of the Joint Staff released a capstone document, Force Health Protection, which also describes a commendable vision for protecting deploying forces (The Joint Staff, Medical Readiness Division, 2000). The committee fears that the vision outlined in that report will meet the same fate as the other reports.

With the 10th anniversary of the Persian Gulf War now here, the Committee on Strategies to Protect the Health of Deployed U.S. Forces has concluded that the implementation of the expert panels' recommendations and government-developed plans has been unacceptable. For example, medical encounters in theater are still not necessarily recorded in individuals ' medical records, and the locations of service members during deployments are still not documented or archived for future use. In addition, environmental and medical hazards are not yet well integrated in the information provided to commanders. The committee believes that a major reason for this lack of progress is the fact that no single authority within DoD has been assigned responsibility for the implementation of the recommendations and plans. The committee believes, because of the complexity of the tasks involved and the overlapping areas of responsibility involved, that the single authority must rest with the Secretary of Defense.

The committee has concluded that immediate action must be taken to accelerate implementation of these plans to demonstrate the importance that should be placed on protecting the health and well-being of service members. This report describes the challenges and recommends a strategy to better protect the health of deployed forces in the future. Many of the recommendations are restatements of recommendations that have been made before, recommendations that have not been implemented. Further delay could result in unnecessary risks to service members and could jeopardize the accomplishment of future missions. The committee recognizes the critical importance of integrated health risk assessment, improved medical surveillance, accurate troop location information, and exposure monitoring to force health protection. Failure to move briskly on these fronts will further erode the traditional trust between the service member and the leadership.

In recent years, U.S. service members have frequently deployed to smaller-scale contingency operations, including operations that involve humanitarian assistance, disaster relief, peacekeeping, enforcement of sanctions, arms control, counterterrorism, counter-drug action, and counter-insurgencies, with the range of combat risk being from low to high (Reuter, 1999). The potential settings of deployments have multiplied along with the types of operations that might be required. Many different climates and terrains are possible and must be factored into the consideration of potential deployment scenarios. The challenges posed by rapidly expanding technologies and interaction with coalition partners during deployments also must be met. This changing environment requires DoD to respond in less traditional ways and has greatly influenced the preparation of this report.

As of the end of February 2000, more than 40,000 U.S. personnel—active-duty, reserves, and civilian employees—were deployed to 15 operations. The largest number in a single deployment was nearly 16,000 participants in Operation Southern Watch, whereas some of the smaller operations had as few as 10

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