SERGEANT
E5
68E2O
DENTAL SERGEANT
1
DENTAL LABORATORY
N5 E5
68E2O
2
SERGEANT
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Chapter 2
Table 2-4. Dental company (area support) (continued)
PARAGRAPH
ADDITIONAL
STAFFING
NUMBER AND
SKILL
GRADE AOC/MOS
TITLE
LEVEL
TITLE
IDENTIFIER
N5
E4
68E1O
DENTAL LABORATORY SPECIALIST
3
E4
68E1O
DENTAL
SPECIALIST
3
03
FIELD DENTAL
CLINIC (AREA)
X2
E4
68E1O
PREVENTIVE DENTISTRY SPECIALIST
4
(continued)
PATIENT ADMINISTRATION
E4
68G1O
1
SPECIALIST
E3
68E1O
DENTAL SPECIALIST
5
04
O4
63B00
COMPREHENSIVE DENTAL OFFICER
1
FORWARD
O3
70B67
FIELD MEDICAL ASSISTANT
1
SUPPORT
PLATOON
HEADQUARTERS
E7
68E4O
PLATOON SERGEANT
1
O4
63B00
CHIEF DENTAL SERVICES
3
O3
63A00
GENERAL DENTAL OFFICER
15
05
E6
68E3O
SENIOR DENTAL SERGEANT
3
FORWARD
DENTAL NONCOMMISSIONED
E5
68E2O
3
SUPPORT
OFFICER
TREATMENT
SECTION
E5
68E2O
DENTAL SERGEANT
3
E4
68E1O
DENTAL SPECIALIST
6
E3
68E1O
DENTAL SPECIALIST
6
Note. For purposes of clarity and ease of discussion the medical company (dental services) and the dental company (area support) will, from this point forward, be referred to in general terms as dental company.
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FM 4-02.19
31 July 2009
Chapter 3
Dental Unit Operations
SECTION I — ESTABLISHING THE DENTAL TREATMENT FACILITY
SITE SELECTION CONSIDERATIONS
3-1. When establishing a DTF in the field careful consideration should be given to the location and choice of terrain on which the DTF will be operating. Some of the advantages that a carefully selected site offers include: easy access to the facility; a smooth flow of vehicle traffic into and out of the area; concealment; defensibility; and adequate drainage during inclement weather.
3-2. There are many factors that influence where the DTF should be located all of which are METT-TC
driven. Considerations which influence the location of the DTF include the—
z
Mission.
z
Commander’s intent.
z
Specifics of the operation plan.
3-3. Additional considerations which should be taken into account when establishing the location of the DTF include—
z
Placing the DTF on terrain that—
Provides easy access to routes of evacuation and which is accessible to the supported troops.
Provides good drainage, is free of obstacles, and provides adequate space to operate.
Is cleared of mines, improvised explosive devices, booby traps, and CBRN hazards.
Enables or enhances communications capabilities.
Provides natural cover and concealment.
Is easy to defend in the event of attack.
Is free of garbage dumps, landfills, toxic industrial materials or other waste disposal sites.
z
Placing the DTF on or within easy reach of terrain that has sufficient space for incoming and outgoing air ambulances and ground ambulance turnaround.
z
Placing the DTF as far as possible/practical from—
Terrain that is a likely breeding site for flies, mosquitoes, and other pests.
Structures, facilities, or equipment that may be considered likely targets for the enemy.
3-4. If the unit’s mission requires that it relocate frequently, establishing a complete treatment area may not be practical. Under these circumstances the DTF may choose to set up an expedient shelter under which to conduct treatment operations. Time may allow only essential services, shelters, and equipment will be used. If however, it is anticipated that the unit will be located at one site for an extended period of time, existing shelters or buildings when available, may be used.
SHELTERING THE DENTAL TREATMENT FACILITY
3-5. When providing dental care in a field environment the DTF should be established so that the patients and staff are sheltered from the elements. It is also desirable to have some degree of environmental control.
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Chapter 3
EXPEDIENT SHELTERS
3-6. Expedient shelters are generally more convenient and easier to establish and use when a unit is conducting a movement and must provide emergency dental care. Expedient shelters may be as simple as a tarp being erected to shield the patient and dental staff from the sun or rain. In situations where weather and terrain permit, a shaded area adjacent to the route of march will suffice. It may be as simple as setting up on the tailgate of a vehicle which may be adequate for the immediate situation.
TENTS
3-7. All U.S. Army field dental units are equipped with tents. The types of tentage available to a unit are based on common tables of allowance and the unit’s modified table of organization and equipment.
