Tab F - Pest Management and Operations

This section describes how the military organized its preventive medicine assets and how it used preventive medicine during Operations Desert Shield and Desert Storm to protect US personnel serving in the Gulf. This section also presents information received during Preventive Medicine personnel interviews regarding symptomatic exposures experienced and reported by some US military personnel.

A. OVERVIEW

The Army and Navy normally train and certify enlisted preventive medicine personnel to apply pesticides during deployments and field training exercises. Navy applicators also support the Marine Corps. This investigation does not include the experiences of Navy personnel who served solely on ships during the Gulf War, since the pesticide exposures they experienced were essentially no different from the exposures encountered aboard ship on assignments elsewhere. In the Air Force, pest control was a civil engineering specialty. Unlike Army and Navy preventive medicine personnel, Air Force pest controllers applied pesticides while stationed at permanent Air Force installations, as well as when deployed. Contracted services or civilian employees provided pest control at permanent Army, Navy, and Marine Corps bases.

Normally only enlisted preventive medicine personnel in the Army and Navy applied pesticides. However, officers in preventive medicine specialties, especially entomologists, were familiar with pest control activities as an integral element of disease control. The Army’s descriptions for preventive medicine occupational specialties, which are similar to the Navy’s, provide insight into the full scope of military preventive medicine duties:[640]

B. PEST MANAGEMENT SUPPORT ORGANIZATIONS

During the Gulf War, the Department of Defense (DoD) assigned pest management responsibilities to several organizations. The Office of the Assistant Secretary of Defense for Health Affairs, supported by the expertise of military preventive medicine officers and military contingency operations planners, developed and disseminated DoD preventive medicine policy.

DoD assigned pest management activities to the Under Secretary of Defense for Acquisition and Technology, with the Deputy Under Secretary of Defense for Environmental Security having day-to-day responsibility. Two organizations provide department-wide preventive medicine support: the Armed Forces Pest Management Board (AFPMB) and Armed Forces Medical Intelligence Center (AFMIC). The AFPMB developed and recommended pest management policy. The AFPMB served as the scientific body for all DoD components, organized pest management research and development functions, coordinated DoD pest management activities, and approved the introduction, stocking, and removal of pest management materials for the military supply system.[643] Through its Defense Pest Management Information Analysis Center, the AFPMB provided Disease Vector Ecology Profiles (DVEPs), publications that prepare deploying units for disease risks they may encounter in the deployment area. AFMIC provided and maintained current disease risk assessments and information on parasitic and communicable diseases as well as other aspects of medical intelligence. An AFMIC representative served on the AFPMB and acted as liaison between the two organizations.

The respective services’ surgeons general developed preventive medicine policy. Each service also has support organizations that aid the service in providing effective preventive medicine support.

The US Army Center for Health Promotion and Preventive Medicine (CHPPM), formerly the US Army Environmental Hygiene Agency, is—and was during the Gulf War—the Army’s principal source of toxicological information, pesticide monitoring, and pesticide resistance testing.[644]

To support Navy and Marine Corps units, the Navy had two types of preventive medicine organizations: the Navy Disease Vector Ecology and Control Centers (NDVECCs) and Navy Environmental and Preventive Medicine Units (NEPMUs). NDVECCs provided technical and specialized vector prevention and management services and supported operating forces and shore installations to prevent disease vectors and pests. NEPMUs provided expert, specialized technical services, consultation, advice, and recommendations on preventive medicine and environmental health matters.[645]

At the time of the Gulf War, the US Air Force School of Aerospace Medicine provided pest management consultations, operational entomological research, medical readiness training, and environmental health personnel training in vector and vector-borne disease surveillance. The US Air Force Armstrong Laboratory, Occupational and Environmental Health Directorate provided pest management consultations and operational entomological research.[646] The Air Force Civil Engineering Support Agency, formerly the Air Force Engineering and Services Center, implemented pest management policy and programs, including professional pest management technical assistance worldwide, pest management support during combat and disaster relief operations, the monitoring of base level training needs, the maintenance of a pest management and pesticide database, a liaison with the medical element on all environmental and health-related issues, and coordination with other military services and appropriate governmental agencies on pesticide disposal and the DoD environmental pesticide monitoring program.[647]

C. PEST MANAGEMENT OPERATIONS IN THE GULF

The following sub-sections summarize the preventive medicine and pest management activities for the US Central Command (USCENTCOM) and each service and depicts each service’s pest management operations organization during the deployment. The amount of information available for the services varies; the Army’s activities are the best documented.

1. USCENTCOM

USCENTCOM’s Commander-in-Chief was concerned about in-theater preventive medicine, but when Operation Desert Shield began, the command’s preventive medicine officer position was temporarily vacant, hampering planning and preparation. An Army entomologist volunteered to help in the interim until a new preventive medicine officer arrived in early September 1990.[648]

On August 10, 1990, USCENTCOM provided preventive medicine guidance for Operation Desert Shield, emphasizing the importance of field sanitation, the proper wear of the battle dress uniform (BDU), and the spraying of the BDU with permethrin.[649]

When USCENTCOM released its Operation Desert Shield medical concept of operations (CONOPS), it charged combat commanders with responsibility for their commands’ health and welfare. Preventive medicine assets assigned to each organization were to provide support and advice.[650] Aside from the published early preventive medicine guidance and the medical CONOPS, little documentation exists on USCENTCOM headquarters’ involvement in preventive medicine and pest management.

2. Army

The Army approached preventive medicine and pest management at various organizational levels—from the division, to corps, and finally to echelons above corps. At each level, one or more organizations provided preventive medicine and pest management support.

a. XVIII Airborne Corps

The first Army corps to deploy was the XVIII Airborne Corps, consisting of three divisions: the 82nd Airborne, the 101st Airborne (Air Assault), and the 24th Mechanized Infantry. Each division had a small preventive medicine section. The divisional preventive medicine sections’ functions included:

Table 113 shows all XVIII Airborne Corps preventive medicine assets. The 44th Medical Brigade provided medical support, including preventive medicine services, for the XVIII Airborne Corps. Among the 44th Medical Brigade’s organizational assets were medical detachments organized to perform various preventive medicine functions. Under the command and control of the 74th Medical Detachment were the 227th Medical Detachment (Epidemiology) and the 61st, 224th, and 926th Medical Detachments (all environmental sanitation).

