Embedded Fragments Medical Management Program

In April 2007, the interagency Task Force On Returning Global War On Terror Heroes report identified the problem of an increasing number of service members with shrapnel or retained fragment wounds received from blast injuries and the concern that some types of fragments could have long-term health effects. In response, the Task Force recommended the creation of an embedded fragment surveillance program and registry at the VA which “would allow the VA to identify and provide clinical surveillance to GWOT veterans with retained fragments and to initiate early intervention for resulting health care problems.” This program would be an expansion of the VA’s mission to follow-up with veterans with depleted uranium exposure.

In December 2007, DoD Health Affairs published HA Policy 07-029 for analysis of metal fragments removed from Department of Defense personnel. The policy "requires the Services to conduct a laboratory analysis of metal fragments, resulting from enemy or friendly fire, that are removed from surviving Department of Defense (DoD) personnel in DoD military treatment facilities (MTFs)." “This 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 body.” “This policy is a 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 services developed their own implementation policies.

In 2008, the VA established the Toxic Embedded Fragment Surveillance Center (TEFSC) at the Baltimore VA Medical Center. “The Center:

  • Provides special testing for chemicals that might be released from the fragments
  • Maintains a registry of OEF/OIF/OND Veterans who have had a fragment removed or who still have a fragment in their body
  • Uses information from the registry to write guidelines for medical care
  • Provides guidelines for medical care to other VA health care providers across the country”

Information on DoD and VA Embedded Fragments Programs

DoD

  • The Defense Health Agency's JPC provides world class diagnostic subspecialty pathology consultation, education and research services to federal agencies and operates the National Pathology Tissue Repository in support of the mission of the DoD and other federal agencies. The Biophysical Toxicology and Depleted Uranium/Embedded Metal Fragment DU/EMF Laboratories provide analysis for combat-associated metal fragments taken from DoD personnel for DU and other metals.

VA

Research

The Armed Forces Radiobiology Research Institute (AFFRI), located at the Uniformed Services University of the Health Sciences, is researching the effects of internal contamination with radionuclides and heavy metals. AFRRI's research includes investigating the long-term health effects of DU and exploring novel materials designed to remove radionuclides from the body.