A.9 LESSONS LEARNED
During the course OSAGWIs pesticide exposure investigation, analysts identified several lessons learned. The recommended areas for improvements include: increased monitoring of host nation pesticide application; revised delousing procedures; improved training; improved supply distribution; formalized local purchase procedures; increased emphasis on personal protective equipment; revised record-keeping procedures; and more thorough occupational health surveillance. In addition, in October 1992, the Armed Forces Pest Management Board conducted a survey of several entomologists and PM personnel from the Army, Navy and Air Force on lessons learned during the Gulf War deployment. Many of the issues identified in the completed questionnaires such as supply problems, communication difficulties and inconsistent command support parallel the issues and lessons learned resulting from the OSAGWI pesticides investigation. Tab C-4 includes a detailed overview of the Pest Management Boards questionnaire.
A. Host Nation Application
Qualified US service personnel, preferably military entomologists, military environmental science officers, or public health officers, need to closely monitor host nation pesticide application activities and, if necessary, recommend appropriate corrective action when US personnel are at risk.
Information on the specific pesticides applied and on any improper activities needs to be documented, especially any that may result in adverse exposures to US personnel.
Host nation contractors frequently applied pesticides in and around areas where US servicemembers were quartered. Some US servicemembers indicated concerns with what they perceived as unsafe and improper handling procedures, or use of unknown or unsafe pesticides. An analysis of the Gulf War by the British Ministry of Defence identified a similar problem with pesticide applications by host nation personnel or by non-British servicemembers. The British have since adopted a procedure requiring supervision or monitoring of host nation applications.
An effective policy for mass delousing needs to be developed. This policy should include: rules for determining which EPWs require delousing; a list of the pesticide(s) permitted for use; guidance on the proper application of the pesticide(s); the personal protective equipment to be used; and the training required for military police and medical personnel.
Delousing personnel were poorly prepared. They lacked adequate training, dependable lindane dispersal equipment, proper personal protective equipment, and effective oversight by PM personnel. In March 1994, the Armed Forces Pest Management Board (AFPMB) sent out a message directing that all military stocks of 1 percent lindane dust be turned in for disposal, as DoD was changing the treatment procedures for mass delousing. The message outlined three reasons for this action, including: 1) DoD is revising its delousing procedures; the indiscriminate application to all individuals without determining whether anyone is infected with lice is not a sound pest management practice; 2) Lindane is very persistent in the environment and has "suggestive evidence of carcinogenicity" according to the Environmental Protection Agency; and 3) discontinuing the use of lindane is consistent with the pesticide reduction goals established by the Defense Environmental Security Council. Currently, DoD depends on showers, laundries, permethrin treated clothing, and international agencies (such as the Red Cross) to control the lice infestations of EPWs, displaced persons, and other infested populations.
C. Training and Experience
Deploy sufficient numbers of trained, certified, and properly equipped pesticide applicators.
Ensure that Army Field Sanitation Teams are properly trained and provisioned prior to deployment.
Ensure pesticide applicators have copies of the Contingency Pest Management Pocket Guide, Technical Information Memorandum No. 24, available for reference during deployments.
Emphasize the importance of reading and complying with pesticide label instructions.
Provide refresher PM courses to all deployable personnel. Stress the proper use of personal repellents and the appropriate use of pesticides during training.
Incorporate formal training on the use of personal protective measures against insects and other pests of military significance to the basic and recurring training of all military personnel.
The pesticides exposure investigation uncovered a significant number of incidents of pesticide misuse. Among these were personnel wearing flea and tick collars as personal repellents. Additionally, the inappropriate uses of pesticides (e.g., use of fly baits on dining tables and under cots) occurred on an individual basis.
The military placed inadequate emphasis on field sanitation supplies, equipment, preparation, and training prior to deployment. In-theater field sanitation team training varied from several hours to two or three days, and appears to have included only a brief discussion on pest control and pesticide issues.
The level of experience and hands-on training for pesticide applicators varied considerably, with many applicators having little or no application experience prior to their deployment to the Gulf. Some had expired certifications or had never been certified.
D. Supply Distribution and Local Purchase
In order to provide deployed servicemembers with the needed pesticide materials, supplies, and related equipment, the military needs to reevaluate pesticides prioritization in supply requisition and transportation processes.
The 1999 Under Secretary of Defense for Acquisition and Technology local purchase guidance needs to be vigorously implemented and extended. Before the local purchase of pesticides, the proper review and approval procedures involving entomologist or environmental science officers must be followed.
Supply distribution problems affected the availability of pesticide supplies and pest control equipment during the Gulf War. These problems resulted in the purchase of pesticides on the local market, some of which were not labeled in English, possibly leading to improper or inappropriate use.
E. Equipment and Facilities
Ensure pest management materiel, particularly pesticide dispersal equipment, is inventoried regularly and missing or broken equipment is replaced or repaired as soon as practical.
