C.8 The Medical Assessment C.8.1 A medical assessment is required to have been conducted for all tasks and refreshed annually. The assessment should ensure inoculations will remain effective for the duration of the Deployment and highlight any known problems to the employer. C.8.2 Medical standards and assessments per se cannot be absolutely prescriptive unless laid down by Statute. This means, therefore, that some latitude is allowed in order that a functional approach may be made. In broad terms, assessments should be carried out by health practitioners with knowledge and experience of the duties, work and climatic conditions experienced when Deployed on operations. It should be born in mind that there may be difficulties in the provision of medication while in an OA, PJOB and other areas designated by PJHQ (even an individual’s own medication may be lost and quick replacement will probably be impossible) so most conditions requiring regular medication will not be considered compatible with operational Deployment. C.8.3 For contracted CONDO tasks that require physical work it will be appropriate to undertake an assessment of physical capacity, general strength of upper and lower limbs and mobility. Whatever the working environment an assessment of hearing, visual acuity and emotional stability will be appropriate. The following provides guidance in relation to some of those assessments: a. Visual Acuity – Should be able to see 6/9 in the best eye and 6/12 in the worst eye and read N 12 at 38 cm with both eyes with spectacles if necessary. The need for any particular level of colour vision (and higher levels of visual acuity) will depend more on job requirements than type of Deployment. b. Hearing Acuity – Audio testing with a sound booth is required for the hearing test. The sum of hearing levels in dB in the lower frequencies (0.5, 1 and 2kHz) should not be worse than 84dB and/or the sum of hearing levels in dB in the higher frequencies (3, 4 and 6 kHz) should not be worse than 123 dB. c. Cardio-vascular System - Any cardiovascular condition that is likely to lead to impaired consciousness, shortness of breath or chest pain or any condition requiring regular medication must be considered a hazard in an operationally Deployed civilian. A history of the following conditions would result in not recommending Deployment: angina, cardiomyopathy, claudication, hypertension with systolic >160 and/or diastolic >90, pacemaker, sick-sinus syndrome, second or third degree heart block, toxic myocarditis (viral myocarditis is acceptable if fully recovered) ventricular tachycardia or fibrillation, coronary angioplasty or by-pass graft, valvular heart disease. d. Respiratory System - The term asthma must be treated with caution and a clear picture of the symptoms experienced should be obtained. Its meaning can vary from slight bronchospasm presenting as a cough, with perhaps wheeziness with colITS, a very common situation in childhood, to serious wheezing attacks with considerable incapacity. Individuals who have only made occasional use of inhaled medication over the last two years and whose lung function tests are within the normal range are acceptable. If there is a history of oral (not-inhaled) steroid therapy for other than discrete episodes of asthma associated with a chest infection and/or lung function is < 80% of expected then they should not be recommended. In cases of chronic obstructive lung disease, if lung function is < 80% of expected they should not be recommended. Anyone with a history of restrictive lung disease or more than one pneumothorax should not be recommended. Anyone who has had a pulmonary embolus needs careful assessment of the circumstances and chances of recurrence. A history of a malignant lung growth is cause for not recommending (even if successfully removed). 44 Def Stan 05-129 Issue 5 e. Endocrine System – Although in recent years there have been significant advances in the diagnosis and treatment of endocrine Def Stan 05-129 Issue 5 m. “Extensive dental disease which has not been treated or stabilised is incompatible with operational Deployment. The operational environment has adverse effects on individuals’ abilities to maintain adequate oral hygiene. In addition, stress, irregular meals and changes in diet may aggravate oral disease. Those with a history of high dental disease rates, irrespective of whether or not they are currently ‘treated’, should not be recommended for operational Deployment unless a period of stability with little or no disease progression over the past six to twelve months can be demonstrated. Similarly those having recently completed endodontic or other complex treatment should not be recommended for at least two months from completion of that treatment. Complicated fixed prostheses, particularly those borne wholly or partially on implants, should be carefully assessed for risk of failure, as subsequent treatment may not be available in a theatre of operations. The key dental factor in determining an individual’s suitability for operational Deployment is whether or not their oral condition presents a high risk of causing morbidity during Deployment. Where cases of doubt exist a second opinion should be sought from a dental surgeon with experience of the military operational environment”. C.8.4 General Physical Standard The CONDO individual’s general physical development, his/her fitness capacity and his/her potential to acquire physical stamina should be assessed to determine whether the individual is able to perform the role. The Contractor may wish to review the CONDO individual for full blood count, kidney, liver function, glucose and cholesterol and Blood Group (if not known) (www.bloodcare.org), blood pressure, urine and body mass index to ensure that the CONDO Personnel is medically suitable and healthy to Deploy. C.8.5 Climatic Restrictions For CONDO Personnel with disabilities which normally remain stable in temperate climates, but which might cause breakdown in tropical or cold climates (e.g. chronic otitis externa, chronic suppurative otitis media, hyperhidrosis, severe ichthyosis, sprue, Raynaud’s phenomena and nonfreezing cold injury), it is important that a higher and lower temperature limit is considered to ensure those individuals are not Deployed to regions where their condition may be adversely affected. Germany, for instance, is considered a cold climate during the winter months. Previous Heat Illness or non-freezing cold injury may exclude recommendation on some Deployments according to expected climatic conditions. C.8.6 Vaccinations C.8.6.1 The following vaccinations are recommended; a. Where CONDO Personnel are required to Deploy, they are recommended to keep the following up to date: Polio (lasts 10 years), Tetanus (10 years – the DoH recommendation of a total of 5 vaccinations during lifetime does not apply), Diphtheria (10 years), TB (BCG scar or test to see if required), Hep A (10 years if initial course completed), HEP B (3 Hep B day 0, day 7 and Day 21), Typhoid (3 years) and Yellow fever (10 years - requires international vaccination certificate). Change to live vaccines must be given on the same day or at least 3 weeks apart (i.e. MMR, chickenpox). b. Additional pre-Deployment vaccinations based on actual Deployment location will be advised to contractors in the MWN or the OSI. 46 Def Stan 05-129 Issue 5 C.8.6.2 Some vaccinations are not immediately effective whilst others cannot be given within three weeks of each other (i.e. Yellow Fever and Polio) and it is obviously preferable to minimise the number of vaccinations that have to be given in the few days before Deployment. Therefore, vaccination courses need to be planned for well in advance of Deployment. C.8.6.3 Anybody can refuse to have vaccinations. However, CONDO Personnel who refuse an essential vaccination may not be Authorised to Deploy to any area where there is a significant risk. C.9 Anthrax Anthrax vaccinations take 6 months before they become fully effective (however, a considerable level of immunity is reached after the 3rd injection – 6 weeks) so it essential that vaccinations are considered prior to Deployment. It is MOD policy that anthrax vaccinations should be voluntary and all recipients must watch an informative video before agreeing to have the vaccination. To obtain Anthrax vaccine contractors will need to contact PJHQ-MED-OPS-SO1 at the number below, as Anthrax is not a UK licensed vaccine and the liability will fall to the Contractor's medical officers. To educate Contractors on the purpose of Anthrax, Contractors may request copies of the MOD video through their PCM. C.10 Smallpox Except for health care staff directly involved in patient care, under present and developing MOD vaccination policy it is extremely unlikely that a Deployed civilian will require smallpox vaccination. In the very rare cases where it is recommended that a CONDO Personnel does have smallpox vaccination, this will be advised to the contractor by the PCM. Contractors should note that technical training is required in the administration of smallpox vaccine.
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