Commentary

Air Force Surgeon General 

Lt. Gen. (Dr.) George Peach

Taylor Jr., says 100,000 postdeployment screenings have

been conducted since January.

Get Registered

New trauma registry at Fort Sam

Houston in Texas is helping to

track casualty information from

OIF and OEF.

Togetherness

Husband, wife team from Rhode

Island National Guard unit spend

a year deployed together in Iraq.

features 2005

spring 

U.S. Navy photo by 

Photographer's Mate 3rd Class John P. Curtis 

U.S. Marines cross a three-strand bridge

at the beginning of the endurance course

at the Jungle Warfare Training Center

located at Camp Gonslaves in Okinawa,

Japan. 

News From Around 

The World 3

New DoD Health Plan Announced 

Scam Targets Families 

Web Site Links Public With Troops

Ask Our Experts 5

Avian Bird Flu

Vaccines, Herbs & Drugs 5

Smoking Cessation Therapies

Available While Deployed

Gulf War Update 9

Environmental Surveillance:

Key Role In Protecting Troops’ Health

Health Beat 17

Determined To Stand 

On Own Two Feet

Resource Guide 19

8

2

6

Speedy Care

Service members injured on

the battlefield are surviving

due to better gear and better

trained combat medics.

Parasite Research

Researchers develop a quick

testing method to determine

diagnosis for leishmaniasis.

JMEWS Live

The next generation of the

Joint Medical Workstation is

expected to go live this 

summer.

11

U.S. Marine Corps photo by Sgt. Stephen D'Alessio 

Ar Ramadi, Iraq — Staff Sgt. Jerome

H. Murkerson, a 33-year-old Adger,

Ala., native and staff non-commissioned officer-in-charge of the Camp

Blue Diamond quick reaction force,

hands a stuffed animal to an Iraqi

child on April 3. In Every Issue

13

14

Get The Facts

Shipping home illegal war

souvenirs from Iraq may land

you in hot water.

Improving Care

Service members injured on

the battlefield are surviving

due to improved battle gear

and better-trained combat

medics.

15

16

On The Cover
Deployment Quarterly 2 Spring 2005 • http://deploymentlink.osd.mil

commentary

he Air Force surgeon 

general spoke before

Congress in March on the

state of medical care for 

service members serving in

the war on terrorism. 

Air Force Surgeon General Lt. Gen.

(Dr.) George Peach Taylor Jr. told

members of the House Armed

Services Committee subcommittee on

military personnel that the Air Force

has done an exceptional job 

throughout operations Enduring

Freedom and Iraqi Freedom of 

providing health care to airmen and

members of its sister services. 

“We attribute our success to our

focus on four health effects, which are

providing care to casualties, ensuring

a fit and healthy force, preventing 

illness and injury, and enhancing

human performance,” Taylor said. 

Taylor told legislators the Air

Force’s mobile expeditionary medical

support units have been the linchpin

of the ground mission to care for 

military casualties, and air transport

teams have made great strides in

reducing the time it takes to return

casualties to the United States for

advanced medical care. 

“We now have more than 600

medics in 10 deployed locations,

[including] a large theater hospital in

Balad, Iraq, and two smaller hospitals

in Kirkuk and Baghdad International

Airport,” he said. “Just as in the

States, these serve as regional medical

AF Top Doc Says 100,000 Post-Deployment

Screenings Have Been Conducted Since Jan.

by staff sgt. c. todd lopez

air force print news

T

facilities for all services. Our critical

care air transport teams have made

possible an astonishing turn-around

time as short as 36 hours from the

battleground to stateside medical care

— unheard of even a decade ago.” 

Part of the Air Force’s commitment

to airmen’s health is ensuring they

are healthy and fit to fight before they

deploy, while on deployment and

upon their return home, Taylor said. 

In submitted testimony, the general

told legislators the Air Force’s annual

preventative health assessments

ensure each airman is fit before he or

she deploys. And when airmen arrive

in theater, he said, their health is

tracked by the service’s preventative

medicine teams. 

“[They] identify, assess, control and

counter the full spectrum of existing

health threats and hazards, greatly

enhancing our ability to prevent 

illness and injury,” he said. 

Air Force officials also ensure 

airmen come home healthy, with a

post-deployment screening for each

one, Taylor said. 

“During the post-deployment

process, we ensure that each 

returning individual has a face-to-face

health assessment with a trained

health care provider,” he said. 

Air Force officials have conducted

nearly 100,000 post-deployment

screenings since January 2003. Of

those assessments, the surgeon 

general said less than 10 percent

required follow-up referrals for 

medical or dental health concerns. 

Taylor also told legislators Air

Force officials are using cutting-edge

research and development to find

ways to improve safety for deployed

airmen and to enhance their 

warfighting performance. 

Air Force officials are working on

converting common tap or surface

water into intravenous solutions in

the field and producing medicalgrade oxygen on site, so heavy 

oxygen cylinders do not need to be 

transported, surgeon general 

officials said.

Additionally, they are working to

create vision devices that allow 

airmen to see to the theoretical limit 

of the human eye. If successful, they

said, it will provide pilots and 

warriors with the ability to see 

twice as far as an adversary. ■

We now have more 

than 600 medics in 10

“

deployed locations.

”

Editor’s Note: Lt. Gen. (Dr.) George

Peach Taylor Jr., is the Surgeon

General of the Air Force. General

Taylor serves as functional manager

of the U.S. Air Force Medical Service.

In this capacity, he advises the

Secretary of the Air Force and the 

Air Force Chief of Staff, as well as the

Assistant Secretary of Defense for

Health Affairs on matters pertaining

to the medical aspects of the air 

expeditionary force and the health 

of Air Force people.
new premium-based, health

care plan is available to 

eligible National Guard and

Reserve members activated

for contingency operations on or after

Sept. 11, 2001.

“This benefit compares most 

favorably with any health plan option

available to our Reserve Components,”

said Dr. William Winkenwerder Jr.,

assistant secretary of defense for health

affairs.

“We hope that individuals will 

consider carefully the value of this benefit for themselves and their families as

well as the commitment to our 

nation’s defense,” said Winkenwerder.

TRICARE Reserve Select is 

authorized under the National Defense

Authorization Act for fiscal 2005 and,

when purchased by a TRICARE

Reserve Select eligible member, 

provides comprehensive health care

coverage similar to TRICARE Standard

and Extra for the member and his or

her eligible family members.

A National

Guard or

Reserve 

member’s

personnel

office will 

determine

eligibility for

TRS based on

active service

on or after

Sept. 11,

2001. The

service period must be

for 90 

consecutive

days or 

more in 

support of a 

contingency 

operation.

Prior to

leaving

active duty,

http://deploymentlink.osd.mil • Spring 2005 3 Deployment Quarterly

A

If the Shoe Fits...

U.S. Air Force photo by Master Sgt. Mark Bucher

TALLIL AIR BASE, Iraq -- Master Sgt. Terry Nelson, from the

388th Fighter Wing, Hill Air Force Base, Utah, fits a new pair of

shoes on a young Bedouin girl during Operation Outreach 

conducted in the vicinity of the air base.

DoD Health Plan for Eligible National Guard

and Reserve Members Announced 

the member must enter into an agreement with his or her Reserve

Component to serve in the selected

Reserve for at least one additional year. 

For those members who already

have left active duty, they must enter

into an additional service agreement no

later than Oct. 28, 2005.

Members are eligible for one whole

year of TRICARE Reserve Select 

coverage for each whole year of service

commitment in the service agreement,

up to a maximum of one whole year 

of coverage for each 90 days of 

continuous active duty served in 

support of a contingency operation. 

For example, members who served a

360-day qualifying active duty period

in the selected Reserve are eligible for

four years of TRICARE Reserve Select 

coverage provided the member agrees

to serve at least another four years in

the selected Reserve.

TRICARE Reserve Select coverage 

for members and covered family 

members will end when the service

agreement ends or sooner if the 

member separates from the selected

Reserve, voluntarily disenrolls from 

the TRICARE Reserve Select program 

or fails to pay the monthly TRICARE

Reserve Select premiums.

