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1 Introduction Despite changes in military tactics and technology, proficiency in the han- dling of weapons remains a cornerstone in the training of the modern combat soldier. Modern military forces are trained on one or more small arms, including handguns, shotguns, rifles, and machine guns. Many of the projectiles used in military small arms contain lead. Exposure to lead during weapons training on firing ranges therefore is an important occupational-health concern. Lead is a ubiquitous metal in the environment, and its adverse effects on human health are well documented. The nervous system is an important target of lead toxicity, which causes adverse cognitive, mood, and psychiatric effects in the central nervous system of adults; causes various peripheral nervous system effects; and has been linked to neurodegenerative diseases. Lead exposure also causes anemia, nephrotoxicity, a variety of adverse reproductive and develop- mental effects, small increases in blood pressure and an increased risk of hyper- tension particularly in middle-aged and older people, and various effects in other organ systems, including joint pain and gastrointestinal pain (ATSDR 2007; EPA 2012; NTP 2012). Various occupations involve lead exposure, including those in lead- smelting, battery-manufacturing, welding, construction, demolition, and firing ranges. Occupational exposure is often the most important source of lead expo- sure of adults (Shannon 1998). Regulations and guidelines limiting occupational lead exposure have been established by the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), the American Conference of Governmental Industrial Hygien- ists (ACGIH®), and other regulatory agencies. Features common to the guide- lines include an airborne exposure limit that is used to monitor lead in the workplace and a recommended blood lead level (BLL) to prevent adverse health effects. OSHA’s lead standard for general industry was established in 1978 (29 CFR 1910.1025). It includes a permissible exposure limit (PEL) of 50 µg/m3 (an 8-hour time-weighted average [TWA]) and an action level of 30 µg/m3 (an 8- hour TWA). If an employee is exposed above the action level for more than 30 8

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Introduction 9 days per year, an employer is required to provide a medical surveillance pro- gram that includes blood-lead sampling and medical examinations. OSHA also requires that any employee who has a BLL of 60 µg/dL or higher or three con- secutive BLLs averaging 50 µg/dL or higher be removed from work that in- volves lead exposure. The employee may resume work that entails lead exposure only after two BLLs are under 40 µg/dL. The OSHA standard assumes that a population of workers exposed at the PEL of 50 µg/m3 will have an average BLL of 40 µg/dL or lower. It allows workers to have BLLs of up to 40 µg/dL for a working lifetime of 40 years. For workers who wish to plan pregnancies, OSHA recommends a BLL of under 30 µg/dL. The NIOSH (1978) and ACGIH (2001a, b) guidelines are designed simi- larly to maintain BLLs below a threshold. NIOSH’s recommended exposure limit of 50 µg/m3 was established in 1978 and was aimed at maintaining the BLL below 60 µg/dL. ACGIH established a biological exposure index (BEI®) in 1995 of 30 µg/dL, and its threshold limit value (TLV®) of 50 µg/m3 was in- tended to maintain workers’ BLLs below the BEI. Exposure standards and guidelines for protecting the general public from lead in ambient air, drinking water, soil, and consumer products have been es- tablished by such agencies as the US Environmental Protection Agency (EPA), the Agency for Toxic Substances and Disease Registry, the Centers for Disease Control and Prevention, the National Toxicology Program (NTP), and the US Food and Drug Administration. The standard for lead in air is undergoing re- view by EPA. Lead is one of several criteria pollutants for which EPA has estab- lished National Ambient Air Quality Standards (NAAQSs). In February 2012, EPA released an Integrated Science Assessment for Lead (Second External Re- view Draft), which indicates that the NAAQS for lead will probably be reduced (EPA 2012). In June 2012, the NTP completed an evaluation of the scientific evidence on the potential health effects of low-level lead exposure and con- cluded that “there is sufficient evidence that [BLLs] <10 µg/dL and <5 µg/dL are associated with adverse health effects in children and adults” (NTP 2012). Because changes in environmental and occupational guidelines could af- fect the use of lead by the Department of Defense (DOD), the department asked the National Research Council to conduct a study of potential occupational health risks posed by exposure to lead. Of particular interest was lead exposure on small-arms firing ranges, especially exposure of range workers, who experi- ence it recurrently. In response, the National Research Council convened the Committee on Potential Health Risks from Recurrent Lead Exposure of DOD Firing Range Personnel. THE COMMITTEE’S TASK Members of the committee were selected for their expertise in general toxicology, inhalation toxicology, neurotoxicology, reproductive and develop- mental toxicology, immunotoxicology, toxicokinetics, epidemiology, industrial

