveillance of field water support.

(6) Provides guidance on the management of wastes associated with the purification of field water.

(7) Provides guidance for maintaining water discipline.

1-2. References Required and related publications and prescribed and referenced forms are listed in appendix A.

1-3. Explanation of abbreviations and terms The glossary contains a list of abbreviations and terms used in this publication.

1-4. Applicability This publication—

a. Applies to the Active Army, U.S. Army Reserve, and Army National Guard and addresses pertinent requirements identified in Joint Chiefs of Staff (JCS) Memorandum MCM–0006–02.

b. Applies to military and civilian personnel concerned with the location, purification, distribution, vulnerability, sanitary control, and surveillance of field water supplies, particularly those intended for consumptive and sanitation uses.

c. Applies to all phases of deployments and training exercises to ensure that water purified in the field for human consumption and other uses is of the best possible quality.

1-5. Technical assistance Requests for technical assistance related to topics addressed in this technical bulletin (medical) (TB MED) should be forwarded through command channels. Table 1–1 lists multiservice organizations and laboratories that can provide additional technical support.

Table 1–1 Support labs and consultative resources Consultative and laboratory services support USACHPPM-Main (Consultation) Water Supply Management Program Aberdeen Proving Ground (APG), MD 21010–5403 Defense Switched Network (DSN) (312) 584–3919;

Commercial (410) 436–3919 http://chppm-www.apgea.army.mil/dehe/pgm31/ Deployment Health: DSN 584–6096 http://chppm-www.apgea.army.mil/desp/

USACHPPM-Europe

CMR 402

APO AE 09180

011–49–6371–86–8084

DSN (314) 486–8084

USACHPPM-Main (Laboratory) Directorate of Laboratory Services

APG, MD 21010–5403

DSN (312) 584–3919; Comm (410) 436–2306

USACHPPM-North Fort George Meade, MD 20755–5225 DSN (312) 923–6502; Comm (301) 677–6502

USACHPPM-West Fort Lewis, WA 98433–9500 DSN (312) 347–8447; Comm (253) 966–8447

USACHPPM-South Fort McPherson, GA 30330–5000 DSN (312) 588–3332; Comm (404) 464–3332

Air Force Detachment 3 Unit 5213 Kadena Air Base

APO AP 96368–5213

DSN (315) 634–1769

Air Force Institute for Operational Health 2402 E Drive Brooks City-Base, TX 78235–5114 DSN (312) 240–3626; Comm (210) 536–3626

USACHPPM-Pacific Unit 45006, Camp Zama, Japan

APO AP 96343–5006

DSN (315) 263–8597

Navy Environmental and Preventive Medicine Unit

(NEPMU)–2

1887 Powhatan St, Norfolk, VA 23511–3394 DSN (312) 564–7671; Comm (757) 444–7671

NEPMU–6

Pearl Harbor, HI 96860 DSN (315) 473–0555; Comm (808) 473–0555 e-mail: PostOffice@nepmu6.med.navy.mil

NEPMU–5

3235 Albacore Alley San Diego, CA 92136–5199 DSN (312) 526; Comm (619) 556–7070 e-mail: nepmu5@nepmu5.med.navy.mil

Navy Environmental Health Center (NEHC) 620 John Paul Jones Cir, Ste 1100 Portsmouth, VA 23708–2103 DSN (312) 377–0700; Comm (757) 953–0700;

After hours (757) 621–1967

NEPMU–7

PSC 825, Box 295, Sicily

FPO AE 09627–2003

nepmu7@nepmu7.sicily.navy.mil DSN (314) 624–9252; Comm 011–39–095–86–9251

Intel consults/support Logistics Armed Forces Medical Intelligence Center (AFMIC) Tech support: DSN 343–2181; Comm (301) 619–2181 Policies or content: DSN 343–7574; Comm (301) 619– http://mic.afmic.detrick.army.mil/ e-mail: support @ afmic.detrick.army.mil e-mail: afmicops@afmic.detrick.army.mil

U.S. Army Quartermaster Fort Lee, VA 23801 Operations, Petroleum and Water Dept.

