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Introduction

The North Atlantic Treaty Organization (NATO) has recently developed guidelines for limits on and controls for exposure of soldiers to ionizing radiation in the course of military operations (NATO, 1996). This guidance addresses radiation doses ranging from those governed by civilian—public and occupational—guidelines up to the high doses expected during a major nuclear conflict. At the request of the U.S. Army Surgeon General, the Institute of Medicine has convened an expert committee to evaluate these guidelines from scientific and ethical perspectives. This report is Part I of the committee's efforts. It focuses on the scientific merit of this new NATO guidance by responding to the charge:

  1. Do the presently proposed NATO guidelines (dose limits, documentation, and control measures) follow generally accepted U.S. national limits and recommended guidelines for radiation protection of occupational and emergency workers?
  2. Are these NATO guidelines reasonable from a scientific viewpoint?
  3. How could the guidelines be improved?

Next year, the committee will report, in Part II, its follow-on deliberations on other critical factors, including ethics, risk perception, recordkeeping, training, communication, decision making, and additional general scientific information as necessary.

During the Cold War, the United States Army established radiation dose limits and controls for soldiers based on a scenario of global nuclear war (NATO, 1986; HQDA, 1994). Battlefields were expected to be highly contaminated. Radiation dose limits for soldiers were based on criteria that maximized immediate survival and the ability to continue with a combat mission. The upper



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--> 1 Introduction The North Atlantic Treaty Organization (NATO) has recently developed guidelines for limits on and controls for exposure of soldiers to ionizing radiation in the course of military operations (NATO, 1996). This guidance addresses radiation doses ranging from those governed by civilian—public and occupational—guidelines up to the high doses expected during a major nuclear conflict. At the request of the U.S. Army Surgeon General, the Institute of Medicine has convened an expert committee to evaluate these guidelines from scientific and ethical perspectives. This report is Part I of the committee's efforts. It focuses on the scientific merit of this new NATO guidance by responding to the charge: Do the presently proposed NATO guidelines (dose limits, documentation, and control measures) follow generally accepted U.S. national limits and recommended guidelines for radiation protection of occupational and emergency workers? Are these NATO guidelines reasonable from a scientific viewpoint? How could the guidelines be improved? Next year, the committee will report, in Part II, its follow-on deliberations on other critical factors, including ethics, risk perception, recordkeeping, training, communication, decision making, and additional general scientific information as necessary. During the Cold War, the United States Army established radiation dose limits and controls for soldiers based on a scenario of global nuclear war (NATO, 1986; HQDA, 1994). Battlefields were expected to be highly contaminated. Radiation dose limits for soldiers were based on criteria that maximized immediate survival and the ability to continue with a combat mission. The upper

