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Subcomm ittee on the Toxicological Risks to Deployed Military Personnel
Com mittee on Toxicology
Board on Environmental Studies and Toxicology
Division on Earth and Life Studies
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, D.C. 20001
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. DAMD 17-99-C-9049 between the
National Academy of Sciences and the U.S. 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 0-309-09221-3 (Book)
International Standard Book Number 0-309-53239-6 (PDF)
Additional copies of this report are available from:
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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 achieve-
ments of engineers. Dr. Wm. 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
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ity given to the National Academy of Sciences by its congressional charter to be an adviser
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The National Research Council was organized by the National Academy of Sciences in
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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 scien-
tific and engineering communities. The Council is administered jointly by both Academies
and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice
chair, respectively, of the National Research Council
www.national-academies.org
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SUBCOMMITTEE ON TOXICOLOGICAL RISKS
TO DEPLOYED MILITARY PERSONNEL
RICHARD J. BULL (Chair), Consultant, Richland, WA
EDWARD BISHOP, Parsons Corporation, Fairfax, VA
KENNETH T. BOGEN, Lawrence Livermore National Laboratory, Livermore, CA
BARBARA CALLAHAN, University Research Engineers and Associates,
Grantham, NH
JUDITH GRAHAM, American Chemistry Council, Arlington, VA
DAVID MOORE, Battelle Eastern Science and Technology Center, Aberdeen,
MD
DEBORAH IMEL NELSON, University of Oklahoma, Norman
CHARLES F. REINHARDT, Consultant, Chadds Ford, PA
ROSALIND A. SCHOOF, Integral Consulting, Inc., Mercer Island, WA
ROBERT G. TARDIFF, The Sapphire Group, Inc., Vienna, VA
NGA L. TRAN, Exponent, Inc., Washington, DC
Staff
SUSAN N.J. MARTEL, Project Director
KELLY CLARK, Editor
TAMARA DAWSON, Program Assistant
Sponsor: U.S. Department of Defense
v
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COMMITTEE ON TOXICOLOGY
BAILUS WALKER, JR. (Chair), Howard University Medical Center and
American Public Health Association, Washington, DC
MELVIN E. ANDERSEN, CIIT-Centers for Health Research, Research Triangle
Park, NC
EDWARD C. BISHOP, Parsons Corporation, Fairfax, VA
GARY P. CARLSON, Purdue University, West Lafayette, IN
JANICE E. CHAMBERS, Mississippi State University, Mississippi State
LEONARD CHIAZZE, JR., Georgetown University, Washington, DC
JUDITH A. GRAHAM, American Chemistry Council, Arlington, VA
SIDNEY GREEN, Howard University, Washington, DC
MERYL KAROL, University of Pittsburgh, Pittsburgh, PA
STEPHEN U. LESTER, Center for Health Environment and Justice, Falls Church,
VA
DAVID H. MOORE, Battelle Memorial Institute, Bel Air, MD
CALVIN C. WILLHITE, Department of Toxic Substances, State of California,
Berkeley
GERALD WOGAN, Massachusetts Institute of Technology, Cambridge
Staff
KULBIR S. BAKSHI, Program Director
ROBERTA M. WEDGE, Senior Program Officer for Risk Analysis
SUSAN N. J. MARTEL, Senior Program Officer
ELLEN K. MANTUS, Senior Program Officer
KELLY CLARK, Assistant Editor
AIDA NEEL, Senior Program Assistant
TAMARA DAWSON, Program Assistant
vi
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BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY1
Members
JONATHAN M. SAMET (Chair), Johns Hopkins University, Baltimore, MD
DAVID ALLEN, University of Texas, Austin
THOMAS BURKE, Johns Hopkins University, Baltimore, MD
JUDITH C. CHOW, Desert Research Institute, Reno, NV
COSTEL D. DENSON, University of Delaware, Newark
E. DONALD ELLIOTT, Willkie, Farr & Gallagher, LLP, Washington, DC
CHRISTOPHER B. FIELD, Carnegie Institute of Washington, Stanford, CA
WILLIAM H. GLAZE, Oregon Health and Science University, Beaverton
SHERRI W. GOODMAN, Center for Naval Analyses, Alexandria, VA
DANIEL S. GREENBAUM, Health Effects Institute, Cambridge, MA
ROGENE HENDERSON, Lovelace Respiratory Research Institute, Albuquerque, NM
CAROL HENRY, American Chemistry Council, Arlington, VA
ROBERT HUGGETT, Michigan State University, East Lansing
BARRY L. JOHNSON Emory University, Atlanta, GA
JAMES H. JOHNSON, Howard University, Washington, DC
JUDITH L. MEYER, University of Georgia, Athens
PATRICK Y. O’BRIEN, ChevronTexaco Energy Technology Company, Richmond, CA
DOROTHY E. PATTON, International Life Sciences Institute, Washington, DC
STEWARD T.A. PICKETT, Institute of Ecosystem Studies, Millbrook, NY
ARMISTEAD G. RUSSELL, Georgia Institute of Technology, Atlanta
LOUISE M. RYAN, Harvard University, Boston, MA
KIRK SMITH, University of California, Berkeley
