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Bringing Military Medicine Into Clearer Focus

Troops Deployed in Iraq and Afghanistan Reporting Respiratory Symptoms

    Troops fighting in Iraq and Afghanistan have a higher rate of developing persistent or recurring cough or shortness of breath than nondeployers (14 percent vs. 10 percent), according to a survey of more than 46,000 military personal.1 Yet, the cause of this spike remains a mystery.

    The survey - based on self-reported symptoms - did not find an increased rate of chronic obstructive pulmonary disease or asthma, noted study co-author Edward J. Boyko, MD, MPH, staff physician at VA Puget Sound and professor of medicine at the University of Washington in Seattle. He would not speculate on whether they would eventually develop these two diseases.

    "There is insufficient information at this time to make any prediction," Dr. Boyko said.

    It is also unclear whether the symptoms of cough or shortness of breath are self-limited or would persist, he said.

    However, further research from this Millennium Cohort Study is on the horizon. The Department of Defense-funded project, designed to evaluate the long-term health effects of military service, began in 2001 and will run until 2022.

    The current study found deployed Army troops and Marines had a greater likelihood of newly reported respiratory symptoms (73 percent and 49 percent, respectively).

    Air Force and Navy personal did not report a similar jump, suggesting that ground troops are probably exposed to an unknown respiratory irritant on land.

    "These are dry, dusty places. Is it that?" Dr. Boyko asked rhetorically. "Is it the fumes they're exposed to from operating military vehicles, generators, and other things?"


    1. Smith B, Wong CA, Smith TC, Boyko EJ, Gackstetter GD; Margaret A. K. Ryan for the Millennium Cohort Study Team. Newly reported respiratory symptoms and conditions among military personnel deployed to Iraq and Afghanistan: a prospective population-based study. Am J Epidemiol. 2009;170(11):1433-42.

    -Mike Bederka

The system would show the times of projected fatigue based on a pilot's sleep and wake cycles. Then, the Air Force can mitigate the risk and proactively model missions before pilots leave from a home station.

Possible actions would be adding another pilot, or changing the takeoff and landing times - usually with little to no impact to the mission.

Walter Reed Army Institute of Research has spent years developing the model, and she wants it firmly embedded in the Air Force's scheduling system.
"It's a crusade of mine to get this in routine use," Lee stressed. For more info, visit

Better solutions

For many of Senior Master Sgt. Dario Rodriquez Jr.'s 26 years of service, he has eyed the future of military medicine. "The impetus behind all our research is to create alternatives and better solutions to providing care in austere environments," said Rodriquez, RRT, superintendent for the Air Force's Center for Sustainment of Trauma and Readiness Skills (C-STARS) in Cincinnati.

In one study, he looked to see if oxygen concentrators can supplement liquid oxygen and compressed gas cylinders on some missions. His team tried to validate the ability of oxygen concentrators to deliver appropriate and consistent Fisub>Osub>2and volume at high altitudes.

"It's not designed to eliminate gas tanks. There are always going to be patients where you need 100 percent oxygen. But maybe we can minimize the number of tanks you need," Rodriquez said. "It allows for better resource planning and could improve efficiency of operations."

A forthcoming study will try to answer whether or not all trauma patients require supplemental oxygen and potentially how much they need. 

"If you have three patients down on the ground and you had one tank of gas, most RTs would try to give oxygen to all three of them," Rodriquez said. "In reality, maybe not all three need it."

In the line of fire

Therapists on the battlefield become a precious commodity, said Staff Sgt. Joseph Buhain, RRT, EMT-B. Few nurse practitioners, anesthesiologists, and nurse anesthetists work on the front lines, so military RTs must wear many hats.

Called up to active duty in 2004, Buhain managed burn patients, intubations, A-lines, chest tube care, and assisted with central lines. Only having one X-ray machine and traveling to villages without electricity were only some of the complications he encountered.

"Imagine doing an intubation on a Blackhawk where everything is blacked out and you're wearing night goggles," Buhain described.

He did not go unscathed on his tour of duty. While on a mission in Southeastern Afghanistan in 2005, an IED hit the vehicle in front of his. Falling armor from the explosion crushed his knee and tore his anterior cruciate ligament.

The injury has since healed, and he now works as director of respiratory therapy at St. Paul College in St. Paul, Minn. He remains in the Army Reserve, where his thoughts are never far from those in active service.

"Don't forget there are wars still going on," said Buhain, a Bronze Star recipient. "There are still respiratory therapists over there."

Contact Mike Bederka at

Joseph Buhain, RRT, EMT-B, served in Kuwait, Iraq, and Afghanistan during an 18-month tour of duty. Pictured here, he evaluates an Iraqi girl with pneumonia.

Photo | Joseph Buhain, RRT, EMT-B

Bringing Military Medicine Into Clearer Focus

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