to this request, a collaborative effort was established between the Institute of Medicine (IOM) and the National Research Council (NRC) and four tasks were identified as key to addressing DoD's request. They were: (1) develop an analytical framework for assessing health risks to deployed forces; (2) review and evaluate technology and methods for detection and tracking of exposures to potentially harmful chemical and biological agents; (3) review and evaluate technology and methods for physical protection and decontamination, particularly of chemical and biological agents; and (4) review and evaluate medical protection, health consequences management and treatment, and medical record keeping.

This report addresses the first task of developing an analytical framework for assessing risks, which would encompass the risks of adverse health effects from battle injuries, including those from chemical- and biological-warfare agents, and the non-battle-related health problems noted above. The presumed spectrum of deployment ranged from peacekeeping to full-scale conflict.

APPROACH TO THE CHARGE

This report was prepared by Dr. Lorenz Rhomberg of Gradient Corporation (formerly of the Harvard School of Public Health), with the help and guidance of 10 advisers who represented various scientific disciplines, including military operations, toxicology, infectious diseases, use of biomarkers, personal exposure assessment, epidemiology, occupational health, psychiatry, and risk assessment (see Appendix B). The group received briefings, reviewed documentation of current DoD practices, considered existing risk-assessment paradigms, and commissioned the preparation of papers on six topics that required in-depth analyses (see Appendix A for abstracts of these papers).

The focus of this report is principally on risk assessment—the identification, characterization, and quantitative description of threats and the impacts they may produce—rather than on the means to control or manage those impacts. It must be borne in mind, however, that such risk assessment must occur within the military context, aimed at enhancing the health and safety of troops while ensuring their military effectiveness, both strategically (through improvement of equipment, doctrine, training, and preparedness) and in actions taken during specific deployments. While the risk assessment framework recommended in this report does not directly address how to put its characterizations of threats to use in risk-management decision-making, it does attempt to steer the conduct of risk-assessment activities so as to provide the most useful and appropriate information while avoiding critical gaps.

Because of the diversity of threats that the recommended framework must be able to address, it cannot be very specific about any one activity, and it does not try to be a flowchart or decision tree that maps out a process, step by step. The term “framework” as used herein means an organized context for conducting assessment activities that defines the relationship of the component activities



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