Index

INDEX

A execution of, 17–18 exposure assessment model, 17–18 Abbreviations, xix–xxii headquarters level role and responsibilities, 12–13 Aberdeen Proving Ground, 9 installation level role and responsibilities, 13–16 Acceleration injury, 268 major command roles and responsibilities, 13 Accreditation Council for Graduate Medical Education, 122 management review, 19 ACGIH. See American Conference of Governmental Industrial overview, 12 Hygienist planning process, 16–17 Acquisition, Technology, and Logistics, Under Secretary of role and responsibilities, 12–16 Defense for, 115–116 supervisor role and responsibilities, 16 Acronyms, xix–xxii Air pollution, 478 ADA. See Americans with Disabilities Act Air-purifying respirators, 220–222 Adams, John, 42 Air sampling, 84–85 Administrative medical examinations, 63–64 Airborne hazards, 596–599 Advanced Very High Resolution Radiometer, 76 Al Tuwaitha Nuclear Research Center, 92 Aerospace medicine Aliphatic nitrate esters acceleration injury, 268 nitrocellulose, 572 altitude-induced hypoxia, 264–265 nitroglycerin, 568–572 barotrauma, 265–266 Altitude-induced hypoxia, 264–265 circadian rhythm disturbance, 273–275 Ambient air regulations, 392 color vision, 279–281 AMC. See Army Materiel Command counter fatigue programs, 278–279 AMCOM. See Aviation and Missile Life Cycle Management decompression sickness, 266–267 Command ejection injury, 268 American Conference of Governmental Industrial Hygienist, 156, environmental risk factors, 276–277 236, 239, 368 ergonomics, 275 American Industrial Hygiene Association, 236, 368 fatigue, 273–275 Americans with Disabilities Act, 129 fi tness testing programs, 278 Ammunition plants, 5–7 hazards, illness and injury, 264–276 Amsden, Sergeant 1st Class Lance, vi heat stress, 268 Anesthetic gases, 175–176 hypothermic injury, 268 , 4 industrial hazards, 275–276 Anniston Defense Munitions Center, 5 laser eye protection, 281 Anthrax att acks, 88–89 loss of consciousness, 268 Anti-G straining maneuver, 270 military aviation administration, 283–286 Antineoplastic agents, 176–177 modifi ed duty programs, 278 AOEHP. See Army Occupational and Environmental Health motion sickness, 271–272 Program new accession exams, 277–278 APHC. See Army Public Health Center night vision goggles, 281–282 Armed Forces Health Longitudinal Technology Application, 100 noise-induced hearing loss, 272–273 Army Center for Health Promotion and Preventive Medicine, 74 personal protective equipment, 279 Army Chemical Materials Activity, 8 pressure illness, 265–268 Army Contracting Command, 7 readiness and deployment, 277–279 Army ergonomics program, 244–245 refractive surgery, 282–283 Army Health Promotion Program, 65–66 sleep deprivation, 273–275 Army Hearing Conservation Program, 200–213 spatial disorientation, 270–271 Army industrial hygiene program, 239–240 structure of atmosphere, 264 Army Materiel Command sustained acceleration, 269–270 Army Materiel Systems Analysis Activity, 8 thermal stress, 268 The Logistics Support Activity, 8 three-dimensional motion, 268–272 mission of, 3 transient acceleration, 269 mott o, 2 travel health hazards, 275 quality of work environment, 8–9 visual performance and protection, 279–283 US Army Aviation and Missile Life Cycle Management weaponry and injury, 275 Command, 5 Afghanistan, Operation Enduring Freedom, 86–100 US Army Chemical Materials Activity, 8 AFMSA. See Air Force Medical Support Agency US Army Communications-Electronics Command, 5 Agency Query System, 146 US Army Contracting Command, 7 Agent Orange, 72 US Army Joint Munitions Command, 5–7 Ahmadi Oil Fields, Kuwait, 73 US Army Military Surface Deployment and Distribution Air evacuation, 285–286 Command, 7–8 Air Force Medical Support Agency, 13 US Army Security Assistance Command, 8 Air Force occupational and environmental health program US Army Sustainment Command, 7 critical elements of, 17 Army Materiel Systems Analysis Activity, 8 emerging developments in Air Force Occupational Medicine, 19 Army Medical Command, 117 employee role and responsibilities, 16

xxiii Occupational Health and the Service Member

Army Military Surface Deployment and Distribution Command, Asbestosis, 380 7–8 Aseptic bone necrosis, 332 Army Occupational and Environmental Health Program Assistant Secretary of Defense for Health Aff airs, Offi ce of, 116 budgeting, 123–124 Atmosphere-supplying respirators, 223–224 contracting for occupational health services, 124 Atmospheric structure, 264 DoD program structure and management, 115–117 Atomic Energy Commission, 424 expanding service delivery, 124 Atomic fi ssion, 401 funding, 123–124 Att ack submarines, 355 management of, 117–118 Audiograms, 134–135 overview, 114–115 Audiology, 33 personnel, 120–123 Audiometry, 208 quality measures, 118–120 Aviation and Missile Life Cycle Management Command, 5 Army Occupational Health Programs Aviation and Missile Research, Development, and Engineering administrative medical examinations, 63–64 Center, 3 Army Occupational and Environmental Health Program, Aviation medicine, 46–47. See also Aerospace medicine 115–124 in Bosnia, Herzegovina, and Kosovo, 83–86 B credentialing and privileging, 60–61 Back injuries, 252–256 disability retirement examinations, 64 Baggage inspection systems radiation, 415 emergency treatment, 66 Ballast handling, 390 employee health clinics, 60 Ballistic missile submarines, 356 employees, 62 Barotrauma, 265–266, 319–323 epidemiological investigations, 65 Base operational medicine clinic, 19 evaluation of, 59 Basic Program Elements for Federal Employee Occupational fi tness-for-duty examinations, 64 Safety and Health Programs, 56 health hazard education, 64 Beaver, Hull Technician Fireman R., 35 health promotion, 65–66 Benton, Thomas Hart, 46 health providers, 61 Beryllium immunizations, 65 acute beryllium disease, 510 industrial hygienists, 61 biomarkers of exposure, 511–512 informatics, 100–103 carcinogenesis of, 511 laws, regulations, and guidance, 56–59 dermatologic eff ects, 511 marketing, 58–59 diagnosis of chronic beryllium disease, 513 medical centers, 59–60 environmental exposure, 507–508 medical directives, 58 exposure prevention and control, 514 medical records management, 62–63 genetic predisposition, 513 medical surveillance, 63 health eff ects, 509–512 monitoring absences due to illness, 64–65 industrial use, 506 nurses, 61 manufactured products that use beryllium, 507 occupational health business plan, 58 occupational exposure, 508–509 occupational health clinics, 59–60 occupational surveillance, 512–513 Operation Enduring Freedom, 86–100 pathophysiology of chronic beryllium disease, 509–510 Operation Iraqi Freedom, 86–100 regulation and legislation, 509 organization of, 59–62 sensitization, 510 during Persian Gulf War, 72–83 symptoms of chronic beryllium disease, 510–511 program document, 57–58 treatment of chronic beryllium disease, 513–514 safety personnel, 61–62 workers with potential occupational exposure to, 507 staffi ng, 60–62 Bioenvironmental engineering, 14–15 standard operating procedures, 58 Biological exposure indices, 239 status report, 57–58 Biological hazards, 178–181 supervisors, 62 Biological monitoring worksite evaluations, 64 airborne hazards, 596–599 Army Public Health Center, 117–118 big data analysis, 606–607 Army Public Health Command, 117 biomarker discovery and applications, 599–602 Army Security Assistance Command, 8 biomarkers defi nition, 594 Army surgeon general, 117 biomarkers of pulmonary injury, 604 Army Sustainment Command, 7 DoD needs for exposure assessment and biomarkers, 596–599 Arsenals, 7 epigenetic biomarkers, 604–606 Arsenic, 369–370 exhaled breath condensate, 603 Arterial gas embolism, 266–267, 323, 328, 335–338 exposure memory, 603–604 Asbestos genetic biomarkers, 604–606 asbestos medical surveillance program, 162, 163 genetics in pulmonary injury research, 605–606 forms of, 380 nasal lavage analysis, 603 health eff ects, 161–162 physiological test matrices, 602–603 medical surveillance, 381 protein biomarkers, 604 routes of exposure, 380 saliva, 603 toxicology, 380–381 serum cytokines, 604 uses, 380 types of biomarkers, 594–596 xxiv Index