Updated information on the 

TRICARE Reserve Select program —

including program start date, eligibility,

benefits and premiums — are posted 

on the TRICARE Web site at 

http://www.tricare.osd.mil/trs.cfm. ■
ASHINGTON —

Officials with the

Department of

Homeland Security

are warning the 

public about two new Iraq-related

Internet scams, including one 

directed at the relatives of fallen 

U.S. service members. 

“These new Internet fraud schemes

are among the worst we have ever

encountered,” said Michael J. Garcia,

assistant secretary of homeland 

security for immigration and customs

enforcement. “Most troubling is the

fact that some are targeting the 

relatives of U.S. service members

killed in Iraq. We are also concerned

about the fact that these criminals are

impersonating [Immigration and

Customs Enforcement] agents and

referring to ICE’s official Web site in

an effort to steal money from

Americans who have lost loved

ones.” 

The first scheme involves 

e-mail sent to relatives of U.S. 

service members killed in Iraq.

Claiming to be a volunteer working

with U.S. forces, the sender states that

a late friend, who also was a U.S.

service member, killed in Iraq, was a

very good friend of the relatives’ slain

son or daughter. The sender then 

goes on to ask for assistance in

obtaining funds kept for them by 

the deceased friend, promising more

details when the relative responds to

the e-mail. The sender then adds a

link to the portion of Immigration

and Customs Enforcement’s actual

Web site discussing ICE operations 

in Iraq. 

In the second scheme, a blanket 

e-mail is being distributed that claims

to be from an Immigration and

Customs Enforcement official in Iraq

who is responsible for tracking down

funds looted from the Iraqi Central

Bank by Saddam Hussein’s son. The

Deployment Quarterly 4 Spring 2005 • http://deploymentlink.osd.mil

news from around the world

ASHINGTON —

Since launching its

“America Supports

You” Web site to

showcase the

many activities taking place across the

nation in support of the troops, the

Department of Defense received

tremendous support as nearly a 

million Americans have logged on

and have gotten involved. 

Individual citizens, businesses,

schools, veterans groups and 

others have visited the site at

htttp://www.AmericaSupportsYou.mil

to register their activities, send a 

message to the troops and identify

programs of support in their own

communities.

Americans can join “America

Supports You” by visiting the site 

and registering their activities, 

large or small, in support of the

troops. The site is updated daily 

with news articles about groups 

and organizations that are showing

their support to our men and 

women serving overseas. ■

U.S. Navy photo by Photographer's Mate Airman Kristopher Wilson

An F-14B Tomcat, assigned to the "Swordsmen" of Fighter Squadron Three

Two (VF-32), lines up on a steam-powered catapult prior to launching from

the flight deck aboard the Nimitz-class aircraft carrier USS Harry S. Truman

(CVN 75). 

Prepare To Fly 

W

Scam Targets Families of Troops Killed in Action

W sender lists ICE’s Web site address 

in the e-mail in an effort to seem 

credible. The sender then asks for 

confirmation of the e-mail address 

of the recipient, stating, “there is a

very important and confidential 

matter which I want us both to 

discuss.” 

To learn more about this Internet

Scam, go to http://www.ice.gov/. ■

Web Site Links American Public with Troops 
irregular or rapid heartbeat,

and difficulty sleeping.

Fortunately, nicotine

replacement therapies are

medicines that help

decrease or stop a smoker’s

withdrawal symptoms.

Nicotine replacement therapies are available as patches, gums, inhalers, nasal

sprays or lozenges. The

U.S. Food and Drug

Administration has approved all

these products as smoking cessation

aids, although some require a 

doctor’s prescription. Combined 

with some form of smoking cessation

support or counseling, many people

have successfully remained tobacco 

or nicotine free for years. 

There are three medications

approved by the FDA as nonprescription products — generally

I have vowed to stop

smoking during my

upcoming deployment. I

don’t know how many

previous attempts I have

made. I know I’m going to

need help. What options 

are available? 

Congratulations on your

decision to quit smoking.

I’m sure I don’t have to

tell you, trying to stop

smoking is tough and 

trying to do so while on deployment

is even tougher.

It is hard to quit because nicotine is

a very addictive drug. However, quitting smoking is one of the most

important things you will ever do.

Medical experts say, if you are successful in your endeavor, you can add

years to you life expectancy. Quitting

reduces your

chance of having a

heart attack, stroke

or cancer. 

Many things can

happen to derail

your desire to quit

smoking such as

stress of deployments, being away

from friends and

family, unfamiliar

surroundings, and the most problematic, other smokers. Being around

other people smoking can make you

want to smoke. While you are trying

to kick the habit, try to avoid drinking

alcohol as it lowers your chance of

success. 

When you stop smoking, your

body starts sending you messages 

of nicotine withdrawal. These 

symptoms include nervousness,

headaches, irritability, restlessness,

I’ve been hearing a lot in

the news lately about the

“bird flu” and how it

could create a pandemic.

What is a pandemic?

Am I in danger of 

catching the bird flu now?

What is being done 

about this?

There are many different

types of influenza viruses

in the world and most of

them are specific to a 

particular species of 

animal. Thus the typical

influenza viruses that infect birds are

different from the influenza viruses

that infect mammals or humans.

Rarely, an avian type virus can 

directly infect a human and cause 

illness. Some 74 people

in Southeast Asia —

Vietnam, Thailand, and

Cambodia — have

recently contracted

avian influenza, 

mainly from handling

infected poultry. These

cases have resulted

in 49 deaths. 

The types of 

influenza viruses that

typically infect humans circulate

throughout the world in seasonal patterns that are fairly well understood

by scientists. We can pretty much

count on an annual epidemic of

influenza in the United States and the

rest of the Northern hemisphere every

winter. Although many people may

think that “the flu” is just an annoying illness, it 

actually kills about 36,000

people in the United

States every year, mostly

elderly people, young

children, and patients

with other medical 

problems. This is why

getting your annual

influenza vaccine is so

important.The viruses

that cause the annual 

epidemics of influenza will change a

little bit every year. We call this 

“antigenic drift” and it is the reason

why the influenza vaccine changes

every year in order to get a good

match with the currently circulating

virus strain. Occasionally, the 

predominant circulating virus will

vaccines, herbs & drugs

ask our experts

http://deploymentlink.osd.mil • Spring 2005 5 Deployment Quarterly

Q

A

Q

A

— Continued on Page 8

— Continued on Page 15
bombs on the force. 

“This is data that affects people

fighting right now,” Hassell said. “It’s

helping answer the question, ‘What

should we do to protect them, and if

they are injured, to save them?’” 

The Army’s Soldier Support 

Center in Natick, Mass., is studying

the data as it strives to improve body

armor systems and the Defense

Advanced Research Projects Agency

is evaluating the amputation data 

as it works on futuristic limb 

regeneration concepts. 

Monthly reports that summarize

the data collected so far have what

the military’s collective appetite for 

more information. “It’s like a feeding 

frenzy,” Hassell said. “They all 

want more.” 

But providing more information

and speeding up its delivery aren’t as

simple as it might seem. It’s a slow,

labor intensive process that involves

sorting through files of hand-written

notes from weary battlefield health

care providers, extracting the critical

details, translating them into medical

codes and entering them into the

database. 

“It’s painfully slow,” Hassell

acknowledged, emphasizing that 

until all the data is collected and 

up-do-date, it offers only a partial

view of the big picture. 

But in the meantime, the database 

is providing combat trauma care 

information never before available,

and certainly not while the war was

still under way. In the past, medical

data from the theater was never 

collected, and inpatient records were

retired to the National Personnel

Records Center in St. Louis, Mo., as

soon as each patient left the hospital. 

Hassell said the emerging 

registry is already beginning to pay

off in terms of supporting medical 

improvements, logistics and 

operational planning and more. ■

of injury,” he said. Medical care

providers call this the most important

stage of the patient’s treatment and

ultimate recovery. 

The data collected in the registry

demonstrates the effectiveness of new

medical devices and techniques, such

as one-armed tourniquets, Hassell said.

“You really want to know are you 

having an impact with a new device

you have developed? Is it saving

lives?” he said. 

