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AFIP Establishes Registry on Embedded Metal Fragments The AFIPs


									AFIP Establishes Registry on Embedded Metal Fragments

The AFIP's Department of Environmental and Infectious Disease Sciences has established a
Registry program on chemical characterization and case material on metal fragments and other
foreign materials that are removed from surviving DoD personnel in military treatment facilities
(MTFs). The establishment of this Registry on Embedded Metal Fragments is in response to a
DoD Health Affairs Policy which 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 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 risks. The AFIP was tapped by DoD Health
Affairs to serve as one of three DoD sites for the analysis and archival of fragments removed
from 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.
         Establishment of the registry is vital because 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.
  Initial steps involved 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.
         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.

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