Adequacy of the Comprehensive Clinical Evaluation Program

Nerve Agents

Committee on the Evaluation of the Department of Defense

Comprehensive Clinical Evaluation Program

Division of Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1997



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--> Adequacy of the Comprehensive Clinical Evaluation Program Nerve Agents Committee on the Evaluation of the Department of Defense Comprehensive Clinical Evaluation Program Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1997

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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by the Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is the president of the Institute of Medicine. This study was supported by the US Department of Defense under Contract Number DASW01-96-K-007. The views presented are those of the Institute of Medicine Committee on the Evalution of the Department of Defense Comprehensive Clinical Evaluation Program and are not necessarily those of the funding organization. International Standard Book No. 0-309-05743-4 Additional copies of this report are available for sale from: National Academy Press 2101 Constitution Avenue, N.W. Box 285 Washington, DC 20055 Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's on-line bookstore at http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at http://www2.nas.edu/iom. Copyright 1997 by the National Academy of Sciences. All rights reserved. Printed in the United States. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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--> COMMITTEE ON THE EVALUATION OF THE DoD COMPREHENSIVE CLINICAL EVALUATION PROGRAM Dan G. Blazer,* Chair, Dean of Medical Education and Professor of Psychiatry, Duke University Medical Center, Durham, North Carolina Margit L. Bleecker, Director of the Center for Occupational and Environmental Neurology, Baltimore, Maryland Evelyn J. Bromet, Professor, Department of Psychiatry, State University of New York at Stony Brook, Stony Brook, New York Gerard Burrow,* Dean, Yale University School of Medicine, New Haven, Connecticut Howard Kipen, Associate Professor and Director, Occupational Health Division, Robert Wood Johnson Medical School, Piscataway, New Jersey Adel A. Mahmoud,* Chairman, Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio Robert S. Pynoos, Associate Professor of Psychiatry and Dean of the Trauma Psychiatry Service, University of California at Los Angeles, Los Angeles, California Guthrie L. Turner, Chief Medical Consultant, Office of Disability Determination Services, State of Washington, Tummwater, Washington Michael Weisman, Professor, Division of Rheumatology, University of California at San Diego Medical Center, San Diego, California Staff Lyla M. Hernandez, Study Director Sanjay S. Baliga, Research Associate David A. Butler, Program Officer Donna M. Livingston, Project Assistant James A. Bowers, Project Assistant Kathleen R. Stratton, Director, Division of Health Promotion and Disease Prevention Constance M. Pechura, Director, Division of Neuroscience and Behavioral Health *   Member, Institute of Medicine.

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--> Contents     Executive Summary   1     Introduction   4     The Comprehensive Clinical Evaluation Program   6     Overview,   6     Implementation,   7     CCEP: The Initial IOM Report,   8     CCEP: IOM Review Continued,   9     Testing For And Identifying Health Effects Of Exposure To Nerve Agents   11     Recommendations   15     References   21     Appendixes         A Recommendations of the Initial CCEP Committee,   25     B Outline of the CCEP Medical Protocol,   44     C Workshop on the Adequacy of the CCEP for Evaluating Individuals Potentially Exposed to Nerve Agents: Agenda and Speakers List,   48     D DoD Memorandum for Persian Gulf War Veterans Concerning Kamisiyah, Iraq,   52     E Persian Gulf War-Related Events: Timeline,   55

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