Strategies to Protect the Health of Deployed U.S. Forces

Analytical Framework for Assessing Risks

Lorenz Rhomberg,
Principal Investigator

Board on Environmental Studies and Toxicology

Commission on Life Sciences

National Research Council

NATIONAL ACADEMY PRESS
Washington, DC



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
--> Strategies to Protect the Health of Deployed U.S. Forces Analytical Framework for Assessing Risks Lorenz Rhomberg, Principal Investigator Board on Environmental Studies and Toxicology Commission on Life Sciences National Research Council NATIONAL ACADEMY PRESS Washington, DC

OCR for page R1
--> NATIONAL ACADEMY PRESS 2101 Constitution Ave., N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was supported by Contract No. DASW01-97-C-0078 between the National Academy of Sciences and the Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-06895-9 Additional copies of this report are available from: National Academy Press 2101 Constitution Ave., NW Box 285 Washington, DC 20055 800-624-6242 202-334-3313 (in the Washington metropolitan area) http://www.nap.edu Copyright 2000 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

OCR for page R1
--> THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

OCR for page R1
This page in the original is blank.

OCR for page R1
--> PRINCIPAL INVESTIGATOR Lorenz Rhomberg, Gradient Corporation, Cambridge, Massachusetts (formerly of Harvard School of Public Health, Boston, Massachusetts) ADVISORY GROUP Arthur J. Barsky, Brigham and Women's Hospital, Boston, Massachusetts Germaine M. Buck, State University of New York at Buffalo, Buffalo, New York William S. Cain, University of California, San Diego, California John Doull, The University of Kansas Medical Center, Kansas City, Kansas Ernest Hodgson, North Carolina State University, Raleigh, North Carolina David H. Moore, Battelle Memorial Institute, Bel Air, Maryland Roy Reuter, Life Systems, Inc., Cleveland, Ohio Ken W. Sexton, University of Minnesota, Minneapolis, Minnesota Robert E. Shope, University of Texas, Medical Branch, Galveston, Texas Ainsley Weston, National Institute of Occupational Safety and Health, Morgantown, West Virginia Staff Carol A. Maczka, Project Director Raymond A. Wassel, Program Director Susan N.J. Pang, Program Officer Robert J. Crossgrove, Editor Norman Grossblatt, Editor Catherine M. Kubik, Senior Project Assistant Leah L. Probst, Project Assistant Mirsada Karalic-Loncarevic, Information Specialist Sponsor U.S. Department of Defense

OCR for page R1
--> BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Gordon Orians (Chair), University of Washington, Seattle, Washington Donald Mattison (Vice Chair), March of Dimes, White Plains, New York David Allen, University of Texas, Austin, Texas Ingrid C. Burke, Colorado State University, Fort Collins, Colorado William L. Chameides, Georgia Institute of Technology, Atlanta, Georgia John Doull, The University of Kansas Medical Center, Kansas City, Kansas Christopher B. Field, Carnegie Institute of Washington, Stanford, California John Gerhart, University of California, Berkeley, California J. Paul Gilman, Celera Genomics, Rockville, Maryland Bruce D. Hammock, University of California, Davis, California Mark Harwell, University of Miami, Miami, Florida Rogene Henderson, Lovelace Respiratory Research Institute, Albuquerque, New Mexico Carol Henry, Chemical Manufacturers Association, Arlington, Virginia Barbara Hulka, University of North Carolina, Chapel Hill, North Carolina James F. Kitchell, University of Wisconsin, Madison, Wisconsin Daniel Krewski, University of Ottawa, Ottawa, Ontario James A. MacMahon, Utah State University, Logan, Utah Mario J. Molina, Massachusetts Institute of Technology, Cambridge, Massachusetts Charles O'Melia, Johns Hopkins University, Baltimore, Maryland Willem F. Passchier, Health Council of the Netherlands Kirk Smith, University of California, Berkeley, California Margaret Strand, Oppenheimer Wolff Donnelly & Bayh, LLP, Washington, D.C. Terry F. Yosie, Chemical Manufacturers Association, Arlington, Virginia Senior Staff James J. Reisa, Director David J. Policansky, Associate Director and Senior Program Director for Applied Ecology Carol A. Maczka, Senior Program Director for Toxicology and Risk Assessment Raymond A. Wassel, Senior Program Director for Environmental Sciences and Engineering Kulbir S. Bakshi, Program Director for the Committee on Toxicology Lee R. Paulson, Program Director for Resource Management

