One prominent hypothesis about illnesses among Gulf War veterans is that some of the reported symptoms are the result of exposure to chemical warfare agents. During and after the Gulf War, some veterans reported that they had been exposed to chemical warfare agents. To investigate these incidents, and to assess the likelihood that chemical warfare agents were present in the Gulf, the Department of Defense developed a methodology for investigation and validation based on work done by the United Nations and the international community. The criteria include:

• A detailed written record of the conditions at the site;
• Physical evidence from the site such as weapons fragments, soil, water, vegetation or human/animal tissue samples;
• A record of the chain of custody during transportation of the evidence;
• The testimony of witnesses;
• Multiple analyses; and
• A review of the evidence by experts.

While the methodology (Tab D) used to investigate suspected chemical warfare agent incidents is based on these protocols, the passage of time since the Gulf War makes it difficult to obtain certain types of documentary evidence, and physical evidence was often not collected at the time of an event. Therefore, we cannot apply a rigid template to all incidents, and each investigation must be tailored to its unique circumstances. Accordingly, we designed our methodology to provide a thorough, investigative process to define the circumstances of each incident and to determine what happened. Alarms alone are not considered to be certain evidence of chemical warfare agent presence, nor is a single observation sufficient to validate the presence of a chemical warfare agent.

After following our methodology and accumulating anecdotal, documentary, and physical evidence; after interviewing witnesses and key servicemembers; and after analyzing the results of all available information, the investigator assesses the validity of the presence of chemical warfare agents on the battlefield. Because we do not expect to always have conclusive evidence, we have developed an assessment scale (Figure 1) ranging from Definitely Not to Definitely, with intermediate assessments of Unlikely, Indeterminate, and Likely. This assessment is tentative, based on facts available as of the date of the report publication; each case is reassessed over time based on new information and feedback.

Figure 1. Assessment of chemical warfare agent presence

In February 1998, investigators from the Office of the Special Assistant to the Under Secretary of Defense (Personnel and Readiness) for Gulf War Illnesses, Medical Readiness, and Military Deployments (formerly called the Office of the Special Assistant for Gulf War Illnesses) interviewed doctors, nurses, and administrators who had been stationed at Fleet Hospital 15 in Al Jubayl, Saudi Arabia, during the Gulf War. During these interviews, two nurses and one administrator told us of possible chemical warfare agent injuries to several Marines of the 2d Reconnaissance battalion during the Gulf War, although they had not personally examined the injured Marines. We investigated these reports and found that, before the start of the ground war, six Marines from this unit sought treatment during early February 1991 for symptoms described as blisters, bumps, or sores on their hands, ears, and necks. These Marines had been assigned to different reconnaissance teams operating different observation posts when the blisters appeared.

Field medical personnel considered a number of causes for these blisters, ranging from mustard agent exposure to a leishmaniasis infection; however, they did not make a definitive diagnosis because many symptoms of these conditions were absent. Since the injuries were not severe or debilitating, field medical personnel declared the Marines fit for duty and returned them to their unit. The blisters healed within a few weeks, and the Marines participated in ground war operations without further complications.

In the course of our investigation, we contacted and interviewed several of the Marines who sought treatment at the hospital, and interviewed hospital personnel, including the doctors who treated the Marines. In addition, we commissioned a chemical warfare medical expert to interview the Marines and evaluate their injuries. Finally, we reviewed the hospital admissions log that the nurses believed documented the chemical warfare agent treatment.

After a thorough investigation, we assess that it is unlikely mustard exposure caused these skin lesions. This assessment is supported primarily by the opinion of a medical expert who specializes in identifying chemical warfare agent casualties. He personally interviewed and examined three of the Marines and conducted a telephone interview with another, showing them skin conditions caused by various exposures. None of the Marines thought the pictures of blisters caused by mustard exposure resembled their blisters. The information the medical expert gathered led him to assess it is unlikely these Marines' blisters were caused by Mustard exposure.

In addition to this expert opinion, our assessment is supported by information gathered in interviews with medical, chemical, and command personnel; and the Marines, corpsmen, doctors, and nurses directly involved. Evidence of a chemical warfare agent exposure could include a confirmed chemical warfare agent detection, notations about the blisters in the Marines' medical records and statements from Fleet Hospital 15 doctors confirming they treated Marines for chemical warfare agent exposure - evidence we lack in this case. We were unable to find any doctors who remembered treating anyone at Fleet Hospital 15 for chemical warfare agent injuries. The only medical personnel from Fleet Hospital 15 who recalled treatment for chemical warfare exposure were not present when the Marines were treated. All the Marines we interviewed confirmed what the admission logs and medical records indicated: they received treatment for respiratory ailments, not chemical warfare agent exposure. Although one Chemical Agent Monitor reportedly detected mustard on a Marine’s glove, the re-test with the same monitor revealed no agent—the first report had been false-positive alarm. Finally, we have no knowledge of Iraq transporting chemical warfare agents within 200 miles of the reported exposure site on the Kuwait-Saudi Arabian border.

Nevertheless, we lack specific evidence to preclude our assessing chemical warfare agents definitely did not cause these blisters and we cannot identify the cause of the blisters. To make this assessment, we require physical evidence from the site of suspected exposure (e.g., sand from the berm or urine and blood specimens taken when the blisters occurred). This evidence was not available to our investigators, because it was not collected at the time of medical treatment.

1. Incident Report

In February 1998, investigators from the predecessor of the Office of the Special Assistant for Gulf War Illnesses, Medical Readiness, and Military Deployments interviewed Navy doctors and medical personnel about various issues. During these interviews, two nurses and one member of Fleet Hospital 15's administrative staff described an incident that occurred at the hospital in Al Jubayl, Saudi Arabia, in early March 1991.

According to a nurse on duty at the time of the incident, approximately 15 to 20 Marines from the 2d Reconnaissance Battalion appeared at the hospital seeking treatment for what she thought doctors diagnosed as symptoms of chemical warfare agent exposure. According to the nurse, hospital personnel admitted seven of these Marines for treatment and had to place one on an intubator due to severe respiratory ailments.[2] The assistant chief of the hospital's Casualty Receiving Area and another nurse, both on duty at the time, made similar statements to our investigators regarding the treatment of these Marines.[3] None of these three persons treated these Marines; however, one thought this incident was so significant that he photocopied the casualty receiving records, retained them, and later provided us those records for this investigation.

2.  The 2d Reconnaissance Battalion

a. Organization

In December 1990 the 2d Reconnaissance Battalion, 2d Marine Division (MARDIV), Fleet Marine Force Atlantic deployed to the Persian Gulf as an operational component of the I Marine Expeditionary Force. The battalion's subordinate commands included a Headquarters Company and Companies B, C, and D (Company A was detached before January 1991). These companies’ personnel divided into 29 reconnaissance teams, of which 24 were motorized with 48 high-mobility multi-purpose wheeled vehicles (HMMWVs).[4] This narrative covers activities that occurred between February 4, 1991 and March 17, 1991.

The Marines involved in this investigation belonged to teams of Company B, which consisted of the company commander and three reconnaissance platoons. The reconnaissance platoons’ teams consisted of a team leader and five to seven Marines.[5] Six Marines from Company B reported experiencing the blisters we investigated. Figure 2 illustrates those Marines’ position in the company's chain of command.

Figure 2. 2d Reconnaissance Battalion organization

b. Mission

The 2d Reconnaissance Battalion supported the 2d MARDIV by conducting reconnaissance and surveillance of the areas forward of Coalition defensive positions. The battalion’s task was to identify enemy units south of the breaching sites and gaps or weaknesses in enemy defenses in those areas.[6] They accomplished this task by establishing observation posts along Kuwait's border and conducting reconnaissance patrols in that vicinity.

We primarily used veterans’ accounts, supported where possible by documented evidence, such as watch logs, unit chronologies, and Gulf War histories to develop this chronology. Figure 3 graphically depicts the time-line of these events.

Figure 3. Sequence of Events

1. Pre-Ground War Activities

On January 29, 1991, Iraq's units probed across the Saudi Arabian border three times, once in the 2d MARDIV's area of responsibility. This prompted the division commander to move the 6th Marine Regiment forward to provide a defensive front for the 2d MARDIV. At this time Company B was detached from the 2d Reconnaissance Battalion to support the 6th Marines, which they did by establishing listening and observation posts four kilometers south of Kuwait’s border. On February 4, 1991, the observation posts moved forward two kilometers to a man-made berm parallel to Kuwait’s border that concealed them from observers north of the position. Five days later, the 8th Marines relieved the 6th Marines. Company B remained in position (Figure 4).[7]

Figure 4. Observation post locations on February 10, 1991

A. Symptoms Develop (February 4-14,1991)

Between February 4 and 14, 1991, six Marines from Company B reported developing what they have described as bumps, blisters, or sores on their hands, ears, and necks. These Marines were from different teams and different platoons, and were assigned to different observation posts. Five Marines were from the 1st Platoon: one from the first reconnaissance team, one from the second, and three from the third reconnaissance team. The sixth Marine to report experiencing these symptoms was 3d Platoon's commander.[8]

The possibility of biological or chemical warfare was heavily emphasized during the Gulf War—Coalition forces expected Iraq’s forces to initiate chemical warfare.[9] Because of this expectation, the proximity of Company B's listening and observation posts to Iraq’s forces, and the obvious concern blisters result from some types of chemical warfare agent exposure, the company commander instructed these Marines to seek medical attention.[10]

