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Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
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Potential Health Risks to DOD
FIRING-RANGE PERSONNEL
from Recurrent Lead Exposure

Committee on Potential Health Risks from Recurrent
Lead Exposure of DOD Firing Range Personnel

Committee on Toxicology

Board on Environmental Studies and Toxicology

Division on Earth and Life Studies

NATIONAL RESEARCH COUNCIL
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
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THE NATIONAL ACADEMIES PRESS     500 Fifth Street, NW     Washington, DC 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 W81K04-11-D-0017 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) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-13: 978-0-309-26736-6

International Standard Book Number-10: 0-309-26736-6

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu/.

Copyright 2013 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
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THE NATIONAL ACADEMIES

Adviser to the Nation on Science, Engineering, and Medicine

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. Ralph J. Cicerone 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. Charles M. Vest 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. Harvey V. Fineberg 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. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

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COMMITTEE ON POTENTIAL HEALTH RISKS FROM RECURRENT LEAD EXPOSURE OF DOD FIRING RANGE PERSONNEL

Members

DAVID C. DORMAN (Chair), North Carolina State University, Raleigh, NC

SUSAN H. BENOFF, Feinstein Institute for Medical Research (retired), Riverdale, NY

EDWARD C. BISHOP, Parsons Government Services (retired), Council Bluffs, IA

MARGIT L. BLEECKER, Center for Occupational and Environmental Neurology, Baltimore, MD

LISA M. BROSSEAU, University of Minnesota School of Public Health, Minneapolis, MN

ROSE H. GOLDMAN, Harvard Medical School and Harvard School of Public Health, Boston, MA

JOSEPH H. GRAZIANO, Columbia University Mailman School of Public Health, New York, NY

SHERYL A. MILZ, University of Toledo, Toledo, OH

SUNG KYUN PARK, University of Michigan School of Public Health, Ann Arbor, MI

MARK A. ROBERTS, Exponent, Chicago, IL

BRISA N. SANCHEZ, University of Michigan, Ann Arbor, MI

BRIAN S. SCHWARTZ, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

LAUREN ZEISE, California Environmental Protection Agency, Oakland, CA

JUDITH T. ZELIKOFF, New York University School of Medical, Tuxedo, NY

Staff

SUSAN N.J. MARTEL, Project Director

KERI STOEVER, Research Associate

NORMAN GROSSBLATT, Senior Editor

MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center

RADIAH ROSE, Manager, Editorial Projects

TAMARA DAWSON, Program Associate

Sponsor

US Department of Defense

Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
×

COMMITTEE ON TOXICOLOGY

Members

GARY P. CARLSON (Chair), Purdue University (retired), West Lafayette, IN

LAWRENCE S. BETTS, Eastern Virginia Medical School, Norfolk

DEEPAK K. BHALLA, Wayne State University, Detroit, MI

DEBORAH A. CORY-SLECHTA, University of Rochester School of Medicine and Dentistry, Rochester, NY

MARY E. DAVIS, West Virginia University, Morgantown

DAVID C. DORMAN, North Carolina State University, Raleigh

MARGARET M. MACDONELL, Argonne National Laboratory, Argonne, IL

IVAN RUSYN, University of North Carolina, Chapel Hill, NC

KENNETH R. STILL, Portland State University, Portland, OR

JOYCE S. TSUJI, Exponent, Inc., Bellevue, WA

Staff

SUSAN N.J. MARTEL, Senior Program Officer for Toxicology

MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center

RADIAH ROSE, Manager, Editorial Projects

TAMARA DAWSON, Program Associate

Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
×

BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY

Members

ROGENE F. HENDERSON (Chair), Lovelace Respiratory Research Institute, Albuquerque, NM