Note. When a unit replaces existing tents, selection criteria for new tents must include compatibility with the unit’s existing heating, cooling, and electrical requirements and capabilities.
3-8. Tents provide dental personnel with a shelter system that is quick to setup and strike. Their portability and convenience are especially useful for forward deployed dental treatment teams. Tents are easy to camouflage and conceal and allow flexibility in site selection.
SEMIPERMANENT BUILDINGS
3-9. Semipermanent buildings are generally constructed and used in base clusters or forward operating bases particularly in long-term stability operations. Semipermanent buildings offer a number of features that make them very desirable. The structures can be built to specific dimensions which are required to establish and operate a DTF.
BUILDINGS OF OPPORTUNITY
3-10. Buildings of opportunity present a number of distinct advantages and should be used whenever possible. These may include electrical lighting, air conditioning and central heat, telephones, running water, and toilets. Prior to establishing a DTF in an existing structure, the building must first be inspected and approved for occupancy by the supporting engineers. The buildings existing layout may pose a significant challenge to dental personnel when trying to establish an efficient layout.
SECTION II — ADMINISTRATIVE TOOLS AND REQUIREMENTS
DENTAL RECORDS
3-11. Maintenance and disposition of dental treatment records are governed by AR 40-66.
OUTPATIENT TREATMENT RECORDS
3-12. Outpatient treatment records are prepared for each patient treated by a U.S. Army DTF. An outpatient treatment record will be prepared by the first DTF to which a person reports for outpatient treatment. After being initiated, the outpatient treatment record will be kept at the DTF.
DENTAL TREATMENT FACILITY TREATMENT LOGBOOKS
3-13. The DTF’s daily dental treatment logs are maintained by the dental officer at each DTF. The DTF
logbook is maintained by each DTF to record the names, rank, and unit of the patients treated at that DTF, and the patient’s disposition. Other useful information includes the date, time, and the reason for the visit and whether the treatment provided was for disease and nonbattle injury or battle injury-related conditions.
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Dental Unit Operations
This log is retained for the clinics record and the information provides a valuable source of data for statistical reporting.
DENTAL REPORTS
DAILY DENTAL UNIT STATUS REPORT
3-14. The daily dental unit status report provides a brief summary of supported units’ current dental condition. The frequency with which the report is submitted is situationally dependant. The report is submitted to the dental company’s higher headquarters.
QUARTERLY DENTAL ACTIVITY REPORT
3-15. The quarterly dental activity report is a summary of the DTF’s activities during the quarter. This report is required to be submitted to the DTFs higher headquarters by the 15th of the month following each fiscal quarter of the year by the division/corps surgeon (see Figure 3-1, p 3-4). For example, each DTF
will submit a report covering the period 1 July through 30 September not later than the 15th of October of that year. If participation in an operation or exercise ends before the end of a quarter, the final dental activity report will be due 15 days after return to the home station.
Unit Information
3-16. The dental activity report will include—
z
Dates of the report period.
z
Name and location of unit or DTF.
Description of facilities.
Dental unit or DTF movement during report period.
Personnel Information
3-17. Personnel information includes the name, rank, and AOC for officers and the name, rank, and MOS
and additional skill identifier for all enlisted personnel.
z
Identity of the officer in charge and noncommissioned officer in charge.
z
Date of arrival and departure of all personnel.
z
Awards, honors, and achievements.
z
Dental and organizational equipment to include deficiencies, excesses, problems, and recommendations.
z
Supply and maintenance, to include deficiencies, excesses, problems, and recommendations.
z
Units supported, to include date support began and date support terminated.
z
Activities and programs (for example, foreign humanitarian assistance, preventive programs, professional and unit training, and distinguished visitors).
z
Suggestions for improvement.
Purpose
3-18. The dental activity report is intended to keep command channels informed of the status of dental resources and activities in the field. The report provides commanders with a tool that may be used to address specific issues and concerns.
3-19. After a complete initial report is submitted, subsequent reports need not repeat information which has not changed. Unless changes are made on subsequent reports, it may be assumed that the data furnished in the previous reports are still valid and serve as a cumulative record of dental service for that unit.
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Chapter 3
Figure 3-1. Sample dental activity report
3-20. Daily dental unit status reports and quarterly dental activity reports are submitted through command channels to the MEDCOM, DS dental surgeon. The DTF dental reports are retained at the dental facility and are available for audit if needed. Medical command and dental command surgeons extract data which is used to assess resource management and professional policy needs before forwarding reports to the next higher level. A summary of the DTF’s daily dental activities report is the only numerical manipulation required at the DTF level. Dental surgeons and dental commanders may extract additional information required to prepare their quarterly dental activities report.
