Rotation Safety & Security Brief, 2008
1. This document is for internal use only by the rotation members and is not to be shared with those
outside the rotation & their supervisors/ family.
2. Pakistan in general is a third world country beset by ethnic, political, & religious strife. As such, there
are hazards to be aware of and plan for. That being said, the consensus of the University, the other schools
involved, the State Department, The United States Army Pacific Command & 1st Special Forces Group is
that the area we will be operating in is secure and no more than routine precautions will be needed. A
specific risk assessment & mitigation plan is given below.
3. General points:
a. While this may seem to be a “high profile” endeavor here, our rotation in Pakistan will not be
advertised nor presented as such, and will indeed be nothing more than a routine medical rotation. There will
be no banners, signs, etc. used off the mountain. A very low profile will be maintained. There will be no large
film crews running around, no public events, etc.
b. In Pakistan the project is controlled by the University of Peshawar Department of Geology who will be
meeting & accompanying team members, providing all administrative needs, etc.
c. An international team of medical personnel makes up the team. This is not an “American” rotation. It is
a Pakistani University of Peshawar project in conjunction with an international team sponsored by the
University of Nebraska, with funding from various organizations and schools.
d. Full coordination with the Pakistani government has been made and the rotation may have Pakistani
government/military liaison personnel with it at times, as is the norm for all rotations of any type. There is no
need for a large contingent of soldiers to accompany the rotation – if the situation required that level we
would not be going. Response forces & military helicopters will be “on-call” for emergencies, as they are for
all rotations.
e. There are, as of this date, 40+ expeditions will be operating in the Karakorum Range area that we will
be in. Some are high profile commercial rotations, others smaller groups. All will have higher visibility than
our project.
f. The Karakorum Range is on the opposite side of the country from the tribal areas of
Afghanistan/Pakistan that house the Taliban & Al-Quida remnants. It lies on the Pakistani/Chinese border
and is not subject to the Pakistani/India border disputes. There are no special US, Pakistani, Indian, or
Chinese military operations in the Karakorum area.
g. The current US State Department Advisory for this area is:
i. “Northern Areas - Visitors wishing to trek in Gilgit, Hunza, Chitral and the upper Swat valley should use
only licensed guides and tourist agencies. While overall crime is low, there have been occasional assaults
on foreign visitors.”
4. Specific Points:
a. Islamabad/Rawlpindi represents the only identified threat area. This is a general threat. An explosive
device was detonated in an international hotel lobby there in 2003. The hotels are secure now. Occasional
demonstrations take place of varying natures. Our time there will be limited to final local shopping and
coordination. Security procedures will be maintained at an elevated level, but there is no specific threat
identified for us. The “two man rule” applies here and no one will be away from the group alone or after dark.
b. Women will maintain modesty provisions at all times with long sleeves, long pants, covered ankles,
and head-scarves or hats. Avoid cleavage in the towns & villages. Somewhat relaxed standards will apply in
Askole, within reason, as the porters are more used to western ways, but care must be maintained
especially with bathing & etc.
c. If you have religious beliefs, by all means practice them but keep them to yourselves. NO proselytizing,
etc. Respect Islamic prayer times and withdraw to areas where your activities will not disturb those at prayer.
Women do NOT approach men when they are praying – this is a segregated activity.
d. The Balti people of the mountains have a layer of Islam superimposed on underlying layers of
Hinduism, Buddhism, and various animistic regional beliefs. Respect everything and everyone; you never
know what has religious or political significance. Don’t mess with flags or bundles left on rock areas or not
obviously dropped in the middle of the trail as they may be prayer items deliberately left there.
e. Do not extend your left hand, offer/take items with your left hand, within reason. This is the “dirty” hand
for bum wiping. Obviously in the mountains during climbing or rescue activities this does not apply.
f. Use formal titles and last names until invited to do otherwise. Ask about family, job, friends but do not
ask specifically about wives or female relatives unless they bring up the topic. Feel free to show pictures of
your family and home. Postcards of your town and local sites, etc., make wonderful gifts.
g. There will be a few team members that have current or prior military affiliations. This will not be
discussed outside the team AT ALL. Period. All will be traveling as civilians. No camo gear. No
photographing military sites. No asking about Pakistan’s nuke program. Do nothing to suggest that you are
gathering intelligence material. A few of the team look and carry themselves like Company types, try to
minimize this and look like a medical type instead please.
