Manual of the Medical Department (NAVMED P-117): Chapter 15: Medical Examinations

Manual of the Medical Department (NAVMED P-117): Chapter 15: Medical Examinations: Special Duty

15-64 Antarctic "Operation DEEP FREEZE"

Department of the Navy
Bureau of Medicine and Surgery

(1) Purpose. The purpose of this examination is to identity civilian DoD employees and contract personnel, visitors, and military personnel who are physically qualified and psychologically adapted for assignment (regardless of assignment category, i.e., summer support a winterover, per SECNAVINST 3160.2 series, OPNAVINST 3120.20 series and MILPERSCOM Notice 1300) or travel to any antarctic research or support station operated by the U.S Antarctic Program (USAP). In addition, U.S. and foreign national visitors sponsored by the National Science Foundation (NSF) or other agencies must also meet the standards outlined by this article before they can be medically approved to visit Antarctica. Duty in Antarctica is medically remote. Medical facilities in Antarctica are limited, and may be distant from working or research sites. Depending on assignment, personnel may be waking at terrestrial elevations as high as 12,000 feet (3,600 meters) and at temperature as low as 123°F ( 86°C) and may be isolated for up to 9 months. Although every effort is made to provide comfortable, sate, and pleasant living conditions, the nature of the Antarctic environment with its potential hazards and extreme remoteness from major medical facilities make stringent medical and surgical history and medical examination screening mandatory to ensure freedom from any disability which might imperil health, restrict activity, a create a burden or hazard for others.

(2) Additional Standards. Any physical detect a disease process though not specifically mentioned in this article, but considered to be a liability to the candidate a the mission, may be cause for rejection. Specific items that may be cause for rejection are listed in section III. Included below are exceptions to section III or are included for emphasis:

(a) Nose. Recurrent or unresolved epistaxis.

(b) Lungs and Chest Wall

(1) Chronic obstructive pulmonary disease, diagnosed by x ray a pulmonary function test of any etiology.

(2) Acute bronchopulmonary infection, until resolved.

(3) Repeated pulmonary embolism or recurrent spontaneous pneumothorax.

(4) Reactive airway disease or asthma.

(1) Hypertension requiring two drug therapies for control. Evidence of progressive target organ damage.

(2) Paroxysmal dysrhythmia, e.g., paroxysmal atrial tachycardia, and conduction abnormalities reflecting underlying head disease.

(d) Abdominal Organ and Gastrointestinal System

(1) Chronic or active peptic ulcer disease, diverticulitis, regional enteritis, or any chronic inflammatory bowel disease.

(2) Symptomatic chronic a recurrent biliary disease or pancreatitis.

(3) Unrepaired inguinal, umbilical, or femoral her nias

(4) Frequently or severely symptomatic hemorrhoids must be repaired.

(e) Endocrine and Metabolic Disorders

(1) Diabetes mellitus.

(2) Any endocrinopathy requiring close monitoring and adjustment of exogenously administered hormones.

(f) Genitalia and Urinary System

(1) History of urinary tract lithiasis.

(2) Chronic or acute pyelonephritis or glomerulonephritis.

(3) Significant dysmenorrhea or menorrhagia.

(4) Pregnancy.

(5) PAP Smear results may be class I and II for summer support, must be class I for winter over.

(6) Any history of treated cervical dysplasia requiring frequent examinations and PAP smears.

(g) Musculoskeletal

(1) Chronic or frequently recurring lumbosacral pain or unresolved back injury.

(2) Instability of the knee or ankle.

(3) Post traumatic or post surgical arthralgia kyllosis of the hip, knee, or ankle.

(4) Recurrent dislocation of the shoulder.

(5) Persons with metallic orthopedic devices such as pins, nails, or plates should be carefully evaluated. Pain upon exposure to cold often occurs.

(h) Skin and Cellular Tissues. Any chronic dermatosis which would be exacerbated by the extreme cold and dryness of Antarctica, wearing of woolen garments, or requiring complicated treatment.

(i) Neurological Disorders. Any seizure disorder.

(j) Psychiatric

(1) History or manifestations of psychosis' permanent brain syndromes, significant neuroses or psychophysiologic disorders, and personality disorders.

(2) Subjects without formal psychiatric diagnosis who have experienced chronically or intermittently conflictual relationships, intolerance for environmental stress, a pattern of marginal performance, injudicious consumption of alcohol or other intoxicant substances, abhorrent sexual maturation, or similar identifiable potentials for psychosocial maladaptation.

(3) Recovering alcoholics requiring continued professional support. A minimum of 1 year of sobriety is required.

(k) Dental

(1) Nonrestored teeth or periodontal disease.

