Deployment occupational and environmental health risk management.
In the 1991 Gulf War, the number of coalition casualties was significantly low from an historical perspective. However, neither service personnel nor the American public were prepared to deal with significant health issues among returning veterans. Of particular impact were those veterans whose symptoms and conditions were not easily diagnosed or treated. To complicate matters, the military services soon became aware of 3 serious shortcomings;
1. the inability to track specific daily locations for deployed personnel and units, making it extremely difficult to cross reference locations with potentially dangerous occupational and environmental health exposures,
2. the health risk communications process was deficient, and
3. the lack of formal pre- and postdeployment screening processes (Note: screenings have since been implemented).
Several of the postwar health concerns centered on veterans' illnesses, mortality, hospitalizations, and reproductive outcome issues. For example, why were some veterans ill with unexplainable symptoms and were untreatable as well, leaving practitioners unable to explain diagnosis, prognosis and long term recovery issues to them? What were the acute, chronic, or delayed health relationships among pesticide exposures, vaccinations and antidotes, air/soil/water pollutants, chemical and biological warfare agents, stress, depleted uranium, and others? What exactly happened within a 50 km radius of Khamisiyah, Iraq when it was destroyed by coalition forces? What about potential exposures at other locations? Were veterans who deployed more likely to become ill and/or hospitalized versus those veterans who had not deployed? And what about birth defects among children born to Gulf War veterans--did the war experiences have anything to do with that?
To address the shortcomings during subsequent deployments, the Presidential Advisory Committee
Army DOEHRM policy objectives:
1. Protect Army personnel, including Dept of the Army civilians and Army contractors, from potential and actual exposures on the battlefield. These exposures include chemical, biological, radiological, and nuclear (CBRN) warfare agents; endemic communicable diseases; food, water, and vector borne diseases; ionizing and nonionizing radiation; combat and operational stress; heat, cold, and altitude extremes; environmental and occupational hazards; toxic industrial materials and other physical agents.
2. Reduce occupational and environmental hazard potential and actual exposures during Army operations to as low as practicable to minimize acute, chronic, and delayed health effects within the context of mission parameters and Army risk management (RM) principles.
3. Make informed risk decisions regarding occupational and environmental health (OEH) threats during Army operations, using the RM process to manage such threats and minimize total risk to Army personnel.
4. Ensure that commanders are aware of and consider acute, chronic, and delayed health risks associated with occupational and environmental potential and actual exposures during all phases of Army operations and activities.
5. Comply with federal, state, local or host nation statutes, regulations, directives, and guidance governing OEH except for uniquely military equipment, systems, and operations while in garrison or during training exercises.
6. During deployments, comply with US, Army-unique, or host nation OEH standards, whichever are more restrictive.
7. Implement health surveillance and readiness programs during Army operations.
8. Collect, document, evaluate, report, and archive OEH sampling data from Army operations, integrating all relevant OEH data with potential and actual exposures and exposure scenarios to individual Army personnel, in their longitudinal health records.
9. Ensure necessary healthcare intervention and follow up for potentially exposed Army personnel.
10. Deploy in such a way that DOEHRM supports modular and interoperable joint forces capabilities provided by the services.
11. Communicate OEH risks from military operations to all Army personnel and share OEH risk management lessons learned during unit rotations. 12. Provide commanders with the capabilities and tools for conducting RM assessments and communicating risks.
13. Provide access to all needed intelligence sources, deployable computer systems with environmental exposure data, unit locations, and movement information.
(PAC) on Gulf War Veterans' Illnesses was established. In its final report issued on Dec 31, 1996, the PAC recommended that the National Science and Technology Council (NSTC) develop an interagency plan to address health preparedness for, and readjustment of, veterans and their families after future conflicts and related military missions. The NSTC recommendation resulted in Presidential Review Directive-5 (PRD-5), A National Obligation-Improving the Health of Our Military, Veterans, and Their Families issued in August 1998. * The Deputy Assistant Secretary of the Army (Environment, Safety and Occupational Health) (DASA[ESOH]) directed implementation of the recommendations contained in PRD-5 in the memorandum Force Health Protection: Occupational and Environmental Health Threats dated 27 June 2001.
