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Dead Men Do Tell Tales

Special to American Forces Press Service

WASHINGTON, Aug. 27, 2002 – When a Special Forces soldier died unexpectedly of malaria in Puerto Rico recently, one of the first military medical officers notified was Army Maj. (Dr.) Lisa Pearse.

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"Our young soldiers are generally healthy, so they don't typically die of infectious causes," said Army Maj. Lisa Pearse of the Armed Forces Institute of Pathology. One of her special focuses is to detect deaths related to emerging infections or possible bioterrorist attacks.

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"The soldier was part of a group that had just returned from Nigeria, so we knew his death could be just the tip of the iceberg as far as others being exposed," said Pearse, the new director of the Armed Forces Institute of Pathology's Mortality Surveillance Division in the Office of the Armed Forces Medical Examiner.

She investigated the circumstances surrounding the soldier's infection and death and learned he was indeed just one of several from the same unit to come down with the infection. Malaria is preventable when proper precautions are taken.

Concerned that these malaria cases could be due to newly drug-resistant parasites, Pearse notified the Office of the Army Surgeon General. In the ensuing investigation, officials discovered that the cases resulted from poor compliance with preventive measures -- a much more manageable issue than dealing with the emergence of drug- resistance in Africa.

"This was a sentinel event -- an epidemiological term that tells us something happened to indicate the existence of a bigger problem," Pearse said. "Sentinel events are what we look for when we're doing medical surveillance."

Pearse's division is the result of a joint effort by the Office of the Armed Forces Medical Examiner and the Department of Defense's Global Emerging Infections Surveillance and Response System to obtain baseline mortality data on military members and to monitor mortality trends. Mortality surveillance through the medical examiner has distinct advantages. It allows timely notification, which leads to more rapid intervention when necessary. It also improves accuracy in determining cause of death, and provides access to the legal authority of the medical examiner.

The division collects data within hours after an active- duty service death is reported to casualty offices. That data is supplemented through direct contact with local pathologists and clinicians. Information includes death certificates, medical records, autopsy reports, AFIP consults, toxicology studies, and investigative reports from legal agencies and safety centers.

Pearse, a preventive medicine expert, was recently program manager of what is now the Reportable Medical Events System for the Army Center for Health Promotion and Preventive Medicine. She joined the medical examiner's staff in August 2001. Currently focusing on deaths among Army active-duty personnel, she hopes to one day become a triservice resource on military active-duty deaths for medical surveillance and prevention research.

"We have the most detailed and accurate information and, with some epidemiological analysis, can provide a lot of answers to the questions folks have about why presumably healthy soldiers die on active duty," she said. A special focus is to detect deaths related to emerging infections or bioterrorist attacks, particularly in postdeployment situations.

"Our young soldiers are generally healthy, so they don't typically die of infectious causes. Bioterrorism has always been something we've been on the lookout for," Pearse said.

If an infectious agent is the suspected cause of death, specimens are sent to the Armed Forces Institute of Pathology in Washington, where experts in multiple departments are available to provide a confirming diagnosis. Prompt diagnosis can lead to rapid and specific treatment options for others who may have been exposed.

Pearse advocates the new system as a sound investment for the military health sector. It produces timely, useful data not only on infectious disease deaths, but also on deaths from causes as diverse as accidents, suicides and cardiovascular disease.

"For instance, we observed a significant increase in motor vehicle deaths in the Army in November 2001. We now believe this increase was due to a preference to drive rather than fly during the holidays in the post-Sept. 11 environment," she said. "These types of findings may play a role in shaping policy decisions related to the amount of time and miles a soldier is permitted to drive."

She also hopes to one day combine forces with the AFIP's world-class tumor registry and the Defense Medical Surveillance System to track cancer deaths among Army personnel.

"These are superb resources with the potential to look in a detailed way at the types of tumors seen in soldiers in the context of assignment histories and deployments and to match our findings and rates to what we would expect to see in the civilian sector."

For more information about the Mortality Surveillance Division, contact Pearse at Pearse@afip.osd.mil.

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