Panel 1: medical surveillance prior to, during, and following potential environmental exposures.

This review assesses the Department of Defense approach to medical surveillance of environmental exposures during deployments. Seven steps in the process are reviewed: (1) exposure assessment, (2) identification of the target population, (3) surveillance for current exposures, (4) surveillance for long-term effects, (5) record keeping for environmental data, (6) analysis of surveillance data, and (7) communication of results. Exposures need to be evaluated as soon as they are recognized, and potentially exposed individuals should be identified at the time of the exposure. Long-term health surveillance relies primarily on electronic medical records. Department of Defense databases are powerful resources for surveillance for service members, up until the time of separation. The Millennium Cohort Study is tracking the health status of 150,000 service members for 21 years, including after separation. Risk communication principles should be incorporated when reporting surveillance results. Often, there are several interested audiences, in addition to military leaders and service members.