The registry also helps medical

instructors better tailor their training

for the theater, he said. But the data

has longer-term implications as well,

Hassell said, helping 

planners look to the future

as they conceive the nextgeneration combat support

hospital and better 

methods of evacuating

patients from the battlefield. In addition to

improving the quality of

trauma care, the registry is

providing concrete data

about a full range of issues

of interest to military leaders and decision makers,

such as the effectiveness of

the new Kevlar helmet and

the impact of roadside

new registry being 

established at Fort Sam

Houston in Texas is helping

track casualty information

from Iraq and Afghanistan

to give senior leaders the concrete

information they need as they make

decisions about everything from 

what protective gear troops will use

to how to better deliver combat 

casualty care. 

The Joint Theater Trauma Registry

is ensuring that decision makers have

more than anecdotal evidence to

guide their decisions that directly

affect troops on the ground, explained

retired Army Col. L. Harrison Hassell,

director of the registry system. 

The registry captures details about

wounds received and the medical

care provided from combat support

hospitals, ships and aircraft and

throughout the course of their 

treatment, as well as the results. 

This shows medical care providers

what treatments were most effective

as they apply those lessons learned to

other patients with similar wounds,

Hassell explained. “A lot of the focus

is on life-saving measures at the point

Deployment Quarterly 6 Spring 2005 • http://deploymentlink.osd.mil

New Trauma Registry Captures 

Valuable Wartime Data

by donna miles

american forces press service

U.S. Army photo by Staff Sgt. Monica R. Garreau

An injured soldier is loaded into a 68th Medical

Company (Air Ambulance) UH-60 Blackhawk 

helicopter for transport.

U.S. Air Force Photo by Tech. Sgt. Mike Buytas

U.S. Army Special Forces scan an

area during a patrol in Iraq. 

A
day-to-day tasks that are required

prior to being deployed. 

“There are quite a few that will not

voice their opinions one way or the

other. Some have said you are so

lucky you are with your spouse and

then you have jealous ones,” said

Joyce. “The best thing for me is

when I hear a boom, I know where

Roland is and that he is OK.

When we go to drop off our 

laundry, the locals that work there

regard us as celebrities or something.

We walk in and they all say ‘they are 

man and wife’, and when we leave 

everyone of them has to come out

and say good-bye. It is kinda cute,”

said Joyce.

Despite being deployed together,

life in Iraq is not the same as it is

back home in Rhode Island. “We are

not allowed to share living quarters,

but try to spend as much time 

together as possible,” said Roland.

The Cagnon’s have had to remember

that its mission first, and your 

spouse second. 

“Just because he is my husband

does not mean I can get away with

anything like some might think. I still

have to respect his rank,” said Joyce.

“I miss being able to just sit down

and talk with him about the 

day-to-day things.”

While, it is comforting for Joyce

and Roland to have each other in

Iraq, it has been hard on their families to have them both deployed.

Joyce’s adult children have picked 

up additional responsibilities to help

their parents during their 

deployment.

“One of our sons has had to take

over caring for our animals and 

managing the bills while we are

away. It has been particularly hard

on him,” said Roland. “Our children

or most service members they

are lucky enough to receive letters, packages or the occasional

phone call from home, but for

one couple they have gotten to

spend almost every day of their

deployment together. 

Both Master Sgt. Roland Cagnon

and his wife, Sgt. Joyce Cagnon, were

called to active duty with the Rhode

Island Army National Guard in July

2004 and are currently stationed in

Iraq with the 103rd Field Artillery

Brigade.

When Joyce and Roland meet in Las

Vegas in July 2002, Joyce was living in

Seattle, Wash., and Roland was in

Rhode Island. After maintaining a

long distance relationship, they decided to be together in Rhode Island and

were married on July 4, 2003. When

Joyce left Washington, she left behind

everything, but was able to find comfort and strength in Roland. Now, she

finds herself in a 

similar situation after

being called to active

duty and deployed 

to Iraq, but again

Roland is by her

side. 

“It seems ironic

that I talked Joyce

into joining the

Rhode Island

National Guard so

she would not get

deployed with the

medical or military

police units, and now we are in Iraq,”

said Roland. 

Joyce, now a chaplain’s assistant

while on deployment, served for 16

years in the Army Reserves prior to

joining the Rhode Island National

Guard.

Roland has been with the Rhode

Island National Guard for 30 years of

service, including serving on active

duty for 22 years. Currently, he is an

operations non-commissioned officerin-charge at the Armory of Mounted

Commands in Providence, R.I. 

“The best thing about 

having my spouse with me in Iraq has

been sharing the experience of serving

our country. Our oath was to defend

and secure good old U.S.A. and this is

just us doing our part,” said Roland.

“There are times I just need to 

visually see him to make me feel that

everything is going to be all right,”

said Joyce. “We are doing this 

together, it has made us bond in a way

that is unexplainable. I feel 

closer to him now than I did before we

were deployed.”

The Cagnon’s have received mixed

reactions from their unit regarding

their deployment. Some service members can’t imagine putting their wife

through the vigorous training and

http://deploymentlink.osd.mil • Spring 2005 7 Deployment Quarterly

Husband and Wife Support Each

Other Through Deployment 

by rebecca gattoni

deployment health support directorate

Courtesy photo

Husband and wife, Sgt. Joyce Cagnon and Master Sgt.

Roland Cagnon, of Providence, R.I., are currently

deployed to Iraq with the 103rd Field Artillery Brigade of

the Rhode Island National Guard. 

We are doing this together; 

it has made us bond in a way that

“

is unexplainable. 

”

F

— Continued on Page 8
Deployment Quarterly 8 Spring 2005 • http://deploymentlink.osd.mil

referred to as over-the-counter products. These over-thecounter nicotine replacement products come in the form

of gums, patches and lozenges and are made 

by several manufacturers under various trade names.

Consult your health care provider or your pharmacist 

for advice and carefully read the information on the

package. 

These over-the-counter products are excellent options

and are relatively convenient to use while deployed,

regardless if your deployment is shipboard, on an 

air base, or in the field. All of these medications will 

more or less double your chances of quitting and 

quitting for good.

There is also a prescription-only product called

WellbutrinTM, which is not a nicotine replacement 

therapy, but works by affecting neurotransmitters in the

central nervous system. Because of its affects on the 

central nervous system, you normally don’t see service

members on this product while deployed. 

I always recommend service members contact their

unit’s health care providers to determine what might be

best for your situation. 

Keep in mind smoking cessation products are usually

available at military treatment facilities’ pharmacies and

via the TRICARE network of retail pharmacies, 

non-network retail pharmacies and the TRICARE 

Mail Order Pharmacy. 

Don’t be discouraged if you start smoking again.

Most relapses occur within the first three months after

quitting. ■

Editor’s Note: U.S. Navy Cmdr. Eugene de Lara is 

the Assistant Head in the Pharmacy Department at the

National Naval Medical Center in Bethesda, Md. 

Prior to this assignment, he was deployed to Iraq for 

six months.

Vaccines, Herbs & Drugs

— Continued from Page 5

are scared and concerned for our safety,

but understand we are proud to serve

our country.”

The Cagnon’s have learned that

unfortunately life does not stop when 

a loved one is deployed. For Joyce 

and Roland this has been particularly

hard to handle. 

“The hardest part of the deployment

has been the family moments we have

missed. We missed a son’s wedding 

in September, our grandson turning

one in December, and we will miss 

the birth of our fourth grandson in

February. This is what has taken a 

bigger toll than almost anything on

us,” Joyce said.

“My children were glad though that

Roland was going to be with me. It

gave them some comfort knowing that

we would have each other. They

understand our dedication to the 

service and to our country,” said Joyce. 

“They know we are here for their

freedom and to try and make it a 

better place for our grandchildren 

and their children to be able to live

without fear.”

The couple expects to be deployed

until September or October 2005. ■

Couple — Continued from Page 7

DoD photo by Tech. Sgt. Cherie A. Thurlby 

Army Spc. Oscar Olguin climbs the rock wall at the 19th National Disabled

Veterans Winter Sports Clinic at Snowmass Village, Colo. The clinic,

organized by the Department of Veterans Affairs and Disabled American

Veterans, is the largest annual disabled learn-to-ski clinic in the world. 

Mind Over Matter
ne of the most important

lessons learned from

Operations Desert Shield

and Desert Storm was the

importance of knowing

what potentially hazardous exposures

service members might encounter.