The 74th Medical Detachment’s mission was to provide command and control for preventive medicine teams and consultation in epidemiology, environmental sanitation, entomology, and preventive medicine aspects of veterinary medicine. The three environmental sanitation detachments were to support and assist in evaluating and correcting health hazards associated with food service, water treatment and distribution, housing, waste disposal, industrial hygiene, and other environmental areas. The 227th Medical Detachment evaluated conditions affecting the health of supported military and civilian populations from an epidemiological perspective, and as such normally would not have been much involved with pest management.[652]

Table 113. XVIII Airborne Corps preventive medicine personnel assets[653]

Organization

Preventive Medicine Physician

Environmental Science Officer

Entomologist

Preventive Medicine Specialist

XVIII Corps Surgeons Office  

1

    
Preventive Medicine Section, 82nd Abn. Div.   

1

  

6

Preventive Medicine Section, 101st Abn. Div.

1

1

 

4

Preventive Medicine Section, 24th Mech. Div.

1

1

 

5

44th Medical Brigade

1

     
1st Medical Group

1

     
62nd Medical Group

1

     
74th Medical Detachment

2

2

1

8

227th Medical Detach. (Epidemiology)

1

1

 

5

61st Medical Detach. (Environ. Sanitation)  

1

 

10*

224th Medical Detach. (Environ. Sanitation)  

1

 

10*

926th Medical Detach. (Environ. Sanitation)  

1

 

10*

Totals

8

10

1

58

* Ten appears to be the authorized level; actual strengths were apparently 6 to 8 individuals in each unit.

 

b. VII Corps

Until November 1990, XVIII Airborne Corps constituted the bulk of the Army’s in-theater strength. However, in November, the VII Corps began deploying from Europe, augmented by forces deployed from the continental US. VII Corps consisted of four assigned divisions: the 1st Armored, the 1st Infantry, the 1st Cavalry, and the 3rd Armored. As with the XVIII Airborne Corps, these divisions each had a small preventive medicine section, shown in Table 114.

Subordinate to the VII Corps’ 30th Medical Group (part of the 332nd Medical Brigade) were several preventive medicine detachments. The 14th Medical Detachment served as the command and control element for three environmental sanitation detachments—the 48th, 71st, and 223rd? providing a large number of the preventive medicine assets.

c. Reorganization to Establish Echelons Above Corps

The deployment of a second Army Corps created the necessity to establish a provisional medical organization at the Army Central Command level. The 12th Medical Detachment became the command and control element for three other preventive medicine detachments: the 714th (Entomology), the 105th (Environmental Engineering), and the 983rd (Environmental Sanitation). The 714th Medical Detachment had been an XVIII Airborne Corps asset during Operation Desert Shield.

Table 114. VII Corps preventive medicine personnel assets[654]

Organization

Preventive Medicine Physician

Environmental Science Officer

Entomologist

Preventive Medicine Specialist

Preventive Medicine Section, 1st Armored Div.

2a

1

 

5

Preventive Medicine Section, 1st Infantry Div.

1

   

6

Preventive Medicine Section, 1st Cavalry Div.

1

1

 

2

Preventive Medicine Section, 3rd Armored Div.

1

1

 

7

30th Medical Group

1

   

1

14th Medical Detachment

1

4

4

65

48th Medical Detach. (Environ. Sanitation)  

1

 

10b

71st Medical Detach. (Environ. Sanitation)  

1

 

10b

223rd Medical Detach. (Environ. Sanitation)  

1

 

10b

Totals

7

10

4

116

a) The 1st Armored Division’s division surgeon was a preventive medicine physician.
b)

Ten appears to be the authorized level, actual strengths were apparently 5 to 8 individuals in each unit.


During Operations Desert Shield and Desert Storm, the 12th Medical Detachment had one objective—to minimize the disease and non-battle injuries rate from all causes. This was accomplished by performing two tasks: first provide preventive medicine command and control for the 3rd Medical Command (MEDCOM); and second, with attached units, provide preventive medicine support to all Echelon Above Corps (EAC) assets. The 12th Medical Detachment conducted typical preventive medicine tasks, including sanitary inspections, inspecting and testing water supplies, field sanitation team training, and pest survey and control activities. Other tasks included ensuring rapid assays of possibly poisoned or contaminated water sources, investigating oil well fire smoke and its effects, occupational medicine, and industrial hygiene support.[655]

Table 115 shows the assigned preventive medicine assets at echelons above corps.

Table 115. Echelons above corps preventive medicine personnel assets[656]

Organization

Preventive Medicine Physician

Environmental Science Officer

Entomologist

Preventive Medicine Specialist

Army Central Command Surgeon/Provisional Medical Command

3

     

12th Medical Detach.

1

5

4

50

105th Medical Detach. (Environ. Engineering)  

3

 

19*

714th Medical Detach. (Entomology)    

3

33*

983d Medical Detach. (Environ. Sanitation)  

1

1

10*

Totals

4

9

8

112

* These are believed to be authorized levels, actual strengths were apparently lower.

 

d. Army Preventive Medicine Operations

According to after-action reports the number of preventive medicine personnel, especially preventive medicine specialists (MOS 91S), was barely sufficient during mass movements involving many transient camps. This created significant problems in communications, especially between various troop concentration areas, and supply sources. Specific communications problems included limited telephone accessibility and slow, irregular mail and distribution service. Couriers using vehicles were the only reliable means of communication.

Logistics problems resulted in significant shortages or a total lack of essential supplies, including pesticides, water analysis reagents, and vehicle repair parts. The unit purchasing agent’s local purchases somewhat alleviated some of these supply problems.[657] An April 15, 1991 situation report documents the supply problems: "There is an increasing problem with insect infestation, especially flies. Few, if any, pesticides are available in the supply system. Therefore we are telling user units of local sources and products their Class A [unit purchasing] agent can procure."[658]

A field report (covering April 8, 1991 to May 15, 1991) from an environmental sanitation team leader assigned to the 12th Medical Detachment at King Khalid Military City (KKMC) in Saudi Arabia provides some insight on preventive medicine activities. The team’s mission was to support VII Corps during redeployment by inspecting mess halls, barber shops, swimming pools, food vendors, field sanitation, water quality, pest control, and waste management. The team also provided heat -injury -prevention awareness training and was responsible for supporting units in a 70 by-70 mile area, including some units more than two hours away. Inspection teams usually spent eight to ten hours inspecting each unit. Unit field sanitation was described as relatively good across the board because most units had been in country at least four months and were conscientious about maintaining their areas. A common problem was latrine maintenance. Some units were not keeping latrines repaired, which resulted in problems with filth flies. The team leader identified the improper disposal of hazardous waste, pesticides, and infectious waste as a problem at KKMC. This problem could have been prevented, in the opinion of the team leader, if preventive medicine had established a waste disposal operating procedure and conducted site visits.[659]