Biological surveillance initiative, 74, 75 diagnosis of, 487–488 Biomarkers emergency and accidental exposures, 493–495 applications, 599–602 emergency response planning guidelines, 494–495 comparison of, 596 environmental exposure standards, 493 defi nition, 594 exposure incidents, 483–484 discovery of, 599–602 health standards and guidelines, 489–496 DoD needs for, 596–599 health status and, 496 of eff ect, 595 heat stress and, 495 epigenetic, 604–606 high temperature and, 495 of exposure, 594–595 historical exposures, 479–480 genetic, 604–606 hydrogen cyanide and, 496 limitations on use of, 596 hyperbaric oxygen treatment location, 489 protein biomarkers, 603–604 industrial exposures, 478–479 of pulmonary injury, 604 internal combustion engines, 479 of susceptibility, 595–596 medical surveillance, 497 Blane, Sir Gilbert, 43 methylene chloride, 479, 496 Blood-borne pathogen exposure control plan, 193–198 military occupational exposures, 490–492 , 7 military sources of exposure, 479–484 BOMC. See Base operational medicine clinic mines, 479 Borden, Captain William C., 403 modern era exposures, 480–483 Bosnia and Herzegovina Navy submarine escape action levels, 494 air sampling, 84–85 nitric oxide and, 496 environmental concerns, 83–84 nonmilitary sources of exposure, 478–479 Operation Joint Guardian, 86 ototoxicity, 496 Operations Joint Endeavor, Joint Guard, and Joint Forge, outdoor air pollution, 478 84–85 pathophysiology, 484–485 pesticide wipe sampling, 86 structural fi res, 479 soil sampling, 86 symptoms, 485 water sampling, 85–86 tobacco smoke, 478, 495–496 Boyle’s law, 315–316 toxicity, 326–327 Brachytherapy, 410 treatment for, 488–489 Bradley fi ghting vehicles, 480–481 work-eff ort constants for predicting carboxyhemoglobin blood Breath-hold diving content, 490, 503 compression of descent, 339–340 Carboxyhemoglobin, 490, 503 decompression sickness, 340 Cardiovascular disease diving refl ex, 338–339 carbon monoxide exposure eff ects, 487 hypercapnia, 340 risk assessment for respirator wearers, 229 hypoxia, 340 Cargo inspection systems radiation, 415–416 Brown, Dr. Ernest, 48 CEMR. See Civilian employee medical records Brown, Tarnisha, 33 Center for Health Promotion and Preventive Medicine, 74, 76, 79, BSI. See Biological surveillance initiative 84, 86–91, 93–95 Buchan, Dr. William, 42 Center for Unit Records Research, 75, 80 BUMED. see Bureau of Medicine and Surgery Central Intelligence Agency, 79, 81 Buoyancy, 306–307, 317 Central nervous system Bureau of Medicine and Surgery, 24, 30 carbon monoxide exposure eff ects, 485–487 Burn pits, 98–100 oxygen toxicity in divers, 293, 324–325 Bush, George W., 87, 143 Central Technical Support Facility, 5 Certifi cation exams, 34–35, 157–158 C Champion, Hospital Corpsman 3rd Class James, 33 Charles’s law, 316 Cadmium, 370–371 Chelation, 395 Camp Freedom, Kuwait, 72 Chemical agent monitor, 413 CAP. See Computer/Electronic Accommodations Program Chemical agent-resistant coatings, 373 Capstone Report, 77 Chemical hazards, 175–178 Carbon dioxide retention, 297–298 Chemical Materials Activity, 8 Carbon dioxide toxicity, 325–326 Chemical Volatile Organic Compound Unit, 28 Carbon monoxide exposure Chemical warfare agents, 8, 78–81, 96–98 altitude and, 494–495 Chest radiographs, 135 appliances, 478 Chiarelli, General Peter, 8 Army housing and tents, 492 CHPPM. See Center for Health Promotion and Preventive autopsy fi ndings, 487 Medicine cardiovascular eff ects, 487 Chrome holes, 90, 91 central nervous system eff ects, 485–487 Chromium, 371–372 chronic eff ects, 487 Chromium exposure, 89–92 clinical presentation, 485–487 Chronic diseases surveillance, 165 Committ ee on Toxicology Emergency Exposure Guidance CIA. See Central Intelligence Agency Levels, 493–494 Circadian rhythm disturbance, 273–275 confounders, 494–496 Civilian employee medical records, 62–63

xxv Occupational Health and the Service Member

Civilian employees medical care, 47–48 D Civilian Personnel Advisory Centers, 128 Civilian Personnel Policy/Defense Civilian Personnel Advisory Dalton’s law, 317 Services, 128 Data quality, 119 Claim management process, 144–145 DBNP. See 2,6-Di-tert-butyl-4-nitrophenol Clean Air Act, 76, 392 DCPAS. See Defense Civilian Personnel Advisory Service Clinton, Bill, 128 Decompression procedures Closed-circuit mixed-gas scuba, 296 decompression sickness, 266–267, 299, 328–338 Closed-circuit oxygen scuba, 294–296 dive computers, 301 COCOs. See Contractor-owned, contractor-operated plants diving at altitude, 303, 332–333 Cold stress fl ying after diving, 303, 332–333 accidental hypothermia, 624–627 helium-oxygen diving, 302 body protection and insulation, 619 in-water decompression stops, 300 cold injuries, 620–627 multilevel diving, 301 estimated survival time in cold water, 624 nitrogen-oxygen diving, 301–302 exposure guidelines, 619–620 no-stop dives, 299–300 external equipment, 620 omitt ed decompression, 302–303 freezing cold injuries, 620–622 repetitive diving, 300, 301 hand protection and insulation, 619 safety of decompression practices, 303 insulation value of clothing, 628 surface decompression, 301 medical surveillance, 627 trimix diving, 302 nonfreezing cold injuries, 622–624 Decompression sickness photokeratitis treatment, 620 altitude exposure after diving, 303, 332–333 physiology of, 618–619 arterial gas embolism, 266–267, 328 prevention, 627–630 aseptic bone necrosis, 332 temperature measurements, 619 bubble formation, 329 work cycle recommendations during cold environmental clinical presentation, 330–332 conditions, 629 decompression tables, 334 Cold temperature risks, 246, 252 diving at altitude, 303, 332–333 Color vision, 279–281 factors aff ecting individual susceptibility, 333–334 Commercial driver medical examinations, 159 of free diving, 340 Commission on Illumination, 463 inert gas exchange, 329 Committ ee on Toxicology Emergency Exposure Guidance Levels, oxygen treatment for table, 267 493–494 patent foramen ovale as risk factor, 334 Communications-Electronics Command, 5 pathophysiology of, 329–330 Compensation. See Federal workers’ compensation prevention of, 299, 334 Compensation specialist, 140–143 probability of, 334 Comprehensive Environmental Response, Compensation, and in saturation diving, 337–338 Liability Act, 391 symptoms of, 331 Computed tomography, 405–406, 410 treatment of, 266, 335–338 Computer/Electronic Accommodations Program, 140 types of, 266 Consciousness loss, 268 US Navy treatment tables, 335–337 Constrictive bronchiolitis, 95 Defense Ammunition Center, 5 Consultative support, 33–34 Defense Civilian Personnel Advisory Service, 141, 143 Consumer Product Safety Improvement Act, 392 Defense Health Agency, 116–117 Contact lenses, 282 Defense Health Board, 91 Contaminated diving, 352–354 Defense Manpower Data Center, 75, 80–81 Continuing education units, 123 Defense Medical Surveillance System, 553 Continuing medical education, 123 Defense Occupational and Environmental Health Readiness Contracting Command, 7 System, 12, 100–101, 240, 553 Contractor-owned, contractor-operated plants, 3 Defense Occupational and Environmental Health Readiness Corrosion control, 36 System-Hearing Conservation, 36, 100–101 Cotinine, 602 Defense Occupational and Environmental Health Readiness Counter fatigue programs, 278–279 System-Industrial Hygiene, 9, 86, 100–102 CPACs. See Civilian Personnel Advisory Centers Defense Safety Oversight Council, 115 Crane Army Ammunition Activity, 5–6 Department of Defense Crane operators examination, 159 Federal Employees Compensation Act program, 141–143, 146 Credentialing, 60–61 Hearing Center of Excellence, 210 Cryogenic fl uids, 465 industrial hygiene exposure assessment model, 237–239 Crystalline silica, 381–382 Laser Injury Hotline, 452 CS. See Compensation specialist military workers’ compensation cost and rates, 143–144 CURR. See Center for Unit Records Research needs for exposure assessment and biomarkers, 596–599 Cutbush, Dr. Edward, 44–45 occupational health regulations and guidance, 57–58 CWAs. See Chemical warfare agents policy for handling exposures to depleted uranium, 434–435 CWM. See Chemical warfare materiel program structure and management, 115–117 Cyanide, 372–373 Protecting Our Workers and Ensuring Reemployment, 143, Cyclosarin, 80 146–148 Cytokines, 604 radiation safety program, 429–434 xxvi Index