DSN (312) 687–2788; Comm (804) 734–2788 pwdweb@lee.army.mil http://www.quartermaster.army.mil/

Additional information sources U.S. Environmental Protection Agency (EPA)—Ground Water & Drinking Water http://www.epa.gov/safewater/

World Health Organization (WHO) http://www.who.int/water_sanitation_health/en/

1-6. Provisions This publication is subject to four international agreements:

a. North Atlantic Treaty Organization (NATO) Standardization Agreement (STANAG) 2136.

b. STANAG 2885.

c. STANAG 2473.

d. Quadripartite (American-British-Canadian-Australian Armies) Standardization Agreement

(QSTAG) 245.

When an amendment, revision, or cancellation of this publication is proposed that will affect or violate one or more of these agreements, the preparing activity will take proper action through international standardization channels.

Use of trademarked names does not imply endorsement by the U.S. Army but is intended only to assist in identification of a specific product.

CHAPTER 2

ROLES AND PROCEDURES

2-1. Overview This chapter describes the roles of PVNTMED and other units and personnel with respect to field drinking water, and the procedures they must follow to ensure the potability of drinking water provided for deployed forces. It also describes the employment and capabilities of PVNTMED personnel during military operations, and outlines specific tasks they must perform to successfully meet their field water mission responsibilities.

2-2. Background

a. Disease and nonbattle injury (DNBI). Military history has demonstrated that more soldiers become injured or ill from DNBI than from combat losses, and that these nonbattle losses play a significant role in the outcome of military operations. PVNTMED practices, when supported by command emphasis, are the most effective and least expensive means of reducing DNBI and maximizing the fighting strength.

b. Water support mission and DNBI. The water support mission is a key component of sustaining forces on the battlefield. The lack of adequate quantities of potable water can produce significant numbers of casualties far more quickly than the lack of food, rest, combat stress, or operational stress. Providing adequate quantities of potable water to deployed forces is critical to maintaining the health and readiness of those forces. If the water support mission is not properly executed, DNBI numbers will increase because of illness and performance degradation caused by either poor water quality or dehydration. Dehydration is one of the greatest nonbattle threats to combat force superiority. Physical work, environmental stress, clothing, and equipment all increase body water losses (BWL) and can lead to dehydration. Modest dehydration (less than 2 percent BWL) degrades physical and mental performance, while larger deficits can be catastrophic.

c. Force health protection (FHP). Recent FHP policies expand DNBI considerations to address additional causes of acute health effects as well as those that can cause delayed or long-term health consequences. Specifically, commanders are now required to ensure that all occupational and environmental health (OEH) hazards, including those that cause DNBI, are identified, assessed, and mitigated to the extent feasible using operational risk management (ORM) decision-making tools. PVNTMED personnel must advise and provide recommendations to commanders to help them evaluate the risks associated with the water support mission and make the best risk management decisions. PVNTMED personnel provide this support at all levels of command and through all phases of the operational cycle.

d. Water discipline. Commanders and leaders must make decisions that will affect DNBI using ORM. They are the most significant factors in the adequate hydration of their personnel and the prevention of dehydration casualties. They are the principal advocates of hydration discipline, ensuring that adequate supplies of potable water are available and consumed by their personnel.

2-3. Roles The following roles support the sanitary control and surveillance of the field water supplies as part of the water support mission for deployed forces.

a. Commanders at all levels will—

(1) Plan for the sanitary control and surveillance of field water supplies in support of the operational mission.

(2) Protect water inventories from contamination.

(3) Maximize the use of type-classified tactical water treatment, storage, and distribution equipment.

(4) Use tactical water concepts for command post and other training exercises.

(5) Establish and enforce water use discipline.

(6) Ensure, when nonmilitary issue, commercial unit-level or individual water purifiers must be used for atypical missions or emergency water supplies, that such devices are as far as possible Army-approved and determined by the Army Surgeon General to meet Army field drinking water performance standards.

(7) Ensure that unit field sanitation teams (FSTs) are trained, equipped, and employed according to FM 4–25.12, to conduct routine inspections of unit water containers and trailers, daily checks of unit water supplies for chlorine residual, and, when necessary, disinfection (rechlorination) of unit water supplies.

(8) Inform, motivate, train, and equip subordinates, and work closely with PVNTMED personnel to minimize DNBI resulting from dehydration, drinking contaminated water, and poor personal and unit sanitation and hygiene practices.

