Protecting THOSE WHO SERVE

Strategies to Protect the Health of Deployed U.S. Forces

Committee on Strategies to Protect the Health of Deployed U.S. Forces

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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Protecting THOSE WHO SERVE: Strategies to Protect the Health of Deployed U.S. Forces Protecting THOSE WHO SERVE Strategies to Protect the Health of Deployed U.S. Forces Committee on Strategies to Protect the Health of Deployed U.S. Forces INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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Protecting THOSE WHO SERVE: Strategies to Protect the Health of Deployed U.S. Forces 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 competences and with regard for appropriate balance. Support for this project was provided by Contract No. DASW01-97-C-0078 between the National Academy of Sciences and the U.S. Department of Defense. The views presented in this report are those of the Institute of Medicine Committee on Strategies to Protect the Health of Deployed U.S. Forces and are not necessarily those of the funding agency. International Standard Book No. 0-309-07189-5 Additional copies of this report are available for sale from the 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 home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2000 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. 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 Staatliche Museen in Berlin.

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Protecting THOSE WHO SERVE: Strategies to Protect the Health of Deployed U.S. Forces “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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Protecting THOSE WHO SERVE: Strategies to Protect the Health of Deployed U.S. Forces THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Protecting THOSE WHO SERVE: Strategies to Protect the Health of Deployed U.S. Forces COMMITTEE ON STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES JOHN H. MOXLEY (Chair), Managing Director, North American Health Care Division, Korn/Ferry International, Los Angeles RUTH L. BERKELMAN, Senior Adviser to the Director, Centers for Disease Control and Prevention, and Rollins School of Public Health, Emory University J. CRIS BISGARD, Director, Health Services, Delta Air Lines, Atlanta GUY A. LABOA, Executive Director, Dailies Manufacturing, CIBA Vision, Duluth, Georgia LAYTON McCURDY, Dean and Vice President of Medical Affairs, Medical University of South Carolina MATTHEW L. PUGLISI, Government Relations Manager, Optical Society of America, Washington, D.C. LYNN A. STREETER, Consultant, Knowledge Analysis Technologies, LLC, Boulder, Colorado ELAINE VAUGHAN, Associate Professor, Department of Psychology and Social Behavior, University of California at Irvine LAUREN ZEISE, Chief, Reproductive and Cancer Hazard Assessment Section, California Environmental Protection Agency, Oakland Staff JOSEPH CASSELLS, Study Director LOIS JOELLENBECK, Senior Program Officer PHILLIP BAILEY, Project Assistant RYAN CATTEAU, Project Assistant RICHARD MILLER, Director, Medical Follow-Up Agency

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Protecting THOSE WHO SERVE: Strategies to Protect the Health of Deployed U.S. Forces REVIEWERS The report was reviewed by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments to assist the authors and the Institute of Medicine in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The contents of the review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. The committee wishes to thank the following individuals for their participation in the report review process: Elizabeth L. Anderson, President and Chief Executive Officer, Sciences International, Inc., Alexandria, Virginia George Anderson, President, American College of Preventive Medicine, Vienna, Virginia John C. Bailar III, Professor, Department of Health Studies, The University of Chicago Paul E. Busick, President and Executive Director, North Carolina Global TransPark Authority, Kinston, North Carolina Daniel J. Clauw, Associate Professor of Medicine and Othorpedics and Scientific Director, Georgetown Chronic Pain and Fatigue Research Center, and Chief, Division of Rheumatology, Immunology, and Allergy, Georgetown University Medical Center Paul D. Clayton, Medical Informaticist, Salt Lake City, Utah Gerald P. Dinneen, Vice President, S&T, Honeywell, Inc., ret., Edina, Minnesota James Terry Scott, Director, National Security Program, John F. Kennedy School of Government, Harvard University Harrison Shull, Professor Emeritus, U.S. Naval Postgraduate School, Monterey, California Stephen B. Thacker, Acting Director, National Center for Injury Prevention and Control, Atlanta While the individuals listed above provided many constructive comments and suggestions, responsibility for the final content of the report rests solely with the authoring committee and the Institute of Medicine.

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Protecting THOSE WHO SERVE: Strategies to Protect the Health of Deployed U.S. Forces Acronyms AFMIC Armed Forces Medical Intelligence Center CBT cognitive behavior therapy CDC Centers for Disease Control and Prevention CPR computer-based patient record DoD U.S. Department of Defense HEAR Health Evaluation and Assessment Review ICD-9 International Classification of Diseases, version 9 IOM Institute of Medicine JCS Joint Chiefs of Staff NIH National Institutes of Health NSTC National Science and Technology Council RAP Recruit Assessment Program VA U.S. Department of Veterans Affairs

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