MILITARY MEDICINE—like the peace-enforcement effort that it supports—now has an open-ended commitment in the former Yugoslavia.
After previous extensions of US forces' stay in the war-torn Bosnia-Herzegovina region, the Clinton administration has now said withdrawal should be determined by progress toward lasting peace rather than by any deadline date. Previously, the administration had announced US troops would leave next June.
As 1998 begins, the United States is contributing slightly more than 8000 troops to the 34000-member North Atlantic Treaty Organization (NATO) force seeking to prevent resumption of the bloody 3
-year civil war among Serbs, Croats, and Muslims in what was the nation of Yugoslavia.
Little Illness or Injury
At the annual meeting in Nashville, Tenn, of the Association of Military Surgeons of the United States (AMSUS), speakers noted that—in the absence of combat—the illness and injury rate for US forces deployed to Bosnia has been the lowest in history.
Ronald R. Blanck, DO, a US Army lieutenant general and current AMSUS president, said the illness and injury rate in Bosnia is 76 cases per 1000 US service members per year. Blanck, who is the US Army's surgeon general, said this rate compares with 153 cases per 1000 during the 1990 and 1991 Desert Shield/Desert Storm deployment against Iraq and 419 cases per 1000 annually during the conflict in Southeast Asia during the 1960s and early 1970s.
According to the US Department of Defense (DOD), before US service members are deployed for NATO's Operation Joint Endeavor in Bosnia, they undergo comprehensive medical screening, collection of blood samples that are stored for future reference, and education about health risks (and preventive measures to be taken) in the region.
To protect US service men and women once they join NATO's stabilization force, surveillance of the environment and any unusual incidence of disease is being conducted, according to the DOD. For the former, more than 112000 analyses of soil, water, and air samples from Bosnia have been done. For medical surveillance, laboratories have been set up where US troops are based to provide immediate on-the-spot diagnostic support.
According to DOD officials, these environmental and medical surveillance efforts resulted in early detection of the threat of tickborne encephalitis in the region. Prompt vaccination has helped prevent the development of this type of encephalitis among US forces deployed there.
US military commanders in Bosnia also must work with military physicians to assure that the troops' medical records are kept up to date and any potentially health-related events are recorded. When US military personnel complete their tours of duty in Bosnia, they undergo additional comprehensive physical and mental health screening and serum collection before leaving or within 10 days of reporting to their new assignment.
The Pentagon has been criticized for the quality of some medical records maintained for US personnel during the war in the Persian Gulf 7 years ago. This in part has prompted the DOD's "force medical protection" effort now under way.
Force medical protection (which in turn is part of the so-called revolution in military affairs affecting future US military doctrine, capability, and operations) includes monitoring of immunizations.
Anthrax Vaccination Increased
The DOD is ordering all of the approximately 1.5 million men and women (unless pregnant) in uniform (who make up an all-volunteer force) to be immunized against anthrax as a precaution against a possible terrorist biological attack. Researchers working in military laboratories and uniformed personnel in the various branches' biological and chemical warfare units or special operations forces already are receiving the anthrax vaccine, according to DOD officials. Six injections are required over an 18-month period, with an annual booster. Some recipients experience mild localized reactions.
Some (state) Army and Air National Guard personnel, who may be designated by the DOD to respond if there is a local terrorist attack using biological weapons, are expected to be immunized against anthrax. Selected other military reservists, certain DOD civilian workers, and perhaps a few others might also be immunized if they are likely to be sent to high-threat areas, according to officials.
Pentagon officials have said that at least a dozen nations are capable of producing anthrax spores and incorporating them into biological weapon delivery systems.
The concern, discussed with increasing frequency in recent weeks as Iraq resists United Nations inspection of potential weapons development and storage sites, is that a rogue state might be tempted to use such mass-casualty weapons for terrorist purposes.
A major theme of the AMSUS meeting was the possible use of biological weapons and its challenges for medicine. Anthrax is one of the potential biological weapons that was discussed in Nashville by researchers and clinicians studying these spores and possible countermeasures.