Because of logistical difficulties, the 983rd Medical Detachment issued guidance entitled "List of Recommended Substitutes Available in the Local Economy." The list provided the names of several pesticides, including rodenticides, fly baits, larvicides, and supplies in the Dammam area. The guidance stated that these pesticides were only recommended substitutes and included a warning not to use any other product without approval of the Preventive Medical Detachment. It also stated that the Ordering Officer or the Class A Agent may purchase the items on the local economy, but they must obtain approval for these purchases through normal channels.[660]

3. Navy and Marine Corps

The Marine Corps organized its Gulf War contingent into the 1st Marine Expeditionary Force (I MEF), whose primary constituents were the 1st and 2nd Marine Divisions (1st MARDIV and 2nd MARDIV), the 5th Marine Expeditionary Brigade (5th MEB), the 3rd Marine Air Wing (3rd MAW), and the 1st Force Service Support Group (1st FSSG). The Marine Corps deployed its ground forces facing the Kuwait border, with the 1st MARDIV to the east, the 2nd MARDIV to the west, and the 5th MEB in the rear as a reserve force. The 3rd MAW was located in Saudi Arabia and Bahrain. I MEF, 1st FSSG, and most support functions for all Marine units were based in and around Al Jubayl. At the peak of deployment, approximately 108,000 Marines were in the Kuwait Theater of Operations. This investigation does not include the 4th Marine Expeditionary Brigade, which was on-board ships afloat in the Gulf.

To provide the Marines’ medical support, the Navy operated four 500-bed hospitals ashore, including the 4th (called the Marine Corps Hospital), the 5th, and 15th Fleet Hospitals at Al Jubayl, Saudi Arabia, and the 6th Fleet Hospital in Bahrain. Navy preventive medicine personnel provided preventive medicine support, including pesticide applications, for Marine Corps units.

In August 1990, in-theater Navy and Marine Corps preventive medicine assets included just two entomologists and 48 preventive medicine technicians. The senior entomologist served as the preventive medicine chief at the surgical and support company facility in Al Jubayl.[661] The I MEF preventive medicine contingent also included five environmental health officers.[662] By the end of 1990, more Navy preventive medicine resources arrived in theater to support the 2nd Marine Division’s reinforcement of I MEF.

Most Marine battalions and air squadrons had an assigned Navy Preventive Medicine Technician (PMT).[663] On-site PMTs, either assigned or augmented, provided routine services for the forward units, with equipment and pesticides coming from the FSSG, Division, or Air Wing assets. PMTs were tasked to conduct vigorous training in preventive medicine, including field sanitation, personal hygiene, and insect control. Unit PMTs were to spray as necessary to control biting flies and insects. To control flies, PMTs were to spray latrines, garbage collection sites, and messing areas. PMTs placed emphasis on following label directions and only allowing pesticide spraying by certified applicators. If any Marine personnel found dead animals close to encampment areas, the Marine divisions’ preventive medicine sections were to be notified so pesticides could be applied if needed.[664] Two-member teams under an entomologist’s direct supervision provided emergency or large-scale vector control services.[665]

The Marine Corps Hospital’s (Al Jubayl) PM section, augmented by a control team from the Disease Vector Ecology and Control Center, provided all the support for the Marines in the Al Jubayl port area.

The personnel registry data for Navy preventive medicine specialties contained the numbers of Navy preventive medicine personnel shown in Table 116. These numbers do not include preventive medicine personnel who served aboard ships.

Table 116. Navy and Marine Corps preventive medicine personnel assets

 

Preventive Medicine Physician

Environmental Health Officer

Entomologist

Preventive Medicine Technician

Navy and Marines

4

21

12

161

4. Air Force

Nearly 79,000 Air Force personnel deployed to the Kuwait theater of operations during the Gulf War. Besides combat units, thousands of other personnel deployed to provide supply, food, equipment, communications, information, planning, and medical support. Air Force personnel were almost exclusively located at fixed facilities in Saudi Arabia or other countries in the KTO. Unlike the Army and Navy, the Air Force had no entomologists in theater and actually depended on the Army and Navy for entomology support.[666] According to personnel registry data, 37 in-theater Air Force pest control personnel handled pest management. In the Air Force, pest controllers are assigned to civil engineering units and performed these functions whether at their home station or deployed.[667]

5. Summary

The pest management functions that the Army preventive medicine specialists, the Navy preventive medicine technicians, and the Air Force pest controllers performed were relatively similar. Table 117 summarizes the personnel who conducted preventive medicine and pest control activities in the KTO.

Table 117. Summary of the preventive medicine/pest control personnel assets

Organization

Preventive Medicine Physician

Environmental Science Officer And Environmental Health Officer

Entomologist

Preventive Medicine Specialist and Preventive Medicine Technician

Totals

Army

19

29

13

286

347

Navy and Marines

4

21

12

161

198

Air Force

Undetermined

0

0

37

37

Totals

23

50

25

484

582

 

D. DATA COLLECTION AND ANALYSIS

The lack of documentation on pesticide application during the Gulf War spurred investigators to look for other sources of information. Investigators interviewed preventive medicine personnel because their duties made them the most likely to know about pesticide use and exposures. Preventive medicine personnel interviewed, include Army, Navy, and Air Force preventive medicine officers (physicians), entomologists, environmental science officers, preventive medicine specialists and technicians, and pest controllers who served in the Gulf between August 1990 and August 1991.

1. Interview Demographics

Investigators used personnel registry data to identify preventive medicine and pest control personnel for interviews. As Table 118 shows, investigators contacted over 400 preventive medicine and pesticide application personnel. A total of 252 personnel provided exposure information about one or more pesticides. These 252 exposure interviews, listed by lead number in Table 119, are an important basis for the health risk assessment. Another 60 provided general information about Gulf War preventive medicine and/or pest management operations, but did not provide definitive exposure information. Approximately 92 provided limited information about pesticide use or had served aboard ship, as opposed to on the ground. Table 120 shows the preventive medicine interviews by service.

