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News from the National Academies
Date: Oct. 10, 2000
Contacts: Vanee Vines, Media Relations Associate
Mark Chesnek, Media Relations Assistant
(202) 334-2138; e-mail <news@nas.edu>

FOR IMMEDIATE RELEASE

Action Needed to Protect U.S. Troops From Environmental and Other Health Hazards

WASHINGTON -- The federal government should take immediate action to implement plans for protecting troops from environmental and other health hazards, because further delay could result in unnecessary risks to their health, says a new report from the Institute of Medicine (IOM) of the National Academies. The committee that wrote the report found that few concrete changes have been made at the field level to improve health protection for deployed service members.

Recommendations for urgent action include improving procedures for recording health problems experienced by individual military personnel in the field, documenting troop locations during deployments better, and communicating more thoroughly with commanders about environmental and medical hazards that may exist in war zones.

"We know that improved medical surveillance, accurate troop location information, and exposure monitoring are key to protecting the health of U.S. forces," said committee chair John H. Moxley, managing director of the North American health care division, Korn/Ferry International, Los Angeles. "While the accomplishment of the mission always will be the paramount objective, soldiers must know that their health and well-being are taken seriously. Failure to move briskly to incorporate these procedures will erode the traditional trust between the service member and the military leadership, and could jeopardize the mission."

The U.S. Department of Defense (DOD) asked the National Academies to draw on lessons learned from the Gulf War experience and other conflicts around the world and provide advice on a long-term strategy for protecting military personnel sent to environments that may be contaminated by harmful agents or contain other health risks not commonly seen in the United States. As a first step, the National Academies released last year four reports addressing the technical aspects of identifying and assessing hazards, reducing risk exposure, and improving medical surveillance and record keeping. These reports were used to craft the unified, long-term strategy that is included in this final report.

Gulf War Lessons

Nearly 10 years ago, the United States deployed 670,000 service members to the Middle East to fight in the Persian Gulf War. The country's swift and overwhelming victory in the war has been overshadowed by subsequent concerns about the long-term health status of those who served. Various groups, including a significant number of veterans, speculate that unidentified risk factors led to chronic, medically unexplained illnesses and question the depth of the military's commitment to protect the health of its deployed forces.

Throughout the 1990s, the federal government commissioned numerous studies by independent expert panels, as well as by its own agencies, to address these concerns. And in 1998 the National Science and Technology Council, a cabinet-level entity that coordinates federal research and development, released an interagency plan to address health preparedness and readjustment for the military. Although DOD has generally concurred with the council's findings and recommendations and those of other studies, few concrete changes have been made in the field. Despite the compelling rationale for immediate action, the most important proposals remain unimplemented, the committee said.

New Trends in Deployment

In recent years, U.S. service members have frequently been assigned to small-scale operations throughout the world -- such as humanitarian assistance, disaster relief, and peacekeeping -- with varying degrees of combat risk. The potential settings of deployments have multiplied along with the types of operations that might be required. Many different climates and terrains could be encountered and must be factored into planning, the committee said. Additionally, challenges posed by rapidly expanding technologies and coordination with coalition partners and allies must be met. At the end of February 2000, more than 40,000 U.S. troops were deployed to 15 military operations.

Further complicating the issue of protecting health is the increased reliance on reserve service members, who often are not linked with the military health system. For example, in March 2000, the 49th Armored Division of the Texas National Guard sent about 700 men and women to Bosnia for peacekeeping duties.

The committee believes a major reason for the lack of movement in adopting plans suggested in earlier studies is that no one entity has been assigned authority to implement the recommendations. The report says that the authority must rest with the secretary of defense and outlines strategies that DOD should implement immediately to ensure that troop health is protected:
  • Designate clear responsibility for developing a process for health risk assessment to evaluate deployment risks. The process should include a review of the likely actions within a deployment that could expose troops to health risks, making sure that the concerns of service members are factored into all decisions.
  • Collect, manage, and integrate information on nonbattle hazards. For major deployments and those where there is an anticipated threat of chemical exposures, biological samples -- such as blood and urine -- should be collected from troops in the field.
  • Develop risk assessment, management, and communication skills in military leaders at all levels. DOD should include service members and their families in developing a plan for risk communication. It also must immediately admit to mistakes and fully air all the facts related to mistakes as quickly and as transparently as possible.
  • Accelerate completion of a health surveillance system that spans a service member's career and continues after separation from the service. DOD should ensure that adequate preventive medicine personnel and resources are available during the early stages of deployments.
  • Put plans in place to address medically unexplained symptoms in populations that have been deployed. Guidelines under development for the management of patients with these symptoms should be completed and health care providers should be trained in the use of these guidelines. A treatment outcomes and health service research program should be established within DOD -- in collaboration with the Department of Veterans Affairs health system and the Department of Health and Human Services -- to provide an empirical basis for improved treatment.
  • Implement the joint computerized patient record and other automated record-keeping systems that meet the information needs of health providers who care for service members individually, as well as of those working in military public health. Methods should be developed to gather and analyze retrievable, electronically stored health data on reservists as well as those in active duty. At a minimum, records of military immunizations should be maintained for all reservists.

The committee's work was supported by the U.S. Department of Defense. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.

Read the full text of Protecting Those Who Serve: Strategies to Protect the Health of Deployed U.S. Forces for free on the Web, as well as more than 1,800 other publications from the National Academies. Printed copies are available for purchase from the National Academy Press Web site or at the mailing address in the letterhead; tel. (202) 334-3313 or 1-800-624-6242. Reporters may obtain a pre-publication copy from the Office of News and Public Information at the letterhead address (contacts listed above).


INSTITUTE OF MEDICINE
Medical Follow-up Agency

Committee on Strategies to Protect the Health of Deployed U.S. Forces

John H. Moxley III, M.D.* (chair)
Managing Director
North American Health Care Division, and
Partner
Physician Executive Practice
Korn/Ferry International
Los Angeles

Ruth L. Berkelman, M.D.
Senior Adviser to the Director
Centers for Disease Control and Prevention, and
Visiting Professor
Rollins School of Public Health
Emory University
Atlanta

J. Crispin Bisgard, M.D., M.P.H.
Director of Health Services
Delta Air Lines Inc., and
Colonel
U.S. Air Force (retired)
Atlanta

Guy A. LaBoa
Executive Director
CIBA Vision, and
Lieutenant General
U.S. Army (retired)
Duluth, Minn.

Layton McCurdy, M.D.
Vice President for Medical Affairs, and
Dean and Professor of Psychiatry
Medical University of South Carolina
Charleston

Matthew L. Puglisi
Manager
Government Relations
Optical Society of America
Washington, D.C.

Lynn A. Streeter, Ph.D.
Consultant
Knowledge Analysis Technologies, LLC
Boulder, Colo.

Elaine Vaughan, Ph.D.
Associate Professor
Department of Psychology and Social Behavior
School of Social Ecology
University of California
Irvine

Lauren A. Zeise, Ph.D.
Chief
Reproductive and Cancer Hazard Assessment Section
Office of Environmental Health Hazard Assessment
California Environmental Protection Agency
Oakland

INSTITUTE STAFF

Joseph S. Cassells, M.D.
Study Director

Lois Joellenbeck, Dr.P.H.
Senior Program Officer