Bioenvironmental Engineering Journeyman Volume 1 PDF

CDC 4B051 Bioenvironmental Engineering Journeyman Volume 1. Introduction to Bioenvironmental Engineering ___________  Air Force Career Development Academy Air University Air Education and Training Command 4B051 01 2005, Edit Code 04 AFSC 4B051 Author: Mr. Mark H. Hanson United States Air Force School of Aerospace Medicine (USAFSAM) Bioenvironmental Education and Training Branch 2510 Fifth Street, Building 840 Wright-Patterson Air Force Base, Ohio 45433 DSN: 798-3010 E-mail address: [email protected] Instructional Systems Specialist: Todd Knowles Editor: Sandra F. Glenn Air Force Career Development Academy (AFCDA) Air University (AETC) Maxwell AFB-Gunter Annex, Alabama Material in this volume is reviewed annually for technical accuracy, adequacy, and currency. For Weighted Airman Promotion System (WAPS) Specialty Knowledge Test (SKT) purposes, the examinee should check the Enlisted Promotions References and Requirements Catalog to determine the correct references to study. Preface ___________________________________________________________________ i NOW THAT YOU have successfully completed technical training and reported to your duty station, this Career Development Course (CDC) 4B051, Bioenvironmental Engineering Journeyman, is the next step in becoming a proficient journeyman in your new career field. This course is made up of six volumes. This first volume is devoted to basic fundamentals and sciences of bioenvironmental engineering. The second volume introduces you to health risk assessment and management and ends with water/liquid sampling. The third volume addresses biological, chemical and physical hazard assessment and control. The fourth volume is comprised of two sub-volumes, and concentrates on radiological hazard assessment and control. The fifth and final volume explains health risk management programs, occupational health, and emergency management principles. In this first volume, you will learn about fundamental knowledge of the bioenvironmental engineering (BE) career field. Unit 1 describes how BE fits into the Air Force Medical Service (AFMS). Units 2 and 3 provide a review of basic chemistry and anatomy and physiology. Unit 4 introduces toxicology and the importance the dose-response relationship plays in measuring exposures. Unit 5 provides a brief review of basic ecology principles with the added bonus of introducing the concepts of transportation and fate of chemicals in the environment and how these substances affect human health. A glossary is included for your use. Code numbers on figures are for preparing agency identification only. The use of a name of any specific manufacturer, commercial product, commodity, or service in this publication does not imply endorsement by the Air Force. To get a response to your questions concerning subject matter in this course, or to point out technical errors in the text, unit review exercises, or course examination, call or write the author using the contact information provided in this volume. NOTE: Do not use Air Force Instruction (AFI) 38-402, Airmen Powered by Innovation and Suggestion Program, to submit corrections for printing or typographical errors. For Air National Guard (ANG) members, do not use Air National Guard Instruction (ANGI) 38-401, Suggestion Program. If you have questions that your supervisor, training manager, or education/training office cannot answer regarding course enrollment, course material, or administrative issues, please contact Air University Educational Support Services at http://www.aueducationsupport.com. Be sure your request includes your name, the last four digits of your social security number, address, and course/volume number. For Guard and Reserve personnel, this volume is valued at 16 hours and 4 points. ii __________________________________________________________________ Preface NOTE: In this volume, the subject matter is divided into self-contained units. A unit menu begins each unit, identifying the lesson headings and numbers. After reading the unit menu page and unit introduction, study the section, answer the self-test questions, and compare your answers with those given at the end of the unit. Then complete the unit review exercises. Contents _________________________________________________________________ iii Page Unit 1. Mission and Organization of the Air Force Medical Service.............................. 1-1 1–1. The Air Force Medical Service................................................................................... 1-1 1–2. Bioenvironmental Engineering................................................................................. 1-10 Unit 2. Chemistry................................................................................................................. 2-1 2–1. Basic Properties of Matter........................................................................................... 2-2 2–2. Solutions.................................................................................................................... 2-16 2–3. Gases......................................................................................................................... 2-22 Unit 3. Anatomy and Physiology........................................................................................ 3-1 3–1. The Structure and Function of Cells and Tissues........................................................ 3-1 3–2. The Structure and Function of the Major Organ Systems........................................... 3-8 Unit 4. Toxicology................................................................................................................ 4-1 4–1. Introduction to Toxicology......................................................................................... 4-2 4–2. Exposure Routes.......................................................................................................... 4-9 4–3. Classification of Toxic Materials/Substances........................................................... 4-17 Unit 5. Ecology and Environmental Toxicology................................................................ 5-1 5–1. The Biosphere and Ecological Life Forms.................................................................. 5-1 5–2. Toxic Substances in the Environment......................................................................... 5-9 Glossary............................................................................................................................................. G–1 Unit 1. Mission and Organization of the Air Force Medical Service 1–1. The Air Force Medical Service................................................................................................ 1–1 001. Purpose and organization of the Air Force Medical Service............................................................. 1–2 002. The Aerospace and Operational Medicine Enterprise....................................................................... 1–7 1–2. Bioenvironmental Engineering.............................................................................................. 1–10 003. Mission and organization of bioenvironmental engineering............................................................ 1–10 004. Roles and interactions of bioenvironmental engineering with other agencies................................. 1–13 005. Bioenvironmental engineering unit type codes................................................................................ 1–17 C ONSIDER YOURSELF FORTUNATE to be in the bioenvironmental engineering (BE) career field. Not only are BE specialty skills honored professions in the civilian community, this career field as a whole is a vital function in support of the primary Air Force (AF) mission. Given the expeditionary mission of the United States Air Force (USAF), you will have a personal and moral responsibility to help maintain the health and readiness of our forces. Regardless of your specific duties, the overall mission will not be accomplished unless you perform your assigned tasks faithfully and to the best of your ability. As a member of BE, you must be able to meet and feel comfortable with personnel at all levels of command to present facts and recommendations convincingly. You must write effectively, speak persuasively, and continually educate yourself and the public in your specialty. You should strive to present an outstanding appearance, personality, and belief in your profession, so that other people will have confidence in you and your work. This broad challenging field is constantly changing. It is your duty and responsibility to learn continually, on and off the job, to sustain dynamic growth in your specialty. You are now a member of the Air Force Medical Service (AFMS) (fig. 1–1); we welcome you. We hope your service time will be rewarding to you and beneficial to the organization. As in all serious undertakings, your reward will be equal to the effort you place in your duties. We will start this phase of your career development training by looking at AFMS and the overall mission your career field team helps to accomplish. 1–1. The Air Force Medical Service Figure 1–1. Seal of the AFMS. Air Force missions will increasingly face unprecedented obstacles and health threats. Global reach and rapid tempo characterize flying operations; unique health hazards from new weapons, such as directed energy and fourth generation chemical weapons, will threaten virtually every operation. The key to successfully executing USAF missions will be Airmen physically and mentally prepared to perform at optimum capability to meet the challenge—the focus of AFMS. Health services personnel must ensure they themselves are ready medical forces and that other Air Force members are medically ready. A ready medical force means health services personnel are organized, trained, and equipped to provide rapid response capabilities to support combatant commanders’ broad range of missions. A medically ready force means proper application of medical initiatives aimed at protecting and maximizing the performance of our fellow military members before, during, and after deployments. This section addresses the important aspects of the AFMS mission, vision, and capabilities that prepare our medical and fighting forces. Together, ready medical forces and healthy, medically ready forces ensure Air Force stability and mission responsiveness. 