From OPNAVINST 1754.2E
Category 1: Enrollment for monitoring purposes
Family member needs do not generally limit assignments. Enrollment is for monitoring purposes due to medical or educational needs.
Category 2: No CONUS assignment restrictions.
OCONUS and remote assignments may be restricted if the qualifying condition cannot be supported due to the availability of required services. If orders are for overseas or remote duty, the family must successfully complete suitability screening.
Category 3: No CONUS assignment restrictions.
No overseas assignments based on non-availability of medical or educational services at overseas locations. The family member’s medical or educational condition precludes assignment to overseas locations.
Category 4: No overseas assignments, CONUS assignments must be near major medical areas.
The family member’s special medical condition or educational needs require assignment to billets within a 2-hour drive under most conditions to access specialty care. This can be an MTF or a civilian TRICARE facility.
Category 5: Meets criteria to homestead.
The family member’s needs are highly specialized, complex or severe, requiring continuity of care. 1Homestead Assignment: A detailing option that may permit a Service member, whose family member is identified by the central screening committees to require specialized intervention of continuity of medical care, with an opportunity to remain in a particular geographic location to establish. Homestead sites must be selected based on their ability to provide requisite services and appropriate operational and shore rotation. Homestead sites that can support operational and shore rotations may include, but are not limited to:
- Bangor, Bremerton, Puget Sound, or Seattle, WA
- Fort Worth, TX
- Groton, CT
- Gulfport, MS
- Jacksonville, NC
- Kings Bay, GA
- Mayport or Jacksonville, FL
- National Capital Region
- Norfolk, VA
- Point Mugu, CA
- Port Hueneme, CA
- San Diego, CA
Note: to ensure career progression and opportunity and the needs of the Navy, service members who have a category 5 EFM(s), can elect to be detailed and relocated to another location as long as the continuity of care can be maintained for the enrolled family member.
Category 6: Temporary category.
The medical or educational condition requires a stable environment for 6 months to 1 year due to ongoing treatment or diagnostic assessments. This category must be updated within 1 year to receive permanent category or disenrollment.
Changes coming to EFMP?
New guidance from DHA designed to improve turnover when members on EFMP PCS to a new location.
Need a handout for a common orthopedic injury? Here are some from two great resources.
The Sports Medicine Patient Advisor, 3rd edition
note: These handouts are actually from an old 2nd edition. The third edition has much nicer, color, updated stuff. If you find these old ones useful you should definitely buy the newest edition.
Essentials of Musculoskeletal Care
What is hand, foot and mouth disease?
Hand, foot and mouth disease (HFMD) is a common infectious disease of infants and children. It is characterized by fever, painful sores in the mouth, and a rash with blisters on hands, feet and also buttocks. It is prevalent in many Asian countries.
Is it the same as foot-and-mouth disease in animals?
No, HFMD is not to be confused with foot-and-mouth (also called hoof-and-mouth) disease which is caused by a different virus and affects cattle, sheep, and pigs.
Where does HFMD occur?
Individual cases and outbreaks of HFMD occur worldwide. In tropical and subtropical countries, outbreaks often occur year-round.
Outbreaks of HFMD occur every few years in different parts of the world, but in recent years these have occurred more in Asia. Countries with recent large increases in the number of reported cases in Asia include: China, Japan, Hong Kong (China), Republic of Korea, Malaysia, Singapore, Thailand, Taiwan (China) and Viet Nam.
What causes HFMD?
Viruses from the group called enteroviruses cause HFMD. There are many different types in the group including polioviruses, coxsackieviruses, echoviruses and other enteroviruses.
HFMD is most commonly caused by coxsackievirus A16 which usually results in a mild self-limiting disease with few complications. However, HFMD is also caused by Enteroviruses, including enterovirus 71 (EV71) which has been associated with serious complications, and may be fatal.
How serious is HFMD?
Most people with HFMD recover fully after the acute illness.
HFMD is usually a mild disease, and nearly all patients recover in 7 to 10 days without medical treatment and complications are uncommon.