At a rear area command post, corpsmen and various medical personnel examined the Marines. No one could diagnose a cause, but several speculated the blisters formed because of something the Marines contacted while digging in the sand at the berm. Because of the threat of chemical attack, someone tested the Marines and their equipment for chemical contamination with a chemical agent monitor (CAM), a portable, hand-held device capable of detecting blister or nerve agent contamination on personnel, equipment, and elements of the surrounding environment (Figure 5 and Tab E). The CAM alerted for the presence of chemical warfare agent on one Marine's glove, so field medical personnel prepared the Marines for decontamination procedures. However, after the operator cleared the CAM and retested the glove, there was no alert. The CAM operator decided the alert had been a false detection and decontamination procedures were unnecessary.[11]

Figure 5. A Chemical Agent Monitor

B. 8th Marines Regimental Aid Station (February 14, 1991)

Because the command post medical staff was unable to determine a cause for the blisters, the Marines traveled farther back to the 1st Battalion, 8th Marine Regiment’s battalion aid station. Medical personnel again examined the Marines but could not diagnose a cause. The Marines stayed overnight, showered, and the next morning continued further back to a larger aid station operated by the 8th Marine Regiment.[12]

At the regimental aid station, medical personnel inspected the blisters. At least one Marine remembered having one of the blisters opened for closer inspection and cleaning. Further inspection of the blisters prompted one unidentified individual to speculate the lesions could be the result of leishmaniasis, a parasitic disease spread by the bite of infected sandflies. This Marine recalled that medical personnel dismissed this explanation due to the absence of any other symptoms commonly associated with this condition, such as fever, fatigue, and abdominal discomfort.[13]

The Marines returned to duty. They were not incapacitated and their symptoms in no way hindered them from performing their daily tasks. Medical personnel had not diagnosed the blisters’ cause and advised only frequent daily hand-washing to treat the blisters. After approximately three to five weeks of daily washing, the blisters healed with no further complications.[14]

Little documentation describes the treatment of these injuries. In fact, after thoroughly searching medical records, unit histories, and watch logs, we could find only one reference to this incident. A 9:15 AM entry on February 14, 1991, in the 2d Reconnaissance Battalion's Watch Officer Log reads:

MSG [message] Received from "B" Co. 1.) Still maning [sic] OP [observation posts] F + D 2.) They have 6 people w/ blisters on hands and are being looked at by 8th MAR M.O. [medical officer] 3.) They wanted to know the status of their HMMWV alternator 4.) They also requested that LCPL [redacted] out of Combat Replacement Co return to BN [battalion].[15]

Company B rejoined the 2d Reconnaissance Battalion on February 18, 1991, as the unit prepared for the ground offensive.[16]

2. Ground War Activities (February 24-26, 1991)

The 2d Reconnaissance Battalion moved through the minefield breaching lane behind the 6th Marines on February 24, 1991, after which the battalion supported the 2d Battalion, 4th Marine Regiment during the final assault from Phase Line Horse to Phase Line Bear (Figure 6), providing navigational support and additional firepower with HMMWV-mounted machine guns.[17] All the Marines who experienced the reported symptoms were with the unit at this time and participated in these events unhindered by any ailments.[18]

Figure 6. Movement of the 2d Reconnaissance Battalion February 26, 1991

3. Fleet Hospital 15 (March 11-17, 1991)

Between March 11 and 17, 1991, approximately one month after field medical personnel examined the Marines at the 8th Marines' regimental aid station, doctors at Fleet Hospital 15 in Al Jubayl treated three Marines from Company B, including the 1st platoon commander, for symptoms attributed to respiratory ailments, and another for a broken jaw. According to the hospital's admission logs, these were the only instances between February 10 and March 21, 1991, that anyone from the 2d Reconnaissance Battalion was admitted to this hospital. Two of the casualties eventually were medically evacuated.[19]

One of the Marines in the group treated for respiratory ailments in March was a corporal from 1st Platoon's third reconnaissance team who had developed blisters before the ground campaign. On this Marine's hand where the blisters were healing were minor scars. When doctors asked about them, the Marine recounted his treatment at the 8th Marines' aid station. It may have been unclear to hospital staff what caused the blisters, but doctors did not find the scars severe enough to require any treatment. Fleet Hospital 15 personnel later reported the treatment of these 2d Reconnaissance Battalion Marines to our office as a nuclear, biological, or chemical (NBC) incident. When questioned, both the Marine corporal and the 1st Platoon commander stated they went to Fleet Hospital 15 in March 1991 for treatment of respiratory ailments they associated with inhaling oil well fire smoke, not chemical warfare agent exposure or the blisters that developed before the ground war.[20]

1. Conditions at the Site

Company B operated observation posts approximately two kilometers south of Kuwait's border in a desert environment of very coarse sand and no noticeable vegetation.[21] The winter weather here was cold at night and cool during the day, averaging lows of 0� to 5� C (32� to 41� F) and highs of 15� to 20� C (59� to 68� F).[22]

2. Interviews of Witnesses and Key Servicemembers

A. Medical Personnel

We interviewed several doctors and corpsmen about these Marines, including the 8th Marine Regiment's medical officer, the 2d Reconnaissance Battalion’s surgeon, and other 2d MARDIV medical personnel.

The 2d Reconnaissance Battalion surgeon was unaware of any 2d Reconnaissance Battalion Marines injured due to exposure to chemical warfare agent; however, he did recall the 3d platoon’s commander (one of the Marines this investigation identified) had acquired a condition then diagnosed as some form of infectious dermatitis.[23]

The senior chief at the 1st Battalion, 8th Marine Regiment’s aid station recalled an unidentified corpsman told him about two Marines from the 2d Reconnaissance Battalion who had blisters on their hands. As far as the chief knows, medical personnel sent the Marines to the 8th Marines Regimental aid station for their doctors to examine. The senior chief thought the blisters were the symptoms of some form of dermatitis, then a common ailment among servicemembers in the area.[24]

When questioned separately about this incident, the 8th Marines medical officer and the regimental aid station's senior corpsman stated they would know and remember if their personnel treated anyone for symptoms of chemical warfare agent exposure. To their knowledge, this never occurred; however, they treated several servicemembers at the various 8th Marine Regiment aid stations for various forms of dermatitis. The medical officer remembered a corpsman taking a group of Marines to a hospital at the 2d Force Service Support Group for symptoms resembling chemical warfare agent contamination. He does not think they were so diagnosed.[25]

We followed the 8th Marines' medical officer's lead by checking previous interviews with 2d Force Service Support Group medical personnel. We interviewed the executive officer of the 2d Medical Battalion; the commanding officer and senior medical officer, Company G, 2d Medical Battalion; a nurse with the 2d Medical Battalion; and the commanding officer, Company F, 2d Medical Battalion. None of them remembered treating 2d Reconnaissance Battalion Marines for injuries resembling those caused by chemical warfare agent exposure.[26]

The 2d MARDIV surgeon and the command master chief of the 2d MARDIV surgeon's office believe they would have been informed of any suspected 2d MARDIV chemical-related casualties; they knew nothing about these injuries.[27]

We also interviewed the Fleet Hospital 15 doctor who signed the medical treatment records of the corporal with blistered hands from 1st Platoon's third reconnaissance team. This doctor heard rumors several 2d Reconnaissance Battalion Marines were treated for chemical warfare agent exposure at his hospital, but he never treated any patients for such injuries. His notes on the corporal's medical records discuss only respiratory problems associated with oil well fire smoke. He did not specifically remember treating this Marine, but was sure he would remember treating a chemical warfare agent casualty.[28]

B. NBC Personnel

In July 1991 the Marine Corps Research Center published "Marine Corps NBC Defense in Southwest Asia," more commonly called the "Manley Report" for then-Captain Thomas F. Manley, who compiled the paper. This report is a contemporary analysis of NBC defense issues, such as training, doctrine, intelligence, individual NBC equipment, operational readiness, and major lessons learned, in the Marine Corps’s areas of operations during the Gulf War.[29]

To compile the report, Captain Manley interviewed several veterans, including the 2d Reconnaissance Battalion NBC officer and non-commissioned officer (NCO); and the 8th Marine Regiment NBC officer and NBC staff non-commissioned officer (SNCO). All these Marines would have been informed about an NBC incident (such as three to six Marines seeking treatment for blisters resembling chemical warfare agent wounds). None of these interviewees mentioned the incident involving Marines from the 2d Reconnaissance Battalion during their interviews with Captain Manley.[30]

The 2d MARDIV NBC officer remembered some details about the incident. Answering a question about Marines from the 2d Reconnaissance Battalion being overcome while digging in the sand walls of the man-made berm near Kuwait's border, he stated he heard speculation the blisters were due to chemical warfare agent exposure.[31] The 2d MARDIV NBC SNCO heard stories about Marines with blisters on their hands and knew no other details except the incident had occurred before the ground offensive.[32] A 2d MARDIV NBC officer heard a rumor one 2d Reconnaissance Battalion Marine developed an irritation caused by a chemical warfare agent.[33]  None of these individuals observed the injuries and we found no evidence to support the statements.

C. Command Personnel

We interviewed Marines at every level in the 2d Reconnaissance Battalion chain of command, including platoon commanders, a company commander, and battalion commander, as well as the 2d MARDIV assistant chief of staff for administration and assistant chief of staff for operations.