PRAVEEN AMAR, Clean Air Task Force, Boston, MA

MICHAEL J. BRADLEY, M.J. Bradley & Associates, Concord, MA

JONATHAN Z. CANNON, University of Virginia, Charlottesville

GAIL CHARNLEY, HealthRisk Strategies, Washington, DC

FRANK W. DAVIS, University of California, Santa Barbara

CHARLES T. DRISCOLL, JR., Syracuse University, New York

LYNN R. GOLDMAN, George Washington University, Washington, DC

LINDA E. GREER, Natural Resources Defense Council, Washington, DC

WILLIAM E. HALPERIN, University of Medicine and Dentistry of New Jersey, Newark

STEVEN P. HAMBURG, Environmental Defense Fund, New York, NY

ROBERT A. HIATT, University of California, San Francisco

PHILIP K. HOPKE, Clarkson University, Potsdam, NY

SAMUEL KACEW, University of Ottawa, Ontario

H. SCOTT MATTHEWS, Carnegie Mellon University, Pittsburgh, PA

THOMAS E. MCKONE, University of California, Berkeley

TERRY L. MEDLEY, E.I. du Pont de Nemours & Company, Wilmington, DE

JANA MILFORD, University of Colorado at Boulder, Boulder

RICHARD L. POIROT, Vermont Department of Environmental Conservation, Waterbury

MARK A. RATNER, Northwestern University, Evanston, IL

KATHRYN G. SESSIONS, Health and Environmental Funders Network, Bethesda, MD

JOYCE S. TSUJI, Exponent Environmental Group, Bellevue, WA

Senior Staff

JAMES J. REISA, Director

DAVID J. POLICANSKY, Scholar

RAYMOND A. WASSEL, Senior Program Officer for Environmental Studies

ELLEN K. MANTUS, Senior Program Officer for Risk Analysis

SUSAN N.J. MARTEL, Senior Program Officer for Toxicology

EILEEN N. ABT, Senior Program Officer

MIRSADA KARALIC-LONCAREVIC, Manager, Technical Information Center

RADIAH ROSE, Manager, Editorial Projects

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Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
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OTHER REPORTS OF THE BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY

Science for Environmental Protection: The Road Ahead (2012)

Exposure Science in the 21st Century: A Vision and A Strategy (2012)

A Research Strategy for Environmental, Health, and Safety Aspects of Engineered Nanomaterials (2012)

Macondo Well–Deepwater Horizon Blowout: Lessons for Improving Offshore Drilling Safety (2012)

Feasibility of Using Mycoherbicides for Controlling Illicit Drug Crops (2011)

Improving Health in the United States: The Role of Health Impact Assessment (2011)

A Risk-Characterization Framework for Decision-Making at the Food and Drug Administration (2011)

Review of the Environmental Protection Agency’s Draft IRIS Assessment of Formaldehyde (2011)

Toxicity-Pathway-Based Risk Assessment: Preparing for Paradigm Change (2010)

The Use of Title 42 Authority at the U.S. Environmental Protection Agency (2010)

Review of the Environmental Protection Agency’s Draft IRIS Assessment of Tetrachloroethylene (2010)

Hidden Costs of Energy: Unpriced Consequences of Energy Production and Use (2009)

Contaminated Water Supplies at Camp Lejeune—Assessing Potential Health Effects (2009)

Review of the Federal Strategy for Nanotechnology-Related Environmental, Health, and Safety Research (2009)

Science and Decisions: Advancing Risk Assessment (2009)

Phthalates and Cumulative Risk Assessment: The Tasks Ahead (2008)

Estimating Mortality Risk Reduction and Economic Benefits from Controlling Ozone Air Pollution (2008)

Respiratory Diseases Research at NIOSH (2008)

Evaluating Research Efficiency in the U.S. Environmental Protection Agency (2008)

Hydrology, Ecology, and Fishes of the Klamath River Basin (2008)

Applications of Toxicogenomic Technologies to Predictive Toxicology and Risk Assessment (2007)

Models in Environmental Regulatory Decision Making (2007)

Toxicity Testing in the Twenty-first Century: A Vision and a Strategy (2007)

Sediment Dredging at Superfund Megasites: Assessing the Effectiveness (2007)

Environmental Impacts of Wind-Energy Projects (2007)

Scientific Review of the Proposed Risk Assessment Bulletin from the Office of Management and Budget (2007)

Assessing the Human Health Risks of Trichloroethylene: Key Scientific Issues (2006)

New Source Review for Stationary Sources of Air Pollution (2006)

Human Biomonitoring for Environmental Chemicals (2006)

Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
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Health Risks from Dioxin and Related Compounds: Evaluation of the EPA Reassessment (2006)

Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (2006)

State and Federal Standards for Mobile-Source Emissions (2006)

Superfund and Mining Megasites—Lessons from the Coeur d’Alene River Basin (2005)

Health Implications of Perchlorate Ingestion (2005)

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)

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 (thirteen volumes, 2000-2012)

