Information on Deployment-Related Exposures

Background

GENERAL REFERENCES FOR DEPLOYMENT-RELATED EXPOSURES

• VA, Veterans Health Initiative
  Healthcare Provider Training Program on the following topics: Agent Orange, Caring for War Wounded, Cold Injury, Endemic Infectious Diseases of SW Asia, Gulf War, Health Effects from CBR Weapons, Hearing Impairment, Military Sexual Trauma, POW, PTSD, Radiation, Spinal Cord Injury, Traumatic Amputation, Traumatic Brain Injury, Visual Impairment.

Disease Exposure References

• USAPHC PHN No: 0811-01, Clinical Protocol for the Management of Pneumonitis/Pneumonia in the US Central Command Area of Responsibility, Aug 11
• Institute of Medicine, Gulf War and Health Reports: Volume 5 Infectious Disease, 16 Oct 06 (including OIF and OEF) This report is the fifth volume produced by IOM for VA in response to a congressional mandate. A committee of nationally recognized experts in infectious diseases was appointed to evaluate the scientific and medical literature on long-term adverse human health outcomes associated with selected infectious diseases pertinent to Gulf War veterans. The following pathogens were selected: Brucella species (spp.), the cause of brucellosis; Campylobacter spp., nontyphoidal Salmonella spp. and Shigella spp., which cause diarrheal disease; Coxiella burnetii, the cause of Q fever; Leishmania spp., the cause of leishmaniasis; Mycobacterium tuberculosis, which causes tuberculosis; Plasmodium spp., the cause of malaria; and West Nile virus, the cause of West Nile fever.
• USAPHC TG 273, Diagnosis and Treatment of Diseases of Tactical Importance to US Central Command, Oct 05 This Technical Guide was compiled to assist military physicians and physician assistants operating outside the continental United States (OCONUS) under the U.S. Central Command (USCENTCOM) manage diseases potentially found in that Area of Operations. The focus is on initial, not definitive, management outside of the hospital in assumed level of care I or II facility and a worst-case evacuation policy of 7 days.
• Emerging Health Concerns (DHCC Web Page with information on the following topics: Acinetobacter, Acute Eosinophilic Pneumonia, Combat/Operational Stress, Depleted Uranium, Influenza, Leishmaniasis, Malaria, Mefloquine/Lariam, Metal Fragments, SARS, Sexually Transmitted Diseases, Traumatic Brain Injury, Tuberculosis and West Nile Virus.)
• Specific Conditions and Concerns (A-Z) (DHCC Web Page with specific health conditions and concerns listed alphabetically.)

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Chemical Exposure References

• USAPHC TG 230, Environmental Health Risk Assessment and Chemical Exposure Guidelines for Deployed Military Personnel, Jun 10 This guide is a standard tool to assess and characterize chemical exposures during deployments in a manner that is consistent with established joint military risk management doctrine. It provides a range of military exposure guidelines (MEGs) that are health-based chemical concentrations in air, water, and soil for various military exposure scenarios during deployments. (Supersedes USACHPPM TG 230,
  May 03)
• USAPHC Reference Document 230 Methodology for Determining Chemical Exposure Guidelines for Deployed Military Personnel, Jun 10 Revision (This is the support document for USAPHC TG 230.)
• ATSDR Toxic Substances Portal Department of Health and Human Services Agency for Toxic Substances and Disease Registry Web portal provides access to the best science, the latest research, and the most important information about toxic substances and how they affect health.
• NIOSH Pocket Guide to Chemical Hazards, NIOSH Publication No. 2005-149, Sep 05 The National Institute of Occupational Safety and Health produced this guide as a source of general industrial hygiene information on several hundred chemicals/classes for workers, employers, and occupational health professionals.
• TB MED 593, Guidelines for Field Waste Management, Sep 06 This bulletin provides technical guidance to the preventive medicine community on the proper management of waste in field settings. Types of waste include: solid nonhazardous waste (garbage and rubbish), hazardous and special waste, medical waste, human waste, and wastewater.)
• Weapons of Mass Destruction(DHCC Web Pages with information on biological, chemical and radiological WMDs and stress-related responses.)

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Occupational/Environmental Health Surveillance References