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10 Potential Health Risks to DOD Firing-Range Personnel hygiene, occupational medicine, exposure assessment, risk assessment, and biostatistics. The committee was specifically asked to accomplish the following task: An expert committee will assess the potential health risks to Department of Defense firing range instructors and other personnel who experience recurring environmental exposures to lead at small-arms firing ranges. Information will be evaluated on recurrent lead exposures at such firing ranges, and relevant toxicological and epidemiological information on any carcinogenic and non-carcinogenic effects of exposures to lead will be evaluated. The evaluated information will include reviews by the Environmental Protection Agency and the National Toxicology Program. The committee will assess whether current exposure standards used at ranges are protective and will evaluate potential risk assessment options. APPROACH TO THE STUDY There is a large amount of scientific literature on lead. To manage the amount of data that it had to review and to structure its analysis to address its task in a timely manner, the committee established the following boundaries for its review:  Evaluation of health effects. The committee did not conduct a system- atic review of the lead literature or conduct a formal risk assessment, but it took advantage of the recent compilations of the toxicologic and epidemiologic stud- ies of lead by the NTP, EPA, and the International Agency for Research on Can- cer. Those reviews were used as a basis for identifying the primary health end points that would be of concern for firing-range personnel. The committee sup- plemented the reviews by evaluating relevant new studies related to those health effects and by determining what exposures would be of greatest concern. The following considerations were used to focus the committee’s review further: o Human studies were the primary source of data, and animal studies and mechanistic information were used when appropriate. Few epidemiologic studies of firing-range personnel were found; therefore, occupational and other studies involving lead exposure were sought. Studies that considered potential covariates in their statistical analyses were favored. o Acute, chronic, and latent health effects of lead exposure were consid- ered. Data on clinical disease outcomes were believed to be more relevant to the committee’s charge than data on early biologic effects. o The preferred measures of exposure were the BLL as a measure of re- cent exposure and the cumulative blood lead index (CBLI) or bone lead concentrations as a measure of cumulative dose. o Health-effects data on BLLs under 40 µg/dL were considered pri- marily, because the current OSHA standard aims to maintain BLLs below

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Introduction 11 that. Evidence on health effects at corresponding estimates of CBLI of 1,600 µg-years/dL (40 years at 40 µg/dL) and tibia lead levels of 40-80 µg/g (2.5-5% of the CBLI) was also sought. The committee decided that if it found evidence to suggest that health effects occur below those BLLs, CBLIs, or bone lead values, it would have to conclude that the OSHA ex- posure standard is inadequate.  Population characteristics. Firing-range workers may be active-duty military or civilians. The health of the population of firing-range workers is probably similar to that of the general working population. Special consideration was given to women who might be pregnant or nursing or might become preg- nant, because of the well-known effects of lead on obstetric outcomes.  Characterization of exposure on firing ranges. The committee focused its attention on airborne lead exposures that are most likely to occur on DOD firing ranges. Measurements and evaluations conducted at DOD ranges were used primarily and were supplemented with information on other types of firing ranges. In addressing the statement of task, the committee focused on answering the following questions: 1. Are OSHA’s guidelines for using BLLs adequate to protect DOD fir- ing-range personnel? 2. Is the current OSHA PEL sufficiently protective of DOD firing-range personnel? 3. Is the current OSHA action level for medical surveillance appropriate? 4. Were data gaps identified in answering the above questions? Is research needed to fill those gaps? FIRING-RANGE ENVIRONMENTS Military firing ranges are specialized facilities designed for small-arms practice. Firearms can be fired inside a closed firing range or on an outdoor range. Both configurations have the potential for contamination with products of combustion (primer) or with a lead-based projectile (bullet). Depending on the weapon and the application, various specialized types of projectiles may be used. For example, jacketed bullets often consist of a soft lead core that is par- tially or fully encased in a shell of harder metal (such as copper). Jacketed bul- lets can minimize lead vaporization and particle generation. Other types of ammunition include fragmentation bullets and frangible bullets (projectiles that are designed to disintegrate on contact with a surface harder than the bullets themselves). The increasing use of full-jacketed bullets, alternative metal projec- tiles, and non-lead-containing primers should reduce airborne lead exposure during live-fire exercises.