Table 118. Summary of the preventive medicine/pest control personnel interviews

Contacted Specific Exposure Information

252

General Pesticides Information

60

Limited Pesticides Information

92

Lindane Applicators (an additional 25 were included in the Specific Exposure Information interviews)

35

Total (adjusted to reflect double counting lindane interviews used in HRA)

439

 

Table 119. Lead sheet numbers for preventive medicine exposure interviews

9818

15050

15225

15375

15660

15805

15997

18318

11090

15051

15230

15376

15663

15808

16000

18399

14384

15053

15232

15378

15666

15813

16008

18421

14966

15054

15237

15400

15674

15814

16012

18774

14967

15055

15241

15402

15678

15816

16019

18775

14968

15056

15245

15405

15685

15844

16034

18777

14971

15057

15258

15413

15691

15848

16041

18778

14973

15058

15268

15415

15704

15849

16044

18779

14992

15059

15269

15416

15706

15851

16047

18781

14998

15061

15270

15419

15707

15864

16048

18791

15002

15062

15275

15422

15708

15868

16073

18792

15004

15100

15282

15424

15713

15871

16142

18795

15006

15101

15287

15431

15718

15874

16175

18797

15009

15106

15289

15444

15727

15883

16192

18820

15010

15110

15290

15452

15728

15898

16267

18824

15012

15111

15291

15456

15733

15906

16374

18827

15015

15122

15293

15458

15734

15915

16503

18829

15016

15127

15295

15460

15738

15916

16572

18845

15018

15135

15322

15462

15746

15928

16702

18848

15019

15137

15324

15471

15747

15929

16769

18853

15026

15164

15333

15472

15749

15932

16775

18858

15030

15169

15337

15479

15752

15934

16823

18860

15032

15174

15341

15480

15755

15935

16860

18862

15033

15175

15347

15502

15758

15941

17007

20824

15036

15176

15348

15505

15764

15943

17074

22700

15038

15177

15349

15506

15769

15946

17075

24948

15040

15178

15350

15526

15789

15947

17080

24965

15043

15180

15351

15527

15793

15952

17155

25262

15044

15210

15352

15531

15795

15968

17156

 

15045

15212

15361

15533

15796

15981

17458

 

15046

15218

15365

15535

15800

15982

17811

 

15048

15221

15366

15651

15801

15990

18181

 

 

Table 120. Preventive medicine interviews by service

Service

Total Forces In Theater

Total Prev. Med. Assets In Theater

Specific Exposure Interviews

General Pesticides Interviews

Army

350,000

347

160

37

Navy/USMC/ USCG

108,000

198

71

16

Air Force

79,000

37

21

7

TOTALS

537,000

582

252

60

 

Table 121 shows the occupational specialty distribution among the interview sample. The interviewees included one Army and two Air Force specialties that were not in the target population (preventive medicine/pest control). The pay grades of the interviewees ranged from E-2 to O-6 (at deployment). Officers accounted for 25% of the total sample: 29% of the Army portion, 21% of the Navy portion, and 4% of the Air Force sample. Soldiers in pay grades E4 to E6 comprised 58 % of the sample. Table 122 presents more specific information on interviews by pay grade.

Table 121. Preventive medicine interviews by occupational specialty

Service

PMOS/DMOS/AFSC

Preventive Medicine Assets In Theater

Specific Exposure Information Interviews

General Pesticide Information Interviews

Army PM Physician (60/61)

19

14

4

Envl. Science Officer (68N/P)

29

21

7

Entomologist

13

9

3

Preventive Med. Spec(91S)

286

114

22

Field Medic (91B)

-

2

1

Navy PM Physician

4

1

0

Envl. Science Officer (1860)

21

5

4

Entomolgist (1850)

12

5

3

PM Technician (HM 8432)

161

60

9

Air Force Bio-Env Engr Officer

-

0

1

Public Health Tech (908XX)

-

0

4

Pest Control Tech (566XX)

37

21

2

TOTALS

582

252

60

Table 123 shows the breakdown by organizational level of Army personnel whose interviews contributed to the investigation. Not all the personnel interviewed had been assigned solely to divisional preventive medicine sections or preventive medicine medical detachments. Of the 197 Army personnel shown in Table 122, nine had been assigned to civil affairs units, three to an EPW camp, and four to special forces units. Table 121 shows that there were 61 Army preventive medicine officers (physicians, entomologists, and environmental science officers) in the KTO. Table 122 shows that investigators contacted 58 of these (or 95% of the Army’s preventive medicine physicians, environmental science officers, and entomologists). Army preventive medicine specialists were more difficult to locate, reflected in the 48% success rate.

Table 122. Preventive medicine interviews by pay grade

 

ARMY

MARINE/NAVY

AIR FORCE

Pay Grade

Specific Exposure Information

General Pesticides Information

Specific Exposure Information

General Pesticides Information

Specific Exposure Information

General Pesticides Information

E-2

1

0

0

0

1

0

E-3

6

0

0

1

0

0

E-4

42

10

2

1

9

2

E-5

32

2

15

1

6

3

E-6

23

2

23

5

2

1

E-7

9

7

18

1

1

0

E-8

2

1

2

0

1

0

E-9

1

0

0

0

1

0

O-1

1

0

0

0

0

0

O-2

6

2

1

1

0

0

O-3

9

4

6

2

0

1

O-4

11

5

3

2

0

0

O-5

13

3

1

2

0

0

O-6

4

1

0

0

0

0

Totals

160

37

71

16

21

7

 

Table 123. Army preventive medicine personnel interviews by organizational level.

Organization

Preventive Medicine Physician

Environmental Science Officer

Entomologist

Preventive Medicine Specialist

Specific

General

Specific

General

Specific

General

Specific

General

Echelons Above Corps/USCENTCOM

1

4

6

2

5

2

41a

12a

XVIII Abn. Corps - Div. Prev. Med. Section

1

 

3

     

16

1

XVIII Abn. Corps - Non-Divisional Unit

6

 

4

4

1

 

18

4

VII Corps - Div. Prev. Med. Section

3

 

2

     

13

0

VII Corps - Non-Divisional Unit

3

 

6

1

3

1

28

6

Sub-Totals

14

4

21

7

9

3

116

23

Totals

18

28

12

139

a) Field Medics (91B) are included with the Preventive Medicine Specialists.

Investigators found contacting and successfully interviewing Navy preventive medicine personnel was more difficult. The Navy did not define its preventive medicine task organizations as clearly as the Army did; consequently the 198 Navy preventive medicine assets (shown on Table 116) are only shown in aggregate. Of 4 Navy preventive medicine physicians identified in the personnel registry, investigators interviewed 2. Of 21 environmental health officers, investigators interviewed 9 (43%). Investigators interviewed 8 of the 12 (67%) Navy entomologists who served in the KTO and identified 161 Navy preventive medicine technicians who served on the ground, of which 69 (43%) were contacted and interviewed. The Navy interviewees served in Al Jubayl, Al Kharj, Al Kabrit, and Bahrain.

Investigators interviewed 23 of the 37 (62%) Air Force pest controllers who served in the Gulf. Additionally, investigators identified and contacted several Air Force public health technicians but discontinued that line of inquiry when no pest control information was developed. The 23 Air Force personnel interviewed served in Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, and Oman.