Dehydration is the most common complication of HFMD infection caused by coxsackieviruses; it can occur if intake of liquids is limited due to painful sores in the mouth.
Rarely, patients develop “aseptic” or viral meningitis, in which the person has fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days.
HFMD caused by EV71 has been associated with meningitis and encephalitis, and on occasion can cause severe complications, including neurological, cardiovascular and respiratory problems. Cases of fatal EV71 encephalitis have occurred during outbreaks.
How soon after exposure do symptoms appear?
The usual period from infection to onset of symptoms is 3–7 days.
Fever, lasting 24-48 hours, is often the first symptom of HFMD.
What are the symptoms?
The disease usually begins with a fever, poor appetite, malaise, and frequently with a sore throat.
One or 2 days after fever onset, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks.
A non-itchy skin rash develops over 1–2 days with flat or raised red spots, some with blisters. The rash is usually located on the palms of the hands and soles of the feet; it may also appear on the buttocks and/or genitalia.
A person with HFMD may not have symptoms, or may have only the rash or only mouth ulcers.
In a small number of cases, children may experience a brief illness, present with mixed neurological and respiratory symptoms and succumb rapidly to the disease.
How do you get HFMD?
HFMD virus is contagious and infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. Infected persons are most contagious during the first week of the illness, but the period of communicability can last for several weeks (as the virus persists in stool).
HFMD is not transmitted to or from pets or other animals.
Who is at risk for HFMD?
Everyone who has not already been infected is at risk of infection, but not everyone who is infected becomes ill.
HFMD occurs mainly in children under 10 years old, but most commonly in children younger than 5 years of age. Younger children tend to have worse symptoms.
Children are more likely to be susceptible to infection and illness from these viruses, because they are less likely than adults to have antibodies and be immune from previous exposures to them. Most adults are immune, but cases in adolescents and adults are not unusual.
Can you be infected with HFMD more than once?
Yes, infection only results in immunity to one specific virus, other episodes may occur following infection with a different virus type.
What about pregnant women?
Ideally pregnant women should avoid close contact with anyone with HFMD and pay particular attention to measures that prevent transmission.
Enterovirus infections, including HFMD are common and pregnant women are frequently exposed to them. They may cause mild or no illness in the pregnant woman and currently there is no clear evidence that maternal enterovirus infection, including HFMD, is associated with any particular adverse outcomes of pregnancy (such as abortion, stillbirth or congenital defects). However, pregnant women may pass the virus to the baby if they are infected shortly before delivery or have symptoms at the time of delivery.
Most newborns infected with an enterovirus have mild illness, but rarely may develop an overwhelming infection of many organs, including liver and heart, and die from the infection. The risk of this severe illness is higher for newborns infected during the first two weeks of life.
How is HFMD treated?
Presently, there is no specific treatment available for HFMD. Patients should drink plenty of water and may require symptomatic treatment to reduce fever and pain from ulcers.
Can HFMD be prevented?
There are no specific antiviral drugs or vaccines available against non-polio enteroviruses causing HFMD. The risk of infection can be lowered by good, hygiene practices and prompt medical attention for children showing severe symptoms.
- Preventive measures include:
frequent handwashing with soap and water especially after touching any blister or sore, before preparing food and eating, before feeding young infants, after using the toilet and after changing diapers;
- cleaning contaminated surfaces and soiled items (including toys) first with soap and water, and then disinfecting them using a dilute solution of chlorine-containing bleach;
- avoiding close contact (kissing, hugging, sharing utensils, etc.) with children with HFMD may also help to reduce of the risk of infection;
- keeping infants and sick children away from kindergarten, nursery, school or gatherings until they are well;
- monitoring the sick child’s condition closely and seeking prompt medical attention if persistent high fever, decrease in alertness or deterioration in general condition occurs;
- covering mouth and nose when sneezing and coughing;
- disposing properly of used tissues and nappies into waste bins that close properly;
- maintaining cleanliness of home, child care centre, kindergartens or schools.