OCR for page R1
--> COMMISSION ON LIFE SCIENCES Michael T. Clegg (Chair), University of California, Riverside, California Paul Berg (Vice Chair), Stanford University, Stanford, California Frederick R. Anderson, Cadwalader, Wickersham & Taft, Washington, D.C. Joanna Burger, Rutgers University, Piscataway, New Jersey James E. Cleaver, University of California, San Francisco, California David Eisenberg, University of California, Los Angeles, California John Emmerson, Fishers, Indiana Neal First, University of Wisconsin, Madison, Wisconsin David J. Galas, Keck Graduate Institute of Applied Life Science, Claremont, California David V. Goeddel, Tularik, Inc., South San Francisco, California Arturo Gomez-Pompa, University of California, Riverside, California Corey S. Goodman, University of California, Berkeley, California Jon W. Gordon, Mount Sinai School of Medicine, New York, New York David G. Hoel, Medical University of South Carolina, Charleston, South Carolina Barbara S. Hulka, University of North Carolina, Chapel Hill, North Carolina Cynthia Kenyon, University of California, San Francisco, California Bruce R. Levin, Emory University, Atlanta, Georgia David Livingston, Dana-Farber Cancer Institute, Boston, Massachusetts Donald R. Mattison, March of Dimes, White Plains, New York Elliot M. Meyerowitz, California Institute of Technology, Pasadena, California Robert T. Paine, University of Washington, Seattle, Washington Ronald R. Sederoff, North Carolina State University, Raleigh, North Carolina Robert R. Sokal, State University of New York, Stony Brook, New York Charles F. Stevens, The Salk Institute, La Jolla, California Shirley M. Tilghman, Princeton University, Princeton, New Jersey Raymond L. White, University of Utah, Salt Lake City, Utah Staff Warren R. Muir, Executive Director Jacqueline K. Prince, Financial Officer Barbara B. Smith, Administrative Associate Kit W. Lee, Administrative Assistant

OCR for page R1
--> OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Waste Incineration and Public Health (1999) Hormonally Active Agents in the Environment (1999) Research Priorities for Airborne Particulate Matter: II. Evaluating Research Progress and Updating the Portfolio (1999) Ozone-Forming Potential of Reformulated Gasoline (1999) Risk-Based Waste Classification in California (1999) Arsenic in Drinking Water (1999) Research Priorities for Airborne Particulate Matter: I. Immediate Priorities and a Long-Range Research Portfolio (1998) Brucellosis in the Greater Yellowstone Area (1998) The National Research Council's Committee on Toxicology: The First 50 Years (1997) Toxicologic Assessment of the Army's Zinc Cadmium Sulfide Dispersion Tests (1997) Carcinogens and Anticarcinogens in the Human Diet (1996) Upstream: Salmon and Society in the Pacific Northwest (1996) Science and the Endangered Species Act (1995) Wetlands: Characteristics and Boundaries (1995) Biologic Markers (5 reports, 1989–1995) Review of EPA's Environmental Monitoring and Assessment Program (3 reports, 1994–1995) Science and Judgment in Risk Assessment (1994) Ranking Hazardous Waste Sites for Remedial Action (1994) Pesticides in the Diets of Infants and Children (1993) Issues in Risk Assessment (1993) Setting Priorities for Land Conservation (1993) Protecting Visibility in National Parks and Wilderness Areas (1993) Dolphins and the Tuna Industry (1992) Hazardous Materials on the Public Lands (1992) Science and the National Parks (1992) Animals as Sentinels of Environmental Health Hazards (1991) Assessment of the U.S. Outer Continental Shelf Environmental Studies Program, Volumes I–IV (1991–1993) Human Exposure Assessment for Airborne Pollutants (1991) Monitoring Human Tissues for Toxic Substances (1991) Rethinking the Ozone Problem in Urban and Regional Air Pollution (1991) Decline of the Sea Turtles (1990) Copies of these reports may be ordered from the National Academy Press (800) 624-6242 (202) 334-3313 www.nap.edu

OCR for page R1
--> Preface Illnesses possibly associated with U.S. military deployments during Operations Desert Storm and Desert Shield (1990–1991) have been the subject of much debate and national attention. In order to help prevent and reduce the number of illnesses in future deployments, the Department of Defense (DOD) requested that the National Academy of Sciences (NAS) develop a long-term strategy for protecting the health of the nation's military personnel when deployed to unfamiliar environments. As part of the academy's response to this request, I was asked to develop an analytical framework for assessing risks to deployed forces from a variety of health threats encountered during deployments. A group of advisers was convened to assist me with the project, providing me with advice in their various areas of expertise and guiding the development of the framework. I am very appreciative of the valuable input they provided. As part of the information gathering for this study, DOD personnel provided very useful presentations on relevant DOD programs. I wish to acknowledge in particular COL Francis O'Donnell (Office of the Special Assistant for Gulf War Illness), Jack Heller (U.S. Army Center for Health Promotion and Preventive Medicine), John Resta (U.S. Army Center for Health Promotion and Preventive Medicine), Hank Gardner (U.S. Army Center for Environmental Health Research), MAJ Larry Kimm (Joint Staff), CDR Paul Knechtges (U.S. Army Center for Environmental Health Research), and Thomas Burke (Johns Hopkins University). These briefings were especially helpful because I was chosen for this project expressly as a person without extensive experience in military matters and am not well versed in military organization structure, operations, policy, or doc-