2. RAND Survey

In 1999, RAND scientifically surveyed 2,005 Gulf War veterans about pesticide use.[668] RAND randomly selected veterans to statistically represent the entire ground population. Information from this survey is most useful for describing the use of those pesticides available to the general ground population (e.g., DEET, permethrin, dichlorvos resin strips, fly baits, and flea/tick collars). The survey, "Pesticide Use During the Gulf War: A Study of Gulf War Veterans," is summarized in the Tab D, the Health Risk Assessment portion of this report.

3. Results of the Preventive Medicine Interviews

Investigators conducted the interviews with preventive medicine and pest control personnel by telephone in an attempt to identify the pesticides and the personal protective equipment veterans used, the application methods, and the possible exposures. Investigators asked physicians, entomologists, and environmental science officers about their involvement with the development of pesticide policy and procedures, about their interactions with other preventive medicine personnel, about unusual exposure incidents, and about any concerns they may have had about pesticide use. Investigators asked Army and Navy preventive medicine specialists and technicians, as well as Air Force pest controllers, about their training, certification, and experience as applicators. Army personnel were also asked about field sanitation teams and the command support for field sanitation teams.

a. Pesticides of Potential Concern

The preventive medicine interviews (reported in detail in the HRA, Tab D) focused investigators on fifteen pesticide formulations, designated the pesticides of potential concern (POPCs). The selection of these pesticides depended on how frequently the preventive medicine personnel reported a particular pesticide and how toxic a pesticide was under field use conditions. Table 124 shows how the different services used eleven of the pesticides of potential concern (lindane, the remaining pesticide of potential concern, is discussed in Tab H); it also shows a breakdown by major organizational levels for the Army and a breakdown by location for the Air Force. Due to the difficulties in determining the actual organizational structure of the Marine preventive medicine assets, investigators determined only a total for the Navy and Marines. The health risk assessment (HRA) in Tab D addresses exposure to these pesticides.

Air Force pest controllers reported using relatively few pesticides while Army and Navy personnel indicated use of a much wider variety. Table 124 displays other differences. For example, none of the services used bendiocarb and propoxur to any significant degree, and the Army used ultra-low volume (ULV) formulations less often than the other services.

 

Table 124. Number of interviews citing pesticides used

Service, Organization, or Location
Army Personnel By Organization                            
XVIII Airborne Corps - Divisions

9

4

11

1

7

12

1

12

5

       

3

XVIII Airborne Corps - Non-divisional

13

7

16

1

6

11

2

6

2

3

   

2

1

VII Corps - Divisions

3

4

10

3

7

4

2

3

     

1

2

 
VII Corps - Non-divisional

9

6

15

1

13

10

3

4

3

1

   

1

 
Echelons Above Corps

16

14

22

3

15

18

7

16

13

9

3

 

2

5

Other Army

1

 

1

 

2

1

 

1

 

1

   

1

 

Army subtotal

51

35

75

9

50

56

15

42

23

14

3

1

8

9

Navy/Marine Ground Force Personnel

26

11

27

10

18

44

1

19

8

27

11

7

12

21

Air Force Personnel By Country                            
Saudi Arabia          

4

   

4

1

 

2

4

1

Qatar          

1

               
Oman          

1

   

1

   

1

   
Bahrain

1

       

2

   

1

   

3

1

 
United Arab Emirates              

1

2

     

2

2

Air Force subtotal

1

0

0

0

0

8

0

1

8

1

0

6

7

3

 

KTO Total

78

46

102

19

68

108

16

62

39

42

14

14

27

33

 

b. Leadership Issues

(1). Policy and Procedure Development

Preventive medicine physicians, entomologists, and environmental science officers had a limited involvement in developing pesticide policies and procedures. Only one Army physician, an Army entomologist, and two Army environmental science officers indicated they had actively participated in developing policies and procedures. Several preventive medicine officers said they enforced doctrine or policies in effect before the deployment.

The USCENTCOM staff preventive medicine physician wrote command recommendations and guidance on personal protection measures.[669] The environmental science officers for two XVIII Airborne Corps divisions contributed to their divisions’ policies — one described protective measures to be employed against pests before the deployment, while the other disseminated division field sanitation team policy on treating latrines and garbage collection sites with pesticides.[670]

(2). Interactions Among Preventive Medicine Leaders

Preventive medicine physicians, entomologists, and environmental science officers interacted with each other to varying degrees on preventive medicine issues. To some extent it appears those who arrived early in the KTO had more opportunity for interaction on operational preventive medicine issues than those who arrived in the late fall of 1990 and in early 1991. Weekly meetings of preventive medicine personnel at the Al Jubayl Marine Hospital provided a forum for an exchange among the services.[671] Several Navy entomologists mentioned interacting primarily with fellow Navy entomologists and environmental health officers and to a lesser extent with Army preventive medicine personnel.[672] Army preventive medicine physicians, especially those with the XVIII Airborne Corps units, communicated with each other on a frequent basis, at least before the beginning of the air war.[673]

(3). Command Support

Command support for preventive medicine and field sanitation teams varied considerably from no support to excellent support.[674] A few veterans noted some unit commanders did not emphasize preventive medicine until after they experienced problems.[675] One individual said command support initially was poor but improved significantly.[676] Other commanders took preventive medicine more seriously and stressed good field sanitation practices from the beginning. One individual stated command support was "really good" and very supportive of field sanitation teams (FSTs).[677] According to one preventive medicine specialist, some units did not allocate the resources needed for the FSTs.[678] Some preventive medicine problems and pesticide use resulted from poor trash and garbage disposal planning. Some dump sites were located too close to camps. Overpopulation and waste generation also led to pest problems.[679] Some units established encampments in areas prone to pest management problems, e.g., a Marine unit set up camp on a chicken farm, prompting frequent pesticide applications.[680] There were too few preventive medicine specialists to provide adequate support.[681] Others reported command authorities viewed preventive medicine and field sanitation as a low priority until just before deployment and then only elevated the importance since it was a requirement.[682] A major concern among the interviewed veterans was verifying whether field sanitation teams correctly applied pesticides and did not place personnel at risk.[683]

