Health Consequences of Service During the Persian Gulf War Recommendations for Research and Information Systems (1996) / Chapter Skim
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Environment and Exposures
Environment and Exposures
Pages 36-66
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From page 36... ...
have not indicated the presence of excessive toxic or heavy metals, particularly when data before and after the oil well fires are compared. Official reports of acute health consequences from exposure to air pollutants were rare.
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Information about "unofficial" exposures, such as the combustion products of leaded fuels in heaters that were sometimes unventilated or nonregulation, wearing flea collars to protect against insect bites, and ingesting alcohol substitutes in the absence of approved alcohol consumption is available only from self-reports. Not surprisingly, the above scenario creates a picture of an extremely stressful environment, filled with the dangers and trauma of war, combined with a hostile living and work environment.
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From page 38... ...
The environment also was made more complex by the exposure of a large number of troops to potentially life-saving vaccinations, to medications administered in an effort to protect troops from chemical warfare (e.g., pyridostigmine) , to clothing treated with permethrin, and to insect repellents (especially N
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From page 39... ...
In the desert environment, daily burning out of waste cans employed mainly diesel filer. Smoke from such fires was common, though rapidly dispersed by prevailing winds.
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There have been numerous and persistent reports in presentations by individuals who were present during the PGW of finding large numbers of dead sheep, goats, camels, and other animals in the region. One published report assessed the histopathologic and chemical analysis of 26 feral cats exposed to the Kuwait oil fires (Moeller et al., 1994~; the analysis concluded that there was little evidence of harm from the environment.
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From page 41... ...
Defense against chemical and biological weapons was a high priority. As a result, Army veterinarians, Air Force Special Operations Medical Officers, Army Chemical Warfare Specialists, and physicians specializing in infectious diseases were in the theater to evaluate any unusual animal deaths.
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From page 42... ...
Personal application of the insect repellent (33 percent Deet) provided to soldiers for use on the skin has been calculated based on the amount of repellent ordered for the Gulf operation and the amount returned (Bolton, 1995~.
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However, a report of eight cases of reversible necrologic disease in individuals with an exposure to an unknown amount of chlorpyrifos has raised some concern that a mild reversible sensory neuropathology may be associated with subchronic administration. In general, it appears that the average personal usage of the pesticides available in the POW theater of operations was low and unlikely to be associated with the induction of chronic disease.
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From page 44... ...
This research initiative has as its chief aim the investigation of rodent responses to exposure conditions similar to those experienced by PGW veterans. In an effort to construct a rodent model of unexplained illness in PGW veterans, SpragueDawley rats will be subjected to controlled experimental exposure to Deet, pyridostigmine, and a mixture of diesel and jet fuel followed by an electrical shock; controls will help to delineate possible effects of chamber exposures alone, compared with exposures with stress-producing electrical shock.
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From page 45... ...
Data available include air and soil pathway analysis and industrial hygiene sampling. Air and soil quality was estimated not to have deteriorated during the sampling interval, and a reference to earlier sampling suggests that air quality at some sites was even higher than before the war.
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From page 46... ...
No evidence was found to support an association between autopsy, histopathologic, and toxicologic findings and any environmental exposures, including smoke from oil well fires. Analysis for heavy metals from blood and tissue obtained at autopsy did not indicate elevated levels attributable to exposure in the Gulf environment (Peterson and Kalasinsky, 1996~.
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Table 3-1 includes most of the potential chemical hazards associated with common maintenance or repair operations. With the exception of vehicle painting, information on actual exposure evaluations for these work settings is not available.
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was reported (Riley, 19929. USAEHA industrial hygiene sampling showed increases in personal or general air monitoring results of outdoor occupational environment from selected times and locations, but these increased levels did not exceed recommended standards.
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However, no known adverse long-term effects of standard immunization have been identified in PGW military personnel. The threat of CBW and questions regarding exposures to CBW agents have been raised as issues in assessing adverse health consequences of service in the PG.
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In evaluating the possibility that CBW agents affected the health of veterans, the committee relied heavily on known toxicological and pathological effects and existing knowledge regarding short- and long-term health effects of CBW agents and on findings reported from extensive DoD and DVA clinical evaluations of veterans. To date, there are no confirmed reports of clinical manifestations of acute nerve agent exposure.
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From page 51... ...
Botulinum toxoid vaccine has the status of an investigational product with FDA and has been used as an investigational vaccine to protect highrisk laboratory workers for more than 20 years. Reaction rates have been estimated after administration of the vaccine at USAMRIID as follows: mild local reactions have been more frequent (up to 10%)
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From page 52... ...
