Strategies to Protect the Health of Deployed U.S.
`Forces: Assessing Health Risks to Deployed U.S.
`Forces -- Workshop Proceedings
`Board on Environmental Studies and Toxicology,
`National Research Council
`ISBN: 0-309-51542-4, 194 pages, 8.5 x 11, (2000)
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`Strategies to
`Protect the Health of
`DEPLOYED U.S. FORCES
`Assessing Health Risks to Deployed U.S. Forces
`
`Workshop Proceedings
`
`Board on Environmental Studies and Toxicology
`Commission on Life Sciences
`National Research Council
`
`NATIONAL ACADEMY PRESS
`Washington, D.C.
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
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`
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`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
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`National Academy of Sciences
`National Academy of Engineering
`Institute of Medicine
`National Research Council
`
`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. Bruce M. Alberts 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
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`
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`members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute
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`The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad commu-
`nity of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government.
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`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 Acad-
`emies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman,
`respectively, of the National Research Council.
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
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`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
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`

`PRINCIPAL INVESTIGATOR
`
`Lorenz Rhomberg, Gradient Corporation, Cambridge, Massachusetts (formerly of the Harvard School
`of Public Health, Boston, Massachusetts)
`
`ADVISORY GROUP FOR STRATEGIES TO PROTECT THE HEALTH OF U.S. FORCES
`
`Arthur J. Barsky, Brigham and Women’s Hospital, Boston, Massachusetts
`Germaine M. Buck, State University of New York at Buffalo, Buffalo, New York
`William S. Cain, University of California, San Diego, California
`John Doull, The University of Kansas Medical Center, Kansas City, Kansas
`Ernest Hodgson, North Carolina State University, Raleigh, North Carolina
`David H. Moore, Battelle Memorial Institute, Bel Air, Maryland
`Roy Reuter, Life Systems, Inc., Cleveland, Ohio
`Ken W. Sexton, University of Minnesota, Minneapolis, Minnesota
`Robert E. Shope, University of Texas, Medical Branch, Galveston, Texas
`Ainsley Weston, National Institute of Occupational Safety and Health, Morgantown, West Virginia
`
`Staff
`
`Carol A. Maczka, Project Director
`Raymond A. Wassel, Program Director
`Susan N.J. Pang, Staff Officer
`Robert Crossgrove, Technical Editor
`Catherine M. Kubik, Senior Project Assistant
`Leah L. Probst, Project Assistant
`Mirsada Karalic-Loncarevic, Information Specialist
`
`Sponsor
`
`U.S. Department of Defense
`
`v
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
`Copyright © National Academy of Sciences. All rights reserved.
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`BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY
`
`Gordon Orians (Chair), University of Washington, Seattle, Washington
`Donald Mattison (Vice Chair), March of Dimes, White Plains, New York
`David Allen, University of Texas, Austin, Texas
`Ingrid C. Burke, Colorado State University, Fort Collins, Colorado
`William L. Chameides, Georgia Institute of Technology, Atlanta, Georgia
`John Doull, The University of Kansas Medical Center, Kansas City, Kansas
`Christopher B. Field, Carnegie Institute of Washington, Stanford, California
`John Gerhart, University of California, Berkeley, California
`J. Paul Gilman, Celera Genomics, Rockville, Maryland
`Bruce D. Hammock, University of California, Davis, California
`Mark Harwell, University of Miami, Miami, Florida
`Rogene Henderson, Lovelace Respiratory Research Institute, Albuquerque, New Mexico
`Carol Henry, Chemical Manufacturers Association, Arlington, Virginia
`Barbara Hulka, University of North Carolina, Chapel Hill, North Carolina
`James F. Kitchell, University of Wisconsin, Madison, Wisconsin
`Daniel Krewski, University of Ottawa, Ottawa, Ontario
`James A. MacMahon, Utah State University, Logan, Utah
`Mario J. Molina, Massachusetts Institute of Technology, Cambridge, Massachusetts
`Charles O’Melia, Johns Hopkins University, Baltimore, Maryland
`Willem F. Passchier, Health Council of the Netherlands
`Kirk Smith, University of California, Berkeley, California
`Margaret Strand, Oppenheimer Wolff Donnelly & Bayh, LLP, Washington, D.C.
