-8196 913 ASSESSING POSS mI MAR DUE TO MID FREQUENCY in1RADIATION(U) AIR FORCE OCCUPATIONAL AND ENVIRONHENTALHEALTH LAB BROOKS AFB TX B J POITRAST FEB 86

UNCLASSIFIED OEHL-B6-U2COI1 BR F/O 6/18 L

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WoW

'11 . L1.

I1111 = 135L_L6

M'CRflCOP' CHART

~uiUSAFOEHL REPORT

SASSESSING POSSIBLE DAMAGE DUE TO

RADIO FREQUENCY RADIATION

BRUCE J. POITRAST, COLONEL, USAF, MC S APR29

February 1986

Final Report

Distribution is unlimited: approved for public release

SFILE COPYUSAF Occupational and Environmental Health Laboratory

Aerospace Medical Division (AFSC)Brooks Air Force Base, Texas 78235-5501

86 4 28 r6

NOTICES

When Government drawings, specifications, or other data are used for any purposeother than a definitely related Government procurement operation, the Governmentthereby incurs no responsibility nor any obligation whatsoever. The fact thatthe Government may have formulated, or in any way supplied the said drawing,specifications, or other data, is not to be regarded by implication, or other-wise, as in any manner licensing the holder or any other person or corporation;or conveying any rights or permission to manufacture, use, or sell any patentedinvention that may in any way be related thereto. ,.

The mention of trade names or commercial products in this publication is forillustration purposes and does not constitute endorsement or recommendation foruse by the United States Air Force.

Do not return this copy. Retain or destroy.

Air Force installations may direct requests for copies of this report to: USAFOccupational and Environmental Health Laboratory (USAFOEHL) Library, Brooks AFBTX 78235-5501.

Other Government agencies and their contractors registered with the DTIC shoulddirect requests for copies of this report to: Defense Technical InformationCenter (DTIC), Cameron Station, Alexandria VA 22314.

Non-Government agencies may purchase copies of this report from: NationalTechnical Information Service (NTIS), 5285 Port Royal Road, Springfield VA 22161

The Public Affairs Office has reviewed this report, and it is releasable to theNational Technical Information Service, where it will be available to thegeneral public, including foreign nations.

This report has been reviewed and is approved for publication.

Prepared By: Reviewed By:

BRUCE J. POITRAST, Colonel, USAF, MC JAMES C. ROCK, Colonel, USAF, BSCConsultant, Occupational Medicine Vice Commander

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SEC UHIT V CLASSIF ICA lIijN 0- [illS 04

REPORT DOCUMENTATION PAGE

la REPORT SfCLJilIY (LAS1iIICATION lb. RESTRICTIVE MARKINGS

Unclassified N/IA2a' LCLRITY CI ASSIHCAI ION AUITHORITY 3 DISTRIBUTION/I AVAILABILITY OF REPORTN/A Distribution is unlimited. Approved for

?b L)ECI ASIFI( AlION 'IiUWNGHAUiN( SCHEDUL E PulIRlae

4 PEMRIHMINUi UNUEII/AI)Nj Rff'OR( NUjMIER(S) 5 MONITORING ORGANIZATION REPORT NUMBER(S)

USAFOEHL Repjo rt 80-020C01 1 1 II 1z -

6a NAME OF PFIE(ORfMING- oRGAN',ATJON 6b OFFICE SYMBOl 7a NAME OF MONITORING ORGANIZATION d

USAF Occtipa iina I nId Envi ron- (if applicable)mental Health laboratory j CVO _________________________

6c. ADDRESS (City. State, and ZIP Code) 7b ADDRESS (City, State, and ZIP Code)

Brooks AFB TX 78235-5501 ________ ________________________

Ba, NAME OF FUFIOINCG ISPONSORIN6 8b OFFICE SYMBOL 9 PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER

OHGAN17A TION (ilf applicable)

Same as 6a ___________________________________________ -

8c. ADORES (City, State, and /lP Code) 10 SOURCE OF FUNDING NUMBERS

PROGRAM IPROJECT ITASK WORK UNITELEMENT NO NO NO I ACCESSION NO.