Thanks to the U.S. Army Center for

Health Promotion and Preventive

Medicine, the military has made 

great progress in environmental 

surveillance during the global war 

on terror, said Jack Heller, the 

director of health risk management 

at USACHPPM. 

“Even though it has been a difficult

combat operation, this has probably

been the most successful operation for

doing environmental surveillance that

I’ve ever been associated with,”

Heller said. “We’re trying to identify

environmental exposures that can

impact our forces early on, mitigate

those exposures, and record what

those exposures are.”

Heller said it is important to avoid

the health issues that arose after the

1991 Gulf War, when questions about

exposures arose that the military

couldn’t answer. An extensive study

of oil well fires was done after the

Gulf War, but several other exposures

were suspected of impacting the

health of military members. For 

example, insufficient information was

available about the possible effects of

depleted uranium or some of the 

vaccines used. Heller says that today

the military does a much better job of

recording possible exposures, and 

that means more than looking for

acute exposures and identifying who

was exposed. 

“We are also cataloging and 

collecting data for the chronic and

low level exposures that might not

have an immediate consequence, but

could have long-term effects,” he said.

During the 1991 Gulf War, and even

in Kosovo and Bosnia, DoD was in a

reactive mode about environmental

exposures. If a problem was 

suspected in a particular place,

experts went there to assess it. For

Operations Enduring Freedom and

Iraqi Freedom, surveillance personnel

are in a proactive mode. 

“In OIF and OEF we got involved

early in the planning of the operation,

looking at potential base camps,”

Heller said.

To make that happen, planning

support is key. The earlier environmental surveillance personnel know

where troops are going, the earlier

they can assess potential threats. Of

course, their job isn’t all about

advance planning. They are part of 

all four phases of deployment, so 

after the planning they participate in

the pre-deployment, deployed and 

post-deployment phases. 

The U.S. Army Center for Health

Promotion and Preventive Medicine

also works with all the services. They

provide equipment to all the 

preventive medicine units that deploy.

http://deploymentlink.osd.mil • Spring 2005 9 Deployment Quarterly

Environmental Surveillance:

Key Role In Protecting Troops’ Health

The Army has separate 

preventive medicine units as well as

division preventive medicine offices.

The center also trains people from the

Air Force Expeditionary Groups,

Marine Expeditionary Forces and

Navy Environmental Preventive

Medicine Units. 

In the last 10 years, environmental

surveillance equipment has become

more portable and easier to operate,

but it is still very specialized. Before

deployment, all preventive medicine

personnel receive training in how to

use the gear and how to assess the

results. They also get the sampling

media needed. Current equipment

can’t provide real-time results, so

when samples are collected they are

sent to U.S. Army Center for Health

Promotion and Preventive Medicine

for analysis and assessment. And to

make the future better than the past,

archiving all that data is vital.

“Much of the info we needed to

answer questions during the Gulf

War was destroyed or left behind,”

Heller said. “We must ensure that 

all the data we get is archived.”

Recorded data includes 

information on the conditions at a

particular base camp and data on the

field water. This kind of information

is needed after the conflict or 

sometimes during it if another unit is

moving into the same area. The

by austin camacho

deployment health support directorate

O

— Continued from Page 10

When we first started 

doing this our main

focus was on industrial 

materials...

“

” Now, we look at historical

contamination on site, and the

potential for weapons of mass

destruction on site.

“

”

gulf war update
Deployment Quarterly 10 Spring 2005 • http://deploymentlink.osd.mil

importance of knowing what threats

may exist in an area troops are

moving to is clearer today than it

was in the past.

“When we started doing this, our

main focus was on industrial 

materials,” Heller said. “Now, we

look at historical contamination on

site, and the potential for weapons 

of mass destruction on site.” 

One thing they did before

Operation Iraqi Freedom was to 

prepare for potential oil well fires.

Because Iraqi forces ignited more than

700 oil wells in Kuwait during the

Gulf War, there was concern about the

possibility that the nearly 1,400 oil

wells in Iraq would be ignited. Before

any service members were deployed,

Army, Navy and Air Force units were

trained on how to assess a mass ignition of oil well fires, and equipment

was pre-positioned in the theater to

be used if a large number of oil well

fires were ignited. 

The experts at the U.S. Army

Surveillance

— Continued from Page 9

Courtesy photo

Jack Heller, the director of health risk management at the U.S. Army Center for

Health Promotion and Preventive Medicine says since Operations Desert Shield and

Desert Storm, the military has made great progress in environmental surveillance.

Heller, pictured here, was part of the team which did a study on the impact of the oil

well fires on service members’ health following the Gulf War.

Center for Health Promotion and

Preventive Medicine provide a 

number of products to the field,

including technical guides such as

“Chemical Exposure Guidelines for

Deployed Military Personnel,” the

“Deployment Environmental

Surveillance Sampling Guide,” and 

a volume on “Entomological

Operations Risk Management.”

In addition, U.S. Army Center for

Health Promotion

and Preventive

Medicine 

performed about

40 different 

intelligence reports on the battlefield

for the different base camps where

U.S. forces were deployed, including

pre-deployment base camps in

Kuwait. Other plans and reports were

produced for occupational and environmental health surveillance. The

needed information has become 

easier to get because preventive 

medicine people are working 

with the intelligence community.

Environmental surveillance experts

now use worldwide intelligence data

to define industrial hazards and

threats. 

“As new data comes in we 

continuously revise the assessment of

As new data comes in we continuously revise

“

the assessment of the data we have.

”

the data we have,” Heller said. “And, 

as we get occupational and 

environmental health data, we use 

it to better revise the assessments we

do on our base camps and other places

our service members are.”

All the useful environmental 

surveillance data is available to 

commanders through secure defense

Web sites. This allows them to know

as much as possible about the location

prior to sending their service 

members to a particular area. The

next step is to refine the system 

tracking troop locations.

“To know who was exposed we

have to know where our people 

are,” Heller said.

After the 1991 Gulf War, the 

Defense Department didn’t have data

on environmental exposures or who

was exposed. Now, an effort is being 

made to create a roster of who was

potentially exposed. This information

could matter to a person’s future

health, whether they were near a 

small oil well fire or suffered heavy

metal exposure from processed water.

Exposure data will be combined 

with personnel information from 

the Defense Manpower Data Center,

resulting in a database to allow DoD

to identify service members 

who were nearby when a particular

exposure occurred. Heller said that 

the services have all become much 

better at adding the information 

needed to the Deployment

Occupational and Environmental

Health Data Repository.

“We archive everything we collect

over there — environmental sample

data, [situation reports], incident

reports on exposures, even dining 

hall inspections,” said Heller.

The interim form of this database

currently in place is searchable so 

that commanders can prepare for 

movement into an area that may 

present exposure risks. By offering 

this information and helping 

commanders to prepare, Heller 

hopes to reduce or someday 

eliminate casualties caused by 

environmental exposures. ■
ervice members fighting the

war on terror are surviving

what normally would be fatal

injuries due to improved 

protective gear, better-trained

combat medics and quicker 

evacuation procedures, according to a

doctor who has been to the front line

three times. 

Army Lt. Col. (Dr.) George Peoples

served two tours of duty in Iraq and

one in Afghanistan as part of a 

forward surgical team. 

He now is chief of surgical 

oncology and on the general-surgery

staff at Walter Reed Army Medical

Center in Washington, D.C., where 

he has treated wounded service 

members from Operation Iraqi

Freedom and Operation 

Enduring Freedom. 

One reason many critically injured

service members are coming home

alive is because of the speed of the

care provided on the battlefield,

Peoples said. 

In Iraq, Peoples was one of 20 or so

doctors, nurses and other health care

professionals who made up the 224th

Forward Surgical Team. 

It takes the teams about an hour to

set up an entire field hospital, he said.

However, he added, using medical

equipment from their backpacks, they

can initiate surgical care within 15

minutes. 

He said in combat, the forward 

surgical team’s role is to perform

“basic life- and limb-preserving 

procedures, and to get patients to the

next level of care.” 

The mobile unit followed closely

behind the 3rd Infantry Division 

during its initial war offensive in Iraq,

and was within “meters of where

some of the fighting was taken place,”

he said. 