1–2 001. Purpose and organization of the Air Force Medical Service First, we must address the AFMS mission, for an organization’s mission describes its purpose—the “what we are here to do” of our job. In a sense, the mission is a target (fig. 1–2). Without it, people usually spend time trying to accomplish ‘something’ in their jobs; however, there is no real direction or purpose established for them to use as a guide. Though intentions may be good, they may not necessarily be on target. We need a mission to focus resources and capabilities. Air Force Medical Service mission and vision As leader of the AFMS, the Air Force Surgeon General (AFSG) establishes Figure 1–2. Illustration of mission target. its medical service mission, making sure it supports the Air Force mission. The AFMS mission lays its foundation and sets the direction for the entire organization. In turn, each organization within AFMS establishes a mission that supports the AFSG defined mission. Doing this ensures a unified top-to-bottom approach to achieving the AFMS mission. AFMS mission statement The following is the AFMS mission statement: The AFMS mission is to ensure medically fit forces, provide expeditionary medics, and improve the health of all we serve to meet our nation’s needs. The AFMS recognizes that each Airman is essential to the function of the USAF as a whole. To fulfill its mission, the AFMS is dedicated to optimizing the potential of each individual. To do so, the AFMS must promote human performance sustainment and enhancement technologies, provide preventive health maintenance and ensure appropriate treatment/therapy for any health and performance deficits, whether physical or mental. The following items include several avenues AFMS pursues to accomplish its mission. The AFMS partners with individuals to accomplish healthcare maintenance activities. The AFMS works with commanders and weapons systems designers to optimize the interface between personnel and machines. AFMS expertise is integral for force protection, sustainment and mobility operations. In addition, the AFMS identifies, evaluates, designs, and recommends controls to health hazards to prevent illness and injuries. If prevention fails, the AFMS will rapidly restore each Airman to a combat ready status or arrange for the appropriate rehabilitative services. The mission is “what we’re here to do” today. However, it is important to understand that an organization also needs a vision to guide it to the future. For this reason, the AFSG establishes the AFMS vision. AFMS vision statement The following is the AFMS vision statement: The AFMS strives to provide reliable access to safe, quality care for all that we serve, promoting positive patient experiences and outcomes. To achieve this goal, we are committed to providing Trusted Care, Anywhere, around the globe at every Air Force medical facility. The AFMS will provide quality healthcare and health service support anywhere in the world at any time to support the entire military family, be they active duty, retired, or a family member. With highly motivated, trained and respected Airmen, the AFMS will accomplish its mission with integrity and the ability to integrate with Joint Forces. The overarching vision is to provide a world-class health system that supports the military mission by fostering, protecting, sustaining, and restoring health, which, in many ways, mirrors the four AFMS effects we will discuss shortly. 1–3 Support for the air expeditionary force Now that we have discussed the AFMS mission and vision, we need to address what the organization “brings to the fight” to support the air expeditionary force (AEF). The Air Force has transitioned from a force founded on the strategy of forward-based presence to one built on the vision of global engagement—the AEFs. The Air Force mission has shifted from major theater war scenarios to multiple, smaller regional conflicts. The AEF concept is one way of responding to the increasing number of contingencies that call for worldwide deployments. As a result, the Air Force has transformed from a threat-based environment to an effects- and capabilities-based service, and with it, so has the AFMS. What do the terms “effects and capabilities” mean? To adjust to the current expeditionary role of the AEF, Air Force planners have realized the advantages of first identifying the desired outcome (or desired effect) of achieving military objectives and then focusing on the required capabilities, instead of particular programs or weapons systems, to achieve that outcome. Simply stated, capabilities are the means necessary to achieve desired effects. In order to support the operational missions carried out by air component commanders, the AFMS must have certain capabilities required to achieve the desired effects of the missions. The AFMS has identified human health effects and capabilities needed to provide medical support to the AEFs and peacetime healthcare. The AFMS effects describe health service support for the warfighter. AFMS effects are what the medical service “brings to the fight.” Air Force Medical Service effects AFMS has five effects-based mission areas. These include promoting and sustaining a medically ready force, prevent illness and injury, restore health, optimize and sustain human performance, and Systematize high reliability throughout the Aerospace & Operational Medicine Enterprise. Promoting and sustaining a medically ready force AFMS defines programs and standards that sustain a fit and healthy force and maintains these standards through prevention and treatment. Health services for this effect include mental and physical health assessments at pre- and post-deployment; medical testing and monitoring; health promotion; disease prevention; and evaluating, preventing, and treating environmental and occupational health issues. Prevent illness and injury Preventive medicine activities ensure the force is available to accomplish the mission. Health services for this effect include identifying, assessing and controlling hazards from the full spectrum of health hazards encountered in garrison or deployed environments. It also includes communicating associated hazard risks, so commanders understand the potential outcomes of exposure, and providing solution sets for managing hazards while continuing the mission. Restore health If prevention fails, the AFMS works to restore health as rapidly as possible from equipping and training forces to performing self-aid/buddy care to casualty management services. These services include triaging, transporting, treating, and rehabilitating ill or injured members until fully recovered. Optimize and sustain human performance This AFMS effect includes enhancing the human weapon system to optimize warfighter performance in all environments; support initiatives range from new fatigue management to Laser-Assisted In-Situ Keratomileusis (LASIK). Systematize high reliability throughout the Aerospace & Operational Medicine Enterprise This AFMS effect includes standardizing workflow processes, leader work and management systems. It also includes continuously improving processes and systematizing organizational learning. 1–4 Now that we have defined and clarified the purpose of the AFMS, let us look at how the medical service is organized. As you read the next section, an important fact to remember is that organizations have both line and staff positions and responsibilities. To state it simply, line responsibility dictates the actual chain of command, while staff responsibility serves an advisory capacity. Staff members help the line leader to manage the organization and do not inherently have directive authority over subordinate line units. Air Force Medical Service organization at the Air Force, major command, and wing level The structure of the AFMS organization permits optimum care for its customers. It is neither possible nor productive to address all organizations within AFMS. Therefore, this section addresses the organization as it pertains to BE personnel. Figure 1–3 illustrates line and staff responsibilities that exist in the AFMS. It may be helpful to refer to this figure from time to time as we discuss the AFMS structure. Figure 1–3. Organization from Chief of Staff of the Air Force to the BE Flight. Air Force The Air Force organization leaders are the Secretary of the Air Force (SECAF) and the Chief of Staff of the Air Force (CSAF). The SECAF, charged with policy and oversight of the Department, is assisted by a staff and advised by the CSAF. The CSAF, responsible for organizing, training and equipping AF units to meet combatant commanders’ requirements, is also assisted by the Air Staff. The Air Staff is a body of high-ranking officials—including AF/SG—who assist the CSAF in carrying out duties. The Air Staff is organized in what is known as the “A-staff” structure that divides duties and responsibilities into nine functional areas; A1–A9. Examples of the functional areas include Personnel, Intelligence, Logistics, and Plans & Programs. This staff structure closely mirrors the United States (US) Army’s General Staff (G-staff); the US Navy’s Deputy Chiefs of Naval Operations (N-staff); and the Joint Staff (J-staff), made up of personnel from the US Army, USAF, 1–5 US Navy, and US Marine Corps. These functional areas make it easier for Airmen to do their jobs, both within the AF and when operating with other services within a joint environment. Air Force Surgeon General The AFSG advises both the SECAF and CSAF on medical matters pertaining to AF operations and readiness. A small staff that includes a BE function and two forward-operating agencies assist the AF Medical Operations Agency (AFMOA) and Air Force Medical Support Agency (AFMSA). This staff has no line authority over AF medical units in the field. The organization of the Office of the AFSG mirrors the A-staff structure, where similar functions exist. For example, A1 is the Directorate of Manpower and Personnel at the Air Staff level. It is responsible for issues related to manpower, personnel, and services. Similarly, SG1, Force Management, is responsible for issues related to medical manpower. The AFSG and staff plan, program, budget, develop policies, and oversee AFMS operations for both the SECAF and CSAF. The AFMSA is the AFMS operational and consultant lead for aerospace medicine, preventive medicine, clinical excellence, optimization of medical resources, BE and occupational health, and radiation protection and population health support. Many BE-specific directives originate from the Air Force Medical Support Agency Bioenvironmental Engineering Office (AFMSA/SG3PB). Major commands From the Air Staff level, forces are organized into major commands (MAJCOM). Each MAJCOM mirrors the organizational flow that exists at the Air Staff level. The line structure of each MAJCOM (indicated by the solid lines in figure 1–3) includes the MAJCOM commander, MAJCOM surgeon, chief, aerospace medicine operations, and MAJCOM BE officer. Each of these positions has a staff responsibility to their respective Air Staff leader (indicated by the dashed line in figure 1–3); however, they exercise no line authority over AF medical units. The MAJCOM surgeon and staff advise the MAJCOM commander on health-related issues for their command and health impact of mission operations. The MAJCOM surgeon also interprets and enforces surgeon general policies and provides guidance to medical treatment facilities on these policies, as necessary. The MAJCOM BE provides similar guidance and assistance to installation- level BE flights. Also, at this level is a BE enlisted MAJCOM functional manager, a senior noncommissioned officer (SNCO) who serves as a liaison between installation level BE flights, MAJCOM, and the career field manager (CFM). The MAJCOM functional manager usually works directly for the MAJCOM BE but may also fill the role as an additional duty while serving at an installation level assignment. Wing MAJCOMs are composed of, in descending order of line responsibility, numbered air forces, wings, groups, squadrons, and flights. The wing structure resembles that of Air Staff and the MAJCOM. Beginning with the wing commander, the chain flows down to the medical treatment facility commander, squadron commander, and finally, to the flight commander. The exact structure of each medical treatment facility (MTF) will vary across the Air Force; however, organizational structures will fit one of four models: medical wing, hospital/medical center, clinic with squadrons, and clinic plus. These structures support both garrison and deployed medical groups. Organization at the group and squadron level The organizational structure of each MTF depends on the mission, size, and capabilities of the organization. A medical wing is unique. It is an organization of such size and capability that it coexists with the line wing on the installation rather than coming under its command. Very few MTFs have a medical wing designation. Most MTFs within the AFMS fit either the “clinic” or “hospital/medical center” designation with a six (fig. 1–4) or four (fig. 1–5) squadron structure. 