(9) Use appropriate ORM methods (see FM 100–14 and FM 3–100.12/MCRP 5–12.1C/ NTTP 5–03.5/AFTTP(I) 3–2.34) to integrate water supply-related health risk information into overall mission planning and execution.

(10) Ensure that all results from chemical and microbiological analyses of field water samples are documented and reported to the U.S. Army Center for Health Promotion and Preventive Medicine Deployment Data Archiving and Policy Integration (USACHPPM DDAPI) Program (see table 1–1 and para 6–5d(2)).

(11) Use risk communication techniques to disseminate water supply-related health risk information to unit personnel. Trained preventive medicine personnel can assist commanders with risk communication.

b. Unit and Theater/Command Surgeons will—

(1) Advise commanders and assist them with recognizing the importance of the sanitary control and surveillance of field water supplies in planning operational missions.

(2) Implement or oversee the implementation of PVNTMED procedures and instructions required for ensuring the security, adequacy, and quality of field water supplies.

(3) Provide medical oversight of field water supply operations for the prevention of waterborne diseases.

(4) Ensure that results of field water quality analyses which indicate the potential for immediate and acute health threats as well as those that may cause chronic or long-term health effects are documented and reported.

(5) Make recommendations to commanders for applying ORM principles to water supply decisions, including ORM-based responses to analytical results of water quality tests.

c. PVNTMED unit commanders and PVNTMED staff officers will—

(1) Advise commanders and combat service support (CSS) personnel in planning for the sanitary control and surveillance of the field water supplies.

(2) Implement PVNTMED procedures required for the sanitary control and surveillance of field potable water supplies.

(3) Provide PVNTMED oversight of field water supply operations for the prevention of waterborne illness and disease.

(4) Document and forward to USACHPPM for archiving the results of field water quality analyses that indicate the potential for immediate and acute health threats as well as those that may cause chronic or long-term health effects.

(5) As directed, assist commanders in applying ORM principles to water supply-related decisions.

d. PVNTMED noncommissioned officers (NCOs) will—

(1) Assist CSS personnel in water source selection by conducting water source reconnaissance surveys.

(2) Assist in certifying purified water as potable.

(3) Conduct sanitary surveys of potable water containers and water points.

(4) Inspect potable water treatment, storage, and distribution equipment.

(5) Test treated water to ensure water quality standards are met and chlorine residual is appropriate.

(6) Inspect field shower points and personnel decontamination stations.

(7) Train and evaluate unit FSTs and soldiers at all levels in proper field water surveillance and sanitation.

e. Unit FSTs will—

(1) Coordinate dining facility sanitation, field waste disposal, and personal hygiene inspections to prevent the spread of waterborne disease.

(2) Test unit water supplies for appropriate chlorine residuals when containers are filled, when water arrives in the unit area, and when directed to do so by medical or command personnel.

(3) Add chlorine to unit water supplies using approved methods when chlorine residuals are below required levels.

(4) Inspect water containers and trailers for cleanliness: quarterly in garrison, prior to deployment, and before filling at distribution points. Ensure containers are maintained in a clean and sanitary condition.

(5) Ensure unit has adequate stocks of iodine tablets, bulk chlorination equipment, and other supplies necessary for field water sanitation.

(6) Ensure water trailers and containers are protected from temperature extremes, when feasible, to keep drinking water as cool as possible for palatability.

(7) Train individual soldiers to perform sanitary control measures for field water supplies.

(8) Request PVNTMED assistance to correct or control field water problems that are beyond the capabilities of the unit FST.

f. Individual soldiers will—

(1) Fill canteens and personal hydration systems with Army-approved potable water at every opportunity.

(2) Use only approved methods of disinfection (according to FM 21–10) when treating raw water supplies for drinking.

(3) Avoid the transmission of disease by keeping personal water containers and unit water supplies clean and secure.

(4) Seek the support of unit FST or local PVNTMED personnel to assist in correcting or controlling problems related to drinking water that are beyond individual soldier capabilities.