LISA SPEER, Natural Resources Defense Council, New York, NY
G. DAVID TILMAN, University of Minnesota, St. Paul
CHRIS G. WHIPPLE, Environ Incorporated, Emeryville, CA
LAUREN A. ZEISE, California Environmental Protection Agency, Oakland
Senior Staff
JAMES J. REISA, Director
DAVID J. POLICANSKY, Scholar
RAYMOND A. WASSEL, Senior Program Officer for Environmental Sciences and
Engineering
KULBIR BAKSHI, Senior Program Officer for Toxicology
ROBERTA M. WEDGE, Senior Program Officer for Risk Analysis
K. JOHN HOLMES, Senior Program Officer
SUSAN N.J. MARTEL, Senior Program Officer
SUZANNE VAN DRUNICK, Senior Program Officer
EILEEN N. ABT, Senior Program Officer
ELLEN K. MANTUS, Senior Program Officer
RUTH E. CROSSGROVE, Senior Editor
1
This study was planned, overseen, and supported by the Board on Environmental Studies and Toxicology.
vii
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OTHER REPORTS OF THE
BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY
Air Quality Management in the United States (2004)
Endangered and Threatened Species of the Platte River (2004)
Atlantic Salmon in Maine (2004)
Endangered and Threatened Fishes in the Klamath River Basin (2004)
Cumulative Environmental Effects of Alaska North Slope Oil and Gas Development
(2003)
Estimating the Public Health Benefits of Proposed Air Pollution Regulations (2002)
Biosolids Applied to Land: Advancing Standards and Practices (2002)
Ecological Dynamics on Yellowstone’s Northern Range (2002)
The Airliner Cabin Environment and Health of Passengers and Crew (2002)
Arsenic in Drinking Water: 2001 Update (2001)
Evaluating Vehicle Emissions Inspection and Maintenance Programs (2001)
Compensating for Wetland Losses Under the Clean Water Act (2001)
A Risk-Management Strategy for PCB-Contaminated Sediments (2001)
Acute Exposure Guideline Levels for Selected Airborne Chemicals (4 volumes,
2000-2003)
Toxicological Effects of Methylmercury (2000)
Strengthening Science at the U.S. Environmental Protection Agency (2000)
Scientific Frontiers in Developmental Toxicology and Risk Assessment (2000)
Ecological Indicators for the Nation (2000)
Modeling Mobile-Source Emissions (2000)
Waste Incineration and Public Health (1999)
Hormonally Active Agents in the Environment (1999)
Research Priorities for Airborne Particulate Matter (4 volumes, 1998-2003)
Ozone-Forming Potential of Reformulated Gasoline (1999)
The National Research Council’s Committee on Toxicology: The First 50 Years
(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 volumes, 1989-1995)
Review of EPA's Environmental Monitoring and Assessment Program (3 volumes,
1994-1995)
Science and Judgment in Risk Assessment (1994)
Pesticides in the Diets of Infants and Children (1993)
Dolphins and the Tuna Industry (1992)
Science and the National Parks (1992)
Human Exposure Assessment for Airborne Pollutants (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 Academies Press
(800) 624-6242 or (202) 334-3313
www.nap.edu
viii
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OTHER REPORTS OF THE COMMITTEE ON TOXICOLOGY
Spacecraft Water Exposure Guidelines for Selected Contaminants, Volume 1
(2004)
Toxicologic Assessment of Jet-Propulsion Fuel 8 (2003)
Review of Submarine Escape Action Levels for Selected Chemicals (2002)
Standing Operating Procedures for Developing Acute Exposure Guideline
Levels for Hazardous Chemicals (2001)
Evaluating Chemical and Other Agent Exposures for Reproductive and
Developmental Toxicity (2001)
Acute Exposure Guideline Levels for Selected Airborne Contaminants, Volume
1 (2000), Volume 2 (2002), Volume 3 (2003), Volume 4 (2004)
Review of the US Navy’s Human Health Risk Assessment of the Naval Air
Facility at Atsugi, Japan (2000)
Methods for Developing Spacecraft Water Exposure Guidelines (2000)
Review of the U.S. Navy Environmental Health Center’s Health-Hazard
Assessment Process (2000)
Review of the U.S. Navy's Exposure Standard for Manufactured Vitreous Fibers
(2000)
Re-Evaluation of Drinking-Water Guidelines for Diisopropyl
Methylphosphonate (2000)
Submarine Exposure Guidance Levels for Selected Hydrofluorocarbons: HFC-
236fa, HFC-23, and HFC-404a (2000)
Review of the U.S. Army’s Health Risk Assessments for Oral Exposure to Six
Chemical-Warfare Agents (1999)
Toxicity of Military Smokes and Obscurants, Volume 1(1997), Volume 2
(1999), Volume 3 (1999)
Assessment of Exposure-Response Functions for Rocket-Emission Toxicants
(1998)
Toxicity of Alternatives to Chlorofluorocarbons: HFC-134a and HCFC-123
(1996)
Permissible Exposure Levels for Selected Military Fuel Vapors (1996)
Spacecraft Maximum Allowable Concentrations for Selected Airborne
Contaminants, Volume 1 (1994), Volume 2 (1996), Volume 3 (1996),
Volume 4 (2000)
ix
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Preface
Military deployments include a spectrum of military activities ranging
from peace-keeping, humanitarian, and nation-building missions to combat.