1–6 Figure 1–4. Hospital or medical center structure. Figure 1–5. Clinic structure. You should be familiar with services provided by each of the squadrons within the medical group. The following paragraphs identify the optimum flights that could be made available within each squadron discussed; however, it is not usual for squadrons to have all the flights listed. Medical operations squadron The medical operations squadron provides direct health care services for the defined population. It may include the following flights: medical services, surgical services, pediatrics, mental health, obstetrics and gynecology (OB/GYN), primary care, family practice, physical and occupational therapy, emergency services, genetics, clinical medicine, maternal/childcare, and diagnostic imaging. It also may include dental operations and aerospace medicine flights when an MTF does not have a dental squadron or an aerospace medicine squadron. Surgical operations squadron The surgical operations squadron provides comprehensive, specialized, surgical care to patients. Flights normally approved for this type of squadron include surgical services, operating room, OB/GYN, anesthesia, orthopedics, general surgery, and surgical specialties. Inpatient operations squadron An inpatient operations squadron provides inpatient clinical health care services. It may include the following flights: medical inpatient, surgical inpatient, mental health inpatient, maternal/child inpatient, critical care (includes special care, intensive care, and cardiac care), perioperative and multiservice. 1–7 Medical support squadron This squadron provides business operations (financial and manpower), administrative support, as well as, clinical laboratory and radiology services to aid in the medical care of beneficiaries. The following are approved flights in this squadron: resource management, medical logistics, medical information services, personnel and administration, diagnostic imaging, and patient administration (optional), pharmacy, clinical laboratory, nutritional medicine, diagnostics and therapeutics, histopathology, and readiness. Dental squadron A dental squadron provides preventative and restorative dental care. It typically includes clinical dentistry, dental laboratory, and dental support. When applicable, it may also provide dental residency, and/or area dental laboratory flights. Aerospace medicine squadron This squadron supports the operational Air Force by enhancing the health of its people. This provides for ensuring a fit force, preventing disease and injury, protecting the environment, and, anticipating and responding to medical contingencies in all environments and workplaces. Flight commanders within the aerospace medicine squadron (AMDS) report to the squadron commander who reports directly to the medical group commander. The AMDS squadron commander is responsible for ensuring the aerospace medicine program (AMP) performs successfully. Like the medical group structure, the AMDS structure varies from base to base according to the mission and clinical capability of the MTF. Regardless of the organization, a number of essential elements and activities will be present at all USAF home station or deployed medical treatment facilities. There are 13 approved flights in the AMDS. Depending upon the installation mission, the first flight will be one of four possible variations to include flight medicine, missile medicine, space medicine, or space and missile medicine. For example, you would see a missile medicine flight on an installation with a primary missile support mission. The remainder of the approved flights included: health promotion, public health, BE, aerospace physiology, aeromedical staging, occupational medicine, optometry, hyperbaric medicine, and audiology. It also may include dental operations when an MTF does not have a dental squadron but does have an aerospace medicine squadron. 002. The Aerospace and Operational Medicine Enterprise We have established that the ability of the Air Force to conduct effective and sustained combat operations depends largely on the physical and mental health of its personnel. According to Air Force Policy Directive (AFPD) 48–1, Aerospace & Operational Medicine Enterprise (AOME), the AOME mission is to optimize force health and warfighter performance. To accomplish its mission, the AOME is divided into the following five effects-based mission areas: 1. Promote and sustain a medically ready force. 2. Prevent illness and injury. 3. Restore health. 4. Optimize and sustain human performance. 5. Systematize high-reliability throughout the AOME. The AOME effects are identical to the AFMS effects. Earlier, we talked about the AFMS mission lining up with the AF mission. These similarities continue at this level of the AFMS organization as well as your flight level. AFMS effects reach down through the layers of the organization to keep our targets aligned appropriately. Aerospace medicine flights Each AMDS flight provides specific capabilities to achieve the AMP effects. The following paragraphs explain the roles and responsibilities of your fellow aerospace medicine flights with which 1–8 you will be working. We will discuss BE-specific responsibilities in the next section. Keep in mind, your individual unit may not have all flights; flight arrangements are dependent upon the specific mission of each AMDS. However, something to remember that when personnel from various flights work together to accomplish the mission, it is the team aerospace concept in action, directed by Air Force Manual (AFMAN) 48–146, Occupational & Environmental Health Program Management. This is not only helpful, but it is also essential to the success of any AMDS. Flight medicine flight This flight provides clinical, occupational, and preventive medical care and consultation to all key elements in the squadron, other medical squadrons, and to line units. For example, they provide flying and occupational preventive health physicals and determine fitness for flight and special operational duties. Elements may include occupational medicine, operational hyperbaric medicine, and optometry. Space medicine and missile medicine flights, which parallel the flight medicine flight, exist at bases where there is no flying mission but rather a space mission and/or missile launch and support mission. Health promotion flight This flight provides programs that encourage healthy lifestyles (e.g., tobacco product cessation, exercise and fitness, nutrition, stress management, cardiovascular disease prevention, and substance abuse education). They provide health assessments and evaluations, and develop strategies to reduce mortality rates of active duty or civil servant populations. Public health flight This flight implements public health programs and activities devoted to preventing disease, disability, and illness in military members and their families. Included are food safety and security inspection; sanitation; medical entomology programs; vector borne, communicable, and occupational disease prevention and control; public health medical readiness activities; and promoting and providing health education and training. Elements may include community health, force health management, occupational health and education, epidemiological surveillance, communicable disease control, health risk assessment (HRA) and communication, food safety, and food facility sanitation. Aerospace physiology flight This flight provides human performance enhancement training, works with flight safety, and provides consultant services for flying safety activities. They also assist in aircraft mishap investigations and participate in high altitude airdrop missions. Key elements in the physiological training flight are administration, training, and maintenance. Occupational medicine flight This flight is devoted to prevention and management of occupational and environmental injury, illness, and disability; and the promotion of health and productivity of workers, their families, and communities. It provides initial management of occupational injuries and illnesses and directs medical monitoring efforts for the work force. Optometry flight This flight provides comprehensive eye care for Department of Defense (DOD) health care beneficiaries. They also manage the spectacle/gas mask inserts, contact lenses, and warfighter/aviation corneal refractive surgery programs. Audiology flight This flight manages the hearing conservation and hearing loss prevention programs evaluating and treating hearing disorders. 1–9 Aeromedical staging flight The aeromedical staging flight provides medical and nursing care to patients who enter, travel in, or leave the aeromedical evacuation system. Key elements in this flight are patient support, transportation, education, risk management (RM), infection control, and nursing. Hyperbaric medicine flight This flight provides care and training for decompression sickness, carbon monoxide poisoning, and gas gangrene. As you can see from the preceding paragraphs, the AMP includes many activities. These activities are conducted with an integrated approach that includes officer, enlisted, and civilian personnel. You and others from the various aerospace medicine flights work together as one team— team aerospace—to accomplish the AMP mission. To illustrate this point, let us look at two hypothetical situations. Example one An employee of the fabrications branch receives a hearing exam during her annual physical health assessment. The test indicates a significant hearing shift or deterioration. After monitoring the audiograms, public health (PH) and BE personnel worked jointly to assess the situation. BE reviewed existing noise exposure data, surveyed new noise sources, and assessed the adequacy of engineering controls and personal protective equipment (PPE) available to workers. PH observed protective equipment donning procedures, and reviewed training documentation. In this case, the worker was not inserting her hearing protection properly. PH retrained the worker to use the proper technique to help manage current hearing loss and attempt to prevent further loss. Example two Your unit deploys to South America supporting humanitarian relief efforts. PH provides pre- deployment screenings and briefings before deploying. Two weeks into the deployment, the medical clinic observes a pattern of dehydration and intestinal occurrences. Patient symptoms are treated at the clinic by flight medicine, water sources and heat stress are evaluated by BE, and diet and food preparation areas are evaluated by PH in a coordinated team effort to identify and correct the threat. So, how are AMP activities coordinated? The Aerospace Medicine Council provides the linkage for all the functions of team aerospace. The council coordinates and standardizes your activities, together with the activities of all the other personnel within team aerospace, resulting in no wasted, misdirected, or ignored efforts. We will discuss this important leading body a little later in this unit. Self-Test Questions After you complete these questions, you may check your answers at the end of the unit. 001. Purpose and organization of the Air Force Medical Service 1. Describe the role of the AFSG within the AFMS. 2. List the five AFMS effects-based mission areas. 3. Describe the prevent illness and injury effects-based mission area. 4. Cite the two Air Force organization leaders and describe their individual responsibilities. 1–10 5. Cite the factors that influence the organizational structure of each MTF. 6. List the 13 approved flights within an aerospace medicine squadron. 