(4). Applicators’ Training, Certification, and Experience

Many preventive medicine specialists and technicians and many Air Force pest controllers said the military trained and certified (or re-certified) them when they deployed to the Kuwait Theater of Operations (KTO).[684] However, at least three Army preventive medicine noncommissioned officers from different active and reserve units said they were not certified or their certification was not current during the deployment.[685] Several 14th Medical Detachment reservists were not certified or were unsure if they were certified.[686] Additionally, a significant number of applicators possessed little or no hands-on experience other than their initial training,[687] while others had several years of pesticide application experience. Air Force personnel generally seemed to have had frequent pesticide application experience.[688] Most Army preventive medicine specialists, on the other hand, claimed little or no previous pesticide application experience.[689] But some Army preventive medicine specialists serving in units that had participated in humanitarian or other types of deployments had gained application experience.[690] Navy preventive medicine technicians were generally experienced, except for the few who recently completed preventive medicine training.[691] Navy preventive medicine technicians with longer service frequently had both shipboard and some on-shore application experience from deployments with Marine units.[692] Other personnel reported no concerns about training or pesticide use,[693] or said applicators did a good job and "went by the book."[694] Some applicators reported little anxiety because of limited pesticide use.[695] Some applicators reported a minimal need for pesticides, so they did not view pesticides as a primary concern.[696] In fact, some applicators described pesticide use as a last resort,[697] meaning that pesticides were used when all other pest control measures, such as properly handling and disposing of wastes, failed.

(5). Personal Protective Equipment

The recollections of the preventive medicine personnel about the availability and use of personal protective equipment (PPE) covered the spectrum. A Navy entomologist said if an applicator needed PPE, it was available in adequate quantities, though he could not comment on the extent to which it was actually used.[698] Occasionally, Navy preventive medicine personnel reported shortages of some, but not all, PPE items.[699] Two Navy preventive medicine personnel noted that they did not wear coveralls, but instead wore the utility uniform. They also said laundry facilities were inadequate,[700] meaning that the facilities were not prepared to effectively handle contaminated clothing. Some interviewees cited high temperatures as a reason for not using appropriate PPE.[701]

Among Army units, FSTs most commonly experienced PPE deficiencies. In one XVIII Airborne Corps division, the environmental science officer estimated about 50% of the field sanitation teams had PPE.[702] A preventive medicine specialist assigned to an XVIII Airborne Corp medical detachment observed that very few people had field sanitation equipment.[703] Some personnel substituted chemical protective gear when PPE was not available.[704]

(6). Record keeping

Investigators asked preventive medicine and pest control personnel about the documentation on pesticide use and exposure, such as medical or supply records, logs, journals, and application records. Most preventive medicine and pest control personnel had no information on records.

Two Air Force pest controllers thought some pest control personnel kept some usage records but did not know if the records still existed.[705] Several Navy preventive medicine technicians named an entomologist they thought had maintained records. When interviewed, the entomologist said he kept an informal, unspecific log containing details of pesticide applications.[706] Almost no Army personnel said they thought pesticide application records had been maintained.

A few personnel mentioned medical record notations. One preventive medicine specialist said her record documented exposure to lindane during delousing operations.[707] Another said his record was stamped "pesticide applicator" and he has a yearly cholinesterase test.[708]

Investigators pursued several leads in an attempt to locate records, but to no avail. There simply was no requirement at that time to document pesticide usage during contingency operations such as the Gulf War. Any records maintained were likely destroyed in accordance with routine records disposition procedures long before investigators began their search.

(7). Disposal

Air Force and Navy personnel reported little pesticide disposal by burial or incineration, while several Army personnel said pesticides were either buried or burned. Some Army accounts were based on second-hand information,[709] though others were first-hand. Some Army units either burned or buried pesticides (along with many other materials[710] ) when they decided to dispose of the pesticides or when they were preparing for redeployment.[711] The largest amount reported to have been disposed of in this manner was 200 to 300 pounds of an unidentified rat poison.[712] Despite the potential for environmental damage and the improper disposal of pesticides (and especially incineration of aerosol containers), these measures apparently raised little concern among the preventive medicine leadership or combat leaders. Pesticide containers that were left in a reusable condition presented a hazard to military personnel and local residents who might use the containers for cooking or as water containers.[713]

c. Symptomatic Exposures

One potentially important consideration in judging the likelihood that pesticide exposures during the Gulf War deployment might have contributed to long-term health problems relates to the prevalence of acute symptomatic exposures. The questions we would like to answer are: 1) how frequently did pesticide exposures cause symptoms either immediately or shortly thereafter? 2) what active ingredients were associated with the exposures? 3) what signs and symptoms occurred? The information we have analyzed to date sheds some light on the issue, but does not satisfactorily answer the questions. The accounts we have of acute symptomatic exposure were generated years after deployment. Some are very detailed and credible, while others are vague. The RAND survey tabulates data on undefined "side effects" self-reported by veterans. These data are of limited value because we do not know the nature of the "side effects" and there is much uncertainty about the specific active ingredients involved. The balance of this subsection summarizes the information accumulated from the PM interviews, delousing interviews, and other interviews.

Table 125 presents a summary of information from over 40 reports of possible symptomatic exposures. Each report indicated that one or more personnel were involved. Most of the reports are first-hand accounts, although a few second-hand and other accounts are included as well. A few of the reports provided fairly detailed information about active ingredients, signs and symptoms, treatment, and disposition of cases, but most of the information provided was incomplete and imprecise.

Table 125. Summary of reported symptomatic exposuresa

Associated Productsb

Description/Signs and Symptoms Attributed to Exposure

Sourcec

Malathion; Pesticides Hospitalized; given atropine; lost work days; paralysis, nausea, stomach cramps, lung pain; headache, dizziness, coughing-up blood, hot flashes, cold flashes, weight loss.

Other[714]
PM[715]

Lindane; Pesticides Physician treated; seizure, temporary blindness, shortness of breath, skin irritation.

PM[716]
DL[717]

Chlorpyrifos; Malathion; Diazinon; Fog; Fly bait; Pesticides Headaches, nausea, runny nose, tearing eyes, lightheadedness, dizziness, tremor, palpitations, heavy salivation, difficulty swallowing, difficulty breathing, coughing, numbness, skin irritation.

PM[718]
Other[719]

Permethrin; DEET; Fog Wheezing, coughing, difficulty breathing, burning in nose and throat.

Other[720]

Permethrin; DEET; Fog; Malathion; Flea collars; Pesticides Headache and/or skin irritation: ankles, wrist, hands, arms, torso, face.

Other[721]

Fly bait; Malathion; Pesticides Became ill; no further information provided on signs and symptoms.

PM[722] Other[723]

a) Investigators identified only one report of a symptomatic exposure generated during the Gulf War deployment (a medical report); the rest were generated years later in the course of interviews..
b)

Product associated with reported exposure. "Pesticides" means that the source did not identify a specific active ingredient.