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31 July 2009
Dental Unit Operations
ANNUAL HISTORICAL REPORT
3-21. This regulation prescribes procedures for providing the DA with annual reports of administrative, professional, and operational activities of the AMEDD. They are essential as reference and source material for the historical programs and missions of the AMEDD. They are frequently referred to when data are required by or requested of the AMEDD in its current operations. The reports are also used as teaching reference material. For a detailed discussion on historical reports refer to AR 40-226.
Format
3-22. Reports will be written in narrative form and prepared on one side of 8 X 10 1⁄2-inch paper. Each page will be identified at the top by the preparing agency designation and calendar year and numbered consecutively in the center of lower margin.
3-23. A margin of 1 1⁄2 inches will be left at the top and left of each page.
3-24. Each report will be stapled by not more than two staples along the left margin. No other form of fasteners will be used.
Suggested Contents
3-25. The following topics are suggestions. It is not intended that each should be reported on solely because it is mentioned. The report should include any subjects which are appropriate to adequately reflect all important activities of the reporting unit.
z
Mission. Identify unusual mission assignments; include changes in mission and/or unit relocation and reasons therefore.
z
Organization. Important changes in organization and reasons therefore; include an
organizational chart for clarity.
z
Personnel. Unusual factors which significantly influence staffing of major professional and administrative elements or other considerations which have significance for development of personnel staffing guides.
z
Training. Significant and unusual training activities, objectives, and programs.
z
Materiel. Significant and unusual supply and maintenance programs.
z
Construction. Major construction, alteration, or repair programs.
z
Patient care and evaluation. Major professional policies or procedures for inpatient or outpatient care; unusual cases of historic importance; special problems and their solutions; comments on significant patient evacuation experience; significant accomplishments and trends.
z
Health and environment. Significant factors affecting the health of the command such as incidence, epidemiology, and control of infectious diseases; environmental hygiene;
occupational health service and nutrition; Army health nursing programs and activities and where indicated, medical and health problems of the civilian or multinational military population in the area.
z
Dental service. Significant factors relating to operation of dental services, progress, and accomplishments in preventive dentistry and continuing educational programs.
DENTAL READINESS AND COMMUNITY ORAL HEALTH PROTECTION REPORT
3-26. Dental readiness is fundamental to maintaining unit readiness and reducing noncombat dental casualties during deployments. Community oral health protection emphasizes not only oral health, but also general wellness and overall fitness of our Soldiers and all authorized beneficiaries. Army Regulation 40-35 provides guidance for the development and conduct of the Dental Readiness and the Community Oral Health Protection programs for all authorized beneficiaries of the Army Dental Care System. It describes the Dental Readiness Program for active duty Soldiers and other programs that benefit all members of the Army community.
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Chapter 3
3-27. The Dental Readiness and Community Oral Health Protection programs include the following components:
z
Dental Readiness Program.
z
Clinical Oral Health and Health Promotion Program.
z
Community Health Promotion and Disease Prevention Program.
SECTION III — CLINICAL OPERATIONS
PATIENT SAFETY
3-28. Patient safety in the health care setting involves a variety of clinical and administrative activities that organizations undertake to identify, evaluate, and reduce the potential for harm to beneficiaries and to improve health care quality. Effective patient safety initiatives seek to control untoward events before they occur and, as such, elements of risk assessment, risk identification, and risk reduction or containment are involved.
3-29. Leaders in MTFs play a critical role in the facility-based patient safety program given the influence that leaders exert on activities directly associated with this program (such as performance improvement, environmental safety, and risk management). Although the beneficiary is the central focus of patient safety, it is difficult to create an organization-wide patient safety initiative that excludes staff, Family members, and others. Many of the activities implemented to improve patient safety (for example, security, fire safety, equipment safety, infection control, and falls prevention) encompass staff and others, as well as patients. Patient safety is a critical component of both a table of distribution and allowances and/or TOE
organization’s comprehensive safety efforts. As such, patient safety activities and processes must be effectively integrated with those of the existing MTF/DTF Safety Program. Patient safety and the reporting of adverse events, especially sentinel events, are likewise important in the field environment.
Wherever practical, efforts must be made by leadership to emphasize patient safety and to minimize patient harm associated with the provision of health care to Soldiers.