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--> bounds of the dose limits were at the threshold for development of radiation sickness. In the post Cold War setting, military scenarios involving radioactive contamination rarely reflect global nuclear war but more often consider limited nuclear exchanges, terrorist actions using improvised nuclear devices, conventional explosives employed as a means of disseminating radioactive materials, or nuclear power plant accidents. In these scenarios, radioactive contamination would be more restricted geographically, and the immediate risks to a soldier might be much lower. Except in rare circumstances, radiation doses under these scenarios would be well below the lethal level, yet they could be above the occupational dose limits that are applied to civilian workers (CFR, 1991). The new NATO guidance addresses protection for soldiers at risk of exposure at levels that could result in doses above background up to 700 mSv. In this report, the Committee to Study Battlefield Radiation Exposure Criteria reviews this guidance as it is expressed in ACE Directive 80-63 (NATO, 1996). During the Persian Gulf War, the Army recognized the potential for exposure of soldiers to levels of radiation that exceeded occupational levels but were below levels set in STANAG 2083, Commanders' Guide on Nuclear Radiation of Groups (NATO, 1986). During Desert Shield and Storm, the Foreign Science and Technology Center warned of the possibility that conventional explosives could be used by threat forces to disseminate radioactive materials (e.g., from reactor waste or radium and radioactive cesium and cobalt from radiotherapy sources) on the battlefield. The U.S. Army participated in developing NATO radiation protection guidelines for the soldier in the new radiation exposure scenario, with an Army representative heading the NATO team of experts. Military commanders have always had to weigh multiple risks in their decisions. In the Cold War setting, the emphasis was on acute (immediately life-threatening) risks related to survival. In this new era, commanders face missions, such as peacekeeping and humanitarian assistance, in nonbattlefield environments, in which the risk of immediately disabling and life-threatening injuries is lower. Thus, the potential for delayed health effects of battlefield activities (e.g., the potential for developing cancer from radiation exposure) takes on new importance. This is new ethical and doctrinal ground for Army planners. They wish to ensure that the standard of protection proposed in the ACE Directive has a sound scientific and ethical basis before they apply it generally in U.S. Army doctrine. Supreme Headquarters, Allied Powers Europe (SHAPE) recognized a need to plan for potential radiation exposure of military forces in Europe that might occur during the peacekeeping mission to Bosnia. In response, SHAPE staff developed the Allied Command Europe (ACE) Directive Number 80-63, ACE Policy for Defensive Measures against Low Level Radiological Hazards during Military Operations. The Directive applies to all NATO forces in Europe and is intended to provide guidance to military commanders whose troops may encounter radiation

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--> sources. The procedures of the ACE Directive apply to what SHAPE defines as low-level4 radiation, that is: The doses received from these exposures are higher than those routinely received by health physics [radiation] workers and the general public and are in the range from background radiation to 70 cGy. . . . These hazards [exclusive of nuclear weapon detonation] may occur from inadequate nuclear waste disposal, deterioration of nuclear power facilities and damage to institutions that routinely use radioactive material/sources and terrorism. (NATO, 1996, §1-1.a.) The ACE Directive (see appendix) provides general policy for the conduct of operations in the presence of radiation. It seeks to avoid unnecessary radiation exposure whenever possible and to minimize doses when exposure is unavoidable. In addition, the policy prescribes planning, coordination, security, dosimetry, recordkeeping, training, equipment, and expertise to deal with radiological hazards. Procedures in the Directive outline actions to be taken by responsible commanders in the event of a situation involving radiation exposure. These include methods for assessment of radiation hazard, dissemination of hazard information, and personnel protection. Finally, the Directive includes a chart that defines radiation exposure status (RES) categories by which it defines actions to be taken when personnel receive (or are at risk of receiving) specified levels of radiation dose. This chart subdivides dose levels defined in existing guidance (HQDA, 1994; NATO, 1986) as being of negligible risk to moderate risk. Radiation is not a new hazard for service personnel. Over 200,000 military personnel participated in U.S. nuclear weapons testing between 1945 and 1962. Five laws have been signed by four presidents in attempts to provide just consideration of claims for compensation for health problems and disabilities these Atomic Veterans attribute to radiation exposure. The Defense Special Weapons Agency was chartered within the Department of Defense to develop a personnel register and estimate doses for the Atomic Veterans. Thus far, it has been funded in excess of $120 million to execute its continuing mission. Inadequate records for estimating radiation doses received by individuals is one of the most contentious issues surrounding the resolution of these veterans' claims. Accurate primary dosimetry records are unavailable for a great many of the Atomic Veterans. The history of the veterans involved in the above-ground nuclear test program demonstrates clearly the need for detailed and advanced planning for radiation protection, assessment of radiation dose, and development of exposure standards before soldiers are put at risk of exposure. The ACE Directive is a significant step in that direction. 4    See Chapter 6, Recommendation 4, on terminology in the ACE Directive.

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--> The committee intends (in Part I of this report and Part II to follow) to assist the Army in developing an appropriate radiation protection philosophy and standards over the wide spectrum of radiation exposure situations soldiers may encounter.