reviews of military compensation programs, 144–146 nitrogen narcosis, 327, 351 Serum Repository, 553, 599 ocular oxygen toxicity, 325 Department of Labor overview, 292 compensation program management eff orts, 146–148 oxygen toxicity, 324–325, 350–351 Department of the Navy pathophysiological eff ects of common diving gases, 323–328 organization of, 24–26 physical principles, 314–317 safety and occupational health programs, 26–37 pulmonary oxygen toxicity, 324 Department of Transportation recompression chambers, 309–310 commercial driver medical examination, 159 role of respiration in diving injuries, 297–299 Depleted uranium, 76–78, 414, 434–436 saturation diving, 303–306 Deployment assessment, 277–279 thermal protection, 306–307 Deployment Environmental Surveillance Program, 100, 101, 555 underwater breathing apparatuses, 293–296 Deployment surveillance vision underwater eff ects, 317–318 active deployment medical surveillance, 554–555 Diving medical offi cers, 307 challenges, 556–557 Diving refl ex, 338–339 consequences of the Persian Gulf War, 550–551 DMDC. See Defense Manpower Data Center data repositories, 552–553 DoD. See Department of Defense Deployment Environmental Surveillance Program, 555 DOEHRS. See Defense Occupational and Environmental Health Disease Reporting System-internet, 554 Readiness System documenting exposures, 551–552 DOEHRS-IH. See Defense Occupational and Environmental during the Ebola outbreak, 555––556 Health Readiness System-Industrial Hygiene medical situational awareness in the theater, 554 DoN. See Department of the Navy modeling, 555 Dosimetry, 422 passive deployment medical surveillance, 554 Drinking water regulations, 392 Periodic Occupational and Environmental Monitoring Drugs, hazardous, 176–177 Summary, 552 DSOC. See Defense Safety Oversight Council postdeployment health surveys, 554 DVCCs. See Disease vector control centers Theater Medical Information Program, 554–555 Dysbaric osteonecrosis, 332 Depots, 7 Dyspnea, 297–298, 354 Dermatitis, 567 DHA. See Defense Health Agency E 2,6-Di-tert-butyl-4-nitrophenol, 357–358 Ear. See also Hearing conservation programs Diesel exhaust, 373 anatomy and physiology, 200–202 Digital radiography, 408 inner ear barotrauma, 321 Dignifi ed Burial and Other Veterans’ Benefi ts Improvement Act, Ebola outbreak, 555––556 99 Edison, Thomas, 419 Diisocyanates, 373–374 Ejection injury, 268 Dinitrotoluene, 576–577 Electrical soldering hazards, 390 Disabilities. See Employees with disabilities Electrocardiograms, 135 Disability retirement examinations, 64 Electromagnetic radiation, 402 Disabled submarines, 359–361 Electronic Data Interchange system, 141 Disease Reporting System-internet, 554 Elemental exposures, 380–383 Disease vector control centers, 27, 28 Emergency contact information, 452 Disinfectants hazards, 174 Emergency Exposure Guidance Levels, 493–494 Dive computers, 301 Emergency Fleet Corporation, 48 Dive medicine, 46–47 Emergency treatment, 66 Diving. See also Undersea medicine Emotional stress, 183 barotrauma, 319–323 Employees. See Federal workers’ compensation; Personnel breath-hold diving, 338–340 Employees with disabilities, 129–131, 165 buoyancy, 306–307, 317 Energy Research and Development Administration, 424 carbon dioxide retention, 297–298 Environment, safety, and occupational health, 12 carbon dioxide toxicity, 325–326 Environmental exposures, 391 carbon monoxide toxicity, 326–327 Environmental extremes, 182 central nervous system oxygen toxicity in divers, 293, 324–325 Environmental health. See Occupational and environmental contraindications to diving, 308–309 health program decompression procedures, 299–303 Environmental monitoring, 84–86 decompression sickness, 299, 328–338 Environmental Protection Agency, 73, 76, 84–86, 273, 423–424 dyspnea, 297–298 Environmental regulations, 391–392 gas laws, 315–317 Environmental Surveillance Integration Program, 101–102 hearing underwater eff ects, 318–319 EPA. See Environmental Protection Agency helium eff ects, 327–328 Epidemiological investigations, 65 hydrogen eff ects, 328 Epigenetic biomarkers, 604–606 hyperbaric oxygen therapy, 309–310 Epigenomics, 602 individual susceptibility to impaired consciousness, 299 Ergonomics inert gas eff ects, 328 active surveillance, 246–247 interactions between gases and impaired consciousness, aviation risks, 275 298–299 basic ergonomics assessment survey form, 260–261 medical standards for diving, 307–309

xxvii Occupational Health and the Service Member

cold temperature assessment, 252 Federal Employees Compensation Act program, 140–141 duration assessment, 251 military workers’ compensation cost and rates, 143–144 forceful exertion assessment, 251 Offi ce of Workers’ Compensation Programs, 140–141 health contribution, 249 reviews of military compensation programs, 144–146 manual material handling, 252–256 Felloney, Landing Signal Offi cer Brian, 33 mechanical compression assessment, 251 Firefi ghters examination, 160 passive surveillance, 247 Firefi ghting operations, 93–96 personal protective equipment, 249–250 Firing ranges hazards, 389–390 posture assessment, 250 Fit test records, 233 program organization, 244–245 Fitness-for-duty examinations, 64, 278, 284–285 program regulations, 244 Fitness standards, 128–131 recognizing hazards, 246–247 Fleet epidemic disease control units, 26 repetition assessment, 251 Flight and operational medicine, 16 risk factor management, 247–249 Flight medicine, 46–47, 284–286 risk factors, 245–246 FMCSA. See Federal Motor Carrier Safety Agency US Army ergonomics program, 244–245 FOM. See Flight and operational medicine vibration assessment, 252 Food and Drug Administration, 392 wellness contribution, 248–249 Food contamination, 392 worksite task analyses, 250–252 Forceful exertion risks, 246, 251 ESIP. See Environmental Surveillance Integration Program Forklift operators examination, 160 ESOH. See Environment, safety, and occupational health Formaldehyde, 177 Exercise stress test, 135 Fort Campbell, Kentucky, 484 Exhaled breath condensate, 603 Fort Hood, Texas, 483–484 Experimental Diving Unit, 47 Fort Irwin National Training Center, California, 484 Explosive ordinance handlers examination, 159–160 Forward deployable preventive medicine units, 28 Explosives Free diving, 338–340 acute exposure decontamination, 567 Free electron laser, 462 administrative controls, 566 Fukushima, Japan, 429 aliphatic nitrate esters, 568–572 Full-face respirators, 221, 223 carcinogenesis, 568 Functional health status, 119 composites, 583–584 dermatitis and, 567 G energetic materials, 563–564 G-induced loss of consciousness, 269–270 engineering controls, 565–566 GAO. See Government Accountability Offi ce exposure, 564–566 Gas laws, 315–317 history of, 562–563 Gas removing respirators, 222 industrial hygiene principles, 565–566 Genetic biomarkers, 604–606 initiating explosives, 583 Genetic Information Nondiscrimination Act, 130–131 methemoglobinemia and, 567–568 Genomics, 600 nitramines, 577–583 Gilmer, Thomas, 45, 46 nitroaromatics, 572–577 GINA. See Genetic Information Nondiscrimination Act personal protective equipment, 566 Glutaraldehyde, 177 preplacement considerations, 566–567 GOCOs. See Government-owned, contractor-operated plants safety practices, 565 GOGOs. See Government-owned, government-operated plants vasodilation and, 568 Goiânia, Brazil, 411–412 Explosives vehicle operators examination, 159–160 Gordon, Dr. Maurice Bear, 42 Exposome, 596 Government Accountability Offi ce, 102, 144, 146 Exposure assessment model, 237–239 Government-owned, contractor-operated plants, 3 Eye tests, 134 Government-owned, government-operated plants, 3 F Green, Dr. Ezra, 42 Ground System Enterprise, 4 FAA. See Federal Aviation Administration Guided missile submarines, 356 Facilities maintenance, 182–183 Gulf War illness, 72–73, 83 Fatigue risks, 273–275, 278–279 Gun propellants, 585 FDPMUs. See Forward deployable preventive medicine units GWI. See Gulf War illness FECA. See Federal Employees Compensation Act FEDCUs. See Fleet epidemic disease control units H Federal Aviation Administration, 133 Half-face respirators, 221 Federal Employees Compensation Act, 48, 57, 140–143, 146 Hawthorne Army Depot, 7 Federal Motor Carrier Safety Agency, 128, 133 Hazardous substances. See also specifi c substances Federal Radiation Council, 423 arsenic, 369–370 Federal workers. See Personnel asbestos, 380–381 Federal workers’ compensation cadmium, 370–371 Computer/Electronic Accommodations Program, 140 chromium, 371–372 Department of Labor program management eff orts, 146–148 crystalline silica, 381–382 DoD FECA program, 141–143 cyanide, 372–373 FECA management challenges, 146 diesel exhaust, 373 xxviii Index