In deployment situations, commanders must consider and balance a variety
of hazards to the mission and to the health of their troops. To facilitate
consideration of chemical threats in the decision-making process for mis-
sion planning, the U.S. Army has developed two technical guides (Techni-
cal Guide 230 and Technical Guide 248) and one reference guide (Refer-
ence Document 230) that outline a process by which chemical hazards can
be characterized in terms of their health risks and categorized in terms of
their impact on the mission (e.g., mission capable, combat ineffective). A
key element of the guidance was the establishment of military exposure
guidelines (MEGs) for air, water, and soil that are to be used for assessing
the significance of field exposures to chemical hazards during deployment.
In this report, the National Research Council’s (NRC) Subcommittee
on Toxicological Risks to Deployed Military Personnel evaluates the
Army’s three guidance documents for their scientific validity and adequacy
in characterizing chemical risks for comparison with other health and opera-
tional risks. Specifically, the subcommittee evaluated the adequacy of the
proposed MEGs for assessing risks to soldier health and missions, the meth-
ods and special military considerations that should be used in developing
exposure guidelines, and the application of the guidelines.
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with proce-
dures approved by the NRC’s Report Review Committee. The purpose of
xi
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xii PREFACE
this independent review is to provide candid and critical comments that will
assist the institution in making its published report as sound as possible and
to ensure that the report meets institutional standards for objectivity, evi-
dence, and responsiveness to the study charge. The review comments and
draft manuscript remain confidential to protect the integrity of the delibera-
tive process. We wish to thank the following individuals for their review
of this report:
Germaine Buck, National Institute of Child Health and Human
Development
Jeffrey Fisher, University of Georgia
Howard Kipen, University of Medicine and Dentistry of New Jersey
David Macys, University of Washington
Roger O. McClellan, Albuquerque, New Mexico
Lorenz Rhomberg, Gradient Corporation
Joseph Rodricks, ENVIRON International Corporation
Smita Siddhanti, EnDyna, Inc.
Palmer W. Taylor, University of California, San Diego
Although the reviewers listed above have provided many constructive
comments and suggestions, they were not asked to endorse the conclusions
or recommendations, nor did they see the final draft of the report before its
release. The review of this report was overseen by Gilbert Omenn, Univer-
sity of Michigan, and Raymond Wymer, Oak Ridge, Tennessee. Appointed
by the NRC, they were responsible for making certain that an independent
examination of this report was carried out in accordance with institutional
procedures and that all review comments were carefully considered. Re-
sponsibility for the final content of this report rests entirely with the
authoring committee and the institution.
The subcommittee gratefully acknowledges the following individuals
for making presentations and providing information to the subcommittee:
LTC John Ciesla, U.S. Army Center for Health Promotion and Preventive
Medicine (USACHPPM); Ellen Embry, Deputy Assistant Secretary of
Defense for Force Health Protection; Robert Garrett, Armed Forces Medical
Intelligence Center; Veronique Hauschild, USACHPPM; Jack Heller,
USACHPPM; Joleen Mobley, USACHPPM; and Tony Pitrat, USACH-
PPM.
The subcommittee is also grateful for the assistance of the NRC staff in
preparing this report. It particularly wishes to acknowledge the contribu-
tions of Susan Martel, project director, who coordinated the project and
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xiii PREFACE
contributed to the subcommittee’s report. Other staff members who con-
tributed to this effort are Kulbir Bakshi, senior program officer for toxicol-
ogy; Kelly Clark, assistant editor; Mirsada Karalic-Loncarevic, research
associate; and Tamara Dawson, program assistant.