1)I TITLE (inlu~tde Security Claissification)

Assessing i'ossible Damage Due to Radio Frequency Radiation Exposures (Unclasied

12 PFRSONAI- AU [hUH(S)Poitrast, liruco J., Col, USAF, MCGPG

ONl~a tPE O REPOT Jl3h TIME COVERED 14 DATE OF REPORT CX ar, Mont h,ODay) 15PG ON

Final FROM _TO __ I February 1986 13

16 SUPPLEMENTARY NOTATION

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19 ABlS IRA( r (Continue on rev~erse it necessary and identify by block number)

This roport i ; written in response to requests from the field for guidance in the clinicalexalniflit ion ot radio frequencv radiation exposures. The report contains basic informationon radio fre(Iuenc1(y radiation and its biological interactions. It also contains a suggestedhistory and phys'ical examination, a list of expected clinical findings, and suggestions forreferral if necessary.

210 OISTRIH0TiUN %AVAIl Af4III C4 O ABSTRACT 121 ABSTRACT SECURITY CLASSIFICATIONjiINf ! 5S1Fi1 I)IIIN) IMI I SAM[ AS Rl IT Fl IC UiSERS IUnclassified

22a NAIVI OF HI SPI)NSIIE INDIVIDUAL-- 22b TEt TPHONE (Include Area Code) 22c OFFICE SYMBOLBruce J. Poitrast, Col. USAF. MC I(512) 536-2002 CVO

DO FORM 1473,84 MAP 83 APR edition may be used until exhausted SEUITY CLASSIFICATION OF THIS PAGEAll other editions are obsolete EUCASFE

iNISSFE

.74 - V 7% 7 -- - -.. I

ACKNOWLEDGEMENT

The ;mithor wi:;h-.i to icknowledge the assistance of Capt John Brewer and Lt! url ():;o)n, tJSAFHW;HL/RZN, and Mr John Mitchell, IJSAFSAM/RZ in the preparation -

of thi 3 report.

A,.cesi4,

NTIS..

4~ By

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NT i ailt Codes

iDisSpecial

TABLE OF CONTENTS

Page ,O

DD Form 1J473

Acknowledgement iii

* I. INTRODUCTION1

11I. DISCUSSION

*III. CONCLUSIONS 2

IVl. RECOMMENDATIONS FOR EXAMINATION 3

-References5

Distribution List 6

i v

.

1. INTRODUCTION

A. Purpose:

The purpose of' this report is to assist base level physicians and

othor health care providers in assessing possible health effects due to radiofrequency radiation (RFR) exposures.

B. Problem:

There is much confusion in the medical literature regarding RFR andits biological effects. Few health care providers have sufficient knowledge . .

of the physical sciences to be able to determine the validity of many medicalRFR studies. Because of these factors many medical reports on individualsthought to be exposed to RFR are either lacking in the scope necessary forcomplete examination, or more often, are unnecessarily broad. Worse yet,there is a tendency to attribute physical findings to RFR in the absence ofany reasonable correlation of RFR and the finding. This report is written in

the hope of alleviating some of these problems.

C. Scope:

'Thi:s report will present basic information regarding RFR, its biolog-ical effects and some of the thinking behind the current Air Force RFR safetyguideline, AFOSH Standard 161-9. Also included is a suggested OperatingInstruction (01) for a medical workup. It is intended as a clinical guide forclinicians and not as the final word on the science of RFR. Its contents mustbe viewed in this context.

II. DISCUSSION

Reading of AFOSH Standard 161-9, "Exposure to Radio Frequency Radiation," '---'-

1 O,tober 1984 is recommended. This has a good section on biological effectsand I.ii information pertaining to RFR. Also recommended are the ACGIHThres.;hold Limit Values Handbook; Documentation of the Threshold Limit Values;and U2AFSAM-TR--83-1, Bioeffects of Radiofrequency Radiation.