2-4. Preventive medicine levels of field water support

a. PVNTMED services are described in terms of five levels of support with increasing capabilities at each higher level as illustrated in figure 2–1. Levels I through IV are normally available in the theater of operations (TO), while level V resides in the continental United States (CONUS) at USACHPPM, U.S. Army Medical Department Center and School, and major Army command (MACOM) surgeon’s office, and outside the CONUS (OCONUS) at combatant command, the component command surgeon’s office and USACHPPM subordinate commands in Japan (CHPPM–PAC) and Germany (CHPPM–EUR). In the TO, PVNTMED support is tailored and employed to enhance mission requirements, to counter the medical threat, and to provide PVNTMED support as far forward as the tactical situation permits within the health service support (HSS) system (see FM 4–02, chap 2). PVNTMED services are provided on an area support basis to afford the utmost benefit to the maximum number of personnel in the TO.

The levels of PVNTMED support are more fully described in FM 4–02.17.

b. Table 2–1 describes the five levels of PVNTMED support to field water operations. Levels II and III can each fulfill the roles and perform the tasks of the levels below them.

2-5. Preventive medicine support to the field water mission through the operational cycle This section lists and describes typical tasks that PVNTMED personnel will perform to fulfill their field water mission responsibilities during all phases of a deployment cycle.

a. Predeployment. PVNTMED personnel will work with logistics and operations planners to plan and prepare for deployment. For PVNTMED personnel, predeployment planning includes determining detailed support requirements and providing the preventive medicine estimate (PME) based on medical and nonmedical intelligence. Predeployment preparation includes assisting in intelligence preparation of the battlespace and conducting strategic-level coordination. Some of the water-related predeployment tasks that PVNTMED personnel should perform include the following (see chap 4 for more detailed guidance):

(1) Assist in estimating consumption requirements based on the location/climate, and the anticipated level, duration, and frequency of operational activities (see chap 3).

Figure 2–1. Levels of PVNTMED support

BSA

xxx

PVNTMED TM

BSA

DIV PVNTMED

Section

DSA

AML

IIIIIIIVV

xx x xx xx x x

PVNTMED TM

II

x

Reserve x

II Denotes highest level of support found in AO

Unit FST

Unit FST

Unit FST

Unit FST

Unit FST

Unit FST

Section

Levels of PVNTMED Support

USACHPPM

BSA

AML

MED DET(PM)

PM

ASMB

MED DET(PM)

PM

MED DET(PM)

PM

MED DET(PM)

PMASMB PVNTMED

Section

LSA

PVNTMED TM

LEGEND:

USACHPPM: United States Army Center for Health Promotion and Preventive Medicine AML: area medical laboratory PM/PVNTMED: preventive medicine LSA: logistics support area DSA: division support area ASMB: area support medical battalion MED DET: medical detachment BSA: brigade support area TM: team

Table 2–1 Levels of PVNTMED support to field water operations

Level

Description Roles Tasks

I Unit FST Assess local unit treated water supplies.

Inspect water containers and trailers; test unit water supplies for chlorine and add additional chlorine when needed; report problems and concerns to unit commander and supporting PVNTMED section (Level

II).

II

PVNTMED sections of divisions, separate brigades, armored cavalry regiments, and area support medical battalions

Identify/assess medical threats;

oversight monitoring of potable water supplies; train FSTs;

provide commanders with recommendations to minimize adverse health effects arising from water-related risks.

Identify and coordinate with logistical elements for needed PVNTMED materials;

use field test kits to screen water supplies and certify them as potable; conduct sanitary surveys and perform additional sampling; coordinate with Levels III–V to characterize risks associated with identified water contaminants; recommend ORM strategy and courses of action (COAs) to command elements to minimize health risks.

III Medical detachments

(PM)

Augment and support FST and Levels I and

II PVNTMED

personnel and provide unique capabilities.

Collect and analyze samples; conduct epidemiological investigations; provide technical consultation.

IV

Area Medical Laboratory

(AML) PVNTMED

support (normally allocated based on the anticipated medical threat); other military units/organizations for specific technical support

Augment and support PVNTMED Levels II & III, and provide unique capabilities.

Provide more advanced laboratory analytical support and technical consultative services.

V

USACHPPM – resource for technical information, sampling assistance, and laboratory support

Maintain all deployment-related environmental (including drinking water) data; augment and support PVNTMED Levels II– IV and provide unique capabilities.

Archive exposure data and provide more advanced laboratory analytical support and technical consultative services regarding health risks and preventive measures.

(2) Obtain and deliver medical threat information including medical intelligence reports, medical threat products, and briefings (FM 4–02.17, para 4–5a). This includes the use of medical and nonmedical intelligence information to evaluate potential threats to field water supplies such as industrial contamination or endemic diseases (see chap 4).