We asked two Company B platoon commanders about this event. The 3d Platoon commander was one of the Marines who experienced blistering on his hands. He believes he had leishmaniasis caused by an insect bite that created a sore on the back of his hand between the first and second knuckle. Over three to four days, more sores developed until they were on all fingers of both hands. The pain associated with these lesions equaled that of an insect bite. The sores healed over three to four weeks of daily, frequent hand washing. This Marine was not aware any other Marines in his platoon had developed this condition. Furthermore, this Marine does not believe his symptoms were related to those experienced by the other Marines because he recalls developing blisters in late January, before the company established the observation posts at the berm. He is included in this investigation because he belonged to Company B and experienced symptoms similar to the other Marines’.[34]

The 1st Platoon commander became involved in this incident almost a month after it occurred, but could not provide many details. He was able to confirm two 1st Platoon Marines had lesions on their hands, which he understood were caused by insect bites or contact with some chemical substance, such as motor oil or cleaning solutions. He confirmed the 3d Platoon commander also had these lesions.[35]

The Company B commanding officer could not remember this event. He was sure no Marines in his company were ever put on medication or light duty and speculated one or more Marines may have reacted to something in the desert and sought a medical opinion about its cause. He does not believe chemical warfare agent exposure affected any of his Marines.[36]

The 2d Reconnaissance Battalion commanding officer recalled Marines in Company B had problems with itchy hands but did not associate this with a chemical incident.[37]

US Army Field Manual 3-100, "NBC Defense, Chemical Warfare, Smoke, and Flame Operations" describes the principles of planning and executing NBC defenses. According to this document, the 2d MARDIV assistant chief of staff, G-1 (administration) would have prepared and maintained any NBC situation reports the 2d MARDIV generated.[38] She had no records of any chemical warfare agent casualties with the 2d MARDIV, but she directed us to the 2d MARDIV assistant chief of staff, G-3 (operations).[39] During our interview, the 2d MARDIV operations officer said he heard about Marines with blisters on their hands but knew nothing else about the incident.[40]

3. Analysis

A. Chemical Warfare Agent Exposure

Blister agents are chemical warfare agents that damage the eyes and lungs and blister the skin to the point of incapacitation or death. Blister agents are persistent and may be employed as colorless gases and liquids. The severity of a blister agent burn directly relates to the agent’s concentration and its duration of contact with the skin.[41]

We considered mustard agent exposure as a possible cause of these Marines' symptoms for several reasons:

• When blisters simultaneously appear on several people, apparently the case in this incident, medical personnel are trained to consider the possibility the casualties have been exposed to a chemical warfare agent.[42]
• At least two Marines involved in this incident recalled personnel at the command post tested a glove with a CAM and received a positive reading for blister agent.[43]
• Some blister agents cause immediate pain on contact, but mustard does not. Mustard agent exposure symptoms may appear anywhere from 4 to 24 hours after contact. The Marines involved in this incident do not know when they came in contact with whatever caused this blistering, but it is likely they would remember contacting lewesite or phosgene oxime because both are extremely painful on contact.[44]
• Fleet Hospital 15 staff, who were the first to report this incident, stated doctors diagnosed the injuries as exposure to mustard agent.[45]

Mustard Injuries

We initiated this investigation to assess the likelihood mustard agent exposure caused the blisters these Marines experienced. The following section compares expected symptoms and treatment of mustard agent exposure and the symptoms and treatment these Marines experienced.

Symptoms

The Marines had some difficulty describing their blisters in detail due to the interval that had passed since they had them. They described the blisters as up to the size of a dime (approximately two centimeters in diameter) with clear or opaque fluid. Some Marines remembered redness or inflammation accompanying the blisters; others did not.[46] The characteristic mustard blister  is dome-shaped, thin-walled, translucent, yellowish, and surrounded by reddened skin. Generally, it is 0.5 to 5.0 centimeters in diameter, although it can be larger. The blister fluid initially is thin and clear or slightly straw-colored; later it turns yellowish and tends to coagulate.[47]

Aside from the blisters, the Marines experienced few other symptoms. Several affected Marines remembered some minor itching associated with the appearance of the blisters,[48] but none remembered feeling a great degree of pain. In comparison, mustard blisters usually are very painful and cause damage comparable to first-, second-, or third-degree burns, depending on the agent’s concentration. At least one Marine experienced diarrhea and nausea,[49] common symptoms associated with mustard exposure.[50] The Marines speculated whatever caused these blisters was in the sand they dug at the berm.[51] If they were exposed to mustard potent enough to cause blistering and nausea, they also should have experienced ocular (eye) effects. We consulted an expert on this issue, and he thinks it is likely mustard of this potency within an arm's reach would have vaporized from body heat and affected the Marines’ eyes.[52] Over one minute, the threshold amount of vapor required to produce a skin lesion is approximately 200 milligrams per cubic meter, while as little as 12 milligrams per cubic meter will damage the eye.[53] None of these Marines experienced ocular effects.[54]

Treatment

The Marines noticed the blisters grew and spread across their hands over several days,[55] which is uncommon with mustard injuries.[56] It is common for secondary skin lesions to appear if a mustard casualty is not decontaminated immediately after contact with the agent, because the agent can spread from the back of the hand to the face, neck, and other areas of the skin. Mustard fixes to the skin within minutes of exposure, ensuring tissue damage if decontamination does not begin immediately after contact. By the time skin lesions appear, most of the agent has been absorbed, while the remaining unabsorbed mustard will have evaporated.[57] The Marines did not seek medical treatment until they noticed the blisters,[58] but this does not account for the blisters spreading over a period of days.

If field medical personnel believed mustard exposure caused these blisters, they did not treat the blisters as such. Treatment for mustard exposure includes cleaning the blistered skin to prevent infection and applying a topical antibiotic to the blisters and surrounding skin. If the casualty is to return to duty, medical personnel most likely would bandage the affected areas.[59] In this instance, the only treatment one Marine recalls was instructions to wash his hands regularly.[60] Field medical personnel did not treat these Marines as mustard agent casualties.

Chemical Agent Monitor Alert

The CAM alert indicates the possibility of a blister agent on the glove of one Marine.  However, the CAM's selectivity causes the device to alert to some non-chemical warfare agent vapors resulting in false positive detections.[61] Therefore, after the first alert, the CAM operator followed proper procedure by clearing the CAM before re-testing the glove.  For this test, did not receive a positive reading, indicating the first alert was a false detection.[62]

Source of Chemical Warfare Agent

Assessing the possibility of any chemical warfare agent exposure requires us to identify how the agent reached the point of exposure. Before the Gulf War, the US intelligence community[63] warned US forces Iraq not only had chemical weapons capabilities, but also had employed them against both its own citizens and against Iran.[64] After the Gulf War, the United Nations Special Commission on Iraq (UNSCOM) chemical and biological weapons inspections program identified, inventoried, and, in some cases, supervised Iraq's destruction of its chemical warfare agents and chemical weapons. During this program, UNSCOM determined Iraq’s only means of delivering mustard agent were 155mm artillery shells and aerial bombs.[65] The area where these Marines operated was in Saudi Arabia and never under Iraq’s control. These Marines did not receive in-coming artillery fire before the lesions developed,[66] and Iraq’s air force did not fly ground-attack sorties after January 25, 1991.[67] For this reason, we do not believe Iraq's forces delivered any chemical warfare agents to the area where these Marines operated.

NBC Incident Procedure 

The standard procedure for reporting actual or suspected chemical or biological hazards is the NBC Warning and Reporting System. All units in an area of operations rely on this system to identify, assess, and limit the effects of chemical or biological attacks and determine the best course of action to complete their missions should such an attack occur. The most widely used report submitted in this system is an NBC-1 report, used to report NBC attack data. The Marines involved in this investigation never witnessed an NBC attack; however, their unit would have submitted an NBC-4 report (used to report possible NBC detections) if the unit NBC personnel believed chemical warfare agents had contaminated these Marines.[68] Our investigators never located an NBC-4 report for this incident, nor do we believe one was ever filed. Fleet Hospital 15 and the 2d Reconnaissance Battalion never filed an NBC report, and no Marine Corps unit histories note this event. Furthermore, the Fleet Hospital 15 admission logs provided by the veterans who reported the incident do not document the admission of anyone for symptoms resembling those described. This indicates no one who treated these Marines within the 2d Reconnaissance Battalion or at Fleet Hospital 15 thought the Marines had been exposed to chemical warfare agents.

Fleet Hospital 15 Casualty Receiving Records

When Fleet Hospital 15 personnel reported the treatment of these Marines to us, they provided us a photocopy of a 20-page hospital admission log that recorded the names, units, diagnoses, and dispositions of everyone admitted to Fleet Hospital 15 between February 10, 1991, and March 21, 2001. According to this log, 2d Reconnaissance Battalion Marines were only admitted to the hospital twice, either for asthma or a broken jaw.[69] The admission logs do not indicate anyone was ever admitted to the hospital for the treatment of chemical warfare agent exposure.