Peoples said having forward 

surgical teams able to set up as many

as two portable operating rooms 

within minutes so “near to the point

S

At the point of injury, a soldier’s life

is either saved or lost by the initial

action taken by a combat medic or

someone who has been trained in 

some basic first-aid skills.

http://deploymentlink.osd.mil • Spring 2005 11 Deployment Quarterly

Helps Troops

Survive Injuries 

by sgt. 1st class doug sample, usa

american forces press service

“

”

Members of the 86th Combat Support Hospital

transport a wounded service member to a 

nearby field hospital. 

Speedy Care, 

Better Gear

— Continued on Page 12

U.S. Air Force photo by Staff Sgt. Edward D. Holzapfel

Ramstein Air Base, Germany — Air Force medical 

personnel and flight crew members carry an injured 

soldier to a bus so he can be taken to nearby Landstuhl

Regional Medical Center for care. 
of injury” presented better opportunity to perform lifesaving procedures. 

“There, he continued, “you basically have a ground ambulance ... that

can bring casualties of the battlefield

directly to your door in matter of

minutes.” 

And the military’s ability to rapidly

evacuate critically injured soldiers

from the battlefield to the next level of

care at facilities such as the Landstuhl

Regional Medical Center in Germany

and Walter Reed, Peoples said, is

another reason lives are being saved. 

He said the Air Force handles the

“movement piece” exceptionally well

and helped reduce the evacuation

time to four days from point of injury

to Walter Reed, down from the 

previous 14 to 15 days. 

“The quicker you can get persons

back, I think the more efficiently they

can be cared for, perhaps better cared

for,” Peoples said. “And ultimately I

think that impacts their long-term

health.” 

Peoples also pointed out

the role combat medics and

troops on the ground play

in saving lives.

“At the point of injury, a

soldier’s life is either saved

or lost by the initial action

taken by a combat medic

or someone who has been

trained in some basic firstaid skills,” he explained. 

Peoples said procedures

such as placing a 

tourniquet, stopping

bleeding or stabilizing

injuries become very 

critical on how well

patients are “going to do 

in the long run.” 

He pointed out that

body armor and 

up-armored vehicles are

another reason many lives

are saved. “People are 

surviving these devastating

injuries because they are

not developing life-threatening injuries to the chest

or abdomen,” he said. 

Peoples noted that body armor

“protects the core of the soldier in

their chest and abdomen” where “a

lot of the injuries would have been

mortal in previous combat.” 

He said the military

is working to revamp

body armor so that

protective plating will

cover even more body

parts, and that ballistic

eyewear has helped 

cut down the number

of eye injuries. In 

addition, more military

units now travel in

armor-clad vehicles. 

But even with these

protective measures,

Peoples said medical facilities are 

seeing “much more devastating

extremity injuries,” with damage to

bones, tendons, ligaments, blood 

vessels and nerves. 

“It’s presented a real challenge for

us surgically, but even more from a

rehab standpoint,” he said. 

Peoples noted that more is being

done to improve care for service

members needing rehabilitation 

services. “New facilities are being 

created, new resources are being put

toward their care. This problem is

being faced head on,” he said,

“because we know that we now 

have a generation of soldiers who

have a lifetime ahead of them of 

having to deal with the ravages of 

this war.” ■

Left: An air crewman aboard an U.S. Navy MH-60S Seahawk 

helicopter, assigned to Helicopter Combat Support Squadron

Five (HC-5), makes final preparations for take-off as Chief

Hospital Corpsman Patrick Nardulli, rear, monitors his patients. 

U.S. Air Force photo by Tech. Sgt. Marc Barnes

Air Force Capt. Tamra Weatherbee gives 

medication to Army Pfc. Matt Baugh at the 

contingency aeromedical staging facility at Balad

Air Base, Iraq. 

Deployment Quarterly 12 Spring 2005 • http://deploymentlink.osd.mil

Speedy Care

— Continued from Page 11

The quicker you can get 

persons back, I think the 

more efficiently they can 

be cared for.

“

”

U.S. Navy photo by Journalist 1st Class Joshua Smith
http://deploymentlink.osd.mil • Spring 2005 13 Deployment Quarterly

patient who had leish, there

were two that didn’t,” Magill

said. “It was an enormous

burden on the laboratory. If

you’re doing one of these a

month, it’s no big deal, but if

you’re getting 80 new 

specimens a week with all 

the smears and culture bottles

involved, it’s kind of over 

the deck.”

During the onslaught of

leishmaniasis cases, either the

WRAIR lab or the Armed

Forces Institute of Pathology looked at

every leish sample coming in from

Iraq to provide diagnosis. While AFIP

experts looked for the parasite in tissue samples and smears, cultures and

Polymerase Chain Reaction, or PCR,

samples were sent to the WRAIR lab

that’s directed by Lt. Col. Pete Weina,

a key player in combating the leish

outbreak when he was deployed in

Iraq in 2003.

“Our personnel looked at the slide

under a microscope to see if there are

parasites on the smear, or they

watched the culture for two, three,

four or five days until they started to

see some movement and see live 

parasites growing,” Magill said. 

The WRAIR lab could also run the

unapproved PCR assay that

researcher Lt. Col. Glenn Wortmann

developed in the late 1990s, but physicians couldn’t make treatment decisions based on the results because the

test hadn’t been validated. 

“Legally, physicians aren’t 

supposed to use an unapproved assay

[for diagnosis],” Magill said. 

Now that the test is CAP approved,

ne of the Army’s specialized

labs got a firmer leash on 

diagnosing “leish” after it

gained approval for a quicker test for the parasite.

This past winter the College of

American Pathologists approved a

new diagnostic test that detects 

parasite DNA to diagnose Leishmania.

Developed by the Walter Reed Army

Institute of Research, the test is based

on polymerase chain reaction to give

definitive results in one hour instead

of the weeks a diagnosis can 

sometimes take. 

“We can basically project this service

anyplace that can reach us by FedEx.

We get the package with the sample,

we prepare the mixture, we run the

assay and we can e-mail the response

back to the physician,” said Col. Alan

Magill, an expert on leishmaniasis and

science director at WRAIR. “It allows

us to project this capability very far

forward, albeit with some logistic

constraints.”

After more than 800 service members from Operation Iraqi Freedom

were sent back to the States for 

treatment for weeping sores that just

would not heal — a sure sign of 

leishmaniasis — the WRAIR

Leishmania Diagnostic Lab was 

operating at a capacity it had never

before witnessed. 

“We literally had hundreds ... of 

culture flasks floating around that we

were trying to keep track of and 

reading every day — along with 

hundreds of smears because for every — Continued on Page 16

research

Quick Testing Approved 

For Leishmania

Parasite

by karen fleming-michael

fort detrick, md., standard staff writer 

Lisa Jones, a sand fly laboratory technician,

works at the Walter Reed Army Institute of

Research’s Leishmania Diagnostic Lab. 

the lab and its customers are benefiting from its strengths. Because the

approved PCR can handle 16 samples

at one time and gives results in one

hour, having the approved diagnostic

speeds up the lab’s workload and 

get results faster to the field. A second

test, expected to be completed soon,

will also tell if the species is Leishmania

Major — the type of leish acquired in

Iraq — so physicians can make

informed decisions about treatment. 

“If you rely on cell culture, it takes

two to three weeks to determine 

what species it is, so you don’t save

any [treatment] time,” said Lt. Col.

Russ Coleman, chief of the WRAIR’s

Department of Entomology, where 

the Leishmania PCR assay is 

performed. 

When treatment options for various

forms of leish can include up to 20

days of an intravenous drug, waiting

weeks to find out what kind of leish a

person has is just too long, said Magill,

also an infectious disease physician at

the Walter Reed Army Medical Center

in Washington, D.C. 

O

Photo by Phil Collins
he Joint Medical Workstation

is one of the latest technological advances employed 

during Operations Iraqi

Freedom and Enduring

Freedom. It allows commanders and

medical planners to monitor service

members’ physical well being and

medical treatment facilities’ 

capabilities. 

The system has been operational

since January 2003 said Air Force Lt.