We would especially like to thank all the members of the subcommittee
for their efforts throughout the development of this report.
Richard J. Bull, Chair
Subcommittee on Toxicological Risks
to Deployed Military Personnel
Bailus Walker, Chair
Committee on Toxicology
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Contents
ABBREVIATIONS................................................................................xvii
SUMMARY...............................................................................................1
1 INTRODUCTION...............................................................................16
Background, 16
Guidance Documents, 21
Statement of Task, 23
The Subcommittee’s Approach, 24
References, 25
2 REVIEW OF THE ARMY’S TECHNICAL GUIDANCE...............27
Earlier Academies Reports on Developing Reliable
Comparative Risk Assessments for Deployments, 27
The Army’s Risk Assessment Guidance for Deployment, 30
Recommendations, 45
References, 46
3 REVIEW OF KEY CONCEPTS, ASSUMPTIONS, AND
DECISIONS MADE IN DEVELOPING TG-248, TG-230,
AND RD-230.....................................................................................47
Use of Pre-Existing Exposure Guidelines, 47
Acceptable Cancer Risk, 60
Consideration of Immediate and Long-term Health Effects, 63
Aggregate Exposure and Cumulative Risk, 65
Exposure Assessment, 67
xv
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xvi CONTENTS
Utility for Decision Makers, 70
Recommendations, 71
References, 72
4 A NEW SET OF EXPOSURE GUIDELINES:
CHEMICAL CASUALTY ESTIMATING GUIDELINES...............76
Introduction, 76
Derivation of Chemical Casualty Estimating Guidelines, 78
Application and Interpretation of CCEGs, 84
Aggregate Exposure and Cumulative Risk, 87
Recommendations, 87
References, 89
5 PROCESS FOR ESTABLISHING AND APPLYING
MILITARY EXPOSURE GUIDELINES............................................91
Air Exposure Guidelines, 91
Drinking Water Guidelines, 105
Soil Exposure Guidelines, 110
Application of MEGs, 119
Recommendations, 125
References, 127
Appendix A. Errata, Inconsistencies, and Comments on Specific Aspects
of TG-248, TG-230, and RD-230, 133
Appendix B. Review of Acceptable Cancer Risk Levels, 137
Appendix C. Example Use of Probits for Developing Chemical Casualty
Estimating Guidelines, 145
Appendix D. Critical Studies and Uncertainty Factors Used in
Developing Acute Exposure Guideline Levels for
Chemical Warfare Agents, 175
Appendix E. Probabilistic Approach to Address Exposure to Multiple
Chemicals for Course-of-Action Analysis, 181
Appendix F. Biographical Information on the Subcommittee on
Toxicological Risks to Deployed Military Personnel, 187
Appendix G. Definitions, 193
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Abbreviations
ACGIH American Conference of Governmental Industrial
Hygienists
AEGL acute exposure guideline level
ATSDR Agency for Toxic Substances and Disease Registry
BW body weight
CCEG chemical casualty estimating guideline
CEGL continuous exposure guidance level
CSF cancer slope factors
CWA chemical warfare agent
EEGL emergency exposure guidance level
ERPG emergency response planning guideline
FDWS field drinking water standards
GSD geometric standard deviation
HA health advisory
HEAST health effects assessment summary tables
HI hazard index
HQ hazard quotient
HSDB hazardous substance databank
IOM Institute of Medicine
IRIS Integrated Risk Information System
LOAEL lowest-observed-adverse-effect level
MAF military adjustment factor
MCGL maximum contaminant level goal
MCL maximum contaminant level
xvii
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xviii ABBREVIATIONS
MEG military exposure guideline
MCRC military cancer risk concentration
MF modifying factor
MRC military risk concentration
MRL minimal risk level
NAAQS national ambient air quality standards
NIOSH National Institute of Safety and Occupational Health
NOAEL no-observed-adverse-effect level
NRC National Research Council
OEH/ED occupational and environmental health/endemic disease
ORM operational risk management
OSHA Occupational Safety and Health Administration
PEF particulate emission factor
PEGL permissible exposure guideline level
PEL permissible exposure limit
PMEG-L preliminary military exposure guidelines–long-term
PPE personal protective equipment
PRG preliminary remediation goal
PSI pollution standard index
RBC risk-based concentration
REL recommended exposure level
RfC reference concentration
RfD reference dose
SPEGL short-term public guidance level
SSL soil screening level
STEL short-term exposure level
TEEL temporary emergency exposure limit
THQ target hazard quotient
TLV Threshold Limit Value
UF uncertainty factor
VOC volatile organic compound
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Review of the Army’s Technical Guides
on Assessing and Managing Chemical
Hazards to Deployed Personnel
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