Expand field sanitation kits to include personal protective equipment such as goggles, coveralls, respirators, and other equipment appropriate to provide adequate protection to the applicators during sustained field operations. Consider alternatives (e.g., disposable coveralls) to avoid the problems of wearing contaminated uniforms. Ensure field sanitation kits include equipment recommended in the Military Pest Management Handbook.
Expand training for uniformed military pesticide applicators to include methods of field expedient laundering and the cleaning of coveralls and other personal protective equipment.
Include proper field expedient storage of pesticides and pesticide dispersal equipment in pesticide applicator training.
Pesticide applicators, including field sanitation team members, were ill-prepared to accomplish their mission because of missing or inoperable pest control equipment and inadequate personal protective equipment (PPE), including coveralls, goggles, and respiratory protection. There was also insufficient water for cleanup, along with a lack of cleanup and laundry facilities, which resulted in applicators wearing contaminated uniforms for extended time periods. In some instances, the inability to store equipment and pesticides properly contributed to concerns of equipment maintenance and pesticide stability.
Require military units with a pesticide application mission to periodically report pesticide acquisitions, inventories, usage, disposal, and amounts unused and returned to points of origin (i.e., a "cradle-to-grave" tracking system).
Little information is known about which pesticide products military units actually had in their possession at the outset of the Gulf War. Similarly, while there is some information on which pesticides were turned in to the supply system, the amounts those units retained or disposed of are unknown. Since very little documentation exists on the levels of pesticides actually applied, the information contained in this report on pesticide usage was largely obtained through veteran interviews and based on veteran recall.
In 1996, Department of Defense Instruction 4150.7, "DoD Pest Management Program," initiated the requirement to record, report, and archive pesticide use. This requirement states, "Ensure that any pesticide applications, excluding arthropod skin and clothing repellents, performed during military operations are recorded using DD Form 1532-1, Pest Management Maintenance Report, or a computer generated equivalent. The DoD Components shall establish a method to archive these records for permanent retention." In response to an August 1997 memorandum from the Under Secretary of Defense (Acquisition and Technology), the Army, Navy and Air Force described the procedures in place for recording, reporting and archiving information on pesticide application. In addition, the Armed Forces Pest Management Board (AFPMB) issued an information paper, "DoD and Service Policy and Guidance on Recording, Reporting, and Archiving Pesticide Use During Military Operations," in May 2000. The paper provides a summary of DoD service policy and guidance related to pesticide use during military operations.
G. Occupational Medical Surveillance
Develop a set of DoD occupational medical surveillance requirements for all pesticide applicators.
Ensure that pesticide applicators, including field sanitation team members, are evaluated in accordance with surveillance requirements (e.g., cholinesterase testing) found in DoD 6055.5-M Occupational Medical Surveillance Manual.
Conduct deployment industrial hygiene surveys that include possible pesticide exposures.
The services have inconsistent requirements for occupational health surveillance of pesticide applicators. Investigators found no evidence that an occupational medical surveillance program was in effect immediately before, during, or after personnel deployed to the Gulf. Also, in a contingency operation that involves Army units, the level of pesticide application done by field sanitation teams probably warrants their inclusion in a medical surveillance program.
Some steps have been taken to address the occupational health surveillance issue, but additional action is needed. DoD 6055.5-M Occupational Medical Surveillance Manual, revised in May 1998, provides requirements for implementing a medical surveillance program. The pesticide applicator evaluations include the workers medical and occupational history, a physical examination (including a complete neurological exam), and cholinesterase testing. Field sanitation teams and delousing personnel should be considered for inclusion in the DoD 6055.5M medical surveillance program if it is likely they would apply organophosphate or carbamate pesticides. A capability for conducting cholinesterase tests in-theater needs to be developed. Post-deployment examinations of applicators should also be conducted.
There is little documentation available indicating that there was any close communication between the various echelons of the PM community. While PM leadership personnel met periodically in Al Jubayl, many individuals were unable to attend, and no formal system existed to disseminate the information developed in these sessions throughout the theatre.
I. Command Support
Emphasize individual personal protective measures, particularly the proper use of DEET and permethrin, and the proper wear of the uniform; so as to provide maximum protection from insects.
Command support for PM varied from poor to excellent. Historically, three times as many US soldiers have been lost to disease and nonbattle injury (DNBI) as to enemy action. The ultimate objective of a military force-success in battle-demands that servicemembers maintain a constant state of good health. That many early deploying Army units did not have trained field sanitation team members is an indicator that PM and field sanitation were not given adequate emphasis prior to deployment.
The Combat Lifesaver concept (to assure rapid response to medical emergencies in combat) might serve as a model for reinforcing the importance of PM and field sanitation teams.
To conserve the fighting strength, military leaders must emphasize effective PM and field sanitation measures during training and when deployed on contingency missions. As a minimum, the importance of the DoD Repellent System needs to be understood and emphasized.
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