Identifying Environmental Health Threats in Theater

By Rob Anastasio
FHP&R Staff Writer

January 30, 2010 - Environmental health exposures pose a major threat to service members in theater. While specific threats such as particulate matter, burning trash pits, pollution, and toxic industrial chemicals seem to be a normal part of in-theater living, the long-term health risks that have transpired have caught the attention of the military, Congressional, and medical communities.

At the 2010 MHS Conference, Dr. Craig Postlewaite, DVM, MPH, acting director of Force Health Protection and Readiness Programs, explained that much of the data gathered from OEF/OIF exposure records are still inconclusive.

With all of the research that has been conducted, professionals have derived a number of lessons learned. “Health care providers should be knowledgeable of occupational and environmental health (OEH) threats and updated on location-specific changes during deployment,” said Postlewaite.

Base camp health assessments should also be completed when the base camp is established. Postlewaite said this is an important lesson that has been discovered, as it includes acute health risks and possible latent/chronic health risks as well, archiving all OEH data in the U.S. Army Public Health Command – Provisional (USAPHC), and being strong advocates for risk mitigation by line commanders.

Other lessons learned show that health care providers must document possible and confirmed exposures in service members’ medical records, investigating, reporting, and documenting all OEH and chemical, biological, radiological, and nuclear (CBRN) exposures, advising commanders on locations of all burn pits, requesting timely reach-back for environmental health support to monitor conditions and identify those at risk, and ensuring that there are environmental health personnel in theater.

“It’s quite a challenge,” said Postlewaite. “Airborne particulate matter exposure alone is dangerous. The blowing sand/dust, coupled with some industrial pollutants is just one of the many exposures that folks are prone to in CENTCOM.” This can lead to water and food contamination, as well as soil contamination.

Burn pit smoke exposures have been the hot topic of Congress and the medical world in the past few years. In 2008, a health risk assessment was conducted at Joint Base Balad (JBB) to study the health effects of burn-pit smoke. While some 400 Veterans and dozens of Service members claim they have chronic health effects due to burn pit smoke exposure, the result of the study (which was validated by the Defense Health Board) stated that there were no elevation in long-term health effects to those that were exposed.

“The metric that this study failed to look at was combined exposures,” said Postlewaite. “If someone was exposed who also smokes tobacco, or has an underlying health problem, or has a genetic predisposition…that is what we didn’t consider.”

However, steps are being taken to mitigate any possible adverse health effects from the smoke exposure. Over the past two years, four industrial trash incinerators have been installed at JBB, and some of the biggest burn pits have been shut down.

Additional studies are being conducted by a number of agencies to explore the dose-response relationship, health outcomes at other burn pits, the persistence of diagnoses and symptoms, and expanded case findings for case control studies. Coming this spring is a report from the Armed Forces Health Surveillance Center (AFHSC) with a new burn pit monitoring plan which is up for review by the DHB. The Institute of Medicine is also conducting a health outcome study on veterans with a special emphasis on burn pit smoke exposure.

While these reactive measures will help clear the air about burn pit smoke exposures, researchers are trying proactive methods as well. “We’re working on an individual deployment longitudinal exposure record system,” said Postlewaite.

Basically, this system is specific to a service member, who will use a self-identifier to insert information to their electronic health record. This information will be distributed to a number of databases that will search deployment locations, possible exposures, and bounce against the Defense Occupational and Environmental Health Readiness System (DOEHRS) data repository. This will give the service member additional information on any OEH exposures that they may have been exposed to.