What might I see after the circumcision?
Your baby may be restless for about 2 to 3 hours after the circumcision and may refuse a feeding. For the next day or two, you can comfort him by giving him extra cuddling, extra feeding (if he wants) and letting him suck whenever he wants.
While the site is healing, you might see crusted blood, or a white or crusted yellow-colored tissue around the circumcision site. This is a normal part of healing. It is not an infection and it will go away on its own. Do not try to rub it off. The head of the penis may be black and blue or in some cases, bright red. The shaft of the foreskin may swell and become black and blue as well. All of these are normal findings.
- Change your baby’s diaper and check the circumcision site at least every 4 hours.
- At each diaper change, gently wash the penis with warm water and pat dry. Do not rub. Do not use soaps, lotions or powder.
- For the first 24 hours, apply petroleum jelly to the penis and diaper at each diaper change. This will keep the diaper from sticking to the penis. Continue applying the jelly, until the redness of the penis goes away. If the gauze dressing or diaper is stuck when you are trying to remove it, do not pull it off. Soak the area with a warm, wet cloth, until it comes off easily.
- At each diaper change, check for bleeding at the circumcision site, blood on the diaper, or swelling of the penis.
- If the circumcision site is bleeding, put gentle pressure on the area with a clean cloth.
Reasons to call your doctor:
- There is bleeding that does not stop with the gentle pressure. Keep gentle pressure on the area as long as the bleeding continues.
- If there is a greenish or bad smelling discharge from the circumcision site or the penis looks red or swollen. There may be an infection in the circumcised area.
- If your baby does not pass urine in 8 hours. Your baby should have at least 3 wet diapers in 24 hours.
About the Procedure
A vasectomy is an elective and permanent surgical procedure for male sterility. This procedure may not be the right form of permanent birth control for every man or family. Before getting this procedure an appointment is required to evaluate the following:
- The person undergoing the vasectomy expresses a certain level of maturity and understanding about the procedure.
- The person undergoing the vasectomy is satisfied with their current number of children and his present personal relationship.
This appointment is also a time when counseling regarding alternative birth control methods, relative risks, benefits, complications, details of the procedure, informed consent and instructions before and after the surgery. After the screening and counseling appointment is completed, a procedure date will be scheduled.
What is a Vasectomy?
A vasectomy is a minor surgical procedure that makes a man sterile (unable to make a woman pregnant). Each year approximately half a million American males undergo a vasectomy.
To begin with, you should have some basic knowledge of the anatomy and physiology of the male reproductive system. Sperms are made in the testicles and are stored next to the testes in tubules called the epididymis. During intercourse, sperm travel from the epididymis through small tubes (vas deferens) to join the seminal and prostate fluid, thus becoming the ejaculate. When the physician performs a vasectomy the vas deferens is cut and the two remaining ends are secured. The object of the procedure is to make it impossible for sperm to become part of the ejaculate. Without sperm in the ejaculate conception cannot take place.
How is the vasectomy done?
The vasectomy is performed in the clinic’s procedure room. Before surgery, a local painkiller will be used to make a portion of the scrotum numb. Your doctor will then make a small opening (incision) in the scrotum. Through this small opening, your doctor gently lifts out each vas deferens and cuts it. The procedure usually takes 40 minutes and causes little pain.
Will I be sterile as soon as the operation is over?
No. Contrary to what many people believe, you will not be sterile immediately after the operation. This is because there are some sperm residing above the area where the vas deferens is cut. Until all the sperm cells have been ejaculated, you will be fertile. In general it takes between 20 to 25 ejaculations following a vasectomy for the sperm to disappear. Most physicians who perform vasectomies require that their patients bring a sample of ejaculate to the office about 12 weeks after surgery. The seminal fluid will be examined under a microscope to be sure that no sperm are present. Only when this has been confirmed can you be sure that the surgery was a success.
Are the effects of surgery permanent?
