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Sandstorms, Oil Well Fires, Burning Trash--- Will that sand/smoke hurt me?
Coleen Baird, MD, MPH
UNCLAS
Aug 2009
Medical Requirements and Chemical Exposures
Slide 2
Requires:Pre- and post- deployment health survey forms Identification, assessment, and documentation Immediate chain of command notification Risk communication Data available for epidemiologic evaluationsDocumentation of area-specific exposure and
monitoring summaries to be posted and accessible
JCS MEMO, MCM 0006-02 Feb 2002Updated Procedures for Deployment Health Surveillance
/MCHB-TS-MEM) 410-436-1010 / Veronique.Hauschild@amedd.army.mil Aug2006UNCLAS
Medical Requirements and Chemical Exposures
Slide 3
How are (chemical) OEH exposure Risk levels determined?
Medical Requirements and Chemical Exposures
Slide 4
HazardSeverity
Qualitative Interpretation of Health Impacts Associated with Hazard
Severity Level
CATASTROPHIC Increasing deaths and casualties....
CRITICAL Few, if any, deaths but significant numbers of disabling/incapacitating casualties….
MARGINAL Many may have noticeable but not disabling health effects… certain complex skills may be degraded….
NEGLIGIBLE Few noticeable health effects during mission ; potential increased risk of post-conflict health effects….
NO HAZARD No health effects (short or long term/ delayed) are anticipated….
Medical Requirements and Chemical Exposures
Slide 5
Military Risk Matrix per FM 100-14 (FM 5-19); FM 3-100.12
HAZARD PROBABILITY
Frequent (A) Likely (B) Occasional (C) Seldom (D) Unlikely (E) HAZARD SEVERITY
Catastrophic (I) Extremely High Extremely High High High Moderate
Critical (II) Extremely High High High Moderate Low
Marginal (III) High Moderate Moderate Low Low
Negligible (IV) Moderate Low Low Low Low
RISK ESTIMATE
Medical Requirements and Chemical Exposures
Slide 6
(COCOM) Country # of ORMS Low Risk Moderate Risk High Risk
CENTCOM
Afghanistan 60 50
8 - Ambient Air - PM10 ;
2 - Treated Water Quality
Djibouti, Egypt; Kenya, Ethiopia;Kyrgyzstan; Saudia Arabia; Uzbekistan; United Arab Emerits; Yemen 31 24
2 - Ambient Air Based on PM10 ;
2 - Treated Water Quality
Iraq195 125
57 - PM10 & metals 9 - Treated Water Quality 2 - Raw Water Quality 2 - PM10 & Lead
Kuwait 37 20 16 - Ambient Air Based on PM10 1 - Treated Water Quality
Qatar 11 9 2 - Ambient Air Based on PM10
EUCOM
Bosnia, Georgia, Kosovo (Serbia); Morocco 5 4 1 - Raw Water Quality
SOUTHCOM
Antigua; Belize; Dominican Republic; Columbia; Grenada; Guatemala; Haiti; Honduras; Netherlands Antilles;Nicaragua; Panama 17 12
1 - Water Quality;1 - Bottled Water 2 - Ambient Air Based on PM10
NORTHCOM - JTF KATRINA
USA 136 133
2 - Ambient Air Based on PM10
1 - Treated Water Quality
TOTALS
Total ORMs:
492
Total Low Risk:
378
Total Moderate Risk:
92 - Ambient Air 19 -Water Quality (e.g., turbidity)
Total High Risk:
2 - Ambient Air 1 – Water Quality
Army OEH Operational Risk Management (ORM) Assessments CY 2005
Medical Requirements and Chemical Exposures
Slide 7
Common OEH Hazards
• Particular Matter (PM10 and increasingly PM 2.5)– Most common and significant deployment OEH hazards
– Real-time health complaints
– DNBI rates do not appear to be significantly impacted
– Potential for long-term effects being investigated
• Potable water quality– 3 types potable water
– TB MED 577 standards often only hazards found
– No real impact on DNBI rates or long-term health
Medical Requirements and Chemical Exposures
Slide 8
What is an OEH “incident”?
