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OCR for page 19
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The Institute of Medicine's Persian Gulf Activities
IOM has undertaken several activities focusing on the potential health
implications of deployment in the Persian Gulf War and on DoD and VA
responses to health concerns. The IOM Medical Follow-up Agency examined
the health consequences of service in the Persian Gulf and developed
recommendations for research and information systems. The first report of that
group (IOM, 1995) recommended that "The VA Persian Gulf Health Registry
should be limited and specific to gathering information to determine the types of
conditions reported.... There should be efforts to implement quality control
and standardization of data collected by the registry." The report went on to
recommend that improved publicity regarding the availability of the Registry
was needed. For a complete list of recommendations, see Appendix A.
The second and final report of the Medical Follow-up Agency (IOM,
1996a) provides 16 recommendations, with accompanying findings, concerning
research and information systems needed regarding the health consequences of
service during the Persian Gulf War (see Appendix B).
In 1994, DoD asked IOM to assemble a group of medical and public health
experts to evaluate the adequacy of the CCEP. That committee concluded that
specific changes in the protocol would help increase its diagnostic yield but that,
overall, the CCEP was a comprehensive effort to address the clinical needs of
those who served in the Persian Gulf War. That report also stated that He CCEP
was not appropriate as a research tool but that the results could and should be
used to educate Persian Gulf veterans and the physicians caring for them, to
improve the medical protocol itself, and to evaluate patient outcomes. (See
Appendix C for a complete set of recommendations.)
19
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20
ADEQUACY OF THE VA PERSIAN GULF~GISTRYAND UCAP
DoD asked IOM to continue its evaluation of the CCEP giving special
attention to three issues: (1) approaches to addressing difficult-to-diagnose
individuals and those with ill-defined conditions, (2) the diagnosis and treatment
of stress and psychiatric conditions, and (3) the assessment of health problems
of those who may have been exposed to low levels of nerve agents. A report
addressing the adequacy of the CCEP relative to nerve agents was released in
April 1997 (IOM, 1997~. It concluded that, overall, the CCEP provides an
appropriate screening approach to the diagnosis of neurological diseases and
conditions but that certain refinements would enhance the program. (See
Appendix D for a complete set of recommendations.)
The issues of medically unexplained conditions and stress and psychiatric
disorders were addressed in a separate and final report. That report concluded
that information provided over time has led to the ability to focus CCEP
evaluation efforts on emerging areas of importance. To that end the committee
made several suggestions including the need to emphasize treatment of
symptoms, whether or not a diagnosis has been determined; the need to provide
increased screening for depression, traumatic exposure, and substance abuse; the
importance of conducting an evaluation across facilities to determine
consistency in terms of examinations and patterns of referral; and the need for
greater communication between DoD and VA, particularly as it relates to the
ongoing treatment of patients. A complete set of recommendations appears in
Appendix E.
In September 1996, VA asked IOM to convene a panel of experts to fulfill
the congressional mandate to review the VA Persian Gulf protocol and its
implementation. Specific areas to be addressed included the adequacy of (1) the
protocol to address the wide range of medical assessment needs of Persian Gulf
veterans, (2) the implementation of the protocol and administration of the
program, (3) outreach efforts to inform veterans of available services, and (4)
education of providers.
Over the course of the project the committee heard presentations and
reviewed written material provided by representatives of VA, the Presidential
Advisory Committee, the General Accounting Office, the American Legion, aIld
Disabled American Veterans. In addition, the committee reviewed the VA
manual and protocol for the Persian Gulf Registry and UCAP; received reports
of the health and research activities being undertaken in Britain and Canada
regarding their Persian Gulf War veterans; examined the relevant scientific
literature; solicited written input from national veterans organizations aIld all
VA health facilities; conducted site visits to three VA facilities; and received
staff updates on testimony, research, quality assurance activities, and other
information related to the health of Persian Gulf veterans. This report contains
the findings and recommendations of that committee.
Representative terms from entire chapter:
gulf war