002. The Aerospace and Operational Medicine Enterprise 1. List the five effects-based mission areas within the AOME. 2. Match the Aerospace Medicine Flight listed in column B with their corresponding responsibilities listed in column A. Column A Column B ____ (1) Provides medical care to patients who enter, travel in, or leave the a. Flight Medicine. aeromedical evacuation system. b. Health Promotion. ____ (2) Provides programs in nutrition and stress management. c. Public Health. ____ (3) Manages the spectacle/gas mask inserts and warfighter/aviation d. Aerospace Physiology. corneal refractive surgery programs. e. Aeromedical Staging. ____ (4) Manages the hearing conservation and hearing loss prevention programs. f. Occupational Medicine. ____ (5) Manages occupational and environmental injuries and illnesses. g. Optometry. ____ (6) Provides clinical, occupational, and preventive medical care. h. Hyperbaric Medicine. ____ (7) Provides human performance enhancement training. i. Audiology. ____ (8) Provides care and training for decompression sickness. ____ (9) Implements food safety and medical entomology programs. 3. What provides the link between all the functions of team aerospace? 1–2. Bioenvironmental Engineering We have looked at the AOME and studied the functional areas. Now, let us take a closer look at your area of responsibility (AOR)—BE—and see how you fit into the big picture of protecting and maintaining a healthy fighting force. 003. Mission and organization of bioenvironmental engineering Earlier, we stated a mission statement describes an organization’s purpose; in other words, “what we are here to accomplish.” Figure 1–6 displays the BE mission along with other statements that provide strategic direction for all BE personnel. 1–11 Figure 1–6. BE strategic direction. To successfully accomplish the BE mission, each BE team member must be able to deliver a common set of capabilities applicable to both home station and deployed environments; consistent application of skills is needed in any setting. The practical application of this philosophy is: Garrison leads to deployed In other words, garrison leads to deployed means BE capabilities and the skills employed to achieve the capabilities are the same regardless of situation or location. Let us look at an example. Aircraft structural maintenance activities are conducted at garrison as well as deployed locations. In fulfilling our responsibilities in support of the AFMS effects-based mission area of preventing illness and injury, we provide the capabilities to identify, analyze, and control occupational and environmental health (OEH) hazards associated with the de-painting operations of aircraft. Let us say for the purpose of this example that health threats posed by de-painting operations include inhaling heavy metal particulates and solvent vapors, and exposure to hazardous noise. These threats are identified and analyzed in the same manner whether the location is Lackland AFB (stateside) or Bagram Air Base (AB), Afghanistan (overseas). There may be slight differences in the tactical execution of activities (emphasis and priorities assigned to accomplishing tasks) in deliberate versus crisis situations and in-garrison versus deployed; however, the skills you apply and capabilities that you provide in these situations are the same. Bioenvironmental engineering primary capabilities BE capabilities are essentially sub-capabilities to AFMS capabilities. They describe what BE members bring to the table to support the AFMS desired effects. The following items provide a summary of the primary BE capabilities. Execute SGI related vulnerability assessments Identify and assess the vulnerability of a terrorist attack on an installation and recommend measures to reduce the overall vulnerability/risk to the mission. 1–12 Conduct predictive exposure assessments Use OEH data, intelligence products, and modeling information for predicting potential OEH exposures across the range of military operations. Evaluate/approve potable and non-potable water systems/sources Analyze surface, ground and/or local supplier sources and storage/distribution systems to determine health risks for garrison and deployed operations. Execute occupational and environmental health site assessment Executing an occupational and environmental health site assessment (OEHSA) is the process for collecting site-specific data to identify and quantify health threats in support of HRAs and to satisfy OEH surveillance requirements. Identify OEH hazards Effectively anticipate and recognize when chemical, biological, radiological, nuclear (CBRN) and physical health threats exist. Analyze OEH hazards Effectively evaluate the extent and effects of existing CBRN and physical health threats. Control OEH hazards Recommend measures to eliminate or control CBRN and physical health threats using health RM techniques. Respond to OEH threats Respond to both deliberate and crisis events. Associate exposure with affected personnel Document OEH hazard analysis data as part of a service member’s longitudinal exposure record. Assist with health risk management Advise decision makers on courses of action to minimize OEH risks while maximizing benefits for operations and missions. The overarching aspect of the BE mission supported by these primary capabilities is performing HRAs performed in the context of RM. As a BE technician, you will use a comprehensive HRA approach to identify and analyze CBRN and physical threats in the air, water or ground; assess associated risk to human health; and recommend courses of action to eliminate or control the hazards. Your activities optimize combat capabilities by preventing illness or injuries and enhancing performance in the deployed and in-garrison environments. As we proceed through this course, we will further explore the BE capabilities and the necessary skills you will apply throughout your career. For now, however, we need to discuss BE flight organization. Bioenvironmental engineering flight organization The organization and management of the BE flight can vary from base to base, reflecting several base-specific and flight-specific factors such as the mission(s) of the base, the number and type of customers served by the BE flight, the number and skill mix of BE staff working in the flight, and the preferences of the flight commander. Further, BE anticipates that the transformation to capabilities- based operations will affect organizational structure as flight operations move away from a program- specific regulatory compliance focus. Figure 1–7 illustrates one organizational construct. Large BE flights may be oriented around two or more broad areas of related functions (i.e., occupational health surveillance, community health 1–13 surveillance, readiness and training, and radiation surveillance). For instance, the flight might establish a readiness element if the unit is part of state and local response capabilities defined by agreement and plans or supports nuclear weapon storage and transport mission. If the installation has a large nuclear medicine function or radiation research mission, the unit might establish a radiation surveillance element. Figure 1–7. BE organizational chart. Another organizational construct centers on teams, where individuals are assigned as managers of specific BE functional areas. They are responsible to either the flight commander or the noncommissioned officer in charge (NCOIC) for their specific functional areas; however, the reporting chain is through team leads. Additionally, this approach may be used to assign responsibility within a geographical area of the installation. Under this construct, teams accomplish all BE-related duties associated with their assigned AOR. This approach cuts across the boundaries of the traditional BE functional areas, encouraging flexibility and cross-flow of training and experience. Regardless of the structure, BE team members are still responsible for executing explicit tasks and meeting specific OEH responsibilities. Our role in team aerospace is accomplished by promoting and maintaining the health and well-being of the operational, industrial, and community environments, enabling commanders to achieve the overall mission. Our training prepares us to handle most problems or needs that might arise during the course of a duty day. Still, there are times we need help or input from other agencies. 004. Roles and interactions of bioenvironmental engineering with other agencies By the nature of your work, you will occasionally need to interact with agencies and committees inside and outside the Air Force. Let us start by taking a brief look at the installation agencies with whom you may interact. Air Force Instruction (AFI) 91–202, The US Air Force Mishap Prevention Program, and AFI 48–145, Occupational and Environmental Health Program, give more detailed descriptions of each agency’s involvement in OEH activities and are good sources of information. You should become familiar with these instructions. Air Force agencies As program partners, several agencies support OEH RM activities, to include recognition, identification, mitigation and control of OEH hazards; health education; medical examinations; injury and illness prevention and reporting; assignment of risk assessment codes (RAC) to OEH hazards in coordination with safety; and lost workday and compensation claim reduction. Ground safety office The installation ground safety manager is responsible for managing the occupational safety program. They conduct workplace safety inspections/assessments and report their findings to the appropriate management officials. BE and the wing safety office (SE) participate together in various installation working groups such as the Installation Hazardous Material Management Program (IHMP), the RAC program, and the confined space program team (CSPT) addressing health and safety issues. As 1–14 program partners, BE team members notify the SE of any safety discrepancies noted during OEH surveillance activities. Civil engineering environmental flight The base environmental coordinator (BEC) manages the hazardous waste program, among other responsibilities. You will also work closely with the BEC and utilities flight to resolve issues related to the drinking water system; for example, water main breaks, water quality issues, and reporting test results. Fire and emergency services As first responders, the civil engineering fire department (CEF) plays an important emergency management role establishing initial command and control at a disaster scene. While fire department personnel are trained for hazardous material (HAZMAT) operations, the BE team provides expertise and advice on proper protection, hazard assessment (identification and quantification), and HRA. Specific actions will depend on the type of incident and response. CEF will also establish gross decontamination for responders and victims. BE team members must evaluate this process and advise the incident commander of any health risks to the receiving health care facility, transportation, or medical care providers. CEF also participates in IHMP and CSPT. Civil engineering emergency management Civil engineering emergency management (CEX) coordinates base response operation plans (OPLAN) and base comprehensive emergency management plan (CEMP) that involve BE input. They also have similar direct reading equipment and work closely with BE in joint training at least once a month. The emergency management flight plays an important role in facilitating response efforts during emergencies. The emergency management flight primarily coordinates the response elements by facilitating on-scene command, control, and communications. It also provides an initial hazard estimate in the form of a hazard plot, and in some cases, an initial detection. The BE team takes the initial assessment to the next levels (identification and quantification of the hazard). In some cases, BE uses chemical plots provided by CEX or other software to supplement the hazard identification process. Other civil engineering agencies Design engineers may consult with BE to ensure plans for new construction or modifications to existing facilities meet occupational safety and health requirements for potentially hazardous operations that will occur in the facility. Each Air Force Form 332, Base Civil Engineer Work Request, must be coordinated through BE before civil engineering can begin work. Public health PH personnel are our partners in OEH surveillance. They apply preventive and public health techniques to reduce and control the incidence of communicable diseases and occupational illnesses. Following OEH surveillance and assessment of exposures performed by BE, PH further evaluates findings for occupational examination recommendations as part of the medical surveillance program. The Occupational and Environmental Health Working Group (OEHWG) reviews and approves these recommendations. BE and PH also work together to resolve community health issues such as indoor air quality, recreational swimming pools and bathing areas; further, they collaborate on work-related illness investigations. Air Force Medical Support Agency – bioenvironmental engineering AFMSA/SG3PB is a field-operating agency of the AFSG. Representatives from each of the medical functions, including BE, develop policy and guidance for their respective functional areas of the AFMS. Many BE-specific occupational and environmental health directives originate from this office. 