4. Medical Expert's Review

During our investigation, we asked a medical expert who specializes in chemical warfare agent casualty identification and treatment to evaluate the six Marines. This independent medical expert has several years’ experience in this field and once taught emergency department physicians and nurses in communities surrounding the eight US chemical weapon facilities how to assess, decontaminate, and treat chemical warfare casualties. In December 2000, almost 10 years after the Gulf War ended, he evaluated the Marines using information gathered by our investigators and through his own interviews with the Marines, three in person and one over the telephone. For the two remaining Marines, the medical expert relied on our interview notes to make his assessment.

During their interviews with the medical expert, the Marines described the blisters to the best of their ability and discussed their environment, clothing, and activities at the time the blisters appeared. The specialist showed five Marines pictures of skin lesions caused by various conditions, including mustard agent exposure, and asked the Marines to identify which ones most resembled their blisters. Pictures they selected included polymorphic light eruptions, leishmaniasis, urticaria, infectious folliculitis, Grover's Disease, and dermatomyositis.[70] None of the Marines identified the pictures of blisters caused by exposure to mustard agent.[71]

The medical expert could not identify with any degree of certainty what might have caused each Marine’s blisters. However, he listed several reasons why it is unlikely mustard agent exposure caused these Marines’ blisters:

• at the time of their skin problems the Marines experienced none of the other symptoms commonly associated with mustard exposure (e.g., eye irritation, redness, eye pain, discharge, or uncontrollable blinking), nor sinus pain, nasal irritation, sore throat, cough, hoarseness, or chest tightness;
• blisters did not form in warm, moist areas of skin where mustard is most likely to produce lesions, and there was no redness or blistering between the fingers, on the wrists, in the creases of the elbows, or behind the knees;
• the blisters did not coalesce to form larger blisters; and
• the Marines did not identify the picture of blisters caused by mustard exposure.[72]

We investigated this issue to determine if 2d Reconnaissance Battalion Marines operating observation posts along Kuwait's border in early February 1991 developed blisters on their hands due to chemical warfare agent exposure. After thoroughly examining all available evidence, we assess it is unlikely chemical warfare agent exposure caused these blisters.

It is clear these Marines experienced symptoms that concerned them. The threat of chemical attack at the time of the Gulf War was real, and the blisters these Marines developed caused at least one unidentified corpsman to speculate the blisters resulted from chemical warfare agent exposure. In addition, anecdotal evidence indicates a CAM alerted once for the possible presence of a blister agent, but subsequent tests proved negative. The blisters, the nurses' second-hand reports, and the single CAM alert constitute the only evidence available indicating a possible chemical warfare agent exposure.

The evidence chemical warfare agents were not present is more substantial. There is no apparent explanation to account for the presence of chemical warfare agents in the company's area of operations. Additionally, the randomness with which the blisters affected Marines on different teams in different locations, while not affecting other Marines at the same place at the same time, is inconsistent with  a chemical warfare incident.

Medical, NBC, and command personnel supporting the 2d Reconnaissance Battalion during the Gulf War would have known about an NBC incident in the battalion, because they would have treated the casualties, investigated the incident, and submitted NBC reports. Interviews with these experts revealed very few knew anything about Marines with blistered hands, and those who were aware did not consider the Marines chemical warfare agent casualties. We were unable to locate any medical records, unit logs, or NBC reports indicating chemical warfare agents injured these Marines. In fact, the Fleet Hospital 15 admission logs, which were provided to us by the people who reported the incident, show that no 2d Reconnaissance Battalion Marines were treated at the hospital for chemical warfare agent exposure.

The most compelling evidence to support our assessment is the opinion of a medical specialist with expertise in chemical warfare agent injuries, who separately evaluated each of the Marines in December 2000. He found these Marines' symptoms to be inconsistent with those associated with chemical warfare agent exposure, and believes it is unlikely mustard or any other chemical warfare agent caused the blisters.

We cannot categorically state these Marines definitely were not exposed to chemical warfare agents. Such an assessment would require laboratory analysis of physical evidence from the site of suspected exposure (sand from the berm) and samples of urine, blood, and blister liquid taken when the injuries occurred. Such evidence was not available to our investigators because it was not collected at the time. However, the expert's opinion, combined with the lack of any corroborating evidence of chemical warfare agent exposure, lead us to assess it is unlikely chemical warfare agents caused these Marines’ blisters.

A. Communication

We are unsure why some medical personnel at Fleet Hospital 15 believed hospital doctors treated several Marines with chemical warfare injuries. Procedures did not allow these medical personnel to have misperceptions corrected until we investigated the incident nine years after the fact. In the future, investigation and reporting of such issues should occur immediately after the deployment.

B. Organizational and Administrative Record-keeping

Not all organizational and administrative medical records were available in this case. Navy instruction at the time of the Gulf War dictated destroying sickness reports, sign-in/sign-out logs, appointment records, etc., after two years. Current policy maintains the two-year retention requirement.[73] The Navy and the other military branches should consider keeping unit medical records from contingency deployments on electronic media for longer than two years.

This case still is under investigation.  If additional information becomes available, we will incorporate it into a revised narrative.  If you have records, photographs, or recollections of this case or find errors in the details reported, please call 1-800-497-6261.

CAM Chemical Agent Monitor

DOD Department of Defense

HMMWV High-mobility, multi-purpose wheeled vehicle

MAGTF Marine Air-Ground Task Force

MARDIV Marine Division

NBC Nuclear, biological, chemical

NCO Non-commissioned officer

SNCO Staff non-commissioned officer

UNSCOM United Nations Special Commission on Iraq

U.S. United States

Blister Agent

A blister agent is a chemical warfare agent that produces local irritation and damage to the skin and mucous membranes, pain and injury to the eyes, reddening and blistering of the skin, and when inhaled, damage to the respiratory tract. Blister agents include mustards (HD, HN, HQ, HT, and Q), arsenicals like lewisite (L), and mustard and lewisite mixtures (HL). Blister agents are also called vesicants or vesicant agents.[74] , [75]

Chemical warfare agent 

A chemical warfare agent is a chemical substance used in military operations to kill, seriously injure, or incapacitate through its physiological effects. Excluded are riot control agents, herbicides, smoke, and flame. Included are blood, nerve, blister, choking, and incapacitating agents.[76]

Dermatomyositis

One of a group of acquired muscle diseases called inflammatory myopathies. Characterized by a short and relatively severe onset, with patchy, bluish-purple rashes and muscle weakness. Some patients develop bumps of hardened calcium deposits under the skin. Muscle weakness is the most common symptom; others include fatigue, weight loss, discomfort, and low-grade fever.[77]

False positive 

A false positive occurs when a chemical warfare agent detector falsely indicates the presence of a chemical warfare agent.[78]

Grover's Disease

A disease lasting weeks to months whose cause is unknown and whose symptoms include a common, itching rash that takes the form of small red bumps on the chest, stomach, back, arms, and/or legs.[79]

Infectious folliculitis

 A skin condition: inflammation of hair follicles, caused by bacterial or fungal infections.[80]

Leishmaniasis 

A parasitic disease spread by the bite of infected sandflies. The most common forms are cutaneous, causing skin sores, and visceral, affecting some internal bodily systems (e.g., the spleen, liver, and bone marrow).[81]

Marine Air-Ground Task Force

 A task organization of Marine forces (division, aircraft wing, and service support groups) under a single command and structured to accomplish a specific mission. Components normally include command, aviation combat, ground combat, and combat service support elements, including Navy support elements. The three expeditionary types are the Marine unit, brigade, and force. The four elements of a Marine air-ground task force are command, aviation combat, ground combat, and combat service support.[82]

Marine Expeditionary Force 

The largest of the Marine air-ground task forces. Normally built around a division, wing, and force service support group team, but can include several divisions and aircraft wings, together with an appropriate combat service support organization. A Marine expeditionary force is capable of conducting a wide range of amphibious assault operations and sustained operations ashore and can be tailored for various combat missions in any geographic environment.[83]

NBC Reports 

Formatted messages of six types designed to rapidly disseminate key information on NBC threats:

• NBC-1. Used by the observing unit to give basic initial and follow-up data about an NBC attack. Battalion and higher elements consolidate reports and decide which to forward.
• NBC-2. Based on two or more NBC-1 reports. It is used to pass evaluated data to units, usually by division-level or higher elements.
• NBC-3. Disseminates information on predicted downwind hazard areas based on analysis of NBC-1 reports. Each unit evaluates the NBC-3 report, determines which of its subordinate units may be affected, and further disseminates the report as required.
• NBC-4. Reports possible detection of NBC hazards determined by monitoring equipment, survey, or reconnaissance.
• NBC-5. Shows possibly contaminated areas based on information from NBC-4 reports plotted on maps. Usually disseminated as a map overlay by division-level elements.
• NBC-6. Summarizes information about a chemical or biological attack(s); prepared at battalion level, but only if higher headquarters so requests. Primarily used as an intelligence tool to help determine future enemy intentions.[84]

Polymorphic light eruptions

Skin lesions caused by an abnormal sensitivity to sunlight. Commonly associated symptoms may include sunburn, red skin rash with small blisters, dizziness, nausea, and vomiting. The reaction often occurs when certain substances are combined with ultraviolet light. Such substances may be taken orally (e.g., common drugs and antibiotics) or applied externally (e.g., perfumes and after-shave lotions). Even deodorant soap and sunscreen ingredients can cause a photosensitive reaction.[85]

Urticaria (Hives)