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)

Waste Incineration and Public Health (2000)

Hormonally Active Agents in the Environment (1999)

Research Priorities for Airborne Particulate Matter (four volumes, 1998-2004)

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 (five volumes, 1989-1995)

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

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Preface

Lead poses an occupational health hazard, and the Occupational Safety and Health Administration (OSHA) developed a lead standard in 1978 for general industry that regulates many workplace exposures to this metal, including exposures on firing ranges. A large body of literature on health effects of lead exposure and factors that influence lead toxicity has been published since the lead standard was established. Most recently, the National Toxicology Program released a monograph on the health effects of low-level lead exposure, and the US Environmental Protection Agency is in the process of updating its Integrated Science Assessment for Lead in support of its review of the National Ambient Air Quality Criteria for lead.

In light of improved knowledge about the hazards posed by occupational lead exposure, the Department of Defense (DOD) asked the National Research Council to evaluate potential health risks related to recurrent lead exposure of firing-range personnel. Specifically, DOD asked the National Research Council to determine whether current exposure standards for lead on DOD firing ranges protect their workers adequately and to evaluate potential risk-assessment options.

In response to DOD’s request, the National Research Council convened the Committee on Potential Health Risks from Recurrent Lead Exposure of DOD Firing Range Personnel, which prepared this report. The members of the committee were selected for their expertise in general toxicology, inhalation toxicology, neurotoxicology, reproductive and developmental toxicology, immunotoxicology, toxicokinetics, epidemiology, industrial hygiene, occupational medicine, exposure assessment, risk assessment, and biostatistics (see Appendix A for biographic information on the members).

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of the 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 of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript

Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
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remain confidential to protect the integrity of the deliberative process. We thank the following for their review of this report: Floyd Bloom, The Scripps Research Institute; Deborah Cory-Slechta, University of Rochester; William Halperin, University of Medicine and Dentistry of New Jersey; David Lawrence, The Wadsworth Center; William J. Moorman, National Institute for Occupational Safety and Health (retired); Rosemary Sokas, Georgetown University; Kenneth Still, Portland State University; and Rochelle Tyl, RTI International.

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 the report was overseen by Robert Goyer, University of Western Ontario (retired), and Linda McCauley, Emory University. Appointed by the National Research Council, they were responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author committee and the institution.

The committee is grateful for the assistance of National Research Council staff in preparing the report. It particularly wishes to acknowledge the support of project director Susan Martel, who coordinated the project and contributed to the committee’s report. Other staff members who contributed to this effort are James Reisa, director of the Board on Environmental Studies and Toxicology; Keri Stoever, research assistant; Tamara Dawson, program associate; Norman Grossblatt, senior editor; and Mirsada Karalic-Loncarevic, manager of the Technical Information Center.

Finally, I thank all the members of the committee for their efforts throughout the development of this report.

David C. Dorman, DVM, PhD, Chair
Committee on Potential Health Risks
from Recurrent Lead Exposure of DoD
Firing Range Personnel