`Terry F. Yosie, Chemical Manufacturers Association, Arlington, Virginia
`
`Senior Staff
`
`James J. Reisa, Director
`David J. Policansky, Associate Director and Senior Program Director for Applied Ecology
`Carol A. Maczka, Senior Program Director for Toxicology and Risk Assessment
`Raymond A. Wassel, Senior Program Director for Environmental Sciences and Engineering
`Kulbir S. Bakshi, Program Director for the Committee on Toxicology
`Lee R. Paulson, Program Director for Resource Management
`
`vi
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
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`

`COMMISSION ON LIFE SCIENCES
`
`Michael T. Clegg (Chair), University of California, Riverside, California
`Paul Berg (Vice Chair), Stanford University, Stanford, California
`Frederick R. Anderson, Cadwalader, Wickersham & Taft, Washington, D.C.
`Joanna Burger, Rutgers University, Piscataway, New Jersey
`James E. Cleaver, University of California, San Francisco, California
`David Eisenberg, University of California, Los Angeles, California
`John Emmerson, Fishers, Indiana
`Neal First, University of Wisconsin, Madison, Wisconsin
`David J. Galas, Keck Graduate Institute of Applied Life Science, Claremont, California
`David V. Goeddel, Tularik, Inc., South San Francisco, California
`Arturo Gomez-Pompa, University of California, Riverside, California
`Corey S. Goodman, University of California, Berkeley, California
`Jon W. Gordon, Mount Sinai School of Medicine, New York, New York
`David G. Hoel, Medical University of South Carolina, Charleston, South Carolina
`Barbara S. Hulka, University of North Carolina, Chapel Hill, North Carolina
`Cynthia Kenyon, University of California, San Francisco, California
`Bruce R. Levin, Emory University, Atlanta, Georgia
`David Livingston, Dana-Farber Cancer Institute, Boston, Massachusetts
`Donald R. Mattison, March of Dimes, White Plains, New York
`Elliot M. Meyerowitz, California Institute of Technology, Pasadena, California
`Robert T. Paine, University of Washington, Seattle, Washington
`Ronald R. Sederoff, North Carolina State University, Raleigh, North Carolina
`Robert R. Sokal, State University of New York, Stony Brook, New York
`Charles F. Stevens, The Salk Institute, La Jolla, California
`Shirley M. Tilghman, Princeton University, Princeton, New Jersey
`Raymond L. White, University of Utah, Salt Lake City, Utah
`
`Staff
`
`Warren R. Muir, Executive Director
`Jacqueline K. Prince, Financial Officer
`Barbara B. Smith, Administrative Associate
`Kit W. Lee, Administrative Assistant
`
`vii
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
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`

`OTHER REPORTS OF THE BOARD ON
`ENVIRONMENTAL STUDIES AND TOXICOLOGY
`
`Waste Incineration and Public Health (1999)
`Hormonally Active Agents in the Environment (1999)
`Research Priorities for Airborne Particulate Matter: II. Evaluating Research Progress and Updating the
`Portfolio (1999)
`Ozone-Forming Potential of Reformulated Gasoline (1999)
`Risk-Based Waste Classification in California (1999)
`Arsenic in Drinking Water (1999)
`Research Priorities for Airborne Particulate Matter: I. Immediate Priorities and a Long-Range Research
`Portfolio (1998)
`Brucellosis in the Greater Yellowstone Area (1998)
`The National Research Council’s Committee on Toxicology: The First 50 Years (1997)
`Toxicologic Assessment of the Army’s Zinc Cadmium Sulfide Dispersion Tests (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 (5 reports, 1989-1995)
`Review of EPA’s Environmental Monitoring and Assessment Program (3 reports, 1994-1995)
`Science and Judgment in Risk Assessment (1994)
`Ranking Hazardous Waste Sites for Remedial Action (1994)
`Pesticides in the Diets of Infants and Children (1993)
`Issues in Risk Assessment (1993)
`Setting Priorities for Land Conservation (1993)
`Protecting Visibility in National Parks and Wilderness Areas (1993)
`Dolphins and the Tuna Industry (1992)
`Hazardous Materials on the Public Lands (1992)
`Science and the National Parks (1992)
`Animals as Sentinels of Environmental Health Hazards (1991)
`Assessment of the U.S. Outer Continental Shelf Environmental Studies Program, Volumes I-IV
`(1991-1993)
`Human Exposure Assessment for Airborne Pollutants (1991)
`Monitoring Human Tissues for Toxic Substances (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 Academy Press
`(800) 624-6242
`(202) 334-3313
`www.nap.edu
`
`viii
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
`Copyright © National Academy of Sciences. All rights reserved.