(3) Assist in identifying and assessing potential field water sources including assessing the quantity, quality, potential health risks, and anticipated treatment and disinfection requirements for all potential and proposed water sources.

(4) Conduct preliminary field water system vulnerability assessments (FWSVAs).

(5) Assist in training unit FSTs in unit-level field water mission tasks.

(6) Assist in determining the equipment that will be needed to conduct surveillance of field water supplies.

(7) Assist in performing predeployment PVNTMED equipment checks for PVNTMED units and unit FSTs.

b. During deployment. PVNTMED personnel will perform surveys, inspections, and evaluations, and will collect samples and perform sample analysis. They will also provide real-time recommendations and assistance to commanders and FST personnel with regard to source selection and treatment, field water testing, water supply inspection and certification, and operational risk assessment and exposure documentation. Typical deployment-phase tasks include—

(1) Using field observations and equipment to perform water source reconnaissance and to screen potential raw water sources based on reverse osmosis (RO)-based water purification system (WPS) (or other available treatment system) capabilities, to identify and assess health hazards, and to support documentation requirements for environmental baseline surveys (EBSs) (see chap 5).

(2) Ensuring that proper treatment and disinfection procedures are followed (see chap 9).

(3) Certifying that water purified at field water purification points is potable based on comparing the results of basic testing to the Tri-Service Field Water Standards (TSFWS) (see chap 5).

(4) Initiating advanced water surveillance monitoring (AWSM) by collecting treated water samples, properly labeling and documenting them, sending them to rear-area laboratories for advanced water testing (AWT), then reviewing and taking appropriate actions based on the results of the analyses (see chap 6).

(5) Conducting field inspections to ensure all potable water supply systems and associated equipment are properly maintained and monitored (see chap 8).

(6) Evaluating AWT analytical results using appropriate military exposure guidelines (MEGs) and take any required actions using ORM methods (see chap 7).

(7) Ensuring that all field water supply-related analytical data, risk assessments, and corrective actions are documented and provided to the USACHPPM DDAPI Program (see chap 6).

(8) Performing FWSVAs.

(9) Assisting commanders with the assessment, oversight, and sustainment training of unit FSTs.

(10) Conducting water sampling and analysis, and provide ORM assessment and recommendations in response to water supply incidents such as environmental spills and suspected tampering.

(11) Advising the commander concerning drinking water quality issues and the use of risk communication techniques to inform unit personnel (see chap 7).

c. Postdeployment. Typical postdeployment tasks that PVNTMED personnel will perform with respect to the field water support mission include—

(1) Ensuring that all field water quality analytical results, with appropriate context information, risk assessments, and corrective actions are forwarded through command channels to the USACHPPM DDAPI Program for archiving.

(2) Providing guidance on field water site/area restoration, including the removal and disposal of waste (see chap 11 and FM 4–02.17).

CHAPTER 3

INTRODUCTION TO FIELD DRINKING WATER

3-1. General

a. Overview. This chapter defines basic field water terms and concepts, describes field water sources, gives water consumption guidelines for promoting good water discipline, and provides guidance for the use of nonpotable water for purposes other than drinking.

b. Background. Water is a required commodity for numerous activities in deployed environments. The most important of these is personal consumption. Water intended for drinking must be readily available and consumed in adequate quantities to prevent dehydration.

Drinking water must be potable or it may have adverse health effects on those who consume it.

It must also be palatable so personnel will be willing to drink it in adequate quantities, and not choose to drink from unapproved sources that may taste better but may cause illness because of chemical or microbiological contamination. Commanders must have confidence in Army-supplied drinking water. They must advocate and implement established field water doctrine to prevent their personnel from consuming water that could cause disease or illness.

3-2. Field water terms and concepts The following field water definitions and concepts apply to the discussions presented throughout this bulletin.

a. Potable water. Potable water for field operations is water that is safe to drink, insofar as it will not be an impediment to mission execution. It does not contain chemical, microbiological, radiological, or other contaminants in concentrations that will make personnel who drink it sick in the short term. The Army generally requires water in the field to be treated (purified) and disinfected before it is considered potable. PVNTMED personnel certify that drinking water produced in the field is potable by ensuring that it meets the TSFWS listed in table B–1.

