The Future of Military Occupational and Environmental Medicine in the Department of Defense

Hazardous non-combat exposures are inherent to military service and occur in three settings: installation workplaces, installation environments, and deployment environments. Few military clinicians receive training in how to recognize, assess, and manage patients with these exposures, and systems improvements are needed to support clinicians with respect to exposure recognition and management. This commentary highlights key concepts surrounding military non-combat exposures by discussing three case examples of exposures occurring in each of these settings. In the workplace, well-coordinated, interdisciplinary occupational health teams improve identification of exposure-related illnesses, and these teams may be further supported by the development of automated clinical decision-support systems. Installation environmental exposures are characterized by high perceived risk, uncertainty in estimating actual risk, and a wide range of stakeholders including military family members and individuals in the surrounding community. Recognizing environmental exposure concerns, gathering a thorough environmental exposure history, and practicing exposure risk communication are vital skills to address these situations. During deployments, exposures may initially be perceived as low risk but then become a concern years later. A functional understanding of the capabilities and limitations of exposure monitoring and potential health effects of exposures helps the military clinician effectively communicate potential health risks to line leaders. For any of these exposure settings, service public health centers and OEM specialty leaders and consultants are available for consultation.

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Hazardous Non-Combat Exposures in the U.S. Department of Defense

Krahl

Mallon

Gaydos

2021

Military Medicine

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The Capability Gap in Occupational Health Information Management

2022

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The lack of an integrated approach to data capture, information management, and analysis limits the contribution of occupational and environmental medicine to protecting 2.3 million uniformed and civilian DoD workers. Despite an abundance of military information systems that include the terms “Safety” and “Occupational Health” in their names, none of these systems provide capabilities needed to aggregate and analyze the results of occupational medicine exams, use medical surveillance to mitigate exposure incidents, provide enterprise-level management of occupational medicine services, or comply with privacy and recordkeeping law and regulation. Instead, they provide a patchwork of data that meets most regulatory compliance requirements but fails to achieve the true objectives of occupational health programs. Bridging these capability gaps will improve the occupational health care of the DoD workforce, improve the quality of occupational medicine services, increase public trust in the DoD management of exposure incidents, and potentially generate hundreds of millions of dollars through cost-avoidance on workers’ compensation claims and through identification and elimination of non–value-added medical certification exams. The ongoing Military Health System transformation represents a unique opportunity to bridge these long-recognized but persistent capability gaps.

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Application of Nanoconfinement Technology for Highly Effective Monitoring of Chemical Exposure During Military Service

Materer,

Apblett,

Kadossov

et al. 2023

Military Medicine

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Introduction There is myriad of volatile compounds to which military personnel are exposed that can potentially have negative effects on their health. Military service occurs in a broad array of environments so it is difficult to predict the hazardous compounds to which the personnel might be exposed. XploSafe is developing passive diffusive samplers to facilitate the sampling and quantification of a wide range of chemical vapor exposures that personnel may be exposed to in the workplace. Materials and Methods Passive diffusive samplers were constructed by filling porous Teflon tubes with OSU-6, a nanoporous silica sorbent, to produce sampler tokens. Three of these tokens were placed within a badge to fabricate passive samplers. Absorption experiments were performed to determine linear exposure regimes, sampling rates, and limits of quantification for 11 compounds, representing 8 chemical classes. Results The sampling rates were determined for 11 compounds representing 8 chemical classes. The measured linear ranges for the studied compounds are sufficiently large to allow effective sampling for 8 hours or longer. Accurate dosimetry is possible even with exposure times of days or weeks. The samplers were able to detect the presence of five airborne compounds in a paint booth of a military contractor located in Bristow, Oklahoma, and determine their average exposure concentrations. Conclusions OSU-6 based sampler badges were able to detect the presence and quantify the average exposures of five airborne compounds in a paint booth of a military contractor located in Bristow, Oklahoma. Experiments show that these samplers can adsorb and quantify a broad array of different volatile organic compounds whose high sampling rates coupled with high capacity provide both sensitivity and the ability to quantify over a large range of exposures. This technology can meet the requirements for personal samplers to create Individual Longitudinal Exposure Record for each military person.

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The Future of Military Occupational and Environmental Medicine in the Department of Defense

Cited by 3 publications

References 34 publications

Hazardous Non-Combat Exposures in the U.S. Department of Defense

Hazardous Non-Combat Exposures in the U.S. Department of Defense

The Capability Gap in Occupational Health Information Management

Application of Nanoconfinement Technology for Highly Effective Monitoring of Chemical Exposure During Military Service

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