RFI i.-; considered to be that portion of the electromagnetic spectrum from10 klV,. to 300 GHz. At its upper end it blends with long wave infrared. Itshare.s, all or its phyal3cal characteristics with other segments of the electro-mnagretic specI,'um; that is, it consists of component electric and magneticfields pro)pagat.ed in space as waves. The interaction of these waves withmattor depends on the wavelength, power and polarization of the wave and the-3ize, :-;hape, or'itntation and nature of the matter. In general, with regard tohurnri hfings, it can be said that the longer the wavelength the greater thede pth (t penetration into the body and the shorter the wavelength the less the(hpth of' penetration. Wavelengths of 3 cm or less (10 GHz or more) are,bsor'hed in the skin. Depth of penetration is only one factor; however,enerFy deposition is the key Issue. In general, the greatest absorption in,%adult humar:- takes place at 70 to 80 MHz if they are not grounded and 35 to 40Nil,, if' tht:y are. Specific conditions at the time of exposure may cause this

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to vary. The mechanism for transfer of energy to human body by RFR is byvibration/rotation of dipole molecules, mainly water. The result is an-.increase in heat due to friction. An increase in temperature may or may notresult depending on the thermoregulatory properties of the body. Since todate no robust effect of RFR has been demonstrated that does not relate tothermogenesis, and since varying wavelengths deposit varying amounts ofenergy, the concept of specific absorption rate (SAR) was developed. This isa measure of the rate of energy transfer to the body normalized to body massand is equivalent to the power transferred. Heat generated is directly pro-portional to power absorbed. At a SAR of 4 W/kg the energy absorption withinthe human body may result in a detectable increase in core body or :[)pecificorgan temperature of one centigrade degree or less. The only demonstratedeffect in organs maintained at this increase over normal is a decrease inspermatogenesis due to heat. This decrease in spermatogenesis reverses oncooling. In addition, the body heat regulatory mechanisms of most normal

" individuals can adequately handle such loads. For comparison the average

running man generates 5 W/kg of metabolic heat and the human heart muscle cangenerate 33 W/kg. To ensure safety, the Permissible Exposure Limit (PEL) wasset at a SAR of 0.4 W/kg for frequencies above 3 MHz. This is averaged overany six-minute period. The curve of power density in mW/cm2 versus frequencywhich will give a SAR of 0.4 W/kg can be found in the ACGIH TLV handbook. Thesame curve presented as a table can be found in AFOSH Std 161-9, 12 October1984, entitled "Permissible Exposure Limits for Personnel."

In considering biological effects from the clinical standpoint, we shouldkeep in mind the pre-eminence of thermal effects as the agent of damage.Cataracts and vacuoles have been produced in animal eyes with power densitiesequal to or greater than 100 mW/cm 2 delivered locally and acutely for U-)minutes or more. This correlates with temperatures in the eye of 410C (1060F)or more. It has been difficult to produce cataracts in animals with wholebody RFR without killing the animal. In animals overexposed directly to the

eye all cataracts and vacuoles were present by the end of the third day.

At frequencies below 3 MHz the Air Force has adopted a maximum powerdensity of 100 mW/cm2 . Air may become ionized at frequencies over 10 KHz atapproximately 1,000 kV/m and can result in potentially hazardous electricdischarges. Because of this the PEL contains a 100 kV/m limit whichincorporates a safety factor of 10.

III. CONCLUSIONS

Specifically, then, we would look for thermal burn, signs of electricshock and/or burn, and fairly prompt cataract formation. Prompt evolution ofclinical problems should be expected. In a review of 296 suspected cases ofoverexposure in the USAFOEHL accident file, only 58 were in fact expos"ed abovethe PEL. About half of the 58 (26) clearly felt a warming an I terminated theexposure. Of those determined not to have been overexposed only 11% felt awarming sensation. By way of interpreting a warming sensation, 26 overex;oiedand 26 people not overexposed felt warming. This means that one i:3 :13 likelyas not to have been overexposed if warming is noticed. Conver.;cly, if nowarming is noticed there is only a 13% chance of having been overexposed.