5. Threat Assessment:
a. Environmental Hazards
i. Air travel by large commercial carrier
1. Risk – minimal
2. Mitigation - routine
ii. Air travel by small carrier
1. Risk – low
2. Mitigation – No travel during bad weather
iii. Contaminated water
1. Risk – moderate
2. Mitigation – true water purification units are already in stock, purify all water
iv. Contaminated food
1. Moderate to high
2. Mitigation – insist on sanitary food preparation by outfitter staff, prepare own food, clean all utensils
v. Heat
1. Risk – high
2. Mitigation – water consumption, activity limitations, protective clothing & topicals, close monitoring by
staff
vi. Sunburn
1. Risk – high
2. Mitigation – topicals & protective clothing
vii. Cold
1. Risk – moderate
2. Mitigation – protective clothing & monitoring by staff
viii. Altitude
1. Risk – high
2. Mitigation – slow acclimatization route, Diamox or Topamax, hydration, close monitoring by staff
ix. Insect & vector borne disease
1. Risk – none significant, annoying flies at times
2. No prophylaxis needed
x. Cadaver contact
1. Risk – minimal, environment is not supportive of blood borne pathogens to exposed remains
2. Mitigation – BSI precautions
xi. Infectious disease
1. Risk – low
2. Mitigation – vaccination plan to be completed by all team members, BSI precautions for patient
contact
b. Physical Hazards
i. Road travel
1. Risk – moderate
2. Mitigation – supervision of drivers, route selection & scouting
ii. Rock/mud slides
1. Risk – moderate
2. Mitigation – route scouting & close surveillance
iii. Floods
1. Risk – moderate
2. Mitigation – route scouting & close surveillance
iv. Glacier & crevasse
1. Risk – low
2. Mitigation – route scouting & close surveillance, proper training and use of standard techniques &
equipment
v. Footbridges
1. Risk – low
2. Mitigation – route scouting & close surveillance, proper training and use of standard techniques &
equipment
vi. River crossing
1. Risk – moderate
2. Mitigation – route scouting & close surveillance, proper training and use of standard techniques &
equipment
vii. Falls & routine injuries
1. Risk – low to moderate
2. Mitigation – proper training and use of standard techniques & equipment
c. Socio-political Hazards
i. Specific targeting for violence
1. Risk – minimal
2. Mitigation – continued intel gathering, personal & team safety awareness measures, exiting
threatening situations
ii. Random targeting for violence
1. Risk – low
2. Mitigation – personal & team safety awareness measures, exiting threatening situations
iii. Incidental presence during demonstrations
1. Risk – low
2. Mitigation – avoidance
ROTATION FIELD HYGIENE BRIEFING
One of the keys to staying healthy in the field is to stay clean – a seeming contradiction, as we promised you
mud, crud, and possibly blood. You will have that and more, your goal is to stay as clean as possible
between the mud, crud, and blood! This minimizes the chance of infection through subsequent loss of skin
integrity (cuts, scrapes, etc.), establishment of fungal & parasite infections, and makes you smell a whole lot
better! Note that we will enforce hygiene, commercial and private expeditions may let themselves go to hell,
stink, and look like Yetis, but we are professionals providing care and need to look like it (and smell like it). In
no particular order:
1. Bathe twice daily or bathe once and swim in the river once a day (when available & safe to do so).
You may bathe either in the showers (if/when available) or in the river, but if you do the latter PLEASE use a
biodegradable soap – you can get it at Wal-Mart in the camping/RV section, or use Dr. Bronners Hippie
Soap. I recommend a morning swim and an evening bath just before bed but suit yourself. You may find
yourself in the river twice a day, just for fun. In any case, don’t go to sleep nasty.
2. Having some wet wipes in your pocket or pack is great for quick face and hands cleaning and a
refreshing break. Also good for wiping your bum in the field. Speaking of, there is a specific technique for
“taking care of business” in the field, see below. Allow at least 2 wet wipes per day.
3. A “Solar Shower” is worth it’s weight in gold if you will not have easy access to hot water – this is a 1-
2.5 gallon bag, black or dark in color, hang in the sun for a couple of hours and it will warm up well.
4. “No Rinse” soaps are available & work well, although are a bit heavy. Nice to have a bottle along for
occasional use though.
5. WASH YOUR HANDS! Before eating, every time! ALL of the cases of traveler’s diarrhea we have
had in the past have been classic fecal-oral viral enteritis, due in my opinion, to a hygiene deficit. WASH
YOUR HANDS! I also recommend you have a small bottle of alcohol gel or foam hand wash available – you
can get little travel bottles at Wal-Mart for 50 cents. Good fire starter too.
6. If you wear contacts have a bottle of eye wash with you went out of camp. I recommend you disinfect
your contacts every night, to minimize the risk of infection.
7. Avoid all perfumes, aftershave, strong smelling deodorants, etc. They attract bugs. I use the baking
soda sport deodorant as it is scent neutral and covers up my funk pretty well. Baby powder is helpful in the
shoes and underwear.
