protection, health consequences and treatment, and medical record keeping. Studies that have addressed topics 1, 2, and 3 have been carried out concurrently by the Commission on Life Sciences and the Commission on Engineering and Technical Systems of the National Research Council.

The study presented here, carried out with staff support from the Medical Follow-up Agency of the Institute of Medicine, addresses the topics of medical protection, health consequences and treatment, and medical record keeping. The study team was charged with addressing the following:

  • Prevention of adverse health outcomes that could result from exposures to threats and risks including chemical warfare and biological warfare, infectious disease, psychological stress, heat and cold injuries, unintentional injuries;

  • Requirements for compliance with active duty retention standards;

  • Predeployment screening, physical evaluation, and risk education for troops and medical personnel;

  • Vaccines and other prophylactic agents;

  • Improvements in risk communication with military personnel in order to minimize stress casualties among exposed or potentially exposed personnel;

  • Improvements in the reintegration of all troops to the home environment;

  • Treatment of the health consequences of prevention failures, including battle injuries, disease and non-battle injury (DNBI), acute management, and long-term follow-up;

  • Surveillance for short- and long-term outcomes, to include adverse reproductive outcomes; and

  • Improvement in keeping medical records, perhaps using entirely new technology, in documenting exposures, treatment, tracking of individuals through the medical evacuation system, and health/administrative outcomes. (Statement of Task, Appendix B)

Within the breadth of this charge, the study team chose to emphasize areas in which greatest needs were evident from the lessons learned from the Gulf War and other recent deployments and to treat other areas (those areas where the study team believed that it had little to offer the military) less thoroughly. Since an important motivating force for the study was the health and reproductive concerns of veterans after the Gulf War, the study team chose to focus on the major challenges for prevention and data needs indicated by the health problems widely reported by deployed forces after the Gulf War and the efforts to better understand them.

What were the lessons of the Gulf War? Briefly, one of the lessons was that even in the absence of widespread acute casualties from battle, war takes its toll on human health and well-being long after the shooting or bombing stops. Although military preventive medicine programs have developed reasonably effective countermeasures against many of the discrete disease and non-battle in-

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