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`Contents
`
`Background
`
`Collection and Use of Personal Exposure and Human Biological-Marker Information
`for Assessing Risks to Deployed U.S. Forces in Hostile Environments
`Morton Lippmann
`
`Characteristics of the Future Battlefield and Deployment
`Edward D. Martin
`
`The Nature of Risk Assessment and Its Application to Deployed U.S. Forces
`Joseph V. Rodricks
`
`Future Health Assessment and Risk-Management Integration for Infectious Diseases
`and Biological Weapons for Deployed U.S. Forces
`Joan B. Rose
`
`Approaches for Using Toxicokinetic Information in Assessing Risk to Deployed
`U.S. Forces
`Karl K. Rozman
`
`Health Risks and Preventive Research Strategy for Deployed U.S. Forces from
`Toxicological Interactions Among Potentially Harmful Agents
`Raymond S.H. Yang
`
`Appendix: Biographical Information on Commissioned Authors
`
`ix
`
`1
`
`2
`
`24
`
`35
`
`59
`
`113
`
`150
`
`183
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
`Copyright © National Academy of Sciences. All rights reserved.
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`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
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`

`Background
`
`The National Academy of Sciences (NAS) was asked to advise the Department of Defense (DOD)
`on a long-term strategy for protecting the health of the nation’s military personnel when deployed to
`unfamiliar environments. As part of the academy’s response to this request, the National Research
`Council’s (NRC’s) Board on Environmental Studies and Toxicology was asked to develop an analytical
`framework for assessing health risks to deployed forces.
`Dr. Lorenz Rhomberg of Gradient Corporation (formerly of the Harvard University School of
`Public Health) served as the project’s principal investigator. He was assisted by 10 advisers represent-
`ing a variety of relevant disciplines.
`To assist Dr. Rhomberg and the advisers, six papers were commissioned on topics identified as key
`issues: (1) possible scenarios of future deployments and battle considerations, (2) existing risk-assess-
`ment methods and their possible application to deployment situations, (3) approaches for collecting and
`using personal exposure and biological-marker information, (4) health assessment and risk management
`integration for biological agents, (5) toxicologic interactions among agents, and (6) possible paradigms
`for incorporating toxicokinetic information in risk assessment. The six papers were presented at a
`workshop on January 28-29, 1999 in Washington, DC. Over 60 participants from the military and
`scientific communities were present. The sessions were moderated by members of the advisory group,
`and the commissioned authors were asked to consider the comments and suggestions that arose during
`the workshop in revising their papers. The final papers were also reviewed by two members of the
`Commission on Life Sciences: Donald Mattison, March of Dimes and John Emmerson, Fishers, Indiana.
`The commissioned papers were used as background for the NRC report A Risk Assessment Frame-
`work for Protecting the Health of Deployed Forces, which is being published concurrently with these
`proceedings. The findings, conclusions, and recommendations that appear in the workshop papers are
`solely those of the authors and should not be interpreted as those of the NRC.
`
`1
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
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`

`

`Collection and Use of Personal Exposure
`and Human Biological-Marker Information for
`Assessing Risks to Deployed
`U.S. Forces in Hostile Environments
`
`by Morton Lippmann1
`
`ABSTRACT
`
`Risk management is especially important for military forces deployed in hostile and/or chemically
`contaminated environments, and on-line or rapid turn-around capabilities for assessing exposures can
`create viable options for preventing or minimizing incapaciting exposures or latent disease or disability
`in the years after the deployment. With military support for the development, testing, and validation of
`state-of-the-art personal and area sensors, telecommunications, and data management resources, the
`DOD can (1) enhance its capabilities for meeting its novel and challenging tasks; and (2) create
`technologies that will find widespread civilian uses.
`This review assesses currently available options and technologies for productive pre-deployment
`environmental surveillance, exposure surveillance during deployments, and retrospective exposure
`surveillance post-deployment, and introduces some opportunities for technological and operational
`advancements in technology for more effective exposure surveillance and effects management options
`for force deployments in future years. The issues discussed are (1) information needs for assessing
`personal exposures and risks for deployed forces; (2) options for pre-deployment baseline determina-
`tions, for collection of personal exposure related data during field deployment, and for post-deployment
`personal exposure assessments; (3) maximizing effective personal exposure data resources during and
`post-deployment; (4) technical capabilities for personal exposure assessment; and (5) assessing risks.
`Advances in information technology have made it possible to envision the collection, maintenance,
`and utilization of a deployment data resource that would enable theater commanders and medical staff
`to recognize and evaluate environmental health hazards and to manage deployments so as to avoid or
`
`1Human Exposure and Health Effects Program, New York University School of Medicine, 57 Old Forge Road, Tuxedo,
`NY 10987
`
`2
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
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`PERSONAL EXPOSURE AND HUMAN BIOLOGICAL-MARKER INFORMATION
`
`3
`
`minimize those hazards. Such data, together with a deployment sample archive, would also facilitate
`future epidemiological studies that could identify additional causal relationships between environmen-
`tal factors and health outcomes.