2

.I

Keep in mind al.so the safety factor of 10 in the PEL. Overexposure does not

necessarily mean exposure to biologically meaningful levels.

IV. RECOMMENDATIONS FOR EXAMINATION

A. History:

1. Present Illness. Where possible include the following

information:

a. Type of' equipment involved in the exposure with model number

and radio frequencies emitted.

b. Distance from the source to the person.

e. Length of time exposed.

d. if exposure was intermittent, then give longest individual

time exposed as well as overall time period exposed.

e. Were any unusual noises heard in the ears?

f. Was a sensation of heat experienced and if so, where on the

body?

g. What body parts does the person believe were exposed?

h. Does a previous history of RFR overexposure exist?

i. Does a previous history of overexposure to any chemical or

phy: ical igent exist?

2. Pa:-t Medical History.

a. list --ll types of work ever done, not only in the Air Force

but priev iisly, if applicable.

h. The remainder of the past medical history is standard.

3. Complete review of systems.

B. i Examination:

:;yst,.m Of primary interest are the eyes and skin. The signs to be

:3ought are cataracts and burns.

a. Eyes. Initial examination should describe the condition of

the ikin around the eyes as well as the eye Itself. Slit lamp examination:,hould be aenompli3hed as soon as practicable. If any question is raised by Cslit. 1imp 4xamination, referral should be made to an ophthalmologist for

dil ted sit lamp examination.

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6b. Skin. Observe for signs of heat-induced change and electrical

burn. Note findings, to include negative findings.

c. The remainder of the examination should be as pertinent.

C. Laboratory Studies:

These should be as indicated.

No single test has any peculiar virtue. Routine tests, if done,

should be limited to CBC and UA. Any others done should be for clinicalreasons.

D. Referral:

If it is believed clinically necessary, referral for further workup of

specific conditions should be accomplished within the usual medical referringsystem. Only very unusual circumstances would warrant referrel outside theusual system. If there is a question regarding the need for referrel or whereit should be accomplished, consultation may be obtained from the UJAFOEHL'

Occupational Medical Consultant at AV 240-2002, Commercial (512) 536-2002 or

by electronic message.

E. Cautions:

1. These patients have a tendency to a great deal of anxiety based ontheir perceptions of an assault by an invisible agent. They're usuallyunfamiliar with the possible results of an overexposure and often have filledin the blanks of their knowledge with generalized fears of cancer and birth

defects. Unless you can see an obvious connection between a finding and theexposure, other than a temporal one, the exposure and the finding are probably

not connected. If you don't know, it is best to say that you don't but thatyou will find out.

2. Epidemlologlcal studies to date have not demonstrated any longterm consequences beyond those present at the time of the exposure.

3. Consultation may be obtained from the USAFOE[{L OccupationalMedical Consultant at Brooks AFB TX AV 240-2002.

iii

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References

Chaniet, E., Environmental Protection. New York: McGraw Hill. (1979).

Docum tittinn of the Threshold Limit Values, 4th Edition. (With Update),

American Conference of Governmental Industrial Hygienist, Cincinnati, Ohio,1980.

Olishirski, P., Editor, The Fundamentals of Industrial Hygiene. 6thEdition. Chicago: National Safety Council. (1982).

Radiofrequency and Microwaves. Environmental Health Criteria #16. WorldHealth Organization, Geneva, Switzerland. (1981).

Wilkening, S., The Industrial Environment, Its Evaluation and Control. The

Department of Health and Human Services, U.S. Government Printing Office,Washington DC, (1973).

