By Lyn Kukral, .S. Army Public Health CommandFebruary 12, 2014
BAGRAM AIRFIELD, Afghanistan (Feb. 12, 2014) -- Service member concern about exposures to ambient air in the Central Command area of responsibility has grown with the passing of time. To date, the Department of Defense has found little scientific evidence of long-term health effects due to these exposures, though short-term effects such as sore throat, cough, eye irritation, runny nose and other cold-like symptoms are possible.
Service member concern has caught the ear of Congress, which last year required the Veterans Administration to establish an airborne hazards registry of service member-reported health issues. Experts from the U.S. Army Public Health Command's, or USAPHC's, Occupational and Environmental Medicine and Health Risk Management portfolios continue to assist the VA in development of the registry. As well, they continue to be involved in air surveillance and analysis.
Since the first Gulf War, the USAPHC and its DOD partners have sought to characterize the ambient air in the U.S. Central Command area of responsibility. Primarily a desert environment, the air there differs from that in most of the United States, routinely exceeding Environmental Protection Agency standards for particulate matter. This particulate matter, or PM, comes primarily from dust in the natural environment, although chemicals and compounds from oil well fires, aviation, vehicle fuel, industry, indigenous solid waste disposal and other human activities contribute.
Deployed preventive medicine detachments routinely collect air samples, which are analyzed in laboratories--the USAPHC's and others--with results stored in the Defense Occupational and Environmental Health Readiness System--Industrial Hygiene, Environmental Health Business Area, or DOEHRS-IH (EH). Additionally, special sampling missions occur -- the USAPHC has participated in the multiple site PM sampling conducted throughout the U.S. Central Command area of responsibility, in 2006-7 and the 2007-10; sampling at Balad, Iraq, specifically focused on air quality and burn pit emissions; and the September 2013 air surveillance mission to Bagram Air Field, Afghanistan. The latter is the most detailed air sampling done in Afghanistan to date by the U.S.
"Our team went there at the request of Task Force Medical Afghanistan," said John Kolivosky, HRM Portfolio environmental engineer and team leader. "The task force concern was overall air quality given the natural dust, emissions from local communities and drifting down the valley from Kabul, Bagram aviation operations and related airfield sources, and ground traffic."
While preventive medicine detachments had conducted air sampling for particulate matter, Kolivosky's team brought in a literal ton of specialized equipment to identify organic and inorganic compounds as well.
"Previously, particulate matter had been sampled at Bagram by preventive medicine detachments, but not the other sampling that we did on this mission," Kolivosky explained. "We had multiple types of samplers, including high-volume samplers, passive canisters, battery-powered samplers, and real-time, continuously operating surveillance data loggers. PM detachments normally are using light-weight, portable samplers that are easy to set up and move, but don't provide this level of capability."
The team was on the ground for three weeks testing multiple areas on the air field.
"We selected locations on the basis of where the most people were concentrated, where the most people would be moving through, and where the aviation brigade operated," Kolivosky said. "Our objectives were to get different air quality based on these locations and to address the potential exposure of the largest number of people."
While deployed, the team encountered scrutiny from the task force's public health chief, who turned out to be a friendly face from home.
"They delivered the most comprehensive sampling that has been done by U.S. forces to date," affirmed Col. Steven Cersovsky, now back from deployment and serving as the USAPHC's director of the Epidemiology and Disease Surveillance Portfolio. "They're providing a detailed snapshot in time -- another series of data points that will help build the repository of exposures we hope to link with future health outcomes. This is the ultimate goal -- the Holy Grail of public health -- a goal that has been very difficult to achieve in the past."
The team sent back about 200 samples for analysis in the Army Institute of Public Health's Laboratory Sciences Portfolio.
"This number of samples is enough to give a good initial screening at a level of detail we previously haven't had for Afghanistan," Kolivosky said.
Once analyzed, a report on findings will be forwarded to Task Force Medical Afghanistan. The report will assess both operational and long-term health risks using Military Exposure Guidelines and EPA models, and will recommend whether additional air surveillance is needed, he said.
In addition to air surveillance, team members also extended the reach of the mission by providing their equipment and the training to use it to a preventive medicine detachment at Kandahar, the next Afghan location selected to yield a detailed snapshot of air quality.
"Our training of the preventive medicine detachment followed the methodical 'crawl, walk and run' approach" said Capt. Ralph Sepulveda, an environmental science and engineering officer who also served as the team's operations officer. "Comprehensive training occurred over a two-day period and included equipment familiarization of the high volume (PS-1) samplers, assembly and disassembly of this equipment, trouble-shooting, maintenance and minor repair, data collection, and site selection. Day two allowed the detachment personnel actual hands-on training with setting up PS-1 samplers and collecting and processing sample media."
The team members on the mission included three civilians and two military environmental science and engineering officers. With Kolivosky were Nathan Cook, environmental scientist, Justin McCardell, physical scientist, and Sepulveda all from the Deployment Environmental Surveillance Program at the AIPH. Capt. Godfrey Nkwantabisa, an environmental science and engineering officer from Public Health Command Region--North, also participated in the mission.
"Our mission was definitely a success," Sepulveda said. "We accomplished all our goals: sample collection, training of deployed personnel and risk communication fielding questions at the CRC (CONUS Replacement Center), during in- and out-briefs, and daily questions from interested base personnel."