Expose and Prepare Injection Site.
(1) Ask the patient or assist the patient to remove outer garments to allow
complete visualization of the selected site for injection. The deltoid area may have to be
further exposed by pushing the sleeve of the T-shirt up and over the deltoid area.
(2) Prepare the site by the use of a suitable cleaning agent (either acetone,
Betadine, or alcohol) and allow to dry thoroughly.
j. Administer Immunization.
(1) Whenever immunizations are given, a military or civilian member of the
medical department/service will be present who is trained and qualified in emergency
resuscitative technique in accordance with local SOP. See AR 40-562 for specific
(2) As indicated earlier, immunizations can also be administered by jet
injection, commonly referred to as "by injection gun." Advantages include facilitating
mass immunization procedures, reducing hazards of transmitting serum hepatitis,
reducing requirements for large numbers of sterilized needles and syringes, and
eliminating many hours expended in the care and processing of reusable syringes and
needles and preparing individual dosage from vaccine vials.
k. Observe Patient. Observe for reactions.
(1) The period for observation may be determined by local SOP--usually 30
minutes. The patient should not leave the inoculation area for at least 10 minutes and
should not be more than five minutes transportation time away from area during the first
(2) Any dangerous, allergic reaction to any biologic agent or drug, the date,
type, and severity of reaction will be recorded on the patient's appropriate immunization
certificates or records. A medical warning tag should also be made.
(3) Urticaria (hives) and pruritis (itching) are common reactions. Allergic
reactions vary in nature, severity, and time of onset. Hives and itching are the most
common, occurring approximately 20 minutes after inoculation. Some vaccines after
several hours to a day may produce general systemic reactions consisting of fever,
malaise (general aches and pains), chills, and gastrointestinal upsets as well as a local
reaction or swelling, redness, and tenderness at the site of injection. This type of
reaction is not usually severe unless accompanied by other life-threatening symptoms.