(2) Symptomatic or potentially symptomatic third molars, until extracted and healing is completed.

(3) Dental classifications other than class 1.

(l) Systemic diseases and miscellaneous conditions

(1) Allergic manifestations which require allergy immunotherapy (AIT). This may be wavered if the AIT can be discontinued while in the Antarctic. This interruption in desensitization therapy must be voluntary on the part of the individual and only upon the advice of the individual's allergist.

(2) Any disability significantly limiting physical activity.

(3) Any illness or condition requiring chronic maintenance medication, which would be exacerbated if the medication were unavailable.

(4) Any malignant neoplasia not considered to have been cured. This includes malignancies currently in remission.

(m) Body fat. Clinical obesity. The examining physician will determine if the candidate is obese according to height, weight, and body build and general physical condition. Military candidates will be subject to current directives applicable to their branch of service.

(3) Special Studies. In addition to the special studies required in article 15 9, the below listed studies will be performed.

(a) All winterover personnel will have a psychiatric evaluation conducted at designated medical facilities. Examinees will be notified individually of the date and location of this evaluation. The psychologic test forms and the results of the psychological assessment, psychiatric examination, and combined evaluation will be forwarded directly to Force Medical Officer, Commander, U. S. Naval Support Force, Antarctica, FPO San Francisco 96601.

(1) Antarctic Assignment Questionnaire, NAVMED 6520/8, will be completed, dated, and signed by each winter over candidate and must be reviewed by a psychiatrist or clinical psychologist as part of their evaluation.

(2) Psychiatric Evaluation Form, NAVMED 6520/9 and Psychological Evaluation Form, NAVMED 6520/10 will be completed by the psychiatrist and clinical psychologist separately, immediately following the interview of the candidate.

(3) Combined Evaluation Form, NAVMED 6520/11 will be completed jointly by the psychiatrist and clinical psychologist.

(4) The completed forms will become a permanent part of the candidates assessment and evaluation record maintained by Medical Department, Naval Support Force, Antarctica, Port Hueneme, CA.

(b) All winterover personnel will have a chest x ray.

(c) All personnel will have a Type II dental examination (including bite wing x rays) and a periodontal examination. Winterover personnel will also have a full set of mouth x rays or a panorex performed.

(4) Annual evaluation. An annual evaluation will be completed while assigned to the Antarctica program. The following are minimum requirements for an annual evaluation, but may be expanded as required, based on the interval medical history, health risk assessment, and whatever physical findings are noted.

(a) Review of ENT status (history of current or recent problems), including audiometric examination if not performed during the preceding 12 months.

(b) Cardiovascular status (history of current or recent problem). EKG tracing.

(d) Height/weight/percent body fat.

(e) Summary of medical care received in previous 12 months.

(f) Summary of current or recent treatment required.

(g) Statement of qualification fu assignment to Antarctica

(h) The results of the evaluation should be entered on the Chronological Record of Medical Care (SF 600).

(5) Periodicity

(a) Medical examinations, recorded on SF 88 and SF93 will be completed at the periodicity of article 15-11 except for winter over military, DoD civilian, and civilian contract personnel who will be examined prior to deployment.

(b) Personnel who return to the Antarctic Program after an absence of 2 or more years, regardless of cause, will be examined as an initial candidate.

(6) Special Reporting Requirements

(a) Military and civilian DoD candidates. A complete examination will be conducted by the member's current command after being ordered to Naval Support Face Antarctica or Antarctic Development Squadron SIX. Forward the completed examination, SF-88 and SF 93, along with any indicated consultations, to the Commander, U.S. Naval Support Force, Antarctica, FPO San Francisco 96601 or Antarctic Development Squadron SK, FPO San Francisco 96601 for approval prior to actual transfer.

(b) Civilian contract candidates. A complete examination will be pertained by a private physician. Results will be forwarded to the above address via the NSF contractor, for final approval prior to deployment. Winterover candidates will be scheduled for the psychiatric examination upon approval of the medical and dental examinations. To ensure all requirements are met initially, civilian contract personnel are encouraged to correspond with the force medical officer prior to completing their examination.

(7) Additional Information

(a) For personnel requiring vision correction, two pairs of standard spectacles are required plus one pair of corrected sunglasses. All personnel must have sunglasses to wear when working outside in the Antarctic. Members may, at their option, but not at Navy expense, wear contact lenses, it appropriately fitted and evaluated for remote duty, but must also have a pair of spectacles.

(b) The examiner must note all medication on the SF93. Personnel will be required to bring a sufficient supply of chronic medication to complete the expected period of deployment.

(8) Waivers. All waiver requests will be submitted, per section V of this chapter, via the chain of command, to Commander, U.S. Naval Support Force, Antarctica for disposition.