The personnel of the Division of Occupational and Environmental Medicine are engaged in a range of clinical surveillance and outreach activities, which are described below:
The Depleted Uranium Program
The Department of Veteran Affairs (DVA) Depleted Uranium (DU) Follow-up Program at the Baltimore VA Medical Center is a clinical surveillance program for identifying, characterizing and following individuals exposed to DU during the Gulf War conflict.
The specific aims of the project are to provide ongoing clinical surveillance of Gulf War veterans with known or suspected embedded DU fragments, DU-contaminated wounds or significant amounts of inhaled DU. This clinical surveillance is designed to detect potential health effects of DU-containing shrapnel or inhalation exposure, and provide recommendations for treatment to participating veterans and physicians caring for them.
Focused investigation into the toxicological and radiological effects of DU is intended to improve the scientific basis for advice about fragment removal; to better model uranium absorption, distribution in tissue and excretion; and to develop improved methods to assess uranium dose. In addition, the program hopes to improve methods of detection of toxic effects from low-dose uranium exposure.
Toxic Embedded Fragment Surveillance Center
The Department of Veteran Affairs (DVA) Toxic Embedded Fragment (TEF) Surveillance Program at the Baltimore VA Medical Center is a clinical surveillance program for veterans with traumatic injury incurred via contact with improvised explosive devices (IED) or other blasts resulting in wound contamination with toxic metals, plastics and composite materials.
The TEF centers is working with DoD to establish a registry of such wounded soldiers which is accessible to clinicians and will allow ‘seamless’ tracking of the active duty patient to veteran status. Center staff is crafting Medical Management Guidance for local VA caregivers to use which will link surveillance elements to the content of a patient’s retained IED fragments. Special biomonitoring for specific metals and other retained material will be made available and modeled after the successful DU urine monitoring accomplished via the mail. The Center may also perform limited in-patient assessments for complex cases.
Employee Health Surveillance Programs
In addition to providing consultation for the individual patient, the division provides comprehensive employee medical and health surveillance services as required by the Occupational Safety and Health Administration (OSHA). These services include surveillance and laboratory testing required by substance specific OSHA standards, as well as those related to the use of respiratory protection. Tuberculin skin testing programs and immunizations are also provided with comprehensive recordkeeping at the patient or workplace facility level, enabled through our electronic medical records systems.