Pale red swellings of skin, also called "wheals," occurring in groups on any part of the skin, varying in size from as small as a pencil eraser to as large as a dinner plate; they may join together to form larger swellings. Each hive lasts a few hours before fading without a trace. New areas may develop as old areas fade. Hives usually itch, but also may burn or sting. They are caused by blood plasma leaking out of small blood vessels in the skin.[86]

• Marine Expeditionary Force 
• 2d Marine Division
• 2d Reconnaissance Battalion
• 6th Marine Regiment
• 8th Marine Regiment
• 1st Battalion, 8th Marines
• 2d Battalion, 4th Marine
• 2d Force Service Support Group
• 2d Medical Battalion
• Fleet Hospital 15

• 2d Reconnaissance Battalion Watch Log entry at 9:15 a.m. on 14 Feb 1991.
• 2d Reconnaissance Battalion, 2d Marine Division, United States Marine Corps, "Command Chronology for the Period 1 Jan 1991 to 28 Feb 1991," March 24, 1991.
• American Academy of Dermatology, "The Sun and Your Skin," web site http://www.aad.org/pamphlets/SunSkin.html (as of March 23, 2001).
• American Academy of Dermatology, "Guidelines of Care for Dermatomyositis," web site http://www.aad.org/Guidelines/dermatomyositis.html (as of January 23, 2001).
• American Academy of Dermatology, "Urticaria - Hives," web site http://www.aad.org/pamphlets/Urticaria.html (as of January 23, 2001).
• Centers for Disease Control, "Fact Sheet: Leishmania Infection," web site http://www.cdc.gov/ncidod/dpd/parasites/leishmania/factsht_leishmania.htm (as of June 21, 2000).
• Central Intelligence Agency, "Factbook on Intelligence," 1997, web site www.odci.gov/cia/publications/facttell/intcomm.htm (as of January 26, 2001).
• Defense Technical Information Center, CB Technical Data Source Book, Volume XIII, "Detection, Identification, and Warning," 1991.
• Fleet Hospital 15 Admission log, February 10-March 21, 1991.
• Handbook for the Investigation of Allegations of the Use of Chemical or Biological Weapons, Departments of External Affairs, National Defence, Health and Welfare, and Agriculture Canada, November 1985.
• Interview with 2d Reconnaissance Battalion NBC NCO, March 23, 1991.
• Interview with 2d Reconnaissance Battalion NBC officer, March 23, 1991.
• Interview with 8th Marines NBC officer, March 21, 1991.
• Interview with 8th Marines NBC Staff NCO, March 18, 1991.
• Lead Report #6475, Interview of nurse, 2d Medical Battalion, 2d Force Service Support Group, October 20, 1997.
• Lead Report #7174, Interview of NBC officer, 2d Marine Division, October 27, 1997.
• Lead Report #7311, Interview of NBC officer, 2d Marine Division, March 18, 1998.
• Lead Report #7350, Interview of NBC Staff NCO, 2d Marine Division, December 16, 1997.
• Lead Report #14211, Interview of executive officer, 2d Medical Battalion, 2d Force Service Support Group, January 20, 1998.
• Lead Report #15151, Interview of nurse, Fleet Hospital 15, February 23, 1998.
• Lead Report #15162, Interview of nurse, Fleet Hospital 15, February 24, 1998.
• Lead Report #15182, Interview of assistant chief, Casualty Receiving Area, Fleet Hospital 15, February 25, 1998.
• Lead Report #15501, Interview of assistant chief of staff, G-3, 2d Marine Division, Fleet Marine Force Atlantic, March 18, 1998.
• Lead Report #18883, Interview of commanding officer, Company B, 2d Reconnaissance Battalion, June 14, 2000.
• Lead Report #21124, Interview of surgeon, 2d Marine Division, January 19, 1999.
• Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998.
• Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998.
• Lead Report #21152, Interview of corporal, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 3, 1998.
• Lead Report #21156 Interview of corporal, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 20, 1998.
• Lead Report #21185, Interview of commanding officer, 2d Reconnaissance Battalion, May 19, 1998.
• Lead Report #21186, Interview of platoon commander, 1st Platoon, Company B, 2d Reconnaissance Battalion, May 20, 1998.
• Lead Report #21386, Interview of command master chief, 2d Marine Division Surgeon's Office, February 2, 1999.
• Lead Report #21911, Interview of assistant chief of staff, G-1, 2d Marine Division, Fleet Marine Force Atlantic, February 24, 1999.
• Lead Report #22292, Interview of medical officer, Company G, 2d Medical Battalion, 2d Force Service Support Group, March 24, 1999.
• Lead Report #22691, Interview of commanding officer, Company G, 2d Medical Battalion, 2d Force Service Support Group, April 22, 1999.
• Lead Report #23476, Interview of commanding officer, Company F, 2d Medical Battalion, 2d Force Service Support Group, April 15, 1999.
• Lead Report #26914, Interview of station chief, 8th Marine Regimental Aid Station, May 23, 2000.
• Lead Report #26948, Interview of medical officer, 8th Marine Regiment, May 30, 2000.
• Lead Report #26982, Interview of surgeon, 2d Reconnaissance Battalion, June 2, 2000.
• Lead Report #27015, Interview with chemical warfare expert, June 19, 2000.
• Lead Report #27066, Interview of doctor, Fleet Hospital 15, June 12, 2000.
• Lead Report #27083, Interview of senior chief, 1/8 Battalion Aid Station, June 13, 2000.
• Lead Report #27187, Interview of team leader, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 20, 2000.
• Lead Report #27313, Interview of team leader, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, July 19, 2000.
• Lead Report #27629, Interview of corporal, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 5, 2000.
• Lead Report #27817, Interview of team leader, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 20, 2000
• Lead Report #27818, Interview of corporal, Team 2, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 20, 2000.
• Lead Report #28089, Physician's Statement of Review, Subject: "Medical Review of Possible Chemical Agent Exposure in Desert Storm - Marines of the 2d Reconnaissance Battalion," August 15, 2000.
• Manley, Capt Thomas F., Marine Corps Research Center Paper 92-0009, "Marine Corps NBC Defense in Southwest Asia," July 1991.
• Michelle Soign�e, Inc. "Grover's Disease," web site http://www.skinsite.com/info_grover's_disease.htm (as of March 9, 2001).
• Mroczkowski, Dennis P., US Marines in the Persian Gulf, 1990-1991: With the 2d Marine Division in Desert Shield and Desert Storm, Washington, DC: US Marine Corps, History and Museums Division, 1993.
• New Zealand Dermatological Society, "Folliculitis," web site http://www.dermnet.org.nz/index.html (as of March 9, 2001).
• Organisation for the Prohibition of Chemical Weapons, "Mustard Agents," web site http://www.opcw.nl/chemhaz/mustard.htm (as of August 22, 2000).
• Persian Gulf War Illnesses Task Force, Central Intelligence Agency , "Khamisiyah: A Historical Perspective on Related Intelligence," April 9, 1997.
• Secretary of the Navy Instruction 5212.5D, "Navy and Marine Corps Records Disposition Manual," April 22, 1998.
• Sidell, Frederick R., et al., "Vesicants," "Medical Aspects of Chemical and Biological Warfare," "Part I, Warfare, Weaponry, and Casualty," Textbook of Military Medicine, eds. BG Russ Zajtchuk and COL Ronald F. Bellamy, Office of the Surgeon General, Walter Reed Army Medical Center, Washington, DC, 1997.
• United Nations Blue Book Series, Volume IX, "The United Nations and the Iraq-Kuwait Conflict, 1990-1996, Document 141, "Fourth Report of the Executive Chairman of UNSCOM," New York: United Nations, Department of Public Information, 1996.
• US Army Chemical School, "Chemical Detection and Reporting," Army Institute for Professional Development, Army Correspondence Course Program, Subcourse CM 1301, Edition E, November 1995.
• US Army Field Manual 101-5-1, US Marine Corps Reference Publication 5-2A, "Operational Terms and Graphics," September 30, 1997-97, web site http://www-cgsc.army.mil/cdd/F545/f545con.htm (as of August 2, 2000).
• US Army Field Manual 19-20, "Law Enforcement Investigations," November 25, 1985.
• US Army Field Manual 3-100, "NBC Defense, Chemical Warfare, Smoke, and Flame Operations," September 17, 1985.
• US Army Field Manual 3-3, US Marine Corps Fleet Marine Force Manual 11-17, "Chemical and Biological Contamination Avoidance," Change 1, September 29, 1994.
• US Army Field Manual 3-4, US Marine Corps Fleet Marine Force Manual 11-9, "NBC Protection," May 1992.
• US Army Field Manual 3-9, US Navy Publication P-467, US Air Force Manual 355-7, "Potential Military Chemical/Biological Agents and Compounds," December 12, 1990.
• US Army Field Manual 8-285, US Navy NAVMED P-5041, US Air Force Manual 44-149, US Marine Corps Fleet Marine Force Manual 11-11 (adopted as NATO Field Manual 8-285), "Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries," December 22, 1995.
• US Army Material Safety Data Sheet on HQ Mustard, Aberdeen Proving Ground, MD, June 30, 1995.
• US Army Soldier and Biological Chemical Command, "Improved Chemical Agent Monitor (ICAM)," web site http://www.sbccom.apgea.army.mil/products/icam.htm (as of August 3, 2000).
• US Army Test and Evaluation Command, Test Operations Procedure number 8-2-555, "Chemical Agent Detector Kits," Dugway, UT: Dugway Proving Ground, April 28, 1989.
• US Army Training Circular 3-4-1, "Chemical Agent Monitor Employment," December 17, 1991.
• Walters, Kenneth R., Sr., Major Kathleen M. Traxler, Michael T. Gilford, Capt Richard D. Arnold, TSgt Richard C. Bonam, and TSgt Kenneth R. Gibson, Gulf War Weather, Scott Air Force Base, IL: USAF Environmental Technical Applications Center, March 1992.
• Watts, Barry D. and Dr. Thomas A. Kearny, Gulf War Air Power Survey, Volume II, "Operations and Effects and Effectiveness," Washington, DC: Government Printing Office, 1993.