3-30. Universal precautions will be implemented by all dental personnel. To prevent cross-contamination barrier protection materials are included in the dental equipment set (DES). Dental equipment sets are discussed in Appendix C.
INFECTION CONTROL AND EXPOSURE CONTROL
3-31. All U.S. Army DTFs and all U.S. Army dental health care workers are governed by infection control policies and regulatory guidance provided by the—
z
Assistant Secretary of Defense for Health Affairs.
z
Office of The Surgeon General.
z
Dental Command (DENCOM).
z
Occupational Safety and Health Administration.
z
Centers for Disease Control and Prevention.
3-32. All Army dental units must adhere to infection control/exposure programs based on existing regulatory guidance. These programs provide site specific guidance in all aspects of infection and exposure control for dental health care workers.
QUALITY ASSURANCE PLAN
3-33. The quality assurance plan is a tool which dental commanders can use to ensure that deployed Soldiers have access to the same quality of care that they would at their home station DTF. The plan allows the dental commander to make a standardize assessment of Soldiers access to care, quality of care provided, effectiveness and utilization of dental assets and resources, and risk management considerations and solutions. Quality assurance plans are discussed in detail in Appendix D.
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31 July 2009
Dental Unit Operations
WASTE MANAGEMENT
3-34. Dental units generate three types of waste materials, they are—
z
General waste.
z
Hazardous waste.
z
Medical waste (to include regulated medical waste).
3-35. For a detailed discussion regarding the collection, handling, and disposal of waste materials refer to FM 4-02.17. Proper handling and disposal of medical waste is required to protect the force and avoid environmental contamination. Assistance with the removal and disposal of medical waste is normally available through supporting engineer units, preventive medicine teams, and local MTFs.
RADIOLOGY OPERATIONS
3-36. The ability to produce x-ray images is an important diagnostic tool in modern dentistry. It is for this reason that handheld digital x-ray equipment is an integral part of each DES. As with all radiology operations, applicable safety precautions must be put in place and observed to reduce the threat of injury associated with this type of equipment.
3-37. Dental radiology equipment is found in the dental company (area support), medical company (dental services), forward treatment sections, and in brigade support medical companies and medical companies (area support). The handheld digital x-ray equipment is capable of producing a full range of intraoral x-rays and, when necessary, may be used for other medical procedures.
3-38. Operation of handheld digital x-ray equipment is an additional responsibility of the dental specialists assigned to the unit. As with all radiology operations, the use of patient protective aprons is mandatory when x-ray images are being made.
3-39. The manufacturer’s instructions and guidelines for the care and use of x-ray equipment and associated materials must be followed. These procedures and precautions should be addressed in the unit’s clinical standing operating procedures (CSOPs).
FIELD DENTISTRY
3-40. Providing dental care in a field environment requires the same basic equipment, clinical skills, and standards of practice, as that provided in garrison DTFs. There are, however, unique challenges to dental personnel working in a field environment presented by the varying terrain features, environmental conditions, availability or lack of facilities, and the tactical situation. To effectively support and quickly return Soldiers to duty, dental personnel must be capable of working quickly and accurately in a field environment.
3-41. Dental treatment can be provided as soon as a suitable working area and power are established.
Patient care operations performed in the field are performed in much the same manner as they would be in a garrison environment. The objective, as previously stated is to provide the necessary care and return Soldiers to duty as quickly as possible.
PROSTHODONTIC CARE OPERATIONS
3-42. Soldiers who wear dentures that begin to cause discomfort and pain, are damaged, or are lost are classified as dental casualties. These casualties can be treated by the dental company prosthodontic section which is capable of repairing or replacing dentures in the field. Dental company DES contain the tools and materials necessary to provide temporary fixed prosthodontic coverage and cementation.
Additionally, each forward treatment section of the medical company (dental services) and forward treatment section of the dental company (area support) are equipped with emergency denture repair kits to effect prosthodontic repairs.
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FM 4-02.19
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Chapter 3
3-43. Theater prosthodontic laboratory capabilities include—
z
Wax records and bases.
z
Impression procedures and cast fabrication.
z
Stain and glazing.
z
Immediate transitional resin dentures.
z
Die fabrication and trimming.
z
Relining/rebasing.
z
Repairs.
3-44. Patient requirements that exceed the capability of the theater laboratory can be mailed through the Army Post Office system back to CONUS area dental laboratories for fabrication.
3-45. The benefit of this capability is that the unit is not required to keep the additional personnel and equipment on hand. The savings in weight and cube contributes significantly to the mobility of the unit.
MEDICAL EVACUATION OF DENTAL PATIENTS