Lt christian’s little blue book
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- ROBERT W. HIGGINS
LT CHRISTIAN’SLITTLE BLUE BOOKAN UNOFFICIAL GUIDE FOR US NAVY SHIPBOARD MEDICAL OFFICERS Original Edition: 1984 by CAPT M. L. COWAN, MC, USN and LT GENE CHRISTIAN, MC, USN 1984 Second Edition: 1992 Revised by LCDR ANN P. FALLON, MC, USN Navy Environmental Health Center Third Edition: 1999 Revised by LT Paul Jeffrey Brady, MC, USNR USS CORONADO (AGF-11) and
LCDR Eric Rasmussen, MC, USN Fleet Surgeon, THIRD Fleet for the Surface WARFARE Medicine institute SAN DIEGO, CALIFORNIA detachment of the naval operational medicine institute pensacola, Florida Please send feedback, suggestions, and any other correspondence to:
Officer-in-Charge Surface Warfare Medicine Institute Building 500, Room 114 140 Sylvester Road Naval Submarine Base San Diego CA 92106-3521 (619) 553-0097 email: jmyoung@nmcsd.med.navy.mil
The Quarterdeck 17 The Wardroom 18 The Bridge 19 Chapter 2, Helpful Hints of General Interest 21 Chapter 3, Naval Correspondence 23 Message Traffic 23 Sample Message 26 Radio Communications 27 Chapter 4, Shipboard Organization 29 Department Head 29 Division Officer 30 Deck 31
Weapons 32 Operations 32 Engineering 32 Air 33
Navigation 33 Supply 33 Admin 34 Communications 35 Repair 35 Medical/Dental 36 Chapter 5, Departmental Administrative Management 39 Chain of Command 40 Confidentiality 42 Other Leadership Issues 42 Chapter 6, Naval Officership 45 Command Relationships 45 Total Quality Leadership 46 Fraternization 51 Good Order and Discipline 51
Medical Guardship 53 Physical Examinations 53 Laundry/Mess Specialist/Barbers/Food Service Assistant Physicals 55 Brig and Correctional Custody Unit Physicals 56 Fitness for Duty Exams 57 Overseas Screen 58 Medical Practice 58 Sick Call 60 Medical Records 61 Dental Records 62 Narcotics and Prescription Writing 62 Prescribing Medical Treatment 64 Intravenous Therapy 65 Non-Medicinal Treatment 65 Laboratory 66 X-rays 67 Operating Rooms 68 Ward Patient Care 68 Referrals 69 Appointments 70 MEDEVAC 70 Quality Assurance 72 Watchbills 73 Chapter 8, Training 75 Yourself 75 Shipboard Qualifications 76 Enlisted Surface Warfare Specialist (ESWS) 77 Shipboard Training Programs 77 Indoctrination of New Personnel 77 All Hands Medical Training 78 Specialty Training 80 Corpsmen In-Service Training 81 Other HM Requirements 83 HM Advancement 84 Strikers 84 PQS Boards 85
Alcohol and Drug Abuse 87 Physical Fitness and Weight Control 89 Women at Sea 90 Chapter 10, Additional Administrative Responsibilities 95 The Supply System 95 AMMAL 95 Operating Target (OPTAR) 96 Supply 97 Open Purchase 98 Routine Supplies 99 Defective Supplies 99 SAC 207 Account 100 Narcotics 100 Medical Equipment Purchases 101 Emergency Equipment and Supplies 101 Contingency Supplies 102 Maintenance and Repair (3M PMS) 103 Medical 3M 106 Fire Station Maintenance (Damage Control) 106 Chapter 11, Administrative versus Battle Organization 109 Nuclear, Biological, Chemical Defense 110 Battle Dressing Stations 111 Mass Casualty 112 Chapter 12, Inspections 115 Medical Readiness Assessment (MRA) 115 Inspection and Survey Aboard (INSURV) 116 Operational Propulsion Plant Examination (OPPE) 116 RCPE/ORSE – Radiological Controls Practice Examination and Operational Reactor Safeguards Examination 117 Nuclear Weapons Acceptance Inspection 117 Inspections You Perform 118 General Cleanliness 118 Zone Inspections 119 Personnel Inspections 120 Health and Sanitation Inspections 121 Galley Inspections 123 Disease Outbreak Investigation 126 Berthing Inspections 127 Head Sanitation 128 Barber Shop 128 Ship’s Laundry 129 Dry Cleaning Plant 130 Coffee Mess 130 Ship’s Store and Fountain 130 Rats 131
Cockroaches 132 CHT Pump Room and Sewage Spills 132 Potable Water 133
Tickler System 135 Internal Reports 135 External Reports 136 Chapter 14, Preventive Medicine 139 Immunizations 139 Sexually Transmitted Diseases 140 HIV Program 141 Malaria 141 PPD and Tuberculosis Control Programs 142 Chapter 15, Occupational Health Programs 143 Radiation Health Program 143 Hearing Conservation 144 Asbestos Program 147 Mercury Control 149 Lead Control 149 Halogenated Hydrocarbons 150 Otto Fuel 11 Program 151 Heat Stress 151
General Safety Items 155 Eye Protection 156 Respiratory Protection 156 Protective Clothing 157 Welding Areas and HT shop 158 Battery Shop 159 Machine Shop 159 General Surface Maintenance 160 Electrical Safety 160 CHT Pump Rooms 160 Oxidizing Materials 161 Safety in Medical Spaces 162 Accident and Injury Reports 163 Chapter 17, Sanitation Programs 165 Garbage and Refuse 165 Biomedical Waste 166 Hazardous Waste 166 Chapter 18, Deployment 169 Refresher Training (REFTRA) 169 Predeployment Schedule 169 Embarked Medical Personnel 170 Medical Intelligence 171
As I write this preface at sea in the North Pacific, I recognize how impressed and grateful I remain from my first exposure to the original edition of this volume. That pleasure resurfaced as I looked at this book again with LT Brady, working together to preserve the character and flavor of both LT Christian’s original work and LCDR Fallon’s strong enhancement. It is, therefore, rewarding now to release this third edition. It is important to get the book back out into the waterfront where it belongs, and, to the credit of the earlier authors, much has remained the same. We take no credit for originality; the expansion has been mild, the details have been brought up to date, and the flow of the book is essentially unchanged. We worked only to help the content reflect our Navy moving toward a new millennium. We otherwise liked the book very much just as it stood. Although some aspects of shipboard medical life are perennial, what is not so easily seen within these pages is the improved communication capability aboard ship that makes shipboard care so much more effective. Store-and-forward email, digital imagery from inexpensive cameras, standard