 

Regarding the symptoms described, some are consistent with those we would expect; others are vague. Additionally, a few of the sources appeared unsure that symptoms occurred at all, or that the symptoms were due to pesticide exposure. There are two other points here: 1) the severity and relevance of the reported signs and symptoms vary substantially, and 2) there may be many more personnel who experienced mild signs and symptoms that were not reported at the time or since. As an example of some signs and symptoms being more relevant than others, possible acute cholinergic symptoms such as temporary cough, burning eyes, and runny nose are probably of more concern with respect to the potential to contribute to long-term adverse health effects than a skin rash would be. Overexposure to organophosphates or carbamates can cause the former; pyrethroids can cause the latter, but the differences are not necessarily that clear cut. Also, pesticides are not the only cause of any of these signs or symptoms.

We found no evidence that exposures were reported to higher headquarters. When asked about unusual exposures, an Army environmental science officer and a Navy entomologist asserted they would have been aware of any reported incidents, and neither had heard of any such incidents.[724]

What can we conclude at present about symptomatic exposures to pesticides? It is apparent that some did occur. As far as we can tell, there may have been a few isolated cases associated with serious signs and symptoms, but these were probably not wide spread, being limited mainly to the small group of personnel assigned to apply various organophosphates and carbamates. There may have been many more cases associated with relatively mild and localized reactions, which would most likely have been of short duration.

4. Host Nation Application

During the Gulf War, the use of contract pest control services was fairly common mostly in more established camps and leased compounds used by US forces. Pest control services tended to be available in or near urban areas and were not prevalent in the more temporary camps in the desert that units moved to after they received their vehicles and equipment and departed the ports and transient holding areas.

Host nations often provided pest control services through the existing contracts, with compounds leased by US forces, or from public health departments of Saudi municipalities, etc. Investigators have not been able to determine conclusively the extent of pest control services contracted by US forces. An Army contracting officer in the Dhahran area thought contracts had been awarded to Saudi pest control services for two camps, probably Cement City and Black Jack Village.[725] Saudi military forces handled pest control measures at some Saudi military installations also housing US personnel, such as Tabuk City.[726] Both US forces and contract personnel serviced (emptied) latrines, depending on the specific location of the military organizations involved. As indicated above, in urban areas, host nation contractors were not uncommon. In fact, a Navy entomologist noted that, "Prompt servicing of garrison latrines by contract personnel...precluded many fly problems in fixed positions."[727]

The interaction between US preventive medicine or pest control personnel and host nation applicators was limited. Most preventive medicine and pest control personnel said they had no contact with host nation applicators. One Army preventive medicine specialist met with certified applicators of the Saudi Arabian Oil Company,[728] while another spoke of witnessing latrine cleaning and pesticide application in Cement City.[729] An Army special forces preventive medicine specialist reported the host nation applicators he came into contact with refused to discuss the pesticides they used.[730] On at least two occasions, an Air Force pest controller stopped host nation applicators from applying pesticides in living areas.[731] A Navy preventive medicine specialist who served in Bahrain mentioned cooperating with local applicators in a mosquito abatement effort.[732]

Early in the deployment, the potential for terrorist acts concerned the Marines.[733] A Navy preventive medicine technician related an incident in which the host nation contractors fogged an area without previous notice, leading some personnel to believe they had been exposed to an enemy or terrorist chemical or biological warfare attack.[734]

Entomologists, environmental science, and health officers did not report witnessing host nation pesticide applications. Preventive medicine specialists, technicians, and Air Force pest controllers witnessed applications in a few instances but had virtually no opportunity to observe the mixing operations. Two Army preventive medicine specialists and two Navy preventive medicine technicians said they observed host nation fogging trucks and operations.[735] Two Army preventive medicine specialists witnessed host nation spraying operations, one at King Fahd International Airport.[736] Air Force pest controllers on bases in Saudi Arabia, the United Arab Emirates, and Bahrain had various contacts with host nation applicators. In each case, the pest controller was unable to say what the host nation applicators applied or were preparing to apply.[737]

Concerned US personnel commonly expressed skepticism about the host nation applicators’ training, products, or procedures. Air Force pest controllers in Saudi Arabia and Bahrain thought the host nation applicators they observed were inadequately trained.[738] An Army environmental science officer, assigned as an advisor to the Saudi Arabian National Guard, said there was no way to know what products the host nations used, which raised the possibility that personnel could have been exposed to products banned in the US.[739] An XVIII Airborne Corps physician expressed concern about pesticide safety and possible mismanagement.[740] An 82nd Airborne Division preventive medicine specialist said preventive medicine personnel at one facility stopped host nation applications because the host nation applicators did not know what product they were using.[741] Navy entomologists and environmental health officers had similar concerns. A Navy entomologist, for example, thought the host nation applicators observed less-stringent standards than US applicators.[742] One Navy environmental health officer reported that host nation applicators applied pesticides despite high wind conditions, while another questioned the standards of host nation applicators.[743]

Several personnel speculated that host nation applicators used DDT. Two Air Force pest controllers and one Navy preventive medicine technician were convinced local applicators used DDT in Bahrain;[744] the Navy technician said his landlord told him that DDT was available for purchase in Bahrain.[745]

Investigators received two reports about the products host nation pest control services used — one from an Air Force environmental health technician who served at the Tabuk, Saudi Arabia air base and one from a Navy entomologist who served with the Marines in the Al Jubayl area. Table 126 lists the pesticides these two personnel encountered when they visited host nation pest control services. Neither individual provided first-hand information on where and for what purpose each of these pesticides was used. It is reasonable to assume that US personnel may have been exposed to pesticides applied by the two pest control facilities.

Table 126. Pesticides stocked at two host nation facilities

Pesticides Used by Pest Control Contractor in Tabuk, Saudi Arabia[746]

 

Pesticides Stocked at a Pest Control Facility in Al Jubayl, Saudi Arabia[747]

Brand Name

Chemical Name

 

Brand Name

Chemical Name

Neocidol Diazinon   K-Othrine 25% Flowable Deltamethrin
Cymprator Cypermethrin   K-Othrine 35% Deltamethrin
Actellic (spelled Actlic in the Lead Sheet) Pirimiphos-methyl   Cymbaz 10 EC Cypermethrin
Malathion Malathion   Abate Temephos (mosquito larvacide)
Permethrin Permethrin   Residex PO 5% WW Dusting Powder Probably Warfarin
K-Othrine Deltamethrin   Various rodenticides Unknown

 

Of the pesticides identified in the two host nation pest control operations, actellic would be of most concern. This organophosphate product is registered in the US for export grains, domestic stored corn, and sorghum, and is more toxic than the organophosphates diazinon and malathion.

