IV. ASSESSMENT OF NFL AND PM EFFECTIVENESS
A. NFL Effectiveness
The NFL provided a critical diagnostic capability during Operations Desert Shield and Desert Storm that enhanced DoD's effective patient care and preventive medicine efforts. Moreover, the NFL provided commanders with accurate information about the nature of the biological threat during this wartime deployment.
The NFL succeeded for two reasons. First, the military's network of overseas infectious diseases research laboratories offered specialized training for DoD personnel in foreign environments and provided support during deployments. Second, all command echelons (particularly the NAVCENT Surgeon and the Assistant Chief, Operational Medicine and Fleet Support at the Bureau of Medicine & Surgery, Department of the Navy) recognized the need for the NFL from the beginning of Desert Shield.
Since the end of the Gulf War, the forward laboratory concept has been institutionalized into the Forward Deployed Laboratory under the coordination of the Navy Environmental Health Center in Norfolk, Virginia. When deployed, this laboratory has a "core" infectious disease diagnostic unit. Layered on top of this "core" are specialized teams, like BW detection. Presently, the BW detection team is provided by the Biological Defense Research Program at the Naval Medical Research Institute (NMRI), where a mobile laboratory for BW detection has been developed.
The NMRI mobile BW laboratory also has critical national security uses outside of military deployments. NMRI laboratory personnel and the mobile laboratory have been used to actively support US and international agencies in identifying potential BW threatsincluding the United Nations controlled sanctions of Iraq and the recent B'nai B'rith incident in Washington, DC in 1997, involving a suspicious package.
B. Preventive Medicine Effectiveness
The Gulf War was unique in that there was an ongoing effort to monitor DNBI rates in a surveillance system backed up by a sophisticated on-site laboratory capability. Also, the US military understood and was ready for the health threats our troops encountered in the Gulf War. Consequently, the DNBI rate during this war was lower than in previous major conflicts involving US military personnel.[23, 24] The good health of US troops was due in part to comprehensive preventive medicine efforts by all Services, accurate and rapid laboratory diagnosis, and the extensive health care system that was established in Saudi Arabia during Operation Desert Shield.
Besides these medical measures, several fortunate circumstances aided US troops:
Although the pioneering system of DNBI surveillance was not perfect, it was a critical tool in immediately defining the major patterns of illness and injury in each Marine unit for most of the deployment. Combined with hospital surveillance, it clearly demonstrated that US Marine Corps and Navy ground personnel remained very healthy during Operations Desert Shield and Desert Storm. Also, when a problem arose it was quickly resolved.
This DNBI surveillance system proved so successful that it was adopted as the standard approach for all subsequent joint deployments involving US military personnel. It has been modified and successfully used during Operation Restore Hope in Somalia, during the Haiti intervention, and during operations in Bosnia.
Although wars cannot be conducted as large epidemiological studies, more medical surveillance information was collected on US troops during the Gulf War than in prior wars. Since the end of the Gulf War, this data has aided investigators in the search for the causes of veterans' health problems. To date, the primary chronic infectious disease problem identified among veterans has been 12 cases of visceral leishmania infection. Nevertheless, investigations are continuing on other possible chronic infectious disease problems.
Following the war, the principal unanswered health question has been the unknown nature and causes of the unexplained symptoms experienced by some Gulf War veterans. Because similar physical symptoms have been reported by war veterans since the US Civil War, veterans of future wars could also experience comparable health problems. The improved surveillance and diagnostic methods pioneered during the Gulf War and the more recent improvements in medical record keeping will help the DoD and Veterans Affairs provide the best health care possible for both current and future veterans.
For additional technical information, refer to the following articles:
Hyams, K.C., A.L. Bourgeois, J. Escamilla, J. Burans, and J.N. Woody, "The Navy Forward Laboratory During Operations Desert Shield/Desert Storm," Military Medicine 1993, vol. 158: p. 729-732.
Hyams, K.C., F.S. Wignall, and R. Roswell, "War Syndromes And Their Evaluation: From The US Civil War To The Persian Gulf War," Annals of Internal Medicine 1996, vol. 125: p. 398-405.
Hyams, K.C., K. Hanson, F.S. Wignall, J. Escamilla, and E.C. Oldfield, "The Impact Of Infectious Diseases On The Health Of US Troops Deployed To The Persian Gulf During Operations Desert Shield/Desert Storm," Clinical Infectious Disease 1995, vol. 20: p. 1497-1504.
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