:.'2

5

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DISTRIBUTION LIST P.-

USAF Academy Hospital/SGP USAF Hospital Columbus/SGP

Air Force Academy CO 80840-5470 Columbus AFB MS 3970-500'

USAF Hospital Altus/SGP USAF Hosp Davis-Montha/SCPAltus fFB OK 73523-5300 Davis-Monthan AFB AZ 85707-5300.

r Malcolm Grow USAF Med Cen/SGPA USAF Hospital Dover/SGP"Andrews AFB MD 20331-5300 Dover AFB DE 19902-5300

HQ AFSC/SGPA USAF Hospital Dyeso/2GPAndrews AFB DC 20334-5000 Dyess AFB TX 79607-5300

HQ ANGSC/SGP USAF Hospital Edwards/SGPAndrews AFB DC 20331-6008 Edwards AFB CA 93523-5300

USAF Hospital Barksdale/SGP USAF Rgn Hos;pital Egli i/SGP SBarksdale AFB LA 71110-5300 Eglin AFB FL 32541---13()O

USAF Hospital Beale/SGP USAF Clinic Eielson/SGPBeale AFB CA 95903-5300 Eielson AFB AK 99702--5300

USAF Hospital Bergstrom/SGP USAF Hospital Ellsworth/SGPBergstrom AFB TX 78743-5300 Ellsworth AFB SD 57706--)300

USAF Hospital Blytheville/SGP HQ AAC/SGPABlytheville AFB AR 72317-5300 Elmendorf AFB AK 99506-5000

HQ USAF/SGPA USAF Hospital Elmeridorf/SOP ,Bolling AFB DC 20332-6188 Elmendorf AFB AK 9950t-53 00

USAF Clinic Brooks/SGP USAF Hospital England/SGPBrooks AFB TX 72835-5300 England AFB LA 71311-5300

USAFSAM/TSK USAF Hospital Fairehild/SGPBrooks AFB TX 78235-5000 Fairchi1 AFB WA 99)11 -1)30

AFOMS/SGPR USAF Hospital V E Warrt n/SGf'Brooks AFB TX 78235-5000 F E Warren AFH WY 8200' -) W0

USAF Hospital Cannon/SGP USAF Hos.pital George/;(;PCannon AFB NM 88103-5300 1;e r'ge AFO CA 9.'-1(4

USAF Rgn Hospital Carswell/SGP :j, AF 7-l itnic G odel !CarswelI AFB TX 7t127-5300 o''.w. AP I AL ' x W'00

USAF Hospital Castle/SGP U:A. rhopit. i ,i Grdld FrKr:;/SG'Castle AFB CA 95342-5300 C;rriI Fork-s, AKi N!' '0.0')O.

USAF Hospital Chanute/SGP t):'AF fi(-yitl ;ril i GPChanute AF1 1L f1868-5300 r F :i AFIP NY 1. il '.1 (,.

USAF Clinic Charleston/SGP IJ,;Al.' Ho:-nitaJ Ori:r:;,<m/S;l

Charleston AFH SC 291104-5300 Gr-i:;.;m AFH IN C '] ,()

6

U, ;A Ciinic Hanscom/SGP USAF Rgn Hospital MacD iiI/SGPln:;&m AI.'P MA 91131 -5300 MacDill AFB FL 33608-5300

iQ PAt:AF/2G(,PA USAF Hospital Malmstrom/SGPIlickim A,!VH HI )8653 -5000 Malmstrom AFB MT 59402-5300

U.:AF CUliic IlI, k;im/SGIP USAF Rgn Hospital March/SGPfiick:im AFH Hi 98%3 ;-5300 March AFB CA 92518-5300

USAF Ho- pitat Hill /SGP USAF Hospital Mather/SGPHli ll AV II' 8L)bL53()0 Mather AFB CA 95655-5000

J;A!- Huspitl liA lorman/SGlP HQ Air University/SGPA

Hotl ,wmi: AFi NN M ! 3 0-5300 Maxwell AFB NM 87117-7001

UJSAF llo:; ita] fIoinest,ad/SGP USAF Rgn Hospital Maxwell/SGPliorn ,tt,id AFl.H Kt, 33039-5300 Maxwell AFB AL 36112-5304