1–15 Major command – bioenvironmental engineering As previously mentioned, each MAJCOM headquarters has its own BE officer—major command bioenvironmental engineering (MAJCOM/BE). This individual advises the command surgeon and provides guidance and assistance to installation-level BE flights. Further, the MAJCOM/BE helps interpret AFMSA policy, develops supplemental information to policy as it applies to the respective MAJCOM, and is an approval authority for variances to policy. At overseas locations, the MAJCOM/BE acts as the approving authority for drinking water laboratory certification to operate. The major command functional manager (MFM) manages enlisted manning and training issues within the respective command. Information that the MFMs receive from the CFM is disseminated to NCOICs or superintendents at all facilities within their respective command. The MFMs also act as liaisons for the facilities by communicating concerns to the CFM. BE flight leadership must be proactive and recognize when concerns should be elevated to the MAJCOM/BE, such as certain funding matters or personnel issues, or the base receives a notice of violation for a compliance issue. United States Air Force School of Aerospace Medicine Along with education and training, the United States Air Force School of Aerospace Medicine (USAFSAM) provides many other analytical and consultative services. The chemistry laboratory provides chemical analytical services for OEH surveillance samples. They also provide consultative services for assessing contract laboratories, sample collection and analysis, data interpretation requirements, and field analytical equipment operations. The Environmental Safety and Occupational Health division furnishes consultation and field support in industrial hygiene, risk assessment, occupational medicine, ergonomics and noise. They provide to all AF installations many of the same BE services that you provide to your installation on a day-to-day basis. Their services help to accomplish tasks that require specialized training or knowledge otherwise left undone due to manning or resource shortages. The Air Force Center for Radiation Dosimetry manages the Air Force Personnel Ionizing Radiation Dosimetry Program and radioanalytical assessment laboratory and consultation. The USAFSAM’s Air Force Radiological Assessment Teams (AFRAT) can assess hazards when a radiological or nuclear threat exists. We will discuss AFRAT teams in more detail later in the unit. United States Air Force Radioisotope Committee The Nuclear Regulatory Commission (NRC) has granted a master material license to the AF for managing licensed radioactive material used by AF agencies. The USAF Radioisotope Committee (RIC) maintains the master material license, issues permits to users, and is responsible for establishing guidance pertaining to use and disposal of licensed radioactive material to ensure compliance with federal regulations. The installation’s radiation safety officer (RSO) (usually a BE officer) manages the acquisition, inventory, storage, use, transfer, disposal, and transportation of radioactive material on the installation. The RSO interfaces with the RIC on matters related to these activities. Air Force Inspection Agency The Air Force Inspection Agency (AFIA) provides periodic independent assessments of AF operations to SECAF, CSAF, Air Force Inspector General, and MAJCOM commanders. The Medical Operations Directorate performs health services inspections assessing medical readiness, management effectiveness, and quality of healthcare delivery at Air Force medical units—they will inspect your programs and work. Additionally, by agreement with the NRC, AFIA inspects radioactive material permits held by the USAF. The AFIA identifies critical deficiencies that exist within medical programs and recommends improvements for accomplishing the mission. Federal agencies A discussion of federal and civilian agencies that may be helpful to you in conducting day-to-day tasks could be endless. The idea behind mentioning these few agencies and committees and their roles 1–16 is to let you know you are not alone with your important responsibilities. Whenever you need to seek guidance from an agency outside the military structure, you should not do so without your supervisor’s knowledge and approval. Additionally, when dealing with commanders, make sure you notify your commander and supervisor. When interacting with these customers and organizations, treat them as you would expect to be treated. The Environmental Protection Agency The Environmental Protection Agency (EPA) is responsible for designing and enforcing programs that guarantee the continued safety and purity of our environment. Preventing pollution in the air, water, and soil are the agency’s domain. The EPA may delegate to states the responsibility for issuing permits, and monitoring and enforcing compliance, or they may retain the right for themselves. It may be necessary to interface with federal or state EPA officials when establishing and conducting community health surveillance such as drinking water monitoring requirements and reporting a violation of a drinking water standard. BE and the base civil engineer (CE) work jointly to resolve such issues, in conjunction with EPA or state officials. Occupational Safety and Health Administration Occupational Safety and Health Administration (OSHA) is the Department of Labor agency that provides the regulation, guidance, and enforcement necessary to meet requirements of the Occupational Safety and Health Act. This act ensures every employee in the US receives a safe and healthful workplace. OSHA standards are used to evaluate AF workplaces and to train AF civilian and military workers. You will be involved with evaluations of workplaces and continuing education of workers exposed to the hazards identified in their respective work areas. OSHA inspectors may visit your base from time to time. You may be asked to accompany the visiting inspectors. Meetings and work groups commonly attended by bioenvironmental engineering Many committees, working groups, and teams will require your participation and support to accomplish the mission. Some of these assemblies are universal throughout the Air Force, while others are unique to specific bases. Aerospace Medicine Council The Aerospace Medicine Council (AMC) is a collective decision-making body responsible for the functional oversight of the AMP. The AMC established objectives and requirements for the base AMP; determines methods for improving the program; and periodically reviews requirements for functional areas within the AMP. The council is comprised of representatives from each flight within the AMP and chaired by the Chief of Aerospace Medicine. Council members, normally flight commanders and NCOICs, meet periodically to discuss the status of their respective functional areas and any other issues pertaining to AMP-specific resources, personnel, and training. Occupational and Environmental Health Working Group The OEHWG usually meets once per month to review and discuss OEH issues, such as industrial hygiene surveillance results, proposed occupational health education, and examination recommendations. The status of major OEH programs and key metrics are discussed and analyzed for trends. Normally, the BE, PH, and occupational health physician attend this meeting. Environment, Safety, and Occupational Health Council The Environment, Safety, and Occupational Health Council (ESOHC) is the cornerstone of the Environment, Safety, and Occupational Health Program and provides senior leadership involvement and direction. This forum meets at least semi-annually to discuss and report to the installation commander matters and solutions related to environmental programs, environmental health, fire protection, safety, and occupational health. Membership includes representatives from civil engineering, financial management, civilian personnel flight, safety, fire protection, PH, BE, and civilian employee representatives. BE-related issues discussed at the forum include such topics as the 1–17 industrial hygiene program, hazard abatement and respiratory protection, the confined space program, radiation protection program, and issues with the drinking water program. Threat working group and force protection working group Senior BE leadership attends these forums to provide health-risk information in decision making for protecting the base. The knowledge BE team members have regarding drinking water vulnerability assessment (WVA) and toxic industrial chemical/toxic industrial material (TIC/TIM) is particularly relevant here. 005. Bioenvironmental engineering unit type codes BE capabilities are required during all three deployment phases: an initial build-up or deployment phase (also called the “ramp-up phase”) where forces are deployed into an area of operation; sustainment phase, characterized by activities geared towards accomplishing the mission; and ramp- down or redeployment phase. Recall our earlier discussion in figure 1–7 regarding the BE Strategic Objective: Garrison = Deployed. The important role as health risk assessor you fulfill in-garrison continues during deployed operations. In deployed situations, the mission may depend on effective delivery of BE capabilities. Every BE team member must be ready to do their part. Let us look at a few of the unit type codes (UTC) that include BE capabilities. Medical global reach laydown team The medical global reach laydown (MGRL) team provides initial preventive medicine capability and limited medical care specifically for an air mobility squadron’s Tanker Airlift Control Element personnel within Air Mobility Command (AMC). The MGRL team supports AMC’s rapid global mobility contingency and emergency relief operations. The MGRL team consists of four personnel in the aerospace medicine, PH, and BE specialties, minimally equipped to provide initial capability during base laydown operations. The MGRL team provides public health, occupational, environmental, disease surveillance, intervention, and abatement to ensure safe, healthy working and living environments. It also provides for a safe food and water supply. The team often uses