Yes. Once the surgery has been declared successful, you will be permanently sterile. It should be understood that while this procedure assures sterility initially, in a very small percentage of men the tubes could grow back together. Once a vasectomy has been performed, a reversal procedure would be needed to restore fertility. Reversal is complex, expensive and does not guarantee fertility.
How will the procedure affect my sex life?
Although the vasectomy will make you sterile, it will have no effect on your libido (desire to have sexual intercourse) or on your potency (ability to have sexual intercourse). In fact, many couples find that their sex life improves after the vasectomy because they no longer worry about the surprise of an unwanted pregnancy.
Will I still ejaculate in the normal manner?
Yes. Most of the seminal/prostate fluid, in which the male ejaculates during intercourse, is produced by the seminal vesicles and the prostate gland. Only 5% of the total ejaculate consists of sperm. Therefore, after a vasectomy, ejaculation will take place in the same way as it did before. The only difference is that there will be less fluid ejaculated, and this difference is barely noticed.
Is a vasectomy painful?
As with any operation, no matter how minor, there will be some discomfort associated with it. However, with proper anesthesia, this discomfort will be kept to a minimum. Local anesthesia is used. The vasectomy is done under local anesthesia and with proper anesthesia, the discomfort is kept to minimum. If you are particularly anxious about the procedure, your physician may prescribe a mild sedative for you to take prior to the procedure.
Are there any complications associated with a vasectomy?
The problems that occur after the operation are usually minor. There will be some pain and tenderness in the area where the surgery is performed. There may also be some swelling and discoloration in the area of the surgical site. Your physician may prescribe some type of pain medication to keep the post-surgical discomfort to a minimum.
There are two common complications that may occur shortly after the procedure. As with any surgery, the possibility of infection is always present. In 1 to 3% of patients, infection may occur around the scrotal stitches or in the epididymis. The majority of these are resolved by removing the infected scrotal stitch and rendering local skin care. Rarely, antibiotics may be needed for deeper infections. In a very small percentage of patients (1%), a blood vessel inside the scrotum continues to bleed after the operation. If this happens, the scrotum will swell and become tender. Should you experience this problem, contact your physician. He/She may have to re-open the scrotum to tie off the bleeder. This could require a visit to the hospital and the administration of general anesthesia.
Other complications may arise weeks later. Sperm granuloma which is a lump caused by sperm leaking from the tied end, occurs in 3 to 25% of vasectomies. These usually resolve on their own. Congestive epididymitis (inflammation of the epididymis) or orchitis (inflammation of the testes) are related to lymphatic and vascular congestion. These are treated with an anti-inflammatory medications and resolve in 5 to 7 days. Sperm antibodies may develop which is your body’s response to absorb sperm protein. These are not harmful to you, but may affect the results of the vasectomy reversal procedures. Reunion of the tubes are rare: 1 in 4,000.
Are there any long term complications?
As far as medical science can determine, there are no long-term complications associated with vasectomies.
How soon after the operation can I have sexual intercourse?
You may resume your normal sexual activity as soon as you feel well enough to do so. This will probably be within a few days of the surgery. Remember, however, you may not be sterile until some time after the operation (20-25 ejaculations), and therefore, you should continue to use some form of birth control until you have confirmed all sperm have disappeared from your semen.
Is there anything special I should do before the surgery?
Once you have elected to have the surgery; first, you should discuss it with your spouse. Secondly you should make arrangements with work for 3 days off and light duty for 11 more days. Please read the patient instructions below and follow them carefully.
What about after the operation?
More detailed instructions are below. Basically, for 3 days after the procedure you should be sedentary (sitting, doing very little physical activity). You may then increase activity over the next 2 weeks. You may shower one day after the procedure.
On choosing to have a vasectomy.
The choice to have a vasectomy is a very personal one. Talk with your partner, and think about what is best for you and your family.
• Vasectomy is safer and cheaper than tubal ligation (blocking the fallopian tubes to prevent pregnancy) in
• The one-time cost of a vasectomy may be cheaper over time than the cost of other birth control methods, such as
condoms or the pill.
