cantly across situations. In hostile situations, the amount of information available may be very limited, but decisions must nonetheless be made. In peacekeeping or other nonhostile operations, however, the commander may have the option of delaying a decision while gathering more detailed information on the scope and magnitude of potential risks.

Justification

Commanders now use data derived by mathematical models to estimate the number and type of acute injuries, including the anticipated numbers of deaths, that would likely result from a given operational situation. These estimates are used to assess combat capabilities and the need for supplies, such as bandages and beds, and replacement personnel. This committee recommends that commanders consider the long-term consequences of radiation exposure when assessing the costs associated with a situation. Although individual commanders often strive to do so, the military has not developed formal guidance to support the assessment of the long-term health risks and consequences of operational decisions. This results, in part, because law and regulations leave the management of long-term injuries and conditions to the U.S. Department of Veterans Affairs. In addition, because of the need to keep soldiers operational on a battlefield, in their assessments commanders may be willing to accept an inappropriately high likelihood of long-term health effects to prevent personnel performance from diminishing while the operation is underway. The committee notes that consideration of radiation-related costs alone would distort the decisionmaking process because long-term costs stemming from other, non-radiation-related, mission-related exposures (e.g., spinal cord injury or posttraumatic stress disorder) would not be assessed.

Because debilitating acute radiation injury is not caused by radiation exposure at organ or whole-body doses of less than 1,000 millisievert (mSv), the concern of major importance after exposure to those doses is long-term effects (particularly cancer). The estimation of cancer risk is complicated by a number of factors including the latent period (time between exposure and diagnosis) and the relatively high (approximately 35 percent) cancer incidence in the general population. Furthermore, rational justification in circumstances involving radiation requires not only that commanders consider the long-term effects of radiation but also that they consider and weigh the long-term health effects of other exposures and injuries. The formal inclusion of this evaluation of long-term consequences in commanders' operational decisionmaking is a relatively new concept for the military.

Despite the difficulties discussed throughout this report, the long-term health risks and effects of radiation exposure are relatively easy to quantify compared with the medical, monetary, and social costs of even clearly defined injuries such as amputation. The commander is not likely to have hard data to use in



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