`Applications can include (1) on-line access to remote sensing and continuous monitoring data for
`tactical planning; (2) data review by medical staff personnel in order to arrange for monitoring military
`personnel for possible effects of toxicant exposures, provide countermeasures during deployments, and
`prioritize medical examinations and biomarker sample collections and analyses in the early post-
`deployment period; (3) additional sampling and/or monitoring, or analysis of archived samples, in
`order to be able to resolve ambiguities or conflicts concerning levels of exposure or environmental
`contamination; and (4) review of medical and environmental data by epidemiologists post-deployment
`in investigations of possible causal factors for delayed illness reports associated with service in a
`specific deployment.
`Each of these applications could consume large amounts of resources, and the allocations should be
`decided according to pre-established priorities by an appropriate panel of peers, including military
`users and state-of-the-art research investigators with expertise in the emerging technologies.
`
`INTRODUCTION
`
`Exposure assessment is a key element in risk assessment and risk management, and is especially
`important for military forces deployed in hostile or uncharacterized environments. Furthermore, on-line
`or rapid turn-around capabilities for assessing exposures can provide military commanders with viable
`options for preventing or minimizing exposures that can incapacitate or degrade the on-site capabilities
`of deployed forces, or that can result in latent disease or disability in the months and years after the
`deployment. Delayed or latent adverse effects resulting from deployment exposures can degrade force
`readiness for future deployments as well as cause pain and suffering to force members and/or create
`compensatory costs needed to care for the force members and their families. Exposure assessments can
`therefore be valuable and cost-effective tools of primary disease and disability protection. The military
`could support and mobilize the high-technological resources that will be needed for the development,
`testing, and validation of state-of-the-art personal and area sensors, telecommunications devices, and
`data management resources. Such investments would not only help the Department of Defense (DOD)
`enhance its capabilities for meeting the novel and challenging tasks in deploying forces in the post-cold-
`war period, but also create technologies that will find productive new uses in other aspects of occupa-
`tional and environmental health protection in the United States and around the world.
`The military services have already established a core unit, the U.S. Army Center for Health
`Promotion and Preventive Medicine (USACHPPM). It fulfills many of the functions that are outlined
`in this paper through its Deployment Environmental Exposure Surveillance Program (DESP), which
`was established in July 1996. The scope of this program could be expanded to include a greater
`emphasis on personal exposure surveillance and the collection and archiving of environmental and
`biological samples for later laboratory analyses needed to resolve emerging questions about expo-
`sures and their health effects among deployed personnel. The sample archive envisioned here could
`be viewed as an expansion of the Armed Forces Serum Repository established in August 1997 under
`DOD Directive 6490.2 for the purpose of joint medical surveillance. The expanded repository would
`include blood cells for biological-marker (biomarker) analyses, as well as air-sampling filters and
`cartridges and soil and water samples.
`Although this paper focuses on disease and non-battle injuries (DNBI), many of the high-techno-
`logical capabilities developed for the nuclear, biological, and chemical (NBC) defense programs’ spiral
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
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`4
`
`STRATEGIES TO PROTECT THE HEALTH OF DEPLOYED U.S. FORCES: WORKSHOP PROCEEDINGS
`
`system developments can be envisioned as being applicable to force protection from unintentional
`exposures to environmental toxicants. This is especially the case for the fully integrated and digitized
`joint warning, reporting, and analysis architecture that the NBC program expects to implement in the
`next 3 to 5 years. Plans to acquire very light-weight hazard sensors under the NBC program will also
`advance measurement technologies that might have eventual applicability to on-site and personal detec-
`tors capable of measuring much lower concentrations of agents of concern with respect to DNBI.
`This paper introduces and spells out, in a conceptual sense, currently available options and technolo-
`gies for productive pre-deployment environmental surveillance, exposure surveillance during deploy-
`ments, and retrospective post-deployment exposure surveillance. It also introduces some opportunities
`for technological and operational advancements in technology for more effective exposure surveillance
`and proposes some risk management options for force deployments in future years. The discussions that
`follow cover
`
`information needs for assessing personal exposures and risks for deployed forces,
`•
`• options for pre-deployment baseline determinations,
`• options for collection of personal exposure data during field deployment,
`• options for post-deployment personal exposure assessments,
`• maximizing effective personal exposure data resource during deployment and post-deployment,
`• current technical capabilities for personal exposure assessment, and
`• assessing risks.
