Pentagon seeks to avoid repeat of 1991 Gulf War health problems

In mid-March, days before the United States launched its invasion of Iraq, the Navy's surgeon general, Vice Adm. Michael Cowan, received a welcome e-mail from a Marine Corps medical officer: The Marines had just begun fielding a quick-clotting bandage to troops deployed to the Middle East.

For weeks, Defense officials had been trying to get approval from the Food and Drug Administration to use the bandage, which was still in the research and development phase. Approval from the agency-or a presidential waiver-was required.

The bandage, Cowan told reporters at a March 13 Pentagon briefing, is "very important for saving lives in a battlefield environment and a very big advancement for us." It dramatically accelerates the blood-clotting process of external wounds, reducing the chances that an injured soldier or Marine will bleed to death on the battlefield.

"This is one more tool that you can put well forward in the hands of a corpsman or a medic or even an infantryman that can help staunch the flow of blood and stabilize a person and keep him stable until you get him back where surgical intervention can do a repair," Cowan said.

From bandages to new drugs to high-tech bio-detection systems and chemical protection suits, military officials have been working for more than a decade to improve the way the Defense Department monitors and cares for battle-bound troops. They want to avoid a repeat of the health problems that resulted from the 1991 Persian Gulf War, which left thousands of troops ill and complaining of a range of ailments most believe resulted directly from their service in Iraq and Kuwait.

"We have learned many lessons over the past decade," said William Winkenwerder, assistant secretary of Defense for health affairs. "Our level of effort and our capability to protect our forces is unprecedented in military history." Winkenwerder presided over the briefing by the services' surgeons general and other Defense health officials.

Winkenwerder said improvements have occurred in three broad areas: efforts to maintain and monitor the general health and fitness of troops; measures to protect troops from disease and prevent exposure to harmful substances; and standards for tracking the health of troops before, during and after deployments.

Defense officials cited several steps they've taken to improve the health outlook for troops:

• To provide a record of vital health data before and after deployment, Defense is maintaining a repository of samples of serum-the clear liquid part of the blood that remains after blood cells and clotting proteins have been removed-for all military personnel.
• The department has set up three deployment health centers, focusing on health surveillance, health care and health research.
• New post-deployment clinical practice guidelines will ensure a uniform standard of care at all treatment facilities run by Defense and the Veterans Affairs Department.
• Officials are now testing a new database, the Theater Medical Information System, designed to show the health effects of deployment across the battlefield.
• Major improvements have been made to equipment used to detect chemical and biological agents, as well as the protective gear troops wear during suspected attacks.
• Advances in technology are allowing medical personnel to provide more sophisticated care, including surgery, on the battlefield.

Immunization programs are also much more thorough today than during the 1991 Gulf War. Troops and medical personnel are well-informed about the medical effects of vaccines and adverse reactions are thoroughly documented, said Peake.

Defense health officials say they are determined not to repeat past shortcomings in caring for troops returning from war. "Because there were soldiers and servicemen who came back [from the 1991 Gulf War] with certain symptoms in some cases, we want to take the lessons from those experiences," Winkenwerder said.

To do that, he said, officials need "to have a better baseline of information when people are deployed that tells us about their health, better surveillance in the theater, and collection of information in a more disciplined way to look at people after they return."