Drinking water produced at bulk water treatment locations in the field must also contain a disinfectant residual (usually chlorine) when it is issued to personnel.

b. Nonpotable water. Nonpotable water is water that has not been determined to be safe for human consumption. Any water in the field, whether raw or treated, that has not been approved for consumption by the theater/command surgeon’s representative (normally a PVNTMED specialist) is considered nonpotable. PVNTMED or using-unit personnel will identify nonpotable water sources (such as taps or spigots) with signs that read “NONPOTABLE

WATER. DO NOT DRINK.”

c. Palatable water. Palatable water is water that is pleasing to the senses. It looks, tastes, and smells good and is neither too hot nor too cold. Palatability is usually quantified in terms of temperature, color, taste, and odor, and acceptable levels for these parameters are also included in the TSFWS.

d. Water treatment/water purification. Water treatment/purification is the combination of one or more processes employed to improve the quality of water. Treatment involves removing suspended and dissolved contaminants and killing or inactivating microorganisms, usually with the goal of making the water potable and palatable. Typical water treatment processes include but are not limited to screening, aeration, chemical addition, coagulation, flocculation, sedimentation, filtration, RO, ion exchange, sorption processes, and disinfection.

e. Disinfection. Disinfection is a water treatment process in which pathogenic (disease producing) organisms are destroyed or otherwise inactivated (see para 9–6 for a detailed discussion of disinfection). Common methods of disinfecting drinking water include boiling, ultraviolet (UV) radiation, and various procedures using chlorine, chlorine dioxide, iodine, or ozone. The preferred field method of water disinfection in the Army is chlorination which can be accomplished using chlorine gas or chlorine compounds such as calcium hypochlorite (granular) and sodium hypochlorite (liquid bleach).

f. Fixed facility water supplies. Fixed facility water supplies consist of permanent water sources, treatment, disinfection, storage, and distribution systems that provide water to a fixed or “brick and mortar” installation. They are characterized by permanent structures, unit operations equipment, and distribution systems of buried water mains, laterals, and connections to building systems.

g. Semifixed field water supplies. A semifixed field water supply employs part or all of a non- U.S. fixed facility water treatment system to provide drinking water for deployed personnel. In the field, water drawn from semifixed supplies is treated the same way as water drawn from raw water sources. It needs to be evaluated for quality and will likely need to receive treatment just as water from any other raw water source in the field prior to being certified potable.

Quartermaster units determine treatment requirements and treat the water, after which PVNTMED personnel must certify that the treated water is potable before it is used for drinking water. On rare occasions, at commanders’ discretion, a semifixed water supply that is tested by PVNTMED personnel and meets the TSFWS may be certified potable requiring no additional treatment prior to consumption. However, those occasions are the exception rather than the rule.

h. Field water supplies. Field water supplies are generally portable and temporary. They include individual emergency, unit, and centralized water source, treatment, disinfection, storage, and distribution systems. Their purpose is to provide potable, palatable water to maintain the combat effectiveness and health of military personnel and civilians.

i. Individual/emergency water supplies. In cases where unit-level or larger water supply systems are not accessible, personnel may be required to find their own sources of raw water and treat them using personal treatment devices and/or disinfectants. Personal water treatment devices have capabilities and limitations that personnel must be aware of to ensure that the devices operate correctly and to reduce the risk of illness from device failure. See paragraph 9–4 and section III of chapter 9 for detailed guidance on individual/emergency water supply treatment and disinfection.

3-3. Field water sources Raw water may be obtained from various sources in the field including surface water (rivers, streams, ponds, lakes, rain, ice, snow, seas, and oceans), ground water (wells or springs), and in some cases, from municipal water treatment systems located in the deployment area. Water from all raw water sources is considered nonpotable until it is treated and certified to meet the

TSFWS, regardless of how clean the water may appear. Raw or inadequately treated water may contain unseen toxic chemicals or microorganisms that can cause illness and waterborne diseases such as cholera, viral hepatitis, gastroenteritis, giardiasis, and cryptosporidiosis. In many modern military operations, locally procured bottled water may also be available. Several factors need to be considered when evaluating the acceptability of water sources and comparing these different water sources for drinking water production. Chapter 5 presents guidance on water source selection.