Col. (Dr.) Mark F. Gentilman, director

of medical readiness information

management at the TRICARE

Management Activity, speaking at the

TRICARE Conference in January in

Washington, D.C. It came about due

to a Secretary of Defense mandate to

provide electronic medical surveillance for operational deployments.

“With this Joint Medical

Workstation, we are now able to provide a real-time medical snapshot of

what is going on in a specific theater

of operation down to the unit or joint

task force level,” said Anthony

DeNicola, Deployment Health

Support Directorate’s program

manger, Information, Technology and

Security. “This information can then

be used to locate, coordinate and provide the best care available to the

service members on the ground in a

deployment situation.”

The second function of the Joint

Medical Workstation is medical surveillance. Each treatment facility

using this system submits a daily

record of its patient encounters. Data

analysis tools then use the data

derived from the patient records and

disease and non-battle injury reports

to determine trends and alert for

spikes in specific areas. If the surveillance tool alerts for a spike, the command surgeon can investigate further

by looking into individual patient

records for particular symptoms.

The workstation is the medical surveillance component of the Theater

Medical Information Program. It also

provides command and control support for operational deployments. 

According to

Gentilman, the 

workstation will

soon be upgraded. The Joint

Medical

Workstation II

will provide a

medical interface to the Global

Combat Support System that allows

the integration of medical support

with the Department of Defense 

command and control systems. 

The upgraded workstation is

expected to go online this summer. It

will provide a Theater Medical

Information Program interface to the

Defense Department’s Clinical Data

Repository. The system also allows

symptom-based medical surveillance

that is seen as an improvement over

the current diagnosis-based medical

surveillance. 

The enhanced capabilities of the

upgraded system include earlier

detection of biological incidents, 

integration with other Defense

Department information systems, a

nd logistics and patient movement 

visibility. It should become a key 

tool for medical decision makers at 

all levels, said Gentilman. 

One new capability of the upgraded system will be the medical watch

board. The medical watch board 

ives commanders and medical 

planners a real-time status of critical

medical systems. Medical professionals down to the brigade surgeon level

can build their own watch boards and

use them to monitor medical systems

and make key decisions.

When the Joint Medical

Workstation II is in place it will provide operational command and control personnel with access to threat

and surveillance data and the capability to receive, process, display and 

analyze situation information. ■

Deployment Quarterly 14 Spring 2005 • http://deploymentlink.osd.mil

2nd Generation JMEWS To Go Live This Summer 

by harry sarles

deployment health support directorate

With this Joint Medical Workstation, we are 

now able to provide a real-time medical snapshot 

of what is going on in a specific theater of operation

down to the unit or joint task force level.

T

“

”

Spc. Scott Brennan, a

medic with the 725th

Main Support Battalion,

examines an Afghan

boy's throat during a

cooperative medical

assistance mission in

Sadak, Afghanistan.

U.S. Army photo by Staff Sgt.

Bradley Rhen

Say Ahhhh...
change drastically, or “shift” in 

its antigenic composition, producing 

a virus for which almost no one in 

the world has any immunity. When

this happens, a world-wide epidemic,

called a pandemic, can occur. When

the influenza virus “shifted” in 1918,

over 20 million people world wide

died from influenza. What is 

concerning scientists today is the 

possibility that the avian influenza

strain that is causing problems in

Southeast Asia could mutate or mix

with human strains to create a 

pandemic strain of influenza. 

While there is no evidence to date

that the “bird flu” virus has mutated

to the point where it can easily be

transmitted from human to human,

the United States Government, 

as well as the World Health

Organization, or WHO, and countries

around the world are preparing for

that possibility. Aggressive research

to develop a vaccine for this type 

of influenza is underway. Careful 

surveillance and study of the current

situation is Southeast Asia is also

being done by the Centers for 

Disease Control and Prevention 

as well as the U.S. military.

Stockpiles of antiviral drugs to 

combat a potential pandemic are

being ordered. 

While the potential for creating 

an influenza pandemic makes the 

current avian influenza outbreak in

Southeast Asia a concern for 

scientists and doctors around the

world, you are not currently at 

risk — unless you travel to Southeast

Asia and handle chickens. You 

should nevertheless pay attention to

information provided by the CDC 

and other public health officials, and

get your annual influenza vaccine

when it becomes available 

in the fall. ■

http://deploymentlink.osd.mil • Spring 2005 15 Deployment Quarterly

Ask Our Experts

— Continued from Page 5

Get The Facts

First Before

Shipping Items

Home From Iraq

f you are about to return to

the United States from a

deployment to Iraq and are

contemplating bringing

home souvenirs or trinkets,

there are several things you

should realize before doing so.

Checking with the proper 

military officials and complying

with all federal regulations and 

requirements may prevent 

future headaches.

First, you should consult with

the Military Provost Marshall’s

Office. Military personnel are 

prohibited from bringing war 

souvenirs such as enemy weapons,

machine guns, weapon magazines,

ammunition — live or spent

rounds — pistols and anti-personnel mines. Shipping weapons or

war trophies as personal property

is punishable under the Uniformed

Code of Military Justice.

After consulting with the 

Provost Marshal’s Office, you will

have to adhere to civilian and

Federal regulations and requirements. For instance, the Office of

Foreign Assets Control establishes

the regulations against embargoed

countries. Although the embargo

against Iraq is still in affect, there

are some items that you are

allowed to bring back, such as

blankets, key chains, t-shirts, handicraft and jewelry. More information is available on the Office of

Foreign Assets Control Web site at

http://www.treas.gov/offices/enforcement/ofac/.

If you are unsure, don’t try 

to ship your items. For more 

information, contact officials at 

the post office, customs office or

legal office. ■

That’s A Mouthful

U.S. Air Force photo by Master Sgt. Val Gempis

YOKOTA AIR BASE, Japan -- Airman First Class Eric Parks, inspects the line

angle of a casts of teeth at the clinic here March 31. He is a dental 

laboratory technician with the 374th Dental Squadron. 

I
hreats faced by military medics

today have increased the need

for ocular surgery in the field,

requiring greater adaptation by

surgical teams.

The 59th Medical Wing’s Mobile

Ophthalmic Surgical Teams, known as

MOST, are part of this evolution.

“The need for eye surgery teams to

respond rapidly to natural disasters,

terrorist attacks and in support of the

war fighter continued to multiply each

day,” said Air Force Maj. (Dr.) Eric

Dudenhoefer, assistant chief of the

Cornea and Refractive Surgery Flight at

Wilford Hall Medical Center at

Lackland Air Force Base in Texas.

Dudenhoefer is the team chief for the

Wilford Hall MOST program.

“Today’s eye surgery teams have

seen a rise of 20 to 25 percent in eye

injuries on the battlefield,” said

Dudenhoefer. “This is due to a higher

use of projectile-type weapons, which

fragment and create extensive wounds

to vulnerable areas of the war fighter.”

He also sighted terrorist attacks on

civilian populations as one of the leading causes requiring mobile teams for

augmentation of local surgical eye

teams.

“The Tokyo sarin release produced

eye symptoms and signs in nearly all of

the 641 casualties seen at a near by 

hospital,” said Dudenhoefer.

“Bombings such as the Oklahoma City

federal building or World Trade Center

produced dozens of patients with acute

need for eye surgery.”

The Centers for Disease Control and

Prevention reported that of the 790

injured patients seen within the first 

48 hours following the September 11

attacks, 26 percent had ocular injures.

Eye injuries were second only to 

inhalation injuries, added the doctor.

“Humanitarian and disaster response

deployments are also the most realistic

and effective way for ophthalmic 

surgeons in training to prepare for

“That’s been one of the problems

with Leishmania therapeutics: 

We’ve been unable to get the species 

diagnosis to the clinician in a 

meaningful timeframe, so we were

stuck with a one-size-fits-all therapy,

which is not good,” he said. “With

PCR we’re basically able to say,

‘Here’s what it is,’ and it allows a clinician to make optimal treatment

decisions.” 

Gaining approval for the test was a

six-month endeavor, said Lisa

Hochberg, who spearheaded getting

the test validated from April 2004

until the evaluators visited in October.

Among other tasks, she and her team

had to run the test over and over to

determine how many parasites the

test could detect and ensure it didn’t

give a positive for anything else but

leish or a negative for any type of

leish. All the while the lab was still

regularly processing samples coming

into the lab from overseas. 

