Page 131 - Journal of Special Operations Medicine - Winter 2015

8. What are the local military and civilian medical ca- mesl/), the results proved the need to test and monitor
pabilities? Besides knowing the location and routes to the the municipal water from Jordan’s Ministry of Water
various MTFs in the area, it is important to understand and Irrigation and water authorities. In two locations,
the capabilities compared to US standards of care. What the exposure limits for drinking per DA TB MED 577,
level of training do their physicians and nurses receive? Sanitary Control and Surveillance of Field Water, were
What pharmaceuticals are safe for use? Is the blood prod- exceeded for annual alpha activity and Ra 228/226. The
ucts considered safe? If not, what is the transfusion plan, municipal water supply was not being used for drink-
especially if the ODA plans to conduct training (i.e., close ing by US personnel, therefore, the memorandum pre-
quarter battle) that could result in its necessity? A few of pared by the 5th SFG(A) PM team for the test results of
many questions one must answer to determine the local the water sampled stated, “based on the intended use,
military and civilian medical capabilities. the probability of exposure is frequent and the sever-
ity is negligible; the overall level of radiological risk is
The eight questions above should provide an 18D with moderate. Due to limited exposure, an elevated health
a good starting point to begin “peeling back the onion” risk is not anticipated.” The memorandum also stated
when it relates to MIPOE; only time and one’s willing- that quarterly sampling should be used to continually
ness to research will limit the extent. The last point of monitor the water supply and to continue building and
importance relates to the frustration expressed by the maintaining a relationship with the water authorities in
junior 18D in regard to the lack of timely and relevant the country (Figure 1). SFC(P) Roy Cruz performed the
information for his upcoming mission. The unfortunate necessary task of explaining the results to deployed 5th
reality is that he only must look to his left and right SFG(A) personnel.
as fellow 18Ds are somewhat responsible for his dis- Figure 1 SFC(P) Cruz meeting with water resource engineers
appointment. The 18D community must place greater in Jordan.
emphasis on the Medical SODARs; the trip report tool
to document medical intelligence from missions exists
and is a SOCOM requirement, but the community must
collectively collaborate for it to be successful.

References
1. Emerg Infect Dis. 2015;21(1). www.cdc.gov/eid.
2. MIL-STD-3041, DOD Standard Practice, Requirements for
FWRA, 2013.
3. MIL-HDBK-3041, DOD Handbook, Guidelines for Conduct-
ing FWRA, 2013.

Monitoring in Countries With In areas with naturally occurring radiation, which can be
Naturally Occurring Radiation identified in the course of a thorough MIPOE, radon (de-
Sean Davis, MS; Roy Cruz, 68S cay product of radionuclides) should be investigated for
levels above 4 piC/L, US EPA action level. Radon is classi-
ike many places in the United States, Jordan has ar- fied by the IARC as carcinogenic to humans, is airborne,
Leas with high levels of naturally occurring radiation. and can accumulate in confined spaces. If the MIPOE
1
In areas with concentrations of naturally occurring ra- indicates that monitoring is prudent, a small radon-
diation, water contamination and air quality, especially monitoring device can be used to examine and monitor
indoor, need to be investigated. The possible contami- living and work areas. A battery-powered monitoring
nation of Jordan’s water supply has been suspected device costs approximately $250. Mitigation can be as
for years. In July 2009, an article published in IEEE simple as placing an operating fan in crawl space or sub-
Spectrum cited one potential cause: “isotopes entered floor. If an exposure cannot be mitigated, then it should
2
the water from the surrounding sandstone through a be documented through a periodic occupational environ-
physical process known as recoil.” Since 2009 Jordan mental monitoring survey (POEMS), which is uploaded to
has produced studies demonstrating their water supply the MESL or an individual exposure SF600 if appropriate.
meets Jordanian standard 248 of 2008 and World Health
Organization drinking water guidelines. However, from
multiple samples taken by 223rd Medical Detachment References
(PM) which are available in the Military Exposure Sur- 1. Xoubi N. Evaluation of uranium concentration in soil samples
veillance Library (MESL) (https://mesl.apgea.army.mil/ of central Jordan. Minerals. 2015;5:133–141.

Medical Intelligence Prep of the Environment 119