a. Surface water. Surface water sources that the Army’s RO-based WPSs can treat include rivers, streams, lakes, ponds, seas, and oceans. These sources are usually more readily available than other sources, and are generally capable of supplying adequate quantities of water for all purposes. However, such sources likely contain infectious microorganisms and may be contaminated with chemicals or radioactive substances. A few common sources of those kinds of contaminants include urban and agricultural runoff, industrial waste discharges, landfill leachates, septic tanks, and raw and treated sewage outfalls. When drawing water from a surface water source, the intakes should be screened and carefully positioned in the body of water to avoid areas of likely contamination. Three actions will help minimize the concentrations of contaminants drawn into surface water intakes:

(1) Avoid placing the intakes directly downstream from known sources of contamination.

(2) Place the intakes away from the shore to a position where the water appears less contaminated.

(3) Suspend the intakes between the surface and the bottom of the source to avoid collecting either settled or floating materials.

The quality of surface water sources should be reevaluated after rain storms to ensure they are still treatable because of the potential for increased contamination from runoff and resuspension of settled contaminants due to increased water flow in the source.

b. Ground water. Ground water comes primarily from various kinds of wells and springs.

Microbiological contamination is less likely to be found in ground water than in surface water, but the quantity of water available from an undeveloped ground-water source may be difficult to determine, and possibility of chemical contamination of ground water from nearby, distant, and long-gone agricultural and industrial operations must be carefully considered. Accessible ground-water sources in the field include existing wells and springs, and wells constructed by military engineers. Latrines, septic tanks, and maintenance areas should be positioned at least 100 yards (yd) away from any ground-water sources used to produce drinking water, and oriented so that any drainage from these facilities flows away from the sources to prevent their contamination.

c. Semifixed/host-nation water systems. Partially or completely intact municipal water systems are sometimes available for use as water sources during deployments. In this TB MED, such systems are referred to as semifixed or host nation water supplies. Despite the ease of access and possible presumption that the water in these systems has been treated and is potable, the water in them is by Army doctrine considered nonpotable until PVNTMED personnel have inspected the systems, tested the water, and approved it for use. While these types of water sources may be appealing, the local water treatment methods may be less than adequate, inconsistent, and unreliable, and the water may become contaminated after it is treated through broken water lines or cross-connections in the storage and distribution systems that are not readily visible. Even if the local population appears healthy, they may have developed immunities to microbiological contaminants and tolerances for chemical impurities in their water through long periods of exposure. The same contaminants could cause severe adverse health effects in unacclimatized deployed personnel and reduce unit readiness. The water may also have contaminants that have the potential to increase long-term health risks to deployed personnel. Further, in areas of civil unrest, the threat of intentional contamination of the local drinking water system by disgruntled local nationals or terrorist groups must be considered.

d. Bottled water. Bottled water is water that is sealed in bottles, packages, or other containers by commercial (nonmilitary) interests for human consumption. It may or may not have been treated prior to bottling. Bottled water provided for Army personnel and operations is classified as a food item (beverage, nonalcoholic) in Army Regulation (AR) 40–657/ NAVSUPINST 4355.4H/MCO P10110.31H. In consonance with that AR, bottled water must be obtained from military-approved sources only. The U.S. Army Veterinary Command (VETCOM) approves commercial sources of bottled water for military use in CONUS and OCONUS. They inspect bottling facilities to ensure compliance with acceptable sanitation standards. A list of military-approved sources worldwide is published by VETCOM at http://vets.amedd.army.mil/vetcom/directory.htm. Appendix C contains useful information concerning the use of bottled water during deployments.

e. Packaged water. Packaged water is potable drinking water that is produced and packaged in sealed containers by military water treatment personnel in the field. It may be issued to deployed units and personnel in plastic bags or bottles. The requirements for treatment, disinfection, and PVNTMED monitoring associated with field water supplies also apply to packaged water operations. See appendix C for additional information.