expertise/experience to identify and resolve threats. Being at the start of a deployment, the MGRL team is in a position to conduct pre- deployment assessments and influence both site selection and base infrastructure during laydown operations. The team includes one BE officer (43E3A) or BE craftsman (4B071) as a substitute. The MGRL team initiates the OEHSA process by providing initial HRA and threat control recommendations. Preventive and aerospace medicine team The preventive and aerospace medicine (PAM) team travels light and is extremely mobile so it can provide timely preventive medicine requirements to meet the needs of the entire population at the beddown location. The team consists of nine personnel from aerospace medicine, PH, and BE specialties in three increments (with UTCs FFPM1/2/3) to provide expertise throughout the spectrum of preventive medicine activities. The increments can deploy together or in stages. The first and second increments provide initial capability, and the third increment provides expanded capabilities and sustainment for extended operations. Collectively, the PAM team evaluates the safety and vulnerability of local food and water sources, performs epidemiological risk assessment, evaluates local medical capabilities, performs vector/pest risk assessment, determines adequacy of local billeting and public facilities, provides medical intelligence, and performs a hazard or environmental risk assessment. It also recommends locations for the medical facilities and addresses infrastructure needs such as water and waste disposal. The PAM team provides medical input into the proper lay down of food, waste, and sanitation facilities at forward operating locations for control of disease vectors. The PAM team leader is the functional expert in casualty prevention. 1–18 The team employs the OEHSA process to perform health threat/risk assessments, health hazard surveillance, and recommend health hazard control and mitigation measures. A BE officer (43E3) and two technicians (4B071, 4B051) provide expertise in water quality, water distribution system analysis, industrial hygiene, radiation safety, waste management (biological, refuse, and human waste), hazardous material incidents, and hazardous material management. The equipment package (with UTC FFPM4) includes water, soil, air and physical hazard analysis instruments. Medical nuclear, biological, and chemical The medical nuclear, biological, and chemical (MNBC) team (with UTC FFGL1) consists of three BE personnel that conduct nuclear, biological, and chemical (NBC) surveillance, advise commanders on NBC health effects, threat impact, protective action posture, recovery activities, and human HRAs. The team is primarily a contingency asset deployed to, or activated at, base operating locations whenever an NBC threat is present or developing; however, it can also deploy for military support to civil authorities. The MNBC team performs environmental sampling for CBRN agents, analyzes the data to identify and quantify human health hazards, and performs risk assessments based on sampling and analysis results. In working together with CE, the MNBC team provides mission-oriented protective posture (MOPP) recommendations to the commander. The MNBC team augments the PAM team on deployed sites in NBC threat environments and interfaces with biological augmentation, medical decontamination, theater epidemiological, and CE readiness teams. Together, these teams provide comprehensive medical NBC defense capability at a beddown location in an NBC threat environment. The MNBC team provides support to the air base in the areas of contamination avoidance, protection, and contamination control. The team performs specialized and confirmatory sampling of suspected NBC contamination. This consists of collection, analysis and monitoring of air, soil, water and other environmental samples. When needed, the team will preserve, package, and ship samples for more comprehensive analysis. The team consists of one BE officer (43E3) and two BE journeymen (4B051). The MNBC team is assigned an equipment package (with UTC FFGL7 and allowance standard 902B), and consists of sampling, analysis and monitoring equipment for chemical, biological, and radiological hazards. For those AFRAT UTCs that include manpower, the following table summarizes team composition. Team members have expertise in areas of health physics, environmental monitoring, and radiation measurement. AFRAT forces perform radiological assessments that include conducting dose rate measurements, measurements of air concentrations and ground depositions, and radioactive plume modeling. They will collect soil, water, air, and foodstuffs, as well as, breathing air, urine, and feces samples as appropriate. 1–19 Team Composition Summary AFRAT Component Teams By UTC BE Officer BE Enlisted Med Lab FFRN1: Med Rad/Nuc Crisis Advon Team (RCAT) 2 - - FFRN2: Med Rad/Nuc Surveillance Team (RST) 2 4 - FFRN3: Med Rad/Nuc Surveillance Augmentation Team (RSAT) 2 9 - FFRN4: Med Rad/Nuc Laboratory Team (RLT) 1 1 1 FFRN5: Med Rad/Nuc Laboratory Augmentation Team (RLAT) 1 4 2 FFRN6: Med Rad/Nuc Dosimetry Team (RDT) 1 1 1 FFRN7: Med Rad/Nuc Dosimetry Augmentation Team (RDAT) 1 1 1 Air Force Radiation Assessment Team The AFRAT (FFRN1, FFRN2, FFRN3, FFRN4, FFRN5, FFRN6, FFRN7) is a rapid global response capability that provides the manpower, equipment and health physics expertise support to the on- scene commander following a radiation accident/incident. The AFRAT includes the advanced echelon (ADVON) team. Consequently, the mission of AFRAT is to assist in planning, measurement, assessment, and mitigation of all types of personnel, operational, and environmental risks associated with radiation/nuclear (RAD/NUC) hazards. The AFRAT is sub-divided into 10 UTCs of various equipment and personnel (BE and medical laboratory) configurations. Activation of these assets would be scaled to the specific mission needs of the incident. AFRAT forces identify and analyze radiological hazards, assess the risks and recommend force protection measures. They provide expert guidance on what radiological threats exist, what measures can be taken to minimize troop and non-combatant exposures to radiation, and what radiation doses deployed forces actually receive. Typical deployment scenarios will include consequence management operations from nuclear weapons accidents, nuclear reactor accidents, and terrorist use of radiological dispersion devices (dirty bombs), improvised nuclear devices, or humanitarian assistance operations to countries that have experienced a nuclear exchange, incidents, or accidents. As a UTC member, you have many responsibilities. Ensuring the team is well trained and maintaining the appropriate functional equipment are the key factors to success. Take care to routinely and critically assess capabilities and identify gaps that may be present to obtain and maintain readiness. 1–20 Self-Test Questions After you complete these questions, you may check your answers at the end of the unit. 003. Mission and organization of bioenvironmental engineering 1. Cite the BE mission within the AOME. 2. How does BE fulfill its responsibilities in support of the AFMS effects-based mission area of preventing illness and injury? 3. Describe the role a BE technician has in supporting the AFMS mission. 4. Regardless of the structure of the flight, what are BE team members’ responsibilities, and how are they accomplished? 004. Roles and interactions of bioenvironmental engineering with other agencies 1. What organization would be notified if a safety discrepancy was noted during an OEH assessment visit? 2. Which base agency would BE team members work closely with on community health issues such as indoor air quality or recreational swimming areas? 3. Describe the role of the MAJCOM/BE, to include overseas locations. 4. When might BE personnel work together with officials from the Environmental Protection Agency, or with state officials? 5. At what meeting group would topics such as industrial hygiene surveillance results and proposed occupational health education and examination recommendations be discussed? 005. Bioenvironmental engineering unit type codes 1. Describe how the medical global reach laydown team initiates the OEHSA process. 1–21 2. Outline the areas of expertise that BE personnel would provide when assigned to the PAM team. 3. Provide a description of the MNBC team. 4. Which unit type code is primarily a contingency asset deployed to, or activated at, base operating locations whenever a chemical, biological, or nuclear threat is present or developing; however, can also deploy for military support to civil authorities? 5. Which response capability mobilizes to provide on-site manpower, equipment, and health physics support to identify and analyze radiological hazards, assess the risks, and recommend force protection measures following a radiation accident/incident? Answers to Self-Test Questions 001 1. The AFSG is the leader of the AFMS and establishes its medical service mission, making sure it supports the Air Force mission. 2. (1) Promoting and sustaining a medically ready force. (2) Prevent illness and injury. (3) Restore health. (4) Optimize and sustain human performance. (5) Systematize high reliability throughout the Aerospace & Operational Medicine Enterprise 3. Preventive medicine activities ensure the force is available to accomplish the mission. Health services for this effect include identifying, assessing and controlling hazards from the full spectrum of health hazards encountered in garrison or deployed environments. It also includes communicating associated hazard risks so commanders understand the potential outcomes of exposure, and providing solution sets for managing hazards while continuing the mission. 4. SECAF and the CSAF. The SECAF is charged with policy and oversight of the department. The CSAF is responsible for organizing, training, and equipping AF units to meet combatant commander requirements. 5. Mission, size, and capabilities of the organization. 6. (1) Flight medicine. (2) Missile medicine. (3) Space medicine. (4) Space and missile medicine. (5) Health promotion (6) Public health. (7) Bioenvironmental engineering. (8) Aerospace physiology. (9) Aeromedical staging. (10) Occupational medicine. (11) Optometry. 1–22 (12) Hyperbaric medicine. (13) Audiology. It also may include dental operations when an MTF does not have a dental squadron. 002 1. (1) Promote and sustain a medically ready force. (2) Prevent illness and injury. (3) Restore health. (4) Optimize and sustain human performance. (5) Systematize high reliability through the AOME. 2. (1) f. (2) b. (3) h. (4) j. (5) g. (6) a. (7) e. (8) i. (9) c. 3. The Aerospace Medicine Council. 003 1. Provide operational HRA expertise to enhance commander decision making and health service support capabilities. 2. By providing the capabilities to identify, analyze, and control OEH hazards. 3. BE technician activities optimize combat capabilities by preventing illness or injuries and enhancing performance in the deployed and in-garrison environments. 4. Responsibilities include executing explicit tasks and meeting specific occupational and environmental health responsibilities; this is accomplished by promoting and maintaining health and well-being of the operational, industrial, and community environments, enabling commanders to achieve the overall mission. 004 1. SE. 2. PH. 3. Advises the MAJCOM’s command surgeon and provides guidance and assistance to installation-level BE flights. Further, the MAJCOM/BE helps interpret AFMSA policy, develops supplemental information to policy as it applies to the respective MAJCOM, and is an approval authority for variances to policy. At overseas locations, the MAJCOM/ BE acts as the approving authority for drinking water laboratory certification to operate. 