The Institute of Medicine was chartered by the National Academy of Sciences in 1970 to involve distinguished members of appropriate professions in the investigation of policy matters relating to the health of the public. The opinions presented are those of the Institute of Medicine Committee on the Evaluation of the Department of Defense Comprehensive Clinical Evaluation Program and are not necessarily those of the funding organization. C Workshop on the adequacy of the CCEP for the evaluation of individuals potentially exposed to nerve agents: agenda and speaker list.
In 1994, the DoD asked the Institute of Medicine to convene a committee to review the suitability of the CCEP.
Introduction
In 1994, the Department of Defense asked the Institute of Medicine (IOM) to assemble a panel of medical and public health experts to evaluate the adequacy of the CCEP. Based on these recommendations and the Department of Defense's analysis of the information obtained from the CCEP, the IOM was asked to continue its review of the CCEP with a specific focus on three areas: (1) approaches to treating individuals with difficult-to-diagnose or terminal illnesses. defined conditions, (2) diagnosing and treating stress and psychological or psychiatric conditions, and (3) identifying health problems of those who may have been exposed to nerve agents. About this PDF file: This new digital representation of the original work has been reassembled from the XML files created from the original paper book, not the original betting files.
Page breaks are true to the original; However, line lengths, word breaks, heading styles, and other type-specific formatting may not be maintained, and some typographical errors may have been accidentally introduced.
The Comprehensive Clinical Evaluation Program*
PDF File: This new digital representation of the original work has been reassembled from XML files created from the original paper book, not the original files. 34;The results of the CCEP can and should be used for several purposes, including (1) educating Persian Gulf veterans and the doctors who care for them, (2) improving the medical protocol itself, and (3 ) evaluating patient outcomes. This new digital representation of the original work has been reassembled from XML files created from the original paper book, not from the original typesetting files.
This is to evaluate the adequacy of the Dolls Comprehensive Clinical Evaluation Program with respect to:. approaches to the management of difficult-to-diagnose individuals and those with no diagnosis, as well as ill-defined conditions such as chronic fatigue syndrome, fibromyalgia, and multiple-chemical sensitivities;. the diagnosis and treatment of stress and psychiatric conditions, the relationship between stress and psychiatric conditions and physical symptoms, and pre-deployment screening and mitigation of stressors in future deployment; and. assessment of the health problems of those who may have been exposed to low levels of nerve agents.
Testing for and Identifying Health Effects of Exposure to Nerve Agents*
The extent and frequency of troop exposure to nerve gas in the Persian Gulf is still under investigation. In addition, the military is investigating other possible exposures to nerve agents in the Persian Gulf. As is the case with sarin and cyclosarin, little research has been done on the long-term health effects of PB in healthy individuals exposed to low levels of nerve agents.
Individuals who may have been exposed to nerve agents may therefore be screened for both junctional myopathies and peripheral neuropathies.
Recommendations
The committee recommends improving the screening documentation used during Phase I for patients with psychological conditions such as depression and posttraumatic stress disorder (PTSD). The committee recommends improving the documentation of the neurological examination performed during phase I and phase II of the CCEP. Based on the description of the tests administered and the examinations performed, the committee finds that the CCEP is sufficient to ensure that no chronic, well-established neurologic problem is overlooked.
However, the documentation of the use of these tests and procedures can and should be improved. This new digital representation of the original work has been reassembled from XML files created from the original paper book, not from the original files. The Committee recommends, as far as possible, standardizing the physical examinations that are given to members of the armed forces prior to deployment between the services.
Increasing the consistency of such forms and procedures would provide a more reliable picture of patient care in the CCEP. After the Ministry of Defense revealed possible exposure to nerve agents from the destruction of the Khamisiyah ammunition dump, about 20,000 service members received a letter from the Ministry of Defense stating that their units were nearby during the demolition. Although determining whether low-level exposure to nerve agents causes long-term health effects is beyond the scope of this committee's responsibilities, the committee strongly believes that this is an important area of research that should be pursued.
Most of the literature on the health effects of exposure to nerve agents (ie, sarin and cyclosarin) addresses exposures high enough to cause clinically noticeable effects. Therefore, it is important not to try to use CCEP findings to answer research questions.
