MEDICAL ISSUES RELATING TO SYMPTOMS
any Gulf War veterans have experienced a variety of
physical symptoms and illnesses in the years since the Gulf War. In response
to veterans' concerns, the Department of Defense established a task force
in June 1995 to investigate incidents and circumstances during the war
that might be related to veterans' symptoms. The Office of the Special
Assistant - now known as the Deployment Health Support Directorate - assumed
responsibility for these investigations on November 12, 1996, and continues
to gather information on medical questions and issues related to the troops
who served there.
Since their return from Southwest Asia for Operations Desert Shield and
Desert Storm, some US military personnel have developed medically undiagnosed
physical symptoms that may relate to their service during their deployment.
A number of veterans and others have expressed concern that the use of vaccines
may have contributed to these symptoms. The Special Assistant examined this
issue, and in December 2000, published the Vaccine
Use During the Gulf War information paper, which addresses military
vaccination policies and practices during and after the Gulf War, as well
as plans for future deployments.
During the Gulf War, anthrax and botulinum toxoid vaccines were used to protect US forces against the threat of Iraq's biological agents. Administration of these vaccines during Operations Desert Shield and Desert Storm was characterized by several difficult issues: lacking sufficient quantities of the vaccines; prioritizing military units for vaccination; using the investigational botulinum toxoid vaccine; obtaining informed consent; providing servicemembers with information about the vaccines dealing with operational security considerations; and documenting vaccines in health records.
Military personnel today are facing increasingly routine deployments overseas, exposures to environmentally hazardous battlefields, and risks associated with biological warfare agents. The Gulf War experience has brought shortfalls in vaccine administration to light and generated improvements in force health protection. Ensuring adequate production sources and maintaining sufficient stockpiles of safe and effective vaccines - especially vaccines in investigational status - remain daunting challenges, as does the communication of associated health risks to servicemembers. Importantly, progress has been demonstrated in vaccine tracking and documentation for deployments, and robust research on military vaccine development is ongoing. The Department of Defense should continue to build upon lessons learned from the Gulf War to ensure that advances in vaccine development and administration keep pace with changing health threats to military personnel.
Medical Recordkeeping During the Gulf War
Following the return of American servicemembers deployed to Southwest Asia during Operations Desert Shield and Desert Storm, veterans reported physical symptoms that believed may have been related to their service in the Gulf War, yet defied medical diagnoses. Medical records from this deployment did not provide substantial support in explaining these symptoms. The Special Assistant examined this issue and in August 1999, published the Military Medical Recordkeeping During and After the Gulf War information paper. This paper addresses recordkeeping policies and practices before, during, and after the Gulf War.
Military medical recordkeeping policies at the time of the Gulf War tended to be service-specific and published by the respective military Surgeons General. Prior to Operations Desert Shield and Desert Storm, these policies focused almost exclusively on the care of deployed forces during peacetime and less with recordkeeping under deployment conditions. During the Gulf War, some services deployed with abbreviated health records, while others typically deployed with their full, original records. The Department of Defense issued supplemental guidance on the documentation of immunizations (anthrax and botulinum toxoid) that were investigational or required some measures of operational security. Analysts with the Special Assistant found documentation of deployment medical information in individual health records to be problematic, mainly due to post-service disposition policies.
Post-Gulf-War medical recordkeeping policy continues to be made for each military service and the military health system as a whole. The Department of Defense (Health Affairs), the Joint Staff, and the military medical services are increasingly focusing on force health protection and the documentation of medical surveillance activities in support of continuing operational deployments in Bosnia, Kosovo, and Southwest Asia. Cooperation has also increased among the Department of Defense, the Department of Veterans Affairs, and the National Archives and Records Administration on issues involving the transfer and storage of medical records.
Groundwork continues for the development of an automated
deployment health information device (e.g., a personal information carrier
or "medical dog tag"), as well as a computer-based patient record
system for all military beneficiaries. The Department of Defense views
these as technological solutions to both the medical recordkeeping deficiencies
associated with the Gulf War and a presidential
mandate to create a force health protection program incorporating
a comprehensive medical record for each military servicemember.
Capture of Data from Gulf War Hospital Inpatient Records
Responding to concerns raised by veterans, the Department of Defense, the Department of Veterans Affairs, and other organizations both inside and outside of government have conducted investigations into possible causes of medically undiagnosed physical symptoms in Gulf War veterans. All of these investigations have one thing in common: they examined illnesses that have been identified and diagnosed, and reported symptoms during the post-Gulf-War period. However, a large grouping of records and documentation for illnesses and injuries unequivocally attributed to service during the Gulf War had not been studied. These were the surviving hospital inpatient treatment records from the Gulf War archived at the National Personnel Records Center (NPRC) in St. Louis, Missouri. In June 1998, the Special Assistant began an effort to establish an Inpatient Treatment Records Database inventory of all Gulf War inpatient hospital treatment records archived at the NPRC. Efforts to locate, document, and inventory these records concluded in October 1999, with approximately 28,000 records identified and inventoried. With this new database, veteran contact managers within the Special Assistant assisted Gulf War veterans in obtaining copies of an existing inpatient record for the purpose of assisting to establish eligibility for VA benefits.
In January 2000, the Special Assistant directed a theater-wide review of inpatient treatment records be conducted archived at the Records Center. The data capture operation was conducted at the NPRC's research facility in St. Louis, from November 2000 through May 2001. At the conclusion of the operation, the Gulf War Inpatient Record Database contained 28,007 records of admissions to US military hospitals in the Kuwait theater of operations (KTO) and evacuee admissions to hospitals in Germany. For this study, KTO unit location data was linked to each US military patient. Unit location data is maintained and provided by the US Armed Services Center for Unit Records Research (CURR). By linking the patient diagnosis with the date of admission with the unit location data, the analysts at Special Assistant were able to produce an "epidemiological snapshot" of US troops deployed for Operations Desert Shield and Desert Storm.
The goal of deployment health surveillance is to ensure a fit and healthy force and to prevent illness, disease,adverse stress responses, and injuries from degrading mission effectiveness. As defined by the Centers for Disease Control and Prevention, health surveillance is the ongoing, systematic collection, analysis, and interpretation of health data essential to planning, implementation, and evaluation of public health practice. Medical surveillance of all servicemembers before, during, and after military deployments is mandated by Public Law 105-85, Section 765. The Deployment Health Support Directorate seeks to facilitate the operational awareness of Deployment Health Surveillance in today's military medical system.
Several new memorandums and directives provide procedures for conducting health surveillance in support of deployments. These include:
The Assistant Secretary of Defense (Health Affairs) issued a policy memorandum requiring both pre- and post-deployment health questionnaires in order to assess a servicemember's state of health before and after deployment. The Pre-Deployment Health Assessment (DD 2795) should be administered at the servicemember's home station or at the mobilization processing station before deployment. The Post-Deployment Health Assessment (DD 2796) should be administered before exiting the theater of operations. Copies of the health assessments are to be placed in the servicemember's permanent medical record.