Report probes cause of injury to Marine
WASHINGTON, March 21, 2000 (GulfLINK) - The Office of the Special Assistant for Gulf War Illnesses released today a case narrative that assesses whether a U.S. Marine was injured from exposure to a possible chemical warfare agent in Kibrit, Saudi Arabia, in March 1991. The interim report focuses on a Marine Corps corporal who developed blisters on his right forearm after testing captured prisoner of war field equipment. Based on the findings of the case, investigators have determined that it is unlikely that a chemical warfare agent caused the corporal's injury.
"Whenever a service member is injured, we have a duty to see that they receive needed medical care," said Bernard Rostker, special assistant for Gulf War illnesses. "In this case, we were not only concerned about the treatment to the injury, but what might have caused it and how to prevent something like this from happening in the future."
Investigators from the special assistant's office learned about the alleged chemical exposure incident while interviewing other Marine Corps personnel who had participated in minefield breaching incidents during the Gulf War.
The incident occurred on March 13, 1991, at the Kibrit compound approximately 12 days after the Gulf War cease-fire. The Marine corporal was asked by another Marine staff sergeant to test some captured Iraqi equipment using the XM93 Fox Reconnaissance Vehicle. The staff sergeant wanted to confirm earlier readings for a potential chemical warfare agent received while scanning items from the three crates which contained gas masks, field belts and suspenders and an ammunition pouch.
When the corporal held one of the pieces of equipment - which was covered with traces of reddish dust - to the probe, he heard an alarm from the Fox's MM-1 Mobile Mass spectrometer. After noticing the indication of a low-level reading for the chemical warfare agent lewisite, the corporal then ran a spectrum analysis and printed a tape which he said indicated the presence of lewisite. Two other items - which also had traces of red dust - also produced low-level readings of lewisite.
Despite the alarms and readings for lewisite, neither the corporal nor the staff sergeant experienced any symptoms consistent with chemical agent exposure nor did they put on any personal protective equipment. They continued to test other pieces of equipment for several more hours. If the agent present was lewisite, it would have caused both individuals immediate pain on contact with their skin. Irritations to their eyes and respiratory system would have also occurred.
The morning after his work with the captured equipment, the corporal noticed a quarter-sized blister in the middle of an irritated area on his right forearm. The corporal sought treatment at Kibrit's medical aid station where he was treated with a cortisone cream ointment and a saline-soaked gauze pad. However, the treatment was not recorded in the corporal's medical record.
On March 14, 1991, the corporal was sent to Al Jubayl to receive further medical treatment. A corpsman at the 2nd Medical Battalion hospital treated the wound - now consisting of three fluid-filled blisters and eight other blisters on the inside of the right forearm - with a dressing of a mixture of bleach and water which is successfully used with burn patients. The treatment at Al Jubayl documented in the corporal's medical records is the first dated record of the injury.
The corpsmen told investigators that the corporal was also examined by a doctor who made the assessment of possible lewisite exposure. However, a physician diagnosis was not recorded in the corporal's medical record on this visit, and investigators have not found the doctor.
After reporting for duty at the Marine Corps Air Station in Yuma, Ariz., the corporal reported to the Yuma medical treatment facility in May 1991 for follow-up treatment. The medical officer there examined the corporal and reviewed his medical record. Noting the documentation "possible blister agent exposure vs. hypersensitivity reaction" in the record, the medical officer referred the corporal to Balboa Naval Hospital in San Diego, Calif., for further evaluation.
Medical personnel at Balboa Naval Hospital assessed the corporal's injury as dermatitis, possibly secondary to lewisite exposure or some other traumatic injury to the skin on the right forearm. The corporal did not seek further medical treatment for dermatitis- a skin inflammation - and reported that his condition healed in September 1991. The injury has left scarring on the corporal's right arm.
"We've had very little to go on in this case, and have had to rely heavily on testimony from the corporal, his crew chief, the medical treatment facility personnel and others to help build the case," said Kelly Niernberger, the lead investigator on the report. "During any investigation, you try to get two sources to confirm an incident. Although a lot of records were kept, many were destroyed once the archival history was written. Evidence that could have been most helpful, such as operational reports, admin reports, and logs, wasn't available."
What hampered the investigation most, according to Niernberger, was the fact that none of the Fox spectrum analysis tapes - which could provide more information about the alarms and the readings from the Fox tapes at the time of the testing of the Iraqi equipment - could be located. Investigators were told that the tapes were given to the I Marine Expeditionary Force nuclear, biological chemical officer, but he says he does not remember receiving any Fox tapes from the crew. Also lacking were operational records or logs, and no one from Kibrit or from the Marine's chain of command submitted a chemical warfare agent incident report.
"I hope that when people read this case narrative, that someone will come forward and say, 'I was there and saw what happened or I knew that staff sergeant.' This could give us more information about the incident," said Niernberger. "The medical record keeping in this case was good. It gave a paper trail back to the injury. One missing piece was the [lack of ] documentation of the initial treatment at the Kibrit aid station."
Investigators also consulted medical experts to better understand the probable cause of the blistering on the corporal's arm. One medical specialist noted that because the corporal did not experience the usual symptoms associated with exposure to lewisite - such as pain or irritation to the nose and eyes within seconds - strong evidence exists that the cause was not lewisite. Yet, even the medical personnel could not determine what caused the blisters on the corporal's forearm. They did agree that there were many possible reasons for the blisters.
From this incident, investigators have drawn several lessons learned that can be applied in future contingencies. They advised that even suspected exposure to possible chemical warfare agent should be handled aggressively, documented and investigated.
Now, with regards to Fox tapes, specific procedures for the maintenance and keeping of the Fox spectrum analysis tapes have become institutionalized in the training process.
The report also emphasized the crucial part corpsmen, nurses and doctors play in the medical treatment and record keeping process. To corroborate events, all treatment must be made part of the patient records. The Defense Department is looking at technology to help resolve some of these issues.
Lastly, the investigators said that training in the use of decontamination procedures should emphasize the potential hazards of using field expedients such as bleach in combination with personal decontamination equipment. The M258 Decontamination Kit used during the Gulf War has since been replaced with a less caustic one, the M291 Decontamination Kit.
This case narrative is an interim, not a final, report. Gulf War veterans who have any knowledge of this incident or other first-hand accounts are encouraged to contact the office for Gulf War illnesses at (800) 497-6261 with information or new evidence.