diisocyanates, 373–374 engineering controls, 208 elemental exposures, 380–383 expanded program components, 211 inorganic exposures, 380–383 garrison-based hearing conservation programs, 207 lead, 388–395 health education, 208–209 metals, 369–372 hearing anatomy and physiology, 200–202 methyl ethyl ketone, 375–376 hearing conservation on the batt lefi eld, 211–213 methylene chloride, 374–375 hearing protection, 208 mustard agents, 376–377 improving hearing loss prevention eff orts, 209–211 occupational exposure limits, 238–239, 368 incidence of hearing loss in the Army, 205–206 organic exposures, 372–380 medical surveillance, 165–166 organophosphate nerve agents, 377–378 mission-critical hearing studies, 210–211 pentachlorophenol, 378–379 monitoring audiometry, 208 trichloroethylene, 379–380 Navy program, 35–36 tritium, 382–383 noise hazard evaluation, 207–208 white phosphorus, 383 noise-induced hearing loss, 202–204 Hazards. See Health hazards preventing noise-induced hearing loss, 207–209 HCV exposure, 195 program evaluation, 209 Health Advisory Program, 85 sound identifi cation, 212–213 Health Aff airs, Assistant Secretary of Defense for, 116 sound localization, 212 Health hazard education, 64 tinnitus, 205 Health Hazard Information Management, 100 Hearing Evaluation Automated Registry System, 100 Health hazards Hearing loss, 35 abatement strategies, 183–185 Hearing protection devices, 208 anesthetic gases, 175–176 Heat stress, 268 antineoplastic agents, 176–177 Helium-oxygen diving, 302, 327–328 biological hazards, 178–181 Henry’s law, 317 blood-borne pathogen exposure control plan, 193–198 Hepatitis B, 178–179, 196 chemical hazards, 175–178 Hepatitis C, 178–179 emotional stress, 183 Hexahydro-1,3,5-trinitro-1,3,5-triazine, 577–579 environmental extremes, 182 High frequency exposures, 203 facilities maintenance, 182–183 High power illuminator radar, 458 formaldehyde, 177 High pressure nervous syndrome, 305–306 glutaraldehyde, 177 HIPAA. See Health Insurance Portability and Accountability Act hazardous drugs, 176–177 HIV. See Human immunodefi ciency virus hepatitis B, 178–179 Holston Army Ammunition Activity, 6 hepatitis C, 178–179 Horner, Dr. G.R.B., 45 human immunodefi ciency virus, 179 Hot-particle trauma, 426 latex, 180–181 HRA. See Health risk assessment medical maintenance, 182–183 HRM. See Human resource management mercury, 178 Human Capital Distribution Plan, 120 methicillin-resistant Staphylococcus aureus, 181 Human immunodefi ciency virus, 179, 195 methyl methacrylate, 178 Human resource management, 128 in military healthcare facilities, 172, 173 Hybrid Single-Particle Lagrangian Integrated Trajectories, 76 musculoskeletal strain, 182 Hydrogen cyanide, 496 noise hazards, 181–182 Hydrogen diving, 328 overview, 172–174 Hyperbaric arthralgia, 305 personnel and population screening, 174–175 Hyperbaric oxygen therapy, 309–310, 489 physical hazards, 181–183 Hypercapnia, 340, 354 psychosocial hazards, 183 Hyperthermia, 307, 352 radiation hazards, 181 Hypothermia, 306–307, 351–352, 624–627 of selected solvents, reagents, and disinfectants, 174 Hypothermic injury, 268 shift work, 183 Hypoxia, 340, 354 tuberculosis, 179–180 Hypoxia, altitude-induced, 264–265 types of, 175–183 workplace violence, 185 I Health Insurance Portability and Accountability Act, 62, 130–131, Imaging radiation, 414–416 158 Immunizations, 65 Health Program business plan, 58 Immunomics, 602 Health promotion, 65–66 Improvised explosive devices, 202 Health risk assessment, 74, 75 IMX, 580–583 Health Services Command, 56 In-water decompression stops, 300 Health status measurement, 119 Industrial hygiene, 28, 31–32, 61, 75 Healthcare workers health hazards. See Health hazards Industrial hygiene program management Hearing, underwater eff ects, 318–319 Army-specifi c requirements, 239–240 Hearing Center of Excellence, 210 Defense Occupational and Environmental Health Readiness Hearing conservation programs System, 240 Army program, 200–213 DoD exposure assessment model, 237–239 DoD Hearing Center of Excellence, 210

xxix Occupational Health and the Service Member

metrics, 240 Jones, Captain John Paul, 42 organization of program, 236–237 Jones, Dr. John, 42 overview, 236 Jones, Dr. Robert, 48 practicing Army industrial hygiene, 237–240 Inert gas diving, 328, 329 K Informatics, 100–103 Kellogg Brown and Root, 89 Initiating explosives, 583 Kennon, Captain Beverly, 45, 46 Injury statistics, 143 Kerst, Donald, 407 Inner ear barotrauma, 321 Khamisiyah Ammunition Supply Point, 78–81 Inorganic exposures, 380–383 Kleghorn, Dr. James, 45 Insensitive munitions, 580–583 Kosovo Installation occupational health regulations, 57 air sampling, 84–85 Institute of Medicine, 78, 99–100 environmental concerns, 83–84 Ionizing radiation Operation Joint Guardian, 86 Army personnel exposure standards, 425 Operations Joint Endeavor, Joint Guard, and Joint Forge, biological eff ects of radiation, 417–421 84–85 categories of eff ects, 420 pesticide wipe sampling, 86 combined internal and external exposures, 426 soil sampling, 86 controlling contamination in the medical treatment facility, water sampling, 85–86 428–429 Kuwait depleted uranium, 414 Ash Shuaiba Port, 92–93 development of dosimetry, 422 oil well fi res, 72–76 development of standards, 422–423 developments in atomic fi ssion, 401 L discovery and applications of X-rays, 402–408 discovery and uses of radioisotopes, 408–413 Laboratory tests, 134 DoD radiation safety program, 429–434 Lake City Army Ammunition Activity, 6 electromagnetic radiation, 402 Laser eye protection, 281 external irradiation, 426 Laser Injury Hotline, 452 the Fukushima incident, 429 Lasers high-dose exposures, 427–428 direct biological eff ects, 462–464 hot-particle trauma, 426 exposure incidents, 469–471 imaging techniques, 414–416 indirect biological eff ects, 464–466 intermediate-dose exposures, 427 laser-generated air contaminants, 465 internal deposition, 425–426 military applications, 467–469 low-dose exposures, 427 overview, 460–461 mass casualties, 426–427 properties of, 461–462 mechanisms of eff ects, 420 protection standards, 466–467 medical examination, 162–164 safety program, 471–473 medical response to depleted uranium exposure, 434–436 LASIK, 282–283 medical response to incidents, 425–429 Latex, 180–181 in military operations, 413–417 Lead non-occupational dose limits, 424–425 air exposures, 391 nuclear reactors, 413–414 ambient air regulations, 392 occupational dose limits, 424 from ballast handling, 390 occupational radiation risks, 420–421 blood lead level, 393 particulate radiation, 400, 402 bone lead measurement, 393 personnel security screening systems, 416 cardiovascular eff ects, 395 physical security systems, 414 chelation, 395 procedures for whole-body exposures, 427–428 clinical implications of lead exposure, 394–395 properties of, 400–402 cumulative blood lead index, 393 protecting the medical team, 428 drinking water regulations, 392 protection against radiation, 421–425 eff ects in adults, 394–395 radiation dispersal devices, 416 eff ects in children, 394 radiation produced by nuclear weapons, 414 from electrical soldering, 390 radiological base camp assessments, 416–417 endocrine eff ects, 394 recognition of eff ects, 417–420 environmental exposures, 391 regulatory agencies, 423–424 environmental regulations, 391–392 types of exposures, 425–427 exposure tests, 393 Iowa Army Ammunition Activity, 6 from fi ring ranges, 389–390 Iraq, Operation Iraqi Freedom, 86–100 food contamination, 392 Isocyanates, 373–374 gastrointestinal eff ects, 395 hematological eff ects, 394 J history of lead toxicity, 388 military occupational exposures, 389–390 Jet propellants JP-5 and JP-8, 82 neurological eff ects, 394 JMC. See Joint Munitions Command occupational surveillance, 392 Joint Munitions Command, 5–7 xxx Index