3-4. Field water discipline To complete their missions, deployed personnel must drink sufficient quantities of potable water to maintain adequate physical and mental health. The daily water requirements for personnel in the field depend on a number of factors including the weather, geographical area, the tactical situation, and the operational tempo. General consumption requirements for various environmental and military work conditions are estimated to be between 5 and 15 liters per day (L/d). It is important to determine and adhere to the appropriate consumption rates, spreading consumption throughout the work day, because medical casualties can result from both insufficient water intake, or dehydration, and too much water intake which results in overhydration.

a. Dehydration. The healthy human body loses water through urination, breathing, and sweating. Dehydration can occur quickly not only in extremely hot climates, but in cold and mountainous environments as well. To meet their bodies’ needs, personnel must sometimes drink water even when they are not thirsty. An active individual subjected to high heat stress may lose more than a liter of water per hour through sweating. Water and salts/electrolytes (primarily sodium and potassium) that are lost through perspiration are essential to proper muscle function; they must be replaced to ensure mission effectiveness. Wearing mission-oriented protective posture (MOPP) gear aggravates heat stress, and additional factors must be considered for fluid intake requirements under such conditions. Sustained dehydration is very serious and can result in heat stress, deterioration of performance, and, if left untreated, death.

b. Overhydration. This condition, also known as “water toxicity” or “hyponatremia,” can cause electrolyte imbalances in the body, and can also result in serious illness and death.

Irreparable harm can also be done when a dehydrated person’s abnormal electrolyte levels are corrected either too quickly or too slowly. Adequately controlled water consumption is paramount, and excessive water consumption must be avoided.

c. Water replacement. The preferred method of water replacement is to drink small volumes of water throughout the work period. During periods of moderate activity with moderate environmental conditions prevailing, the individual water requirement is 0.5 quart (qt) or more per hour and is best taken as a cup or so at 20- to 30-minute (min) intervals. As activities or conditions become more severe, the command must take action to ensure that individual water intake is increased accordingly. Table 3–1 in TB MED 507/AFPAM 48–152 (I) provides fluid replacement and work/rest guidelines for warm weather training conditions. Table 3–3 in TB MED 507/AFPAM 48–152 (I) provides guidelines for continuous work duration and fluid replacement during warm weather training conditions. Individual water needs may vary by up to ¼ qt per hour. Hourly fluid intake should not exceed 1.5 qt, and daily fluid intake should not exceed 12 qt. Unit commanders will provide the required amount of safe drinking water. When sufficient quantities do not exist, work/rest cycles must be modified to prevent dehydration.

3-5. Uses for potable and nonpotable water In situations where the potable water supply is insufficient to meet all water requirements, nonpotable water may be used for purposes other than drinking. Table 3–1 lists activities that require potable water and those that can be performed adequately using water of lesser quality.

Note that brackish and sea water should be used only as last resorts, since their high salt content can cause corrosion of mechanical and electrical components, as well as have adverse effects on other materials.

Table 3–1 Acceptable uses for different quality water

Water quality Acceptable activities

a. Drinking water

b. Dining facility operations such as food washing

c. Brushing teeth

d. Medical treatment

e. Ice production for food preservation and cooling

f. Water hose and pipeline testing and flushing

Potable water

g. Photo-processing (for quality control, not health reasons— separate standards apply)

a. Centralized hygiene such as field showers

b. Decontamination of personnel

c. Retrograde cargo washing

d. Heat casualty body cooling

e. Graves registration personnel sanitation

Disinfected fresh water (nonpotable)

f. Well development

a. Vehicle coolant

b. Aircraft washing

c. Pest control

d. Field laundry

e. Concrete construction

Fresh water (nonpotable)

f. Well drilling

a. Vehicle washing

b. Electrical grounding

c. Fire fighting Brackish and seawater1 d. Chemical, biological, radiological, nuclear, and explosives (CBRNE) decontamination of material

Note:

1Brackish and seawater are minimally acceptable and may lead to significant corrosion if used;

therefore, fresh water should be used if at all possible. It is acceptable to use water of higher quality for activities requiring lower quality water but not vice versa.

CHAPTER 4

PREDEPLOYMENT PLANNING AND PREPARATION

4-1. General

a. Overview. This chapter describes PVNTMED participation in the predeployment planning and preparation phase of the field water support mission. For PVNTMED personnel, predeployment planning includes determining detailed support requirements and using medical and nonmedical strategic and tactical intelligence to develop the PME. Predeployment preparation includes assisting in preparation of the battlespace and conducting strategic-level coordination.

b. Background. During the predeployment phase of the operations process, PVNTMED personnel assist commanders and CSS personnel in planning and preparing the field water support mission. PVNTMED participation is important because it helps ensure successful execution of the field water support mission.