• A vasectomy does not protect against sexually transmitted diseases (STDs). Use condoms to protect against STDs.
- Lastly, it is important to note vasectomy is a permanent
method of birth control. This may be a plus or a minus based on your own situation. You should not have a vasectomy if you may want to father children in the future. While it is
possible to have a vasectomy reversed, this is more complex and costly. Also, reversing or “undoing” a vasectomy does not always result in pregnancy. So it is important to think through all your choices carefully before deciding to have a vasectomy. Be sure to bring up any questions you may have about the procedure before the surgery takes place.
Before the Procedure
- If you can not be here for your appointment call the clinic so we can reschedule your procedure for another date.
- The vasectomy is an elective procedure and you must inform your command of your surgery date and obtain permission via special request chit for two (2) days of bed rest and (11) days of light duty. During this period there will be **NO RUNNING, LIFTING (over 15 lbs.), CLIMBING OR PROLONGED STANDING.**If you are on flight status, you will be grounded for 2 weeks and will be required to see your flight surgeon afterwards for an up chit.
- DO NOT take Aspirin or Ibuprofen (Motrin/Advil) for one full week before your procedure because it can interfere with your body’s ability to effectively stop bleeding.
- You must bring the following items with you for your surgery:
- Jock strap or scrotal support.
- Some one to drive you home.
- The night before your surgery, shave your scrotum. Take your time and work carefully being careful not to nick the skin. A few warnings:
- *Do not use Nair or any other hair removal products, unless directed by your physician.
- *Do not use an electric razor.
- Take a shower the morning of your procedure.
- Wear comfortable (loose) clothing the day of your procedure. The uniform of the day is NOT required.
- Please inform the technician if you have any injuries or infection of your reproductive organs or if you have any medication or solution allergies.
After the Procedure
- Go directly home after your procedure and remain there on bed rest for at least twenty-four (24) hours. You can get up to go to the bathroom and to eat.
- You may wash off the surgical disinfectant with a wash cloth when you get home. You may take a shower the next day. Avoid baths for 2 to 3 days.
- Apply ice to your scrotum for about 20 to 30 minutes every 2-3 hours while awake, for the first 3 days. Then in the evening a couple times each day for the next week. This will reduce swelling and discomfort. Make sure you have a washcloth, towel, etc. between the ice pack and your skin. You should be able to feel the coldness of the ice, but you must avoid freeze injury to the skin.
- You can take two to three Acetaminophen (Tylenol if you have no allergies to these medications) 325 mg tablets every 4-6 hours as needed for discomfort. This is usually sufficient for any discomfort you will have. If your discomfort is still not well controlled, your physician may also give you a stronger pain medication to take in case of significant pain.
- You should wear the bulky gauze dressing for 24 hours. After that, the only dressing needed is a dab of bacitracin on each wound with a circular bandaid-which you should change twice per day until sutures are gone.
- You will begin your light duty the day you return to work following your vasectomy. Remember, NO RUNNING, NO PROLONGED STANDING, NO CLIMBING OR LIFTING (over 15 lbs.).
- You may have a small amount of bleeding or oozing from your incision. There may also be some bruising or discoloration in the scrotum. If you develop severe pain or significant enlargement of the scrotum contact your provider, go to urgent care, or the ER if unable to reach provider!
- Your stitches/sutures (if placed) will dissolve in about 7 to 14 days. You may notice a small amount of brownish drainage (usually a few spots on your underwear as the stitch dissolve).
- Inspect the vasectomy incision daily for signs of infection. The signs of infection are: fever, redness around the incision, tenderness, pus or drainage, or pain (significantly greater than what you have been experiencing after the procedure).
- Wait one week, then you may resume sexual activity when you feel comfortable. Do not forget to use some form of birth control until you get the results of your semen analysis.
- After 12 weeks, return to the lab to submit a semen specimen for analysis. Only after the results show no sperm is the procedure considered a success.