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Abbreviations

ACGIH®   American Conference of Governmental Industrial Hygienists
ACOEM   American College of Occupational and Environmental Medicine
AIHA®   American Industrial Hygiene Association
ALA   aminolevulinic acid
ALAD   delta-aminolevulinic acid dehydratase
ALAU   aminolevulinic acid level in urine
AOEC   Association of Occupational and Environmental Clinics
AQCD   air quality criteria document
BAT   biological tolerance values (German)
BAEP   brainstem auditory evoked potential
BEI®   biological exposure index
BLL   blood lead level
CaNa2EDTA   calcium disodium ethylenediamine tetraacetic acid
CBLI   cumulative blood lead index
CD   cluster of differentiation
CDC   Centers for Disease Control and Prevention
CES-D   Center for Epidemiological Studies – Depression Scale
CI   confidence interval
CKD   chronic kidney disease
CPA   Center for Policy Alternatives (at the Massachusetts Institute of Technology)
CPT   current perception threshold
CSTE   Council of State and Territorial Epidemiologists
CTL   cytotoxic T lymphocyte
CVD   cardiovascular disease
DBP   diastolic blood pressure
DMSA   2,3-dimercaptosuccinic acid
ECG   electrocardiogram
EEG   electroencephalogram
EPO   erythropoietin
FEP   free erythrocyte protoporphyrin
Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
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GFR   glomerular filtration rate
HFE   human hemochromatosis protein
HR   hazard ratio
HSE   Health and Safety Executive
Ig   immunoglobulin (also called an antibody)
IgA   immunoglobulin A
IgD   immunoglobulin D
IgE   immunoglobulin E
IgG   immunoglobulin G
IgM   immunoglobulin M
IFNγ   interferon gamma
IL-10   interleukin-10 cytokine (released from TH-2 cells)
MCV   mean corpuscular volume
MCH   mean corpuscular hemoglobin
MMSE   Mini-mental State Examination
MRI   magnetic resonance imaging
MRS   magnetic resonance spectroscopy
NAG   N-acetyl-beta-D-glucosaminidase
NF-κB   nuclear factor κB
NHANES   National Health and Nutrition Examination Survey
NIOSH   National Institute for Occupational Safety and Health
NK-CD56+   natural killer cells
NTP   National Toxicology Program
NIEHS   National Institute of Environmental Health Sciences
OR   odds ratio
OSHA   Occupational Safety and Health Administration
PBPK   physiologically based pharmacokinetic
PEL   permissible exposure limit
PKC   protein kinase C
PNS   peripheral nervous system
POMS   Profile of Mood State
ROS   reactive oxygen species
SBP   systolic blood pressure
SCOEL   Scientific Committee on Occupational Exposure Limits (European Union)
SD   standard deviation
SE   standard error
SMR   standardized mortality ratio
SRT   simple reaction time
SWHS   Swedish Women’s Health Study
TH   T-helper lymphocyte
TH1   T-helper 1 lymphocyte
TH2   T-helper 2 lymphocyte
TLV®   threshold limit value
TNF-α   tumor necrosis factor α (TH-1 pro-inflammatory cytokine)
Suggested Citation:"Front Matter." National Research Council. 2013. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure. Washington, DC: The National Academies Press. doi: 10.17226/18249.
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TWA   time-weighted average
VEP   visual evoked potential
WMC   white matter change
XRF   x-ray fluorescence
ZPP   zinc protoporphyrin
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Lead is a ubiquitous metal in the environment, and its adverse effects on human health are well documented. Lead interacts at multiple cellular sites and can alter protein function in part through binding to amino acid sulfhydryl and carboxyl groups on a wide variety of structural and functional proteins. In addition, lead mimics calcium and other divalent cations, and it induces the increased production of cytotoxic reactive oxygen species. Adverse effects associated with lead exposure can be observed in multiple body systems, including the nervous, cardiovascular, renal, hematologic, immunologic, and reproductive systems. Lead exposure is also known to induce adverse developmental effects in utero and in the developing neonate.

Lead poses an occupational health hazard, and the Occupational Safety and Health Administration (OSHA) developed a lead standard for general industry that regulates many workplace exposures to this metal. The standard was promulgated in 1978 and encompasses several approaches for reducing exposure to lead, including the establishment of a permissible exposure limit (PEL) of 50 μg/m3 in air (an 8-hour time-weighted average [TWA]), exposure guidelines for instituting medical surveillance, guidelines for removal from and return to work, and other risk-management strategies. An action level of 30 μg/m3 (an 8-hour TWA) for lead was established to trigger medical surveillance in employees exposed above that level for more than 30 days per year. Another provision is that any employee who has a blood lead level (BLL) of 60 μg/dL or higher or three consecutive BLLs averaging 50 μg/dL or higher must be removed from work involving lead exposure. An employee may resume work associated with lead exposure only after two BLLs are lower than 40 μg/dL. Thus, maintaining BLLs lower than 40 μg/dL was judged by OSHA to protect workers from adverse health effects. The OSHA standard also includes a recommendation that BLLs of workers who are planning a pregnancy be under 30μg/dL.

In light of knowledge about the hazards posed by occupational lead exposure, the Department of Defense (DOD) asked the National Research Council to evaluate potential health risks from recurrent lead exposure of firing-range personnel. Specifically, DOD asked the National Research Council to determine whether current exposure standards for lead on DOD firing ranges protect its workers adequately.The committee also considered measures of cumulative lead dose. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure will help to inform decisions about setting new air exposure limits for lead on firing ranges, about whether to implement limits for surface contamination, and about how to design lead-surveillance programs for range personnel appropriately.

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