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12 Potential Health Risks to DOD Firing-Range Personnel Generation of Atmospheric Lead on Firing Ranges The committee sought but did not find data on chemical speciation of air- borne lead particles on firing ranges. The following discussion therefore is a general characterization of atmospheric lead on ranges and applies primarily to nonjacketed lead-based ammunition with lead-containing primers. As a shooter pulls the trigger, the firing pin causes the primer, which contains lead styphnate (an explosive compound), to initiate the combustion of the gunpowder in the cartridge (Valway et al. 1989). The propellant burns at temperatures up to 1,000oC and can generate pressures of up to 1,400 kg/cm2 (20,000 lb/in2 [psi]), which propel the bullet down the barrel and toward the target (NEHC 2002). At 1,000oC, lead is vaporized at the base of the bullet and is released at the muzzle, and probably at the chamber when the shell casing is ejected, as lead fume, pos- sibly as lead oxide fume as the lead fume reacts with atmospheric oxygen. As the bullet passes through the barrel, the barrel’s rifling may generate additional particles that are released at the muzzle. Misalignment as the bullet enters the chamber from the magazine or revolver cylinder may also generate particles (Anania and Seta 1975; Fischbein et al. 1979). Large lead particles settle out quickly and deposit on the floor and other surfaces (Jones 1999; NEHC 2002). The bullets will fragment on striking the target or backstop, and this contributes to the airborne particles (Anania and Seta 1975; Fischbein et al. 1979); this source will be close to the target or backstop. Lead dust can contaminate the shooter’s hands, face, and clothing. Dermal or oral exposure can also occur dur- ing weapon cleaning or during handling of empty casings. US Military Firing Ranges Military firing ranges can be indoor or outdoor and may be restricted to particular weapons (such as pistols, rifles, grenade launchers, and machine guns). A firing range typically is overseen by supervisory personnel (such as a range master or a range safety officer) who are responsible for ensuring that all safety rules are followed. Modern firing ranges are designed to prevent injury and property damage caused by misdirected or accidental firing and ricochets. They are also designed to direct ricochets away from the firing line (DOE 2012). Various materials are commonly used for that purpose, including concrete, gravel-filled concrete-masonry units, sand, stone logs, and earth. Some surfaces (such as baffles, wing walls, and metal connectors) may be covered with ply- wood to prevent back splatter. Indoor ranges typically have specially constructed back walls or bullet traps, roofs, and side walls. Outdoor ranges may have concrete tubes to prevent stray shots (such as 10-m machine gun ranges), may lack a backstop to allow rounds to travel to their maximum range, or may be designed as fully or partially contained ranges (combination of side walls, bullet trap, canopy baffle, and