“It’s very lab and paperwork 

intensive,” Hochberg said. 

In keeping with CAP standards, 

the approved test can only be used 

in the WRAIR lab. But researchers at

Deployment Quarterly 16 Spring 2005 • http://deploymentlink.osd.mil

Parasite

— Continued from Page 13

‘MOST’ Missions Improving Patient Care

by master sgt. kimberly spencer

59th medical wing public affairs

T

— Continued on Page 18

the institute are working toward a

Food and Drug Administrationapproved PCR test that can be used 

in the field military medical labs.

Working with Cepheid Corporation, 

a manufacturer of PCR technology,

researchers have created a test that

uses the same chemicals in the

approved PCR test but dries them

down into little beads so they’re more

deployable.

“You get a tube that ... already has

the beads in it. You add your sample,

close it shut and put it into a 

[PCR],” Magill said. “It’s a vastly 

easier set up.”

Researchers already met with the

FDA to ensure they’re on the right

track with the dried PCR test. 

“The initial results [of the dried

PCR] suggest the dried chemistry is

about tenfold better in terms of limit

of detection than the current wet

chemistry,” said Maj. David

Shoemaker, a microbiologist who 

has an extensive background with

developing PCR tests and spent a

year at the FDA reviewing 

applications from companies that

develop PCR tests. 

The dried PCR test, Shoemaker

said, is also strengthened because of

work done at the U.S. Army Medical

Research Institute of Infectious

Diseases. An internal positive 

control test that Dr. David Norwood

developed will let the tester know if

there’s anything in the sample that

might inhibit the PCR from working

correctly. 

“PCR is very susceptible to a 

variety of chemicals in terms of its

ability to work,” Shoemaker said.

“For example, if you put whole blood

in there, it contains compounds ... that

interfere with a reaction, so you may

get a negative result in your reaction

when you actually had the organism

present. The internal positive 

control will tell you if you have 

PCR inhibition.”

If all goes as planned, researchers

will submit their application for FDA

review of the dried PCR test late this

year. 

Though so far this year there have

been fewer numbers of infections —

”twos and threes as opposed to the

twenties to forties per week last 

year,” Magill said— having the new

test and the dried PCR will prevent

the lab from ever again being inundated with too many samples and too

little time. ■
off my leg and get back into the 

wheelchair.”

Cain was hospitalized for three

months, working through his 

rehabilitation at Walter Reed. He

admits that it was a difficult ordeal,

but he was able to maintain a positive

attitude thanks to his wife, parents 

and two sisters who were staying at 

a nearby Ronald McDonald House. 

At the end of the rehab process, he 

was ready and willing to get on with

his life.

“I’m glad it happened to me and not

anybody else,” Cain said. “I think I

took it very well. I’m alive. That’s all I

care about.”

Today he lives in Gladstone, N.D.,

with his wife, Leslie, and son,

Desmond. Cain still travels to the

Washington, D.C., area frequently to

talk about the programs in place to

help seriously wounded soldiers and

to serve as a disabled veterans’ 

advocate to federal employment

groups. He also visits with friends

who are still at Walter Reed Army

http://deploymentlink.osd.mil • Spring 2005 17 Deployment Quarterly

ike many others, Michael Cain

served four years in the Army

and hopes to get on with his

life. At 23, he has a wife and

son to take care of and has his

sights set on higher education. And,

like so many of his peers, he’s 

determined to stand on his own two

feet, even if one of them is artificial.

Michael Cain lost his right leg in the

service of his country, but he says

that’s not going to stop him from

attaining any of his goals. 

“I lost a leg, had other setbacks, but

I’m alive,” Cain said. “I have my wife.

I have my son. I have my life.”

Sgt. Michael Cain deployed from

Fort Hood, Texas, to Operation Iraqi

Freedom with the 299th Engineers,

part of the 4th Infantry Division. His

unit handled vital re-supply missions,

driving needed equipment into Tikrit,

Iraq. He was not just a truck driver,

but was the non-commissioned 

officer-in-charge of the convoy that

headed out on the morning of Aug. 10,

2003. He says they had not gotten far

when his vehicle rolled over a mine or

an improvised explosive device. The

explosion welded the cab of his truck

shut, trapping him inside the vehicle.

“My legs were cauterized,” he says.

“They had to bring out the contact

truck with a welder to cut the door off

to get me out of the vehicle.” 

Cain says he would have died if the

heat from the blast had not cauterized

all the blood vessels. 

Cain was evacuated first to

Baghdad, then flown to Landstuhl

Regional Medical Center in Germany

for treatment, and finally to Walter

Reed Army Medical Center in

Washington, D.C. He had to be told

about these movements after the fact

because he had lapsed into a coma.

Three days after being caught in the

explosion, he awoke to learn that he

had endured a long series of injuries,

including a broken jaw and an 

amputation. In the beginning, people

had to tell him what had happened in

Iraq. Originally he had no memory of

the explosions. His memories began 

to surface at first in the form of nightmares that made sleeping almost

impossible for a while. 

“In the dreams I have I can see

every little detail,” he said. “I can see

every sliver of glass come out of that

windshield toward my face. I can see

the tendons in my leg. A piece of glass

went into the back of my head, and I

can see that. I can see the glass 

sticking out of the back of my skull.

Blood is pouring down the back of 

my head.”

Cain explained that the process of

coming to terms with the loss of a limb

was, for him, a series of ups and

downs. He describes his emotional

roller coaster this way:

“The first down part — finding out

what happened. The up part — I’m

still alive. The down — [the] surgeries. I hated them. Then an up — I got

my prosthetic leg. I got to stand up

and walk around.

“Then down again — extra bone

growth on my leg, so I had to come 

Determined To Stand 

On His Own Two Feet 

by austin camacho

deployment health support directorate

— Courtesy photo

Former Army Sgt. Michael Cain, who

was lost a leg while deployed to Iraq,

talks about working with the Disabled

Soldier Support System at Walter

Reed Army Medical Center in

Washington, D.C.

— Continued on Page 18

L

health beat

I go to the ward all the time

to talk to people who are new

amputees. I let them know 

that it gets better.

“

”
actual wartime deployments, explained

Dudenhoefer.

In fact, the MOST concept was 

initially born from humanitarian 

mission eye surgery done in 1991 by an

Air Force ophthalmologist from

Wilford Hall, Maj. (Dr.) Jane Ward, 

now a retired colonel.

When Ward went to northern Mexico

on leave status with a non-governmental missionary group, she recognized

the operational training value of her

experience. She subsequently led a

WHMC team to another Mexican site 

in 1992.

Based on the success of these 

missions, Honduras later requested

U.S. Southern Command humanitarian

eye missions. After a series of 

successful eye surgery teams visited

there, the MOST concept was born.

During these early humanitarian

missions members learned that a large,

inflexible response would often be

delayed by transportation limitations.

Responding rapidly requires efficient

use of airlift, which means paying

attention to the weight and amount of

gear. All the gear and supplies needed

to perform surgery in austere locations

can now be hand-carried by MOST

members. However, teams depend on

the host nation or other deployed units

for security, power, transportation,

quarters and food.

The humanitarian teams generally

consist of four to 12 individuals. Teams

typically operate in a host country 

hospital. A large open area is needed

for patient waiting and screening, 

while smaller rooms are used for 

preoperative evaluations and surgeries.

Real-world contingency or natural

disaster response team missions are

typically made up of two-person teams.

The equipment needed is backpack

portable and teams can be ready to

deploy within two hours. These teams

hand-carry supplies for ten restorative

eye surgeries and 100 outpatient visits.

Missions requiring a team to be in

place for a longer duration can be 

supplemented by pallets of gear 

and supplies.

“There has been a vast improvement

in treatment capability,” said

Dudenhoefer.

“More advanced surgeries are now

possible, and require less healing time.

For many penetrating eye injuries,

treatment within twelve hours to 

stabilize the eye is needed to 

achieve the highest probability of 

useful vision.”

Innovations in the equipment 

needed to perform advanced 

surgeries make improvements 

possible said the doctor.

