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and able to participate in all activities. Occasionally you may be pressured from above
to get a crewmember swiftly processed to go to the CCU don t allow that to happen.
Don t make the mistake of sending an individual with a physical problem or limitation to
the CCU with a clean bill of health.
If a crewmember is awarded time at the correctional unit, they should return to the
command within thirty days. People being administratively processed for separation are
not allowed assignment to the CCU purely as a punishment.
FITNESS FOR DUTY EXAMS
This is described in the GMO Manual and BUMEDINST 6120.20 series. Only the CO or
a designated representative, e.g., the CDO, can order them. When ordered, find out
why they want them. Usually it is because someone came to work intoxicated or had
alcohol on their breath, and they want to use this exam against them at NJP. If that s all
they want it for, they don t need a competency for duty exam. They can charge the
individual for being drunk on duty if the supervisor smells alcohol on their breath, and
they can send the person to their rack. If the supervisor wants a legal blood alcohol,
then the individual must be read their rights by the MAA and consent to giving the blood
sample, or there must be a warrant. If you are doing a blood alcohol because you think
someone is drunk, or you just want to do one, you can draw the specimen, and it can be
used at an NJP, but probably not at a court martial (you will have to talk to the lawyers to
get all the fine points of legal evidence).
When doing competency for duty exams, always take a very conservative approach. If
the individual in question does anything of importance i.e., beyond punching tickets in
the mess hall and you think they MIGHT be under the influence of drugs or alcohol, put
them in their rack in a down status until your screening tests come back or they have
slept it off. Having someone lose a day of work is better than having them lose their life
or someone else s.
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The results of any fitness for duty exam are completed in triplicate on NAVMED 6120/1
form. One copy goes in the record, one to the patient, and one to your file. Make sure
you do the exam by the numbers.
OVERSEAS SCREEN
Personnel assigned to overseas duty, as well as their dependents, must have an
overseas screen done prior to transfer. This includes a command screen (to make sure
that there are no legal, financial or social problems), and medical and dental screen
(some duty stations are isolated and have limited medical and dental facilities).
Personnel who require unusual resources (e.g., specialized medical care) are not
supposed to be assigned overseas. It is very expensive to have to bring these people
back early. OPNAVINST 1300.14A and NAVMEDCOMINST 1300.1C govern this
program and have the appropriate forms the command will need, but your command
already has the forms. You make up a special SF-600 for the medical record.
Read the instructions before you do an overseas screen. Basically, you have to do a
history and a physical if theirs is not up to date. Immunizations should be up to date,
and they must have an HIV test within six months. Any medical problem that may need
treatment should be referred to the appropriate specialist. Ask the question,  Is the
individual fit for overseas assignment? This will be case by case and depend upon the
duty station. If you are unsure whether or not a duty station can manage a particular
medical problem, you must send them a message that describes the problem and
receive a reply before recommending someone for overseas assignment. DO NOT do
dependent screens (or dependent health care); you are not credentialed for this.
Dependents must get their overseas screen at the nearest military facility.
MEDICAL PRACTICE
Your primary day-to-day duty is patient care, and you are responsible for maintaining the
health of all crewmembers. Although the CO has ultimate responsibility, you are the
ship s medical expert. Your decisions will be scrutinized more carefully than if you were
working in a clinic or emergency room because of the close proximity to the rest of your
crew. You are literally  on call 24 hours a day when the ship is deployed.
At Sick Call, you ll be seeing approximately 20-50% orthopedic problems (both
occupational and non-occupational injuries). The former can be knees and backs that
have previous injury and have pain secondary to the steel decks and ladders on the
ship. The non-work related injuries are usually sports or PT injuries, although motor
vehicle accidents are still a big problem. 10-15% will be psychological problems (mostly
personality disorders). Another 20% will be infectious disease, respiratory, diarrheas,
STDs. 20% will be GYN (if your ship has women on board) and the other 20% or so will
be a variety of ailments related to routine outpatient medicine. There will be adequate
medical resources to take care of most ailments yourself, and you will have to refer or
MEDEVAC (see MEDEVAC section) a very small percentage of cases.
Note: There are plenty of people who present with suicidal ideation, and you must take
these threats seriously. Ask them the standard Psych questions. Most of them will tell
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you honestly if they want to kill themselves. If they say the magic words, you MUST
send them to Psych for an evaluation and let them clear the patient for duty. One
successful suicide on a ship is one too many. Always send an escort with the patient all
the way to Psychiatry. Give explicit instructions to escorts, and inform them of the
reason an escort is required
Because of your ready availability, you may see patients with problems that normally
wouldn t get taken to a doctor. Don t be surprised when you are bombarded with
requests to remove warts, do vasectomies, or just answer  curbside consults. For many
sailors, getting appointments at shore-based clinics for routine care is very difficult and
frustrating. They would prefer to see you because you are right there and you are  their
doc. Be accommodating when you can.
 House calls should be kept to a minimum. Otherwise, you will be running all over the
ship. Sick Bay is designed as your clinic. Use it as such. Keep regular Sick Call hours
and post them so everyone knows when you are available. If you see people as a
 curbside consultant, you will have poor documentation of health care, and you will
never get through a meal without having to look at someone s tonsils or hear about their
hemorrhoids. Have them come to the clinic, and everyone will be happier in the long
run. The same holds true for wardroom members, who may try to see you, alone, in
your cabin for medical problems. Have them come to your office.
There are exceptions. Go to the Captain s cabin when you suspect the CO is under the
weather. It is courteous and shows respect for the position. The same holds for the XO.
Consider yourself their personal physician! [ Pobierz całość w formacie PDF ]