Exposure science in U.S. military operations: a review.

Since 1991, the U.S. Department of Defense has conducted deployment occupational and environmental health surveillance activities in the geographic combatant commands for major conflicts, military exercises, and humanitarian and peace-building missions. The DoD has made significant improvements in documenting and assessing deployment environmental hazards and threats since 1991, illustrated by accomplishments in Bosnia, Kosovo, and Operations Noble Eagle (following the September 11, 2001 terrorist attacks); Enduring Freedom-Afghanistan; and Iraqi Freedom (2003-2010). Sampling is now recommended as part of the DoD Exposure Assessment Method, a dynamic process that is performed during all phases of military operations: I--Predeployment, II--Mobilization, III--Conflict, and IV-Postdeployment. From 2001 to 2009, deployed personnel collected over 24,500 air, water, soil, and bulk samples during operations. These efforts have lead to the creation of an environmental health surveillance database that has been used to investigate public health issues. However, gaps exist, especially in the assessment of individual exposures during deployment.