in paint, 392 Medical intelligence, 535 from paint stripping, 389 Medical maintenance, 182–183 pregnancy eff ects, 394 Medical Matrix, 50 renal eff ects, 394 Medical Matrix Committ ee, 50 soil exposures, 391 Medical Matrix Validation Committ ee, 34–35, 50 water exposures, 391 Medical records management, 62–63 from welding, 389 Medical standards of fi tness, 128–131, 307–309 zinc protoporphyrin test, 393 Medical surveillance Lead azide, 583 Army program, 63 Lead styphnate, 583 asbestos, 161–162, 163 Lett erkenny Munitions Center, 6 assessing need for programs, 154–155 Life Cycle Management Command, 4–5 certifi cation examinations, 157–158 Lightfoot, Hull Maintenance Technician 2nd Class A., 35 crane operators, 159 Lind, Dr. James, 43 Department of Transportation commercial driver medical Linear accelerator, 407 examination, 159 Liquid propellants, 584–585 documenting physical exam and managing results, 158–159 Livingston, Stanley, 409 employees with chronic diseases, 165 Log of Federal Occupational Injuries and Illnesses, 59 employees with physical disabilities, 165 Logistics and Readiness Center, 5 examinations, 132–133 Logistics Support Activity, 8 explosive ordinance handler, 159–160 Longshore and Harbor Workers’ Compensation Act of 1927, 48 explosives vehicle operator, 159–160 Lukavac Base, 84 fi refi ghter, 160 forklift operator, 160 M hearing conservation, 165–166 Navy program, 34–35 Maiello, Commander Richard, 28 police, 160–161 Mail inspection systems radiation, 415 program design, 155–157 MAJCOM. See Major command radiation, 162–164 Major command roles, 13 reproductive hazards, 164–165 Malaria and Epidemic Control Organization, 26 security guards, 160–161 Management information system, 12, 13 specifi c occupations, 159–161 Manpower Review Program, 120 Medical Surveillance Procedures Manual, 50 Manual material handling Medical treatment facilities, 24–25 administrative control, 253–254 Mercury, 178 engineering control, 253 MESL. See Military Exposure Surveillance Library frequency factors, 256 Metabolomics, 601 individual risk factors, 254–255 Metallomics, 602 lifting, 252–254 Metals toxicology, 369–372 objects distribution, 255–256 Methemoglobinemia, 567–568 weight distribution, 255–256 Methicillin-resistant Staphylococcus aureus, 181 Marine Corps Methyl ethyl ketone, 375–376 Marine Corps War Memorial, 26 Methyl methacrylate, 178 Navy and Marine Corps Public Health Center, 24, 26, 30, 34, Methylene chloride, 374–375, 496 49–50 MicroRNA, 602 Marine Corps safety and occupational health program Microwave radar, 448, 456–457 components of, 34–37 Middle ear barotrauma, 319–321 organization of, 30, 31 Milan Army Ammunition Activity, 6 Public Health Center technical manuals, 34 Military aviation administration resources, 34–37 air evacuation, 285–286 staffi ng, 30 aviation fi tness evaluation, 284–285 Marine life risks, 354–355 determining fl ight status, 285 Marshall, General George E., 274 determining work relatedness, 285 Mass casualties, 426–427, 544 facility and equipment design, 283 Materiel Systems Analysis Activity, 8 fl ight medicine, 284–286 Maximum contaminant levels, 85 health hazard evaluations, 284 McAlester Army Ammunition Activity, 6 inspections, 284 McCann rescue chamber, 47 management commitment, 283 MCLs. See Maximum contaminant levels mishap investigation, 284 M1E1 tanks, 480 safety and health, 283–284 Mechanical compression, 246, 251 training and education, 283–284 MEDCOM. See Medical Command Military diving operations. See Diving MEDEVAC, 285 Military Exposure Guidelines, 86 Mediastinal emphysema, 322 Military Exposure Surveillance Library, 86, 101–102 Medical Command, 117, 120–121 Military Surface Deployment and Distribution Command, 7–8 Medical Department of the Army Coat of Arms, iii MIS. See Management information system Medical directives, 58 Mishap investigation, 284 Medical evaluation records, 232–233 Mishraq State Sulfur Mine, 93–96 Medical Information Module, 100 Modifi ed duty programs, 278

xxxi Occupational Health and the Service Member

Motion sickness, 271–272 NECE. See Navy Entomology Center of Excellence Mouth bit respirators, 221 Negative pressure respirators, 230–231 MRSA. See Methicillin-resistant Staphylococcus aureus NEHC. See Navy Environmental Health Center MTFs. See Medical treatment facilities NEPMUs. See Navy Environmental and Preventative Medicine Multilevel diving, 301 Units Musculoskeletal strain, 182 New accession exams, 277–278 Mustard agents, 376–377 NIEHC. See Navy Industrial Environmental Health Center Night vision goggles, 281–282 N Nightingale, Florence, 172 NIHL. See Noise-induced hearing loss NAS-CT. See National Academy of Science’s Committ ee on 9/11 terrorism att acks, 87–88 Toxicology NIOSH. See National Institute for Occupational Safety and Health Nasal lavage analysis, 603 Nitramines National Academy of Science’s Committ ee on Toxicology, 77 hexahydro-1,3,5-trinitro-1,3,5-triazine, 577–579 National Ambient Air Quality Standards, 76, 84 insensitive munitions, 580–583 National Defense Authorization Act for Fiscal Years 1992 and nitroguanidine, 579–580 1993, 73 octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine, 579 National Fire Protection Association, 160 Nitric oxide, 496 National Institute for Occupational Safety and Health, 368, 493 Nitroaromatics National Research Council, 390, 493 dinitrotoluene, 576–577 National Safety Council, 115 trinitrotoluene, 572–576 National Toxicology Program, 389–390 Nitrocellulose, 572 Natural uranium, 76 Nitrogen narcosis, 327, 351 Naval Armament Act of 1797, 43 Nitrogen-oxygen diving, 301–302 Naval Diving and Salvage Training Center, 292 Nitroglycerin Naval Health Research Center, 50 freezing point of, 568 Naval Medical Center, 24–25, 28 health eff ects, 569–570 Naval Ordnance Systems Command Environmental Health manufacture and exposure hazards, 569 Center, 49 medical surveillance, 570–571 Naval Safety Center, 29 primary prevention, 571–572 Navy and Marine Corps Public Health Center, 24, 26, 30, 34, 49–50 Nitroguanidine, 579–580 Navy Bureau of Medicine and Surgery, 24 NITROX, 301–302 Navy Entomology Center of Excellence, 28 NMC. See Naval Medical Center Navy Environmental and Preventative Medicine Units, 28 NMCPHC. See Navy and Marine Corps Public Health Center Navy Environmental Health Center, 28 No-stop dives, 299–300 Navy Industrial Environmental Health Center, 49–50 NOHIMS. See Navy Occupational Health Information Navy Medical Department organization, 27 Management System Navy Medical Service Corps, 28 Noise Control Act of 1972, 273 Navy Medicine Noise hazards, 181–182 the colonial Navy, 42–43 Noise-induced hearing loss establishment of fl ight and dive medicine, 46–47 aviation hazards, 272–273 evolution of occupational medicine practice, 42–50 high frequency exposures, 203 the new Navy, 43–46 mechanisms of, 202–203 occupational and environmental health programs, 24–37, 50 ototoxins, 203–204 organization of, 24–26 preventing, 207–209, 273 preventive medicine, 26–28 susceptibility to, 203 role of, 30 ultrasonic exposures, 203 Navy Occupational Health Information Management System, 50 Non-coding RNAs, 604–605 Navy safety and occupational health program Nonionizing radiation audiology, 33 absorption, 447 certifi cation exams, 34–35 characteristics of electromagnetic radiation, 443–447 components of, 34–37 coherence, 445 consultative support and oversight, 33–34 diff raction, 447 current strategic-level responsibilities, 29 divergence, 444–445 history of, 26–28 electromagnetic spectrum, 442 industrial hygiene, 31–32 emergency contact information, 452 laws, regulations, and guidance, 30 interaction with matt er, 445–447 Medical Matrix Validation Committ ee, 34–35 interference, 445 medical surveillance, 34–35 lasers, 460–473 occupational and environmental medicine, 32–33, 50 optical radiation, 460–473 organization of, 30–34 overview, 442–443 process improvement, 37 physical properties, 444–445 program self-assessment, 37 polarization, 445 Public Health Center technical manuals, 34 radio frequency radiation, 447–460 resources, 34–37 refl ection, refraction, and scatt er, 445–446 safety offi cers, 30–31 transmission, 446–447 staffi ng, 30–34 Nonneutral postures, 245, 250 worksite visits, 36 xxxii Index