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Introduction 13 overhead baffles). Proper firing-range ventilation systems push and pull smoke and lead particles away from the shooting line to reduce lead exposure. How- ever, because of the high noise levels produced at firing ranges (over 140 dB), many ranges have an air-locked corridor for soundproofing with doors at oppo- site ends of the egress corridor; most indoor ranges therefore have more lead- dust contamination than outdoor ranges because of their semiclosed (air) envi- ronment. Lead exposure in indoor ranges occurs at the firing line (for example, from primer ignition and muzzle blast) and at the bullet trap from projectiles’ striking of the trap (Jones 1999). Outdoor facilities are often used for longer-distance shooting (up to 1,000 m) under ambient environmental conditions (US Department of the Army 2010). High retaining walls, earth mounds, sandbag barriers, or specially designed traps are used on outdoor ranges to prevent bullets or shots from ricocheting outside the bounds of the range. Firing-range environments that resemble common combat scenarios (for example, urban combat in Middle East operations) are increasingly used in the training of US armed forces. Mock facilities can include “shoot houses”, method-of-entry buildings, maritime counterterrorism facilities, partition ranges that can be reconfigured to rooms of different sizes, combat ranges, combat vil- lages, vehicle ranges (for land and air vehicles), and other full-size mockups (such as mockups of aircraft, shipside, and oil rigs). One subclass of specialized range mimics urban terrain, for example, Military Operations on Urbanized Ter- rain (MOUT). Each range can pose different risks of lead exposure. For exam- ple, MOUT training increases the possible contribution from fragmentation of bullets that strike targets inasmuch as it involves moving through mock build- ings and firing at targets as close as 5 m away, a much shorter distance than the 25 m or more used on static target ranges (Mancuso et al. 2008). Resuspension and later inhalation of settled lead dust is another source of exposure as shooters move down range after firing; this could be an important contributor to lead ex- posure in MOUT training as shooters move through hallways, down lanes, and past targets at which they recently fired. Resuspension of settled lead dust is a major source of exposure during range maintenance and cleaning. DEPARTMENT OF DEFENSE FIRING-RANGE PERSONNEL The committee asked DOD to provide information about the range per- sonnel in each service, including the number of personnel working on firing ranges, demographics, eligibility requirements, typical workday, requirements for physicals, and whether there are special considerations for pregnant range personnel. Little information was provided on the number of DOD ranges or on the number or demographics of range personnel. Below is a summary of infor- mation provided to DOD by each service and information located by the com- mittee through its own literature searches.

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14 Potential Health Risks to DOD Firing-Range Personnel US Army The US Army has about 95 live-fire shoot houses at active installations and about 14 more that belong to reserve units. No information on the number indoor or outdoor ranges was provided. Firing-range personnel may have the following job classifications: range manager, range operations specialist, range technician, training technician, small-arms range lead, and live-fire range opera- tions specialist (personal communication, J. Seibert, Office of the Deputy Under Secretary of Defense for Installations and Environment, July 2, 2012). Some Army firing ranges have adopted lead-exposure guidelines more stringent than OSHA’s. For example, the John F. Kennedy Special Warfare Cen- ter and School in Fort Bragg, North Carolina, has adopted medical removal- guidelines that are consistent with the recommendations of the American Col- lege of Occupational and Environmental Medicine. Instructors are removed if they have a single BLL over 30 µg/dL or two consecutive BLLs over 20 µg/dL (personal communication, J. Seibert, July 2, 2012). Army policy for pregnant range personnel is to follow DOD’s Occupational Medical Examinations and Surveillance Manual (DOD 2007). The guidance is to maintain pregnant women or women who may be pregnant at BLLs under 5 µg/dL. US Air Force Air Force security forces combat-arms personnel operate 193 small-arms ranges (personal communication, J. Seibert, May 21, 2012). The Air Force has about 1,220 authorized range personnel. Personnel with this specialty (Air Force specialty code P0X1B and special experience identifier 312) are trained in com- bat-arms operation, facility maintenance, firearms instruction, occupational safety and health, and related subjects (US Department of the Air Force 2010). Combat-arms personnel must meet minimum physical requirements specified in the Air Force Enlisted Classification Directory related to physical condition, mobility and strength of upper and lower extremities, hearing, vision, and psy- chiatric health. Range workers typically get physicals twice a year. Potential medical reasons for exclusion from range work include those specified by OSHA. Other medical conditions that could require exclusion are assessed case by case. Workers may also be excluded if they are unable to wear required respi- rators. Duration of work on ranges varies with the weapon and course of instruc- tion, but range workers typically work 8-10 hours per day 5 days per week. The daily average of work during live firing is estimated to be about 2.5-3 hours (personal communication, J. Seibert, May 21, 2012). Pregnant military workers are required to undergo an evaluation for rec- ommended modification of work activities. The Air Force Combat Arms Pro- gram (U.S. Department of the Air Force 2009) requires the local medical treatment facility to provide medical assessment of and line-of-duty determina- tion on pregnant women who are working in and around firing-range operations or weapons maintenance. Civilian workers may also elect to undergo evaluation