• Air Force Manual 48-146, Occupational and Environmental Health Program Management, 9 Oct 12 (This manual implements requirements of AFPD 48-1, Aerospace Medicine Enterprise and AFI 48-145, Occupational and Environmental Health Program. It provides guidance on overall Occupational and Environmental Health (OEH) program management and incorporates Risk Management (RM) principles into the OEH program.)
• Change 141, Manual of the Medical Department, U.S. Navy NAVMED P-117, 8 Jun 12 Chapter 22, Preventive Medicine and Occupational Health (Totally revised content on Preventive Medicine and Occupational Health Programs.)
• Air Force Instruction 48-145, Occupational and Environmental Health Program, 15 Sep 11 (This AFI implements Air Force Policy Directive (AFPD) 48-1, Aerospace Medical Programs, DoD Instruction (DoDI) 6055.05, Occupational and Environmental Health and is consistent with AFPD 90-8, Environment, Safety, and Occupational Health.)
• DoDI 6490.03, Deployment Health, 11 Aug 06, Certified Current as of 30 Sep 11 (Implements policies and prescribes procedures for deployment health activities, including deployment health assessments, for Joint and Service-specific deployments.)
• USAPHC Technical Information Paper No., 64-002-1110, The Periodic Occupational and Environmental Monitoring Summary (POEMS)—History, Intent, and Relationship to Individual Exposures and Health Outcomes, Nov 10
• CENTCOM Reg 220-1, Deployment Health Surveillance and Force Health Protection, 24 Feb 10 (Implements policies and prescribes procedures for deployment health activities for Joint and Service-specific deployments and exercises.)
• AR 11-35 Deployment Occupational Health and Environmental Health Risk Management, 16 May 07 Army Regulation which covers the policies, responsibilities, and procedures for managing risks associated with occupational and environmental health threats during deployments.
• DoDI 6055.05, Occupational and Environmental Health (OEH), 11 Nov 08  This Department of Defense Instruction provides guidance for all activities related to preventing OEH-related illnesses for DoD personnel. OEH includes, but is not limited to, industrial hygiene (IH), ergonomics, occupational and environmental medicine (OEM), epidemiology, hearing conservation, radiation protection, OEH surveillance in military operations, engineering, and risk management of health hazards.
• DoD 6055.05-M Occupational Medical Examinations and Surveillance Manual, 2 May 07, Incorporating Change 1, 16 Sep 08 This Department of Defense Manual provides health professionals with information and references appropriate for developing, performing, interpreting, and conducting occupational medical examinations and surveillance for Service members as well as DoD civilian based on identified health risks associated with specific jobs, processes, and exposures
• Navy And Marine Corps Public Health Center Technical Manual NMCPHC-TM OM 6260, Medical Surveillance Procedures Manual and Medical Matrix (Edition 11), Jul 11 (This manual establishes the minimum requirements for medical surveillance and certification examinations aimed at protecting workers who are exposed or potentially exposed to hazardous substances in the workplace.)
• Air Force Manual 48-155, Occupational and Environmental Health Exposure Controls, 1 Oct 08 This manual implements AFPD 48-1 and establishes procedures for determination of Occupational and Environmental Health (OEH) exposure controls.
• Air Force Manual 48-154 Occupational and Environmental Health Site Assessment, 28 Mar 07  .This manual standardizes procedures for developing and executing occupational and environmental health site assessments (OEHSA). This manual also provides guidance for occupational and environmental health (OEH) surveillance activities in both home station (i.e., garrison) and expeditionary (i.e., deployed) settings.

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Environmental Surveillance References

• AF Handbook 10-222, Environmental Considerations for Overseas Contingency Operations, 1 Sep 12 (This handbook contains guidance on environmental considerations for Air Force civil engineer personnel, including Air National Guard and AF Reserve personnel deployed in support of OCONUS contingency operations. It outlines strategies for use in minimizing negative impacts on the mission resulting from environmental health and safety hazards and environmental neglect.)
• USAPHC Fact Sheet 64-018-1111, Summary of Evidence Statement: Chronic Respiratory Conditions and Military Deployment, May 12 (This document is intended to provide technical audiences with a summary of the current scientific evidence regarding potential associations between deployment-related exposures and post-deployment chronic respiratory conditions. This information may be used by health care personnel to brief leaders, other health care professionals, etc., as well as to assist with counseling individual Service members and their Family members.)
• GAO Report 12-412, DOD Can Improve Its Response to Environmental Exposures on Military Installations, 1 May 12 (This report contains GAO's assessment of DoD policies on environmental exposures and DoD healthcare and compensation programs for individuals who sustained environmental exposures. It also reviewed other federal programs for features that may aid in designing future compensation programs.)
• US Medicine, Article in 2011 Compendium of Federal Medicine, Where There's Smoke: DoD Investigates Causes of Deployment-Related Pulmonary Symptoms Reported by Troops
• Is Deployment Associated with an Increased Risk of Respiratory Outcomes? What Do We Know? What Do We Think?, The Army Medical Department Journal, pages 80-86, Jul-Sep 11
• VA 211A Training Letter 10-03, Environmental Hazards in Iraq, Afghanistan, and Other Military Installations, 26 Apr 10
• 2010 Military Health System Conference, Environmental Health Threats in Theater -- Lessons Learned Power Point Presentation, 26 Jan 10
• USAPHC Deployment Environmental Surveillance Program (DESP) The primary function of DESP is deployment occupational and environmental health site (OEHS) data analysis, information production on detecting, assessing and countering environmental health risks during deployments for world-wide Combatant Command locations. For Occupational and Environmental Surveillance Data at Deployment Locations worldwide see:
  • Military Exposure Surveillance Library (The MESL is a military information management system available via the Internet. The system was developed to meet the requirements of Department of Defense (DoD) Directive 6490.2 which mandates the establishment of a centralized repository for the collection of deployment occupational and environmental health surveillance (DOEHS) related data. MESL Brochure, Feb 12)
  • Periodic Occupational and Environmental Health Monitoring Summaries (POEMS) are available on the MESL. POEMS summarize the results of environmental monitoring (e.g., air, water, soil) and surveys (e.g., endemic and infectious disease, noise, heat/cold, and other hazards) performed in theater. History of POEMS