A Navy preventive medicine technician reported he saw phostoxin (aluminum phosphide), a EPA restricted-use pesticide, spilled on the floor of the Kuwait Pest Control Center during the Marines’ liberation of Kuwait.[748] The preventive medicine technician provided no additional information to indicate if other US personnel were exposed to the facility.

Despite these criticisms of host nation pest services, US preventive medicine and pest control personnel also commented favorably about host nation pesticide activities. An Air Force pest controller assigned to a United Arab Emirates airbase thought the host nation applicators he observed appeared to follow "standard application procedures."[749] In one Army entomologist’s opinion, the local pest control contractors had good training.[750] A Navy entomologist visited a Saudi pest control shop run by a Ph.D. entomologist and found good equipment and pesticide products he considered fairly safe.[751]

Overall, there is insufficient information about host nation pesticide support activities.

5. Armed Forces Pest Management Board Questionnaire on Lessons Learned from the Gulf War

In October 1992, the Armed Forces Pest Management Board (AFPMB) surveyed several Gulf War entomologists and preventive medicine officers from the Army, Navy and Air Force on lessons learned during the Gulf War deployment.[752] The individuals interviewed as part of the AFPMB study were also included in the preventive medicine interviews conducted by investigators beginning in 1998. Many of the issues and lessons learned identified during the pesticides investigation are consistent with and are validated by those identified in the AFPMB lessons learned questionnaires completed one year after the Gulf War ended.

AFPMB survey respondents stressed the need to get familiar with the area of responsibility prior to deployment and as soon as possible once in-theater as the most significant lesson learned toward preparation for similar deployments. In addition, personnel and units should deploy with as much pest management equipment and supplies as possible due to logistics lags and potential re-supply problems in-theater. Corps plans need to ensure preventive medicine unit coordination from the outset of the deployment. Reserve units need to ensure that they establish technical contacts prior to deployment. Finally, personnel need to arrive trained and prepared to operate, be versatile, exercise initiative as needed, and have strong interpersonal skills.[753]

Those surveyed reported that they spent their time conducting a variety of activities, including: vector control, field sanitation and hygiene, nuisance pest control, quarantine and agricultural washdown, and activities such as arranging transportation, conducting administrative and coordinating activities, and attending meetings.[754]

Preventive medicine personnel felt that the existing equipment and supplies should be improved. The entomologists identified the need for a more effective wettable powder formulation, smaller and more dependable ultra-low volume (ULV) fogger and hydraulic sprayers, thermal foggers, and a power delouser. In addition, several of those surveyed expressed a need for communication gear, portable computers and printers, and enhanced water testing capability. It should be noted that both equipment issues have been resolved with the subsequent fielding of small, lightweight sprayer units and that mass delousing with power delousers is no longer a DoD capability.[755]

The entomologists noted the absence of a good identification guide to a variety of pests in the area of responsibility (including the local common names of pests) prior to and during the deployment. Others wanted prior information on emergency supply ordering procedures for pest management supplies and on local procurement procedures. Several respondents noted that the Armed Forces Pest Management Board’s Defense Pest Management Information Analysis Center and the US Army Medical Research and Materiel Command (USAMRMC) research community provided necessary country-specific technical information before and during the deployment. It should be noted that the Technical Information Memorandum 24, Contingency Pest Management Guide includes emergency supply ordering procedures for pest management supplies.[756]

A number of obstacles inhibited job performance. These obstacles included a general failure of Air Force engineering and medical organizations to work together to use preventive medicine assets efficiently. Some respondents noted long delays in receiving supplies and the lack of command support for the mission of preventive medicine personnel. Although preventive medicine was stressed at the individual level and many preventive medicine units were deployed, several respondents noted problems convincing their chains of command to let them implement their missions, resulting in some assets being used inefficiently. Many noted a general lack of good communication and transportation support for preventive medicine personnel. Lastly, an Army reserve officer perceived a lack of trust in Reserve Component preventive medicine assets by Echelon Above Corps MEDCOM units.[757]

In order to improve pest management activities during the next deployment, respondents suggested several institutional changes. Representatives from the Air Force and Navy believed that each service needs to support its own units in field so they do not have to rely on other services for preventive medicine support. Several felt entomologists needed better contingency training. Others noted that medical and engineering staffs sometimes either misused or hampered the use of preventive medicine assets. Some suggested that preventive medicine personnel need more organic transportation and communication assets and that they need better support from their chains of command in order to do their jobs more effectively and efficiently.[758]

Lastly, an Air Force officer felt that preventive medicine expertise must be located in-theater rather than trying to manage from afar (e.g., Turkey for South West Asia operation). Navy officers noted that preventive medicine personnel need to be allowed to do their jobs without being encumbered by a leadership who is unfamiliar with how to best utilize their skills and that organic preventive medicine units need to be deployed to support their units rather than relying on other services’ preventive medicine assets.[759]

6. Summary

The Army, Navy, and Air Force applied extensive preventive medicine and pest control resources in an attempt to control disease-carrying organisms and pests during the Gulf War. At the Department of Defense, organizations such as the Armed Forces Pest Management Board and Armed Forces Medical Intelligence Center supported deployed forces to varying degrees. At the service level were the US Army Environmental Hygiene Agency (now the US Army Center for Health Promotion and Preventive Medicine), Navy Disease Vector Ecology Control Centers, Navy Environmental and Preventive Medicine Units, and the Air Force Engineering and Services Center (now the Air Force Civil Engineering Support Agency).

The best information available indicates approximately 582 preventive medicine and pest control professionals served in the Gulf: preventive medicine physicians, entomologists, environmental science or environmental health officers, specialists, and technicians in the Army and Navy. Additionally, Air Force civil engineering organizations included pest controllers. Each of these occupational specialties, but not all personnel in each specialty, was involved in pest management operations.

Investigators successfully interviewed 75% of the identified KTO preventive medicine and pest control population, of whom 57% provided substantive information for increased understanding of pesticides in the Gulf. The interviews revealed preventive medicine physicians, entomologists, and environmental science officers had little involvement in developing pesticide policies and procedures. Existing policies and procedures were largely enforced with little apparent need for tailoring to local circumstances. Several preventive medicine personnel reported unusual pesticide exposure incidents, most of which involved exposures only to applicators. Some personnel also expressed skepticism about host nation pesticide practices and some thought it was possible that DDT was used in Bahrain. However, when knowledgeable US personnel visited host nation pest control operations, they found relatively safe pesticides.

In addition, a survey conducted by the Armed Forces Pest Management Board of several entomologists and preventive medicine personnel during the Gulf War deployment reveals striking similarities to the issues and lessons learned identified during the pesticides investigation.


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