The DOD requires a common framework for our investigations and assessments of chemical warfare agent reports, so we turned to the United Nations and the international community, which had chemical weapons experience (e.g., the United Nations’ investigation of the chemical weapons used during the 1980-88 Iran-Iraq war). Because the modern battlefield is complex, the international community developed investigation and validation protocols[87] to provide objective procedures for possible chemical weapons incidents. The methodology we use is based on these international protocols and guidelines and includes:

• A detailed written record of the conditions at the site;
• Physical evidence from the site, such as weapons fragments, soil, water, vegetation, or human or animal tissue samples;
• A record of the chain of custody during transportation of the evidence;
• Witnesses’ testimony;
• Multiple analyses; and
• An expert panel’s review of the evidence.

While the methodology used to investigate chemical incidents (Figure 7) is based on these protocols, the passage of time since the Gulf War makes it difficult to obtain certain types of documentary evidence, and physical evidence often was not collected at the time of an event. Therefore, we cannot apply a rigid template to all incidents, and each investigation must be tailored to its unique circumstances. Accordingly, we designed our methodology to provide a thorough, investigative process to define the circumstances of each incident and determine what happened. The major efforts in our methodology are:

• To substantiate the incident;
• To document available medical reports related to the incident;
• To interview appropriate people;
• To obtain information available to external organizations; and
• To assess the results.

Figure 7. Chemical warfare incident investigation methodology

A case usually starts with a report of a possible chemical warfare agent incident, often from a veteran. To substantiate the circumstances surrounding an incident, the investigator searches for documentation from operational, intelligence, and environmental logs. This focuses the investigation on a specific time, date, and location, clarifies the conditions under which the incident occurred, and determines whether there is "hard," as well as anecdotal, evidence.

Alarms alone are not considered certain evidence of chemical warfare agent presence, nor is a single observation sufficient to validate a chemical warfare agent presence. The investigator looks for physical evidence collected at the time of the incident that might indicate that chemical agents were present in the vicinity of the incident. Such evidence might include tissue samples, body fluid samples, clothing, environmental samples of soil or vegetation, weapons parts, and Fox MM-1 tapes with properly documented spectrums.

The investigator searches available medical records to determine if the incident injured anyone. Deaths, injuries, sicknesses, etc., near the time and location of an incident are noted and considered. Medical experts are asked to provide information about any alleged chemical warfare agent casualties.

We interview those involved in or near the incident (participants or witnesses). First-hand witnesses provide valuable insight into the conditions surrounding the incident and the mind-set of those involved, and are particularly important if physical evidence is lacking. Nuclear, biological, and chemical officers or specialists trained in chemical testing, confirmation, and reporting are interviewed to identify the unit’s response, the tests that were run, the injuries sustained, and the reports submitted. Commanders are contacted to ascertain what they knew, what decisions they made concerning the events surrounding the incident, and their assessment of the incident. Where appropriate, subject matter experts also provide opinions on the capabilities, limitations, and operation of technical equipment, and submit their evaluations of selected topics of interest.

Additionally, the investigator contacts agencies and organizations that may be able to provide additional clarifying information about the case, including, among others:

• Intelligence agencies that might be able to provide insight into events leading to the event, imagery of the area of the incident, and assessments of factors affecting the case;
• The Departments of Defense and Veterans Affairs’ clinical registries that may provide data about the medical condition of those involved in the incident; and
• Agencies capable of computer modeling meteorological and source characterization data in cases where airborne dispersion of agent is suspected.

Once the investigation is complete, the investigator evaluates the available evidence make a subjective assessment. The available evidence is often incomplete or contradictory and thus must be looked at in the total context of what is known about the incident being investigated. Physical evidence collected at the time of the incident, for example, can be of tremendous value to an investigation. Properly documented physical evidence would generally be given the greatest weight in any assessment. The testimony of witnesses and contemporaneous operational documentation is also significant when making an assessment. Testimony from witnesses who also happen to be subject matter experts is usually more meaningful than testimony from untrained observers. Typically, secondhand accounts are given less weight than witness testimony. When investigators are presented with conflicting witness testimony, they look for other pieces of information supporting the statements of the witnesses. Investigators evaluate the supporting information to determine how it corroborates any of the conflicting positions. Generally, such supporting information will fit into a pattern corroborating one of the conflicting accounts of the incident over the others. Where the bulk of corroborating evidence supports one witness more than another, that person's information would be considered more compelling.

Our assessments rely on the investigators’ evaluation of the available information for each investigation. Because we do not expect to always have conclusive evidence, we have developed an assessment scale (Figure 8) ranging from Definitely Not to Definitely, with intermediate assessments of Unlikely, Indeterminate, and Likely. The investigator will use this scale to make an assessment based on facts available as of the date of the report publication. Each case is reassessed over time based on new information and feedback.

Figure 8. Assessment of chemical warfare agent presence

The standard for making the assessment is based on common sense: Do the available facts lead a reasonable person to conclude chemical warfare agents were present or not? If insufficient information is available, the assessment is Indeterminate until more evidence can be found.

A chemical agent monitor (CAM) is a portable, hand-held device capable of detecting blister or nerve agent contamination on persons, equipment, and elements of the surrounding environment. It is designed so personnel in full protective clothing can easily use it to perform these tasks:

• Rapidly determine the extent to which personnel and equipment are contaminated;
• Determine the effectiveness of decontamination procedures; and
• Assist commanders in deciding whether to reduce the protection level.

The CAM has a liquid crystal display that shows the mode the detector is using, the battery status, whether the unit is in a warm-up phase, and the relative toxicity of the agent detected.[88]

A. Operation

A CAM draws in vapor samples through its nozzle and analyzes them for molecular composition and mobility. Timing and microprocessor techniques are used to reject interference.[89] When the analysis of the sample is complete, the instrument display projects a read-out to indicate if it has detected chemical warfare agent.

Figure 9. Testing personnel with a CAM

If a CAM detects such an agent, the display shows a number of bars indicating the extent of chemical contamination. If the machine detects no contamination, no bars are visible. If the display shows one, two, or three bars, the machine has detected a low vapor concentration. Four, five, or six bars indicate a high vapor concentration; and seven or eight indicate very high chemical contamination.[90]

A CAM is a point monitor, and cannot determine the vapor hazard over an entire area based on detections at one position. If a CAM has no contact with chemical warfare agent vapors, it will not detect their presence. Furthermore, under some circumstances, liquid agents may not vaporize readily. For these reasons, this detection device works best when used in calm air. Monitoring in still air aids in quickly and efficiently identifying contaminated personnel and equipment.[91]

B. Causes of Inaccurate Detections

Because of the CAM’s sensitivity, many other vapors cause positive detections. Interferents include the substance found in Wipe Number 1 of the M258A1 Decontamination Kit, Decontamination Solution #2 (DS2), insect repellent, brake fluid, burning kerosene, breath mints, burning grass, and ammonia. Other substances that can cause a false-positive reading include perfumes and after-shaves, food flavorings, and cleaning compounds.[92]

Maintaining and using the instrument improperly also can cause inaccurate readings. The CAM can operate at environmental temperatures from -30� to 45� C (-22� to 113� F). At high temperatures the agent reaction chemistry changes and the agent does not ionize the same as at the designated operating temperature range. At low temperatures, chemical agents do not vaporize readily; thus, agent vapor concentration is too low to be detected.[93]

