Mobilization

File: aaabf_29.txt
Page: 29
Total Pages: 51

Appendix E

Operational Use of Pyridostigmine Bromide

In 1985, TAC initiated the ground testing of all aircrews with pyridostigmine bromide. Reported side effects were so low
(<1%) that testing was discontinued in 1987. During Operation Desert Storm, some units were ordered to begin pyridostigmine
bromide prophylaxis. The following results were provided by LtCol Joseph M. Palma from a questionnaire he prepared and
distributed at a deployed Wing.
Questionnaires distributed = 156//returned = 106 (return rate 68%)

Findings:
-Compliance was poor -- only 9.5% completed the full directed course of 7 days. 61% had quit the prophylaxis after three days.
5.7% did not begin prophylaxis.
-Side effects were prevalent in an uncontrolled assessment (62% reported some side effects)

Headaches 8%
Rash 2%
Somnolence 5%
Weakness 5%
Salivation/Tearing 0%
Bloated stomach 6%
Belly cramps 10%
Loose bowel movements 18%
Two or more stools/day 9%
Muscle cramps or twitching 4%

-The most common side effects were gastrointestinal -- 40%
-Pyridostigmine side effects had no adverse impact on the mission -
100% said no missions were canceled due to side effects.
-Side effects were a significant but not predominant reason for poor compliance -- of the 91% who stopped
prophylaxis before authorized, 36.5% stated side effects were the reason.

In a less formal report, an F-16 wing SME estimated only 20% compliance with the order to take pyridostigmine among pilots.
Of those, 30-40% complained of GI side effects (abdominal cramping and nausea). Those who did not comply cited uncertainty
about a strange medication and the apparent low threat of chemical contact as reasons.