With encouragement and support from the Army Surgeon General, LTG James Peake, the Army Deputy Chief of Staff (DCS), G-3/5/7 took the lead responsibilities for implementation. The program was renamed Deployment Occupational and Environmental Health Risk Management to better describe the intent of the DASA(ESOH) memo. As part of the program, a governing Army regulation in the 11 series is in final staffing as the source document for DOEHRM. The 11 series (Army Programs) of regulations was chosen as the appropriate location for the DOEHRM regulation since it represents much more than a medical issue. DOEHRM is an Army issue to be executed by commanders and the Army leadership.
In addition to the impending Army regulation, an implementation plan for DOEHRM has been authored, directing numerous organizations within the Army to incorporate DOEHRM into their respective areas of responsibility. With finalization of the DOEHRM regulation and publication of the implementation plan, major commands (MACOMs) and Special Staff will be tasked to author their own implementation plans and identify requirements for the program. The DCS, G-3/5/7 will then assemble and validate all MACOM requirements as identified in the MACOM and Special Staff implementation plans, and staff DOEHRM through the Program Objective Memorandum process for implementation throughout the Army.
With the guidance as provided by the Army regulation and the specific instructions of the DOEHRM implementation plan, MACOMs and Army staff offices will be responsible for DOEHRM integration into their respective areas of responsibility. For example, the following are representative lead responsibilities of several major Army organizations:
1. The DCS, G-3/5/7 will
* ensure all relevant Army publications are modified to include DOEHRM;
* review modified tables of organization and equipment to ensure DOEHRM equipment requirements are properly included;
* integrate the DOEHRM implementation plan with current and future CBRN and high explosive surveillance and bioanalysis systems;
* identify, track and review DOEHRM issues, resolution and assessments.
2. The Training and Doctrine Command will
* develop and publish DOEHRM doctrine in accordance with doctrine, organization, training, materiel, leadership, personnel, and facility (DOTMLPF) domains;
* develop consistent operational guidance that allows appropriate personnel to assist commanders in managing risks from deployment occupational and environmental health hazards and incorporating same into the Army DOTMLPF process;
* as DOEHRM requirements are identified, examine force structure to ensure said requirements are defined and addressed by appropriate organizations;
* review current training practices to ensure appropriate risk is being communicated to those having DOEHRM responsibilities;
* develop exportable leader and Soldier training packets on sustainment DOEHRM training for all components after doctrine is approved;
* develop unit/organization training programs.
3. The DCS, G1 will
* review and identify modifications to or expansion of Chapter 7 (Medical and Dental) of the Department of the Army Personnel Policy Guidance for Contingency Operations in Support of GWOT* (global war on terror) to accommodate DOEHRM;
* review and/or develop personnel policies to support integration and direct access of daily personnel and unit location cross-referenced data in DOEHRM information management/ information technology (IM/IT) systems in coordination and linkage with other IM/IT systems.
4. The Medical Command will
* develop, improve, and disseminate criteria and guidance to include, but not be limited to, chemical, biological, radiological, nuclear, high explosive, physical, entomological, combat and operational stress health risks, endemic diseases, and preventive measures throughout the range of exposure levels for acute, chronic, and delayed health effects;
* examine medical technology transition projects and processes for potential DOEHRM applicability and priority;
* conduct reviews of existing medical research and development programs to determine DOEHRM applicability and opportunities for integration.
5. The Combat Readiness Center (CRC) will integrate the DOEHRM implementation plan with the CRC strategic plan and into RM doctrine.
6. Forces Command will incorporate procedures in the DOEHRM implementation plan into all mission training plans and deployment training exercises for both line and medical units. Other MACOMs and staff offices have additional responsibilities outlined in the implementation plan.
The Surgeon General is confident that, under the leadership of the Deputy Chief of Staff, G-3/5/7, the DOEHRM program will enable commanders to better manage their war-fighting responsibilities and, at the same time minimize harmful occupational and environmental health threat exposures to the Soldier, Dept of the Army civilian, and Army contractor.
COL Eng is the Director, Proponency Office for Preventive Medicine-San Antonio (POPM-SA) at Headquarters, US Army Medical Command, Fort Sam Houston, Texas.
COL (Ret) Pearson is employed by the Battelle Memorial Institute as the Senior Technical Consultant to POPM-SA at Headquarters, US Army Medical Command, Fort Sam Houston, Texas
* Available at: http://fas.org/irp/offdocs/prd-5-report.htm.
COL Robert R. Eng, MS, USA
COL (Ret) Curtis W. Pearson, MSC, USAF