1. Tab A lists acronyms, abbreviations, and a glossary.
2. Lead Report #15162, Interview of nurse, Fleet Hospital 15, February 24, 1998, p. 1.
3. Lead Report #15182, Interview of assistant chief, Casualty Receiving Area, Fleet Hospital 15, February 25, 1998, p. 1; and Lead Report #15151, Interview of nurse, Fleet Hospital 15, February 23, 1998, p. 1.
4. 2d Reconnaissance Battalion, 2d Marine Division, United States Marine Corps, "Command Chronology for the Period 1 Jan 1991 to 28 Feb 1991," March 24, 1991, p. 3, 9.
5. Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998, p. 1; Lead Report #18883, Interview of commanding officer, Company B, 2d Reconnaissance Battalion, June 14, 2000, p. 3; and Lead Report #21186, Interview of platoon commander, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 5, 2000, p. 2.
6. Mroczkowski, Dennis P., US Marines in the Persian Gulf, 1990-1991: With the 2d Marine Division in Desert Shield and Desert Storm, Washington, DC: US Marine Corps, History and Museums Division, 1993, p. 31.
7. 2d Reconnaissance Battalion, 2d Marine Division, United States Marine Corps, "Command Chronology for the Period 1 Jan 1991 to 28 Feb 1991," March 24, 1991, p. 11.
8. Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998, p. 1; Lead Report #21152, Interview of corporal, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 3, 1998, p. 1; Lead Report #27818, Interview of corporal, Team 2, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 20, 2000, p. 1; Lead Report #27817, Interview of team leader, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 20, 2000, p. 1; Lead Report #27629, Interview of corporal, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 5, 2000, p. 1; and Lead Report #21156 Interview of corporal, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 20, 1998, p. 4.
9. Manley, Capt Thomas F., Marine Corps Research Center Paper 92-0009, "Marine Corps NBC Defense in Southwest Asia," July 1991, p. 46.
10. Lead Report #18883, Interview of commanding officer, Company B, 2d Reconnaissance Battalion, June 14, 2000, p. 3.
11. Lead Report #21156 Interview of corporal, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 20, 1998, p. 4.
12. 2d Reconnaissance Battalion Watch Log entry at 0915 on 14 Feb 1991.
13. Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998, p. 1.
14. Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998, p. 1; and Lead Report #28089, Physician's Statement of Review, Subject: "Medical Review of Chemical Agent Exposure in Desert Storm - Marines of the 2d Reconnaissance Battalion," August 15, 2000, p. 5.
15. 2d Reconnaissance Battalion Watch Log entry at 0915 on 14 Feb 1991.
16. 2d Reconnaissance Battalion, 2d Marine Division, United States Marine Corps, "Command Chronology for the Period 1 Jan 1991 to 28 Feb 1991," March 24, 1991, p. 7.
17. 2d Reconnaissance Battalion, 2d Marine Division, United States Marine Corps, "Command Chronology for the Period 1 Jan 1991 to 28 Feb 1991," March 24, 1991, p. 8.
18. Lead Report #27313, Interview of team leader, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, July 19, 2000, p. 3.
19. Fleet Hospital 15 Admission log, February 10-March 21, 1991, p.13, 18.
20. Lead Report #21152, Interview of corporal, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 3, 1998, p. 1; and Lead Report #21186, Interview of platoon commander, 1st Platoon, Company B, 2d Reconnaissance Battalion, May 20, 1998, p. 1.
21. Lead Report #21156 Interview of corporal, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, June 30, 2000, p. 5.
22. Walters, Kenneth R., Sr., Major Kathleen M. Traxler, Michael T. Gilford, Capt Richard D. Arnold, TSgt Richard C. Bonam, and TSgt Kenneth R. Gibson, Gulf War Weather, Scott Air Force Base, IL: USAF Environmental Technical Applications Center, March 1992, p. 3-55-3-64.
23. Lead Report #26982, Interview of surgeon, 2d Reconnaissance Battalion, June 2, 2000, p. 1.
24. Lead Report #27083, Interview of senior chief, 1/8 Battalion Aid Station, June 13, 2000, p. 1.
25. Lead Report #26948, Interview of medical officer, 8th Marine Regiment, May 30, 2000, p. 1; and Lead Report #26914, Interview of station chief, 8th Marine Regimental Aid Station, May 23, 2000, p. 1.
26. Lead Report #14211, Interview of executive officer, 2d Medical Battalion, 2d Force Service Support Group, January 20, 1998, p. 1; Lead Report #22691, Interview of commanding officer, Company G, 2d Medical Battalion, 2d Force Service Support Group, April 22, 1999, p. 1; Lead Report #22292, Interview of medical officer, Company G, 2d Medical Battalion, 2d Force Service Support Group, March 24, 1999, p. 1; Lead Report #6475, Interview of nurse, 2d Medical Battalion, 2d Force Service Support Group, October 20, 1997, p. 1; and Lead Report #23476, Interview of commanding officer, Company F, 2d Medical Battalion, 2d Force Service Support Group, April 15, 1999, p. 2.
27. Lead Report #21124, Interview of surgeon, 2d Marine Division, January 19, 1999, p. 1; and Lead Report #21386, Interview of command master chief, 2d Marine Division Surgeon's Office, February 2, 1999, p. 1.
28. Lead Report #27066, Interview of doctor, Fleet Hospital 15, June 12, 2000, p. 1.
29. Manley, Capt Thomas F., Marine Corps Research Center Research Paper 92-0009, "Marine Corps NBC Defense in Southwest Asia," July 1991, p. 11.
30. Interview with 2d Reconnaissance Battalion NBC officer, March 23, 1991; Interview with 2d Reconnaissance Battalion NBC NCO, March 23, 1991; Interview with 8th Marines NBC officer, March 21, 1991; and Interview with 8th Marines NBC Staff NCO, March 18, 1991.
31. Lead Report #7174, Interview of NBC officer, 2d Marine Division, October 27, 1997, p. 3.
32. Lead Report #7350, Interview of NBC Staff NCO, 2d Marine Division, December 16, 1997, p. 2.
33. Lead Report #7311, Interview of NBC officer, 2d Marine Division, March 18, 1998, p. 2.
34. Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998, p. 1.
35. Lead Report #21186, Interview of platoon commander, 1st Platoon, Company B, 2d Reconnaissance Battalion, May 20, 1998, p. 1.
36. Lead Report #18883, Interview of commanding officer, Company B, 2d Reconnaissance Battalion, June 14, 2000, p. 3.
37. Lead Report #21185, Interview of commanding officer, 2d Reconnaissance Battalion, May 19, 1998, p. 1.
38. US Army Field Manual 3-100, "NBC Defense, Chemical Warfare, Smoke, and Flame Operations," September 17, 1985, p. B-2.
39. Lead Report # 21911, Interview of assistant chief of staff, G-1, 2d Marine Division, Fleet Marine Force Atlantic, February 24, 1999, p. 1.
40. Lead Report #15501, Interview of assistant chief of staff, G-3, 2d Marine Division, Fleet Marine Force Atlantic, March 18, 1998, p. 1.
    
    
41. US Army Field Manual 3-9, US Navy Publication P-467, US Air Force Manual 355-7, "Potential Military Chemical/Biological Agents and Compounds," December 12, 1990, p. 14, 30, 47.
42. Sidell, Frederick R., et al., "Vesicants," "Medical Aspects of Chemical and Biological Warfare," "Part I, Warfare, Weaponry, and Casualty," Textbook of Military Medicine, eds. BG Russ Zajtchuk and COL Ronald F. Bellamy, Office of the Surgeon General, Walter Reed Army Medical Center, Washington, DC, 1997, p. 213.
    