Presents a Moderate or higher level of operational risk
Presents a perceived or actual significant health risk to troops
Identified as a likely or known source of medically-related health outcomes
NOTE: “Incidents” may be over before actual sampling is conducted or results are obtained
Medical Requirements and Chemical Exposures
Slide 9
Example Exposure Incidents of Interest Fire Incident, Iraq Summer 2004
Exposure Group A
▪ Military troop responders
▪ Critical >250 persons - mostly active duty
▪ Several reported acute effects during course of ~ 3 week response
Exposure Group B
▪ Troops located a camp @ 5K away
▪ Exposures considered negligible
Medical Requirements and Chemical Exposures
Slide 10
Example Exposure Incidents of Interest
• Highly industrialized area
• Routinely elevated PM10 levels (Moderate Risk)– Daily PM monitoring
– Other sporadic short-term industrial chemical releases:
• Sulfur dioxide, 2004
• Ammonia, 2006
– Standard SF600 has been generated and updated • For all troops medical records deployed to this site
• Indicates no long term effects anticipated……..
Ash Shuaiba Port/SPOD/E
Medical Requirements and Chemical Exposures
Slide 11
Example Exposure Incidents of Interest
• 2 Soldiers of EOD unit were exposed to Sarin (GB)
• Signs: pin point pupils, blurred vision, nausea
• Dx: Stable, no antidote administered
• RBC indicated mild-moderate exposure
• Non-symptomatic
• Returned to light duty in 3 days
• Other soldiers released with no signs/ symptoms
• No long-term effects
Sarin Incident, May 2004
Medical Requirements and Chemical Exposures
Slide 12
Example Exposure Incidents of Interest
• Lead in air exposures exceed ‘no hazard’ criteria
• Blood lead screening of returning troops per DoD Policy• No levels of concern noted
• No additional follow up required
• Current (2005-2006) air monitoring • Lower lead levels
• PM10 Moderate Risk
Camp War Eagle (Camp Hope) , Iraq 2004 – present
Medical Requirements and Chemical Exposures
Slide 13
Example Exposure Incidents of Interest
• Collateral damage resulted in chemical release – 11 soldiers washed down, placed on oxygen, and observed
– Equates to Critical severity/High risk
• No specific follow up
• Long-term effects not anticipated
Bagdad Industrial Complex Chlorine Release, Iraq 2005
Medical Requirements and Chemical Exposures
Slide 14
Example Exposure Incidents of Interest
• Prominent base with airfield
• Notable dust/PM10 hazards – – Smoke from open trash-burning pits – Includes dioxins at Negligible risk– Routine health complaints – Several SF 600s developed (AF, Army)
Balad (and Camp Anaconda) , Iraq 2004 – present
Medical Requirements and Chemical Exposures
Slide 15
Where does OEH related data go?
USACHPPM is designated DoD data repository for OEH data
Currently not capturing all DoD data
Moving towards DOEHRS - users can input and access info
Medical information (associated with OEH exposures) is not required to be reported with OEH data
Medical Requirements and Chemical Exposures
Slide 16
So, if you as a health care provider had a soldier report with complaints
of an chemical (e.g. chromium?) exposure during deployment …
What would you do?
Where would you go for information?
What specific information/tools would you want?
Medical Requirements and Chemical Exposures
Slide 18
CHPPM POC INFORMATION
UNCLAS/MCHB-TS-MEM) 410-436-1010 / Veronique.Hauschild@amedd.army.mil May 2006
Environmental Medicine ProgramUS Army Ctr for Health Promotion and Preventive Medicine (USACHPPM)Bldg E1570 Stark Rd Aberdeen Proving Ground-Edgewood Area (APG-EA), MD 21010-5403FAX 410-436-4117
Coleen B. Weese, MD, MPH (Program Manager)Coleen.Weese@amedd.army.mil ; coleen.weese@us.army.mil410-436-2714
Veronique Hauschild, MPH Veronique.Hauschild@amedd.army.mil ; v.hauschild@us.army.mil410-436-1010
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