This pharmacological action would be useful in protecting military personnel from the effects of certain chemical warfare agents (organophosphate nerve agents) that bind irreversibly with AChE and can cause lethal and life-threatening complications.
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Second, the troops were not screened for those conditions that are contraindications to use of PB, including asthma, peptic ulcer, liver disease, kidney disease, or hypersensitivity to PB, although predeployment medical examinations generally should ensure that these conditions (other than hypersensitivity) were present in few of the troops on active duty.
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From page 54... ...
The investigators also note that there is a known polymorphism in the butylcholinesterase enzyme that could further exacerbate the demonstrated interaction of these compounds. The investigators point out that the actual exposure conditions present in the PG are not mimicked by the doses administered in the chicken experiments because the experimental doses and routes of administration were not directly comparable to use by troops in the PG.
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From page 55... ...
With the lack of a defined case for studying unexplained illnesses and with little evidence that chronic health effects are seen from pyridostigmine, the precise path for investigators to follow in the study of POW veterans remains to be clarified. Other medications could possibly increase the risk of side effects of PB.
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From page 56... ...
The first study is designed to investigate a rodent model of DU tumorigenesis and is being conducted by investigators at the Armed Forces Radiation Research Institute. Since little is known of the precise tumorigenic potential of this material, these researchers propose to conduct a long-term study in male F344 rats.
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From page 57... ...
One difference is that PG military personnel did not have the level of detachment possible in prior conflicts. Easy telephone communication to family and friends, up-to-date news services, even the very rapid mobilization itself tended to keep people's "heads" back home while their bodies were in the Gulf theater.
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Studies of active duty units included men only; studies with reserve units included men and 8-9% women (Marlowe, 1996~.
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Examples of other stressors for some persons or groups in the theater include separation from family and concerns about home; difficulties with mail or telephone communications with home; heavy workload and sleep deprivation, especially for combat support and service units; unsatisfactory living conditions, including extreme crowding with resultant interpersonal pressure and hostility; apprehensions about being in imminent danger; social and psychological isolation of members of combat arms units; leadership issues including poor morale; the lack of recreation facilities; heat, sand, and the desert environment; and the severity of climatic conditions. Once telecommunications were in place, soldiers could benefit from communicating with their families at home, which remained a primary source of support (Wright et al., 1991~.
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Unexpected, relatively sudden changes in circumstances created significant financial and job-related concerns for many reasons. The ODS experience of support units, many of whom were reservists, also differed from that of combat units, most of whom were on active duty.
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Stressor clusters of deployment identified retrospectively in the Pennsylvania and Hawaii study by reservists included possible exposure to traumatic events, actual exposure to traumatic events, stresses of waiting for deployment, stresses in the theater, and stresses at home. The pattern of stressors was similar for the active duty component, with the exception of their exposure to explicit stressors of combat such as being fired on by the enemy and engaging the enemy in firefights.
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From page 62... ...
, 66 and 67% of the active duty and reserve study participants who were deployed said they were experiencing moderate to extreme stress compared with 59 and 55% of the nondeployed active duty and reserve troops. When asked about the effects of stress on their lives, 46 and 41% of the active duty and reserve troops who were deployed responded that the effects were moderate or greater, compared with 35 and 30%, respectively, of the nondeployed (USAMRMC, 19943.
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From page 63... ...
These women were a self-selected sample of a larger group of 241 women originally studied by Wolfe. Of the participants, 8% reported attempted or completed sexual assault, 31% reported physical harassment, and 63% reported verbal harassment during their Gulf War deployment (Wolfe et al., 1992b)
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DVA ENVIRONMENTAL HAZARDS RESEARCH CENTERS In January 1994, DVA announced a program to establish centers for basic and clinical science studies of environmental hazards. Up to $500,000 per year for 5 years would be provided for support of the centers to engage in basic research on environmental health effects, with special emphasis on the diagnosis and treatment of medical problems currently being reported by POW veterans.
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From page 65... ...
If chronic fatigue and chemical sensitivity become accepted medical entities, the lack of population-based estimates of frequency and severity will still complicate assessment of whether these syndromes among returning veterans are associated with or caused by military service. The use of extensive (and expensive)
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66 HEALTH CONSEQUENCES OF THE PERSIAN GULF WAR In summary, the DVA-funded EHRCs facilitate the application of research skills available at selected VAMCs across the United States, but these research efforts will have limited ability, individually or collectively, to contribute to understanding the health effects of military service in the POW. The committee has not evaluated other uses of these research programs.
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