`
`INFORMATION NEEDS FOR ASSESSING PERSONAL EXPOSURES
`AND RISKS FOR DEPLOYED FORCES
`
`Environmental Quality Factors at Deployment Sites
`
`The military is obligated to determine identifiable on-site risks whenever possible prior to the
`deployment of forces. Contaminated sites, such as abandoned gas works, chemical manufacturing sites
`and waste dumps, with the actual and potential risks of personnel contacting hazardous chemical
`residues should be avoided whenever mission options permit and less contaminated or noncontaminated
`alternate sites compatible with operational necessities are available.
`Prescreening of potential deployment sites should be done at the candidate sites by appropriately
`trained environmental specialists or industrial hygienists whenever possible. When on-site surveys are
`not possible, remote sensors or scanners should be employed to the extent that they are technologically
`and operationally feasible. (See NRC 1999.)
`Survey personnel should prepare guidance and background data on the extent or potential of site
`contamination to the military (or civilian) engineers assigned to site preparation for large-scale deploy-
`ments. In turn, the military engineers should take care to prepare the site, to the extent feasible, in ways
`that prevent or minimize the potential for exposure to preexisting on-site contamination. Both the site
`survey and site preparation teams should create a record trail on on-site contamination that is accessible
`to hygienists, medical personnel, and epidemiologists in case subsequent actions or investigations are
`needed during on-site deployment or for post-deployment follow-up investigations.
`During force deployments, the emphasis should shift to the collection of data on personal exposures
`to on-site contaminants, using personal samplers and monitors, as well as the collection of exposure
`biomarkers whenever appropriate equipment, sampling opportunities, analytical methods, and proce-
`
`Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces -- Workshop Proceedings
`http://www.nap.edu/catalog/9709.html
`
`Copyright © National Academy of Sciences. All rights reserved.
`
`Auspex Exhibit 2013
`Apotex v. Auspex
`IPR2021-01507
`Page 15
`
`

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`PERSONAL EXPOSURE AND HUMAN BIOLOGICAL-MARKER INFORMATION
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`5
`
`dures are available. Because it will seldom, if ever, be feasible to collect personal exposure data on all
`members of a deployed force, a sampling strategy will be needed to identify suitable and willing
`individuals within the force who can serve effectively as representatives of their group for determinating
`exposure. There will also need to be plans and procedures to investigate and ameliorate the sources and
`extent of detected excessive exposure, as well as procedures for feasible countermeasures for docu-
`mented excessive exposures.
`
`Exposure-Reponse Relationships and Exposure Limits for Toxicants
`
`For chemical agents of known toxicity, it is important to have or be able to develop exposure
`limits or guidelines to serve as benchmarks of excessive exposure for either short or long-term
`exposures. The recently prepared TG230A Short-Term Chemical Exposure Guidelines for Deployed
`Military Personnel (USACHPPM 1999a) and the RD230A Reference Document (USACHPPM 1999b)
`provide guidance for 1-h inhalation exposures for 43 chemicals, for 1-to 14-day exposures for 91
`chemicals, and drinking-water concentration limits for 170 chemicals. Guidance for 1-h inhalation
`exposure limits for other chemicals is available from the American Industrial Hygiene Association
`(AIHA) in their Emergency Response Planning Guidelines (ERPGs). Currently, the U.S. Environ-
`mental Protection Agency (EPA) is supporting a National Research Council (NRC) Committee on
`Toxicology program to prepare Guidelines for Community Emergency Exposure Levels that will
`gradually be substituted for ERPGs where appropriate. Based upon the AIHA criteria of protection of
`“nearly all individuals” against “experiencing or developing irreversible or other serious health ef-
`fects or symptoms that could impair. . . abilities to take protective action,” the 1-h TG230A criteria
`are all conservative by factors ranging from 2 to 80. The American Conference of Governmental
`Industrial Hygenists (ACGIH) threshold limit values and biological exposure indices provide guid-
`ance for 15-min exposures and longer-term (8-h) exposures.
`
`Descriptors of Deployed Forces
`
`Deployed forces can be expected to vary greatly in age, ethnicity, genetic susceptibilities, and prior
`histories of exposures to toxicants and disease, as well as in possible allergic or stress reactions to
`exposures or countermeasures. The information resource that will be used to document known expo-
`sures and possible responses to these exposures should contain as much descriptive information on each
`person in the force as possible to facilitate primary medical management of in