Metal Fragments

Background

In April 2007, one of the problems that the Report Of The Interagency Task Force On Returning Global War On Terror Heroes identified was the growing number of servicemembers with shrapnel or retained fragment wounds received from blast injuries and the concern that some types of fragments could have long-term health effects. In response, one of the recommendations included the creation of a VA Embedded Fragment Surveillance Center and Registry which “would allow VA to identify and provide clinical surveillance to GWOT veterans with retained fragments and to initiate early intervention for resulting health care problems.” This program is an expansion of the VA’s mission to follow-up veterans with depleted uranium exposure.

On 18 Dec 07, Health Affairs published a new policy (HA Policy 07-029) on analysis of metal fragments removed from Department of Defense personnel. The policy "requires the Services to conduct a laboratory analysis of metal fragments, resulting from enemy or friendly fire, that are removed from surviving Department of Defense (DoD) personnel in DoD military treatment facilities (MTFs)." “This policy recognizes that some munitions may contain certain tungsten alloys and other metals that may pose a long-term toxicological hazard when retained in the body. “ “This policy is a first step in establishing a mechanism for tracking DoD personnel bearing potentially hazardous embedded fragments, since currently there are insufficient data available to assess specific risk.” The Services have developed their own implementing policies.

This Web page was developed to provide policies and directives, training material, and related links to assist healthcare providers and Service members and their families.

Table of Contents

• Policies and Directives
  • DoD/Joint Forces
  • Army
  • Air Force
  • Navy/Marines
  • VA (Department of Veterans Affairs)
• Forms and Measures
• Other Related Information
• Education and Training
• Research
• Related Links

Policies and Directives

DoD/Joint Forces

• HA Policy 12-001, Operation IRAQI FREEDOM/Operation NEW DAWN Depleted Uranium Bioassay Results - 16th Semi-Annual Report and Policy on Future Data Submissions, 23 Jan 12
• HA Policy 07-029, Policy on Analysis of Metal Fragments Removed from Department of Defense Personnel, 18 Dec 07

Army

• OTSG/MEDCOM Policy Memo 12-055, Management of Metal Fragments Removed from Army Personnel, 6 Jul 12 (On AKO)

Air Force

• HQ USAF/SG3, AFMS Implementation of Health Affairs Policy on Analysis of Metal Fragments Removed from DoD Personnel, 14 Mar 08

Navy/Marines

• NAVMED Policy 08-016, Policy Guidance for Analysis of Removed Combat-Related Metal Fragments, 20 Jun 08

VA (Department of Veterans Affairs)

• VHA Directive 2010-029, Screening and Evaluation of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans with Embedded Fragments, 9 Jun 10

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Forms and Measures

• USAFSAM/OEHTA Embedded Metal Fragment Analysis Request Form

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Other Related Information

• Pentagon Channel Video, DOD Lab Analyzes Fragments Embedded in Wounded Warriors, 20 Apr 12 (Joint Pathology Center's Biophysical Toxicology and Depleted Uranium/Embedded Metal Fragment Laboratory)



• Laboratory Analyzes Shrapnel to Look for Uranium, American Forces Press Service, 19 Apr 12



• UK Ministry of Defence, A Review of the Toxicology of Tungsten Based Heavy Metal Alloys



• Force Health Protection and Readiness (FHP&R), Tungsten/Nickel/Cobalt Alloy Study Page Fact Sheet, 8 Jan 08

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Education and Training

• VA Conference, Depleted Uranium and Toxic Embedded Fragment Surveillance Programs Update Presentation, Aug 11



• Force Health Protection Conference 2009, Aug 09
• Update on the DoD Embedded Metal Fragment Registry
• U.S. Army CHPPM Laboratory Analysis of Metal Fragments Removed from Injured Army Personnel

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Research

• Protocol for the Assessment of Potential Health Effects From Embedded Metal Fragments, Military Medicine, Mar 09



• Protocol for the Assessment of Potential Health Effects from Embedded Metal Fragments, Abstract of Article in Military Medicine Vol 174 No 3, Mar 09



• The Use of Established Skeletal Muscle Cell Lines to Assess Potential Toxicity from Embedded Metal Fragments, Abstract of Article in Toxicology in Vitro Vol 23 No 2, Mar 09



• Urinary and Serum Metal Levels As Indicators of Embedded Tungsten Alloy Fragments, Abstract of Article in Military Medicine Vol 173 No 8, Aug 08

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Related Links

• US Army Public Health Command (USAPHC) (Provides comprehensive laboratory science services worldwide as part of the occupational and environmental health assessment and medical surveillance process in support of Army readiness.)



• Air Force Medical Service (AFMS) Chemistry Laboratory (Provides analytical chemistry data and related support for AF-wide occupational health surveillance and environmental security programs. USAFSAM/OEHTA_Analytical@wpafb.af.mil)



• Armed Forces Radiobiology Research Institute (AFRRI) Internal Contamination and Metal Toxicity Research Program (The mission of this program is to determine whether the short-term and long-term radiological and toxicological risks of embedded metals warrant changes in the current combat and postcombat fragment removal policies for military personnel and, in the case of internalized radiological hazards, to investigate treatment strategies to enhance elimination of these metals from the body.)



• The Joint Pathology Center (The JPC provides world class diagnostic subspecialty pathology consultation, education and research services to federal agencies and operates the National Pathology Tissue Repository in support of the mission of the Department of Defense and other federal agencies. The Biophysical Toxicology and Depleted Uranium/Embedded Metal Fragment DU/EMF Laboratories provides analysis for combat-associated metal fragments taken from DoD personnel for depleted uranium and other metals.)



• Uniformed Services University of the Health Sciences Department of Radiation Biology (Investigates the health effects of embedded metal fragments, including those metals found in military munitions (e.g., depleted uranium, tungsten alloys) and radiological dispersal devices (e.g., strontium, cobalt, iridium).)



• Department of Veterans Affairs Office of Public Health and Environmental Hazards, Toxic Embedded Fragments (Information for veterans and the public about toxic embedded fragments, possible health problems, and related VA programs.)
  • Department of Veterans Affairs Toxic Embedded Fragment Surveillance Center (The TEFSC, located at the Baltimore VA Medical Center, was established to follow OEF/OIF veterans with fragments and to identify and treat potential health problems early.)


• DHCC Depleted Uranium Page (Contains policies and directives, clinical guidance, provider and patient education materials, research information, and related links regarding the DoD Depleted Uranium Program.)

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