Nuclear medicine, 49 Organic exposures, 372–380 Nuclear reactors, 413–414 Organophosphate nerve agents, 377–378 Nuclear Regulatory Commission, 423–424 OSAGWI. See Offi ce of the Special Assistant for Gulf War Illnesses Nuclear weapons radiation, 414 OSHA. See Occupational Safety and Health Administration Nurses, occupational health, 61 OSHA 300 Log of Federal Occupational Injuries and Illnesses, 59 Ototoxicity, 496 O Ototoxins, 203–204 OWCP. See Offi ce of Workers’ Compensation Programs Obama, Barack, 143 Oxygen toxicity, 293, 324–325, 350–351 Occupational and Environmental Health Data Portal, 101–102 Occupational and environmental health programs. See also Army P Occupational Health Programs Air Force, 12–19 Paint Navy, 24–37, 50 lead from paint stripping, 389 Occupational and Environmental Health Site Assessment, 102– lead in, 392 103 Particulate matt er, 84–85, 94 Occupational and environmental medicine, 32–33 Particulate radiation, 400, 402 Occupational exposure limits, 238–239, 368 Particulate respirators, 222 Occupational hazards. See Health hazards Pascal’s law, 317 Occupational health business plan, 58 Patent foramen ovale, 334 Occupational health clinicians, 142–143 Pathogens, blood-borne, 193–198 Occupational Health Management Information System, 101 “Peacemaker,” 45–46 Occupational Health Program Evaluation Guide, 37 Pentachlorophenol, 378–379 Occupational Medicine Program Assessment, 37 Pentagon terrorism att acks, 86–88 Occupational Safety and Health Act of 1970, 30, 50, 101 Performance measurement systems, 119 Occupational Safety and Health Administration Periodic evaluations, 131–135 ionizing radiation regulation, 423–424 Periodic Occupational and Environmental Monitoring Summary, lead standard, 389–390 102–103, 552 occupational exposure limits, 368 Permissible exposure levels, 156, 239 Occupational Safety and Health Administration Act, 12, 56–57 Perry, Commodore Matt hew, 45 required medical surveillance examinations, 132–133 Persian Gulf War respiratory protection, 220–233 chemical weapons use, 78–81 standards, 30 depleted uranium exposure, 76–78 Occupational Safety and Health Administration Act, 12, 56–57 deployment surveillance consequences, 550–551 Octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine, 579 Gulf War illness, 72–73, 83 Ocular oxygen toxicity, 325 jet propellants JP-5 and JP-8, 82 OEH. See Occupational and environmental health programs Khamisiyah storage facility, 78–81 OEHSA. See Occupational and Environmental Health Site Kuwaiti oil well fi res, 72–76 Assessment Personal protective equipment, 155, 237–238, 248–250, 279, 566 Offi ce of Personnel Management Personnel. See also Federal workers’ compensation general schedule occupations with medical or physical Army staffi ng assessment model for civilian occupational requirements, 130 health providers, 121–122 role of, 128 documentation requirements, 135 Offi ce of the Special Assistant for Gulf War Illnesses, 77, 79–81 employees with disabilities, 129–131 Offi ce of the Surgeon, 2 Human Capital Distribution Plan, 120 Offi ce of Workers’ Compensation Programs, 140–141, 146 making the case for more personnel, 122 OHP. See Occupational Health Program managing authorizations and requirements, 120–121 OHPEG. See Occupational Health Program Evaluation Guide medical standards of fi tness, 128–131 Oil well fi res, 72–76 medical tests and procedures, 134–135 Olsbrucken, Germany, 484 OSHA-mandated medical surveillance examinations, 132–133 “OMICS” technologies, 600 periodic evaluations, 131–135 Omitt ed decompression, 302–303 physical requirements, 129 OMPA. See Occupational Medicine Program Assessment physician professional development, 122–123 Open-circuit, self-contained underwater breathing apparatus, 293 policy enforcement examinations, 135–136 Operation Enduring Freedom, 86–100 preplacement evaluations, 131–135 Operation Iraqi Freedom, 86–100 provider-patient relationship, 128–129 Operation Joint Guardian, 86 recruitment and retention, 122 Operation New Dawn, 87 role of providers, 121 Operation Vigilant Warrior, 92–93 role of surgeon general’s consultant, 120–121 Operations Joint Endeavor/Joint Guard/Joint Forge, 84–85 special surveillance programs and examinations, 133 OPM. See Offi ce of Personnel Management surveillance examination content, 133–134 Optical radiation termination medical examinations, 137 direct biological eff ects, 462–464 training and competencies, 122 exposure incidents, 469–471 Personnel and Readiness, Under Secretary of Defense for, 115–116 indirect biological eff ects, 464–466 Personnel Proponency Directorate, 121 overview, 460–461 Personnel security screening systems, 416 properties of, 461–462 Pesticide wipe sampling, 86 Organ of Corti, 202–203 Phased array antenna systems, 457

xxxiii Occupational Health and the Service Member

Phillips, Dr. Ralph, 406 Public Law 79-658, 56 Photokeratitis, 620 Puget Sound Naval Shipyard and Intermediate Maintenance Photorefractive keratectomy, 282–283 Facility, 36 Physical examinations Pulmonary barotrauma, 321–322 documenting, 158–159 Pulmonary function tests, 90–91, 94–95, 135, 156, 229 managing results, 158–159 Pulmonary oxygen toxicity, 324 pre-employment, 43 Pyrotechnics, 564 Physical hazards, 181–183 Pine Bluff Arsenal, 7 Q Pleural plaques, 380 Qarmat Ali Water Treatment Plant, 89–92 PMUs. See Preventive medicine units Quality improvement, 119–120 Pneumothorax, 322–323 Quality measures, 118–120 POEMS. See Periodic Occupational and Environmental Quality of life measurement, 119 Monitoring Summary Quality of work environment, 8–9 Police examination, 160–161 Quiet Communities Act of 1978, 273 Policy enforcement examinations, 135–136 QWE. See Quality of work environment Position risks, 245–246 Positive pressure respirators, 230–231 R Postdeployment health surveys, 554 Postexposure prophylaxis, hepatitis B, 196 Radar technology, 447–448 Posture risks, 245, 250 Radford Army Ammunition Activity, 7 POWER. See Protecting Our Workers and Ensuring Radiation. See also Ionizing radiation; Nonionizing radiation Reemployment classifi cation of, 162–163 Powered air-purifying respirators, 221–222 regulations, 163 Pre-employment physicals, 43 Radiation Control for Health and Safety Act, 423 Preplacement evaluations, 131–135 Radiation dispersal devices, 416 Pressure equivalents, 316 Radiation hazards, 181 Pressure illness, 265–268 Radiation safety program Preventative health assessment, 277 administrative controls, 431–432 Preventive medicine, 26–28 designation of restricted areas, 432 Primary prevention, 154 elements of, 431–434 Privileging, 60–61 engineering controls, 432 Process improvement, 37 goals of, 429–430 Program assessment tools, 119–120 medical surveillance, 433 Program Objective Memorandum, 9 personnel monitoring, 433–434 Program self-assessment, 37 radiation safety committ ee, 430 Propellants radiation safety offi cer, 430–431 acute exposure decontamination, 567 recordkeeping, 434 administrative controls, 566 respiratory protection, 434 aliphatic nitrate esters, 568–572 responsibilities, 430–431 carcinogenesis, 568 standard operating procedures, 431 composites, 583–584 training, 431–432 dermatitis and, 567 Radio communication, 447–448 energetic materials, 564 Radio communications systems, 455 exposure, 564–566 Radio frequency radiation history of, 562–563 absorption, 450 industrial hygiene principles, 565–566 administrative procedures, 460 initiating explosives, 583 conduction, 449 liquid, 584–585 controls, 460 methemoglobinemia and, 567–568 coupling, 449–450 nitramines, 577–583 direct biological eff ect, 450–451 nitroaromatics, 572–577 emergency contact information, 452 personal protective equipment, 566 emission of, 454–455 preplacement considerations, 566–567 exposure incidents, 457–459 safety practices, 565 exposure limits, 452 vasodilation and, 568 indirect biological eff ects, 451 Protecting Our Workers and Ensuring Reemployment, 143, inventory of radio frequency-producing sources, 460 146–148 low-level eff ects, 451 Protein biomarkers, 604 microwave radar, 448 Proteomics, 601 military applications, 455–458 Provider-patient relationships, 128–129 physical properties that determine energy transfer, 449–450 Psychosocial hazards, 183 radar during World War II, 448–449 Public health radar technology, 447–448 Air Force, 15–16 radiation control, 453 Navy and Marine Corps Public Health Center, 24, 26, 30, 34, radiation protection, 451–453 49–50 radio communication, 447–448 Public Health Center technical manuals, 34 safety program, 459–460 training programs, 460 xxxiv Index