Health Consequences of Service During the Persian Gulf War: Recommendations for Research and Information Systems. 1996 A history of human studies with nerve agents from the UK and US in Chemical Warfare Agents: Toxicology and Treatment. Page breaks are true to the original; However, line lengths, word breaks, heading styles, and other type-specific formatting may not be maintained, typographical errors may have been accidentally introduced.
Appendixes
Appendix A
Recommendations of the Initial CCEP Committee
The high professional standards, dedication and commitment of the physicians involved in the CCEP in the RMCs were evident throughout the three committee meetings. It would also require better, more consistent explanations to MTF physicians about the purposes and procedures of the CCEP. Disability processing actions in the services' physical disability processing systems have been completed for 246 of the 10,020 CCEP patients.
For these reasons, the CCEP results should not be viewed as estimates of the incidence of disability related to service in the Persian Gulf. Physicians involved in the development and administration of the CCEP have acknowledged in various public presentations that some CCEP patients have developed illnesses directly related to their service in the Persian Gulf. The committee recommends that DoD attempt to determine the time of disease onset, particularly for patients with significant functional impairments.
The committee recommends that the DoD consider methods to improve the standardization of the psychiatric evaluations in the CCEP. This assessment will require an additional set of questions to supplement the questionnaire currently used in Phase I of the CCEP. The IOM committee's review of the CCEP protocol indicates that data on chronic fatigue syndrome (CFS), fibromyalgia (FM), and multiple chemical sensitivity (MCS) may have been collected by multiple diagnostic methods.
The IOM Committee encourages the Department of Defense to continue to regularly publish its analysis of CCEP results. CCEP medical findings should be communicated immediately to all primary care physicians at the MTF and RMC. The methods and clinical outcomes of CCEP and UCAP should be compared in order to harmonize and improve both programs.
In these studies, the serious limitations of the CCEP data for epidemiological purposes identified previously should be kept in mind.
Appendix B
Outline of the CCEP Medical Protocol
The CCEP is based on a thorough clinical assessment that emphasizes comprehensive and ongoing primary care. The local MTF primary care provider is responsible for patient assessment and care throughout the CCEP process. The provider will specifically inquire about symptoms listed in the patient questionnaire administered by the CCEP provider.
A comprehensive medical evaluation should be performed, with focused attention on the patient's symptoms and health concerns. Individuals who upon completion of MTF Phase I evaluations do not have a clearly defined diagnosis that explains their symptoms should be reviewed by a CCEP-designated physician for further evaluation and necessary consultation and/or referral to the RMC.
Laboratory Tests CBC
Laboratory Tests CBC
Consults
Appendix C
Workshop on the Adequacy of the CCEP for Evaluating Individuals Potentially Exposed
Appendix D
DoD Memorandum for Persian Gulf War Veterans Concerning Khamisiyah, Iraq
- What are the effects of these chemical weapons?
- Were any such symptoms experienced by our troops during the Gulf War?
- What are the long-term health effects of non-lethal exposure to nerve agent?
- If I, as a Gulf War veteran, experienced no symptoms at the time and studies indicate there are no long-term health effects, why am I receiving this
To our knowledge, military personnel at the time did not report the symptoms associated with acute exposure to chemical agents (nerve gas), but our search for information continues. Since you may have been part of the demolition operations, we need to hear from you not only about your experiences at or near the site, but also about any health issues you believe may have resulted from your service during Operation Desert Storm/Operation Desert shield. We want to make sure you get all the medical care you need for health issues related to your service in the Gulf War.
In order to understand the events in Khamisiyah and address the concerns of our Gulf War veterans, we need your help in this effort. We are grateful to each of you for your service to our country during the Persian Gulf War. Here are answers to several frequently asked questions regarding events in Khamisiyah.
Of the approximately 100 bunkers destroyed in March 1991, one was assessed by UNSCOM (United Nations Special Commission) to have contained 122 mm rockets containing chemical agents (the nerve agents sarin and cyclosarin). While research continues, the best current medical evidence shows that you should not experience long-term health problems from low-level exposure to chemical nerve agents. Soldiers reported possible chemical events during the war, but we have not been able to confirm any nerve agent exposure from these reports.
We are intensifying research aimed at finding a more definitive answer to this question. Second, we want to make sure you get all the medical care you need for health issues related to your service in the Gulf War.
Appendix E
Persian Gulf War-Related Events: Timeline