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Introduction 15 with an assessment in the interest of fetal health and the possibility of recom- mended modification of work activities. Modifications of work activities are site-specific and worker-specific (personal communication, J. Seibert, May 21, 2012). US Navy and Marine Corps No information on the number and types of ranges in the Navy or Marine Corps was provided. The Navy has small-arms marksmanship instructors (GM- 0812), who conduct training in all phases of basic marksmanship. Duties include firearms safety, mechanical training on small arms, instructional and qualifica- tion firing, and basic range operations (US Department of the Navy 2011a). Fir- ing-range personnel typically work 8 hours per day 5 days per week (personal communication, J. Seibert, May 2, 2012). Firing-range occupational specialties in the Marine Corps include range officers (MOS 0930), marksmanship instructors (MOS 0931), small-arms weap- ons instructors (MOS 0932), and marksmanship coaches (MOS 0933). Range officers supervise marksmanship-training programs and develop marksmanship training doctrine and techniques. Duties may include planning range layout, organizing courses of instruction, interpretation and enforcement of regulation, inspecting weapons and ammunition, and supervising test firing of weapons. Marksmanship instructors teach in all phases of the Marine Corps marksmanship program on qualification and requalification on small-arms use, and small-arms weapons instructors conduct and supervise all small-arms marksmanship train- ing. Marksmanship coaches analyze the performance of shooters during dry- and live-fire exercises for qualification and requalification. Weapons instructors and marksmanship coaches also assist in the operation of firing ranges (US Depart- ment of the Navy 2008). Workers who may be exposed at or above the OSHA action level of 30 µg/m3 for 30 days per year are included in the surveillance program. Medical examinations are conducted annually for each person who is found to have a BLL of 30 µg/dL or higher (NMCPHC 2011; US Department of the Navy 2011b). Clinicians may counsel workers who want to plan pregnancies to achieve BLLs lower than those specified by OSHA (30 µg/dL). Navy guidance indicates that it may be advisable for BLLs to be under 20 µg/dL preceding con- ception and during pregnancy. Women who have BLLs over 20 µg/dL might be advised to avoid uncontrolled lead exposure for 1-2 years before attempting to conceive (NMCPHC 2010). LEAD EXPOSURE ON DEPARTMENT OF DEFENSE FIRING RANGES DOD was asked to provide the committee with air-sampling data on lead and BLLs collected over the last 5 years for range personnel, if possible accord- ing to job classification. In response to the request, the US Army submitted data extracted from the Defense Occupational and Environmental Health Readiness

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16 Potential Health Risks to DOD Firing-Range Personnel System—Industrial Hygiene (personal communication, J. Seibert, July 2, 2012). Information was available on only a few small-arms firing ranges. Table 1-1 shows that mean airborne concentrations of lead ranged from 0.7 to 238 µg/m3 and that the current OSHA PEL of 50 µg/m3 was exceeded to some degree in almost all duties. The greatest percentage of samples that were above the PEL were collected during weapons handling at shoot houses (60%) and during range maintenance and cleaning activities (50%). The Army’s industrial-hygiene pro- gram offices use the concept of similar exposure groups. A person who has a given job classification may perform many duties, and a sample and its TWA may have been determined to be valid for many processes that a worker has been performing during the time when the sample was taken. Data provided by the Army show overlap in job duties, so it was difficult to distinguish which tasks might have accounted for the highest exposures. For example, a maximum airborne concentration of 4,386 µg/m3 was reported for several duties in the categories of supervision, cleaning and maintenance, weapons handling and fir- ing, fire services, and ambulance drivers. The available BLL data from 2007- 2011 obtained from the Army’s Occupational Health Program Surveillance Re- ports indicated that the percentage of screened employees who had “abnormal” results ranged from less than 1% to 5%. However, the reports did not identify the sources of lead exposure—for example, shoot houses, indoor ranges, or other occupationally related exposures, such as exposure to plumbing, pipefitting, or handling of cable sheaths—or indicate the magnitude of the abnormalities. The Navy provided the committee with results of personal air monitoring at its firing ranges (personal communication, J. Seibert, May 2, 2012). Personal air breathing-zone monitoring was performed during the period January 2008- April 2012 for a variety of firing-range tasks (Table 1-2). Air samples were col- lected in accordance with the US Navy’s standard operating procedures (US Navy Industrial Hygiene Field Operations Manual) (NEHC 2012). In general, nearly full-shift samples (for example, 7 hours of an 8-hour work shift or 11 hours of a 12-hour work shift) are used to evaluate TWA exposures. Sampling during the period of greatest exposure during an operation is also stressed. Data presented in Table 1-2 confirm that air lead concentrations can vary widely be- tween job categories and the type of firing range. Concentrations were highest in the cleaning of ranges; 58% of the samples were above the PEL, and the mean concentration was 190 µg/m3. Air measurements in other job categories were also well above the current OSHA PEL of 50 µg/m3 (see Table 1-2). BLLs of firing-range personnel during that time were unavailable to the committee be- cause the central Navy electronic medical-records data system does not include information about personnel by job classification. The Air Force also provided the committee with air-monitoring data from 2007-2012 and was the only service1 to provide data on BLLs of range instructors 1 After the committee completed its evaluation and released the prepublication draft of this report, the Army submitted data on BLLs for Department of the Army civilian per- sonnel working at shoot houses. The Army’s submission can be obtained by contacting