Radioisotopes S accident at Goiânia, Brazil, 411–412 brachytherapy, 410 Safe Drinking Water Act, 85, 391 diagnostic uses, 409–410 Safety, Health, and Return to Employment, 143 industrial uses, 411–413 Safety and occupational health programs medical uses, 408–411 Air Force, 12–19 nondestructive inspection, 411 Marine Corps, 30, 31 radioactive commodities, 411–413 Navy, 24–37 radiopharmaceutical therapy, 410 Safety offi cers, 30–31 teletherapy, 410–411 Saliva analysis, 603 therapeutic uses, 410 , 80 Radiological base camp assessments, 416–417 Saturation diving Radiopharmaceutical therapy, 410 atmospheric control, 304–305 RDECOM. See Research, Development and Engineering decompression, 306 Command decompression sickness, 337–338 Readiness assessment, 277–279 fi re risk, 305 Reagents hazards, 174 high pressure nervous syndrome, 305–306 Recompression chambers, 309–310 hyperbaric arthralgia, 305 Recording and Reporting Occupational Injuries and Illnesses, 57 infection risk, 305 Recruit screening, 45 overview, 303–304 Red River Army Depot, 4 temperature control, 306 Redstone Arsenal, 7, 8 Scott Air Force Base, 7 Refractive surgery, 282–283 Scranton Army Ammunition Activity, 7 Rehabilitation Act of 1973, 129 Scuba diving. See Diving Repetition risks, 245–246, 251 Scurvy prevention, 43 Repetitive diving, 300, 301 Sea port of debarkation/embarkation, 92–93 Reproductive hazards, 164–165 SEAL delivery vehicles, 292 Research, Development and Engineering Command, 3–4 Seaman’s Sickness and Disability Act of 1798, 45 Resource Conservation Recovery Act, 391 Secondary prevention, 154 Respiration, diving injuries and, 297–299 Secret Internet Protocol Router Network, 102 Respiratory protection Secretary of Defense, Offi ce of, 115–116 air-purifying respirators, 220–222 Security Assistance Command, 8 atmosphere-supplying respirators, 223–224 Security guards examination, 160–161 breathing air for supplied-air respirators, 232 Self-contained breathing apparatus, 223–224 cardiovascular risk assessment and evaluation procedures, 229 Self-propelled howitz ers, 481–483 cleaning and storage, 231 Semmelweis, Dr. Philipp Ignaz, 172 color coding, 231 Serum cotinine, 602 disqualifying conditions for respirator use, 227 Serum cytokines, 604 fi ltration mechanisms and classifi cation, 222–223 Serum IgE, 602 fi t test records, 233 Serum Repository, 553, 599 function checks, 231 SHARE. See Safety, Health, and Return to Employment inspection, 231 Shift work hazards, 183 maintenance, 231–232 Shipboard medicine medical considerations and evaluation, 226–229 amphibious operations, 530–531 medical evaluation records, 232–233 blood bank, 544 physiological eff ects of respirator wear, 226 classes of ships, 524 physiological problems, 226–228 competence for duty examinations, 543 program evaluation, 232 corpses, 544 psychological problems, 226–228 crew preparation and screening, 535–536 pulmonary function testing, 229 disposal of medical waste, 544–545 purpose of medical evaluation, 228 disposition of the sick sailor, 541 record keeping, 232–233 elective surgery, 543 respirator classifi cation, 220–224 environment in shipyards, underway, and at port calls, respirator selection guidelines, 225–226 536–540 respirator service life, 224 epidemiology and epidemics, 538–539 respirator tests and checks, 230–231 fl ight operations, 539–540 respiratory protection programs, 224–225 heat issues, 537 training, 232 hypoxic spaces, 539 training records, 233 isolation and confi nement, 537–538 Risk adjustment, 119 life aboard, 523, 525–526 Risk categorization, 15 mass casualties, 544 Risk management process, 12, 14 medical care of women, 542–543 Rock Island Arsenal, 5, 7 medical departments, 524, 531–534 Rock Island Arsenal Joint Manufacturing and Technology Center, 4 medical evacuation, 541–542 Rocket propellants, 584 medical intelligence, 535 Roentgen-ray tubes, 403 mortality associated with drinking seawater, 531 noise issues, 537 operational medicine during wartime, 527–531

xxxv Occupational Health and the Service Member

organization aboard ship, 522 T pests and vectors, 539 planning for medical evacuation, 535 Tank-Automotive and Armaments Command Life Cycle port calls, 542 Management Command, 4–5 predeployment planning, 534–536 Team Aerospace requirements for specifi c medical equipment, 529 bioenvironmental engineering, 14–15 ships and missions, 522–523 fl ight and operational medicine, 16 the ship’s cycle, 526–527 public health, 15–16 sick call, 540–541 TEH. See Total Exposure Health sinking, immersion, and survival, 529–530 Telemedicine, 541 telemedicine, 541 Teletherapy, 410–411 Sick call, 540–541 Termination medical examinations, 137 Sierra River Army Depot, 4–5 Terrorism att acks, 9/11, 87–88 Silicosis, 381–382 Tertiary prevention, 154 Similar exposure groups, 238 The Gulf War Oil Spill, 73 Sinus barotrauma, 321 The Logistics Support Activity, 8 SIPRNet, 102 Theater Medical Information Program, 554–555 Sleep deprivation risks, 273–275 Thermal stress, 268 SMART-PM. See Special Medical Augmentation and Response Three-dimensional motion, 268–272 Team-Preventive Medicine Threshold limit values, 156, 239 Smith, Lieutenant Linwood, 48 Tinnitus, 35, 205 Snow blindness, 620 Tobacco smoke, 478, 495–496 Software Engineering Center, 5 Tobyhanna Army Depot, 5 SOH. See Safety and occupational health programs Tooele Army Depot, 7 Soil sampling, 86 Total Exposure Health, 19 Solvents hazards, 174 TRANSCOM. See US Transportation Command Sound navigation, 355 Transcriptomics, 600–601 Spatial disorientation, 270–271 Transient acceleration, 269 Special Medical Augmentation and Response Team-Preventive Transmission imaging, 414–415 Medicine, 87, 89–91 Travel health hazards, 275 SPOD/E. See Sea port of debarkation/embarkation Treadway, Lieutenant Commander Paul, 32 SRDRS. See Submarine rescue diving and recompression system Tri-service industrial base, 3–9 St. Medard, Dr. Peter, 44 TRICARE Management Agency, 116 Standard operating procedures, 58 Trichloroethylene, 379–380 Standards of fi tness, 128–131 Trimix diving, 302 Staphylococcus aureus, methicillin-resistant, 181 Trinitrotoluene, 572–576 Status report, 57–58 Troop Movement Database, 75, 80 Steam-powered ships, 45–46 Tuberculosis, 179–180, 382 Stephenson, Rear Admiral Charles, 49 Tuzla Air Base, 84 Stockton, Captain Robert F., 46 Tyler, John, 45 Stoddert, Benjamin, 44 Stress, emotional, 183 U Submarine rescue diving and recompression system, 360–361 UHF radio communications systems, 455 Submarines Ultrasonic exposures, 203 2,6-di-tert-butyl-4-nitrophenol, 357–358 Under Secretary of Defense for Personnel and Readiness, 115–116 atmosphere management and control, 358–359 Undersea medicine att ack submarines, 355 contaminated diving, 352–354 ballistic missile submarines, 356 dyspnea, 297–298, 354 carbon monoxide exposure, 494 hypercapnia, 340, 354 central atmosphere monitoring system, 357 hyperthermia, 307, 352 disabled submarines, 359–361 hypothermia, 306–307, 351–352 environment, 357 hypoxia, 340, 354 escape and rescue, 360–361, 494 illness or injury resulting from diving, 349–350 guided missile submarines, 356 marine life risks, 354–355 oxygen depletion, 359–360 nitrogen narcosis, 327, 351 sleep, 361–362 oxygen toxicity, 293, 324–325, 350–351 toxic gases, 359–360 physical properties, 350 types and classes, 355–356 pressure, 350 working schedule, 361–362 problems with underwater breathing equipment, 354 Sulfur mine fi re, 93–96 protective gear, 352–354 Supplied-air respirators, 232 sound, 351 Surface decompression, 301 sound navigation and ranging, 355 Surface-supplied diving, 293–294 submarines, 355–362 Surveillance programs. See Medical surveillance temperature, 351–352 Sustained acceleration, 269–270 undersea operations, 348–349 Sustainment Command, 7 underwater hazards, 354–355 visibility, 351 water quality, 352–354 xxxvi Index