“We now have portable 

ophthalmic-operating microscopes, 

as well as portable diode lasers,”

explained Dudenhoefer. “Other

advancements have been made in the

equipment needed for diagnostics,

enhancing the clinical and surgical 

abilities of the MOST teams.”

Realities such as the war in Iraq, as

well as the recent tsunami, clearly 

show a need for ophthalmologists to

continue honing the mission-ready

skills needed to respond quickly and

rapidly anywhere in the world. ■

Deployment Quarterly 18 Spring 2005 • http://deploymentlink.osd.mil

Medical Center, and spends time with those who are dealing with the same loss he has endured.

“I go to the ward all the time to talk to people who are

new amputees,” Cain said. “I let them know that it gets

better.”

Cain’s next goal is to attend college and get the training

to become a physical therapist. He says that his 

experience combined with his military training make 

him well equipped for the job.

“I know what to do, and I know how to do it,” Cain

said. “I know how to motivate people.”

Cain says that well-meaning physical therapists have

told him that they understood what he was going through,

but he never really believed it. He feels that with the 

proper training, he can be a therapist to whom patients

will be able to relate.

“My goal is to go out and help other amputees,” 

Cain said. “I’ll say I know what you’re going through. “■

Own Two Feet

— Continued from Page 17

MOST Missions

— Continued from Page 17

More Light, Please

Camp Arifjan, Kuwait — Navy Lt. Cmdr. (Dr.) Morteza Farr, MC,

left, and Cmdr. (Dr.) Greg Wolff, MC, examine an U.S. Army 

soldier’s broken wrist as Lt. Jason Gillespie, adjusts the lights in

the operating room at the U.S. military hospital at Camp Arifjan

in Kuwait. The hospital is staffed by Naval Reserve sailors

assigned to the Expeditionary Medical Facility from Dallas,

Texas, and has 380 people in eight clinics throughout Kuwait. 

U.S. Navy photo by Chief Journalist Kevin Elliott 
http://deploymentlink.osd.mil • Spring 2005 19 Deployment Quarterly

resource guide

Air Force Association

1501 Lee Highway

Arlington, VA 22209-1198

Phone: (800) 727 - 3337

http://www.afa.org

American Legion

1608 K St., NW

Washington, DC 20006

Phone: (202) 861 - 2700

http://www.legion.org

American Red Cross

17th & D Streets, NW

Washington, DC 20006

Phone: (202) 639 - 3520

http://www.redcross.org

AMVETS

4647 Forbes Blvd.

Lanham, MD 20706

Phone: (877) 726 - 8387

http://www.amvets.org

Army Retirement Services

ATTN: DAPE-RSO

200 Stovall Street

Alexandria, VA 22332-0470

Phone: (703) 325 - 9158

http://www.armyg1.army.mil/retire

Association of the U.S. Army

2425 Wilson Blvd.

Arlington, VA 22201

Phone: (800) 336 - 4570

http://www.ausa.org

Department of Veterans Affairs

810 Vermont Ave., NW

Washington, DC 20400

Phone: (202) 273 - 4300

http://www.va.gov

Disabled American Veterans

807 Maine St., SW

Washington, DC 20024

Phone: (202) 554 - 3501

http://www.dav.org 

Enlisted Association of 

the National Guard

3133 Mount Vernon Ave.

Alexandria, VA 22305

Phone: (800) 234 - 3264 

http://www.eangus.org

Fleet Reserve Association

125 N. West St.

Alexandria, VA 22314-2754

Phone: (703) 683 - 1400

http://www.fra.org

Marine Corps Association

715 Broadway St.

Quantico, VA 22134

Phone: (866) 622 - 1775

http://www.mca-marines.org

Marine Corps League

8626 Lee Highway, Suite 201

Merrifield, VA 22031

Phone: (800) 625 - 1775

http://www.mcleague.org

Military Officers Association

201 N. Washington St.

Alexandria, VA 22314

Phone: (800) 234 - 6622

http://www.moaa.org

Military Order of the Purple Heart 

5413-B Backlick Road 

Springfield, VA 22151-3960 

Phone: (703) 642 - 5360 

http://www.purpleheart.org

National Association for 

Uniformed Services

5535 Hempstead Way

Springfield, VA 22151

Phone: (800) 842 - 3451

http://www.naus.org

National Committee for Employer

Support of the Guard and Reserve

1555 Wilson Blvd., Suite 200

Arlington, VA 22209-2405

Phone: (800) 336 - 4590

http://www.esgr.org

National Guard Association of 

the United States

1 Massachusetts Ave., NW

Washington, DC 20001

Phone: (202) 789 - 0031

http://www.ngaus.org

National Military Family Association

2500 North Van Dorn St., Suite 102

Alexandria, VA 22302

Phone: (800) 260 - 0218

http://www.nmfa.org

Naval Reserve Association

1619 King St.

Alexandria, VA 22314-2793

Phone: (703) 548 - 5800

http://www.navy-reserve.org

Navy League

2300 Wilson Blvd.

Arlington, VA 22201

Phone: (800) 356 - 5760

http://www.navyleague.org

Non-Commissioned Officers 

Association

610 Madison St.

Alexandria, VA 22314

Phone: (703) 549 - 0311

http://www.ncoausa.org

Quartermaster 2nd Class Tony Evans sends Morse code signals from the

bridge wing aboard the command ship USS Blue Ridge (LCC 19) to the

Military Sealift Command combat stores ship USNS Concord (T-AFS 5), 

during a replenishment at sea in March in the Philippine Sea. U.S. Navy photo by Photographer's Mate 3rd Class Tucker M. Yates 
Deployment Quarterly 20 Spring 2005 • http://deploymentlink.osd.mil

resource guide

Paralyzed Veterans of America

801 Eighteenth St., NW

Washington, DC 20006-3517

Phone: (800) 424 - 8200

http://www.pva.org

Reserve Officers Association

1 Constitution Ave., NE

Washington, DC 20002

Phone: (800) 809 - 9448

http://www.roa.org

Reserve Enlisted Association

1 Constitution Ave., NE

Washington, DC 20002

Phone: (202) 646 - 7758

http://www.reaus.org

Veterans of Foreign Wars

200 Maryland Ave., NE

Washington, DC 20002

Phone: (202) 543 - 2239

http://www.vfw.org

Vietnam Veterans of America

8605 Cameron Street, Suite 400

Silver Spring, MD 20910-3710

Phone: (301) 585 - 4000

http://www.vva.org

Direct Helpline for Service Members,

Veterans and Families

(800) 497 – 6261

Deployment Health 

Clinical Care Center

(800) 769 – 9699 

or from Europe 

00 – 800 – 8666 – 8666

TRICARE Active Duty Programs 

(active duty and family members)

(888) DOD – CARE 

or (888) 363 – 2273

TRICARE Mail Order Pharmacy 

Express Scripts 

(866) 363 – 8667

TRICARE Dental Program (TDP) 

United Concordia 

(800) 866 – 8499

TRICARE Pharmacy Program 

(877) DOD – MEDS 

or (877) 363 – 6337

TRICARE For Life

(888) DOD – LIFE 

or (888) 363 – 5433

TRICARE Retiree Dental Plan

Delta Dental 

(888) 838 – 8737 

Defense Enrollment Eligibility 

Reporting Systems (DEERS) 

(800) 538 – 9552

TRICARE Online 

(866) DOD – EWEB 

or (866) 363 – 3932

Health Insurance Portability and

Accountability Act (HIPAA) 

(888) DOD – HIPA 

or (888) 363 – 4472

Department of Veterans Affairs

(800) 827 – 1000

VA Gulf War Registry

(800) 749 – 8387

VA Benefits and Services

(877) 222 – VETS 

or (877) 222 – 8387

Department of Defense

http://www.defenselink.mil

DeploymentLINK

http://deploymentlink.osd.mil

GulfLINK

http://www.gulflink.osd.mil

MedSearch

http://www.gulflink.osd.mil/medsearch

DeployMed

http://deploymentlink.osd.mil/

deploymed/

PDhealth

http://www.pdhealth.mil

Hooah4Health

http://www.hooah4health.com/

TRICARE

http://www.tricare.osd.mil/

Department of Veterans Affairs

http://www.va.gov

Phone Resources

Internet Resources