4. When establishing and conducting community health surveillance such as drinking water monitoring requirements and reporting violations of a drinking water standard. 5. The OEHWG. 005 1. The team initiates the OEHSA process by providing initial health risk assessment and threat control recommendations. 2. Expertise in water quality, water distribution system analysis, industrial hygiene, radiation safety, waste management, hazardous material incidents, and hazardous materials management. 3. Three BE personnel that conduct nuclear, biological and chemical surveillance, advises commanders on associated health effects, threat impact, protective action posture, recovery activities, and human HRAs. 4. MNBC team. 1–23 5. AFRAT. Complete the unit review exercises before going to the next unit. 1–24 Unit Review Exercises Note to Student: Consider all choices carefully, select the best answer to each question, and circle the corresponding letter. When you have completed all unit review exercises, transfer your answers to the Field-Scoring Answer Sheet. Do not return your answer sheet to the Air Force Career Development Academy (AFCDA). 1. (001) Who establishes the mission of the Air Force Medical Service? a. Air Force Surgeon General. b. Secretary of the Air Force. c. Chief of Staff of the Air Force. d. Major Command Surgeon General. 2. (001) Ensuring medically fit forces, providing expeditionary medics, and improving the health of all we serve to meet our nation’s needs is best described as a part of the Air Force Medical Service’s a. values. b. vision. c. mission. d. strategy. 3. (001) The prevent illness and injury effect can best be described as the a. ability to achieve Air Force Medical Service objectives. b. war-fighting skills the medics bring to deployment. c. health service support in garrison or deployed environments. d. defensive measures medics provide during contingency operations. 4. (001) Which Air Force Medical Service effects include identifying, assessing and controlling health hazards? a. Restore health. b. Prevent illness and injury. c. Optimize and sustain human performance. d. Promote and sustain a medically ready force. 5. (002) Optimizing force health and warfighter performance is best described as a part of the Aerospace & Operational Medicine Enterprise’s a. vision. b. values. c. strategy. d. mission. 6. (002) All aerospace medicine squadron (AMDS) members working together to accomplish the mission best describes a. aerospace vision. b. aerospace mission. c. the team aerospace concept. d. the aerospace working group. 7. (002) The team aerospace concept is best illustrated by members of a. bioenvironmental engineering (BE) working together with base safety and the fire department to correct health hazards. b. health promotions providing stress management education to all installation agencies. c. public health and BE working together to prevent and manage occupational injuries. d. public health educating and training industrial shop workers. 1–25 8. (002) Which of the following examples best illustrates the team aerospace concept? a. Public health (PH) and bioenvironmental engineering (BE) team members working together to investigate a possible waterborne illness. b. A flight medicine technician performing an occupational physical exam on a fellow aerospace medicine squadron (AMDS) member. c. Fire department and the base safety office working with BE to correct health hazards. d. A health promotion technician conducting stress management classes. 9. (003) Providing health risk assessment capability to enhance a commander’s decision making is part of the bioenvironmental engineering (BE) a. values. b. vision. c. mission. d. strategy. 10. (003) Which example best describes the bioenvironmental engineering (BE) primary capability of conducting predictive exposure assessments? a. Use occupational and environmental health (OEH) data for predicting potential exposures. b. Effectively anticipate and recognize when physical health threats exist. c. Recommend measures to eliminate or control physical health threats. d. Responds to both deliberate and crisis events. 11. (004) Which agencies would bioenvironmental engineering interface with to correct a drinking water standard violation? a. Air Force Inspection Agency and the Environmental Protection Agency. b. Air Force Medical Operations and the Air Force Inspection Agency. c. Civil engineering and the Environmental Protection Agency. d. Civil engineering and the Air Force Inspection Agency. 12. (004) Which agency would you consult for assistance when interpreting an Air Force Medical Support Agency policy? a. The major command’s (MAJCOM) bioenvironmental engineering. b. United States Air Force School of Aerospace Medicine. c. Occupational, Safety and Health Administration. d. Air Force Medical Service. 13. (004) Which forum meets once per month to review, discuss, and approve issues such as industrial hygiene recommendations? a. Environmental, Safety and Occupational Health Council. b. Occupational and Environmental Health Working Group. c. Aerospace Occupational and Environmental Council. d. Aerospace Medicine Council. 14. (005) If your responsibilities at a deployed location include performing vulnerability assessments, health hazard surveillance, and drinking water sampling, then you are a member of the a. Medical nuclear, biological and chemical (MNBC) team. b. Preventive and aerospace medicine (PAM) team. c. Medical global reach laydown team. d. Air Force radiation assessment team. 1–26 15. (005) If you are deployed following a radiological incident and asked to identify the radiological environment along with providing recommendations for protective actions then, you are a member of the a. medical nuclear, biological and chemical (MNBC) team. b. preventive and aerospace medicine (PAM) team. c. medical global reach laydown team. d. Air Force radiation assessment team. 16. (005) If you are deployed for the purpose of identifying the radiological environment and recommend protective actions to insure the health and safety of personnel and the surrounding community following radiological incidents, then you are a member of which unit type code (UTC)? a. Medical nuclear, biological and chemical (MNBC) team. b. Preventive and aerospace medicine (PAM) team. c. Medical global reach laydown team. d. Air Force radiation assessment team. Please read the unit menu for unit 2 and continue  Unit 2. Chemistry 2–1. Basic Properties of Matter....................................................................................................... 2–2 006. Physical states of matter.................................................................................................................... 2–2 007. Composition and properties of matter................................................................................................ 2–2 008. Periodic table of the elements............................................................................................................ 2–4 009. Structure of compounds..................................................................................................................... 2–7 2–2. Solutions.................................................................................................................................. 2–16 010. Calculate solution strengths............................................................................................................. 2–16 011. Acids and bases............................................................................................................................... 2–19 2–3. Gases........................................................................................................................................ 2–22 012. Calculate gas laws........................................................................................................................... 2–22 C HEMISTRY IS AN IMPORTANT part of your life. One way or another, chemistry permeates every aspect of BE. The mixing of reagents and buffers in the laboratory, the evaluation of pollution control measures, the interpretation of air sampling results, even the tracking of industrial materials all involve some form of chemistry. What do you think when you hear the word chemical? Did you know that chemicals are not limited to laboratory environments? Chemicals are everywhere. Your body is a collection of chemicals, the most abundant of which is water. Therefore, we can say that when we study chemistry, we also are studying life. Figure 2–1 illustrates the various elements that comprise the field of chemistry. Figure 2–1. Chemistry concepts. You already know one of the most important things about chemistry—it is a science. Chemistry is the science concerned with the composition of substances and the changes they undergo. For example, chemistry is concerned with the components of water (composition) and the interactions between water and other substances. Take a moment to review some of the more common terms and definitions that apply to chemistry’s basic concepts in the glossary. You probably recall many of these terms and definitions from your high school chemistry classes. The goal of this unit is simple: to help you learn chemistry. 2–2 As we said before, chemistry is the study of substances (matter) and the changes they undergo. Everything on Earth, everything in our solar system, everything in our galaxy, and everything in the universe is made of matter. Matter is the name that scientists have given to everything that you can touch, or see, or feel, or smell. 2–1. Basic Properties of Matter We can define matter as anything that has mass and occupies space. Notice that in this definition we use the term mass and not weight—although many people consider them one in the same. Mass is how much stuff you are made of, and it is the same whether you are on Earth, on the moon, on Mercury, or anywhere else that comes to mind. Gravity holds you on Earth; gravity pulling on your mass is your weight. 006. Physical states of matter Matter has three basic forms: solid, liquid and gas. The physical state depends on the temperature, atmospheric pressure and specific characteristics of the particular type of matter. A solid has a definite shape and volume. When enough heat is applied to a solid, it becomes a liquid, which has definite volume but lacks shape. Of the three basic forms of matter, a liquid cannot be compressed; it, therefore, will take the shape of its container. When enough heat is applied to a liquid, it becomes a gas, which lacks both volume and shape. In contrast to a liquid, a gas can be compressed to fill a container with a smaller volume than the original volume of the gas. Upon release from the container, the gas quickly diffuses (spreads out) to fill a larger area. Some matter can actually exist in all three states whereas other matter will break down into new substances when attempting to change its physical state. 007. Composition and properties of matter Regardless of its physical state (solid, liquid, or gas), all matter is either homogeneous or heterogeneous. The difference lies in the fact that homogeneous matter is uniform in composition and properties while heterogeneous matter is not. For example, an office consisting of all women is comparable to homogeneous matter, while a workplace of both women and men is comparable to heterogeneous matter. Figure 2–2 summarizes the organization of matter. Figure 2–2. Organization of matter. Homogenous matter divides into three categories: homogeneous mixtures, solutions, and pure substances. Mixtures of gases are generally referred to as homogeneous mixtures. Solutions are homogeneous mixtures consisting of gases, liquids, or solids dissolved in liquids. 