Underwater breathing apparatuses, 293–296 employees, 62 United Nations Special Commission, 80 epidemiological investigations, 65 Universal gas equation, 316 evaluation, 59 Upshur, Abel, 45, 46 evaluation of, 59 Uranium, depleted, 76–78 fi tness-for-duty examinations, 64 US Air Force occupational and environmental health program health hazard education, 64 critical elements of, 17 health promotion, 65–66 emerging developments in Air Force Occupational Medicine, health providers, 61 19 immunizations, 65 employee role and responsibilities, 16 industrial hygienists, 61 execution of, 17–18 informatics, 100–103 exposure assessment model, 17–18 laws, regulations, and guidance, 56–59 headquarters level role and responsibilities, 12–13 marketing, 58–59 installation level role and responsibilities, 13–16 medical centers, 59–60 major command roles and responsibilities, 13 medical directives, 58 management review, 19 medical records management, 62–63 overview, 12 medical surveillance, 63 planning process, 16–17 monitoring absences due to illness, 64–65 role and responsibilities, 12–16 nurses, 61 supervisor role and responsibilities, 16 occupational health clinics, 59–60 US Army Armament Research, Development and Engineering Operation Enduring Freedom, 86–100 Center, 4 Operation Iraqi Freedom, 86–100 US Army Aviation and Missile Life Cycle Management organization of, 59–62 Command, 5 during Persian Gulf War, 72–83 US Army Center for Health Promotion and Preventive Medicine, program document, 57–58 74 safety personnel, 61–62 US Army Chemical Materials Activity, 8 staffi ng, 60–62 US Army Communications-Electronics Command, 5 standard operating procedures, 58 US Army Communications-Electronics Research, Development status report, 57–58 and Engineering Center, 4 supervisors, 62 US Army Contracting Command, 7 worksite evaluations, 64 US Army Edgewood Chemical Biological Center, 4 US Army Research Laboratory, 3 US Army Environmental Hygiene Agency, 74 US Army Security Assistance Command, 8 US Army ergonomics program, 244–245 US Army Sustainment Command, 7 US Army Joint Munitions Command, 5–7 US Army Tank Automotive Research, Development and US Army Materiel Command Engineering Center, 4 Army Materiel Systems Analysis Activity, 8 US Department of Defense The Logistics Support Activity, 8 Federal Employees Compensation Act program, 141–143, 146 mission of, 3 Hearing Center of Excellence, 210 mott o, 2 industrial hygiene exposure assessment model, 237–239 quality of work environment, 8–9 Laser Injury Hotline, 452 Research, Development and Engineering Command, 3–4 military workers’ compensation cost and rates, 143–144 Tank-Automotive and Armaments Command Life Cycle needs for exposure assessment and biomarkers, 596–599 Management Command, 4–5 occupational health regulations and guidance, 57–58 US Army Aviation and Missile Life Cycle Management personnel medical evaluations, 128–137 Command, 5 policy for handling exposures to depleted uranium, 434–435 US Army Chemical Materials Activity, 8 program structure and management, 115–117 US Army Communications-Electronics Command, 5 Protecting Our Workers and Ensuring Reemployment, 143, US Army Contracting Command, 7 146–148 US Army Joint Munitions Command, 5–7 radiation safety program, 429–434 US Army Military Surface Deployment and Distribution reviews of military compensation programs, 144–146 Command, 7–8 Serum Repository, 553, 599 US Army Security Assistance Command, 8 US Department of Labor US Army Sustainment Command, 7 compensation program management eff orts, 146–148 US Army Military Surface Deployment and Distribution US Department of Transportation Command, 7–8 commercial driver medical examination, 159 US Army Natick Soldier Research, Development and Engineering US Marine Corps Center, 4, 5 Navy and Marine Corps Public Health Center, 24, 26, 30, 34, US Army Occupational Health Programs 49–50 administrative medical examinations, 63–64 US Marine Corps War Memorial, 26 Army Occupational and Environmental Health Program, US Marine Corps safety and occupational health program 115–124 components of, 34–37 in Bosnia, Herzegovina, and Kosovo, 83–86 organization of, 30 credentialing and privileging, 60–61 Public Health Center technical manuals, 34 disability retirement examinations, 64 resources, 34–37 emergency treatment, 66 staffi ng, 30 employee health clinics, 60

xxxvii Occupational Health and the Service Member

US Navy W the colonial Navy, 42–43 comprehensive occupational health programs during World Walter Reed National Military Medical Center, 25 War II, 48–49 Waste anesthetic gases, 176 decompression sickness treatment tables, 335–337 Water sampling, 85–86 development of steam-powered ships, 45–46 Watervliet Arsenal, 5 evolution of occupational medicine practice, 42–50 Weaponry injuries, 275 Navy and Marine Corps Public Health Center, 24, 26, 30, 34, Welding hazards, 389 49–50 White phosphorus, 383 the new Navy, 43–46 Whole-blood tests, 90 occupational health programs during World War I, 48–49 Workers. See Federal workers’ compensation; Personnel organization of, 24–26 Workers’ compensation program. See also Federal workers’ in the 20th Century, 46–50 compensation US Navy Medical Department systems analysis, 144–145 the colonial Navy, 42–43 Workplace organization of, 27 risk categorization, 15 US Navy Medicine violence in, 185 care for civilian employees, 47–48 Worksite evaluations, 64 establishment of fl ight and dive medicine, 46–47 Worksite task analyses, 250–252 organization of, 24–26 Worksite visits, 36 preventive medicine, 26–28 World Trade Center terrorism att acks, 86–88 role of, 30 World War I US Navy safety and occupational health program need for occupational health programs, 48 audiology, 33 World War II certifi cation exams, 34–35 comprehensive Navy occupational health programs, 48–49 components of, 34–37 WRNMMC. See Walter Reed National Military Medical Center consultative support and oversight, 33–34 current strategic-level responsibilities, 29 X hearing conservation program, 35–36 X-rays history of, 26–28 diagnostic uses, 405–406 industrial hygiene, 31–32 digital radiography, 408 laws, regulations, and guidance, 30 industrial uses, 407–408 Medical Matrix Validation Committ ee, 34–35 medical uses, 402–407 medical surveillance, 34–35 therapeutic uses, 406–407 occupational and environmental medicine, 32–33, 50 organization of, 30–34 Y process improvement, 37 program self-assessment, 37 Yellow sodium dichromate exposure, 89 Public Health Center technical manuals, 34 resources, 34–37 Z safety offi cers, 30–31 Zinc protoporphyrin test, 393 staffi ng, 30–34 worksite visits, 36 US Transportation Command, 285 USAEHA. See US Army Environmental Hygiene Agency USS Constitution, 26, 43–44 USS Falcon, 47 USS Harry S. Truman, 35 USS Independence, 45 USS Ohio, 36 USS Princeton, 45–46 V VA Airborne Hazards and Open Burn Pit Registry, 99 Vapor removing respirators, 222 Vehicle inspection systems radiation, 415–416 Very small aperture terminal communication systems, 456 Veterans Health Care Act of 1992, 73 VHF radio communications systems, 455 Vibration risks, 246, 252 , 72 Violence, workplace, 185 Vision, underwater eff ects, 317–318 Vision tests, 134

xxxviii