U.';AF. i;] i liir. iburt/SGP USAF Clinic McChord/SGPHlur I) t H'i I1<FL 3 ).-O053 McChord AFB WA 98438-5300

KTI /-'', USAF Clinic McClellan/SGPKet:_ler AFB MS 39 34-5300 McClellan AFB CA 95652-5300

1)'AP Ilinic K',I y/SGP USAF Hospital McConnell/SGPKe 1 y AF' TX 782141 -5000 McConnell AFB KS 67221-5300

'JAF H o;- i tal K t rt land/SGP USAF Clinic McGuire/SGPKirukmd AFfi Ni" 87117-5300 McGuire AFB NJ 08641-5300

UrSAF lhe:pital K I Sawyer/SGP USAF Rgn Hospital Minot/SGP,K I iawy,,r AFH MI 49843-5300 Minot AFB ND 58705-5300

Will'oid !,ill ISAF Med Cen/SGKFE USAF Hospital Moody/SGPl,,ailiI. AFH IX 78236--5300 Moody AFB GA 31699-5300

*tH IIAQ/:;(IPA USAF Hospital Mt Home/SGP1,.irwIyj AFfi VA 3b6 -5001 Mountain Home AFB ID 83648-5300

iSA Ip.;il iiughliti/SGP USAF Hospital Myrtle Beach/SGPLaijhlb i AFiK TX h884 IJ-)OOO Myrtle Beach AFB SC 29579-5300

rl',Ap Ho",plttl 1,oring/SGP USAF Hospital Nellis/SGP

,r'ii AFIi ME ,)4751--5300 Nellis AFB NV 89191-5300

:.AF ('irij e Los Angeles/SGP USAF Clinic Norton/SGPI'.(). PHx 14."!,)0 Wordway Pust Cen Norton AFB CA 92409-5300(,,2 Arg,' 1 ,s A 90009-2960 ..

HQ SAC/SGPA'PA" f lici Lowry/SGP Offutt AFB NE 68113-5001[.,>wry A[-h (1*) 80230-5300

Ehrling BerquistU: ;AV lo;pital ILuke/SGP USAF Regional Hospital/SGPT,uke AL'i; AZ 8',309-5300 Offutt AFB NE 68113-5300

7

7A

USAF Hospital Patrick/SOP USAF Hospital Vandenberg/SGP l..6

Patrick AFB FL 32925-5300 Vandenberg AFB CA 934 37-5300

USAF Hospital Pease/SGP USAF Hospital Whiteman/SGPPease AFB NH 03803-5300 Whiteman AFB MO 6530'.-O300

USAF Clinic Peterson/SGP USAF Hospital WilLiams/SGP

Peterson AFB CO 80914-5300 A 8-40

USAF Hospital Plattsburgh/SGP HQ AFLC/SGPA

Plattsburgh AFB NY 12903-5300 Wright-Patterson AFB OH 45433-5001

USAF Clinic Pope/SOP USAF Medical Center

Pope AFB NC 28308-5300 Wright-Patterson/SGP

Wright-Patterson AFF OH 45433-5300HQ ATC/SGPARandolph AFB TX 78150-5001 USAF Hospital 4urtsmith/SGP

Wurtsmith AFB MI 487',3 5300 .USAF Clinic Randolph/SGP

Randolph AFB TX 78150-5000 USAF Clinic Alconbury/SGP

APO New York 09238 -5300.USAF Hospital Reese/SGPReese AFB TX 79489-5300 USAF Clinic Andersen/SGP

APO San Francisco 9634-5300USAF Hospital Robins/SGPRobins AFB GA 31098-5300 USAF Clinic Ankara/SGP

APO New York 09254-5300HQ USAF Med Cen Scott/SGPScott AFB IL 62225-5001 USAF Clinic Aviano/SGP

