in hostile environments, (2) technologies and methods for detection and tracking of exposures to a subset of harmful agents, (3) physical protection and decontamination, and (4) medical protection, health consequences and treatment, and medical record keeping. Particular emphasis was to be placed on chemical and biological warfare injuries and disease and non-battle injuries from chemical contaminants in the environment. These studies were conducted concurrently by the Commission on Life Sciences, Commission on Engineering and Technical Systems, and the Institute of Medicine, all components of the National Research Council. The four technical reports and a workshop summary prepared by these units were completed in the fall of 1999 (IOM, 1999; NRC, 2000a–d). These reports were circulated to various divisions, services, and agencies within DoD with responsibilities in these technical areas. Comments were received in writing and in person.

In the study's final year, the present Institute of Medicine committee was formed and used those responses and the reports developed by the four respective sets of principal investigators and advisory panels as a starting point to inform this final report (the executive summary of each technical report is included in Appendix B, Appendix C, Appendix D to Appendix E of this report; the statement of task is found in Appendix A). The committee believes that these technical reports can stand on their own merits and endorses the recommendations that they contain. It has not been the present committee's intent to recapitulate or summarize those reports. Rather, the committee used them to extend the findings and recommendations that it considered to be most important to a long-term strategy for protection of the health of deployed forces, and to expand on broader, cross-cutting issues. The committee urges deliberate action to bring about concrete changes in response to recommendations in those reports.

The committee's overriding concern is that everything consistent with mission accomplishment be done to protect the health and lives of U.S. service members who are knowingly placed in harm's way. The committee understands that the changes will be costly and will inflict the pain of organizational change. The Department of Defense, however, has the obligation to avoid unnecessary disease, injury, disability, and death as it pursues the accomplishment of its missions. Not to fulfill that obligation would be simply unconscionable.



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