II. SUMMARY

A. Why We Investigated Pesticides

For decades, the United States has formulated and used chemical products to control insects and other animal populations that may transmit diseases. Over the past 20 years, pesticides used according to label directions have posed only a minimal health threat to healthy adults. However, there are numerous civilian sector reports of health problems resulting from overexposures due to misuse or accidents. Of particular note for this investigation are reports documenting the potential for organophosphate and carbamate pesticides, which exhibit some similarities to certain chemical warfare agents, to cause adverse neurological effects in humans. During the Gulf War, military preventive medicine personnel, and those they supervised, applied pesticides throughout the theater of operations. The possibility that pesticides may cause long-term adverse health effects has caused concern for some veterans and some within the medical and scientific communities. Indeed, some Gulf War veterans have reported a wide array of unexplained illnesses that some believe may be related to their use of and exposure to pesticides, alone or in combination with other health stressors that were present during the war.

B. Exposures

Pesticides available within the military supply system were all registered with the Environmental Protection Agency. To conform to Agency standards, the pesticide had to be applied by the military in accordance with the product label to control the pests listed on the label. Failure to comply with any part of the label constituted misapplication of the pesticide, increasing the risk of overexposures. Actual application procedures were largely undocumented. For instance, investigators have not been able to determine the amounts of each pesticide used during the Gulf War. They were only able to find material ordering data, not actual usage data (i.e., application rates). By considering the reported frequency of use and potential toxicity, investigators have identified 15 pesticides of potential concern comprising 12 different active ingredients.

During the Gulf War, the potential existed for servicemembers to be exposed to levels of pesticides that could result in adverse health effects. US military personnel used preventive medicine capabilities and guidance to control pest-borne diseases, often through the direct action of applying pesticides. The personnel, known as applicators, who applied pesticides, were at the greatest risk of exposures above safe levels. In addition, individual soldiers used personal pesticides such as DEET and permethrin, and coalition forces and host nation personnel applied a variety of pesticides.

For the pesticides used in the Gulf, exposures may have occurred in a variety of ways, despite all precautions. A pesticide may have been inhaled, swallowed, and deposited on the skin. A pesticide may also have been deposited on soil and surface water, buildings, tents, and clothing. Once the pesticide contacted human tissue, it may have been absorbed completely, partially, or not at all, depending on circumstances. For example, perhaps one-fifth of the DEET applied would have been absorbed through the skin, while little or none would have been ingested and inhaled. A small fraction of the permethrin sprayed on clothing, tents, insect netting and helmet covers may have been absorbed through the skin and inhaled, while little or none would have been ingested. Pesticide fogging around living quarters also may have contributed to a significant level of pesticide inhalation. Servicemembers in the immediate vicinity of pest strips would have been exposed to pesticides via inhalation. Pesticides may have been absorbed through the skin and inhaled due to the unauthorized use of pet flea and tick collars. Under conditions of inappropriate use and application, these exposures may have resulted in exposure of US troops to levels of pesticides that could result in adverse health effects.

Preventive medicine personnel who apply certain pesticide sprays and fogs are required to use the appropriate personal protective equipment, which may include boots, gloves, coveralls, goggles and respirators. The required protection depends on the pesticide applied. During the Gulf War, the use of personal protective equipment by applicators varied depending on several factors, including availability, serviceability, and whether the applicator followed the guidance. In some cases, applicators did not use appropriate personal protective equipment.

C. Investigation

The Deployment Health Support Directorate could locate no sampling data and no information about pesticide application rates generated during the Gulf War. However, we conducted over 900 interviews with veterans we believed might have information about pesticide use during the Gulf War, including preventive medicine personnel. Of these interviews, 322 provided specific information related to pesticide exposure.

This report also relies on information from the RAND literature review and RAND Gulf War veteran survey, as described in Sections IV.E.3 and IV.E.4, respectively. The survey describes pesticide use by the average servicemember during the Gulf War, and provides the best available information on which pesticides the general military population may have used for personal use, or applied in or around their living or working environment.

As part of this investigation, we performed a health risk assessment of pesticide use by land-based servicemembers deployed to the Gulf. The health risk assessment identifies groups who, because of their occupational specialty, may have been at greater risk for adverse health effects arising from exposures to pesticides. Most veterans were exposed to pesticides, but at levels insufficient to cause even minor health problems. Investigators uncovered no evidence that the majority of veterans were exposed to unhealthful levels of pesticides.

The results of this analysis benefit our understanding of the issues related to the military’s use of pesticides. A number of the findings and conclusions reached in this report will benefit pesticide handling and management activities in future deployments, as well as provide DoD with areas for additional research in order to better define health risks under conditions that previously may not have been suspect.

D. Conclusions

During the Gulf War:

Further research is needed in the following areas:


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