Go To Page 3...
1. This document is for internal use only by the rotation members and is not to be shared with those
outside the rotation & their supervisors/ family.
2. Pakistan in general is a third world country beset by ethnic, political, & religious strife. As such, there
are hazards to be aware of and plan for. That being said, the consensus of the University, the other schools
involved, the State Department, The United States Army Pacific Command & 1st Special Forces Group is
that the area we will be operating in is secure and no more than routine precautions will be needed. A
specific risk assessment & mitigation plan is given below.
3. General points:
a. While this may seem to be a “high profile” endeavor here, our rotation in Pakistan will not be
advertised nor presented as such, and will indeed be nothing more than a routine medical rotation. There will
be no banners, signs, etc. used off the mountain. A very low profile will be maintained. There will be no large
film crews running around, no public events, etc.
b. In Pakistan the project is controlled by the University of Peshawar Department of Geology who will be
meeting & accompanying team members, providing all administrative needs, etc.
c. An international team of medical personnel makes up the team. This is not an “American” rotation. It is
a Pakistani University of Peshawar project in conjunction with an international team sponsored by the
University of Nebraska, with funding from various organizations and schools.
d. Full coordination with the Pakistani government has been made and the rotation may have Pakistani
government/military liaison personnel with it at times, as is the norm for all rotations of any type. There is no
need for a large contingent of soldiers to accompany the rotation – if the situation required that level we
would not be going. Response forces & military helicopters will be “on-call” for emergencies, as they are for
all rotations.
e. There are, as of this date, 40+ expeditions will be operating in the Karakorum Range area that we will
be in. Some are high profile commercial rotations, others smaller groups. All will have higher visibility than
our project.
f. The Karakorum Range is on the opposite side of the country from the tribal areas of
Afghanistan/Pakistan that house the Taliban & Al-Quida remnants. It lies on the Pakistani/Chinese border
and is not subject to the Pakistani/India border disputes. There are no special US, Pakistani, Indian, or
Chinese military operations in the Karakorum area.
g. The current US State Department Advisory for this area is:
i. “Northern Areas - Visitors wishing to trek in Gilgit, Hunza, Chitral and the upper Swat valley should use
only licensed guides and tourist agencies. While overall crime is low, there have been occasional assaults
on foreign visitors.”
4. Specific Points:
a. Islamabad/Rawlpindi represents the only identified threat area. This is a general threat. An explosive
device was detonated in an international hotel lobby there in 2003. The hotels are secure now. Occasional
demonstrations take place of varying natures. Our time there will be limited to final local shopping and
coordination. Security procedures will be maintained at an elevated level, but there is no specific threat
identified for us. The “two man rule” applies here and no one will be away from the group alone or after dark.
b. Women will maintain modesty provisions at all times with long sleeves, long pants, covered ankles,
and head-scarves or hats. Avoid cleavage in the towns & villages. Somewhat relaxed standards will apply in
Askole, within reason, as the porters are more used to western ways, but care must be maintained
especially with bathing & etc.
c. If you have religious beliefs, by all means practice them but keep them to yourselves. NO proselytizing,
etc. Respect Islamic prayer times and withdraw to areas where your activities will not disturb those at prayer.
Women do NOT approach men when they are praying – this is a segregated activity.
d. The Balti people of the mountains have a layer of Islam superimposed on underlying layers of
Hinduism, Buddhism, and various animistic regional beliefs. Respect everything and everyone; you never
know what has religious or political significance. Don’t mess with flags or bundles left on rock areas or not
obviously dropped in the middle of the trail as they may be prayer items deliberately left there.
e. Do not extend your left hand, offer/take items with your left hand, within reason. This is the “dirty” hand
for bum wiping. Obviously in the mountains during climbing or rescue activities this does not apply.
f. Use formal titles and last names until invited to do otherwise. Ask about family, job, friends but do not
ask specifically about wives or female relatives unless they bring up the topic. Feel free to show pictures of
your family and home. Postcards of your town and local sites, etc., make wonderful gifts.
g. There will be a few team members that have current or prior military affiliations. This will not be
discussed outside the team AT ALL. Period. All will be traveling as civilians. No camo gear. No
photographing military sites. No asking about Pakistan’s nuke program. Do nothing to suggest that you are
gathering intelligence material. A few of the team look and carry themselves like Company types, try to
minimize this and look like a medical type instead please.