medical textbooks on CD-ROM, and standardized reporting templates on the World Wide Web have done much to help shipboard providers take care of their crews. That technology has its valued place, but that place is well circumscribed. Of greater importance are the mind and heart required to deliver competent, compassionate care in a remote and hazardous location. The repeated emphasis on initiative, leadership, training, and responsibility runs as a silver thread through this book, and cultivation of those qualities will do more to heal the hurt and sick than any electronic aid. Shipboard care delivery is, without a doubt, challenging. It is perhaps made more so by the frequent perception that we care more about the major hospitals than we do about the operational providers. That emphasis is shifting, and I hope that that the delivery of medical care within the operational forces, Blue and Green, will continue to increase as the focus of the Navy Medical Corps. In addition, RADM Higgins, in the forward to the second edition, encourages the development of a career path in operational medicine. To further both these aims, the Surface Warfare Medicine Institute has been established, dedicated to preparing medical personnel to meet the needs of sailors and Marines afloat. Those men and women at sea are the reason for our existence as a Medical Corps. They are our first and foremost responsibility, and we serve in their support. This fine little book, with advice from those who serve at sea, can help your transition onto our gray hulls. We welcome you aboard and wish for you a richly satisfying tour. ERIC RASMUSSEN, MD, FACP Lieutenant Commander, Medical Corps, United States Navy Fleet Surgeon, THIRD Fleet July 1998 FOREWORD TO SECOND EDITION It is a distinct pleasure to address you in this “down-to-earth survival manual” as you begin your first operational tour as a Navy physician. Please read Admiral McDermott’s Foreword to the original edition in which he elegantly explains why this book was written. I would like to elaborate on this theme to include careers in the exciting world of operational medicine. Your enjoyment of fleet medicine does not have to be a one-time opportunity. Why not repeat the adventure after your residency? Operational tours can be alternated with assignments to MTFs/Clinics to produce a truly challenging and rewarding career pathway. Additionally, operationally focused careers can be built from tours as senior Medical Officers aboard ship, group Medical Officers, fleet staff, medical type commanders, and fleet medical advisors. You will seldom hear about these opportunities in hospital settings but this career path can be just as rewarding as hospital-based duty. This book goes into its second edition thanks to the enterprising skills of a young Medical Officer, LCDR Ann Fallon. LCDR Fallon is part of a new breed of physicians who have decided to specialize in “Fleet Medicine.” This revised shipboard book was a MPH project for her preventive medicine residency at the Uniformed Services University of the Health Sciences. Prior to her residency she served 3 years aboard a tender. These experiences resulted in the revisions and updates to this sought-after and hoarded book, first compiled by CAPT Mike Cowan and LT Gene Christian in 1984. As your assignment in the operational environment unfolds, I encourage you to be sensitive to the unique challenges this assignment will present—challenges clearly different from civilian medical practice. You will quickly realize that you are responsible for not just providing medical care, but also for managing a health care system, providing leadership to a department, and offering medical advice to our line colleagues. Use the information contained in this book to assist in the performance of your multiple duties, and welcome to the world of operational medicine. This professional experience will test your mettle as a physician, leader, and manager. You can handle the challenge; this is the true essence of Navy Medicine. Good luck and my very best wishes for an exciting and professionally rewarding experience. ROBERT W. HIGGINSRear Admiral, Medical Corps, United States Navy Chief, Medical Corps PREFACE TO SECOND EDITION This book is an unofficial guide intended to complement the GMO Manual NAVMED P-5134. It is written for the GMO who will be going to sea or assigned to surface ship staffs and addresses the unique aspects of surface medicine. It is intended to take some of the mystery and anxiety out of the new and unknown environment. This book does not have all the answers, but merely some solutions that have worked for others before you. It is a tool that is to be used in conjunction with our Type Commanders’ instructions and other Navy instructions. This author would like to thank CAPT Cunnion, CAPT Yang, and LT Rebholz for their technical and editorial assistance, LT Christian and CAPT Cowan for their fine original edition, as well as everyone who reviewed the draft edition and submitted much appreciated comments. The sea is a demanding environment and exacts a toll on all that face her. However, nothing can be more rewarding than the satisfaction of doing your part in support of the mission and meeting that challenge head on. Those of us who have been to sea know the unique challenges that you face and are there to help you in any way we can. The Navy Preventive Medicine and Occupational Health Department is one such group. It is with their assistance that this new edition of the shipboard medical guide is being published. Preventive Medicine Officers know that one outbreak of disease can destroy both the health and morale of any fine crew very quickly. Attention to detail and common sense can avert many a disaster. Remember that help is just a phone call or a message away…. Good luck and may you have fair winds and following seas. 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