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Introduction 17 (Table 1-3). With the exception of data from 2011, it can be seen that mean air lead concentrations over the 6-year sampling time were well above the current OSHA PEL of 50 µg/m3. It can also be seen that individual ranges can have ap- preciably higher air lead concentrations that are several orders of magnitude higher than the PEL (maximum values ranged from 247 to 386,000 µg/m3). The Air Force began substituting lead-free ammunition for small-arms training in 2004 (AFIOH 2008), but no distinction was made about whether the data in Ta- ble 1-3 included measurements taken on ranges where the substitution was im- plemented. The maximum BLLs of Air Force range instructors in 2008-2012 were below the current OSHA standard of 40 μg/dL. In addition to the data provided by DOD, the committee reviewed pub- lished data on BLLs and air concentrations of lead reported in connection with civilian and military firing ranges (IARC 2006). Table 1-4 shows the large vari- ability in air lead concentrations and BLLs measured within and between firing ranges. No clear relationship between air lead concentrations and BLLs is ap- parent; the table has examples of higher mean BLLs at firing ranges that have lower mean air lead concentrations and examples of lower BLLs at ranges that have higher mean air lead concentrations. The latter observation was particularly relevant to the committee’s work because it suggests that there are limitations on the use of air lead monitoring to protect personnel in this setting, especially at lower air lead concentrations. Differences in air lead concentrations and BLLs on firing ranges may reflect differences in the use of personal protective equip- ment; range hygiene and ventilation; personal hygiene; hand-to-mouth behav- iors; smoking, eating, and drinking policies and practices; and policies and practices concerning hand-washing and clothes-laundering. ORGANIZATION OF THE REPORT The committee organized its review into three major components: under- standing the basis of occupational standards and guidelines for lead, exposure considerations for lead on DOD firing ranges, and health effects of lead expo- sure. Chapter 2 provides an overview of different occupational standards and guidelines for lead and their bases. In addition to US guidelines, the guidelines of relevant organizations of other countries are considered. Chapter 3 presents exposure considerations for lead, including an overview of routes of exposure, biomarkers, toxicokinetics and toxicodynamics, and exposure factors that influ- ence health outcomes. Health effects of exposure to lead are discussed in Chap- ter 4 (noncancer effects) and Chapter 5 (cancer effects), with a focus on studies relevant to DOD firing-range personnel. Chapter 6 presents a summary of the committee’s findings. the National Research Council’s Public Access Records Office at (202) 334-3543 or paro@nas.edu.

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18 TABLE 1-1 Airborne Lead Concentration During Performance of Different Job Duties on US Army Weapons and Small-Arms Firing Rangesa Geometric Mean Geometric Standard Samples Duty No. Sites No. Samples Mean (µg/m3) (µg/m3) Deviation (µg/m3) Above the PEL Supervision Firing-range supervision, 3 84 103 7 6,730 13.1% protective services Range supervision, monitor 1 58 239 11.2 6,340 6.9% Range supervision 1 29 239 11.2 6,440 6.9% Range support, range 1 29 239 11.2 6.440 6.9% instructor Weapons or small arms, 5 106 74 12.3 4,580 11.3% range supervision Cleaning and Maintenance Range, equipment 1 5 0.7 0.7 1,150 0% repair, preventive maintenance, NOCb Range maintenance, 1 2 89.4 76.7 2,230 50% cleaning, other Firing-range cleaning, 3 39 26.6 8.1 5,570 17.9% protective services Range cleaning, scraping 1 2 89.4 76.7 2,230 50% Firing-range pit cleaning, 1 11 35.9 3.1 8,050 9.1% protective services

