Gijsbert van der Voet, PhD, ERT, Clinical Toxicologist (Co-PI)
Florabel G. Mullick, MD, SES (Co-PI)
Department of Environmental and Infectious Disease Sciences
Objective(s): To establish a Registry program on chemical characterization and case material on metal fragments and other foreign materials that are removed from surviving DoD personnel in DoD military treatment facilities (MTFs). The establishment of this Registry on Embedded Metal Fragments is in response to the recently approved Health Affairs Policy number 07-029 (see Attachment 1). This HA policy recognizes that some munitions may contain certain tungsten alloys and other metals that may pose a long-term toxicological hazard when retained in the human body. Accordingly, it is therefore, prudent to identify the chemical make-up of metal fragments removed because it is known that affected personnel often still harbor multiple fragments of similar composition. The HA Policy is the first step in establishing a mechanism for tracking DoD personnel bearing potentially hazardous embedded fragments, since currently there are insufficient data available to assess specific risk. The AFIP has been tapped by HA to serve as one of three DoD sites for the analysis and archival of fragments removed DoD personnel. Accordingly, the AFIP Registry on Embedded Metal Fragments will serve as a central facility for the characterization, chemical toxicological analysis and archival of cases with potential exposure to metal and non-metal materials.
Military Relevance: The signature wound of the current conflict in Iraq, and increasingly in Afghanistan, is the traumatic injury incurred via contact with improvised explosive devices (IED) resulting in wound contamination with toxic metals, plastics and composite materials. Fragments received through wounds from IED or other battlefield threats, are raising concerns about the long-term implications of living with embedded metal fragments. Military arsenals around the world are increasing their reliance on modern technology, and the search for more effective munitions has led to the use of many unique heavy metals on the battlefield from depleted uranium to the recently suggested use of tungsten-based alloys. Recently published studies from the Armed Forces Radiobiology Research Institute on experimental laboratory animals implanted with a tungsten-cobalt-nickel alloy have demonstrated the tungsten/cobalt/nickel alloy used in some armor-piercing munitions may pose a long-term health risk in the form of embedded metal fragments. Accordingly, the potential use of these metal alloys in the battlefield may present potential problems for health professionals who are concerned about long-term exposure to embedded metal fragments.
With estimates of IED or other battlefield threat induced injuries numbering in the thousands, the analytical and toxicologic expertise of the AFIP Division of Biophysical Toxicology at the Department of Environmental and Infectious Disease Sciences has again been tapped by HA to enlarge its mission and to offer chemical toxicological and surveillance of IED wounded personnel. Initial steps involve working together with the HA Force Health Protection and Readiness Program, and with the VA to establish a working registry of case material and chemical information which is accessible to clinicians and health care providers to better manage any future medical problems related to this issue.
Methods and Procedures: Procedures are in place for the collection and archival of clinical, pathological and chemical specimens from cases resulting on removal of metal fragments. A wide range of chemical analytical techniques for the characterization of metal fragments will be used including inductively coupled plasma mass spectrometry (ICP-MS), laser ablation ICP-MS and scanning electron microscopy. The chemical analysis, database processing, archival and Registry management will be conducted by the Division of Biophysical Toxicology, Department of Environmental and Infectious Disease Sciences.