OCR for page R1
--> trine. Since DOD's aim was specifically to obtain an independent assessment of how the military can protect their deployed personnel in the future, I hope my newness to these matters can lead to some benefit in freshness of point of view that will offset the lack of extensive experience into the military's current extensive activities and programs. Special thanks are owed to the six authors who were commissioned to write papers on topics that needed more in-depth analysis. Morton Lippmann (New York University School of Medicine) discussed approaches for collecting and using personal exposure and biological-marker information for assessing health risks; Edward Martin (Edward Martin and Associates, Inc.) characterized possible scenarios of future deployments and battle considerations; Joseph Rodricks (The Life Sciences Consultancy) reviewed traditional risk assessment methods and how risk assessment in general might be applied to deployment scenarios; Joan Rose (University of South Florida) addressed health assessment and risk management integration for biological agents; Karl Rozman (University of Kansas Medical Center) proposed a new paradigm for incorporating toxicokinetic information in risk assessment; and Raymond Yang (Colorado State University) discussed toxicologic interactions among harmful agents. These authoritative papers were presented at a workshop on January 28–29, 1999 in Washington, DC, and have been published concurrently with this report (see Workshop Proceedings on Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces). This report has been reviewed in draft form by individuals chosen for their technical expertise and diverse perspectives in accordance with procedures approved by the NRC's Report Review Committee for reviewing NRC and Institute of Medicine reports. The purpose of that independent review was to provide candid and critical comments to assist the NRC in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. I wish to thank the following individuals, who are neither officials nor employees of the NRC, for their participation in the review of this report: John C. Bailar, III, University of Chicago; Thomas A. Burke, Johns Hopkins University; Steven D. Colome, Irvine, California; John L. Emmerson, Fishers, Indiana; Bernard D. Goldstein, Rutgers University; Rogene F. Henderson, Lovelace Respiratory Research Institute; Peter Hidalgo, Waverly Hall, Georgia; Paul Knechtges, Sherikon, Inc.; Matthew S. Meselson, Harvard University; and Arthur C. Upton, Rutgers University. The individuals listed above, as well as the advisers for this project,

OCR for page R1
--> have provided many constructive comments and suggestions. It must be emphasized, however, that responsibility for the final content of this report rests entirely with the principal investigator and the NRC. I would also like to acknowledge the principal investigators of the three sister projects that were conducted concurrently with this one. Thomas McKone (University of California, Berkeley) was the principal investigator of a project that considered technology and methods for detection and tracking of exposures to a subset of harmful agents; Michael Kleinman (University of California, Irvine) and Michael Wartell (Indiana University—Purdue University Fort Wayne) were co-investigators of a project that reviewed and evaluated approaches and technologies used in the development and evaluation of equipment and clothing for physical protection and decontamination; and Samuel Guze (Washington University) and Phillip Russell were co-investigators who reviewed and evaluated medical protection, health consequences management and treatment, and medical record keeping. My personal thanks are also owed to the NRC staff who were involved in this project. In particular, Carol A. Maczka and Raymond A. Wassel expertly brought structure to the project and guided the interactions among DOD briefers, the advisory committee, and the commissioned authors along productive lines. Susan N.J. Pang provided essential technical help, especially in obtaining documentation and preparing material. Other staff members who contributed to this effort are James J. Reisa, Robert J. Crossgrove, Catherine M. Kubik, and Leah L. Probst. LORENZ RHOMBERG PRINCIPAL INVESTIGATOR

OCR for page R1
This page in the original is blank.

OCR for page R1
--> Contents     Executive Summary   1 1   Introduction   11     Assessing Health Risks to Deployed Forces,   12     The Approach to the Task,   13     Organization of the Report,   18 2   Rationale and Objectives for Examining Risks to Deployed Forces   19     Deployment Environment,   19     Degree and Nature of the Threat,   20     Chemical and Biological Warfare Agents,   20     Changing Nature of Deployment and Warfare,   21     Changing Expectations and Establishing Trust,   22     Need for Openness,   24     Objectives for a Program of Assessing Risk to Deployed Forces,   24     Summary and Conclusions,   26 3   Existing Frameworks and Special Considerations   28     Existing Frameworks for Risk Assessment,   29     Special Considerations About Risk Assessment for Deployment,   37     Summary and Conclusions,   42

OCR for page R1
--> 4   A Framework for Assessing Risk to Deployed Forces   44     Ongoing Strategic Baseline Preparation and Planning,   45     Specific Deployment Activities,   73     Post-Deployment Activities,   73     Summary and Conclusions,   79 5   Considerations and Recommendations for Implementing the Framework   82     Areas of Emphasis for Implementing the Framework,   82     Meeting the Stated Objectives for the Framework,   85     Recommendations,   88     References   94 Appendix A:   Abstracts of Commissioned Papers   101 Appendix B:   Biographical Information on Principal Investigator and Advisory Group   111

OCR for page R1
This page in the original is blank.

OCR for page R1
This page in the original is blank.