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Burn Pits: The "Agent Orange" of the Iraq War

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Permethrins' connection to the IRAQ WAR:

  • Vector-borne diseases quickly became an increasing issue early in the March 2003 invasion of Iraq. In January 2004, there had been 659 cases of the extremely rare parasite cutaneous leishmaniasis, an and 10 cases of plasmodium resulting in malaria (White et al., 2005).
    • Although mosquitoes potentially carrying malaria were seen typically in the months of May to November verses sand flies infected with leishmaniasis which are continuous year-round, the United States Army applied greater attention and funding to the prevention of the infrequent transmissions of malaria.
    • January 2004: the United States Army 8th Medical Brigade conducted a survey at a staging-base in Kuwait while units waited to disburse throughout Iraq - surveying 754 servicemembers about whether they had received preventive measures against vector-borne illnesses.
    • Out of 754 servicemembers, 316 (36.3%) received DEET repellant, 392 (47.5%) received permethrin aerosol insecticides and 357 (41%) receiving ‘three or more’ permethrin-treated uniforms (White et al., 2005). 
    • One-third of deploying servicemembers received DEET and only half received permethrin as of January 2004; the Army Office of the Surgeon General, Army Medical Department and the Office of Preventative Medicine called for a “proactive supply” and by the late 2004 nearly ALL deploying servicemembers had a minimum of three permethrin-soaked uniforms and an endless supply of DEET.
    • *It is very important to note, considering the constant wearing and use of these uniforms, they need to be replaced quite frequently – leaving the old uniforms that had been soaked in permethrin to be disposed of; burned in the burn pits for security purposes and to prevent reusing.


The Dangers of BURNING Permethrin:

  • Permethrin does NOT burn easily and is difficult to continue burning if alone.
    • Melting point is 93°F which allows the breakdown process to begin fairly early; when heated, toxic fumes of the poisonous gas hydrogen chloride are emitted into the air.
    • Fire and smoke vapors from permethrin can cause IMMEDIATE dizziness and suffocation.
  • The EPA states [permethrin] "is likely a human carcinogen" as evidenced by liver and lung tumors identified on lab mice, therefore the EPA recommends the following "safe" distances for permethrin exposure:
    • Spill (solid) = 25m / 75 ft.
    • Spill (liquid) = 50 m / 150 ft.
    • Fire = 800 m/ half-mile
  • EPA also recommends never taking CONTAMINATED clothing into residential areas (cooking, sleeping, showering, etc.) and to never wear clothing excessively.
  • If a spill occurs, moisten with water to prevent dust formation.
  • EPA lab tests state permethrin toxicity on a lab rat via oral route is 430-4000 mg/kg and toxicity on a lab rabbit via skin contact route is 2000 mg/kg - providing evidence that skin exposure can be equally if not more toxic to the human body than ingesting orally.

PERMETHRIN: the Chemical:

  • C₂₁H₂₀Cl₂O₃
  • "Acceptable daily intake" - 0.05 mg/kg
  • Water insoluble (Specific Gravity = 1.2 vs. Water = 1.0)
  • Molecular weight = 391.3 g/mol
  • Melting point = 93°F / Boiling point = 392°F
  • When heated to "decompose" - toxic fumes of hydrogen chloride are emitted.


Permethrin EXPOSURE and the Human Body:

  • Incehm.org states permethrin is a 'neurotoxin that acts directly on neuronal membranes, prolonging the sodium-ion pump during the excititory phase...'
  • When permethrin enters the body, it is readily absorbed in the gastrointestinal tract, and is absorbed/distributed into most body tissues and fluids (extracellular, blood, urine) with PEAK CONCENTRATION in the BRAIN and SCIATIC NERVE region (Amer. Soc. of Health-System Pharm., 2013).
  • Once distributed throughout the body, it is metabolized by ester hydrolysis to inactive metabolites and excreted in the urine.
  • When permethrin is INHALED, repeated and prolonged exposures can cause a "pins and needles"  neuropathy in hands and feet (related to lapse in the neurological systems depolarization from disrupted sodium channel currents),  irritation to the lungs, nose, throat such as tightness, swelling, choking and coughing spells. Exposures short term (within minutes/hours after exposures) can have the following symptoms both locally and systemically:
    • Headaches
    • Dizziness
    • Coughing/wheezing
    • Shortness of breath (laryngeal & mucosal edema)
    • Fatigue
    • Muscle weakness
    • Chest pain
    • Excessive salvation (laryngeal & mucosal edema)
    • Nausea and vomiting
  • Long-term affects of permethrin exposure includes, but not limited to:
    • Liver-related issues (increased risk with alcohol usage)
    • Peripheral neuropathy
    • Brain and spinal tumors/cancers.
    • Decreased sperm count
    • Reproductive system damage (males and females)
    • Hypersensitive reoccurring pneumonia



How to TREAT a servicemember for acute permethrin exposure:

  • If INGESTED: give Activated Charcoal
    • consider orotracheal/nasotracheal intubation
    • Beta-agnoist Albuterol
    • IV D5W to KVO "keep vein open"
    • If hypovolemic: 0.9% Normal Saline or Lactated Ringers



DEET vs. Permethrin:

  • DEET = N,N-Diethyl-meta-toluamide
  • Broken down into smaller chemicals by liver (cytochrome P450), can be found in blood up to 12-hours post-exposure, eliminated via urine within 24-hours after exposure.
  • EPA states DEET is "not classifiable as a human carcinogen"