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Range or ground maintenance, 1 29 239 11.2 6,440 6.9% heavy-equipment operator Range or ground maintenance 2 44 191 16.3 6,900 25% Maintenance-structures 4 6 0.8 0.4 3,510 0% ranges, multiple operations Range cleaning 1 22 24.3 13.3 3,710 27.3% Weapons or small arms, 1 4 114 14.4 25,420 50% backstop or pit cleanup Weapons or small arms, 6 116 85.2 10.2 5,830 13.8% range cleaning Disposition of range residue, 1 22 24.3 13.3 3,710 27.3% HM/HW hand cleanup Weapons Handling or Firing Firing range, testing NOCb 1 22 24.3 13.3 3,710 27.3% Indoor range, 6 100 30.6 2.9 9,570 19% small-arms firing Indoor firing range, 1 22 24.3 13.3 3,710 27.3% ordnance testing Outdoors, weapons or 7 114 84.8 4.8 9,390 16.7% small-arms firing Shoot house, weapons or 1 15 97.7 33.8 6,750 60% small-arms firing, NOCb Shoot house, small-arms 3 48 37.2 2.4 12,030 20.8% handling (Continued) 19

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20 TABLE 1-1 Continued Geometric Mean Geometric Standard Samples Above Duty No. Sites No. Samples Mean (µg/m3) (µg/m3) Deviation (µg/m3) the PEL Operations or Services Range operations, weapons 1 4 114 14.4 25,420 50% and ordnance Skeet and trap range, 1 4 1.9 0.5 6,760 0% recreational services Fire services, ranges 1 29 239 11.2 6,440 6.9% Other Ambulance drivers or 1 29 239 11.2 6,440 6.9% EMT, range a Data extracted from the Defense Occupational and Environmental Health Readiness System—Industrial Hygiene. Army industrial hygiene program offices use the concept of similar exposure groups. A person who has a given job classification may perform many duties. A sample and its TWA may have been determined to be valid for many processes that a worker may have been performing during the time when the sample was taken. b Not otherwise classified. Source: Personal communication, J. Seibert, Office of the Deputy Under Secretary of Defense for Installations and Environment, July 2, 2012.

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TABLE 1-2 Airborne Lead Concentration During Performance of Different Job Duties on US Navy Weapons and Small-arms Firing Ranges Lead Indoor Weapons Outdoor Indoor Simulated and Range Ammunition Range Range Range Backstop Marksmanship Ordnance Cleaning Handling NOCa Firing Firing Supervision Pit Cleanup Breeching Trainer NOCa No. samples 19 3 138 9 50 106 19 14 11 4 Maximum, µg/m3 848 78.4 482 558 442 342 29.6 18.7 40.6 0.92 Minimum, µg/m3 2.12 25.5 0.46 4 0.71 0.71 0.71 3.5 0.8 0.71 Mean, µg/m3 190 44 48 22 46 23 9 9 13 1 Geometric mean, µg/m3 50 39 13 15 11 8 5 7 8 1 Geometric standard 8,169 1,849 5,980 2,669 4,730 4,274 3,669 1,940 3,476 1,140 deviation, µg/m3 Samples above PEL, % 58 33 31.9 22.2 16 14.2 0 0 0 0 b 3 95th percentile , µg/m 1,583 1,060 2,400 76 148 83 39 21 61 1 a Not otherwise classified. Not a specific operation that can be further classified. b Lognormal distribution. Source: Personal communication, J. Seibert, Office of the Deputy Under Secretary of Defense for Installations and Environment, May 2, 2012. 21