5. Threat Assessment:
a. Environmental Hazards
i. Air travel by large commercial carrier
1. Risk – minimal
2. Mitigation - routine
ii. Air travel by small carrier
1. Risk – low
2. Mitigation – No travel during bad weather
iii. Contaminated water
1. Risk – moderate
2. Mitigation – true water purification units are already in stock, purify all water
iv. Contaminated food
1. Moderate to high
2. Mitigation – insist on sanitary food preparation by outfitter staff, prepare own food, clean all utensils
v. Heat
1. Risk – high
2. Mitigation – water consumption, activity limitations, protective clothing & topicals, close monitoring by
staff
vi. Sunburn
1. Risk – high
2. Mitigation – topicals & protective clothing
vii. Cold
1. Risk – moderate
2. Mitigation – protective clothing & monitoring by staff
viii. Altitude
1. Risk – high
2. Mitigation – slow acclimatization route, Diamox or Topamax, hydration, close monitoring by staff
ix. Insect & vector borne disease
1. Risk – none significant, annoying flies at times
2. No prophylaxis needed
x. Cadaver contact
1. Risk – minimal, environment is not supportive of blood borne pathogens to exposed remains
2. Mitigation – BSI precautions
xi. Infectious disease
1. Risk – low
2. Mitigation – vaccination plan to be completed by all team members, BSI precautions for patient
contact
b. Physical Hazards
i. Road travel
1. Risk – moderate
2. Mitigation – supervision of drivers, route selection & scouting
ii. Rock/mud slides
1. Risk – moderate
2. Mitigation – route scouting & close surveillance
iii. Floods
1. Risk – moderate
2. Mitigation – route scouting & close surveillance
iv. Glacier & crevasse
1. Risk – low
2. Mitigation – route scouting & close surveillance, proper training and use of standard techniques &
equipment
v. Footbridges
1. Risk – low
2. Mitigation – route scouting & close surveillance, proper training and use of standard techniques &
equipment
vi. River crossing
1. Risk – moderate
2. Mitigation – route scouting & close surveillance, proper training and use of standard techniques &
equipment
vii. Falls & routine injuries
1. Risk – low to moderate
2. Mitigation – proper training and use of standard techniques & equipment
c. Socio-political Hazards
i. Specific targeting for violence
1. Risk – minimal
2. Mitigation – continued intel gathering, personal & team safety awareness measures, exiting
threatening situations
ii. Random targeting for violence
1. Risk – low
2. Mitigation – personal & team safety awareness measures, exiting threatening situations
iii. Incidental presence during demonstrations
1. Risk – low
2. Mitigation – avoidance
ROTATION FIELD HYGIENE BRIEFING
One of the keys to staying healthy in the field is to stay clean – a seeming contradiction, as we promised you
mud, crud, and possibly blood. You will have that and more, your goal is to stay as clean as possible
between the mud, crud, and blood! This minimizes the chance of infection through subsequent loss of skin
integrity (cuts, scrapes, etc.), establishment of fungal & parasite infections, and makes you smell a whole lot
better! Note that we will enforce hygiene, commercial and private expeditions may let themselves go to hell,
stink, and look like Yetis, but we are professionals providing care and need to look like it (and smell like it). In
no particular order:
1. Bathe twice daily or bathe once and swim in the river once a day (when available & safe to do so).
You may bathe either in the showers (if/when available) or in the river, but if you do the latter PLEASE use a
biodegradable soap – you can get it at Wal-Mart in the camping/RV section, or use Dr. Bronners Hippie
Soap. I recommend a morning swim and an evening bath just before bed but suit yourself. You may find
yourself in the river twice a day, just for fun. In any case, don’t go to sleep nasty.
2. Having some wet wipes in your pocket or pack is great for quick face and hands cleaning and a
refreshing break. Also good for wiping your bum in the field. Speaking of, there is a specific technique for
“taking care of business” in the field, see below. Allow at least 2 wet wipes per day.
3. A “Solar Shower” is worth it’s weight in gold if you will not have easy access to hot water – this is a 1-
2.5 gallon bag, black or dark in color, hang in the sun for a couple of hours and it will warm up well.
4. “No Rinse” soaps are available & work well, although are a bit heavy. Nice to have a bottle along for
occasional use though.
5. WASH YOUR HANDS! Before eating, every time! ALL of the cases of traveler’s diarrhea we have
had in the past have been classic fecal-oral viral enteritis, due in my opinion, to a hygiene deficit. WASH
YOUR HANDS! I also recommend you have a small bottle of alcohol gel or foam hand wash available – you
can get little travel bottles at Wal-Mart for 50 cents. Good fire starter too.
6. If you wear contacts have a bottle of eye wash with you went out of camp. I recommend you disinfect
your contacts every night, to minimize the risk of infection.
7. Avoid all perfumes, aftershave, strong smelling deodorants, etc. They attract bugs. I use the baking
soda sport deodorant as it is scent neutral and covers up my funk pretty well. Baby powder is helpful in the
shoes and underwear.
Go To Page 3...
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