    
43. Lead Report #21152, Interview of corporal, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 3, 1998, p. 1; and Lead Report #21156, Interview of corporal, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 20, 1998, p. 4.
44. US Army Field Manual 3-9, US Navy Publication P-467, US Air Force Manual 355-7, "Potential Military Chemical/Biological Agents and Compounds," December 12, 1990, p. 30, 38, 45.
45. Lead Report #15182, Interview of assistant chief, Casualty Receiving Area, Fleet Hospital 15, February 25, 1998, p. 1; and Lead Report #15151, Interview of nurse, Fleet Hospital 15, February 23, 1998, p. 1.
46. Lead Report #28089, Physician's Statement of Review, Subject: "Medical Review of Possible Chemical Agent Exposure in Desert Storm - Marines of the 2d Reconnaissance Battalion," August 15, 2000.
47. US Army Field Manual 8-285, US Navy Medical Publication P-5041, US Air Force Manual 44-149, US Marine Corps Fleet Marine Force Manual 11-11, "Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries," December 22, 1995, Part I, Chapter 4, Section II, Paragraph 4-8, web site www.nbc-med.org/SiteContent/MedRef/OnlineRef/FieldManuals/fm8_285/PART_I/index.htm (as of July 20, 2000).
48. Lead Report #28089, Physician's Statement of Review, Subject: "Medical Review of Possible Chemical Agent Exposure in Desert Storm - Marines of the 2d Reconnaissance Battalion," August 15, 2000.
49. Lead Report #27817, Interview of team leader, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 20, 2000, p. 2.
50. Sidell, Frederick R., et al., "Vesicants," "Medical Aspects of Chemical and Biological Warfare," "Part I, Warfare, Weaponry, and Casualty," Textbook of Military Medicine, eds. BG Russ Zajtchuk and COL Ronald F. Bellamy, Office of the Surgeon General, Walter Reed Army Medical Center, Washington, DC, 1997, p. 212.
51. Lead Report #21152, Interview of corporal, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 3, 1998, p. 1.
52. Lead Report #28089, Physician's Statement of Review, Subject: "Medical Review of Possible Chemical Agent Exposure in Desert Storm - Marines of the 2d Reconnaissance Battalion," August 15, 2000.
53. Sidell, Frederick R., et al., "Vesicants," "Medical Aspects of Chemical and Biological Warfare," "Part I, Warfare, Weaponry, and Casualty," Textbook of Military Medicine, eds. BG Russ Zajtchuk and COL Ronald F. Bellamy, Office of the Surgeon General, Walter Reed Army Medical Center, Washington, DC, 1997, p. 205, 208.
54.  Lead Report #28089, Physician's Statement of Review, Subject: "Medical Review of Possible Chemical Agent Exposure in Desert Storm - Marines of the 2d Reconnaissance Battalion," August 15, 2000.
55. Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998, p. 1.
56. Lead Report #27015, Interview with chemical warfare expert, June 19, 2000, p. 3.
57. US Army Field Manual 8-285, US Navy Medical Publication P-5041, US Air Force Manual 44-149, US Marine Corps Fleet Marine Force Manual 11-11, "Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries," December 22, 1995, Part I, Chapter 4, Section II, Paragraph 4-8, web site www.nbc-med.org/SiteContent/MedRef/OnlineRef/FieldManuals/fm8_285/PART_I/index.htm (as of July 20, 2000).
58. Lead Report #21152, Interview of corporal, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, August 16, 2000, p. 2.
59. Sidell, Frederick R., et al., "Vesicants," "Medical Aspects of Chemical and Biological Warfare," "Part I, Warfare, Weaponry, and Casualty," Textbook of Military Medicine, eds. BG Russ Zajtchuk and COL Ronald F. Bellamy, Office of the Surgeon General, Walter Reed Army Medical Center, Washington, DC, 1997, pp. 207, 214.
60. Lead Report #21151, Interview of platoon commander, 3d Platoon, Company B, 2d Reconnaissance Battalion, August 19, 1998, p. 2.
61. US Army Training Circular 3-4-1, "Chemical Agent Monitor Employment," December 17, 1991, p. 9-12.
62. Lead Report #21156, Interview of corporal, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, June 30, 2000, p. 4.
63. The Central Intelligence Agency, Defense Intelligence Agency, Bureau of Intelligence and Research (Department of State), National Security Agency, National Imagery and Mapping Agency, military services' intelligence staffs and centers, and several other organizations in the Defense, Treasury, Justice, and Energy Departments constitute the intelligence community. Military intelligence includes strategic, operational, and tactical information. Central Intelligence Agency, "Factbook on Intelligence," 1997, web site www.odci.gov/cia/publications/facttell/intcomm.htm (as of January 26, 2001).
64. Persian Gulf War Illnesses Task Force, Central Intelligence Agency , "Khamisiyah: A Historical Perspective on Related Intelligence," April 9, 1997, p. 1.
65. Although mustard-filled mortar rounds were reported, UNSCOM found none in its post-war investigations. The United Nations Blue Book Series, Volume IX, "The United Nations and the Iraq-Kuwait Conflict, 1990-1996," Document 141, "Fourth Report of the Executive Chairman of UNSCOM," New York, NY: United Nations, Department of Public Information, 1996, p. 502.
66. Lead Report #21156, Interview of corporal, Team 1, 1st Platoon, Company B, 2d Reconnaissance Battalion, June 30, 2000, p. 5.
67. Watts, Barry D. and Dr. Thomas A. Kearny, Gulf War Air Power Survey, Volume II, "Operations and Effects and Effectiveness," Washington, DC: Government Printing Office, 1993, p. 109.
68. An NBC-4 report documents actual chemical warfare agent contamination. US Army Field Manual 3-3, US Marine Corps Fleet Marine Force Manual 11-17, "Chemical and Biological Contamination Avoidance," September 29, 1994, Change 1, Chapter 2, p.2-3.  The Glossary describes other NBC reports.
69. Fleet Hospital 15 Admission log, February 10-March 21, 1991, p.13, 18.
70. See glossary for definitions of these skin conditions.
71. Lead Report #28089, Physician's Statement of Review, Subject: "Medical Review of Possible Chemical Agent Exposure in Desert Storm - Marines of the 2d Reconnaissance Battalion," August 15, 2000; and Lead Report #27187, Interview of team leader, Team 3, 1st Platoon, Company B, 2d Reconnaissance Battalion, September 20, 2000, p. 2.
72. Lead Report #28089, Physician's Statement of Review, Subject: "Medical Review of Possible Chemical Agent Exposure in Desert Storm - Marines of the 2d Reconnaissance Battalion," August 15, 2000.
73. Secretary of the Navy Instruction 5212.5D, "Navy and Marine Corps Records Disposition Manual," April 22, 1998, p. III-6-3.
74. US Army Field Manual 8-285, US Navy Medical Publication P-5041, US Air Force Joint Manual 44-149, US Marine Corps Fleet Marine Force Manual 11-11, "Treatment Of Chemical Agent Casualties and Conventional Military Chemical Injuries," December 22, 1995, Glossary, Section II, Definitions and Terms, p. 4-5, web site www.nbc-med.org/SiteContent/MedRef/OnlineRef/FieldManuals/fm8_285/PART_I/index.htm (as of June 25, 1999).
75. US Army Material Safety Data Sheet on HQ Mustard, Aberdeen Proving Ground, MD, June 30, 1995.
76. US Army Field Manual 8-285, US Navy Medical Publication P-5041, US Air Force Joint Manual 44-149, US Marine Corps Fleet Marine Force Manual 11-11, "Treatment Of Chemical Agent Casualties and Conventional Military Chemical Injuries," December 22, 1995, Glossary, Section II, Definitions and Terms, p. 6, web site www.nbc-med.org/SiteContent/MedRef/OnlineRef/FieldManuals/fm8_285/PART_I/index.htm (as of June 25, 1999).
77. American Academy of Dermatology, "Guidelines of Care for Dermatomyositis," web site http://www.aad.org/Guidelines/dermatomyositis.html (as of January 23, 2001).
78. US Army Test and Evaluation Command, Test Operations Procedure number 8-2-555, "Chemical Agent Detector Kits," Dugway, UT: Dugway Proving Ground, April 28, 1989, p. 37.
79. Michelle Soign�e, Inc. "Grover's Disease," web site http://www.skinsite.com/info_grover's_disease.htm (as of March 9, 2001).
80. New Zealand Dermatological Society, "Folliculitis," web site http://www.dermnet.org.nz/dna.folliculitis/info.html (as of March 9, 2001)
81. Centers for Disease Control, "Fact Sheet: Leishmania Infection," web site http://www.cdc.gov/ncidod/dpd/parasites/leishmania/factsht_leishmania.htm (as of June 21, 2000).
82. US Army Field Manual 101-5-1, US Marine Corps Reference Publication 5-2A, "Operational Terms and Graphics," September 30, 1997, p. 1-97, web site http://www-cgsc.army.mil/cdd/F545/f545-m.htm (as of August 2, 2000).
83. US Army Field Manual 101-5-1, US Marine Corps Reference Publication 5-2A, "Operational Terms and Graphics," September 30, 1997, p. 1-97, web site http://www-cgsc.army.mil/cdd/F545/f545-m.htm (as of August 2, 2000).
84. US Army Field Manual 3-3, US Marine Corps Fleet Marine Force Manual 11-17, "Chemical and Biological Contamination Avoidance," Change 1, September 29, 1994, Chapter 2, p. 2-1-2-4.
85. American Academy of Dermatology , "The Sun and Your Skin," web site http://www.aad.org/pamphlets/SunSkin.html (as of March 23, 2001).
86. American Academy of Dermatology, "Urticaria - Hives," web site http://www.aad.org/pamphlets/Urticaria.html (as of January 23, 2001).
87. "Convention on the Prohibition of the Development, Production, Stockpiling, and Use of Chemical Weapons and on Their Destruction," April 29, 1997. Since this chemical weapons Convention was opened for signature in Paris, France, on January 13, 1993, 165 states have signed it and 106 have ratified or acceded to it as of February 1998. The United States signed it on January 13, 1993, and ratified it on April 25, 1997. Part XI, "Investigations in Cases of Alleged Use of Chemical Weapons," details some procedures. We found other protocols and guidelines in Methodology and Instrumentation for Sampling and Analysis in the Verification of Chemical Disarmament, Ministry for Foreign Affairs of Finland, Helsinki, Finland, 1985; Verification Methods, Handling, and Assessment of Unusual Events in Relation to Allegations of the Use of Novel Chemical Warfare Agents, Consultant University of Saskatchewan in conjunction with the Verification Research Unit of External Affairs and International Trade Canada, March 1990; and Handbook for the Investigation of Allegations of the Use of Chemical or Biological Weapons, Departments of External Affairs, National Defence, Health and Welfare, and Agriculture Canada, November 1985. US Army Field Manual 3-4, US Marine Corps Fleet Marine Force Manual 11-9, "NBC Protection," May 1992; US Army Field Manual 8-285, US Navy NAVMED P-5041, US Air Force Manual 44-149, US Marine Corps Fleet Marine Force Manual 11-11 (adopted as NATO Field Manual 8-285), "Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries," December 22, 1995; US Army Field Manual 19-20, "Law Enforcement Investigations," November 25, 1985; and other DoD investigational procedures contributed ideas for developing this methodology.
88.  Defense Technical Information Center, CB Technical Data Source Book, Volume XIII, "Detection, Identification, and Warning," 1991, p. 42.
89. US Army Soldier and Biological Chemical Command, "Improved Chemical Agent Monitor (ICAM)," web site http://www.sbccom.apgea.army.mil/products/icam.htm (as of August 3, 2000).
90. US Army Chemical School, "Chemical Detection and Reporting," Army Institute for Professional Development, Army Correspondence Course Program, Subcourse CM 1301, Edition E, November 1995, p. 2-11.
91. US Army Training Circular 3-4-1, "Chemical Agent Monitor Employment," December 17, 1991, p. 3.
92. US Army Training Circular 3-4-1, "Chemical Agent Monitor Employment," December 17, 1991, p. 9-12.
93. Defense Technical Information Center, CB Technical Data Source Book, Volume XIII, "Detection, Identification, and Warning," July 1991, p. 43-44.