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22 TABLE 1-3 Lead Exposure on US Air Force Firing Ranges (2007-2012)—Air Lead Concentrations on Weapons and Small-Arms Firing Ranges and Blood Lead Levels of Combat-Arms Training and Maintenance Instructors 2007 2008 2009 2010 2011 2012 Air Sampling Data No. samples 81 139 307 154 303 100 No. locations 12 18 23 24 27 16 Maximum, µg/m3 386,000 1,650 14,900 7,820 247 19,500 Minimum, µg/m3 0.21 ND 0.03 ND ND ND Mean (± SD) , µg/m3 9,120 ± 51,081 82.3 ± 209 80.3 ± 850 82.8 ± 652 19.7 ± 31 267 ± 218 Blood Lead Levels No. samples — 37 41 57 93 69 Maximum, µg/dL — 31 16 23 26 21 Minimum, µg/dL — 1 1 1 1 1 Mean (± SD) , µg/dL — 5.0 ± 5.7 4.6 ± 4.0 4.1 ± 4.4 5.4 ± 4.6 5.2 ± 4.4 Abbreviations: ND, not detected; SD, standard deviation. Source: Personal communication, J. Seibert, Office of the Deputy Under Secretary of Defense for Installations and Environment, May 21, 2012.

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TABLE 1-4 Air and Blood Lead Concentrations Measured on Indoor and Outdoor Firing Ranges Blood Lead Lead in Air (µg/dL) (µg/m3) Job History Country Settings or Tasks (years) Mean Range Mean Range Reference China Employees in 4-21 37.2 22.4-59.6 GA: 134 NR Chau et al. 1995 (Province of indoor range PBZ: 413 Taiwan) New Zealand Indoor small-bore Recreational End of season: GA: 140-210 George et al. 1993 rifle range shooters 55.0; start of PBZ: 120 season 33.3 Sweden Indoor range Svensson et al. 1992 Powder gun 10.2 13.8a 6.9-22.8 660 112-2,238 Air gun 13.7 8.4 a 2.0-22.2 4.6 1.8-7.2 On-duty and off-duty NR 5.0 1.0-18.2 NR Löfstedt et al. 1999 police officers >9 3.7 United Indoor range for NR 30-59 30-160 Smith 1976 Kingdom police officers Soldiers 4.2 19.25 9.6-30.1 TWA: 190 Brown 1983 United States Indoor range Full-time employee NR 30-77 Showroom: 2.7 Novotny et al. 1987 Part-time employee NR 17-49 Firing line: 13.6 Midway to target: 57.4 Target: 90.5 (Continued) 23

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24 TABLE 1-4 Continued Blood Lead Lead in Air (µg/dL) (µg/m3) Job History Country Settings or Tasks (years) Mean Range Mean Range Reference Covered outdoor NR 5.6 (pre- GA: 68.4 3.8-298.6 Tripathi et al. 1989 range exposure) PBZ: 128.5 34.7-314.3 10.7 (day 2) 14.9 (day 5) 8.7 (day 69) Indoor range with Trainees Valway et al. 1989 training February 3-April 28 6.45 <5-23.1 1,483-1,860 304-2,688 51.4 31.2-73.3 2,906-3,226 994-5,589 44.6 27.1-62.3 1,231 553-2,567b 39.8 23.1-51.2 Lead bullet 1,410 Nylon-coated 78.3 Copper-jacketed 43.1 Covered outdoor NR Before shooting: GA: 9.53 5.50-14.56 Tripathi et al. 1990 range using copper- 6.0 ± 1.7 PBZ: 5.88 0.42-7.66 jacketed bullets After shooting: 6.5 ± 1.5 Uncovered Goldberg et al. 1991 outdoor range NR 28-66 — NR — 460-510 (3-h TWA) NR 25-70 —

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NR — 100-170 (3-h TWA) 28-38 — Covered Tripathi et al. 1991 outdoor range Nonjacketed bullets Instructors 14.2-24.2c 10-27 67.1-211.1 36.7-431.5 Jacketed bullets Instructors 13.1-22.1 5.4-8.7 University rifle range Recreational Prince and shooters Horstman 1993 Old ventilation 11.8-16.4 5-21 176 24-239 New ventilation 13.2-13.6 8-23 129 67-211 a Median value. b New ventilation system installed. c Range on three sampling dates. Abbreviations: GA, general area; NA, not applicable; NR, not reported; PBZ, personal breathing zone; TWA, time-weighted average. Source: Adapted from IARC 2006. 25

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