2–3 A solution is a homogeneous mixture in which one pure substance evenly disperses in another pure substance. The dispersed substance is normally the lesser quantity and is called the solute. Whatever the substance is dispersed into possesses greater quantity and is the solvent. We typically think of a solution as having some solid dissolved in a liquid—for example, sodium hydroxide (solute) dissolved in water (solvent). The following are some common examples of solutions: Sugar solutions—sugar dissolved in water. Salt solutions—salt dissolved in water. Alcohol solutions—ethyl alcohol dissolved in water. Vinegar solutions—acetic acid dissolved in water. In some instances, solids can dissolve in other solids to form solid solutions. A good example of a solid solution is brass, which consists of zinc dissolved in copper. Since solutions are mixtures, remember that each component retains its own properties and can be easily separated from the others; they are not in chemical combination. Pure substances differ from homogeneous mixtures and solutions in that they have distinct and constant compositions. Further, they are divided into two groups: elements and compounds. Conversely, mixtures and solutions consist of two or more pure substances in variable proportions. An element is a pure substance that cannot be broken down into a simpler substance by ordinary chemical means. An atom is the smallest particle of an element that possesses the chemical properties of that element. Each atom is composed of three fundamental particles that are best described in terms of their electrical charge and mass (fig. 2–3). The proton, abbreviated p or p+, has a positive electrical charge (+1) and a mass of approximately one atomic mass unit (AMU). The number of protons in a nucleus is called the atomic number— this number determines the element. The next particle is the neutron, abbreviated n or n0, which has no electrical charge and a mass of approximately 1 AMU. Since protons and neutrons are both found in the nucleus of the atom, the total number of protons and neutrons within an atom is called the mass number. Slight variations in the number of neutrons found in the nucleus of the atom result in different atomic masses but may not affect the chemical properties of the element. The third particle of an atom is the electron. The electron, abbreviated e-, has a negative electrical charge (–1) and a mass of 0.0005486 AMU (which is Figure 2–3. Composition of an atom. considered negligible for most practical purposes). The electrons exist in orbit around the nucleus. Each higher orbit from the nucleus represents a higher energy level of the electron. 2–4 The number of protons, neutrons, and electrons in an atom can be determined from a set of simple rules: The number of protons in the nucleus of the atom is equal to the atomic number (Z). The number of electrons in a neutral atom is equal to the number of protons. The mass number of the atom (M) is equal to the sum of the number of protons and neutrons in the nucleus. The number of neutrons is equal to the difference between the M and the Z. The properties of chemical elements depend on the structure of the atom and vary with atomic number. Since the periodic table is arranged by the atomic number, elements having similar chemical properties conveniently line up in the same group. 008. Periodic table of the elements As you can see, the periodic table is organized like a giant grid (fig. 2–4). The elements are located in specific places within the table because of the way they look and act. As previously noted, elements with similar properties are aligned in the columns called groups. The elements in each group all have the same number of valence electrons in their outer shells. The horizontal rows indicate the orbits and number of electrons in the outer shells—increasing from left to right and top to bottom. The far right column reflects inert material, better known as the noble gases. Their outer orbitals are full with electrons and have no advantage to react with anything else. Therefore, these elements are inert (not reactive). Two major groups you should be familiar with are the alkali metals (fig. 2–4, Column IA) and the halogens (fig. 2–4, Column VIIA). The alkali group elements are considered metals—they have luster and conduct heat and electricity. All the elements within this group react vigorously with water to form a basic solution while releasing hydrogen gas. The halogens are considered non-metals and are also very reactive. They react with water to form acid compounds but release no hydrogen. Due to their high reactivity, halogens commonly combine with organic compounds to form dangerous chemicals that can be toxic to humans. The main value of the periodic table is the ability to predict the chemical properties of an element based on its location within the table. Shown on the following page (fig. 2–4), the periodic table shows the positive valence elements running toward the left and the negative toward the right. This is not a random arrangement. Remember that the table is arranged in order of the number of protons. Since the number of electrons equals the number of protons, you can also say that the table is arranged according to the electrons. You may have noticed by now that elements with the same valence tend to be in the same vertical columns, or groups. As you can see, the periodic table is a very clever device for showing the arrangement of electrons and, therefore, the valences and combining abilities of the elements. 2–5 Figure 2–4. Periodic table of elements. 2–6 Atomic weight The atomic weight of an element closely relates to its mass number. They are approximately the same value. Whereas the mass number represents the combined number of protons and neutrons, the atomic weight is based on a comparison to a standard. The standard we use is based on an arbitrarily assigned value of exactly 12 AMUs for a single atom of carbon-12. All other atomic weights are based on 1/12 (1 AMU) of the carbon-12 atom. For example, the mass of the lightest isotope of hydrogen is about one (1.007825) AMU. An AMU, being about the same mass as a proton or neutron, is a very handy unit. Its mass is only 1.66 × 10 −24 grams; therefore, you can see that it is much more practical to express the masses of atomic particles in AMUs. If you take the numerical value of an atomic weight of a given element and simply add the unit grams to it, you have the gram atomic weight. To show the relationship of grams and AMU, you can say that one gram of any element contains 6.02 × 10 23 AMU. Valence The electrons determine the ways elements combine with each other. Electrons are arranged in orbits called shells at varying distances from the nucleus. For any given atom, there are a definite number of electrons a shell can hold. There can be no more than two in the innermost shell (the shell closest to the nucleus), no more than eight in the second shell, and never more than eight in the outermost shell. It is this outermost or outer shell we are mainly interested in—this is where most of the reaction activity takes place. If an outer shell contains all of the possible electrons it can hold, it is considered full—or satisfied; meaning the atom will not combine with any other. This is defined as being inert. All inert elements appear on the right side of the periodic table. These include the noble elements such as helium, neon, argon, krypton, xenon, and radon. Each has its outer shell completely full—so they will not give, receive, or share electrons with another element. This brings us back to the topic of a valence, which is the number of electrons (called valence electrons) an atom will give, receive, or share with another in a chemical reaction to become more stable and have a full shell. Valence can be positive or negative. Just as eight is the magic number for a satisfied outer shell, one- half that number (four) is the critical point for determining a positive or negative valence. Any element with more than four outer electrons has a negative valence. This means that the number of electrons is close to eight but lacks (negative) just a few. It will receive electrons from an element with a positive valence to fill the gap. An element with fewer than four outer electrons has a positive valence. It can be viewed as having a slight excess (positive) of electrons that it will give up. This is somewhat like saying that the previous shell was filled up and a few were left over to start a new shell. Figure 2–5 shows the formation of a water molecule (H2O) from oxygen (valence –2) and hydrogen (+1). Note that it takes two hydrogen atoms to match oxygen’s –2 valences. Figure 2–5. Formation of water (H2O). 2–7 So what happens when the valence is exactly four? Taking carbon as the best example, a valence of four can be positive or negative depending on the combined element. The valence of carbon is –4 when it combines with hydrogen (which has a valence of +1) to form methane (CH4) (fig. 2–6). Figure 2–6. Formation of CH4. Figure 2–7 shows carbon exhibiting a positive valence when it combines with fluorine to form carbon tetrafluoride (CF4). Figure 2–7. Formation of CF4. 009. Structure of compounds Elements form compounds to become more stable. A compound is composed of any two elements that combine chemically. When the elements join, the atoms lose their individual properties and possess different properties from the elements that now make up the compound. Water, salt, and sugar are examples of compounds. A given compound has its own distinctive set of properties that are often very different from the elements it was made from. A good example is combining of the gases hydrogen and oxygen to form the liquid water. 2–8 Chemical bonds are the attractive forces that hold atoms together. Ionic bonds and covalent bonds are the two general types of bonds between atoms in a compound. These bonds form through interactions among the valence electrons of the atoms in the compound. The formation of compounds and molecules depends not only on the existence of unfilled energy levels in many elements but also on the ionization energy of the atoms involved. The ionization energy of an atom is the amount of energy required to remove only the most loosely bound electron from the atom. The remaining portion of the atom is then a cation—a positively charged ion—because the atom now has more protons than electrons. The counterpart of ionization energy is an atom’s electron affinity, which is the amount of energy given off when an atom gains an extra electron. By picking up an extra electron, the atom is now called an anion—a negatively charged ion because the atom now has more electrons than protons with a net negative charge. Ionization energy and electron affinity are important concepts because they help us understand bonding between atoms. For example, atoms gain, lose, or share electrons in the act of bonding. The ionization energy helps a chemist understand what happens when an atom loses an electron, while electron affinity helps describe what happens when an atom gains an electron. Formulas The science community uses formulas to describe the arrangement of compounds. Their symbols and the numbers of each atom show the number of component elements by the subscripts. A symbol without a subscript means that there is only one element in that combination. Molecular This type of formula uses chemical symbols with subscript numbers to indicate the number of atoms of each element. Examples include O2 for molecular oxygen, O3 for ozone, CH4 for methane, and C6H6 for benzene. Empirical If the substance does not exist a

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