The exposure of Gulf War troops to numerous environmental and chemical agents has been addressed in previous volumes of the Gulf War and Health series, and such exposures will not be considered here except to note that many troops may have found such exposures—anticipated, known, or suspected—to be psychologically stressful and physiologically challenging. Troops in the 1991 Gulf War were exposed to environmental and chemical agents, possibly including chemical-warfare agents. Some exposures were the result of living and working conditions at camp or in the field, such as exposures to petroleum-based combustion products, including those of kerosene, diesel, and leaded gasoline used in unventilated tent heaters, cooking stoves, and portable generators. Some troops were exposed to the smoke from more than 750 oil-well fires. Pesticides, including dog flea collars, were widely used by troops in the Persian Gulf to combat the region’s ubiquitous insect and rodent populations. Exposure of U.S. personnel to depleted uranium occurred as the result of “friendly-fire” incidents, cleanup operations, and accidents (including accidental fires).
U.S. troops in the gulf had been warned that they might be exposed to biologic and chemical weapons. Iraq previously had used such weapons in fighting Iran and in attacks on the Kurdish minority in Iraq. U.S. military leaders feared that the use of such weapons in the gulf could result in the deaths of tens of thousands of Americans. Therefore, in addition to the standard predeployment immunizations, the anthrax and botulinum toxoid vaccine were also provided to some military personnel. Troops were also given blister packs of 21 tablets of pyridostigmine bromide (PB) to protect against nerve gas. Troops were to take PB on the orders of a commanding officer when a chemical-warfare attack was believed to be imminent. Alarms sounded often, and troops responded by donning the confining protective gear and ingesting PB as an antidote to nerve gas. DoD has estimated that about 250,000 personnel took PB at some time during the Gulf War (IOM 2006). The sounding of the alarms, the reports of dead animals, and rumors that other units had been hit by chemical-warfare agents caused the troops to be concerned that they would be or had been exposed to such agents.
Despite the relatively small numbers of U.S. personnel injured or killed during combat in the Gulf War, the troops, as in any war, faced the fear of death, injury, capture by the enemy, and, in the case of the demolition of a munitions-storage complex at Khamisiyah, Iraq, possible exposure to the nerve agents sarin and cyclosarin.
The Gulf War was the first since World War II in which reserve and National Guard units were activated and deployed. The greater participation of reserve and National Guard troops in the Gulf War has now been surpassed by OEF and OIF (Table 3-3). As of February 14, 2007, almost 85,000 reserve and National Guard personnel have been mobilized to serve in OEF and OIF.
Reservists and National Guard troops may encounter more stressors going to a war zone than those faced by active-duty military personnel; many of the additional stressors were unanticipated at the time the reservists and National Guard troops signed up for service. The stressors experienced by reservists and National Guard troops might include financial concerns, such as significant loss of income due to leaving more lucrative civilian jobs for lower military