PostDeployment Workshop Preliminary Results

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Post-Deployment WorkshopPreliminary Results

• Ms. Marilyn Null, USACHPPM
• Lt. Col. Kenneth Cox, AFIERA

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Background

• Environmental contamination found at K2 November
  2001
• USACHPPM conducted risk assessment and
  recommended mitigation measures
• Low risk if no action
• Fill in trenches cover non-US depleted uranium
  post no-entry/no digging areas
• Mitigation measures established

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Risk Communication

• Article in local newsletter (Nov 2001)
• Town Hall meetings (Spring 2002)
• Service members remained concerned
• Letters to Congressmen
• USACHPPM briefings to Army Under Secretary and
  Congress
• Calls to CENTCOM and USACHPPM for assistance
  addressing health concerns
• (May/June 2002)

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Post-Deployment Workshop Initiative

• Need to gather information to determine source of
  concerns to improve risk communication and OEH
  surveillance
• Preliminary USACHPPM research of DMSS database
  indicated primarily Air Force, and some Army
  concerns
• USACHPPM initiated formation of tri-service
  workgroup for further efforts

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Tri-Service Workgroup

• Ms. Marilyn Null, USACHPPM
• Lt. Col. Ken Cox, AFIERA
• CAPT Paul Gillooly, NEHC
• LTC Chuck Engel, DHCC
• Agreed on approach
• Each service responsible for lead on issue,
  coordination with workgroup for consistency
• USACHPPM funded contract support for initial
  effort
• Engaged VA later in process

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Approach

• Target units requesting assistance addressing
  exposure-related health concerns
• Three-tiered
• Focus group/feedback session
• QA with Subject Matter Experts
• Opportunity for risk communication training for
  those interacting with returning service members
  and their families

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Workshops to Date

• AFIERA took lead with ANG units
• NC ANG, August 2002
• MN ANG, October 2002
• Others with interest
• Ft. Drum expressed interest awaiting official
  request
• Ft. Bragg possible

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Results to Date

• IMPORTANT Findings based on only two workshops
  additional workshops needed
• Both with ANG units
• Need Army service member perspective
• Indications from workshops and other informal
  feedback that a number of important processes not
  working
• Sept 2002 redeploying service member feedback
  indicates processes remain broken

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Summary of Issues

• Inadequate and/or inconsistent information
  resulting in confusion, skepticism, and coverup
  allegations
• Difficulty in identifying and tracking those at
  K2
• Lack of individual-level member DNBI health event
  data
• Inconsistency in Post-Deployment questionnaire
  process

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Summary of Issues (cont)

• Inconsistent/contradictory preventive
  medicine/public health communication
• Medical record documentation in deployed settings
• Integration/coordination/availability of medical
  intelligence sources and information

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Issues Pre-Deployment

• Inadequate and/or inconsistent information
  throughout deployment cycle (pre, during, post)
• Pre-deployment briefs contain no site-specific
  information
• One unit didnt know K2 was final destination
• Inadequate access to/understanding of SIPRNET
  sites to gain reliable information

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Issues Intradeployment

• Neither unit informed of environmental issues
  upon arrival
• Rumor mill rampant
• Told K2 was dangerous situated atop a toxic
  waste dump
• Heard berms prevented drainage verified upon
  arrival
• Army chem-bio troops said If you put a Geiger
  counter anywhere, it will register.
• Uzbek officer told people to shower daily because
  of uranium in the dust

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Issues Intradeployment (cont)

• Senior Army PM officer saying things were safe
  while junior PM officer saying they were at risk
  and should get out as soon as possible.
• Town Hall meetings perceived as sugar-coating
• Participants unfamiliar with newsletter article
  re Nov 2001 USACHPPM effort
• Efficacy of mitigation measures questioned
• Observed dust, water erosion
• One unit reported no cordoned-off areas

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Issues Intradeployment (cont)

• Some participants accessed classified NIMA report
  on SIPRNET, alleging cover-up when information
  contradicted what leadership and PMs said
• AF Flight Surgeon could not get information from
  Army environmental and hospital commanders at K2
  told information was classified

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Issues Intradeployment (cont)

• AF Flight Surgeon did not know where to look on
  SIPRNET for information
• Medical personnel not given consistent
  information re prophylaxis for malaria
• Participants concerned about lack of
  communication from their own leadership

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Issues Post-Deployment

• No exit briefing when leaving K2
• No updates or supplemental information regarding
  K2 upon returning to home station
• Participants receiving post-deployment medical
  examinations were not reassured while Flight
  Surgeon thought exams went well
• In spite of information provided directly by
  AFIERA and DHCC prior to exams, reported Flight
  Surgeon statements included everybody dies,
  and VA will give disability if you develop
  problems later.

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Issues Post-Deployment (cont)

• No effort made to inform family members
• Completion of Post-Deployment questionnaires
  inconsistent
• Some Army members reportedly told not to document
  concerns
• Reports of others being coached on what to put in
  Concerns section
• Units concerned about reusing equipment from K2

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Additional Comments

• Participants found Workshop/Focus Group very
  useful glad to finally have a venue to discuss
  their concerns
• Majority of participants said they would trust
  unit medics if medics could provide suitable
  information
• If more information was given to us while we
  were there, we wouldnt need to be here today.

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Underlying Drivers

• Past government actions (Agent Orange, Gulf War)
  decreases credibility
• Classifying environmental surveillance
  information considered overkill and leads to
  mistrust
• Adverse living conditions at K2
• Army/AF cultural differences lead to perceived
  inequities

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Recommendations

• Conduct additional Post-Deployment Workshop/Focus
  Groups to verify trends
• Request policy-level examination of broken
  processes/systems
• Initiate process improvements for systematic and
  consistent identification of information
  needs/develop overarching risk communication and
  coordination strategies for specific deployment
  locations