been difficult to correlate veterans’ self-reports of exposure to the smoke with dispersion models based on troop location information (IOM, 2006b). There were additional potential sources of exposure to petroleum-based combustion products. Kerosene, diesel, and leaded gasoline were used in unvented tent heaters, cooking stoves, and portable generators. Exposures to tent-heater emissions were not specifically documented, but a simulation study was conducted after the war to determine exposure (Cheng et al., 2001). Petroleum products, including diesel fuels, were also used to suppress sand and dust, and petroleum fuels were used to aid in the burning of waste and trash.

Pesticides, including dog flea collars, were widely used by troops in the Persian Gulf to combat the region’s ubiquitous insect and rodent populations, and although guidelines for use were strict, there were many reports of misuse. The pesticides used included methyl carbamates, organophosphates, pyrethroids, and chlorinated hydrocarbons. The use of those pesticides is covered in several reports (for example, DoD, 2001; RAND, 2000); however, objective information regarding individual levels of pesticide exposure is generally not available, and reports by individual veterans as to their use of and possible exposure to pesticides are subject to considerable recall bias.

Many exposures could have been related to particular occupational activities in the Gulf War. The majority of occupational chemical exposures appear to have been related to repair and maintenance activities, including battery repair (corrosive liquids), cleaning and degreasing (solvents, including chlorinated hydrocarbons), sandblasting (abrasive particles), vehicle repair (asbestos, carbon monoxide, and organic solvents), weapon repair (lead particles), and welding and cutting (chromates, nitrogen dioxide, and heated metal fumes). In addition, troops painted vehicles and other equipment used in the gulf with a chemical-agent-resistant coating either before being shipped to the gulf or at ports in Saudi Arabia. Working conditions in the field were not ideal and recommended occupational-hygiene standards might not have been followed at all times.

Exposure of US personnel to depleted uranium (DU) occurred as the result of friendly-fire incidents, cleanup operations, and accidents (including fires). Other personnel might have inhaled DU dust through contact with DU-contaminated tanks or munitions. Assessment of DU exposure, especially high exposure, is considered to be more accurate than assessment of exposure to most other agents because of the availability of biologic monitoring information.

Threat of Chemical and Biologic Warfare

When US troops arrived in the gulf, they had no way of knowing whether they would 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. 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 vaccinations before military deployment, about 150,000 troops received anthrax vaccine and about 8,000 troops received botulinum toxoid vaccine. In some cases, vaccination records were kept, and they provide an objective measure of exposure in addition to self-reporting by troops.

Troops were also given blister packs of 21 tablets of pyridostigmine bromide (PB) to protect against agents of chemical warfare, specifically nerve gas. Troops were to take PB on the orders of a commanding officer when a chemical-warfare attack was believed to be imminent. Chemical sensors and alarms were distributed throughout the region to warn of such attacks. The alarms were extremely sensitive and could be triggered by many substances, including some



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