APO New York 09293-5300HQ MAC/SGPA [i'

Scott AFB IL 62225-5001 USAF Clinic Bentwaters/SGP'

APO New York 09755--')300USAF Hosp Seymour-Johnson/SOPSeymour-Johnson AFB NC 27531-5300 USAF Hospital Bitburg/SGP

APO New York 09132-530()USAF Hospital Shaw/SGPShaw AFB SC 29152-5000 USAF Clinic Camp New Am,;Lordam/SGP

APO New York 09292-5300USAF Rgn Hospital Sheppard/SGPSheppard AFB TX 76311-5300 U:;:AF Clinic Chicksands/SGP

APO New York 09193-')300USAF Hospital Tinker/SGPTinker AFB OK 73145-5300 USAF Rgri Med Cen Cl a,'k/r P "..

APO San Francisco 9(274-500 ."David Grant USAF Med Cen/SGP

Travis AFB CA 94535-5300 USAF Med Aid Statiuri (;ori.-)/SGP

APO New York 09(94-5000USAF Hospital Tyndall/SGPTyndall AFB FL 32403-5000 USAF Clinic F;airfor,1/:;(;P'

APO New York 091 1 -1300 %"USAF Clinic Vance/SGPVance AFB OK 73705--5000 USAF Clinic Florenn(-:;/SGP

APO New York 09188 -,000

dJ

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..". . . . . . . . ..". ... .-. • -. ." -. -.,. .".,..'.' ' ,.:.' ..' _ .' k '. _. =,. k_ kCa.' k ..

.AA

USAF Clinic Gielenkirchen/SGPAPO New York 09104-5000 USAF Clinic Sembach/SGP j

APO New York 09130-5300USAF Hospital Hahn/SGPAPO New York 09109-5300 5073 ABG/SGP

APO Seattle 98736-5000USAF Hospital Hellenikon/SGPAPO New York 09223-5300 USAF Clinic Spangdablem/SOP jIUSAF Clinic Howard/SGP APO New York 09123-5300

APO Miami 34001-5000 USAF Hospital Torrejon/SGPAPO New York 09283-5300'<

USAF Hospital Incirlik/SGP A N Yk 2 5APO New York 09289-5300 USAF Hospital/SGP

APO New York 09194-5300USAF Hospital Iraklion/SGPAPO New York 09291-5300 USAF Rgn Med Cen Wiesbaden/SGP

APO New York 09220-5300USAF Clinic lsmIr/SGPAPO New York 09224-5300 USAF Hospital Yokota/SGP

APO San Francisco 96328-5300' ~~USAF Clinic Kadena/SGP _________

APO San Francisco 96239-5300 USAF Clinic Zaragoza/SGPAPO New York 98286-5300

57 FIS/SGPFPO New York 09571-2055 USAF Clinic Zwiebrucken/SGP| ~APO New York 09860-5300 -

USAF Hospital Kunsan/SGPAPO San Francisco 96264-5300 HQ USAFE/SGPA

APO New York 09012-5000USAF Hospital Lakenheath/SGPAPO New York 09179-5300 OL AD, USAFOEHL

APO San Francisco 96274-5000USAF Hospital Lajes/SGPAPO New York 09406-5300 DTIC

Cameron StationDet 1, USAF Hospital Alexandria VA 22314Capt Henry WoodcockAPO New York 09194-5300 HQ SPACECOM/SGPA

Peterson AFB CO 80914-5000USAF Hospital Misawa/SGPAPO San Francisco 96519-5300 HQ ESC/SGPA

Kelly AFB TX 78241-5000USAF Hospital Osan/SGPAPO San Francisco 96570-5300

USAF Clinic Ramstein/SGPAPO New York 09012-5300

USAF Clinic Rhein-Main/SGPAPO New York 09057-5300

USAF Clinic San Vito/SGPAPO New York 09240-5300 V

9

* *%* *.*** .,-. . . . . . . . . . . .

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