Strategies to Protect the Health of Deployed U.S. Forces Assessing Health Risks to Deployed U.S. Forces: Workshop Proceedings (2000) / Chapter Skim
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2 Collection and Use of Personal Exposure and Human Biological-Marker Information for Assessing Risks to Deployed U.S. Forces in Hostile Environments
2 Collection and Use of Personal Exposure and Human Biological-Marker Information for Assessing Risks to Deployed U.S. Forces in Hostile Environments
Pages 2-23
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From page 2... ...
options for pre-deployment baseline determinations, for collection of personal exposure related data during field deployment, andfor post-deployment personal exposure assessments; (3) maximizing elective personal exposure data resources during and post-deployment; (4)
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data review by medical sta~personnel in order to arrange for monitoring military personnelfor possible elects of toxicant exposures, provide countermeasures during deployments, and prioritize medical examinations and biomarker sample collections and analyses in the early postdeployment 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)
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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 .
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In setting up a computerized data resource to serve such functions, consideration must be given to limiting access of sensitive personal information to those with an approved right-to-know. The activity patterns of members of the force can be critically important determinants of the extent of the internal doses received as a result of toxicant exposures by dermal contact and inhalation.
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The overall integration of some of the deployment riskassessment elements is well illustrated in Figure 1, which appeared in the Deployment Toxicology Research and Development Master Plan in September 1997 (GEO CENTERS, Inch. An approach to combining data resources for developing an overall exposure (and risk)
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This model illustrates the focus and scope of the recommended data elements for the occupational exposure database. (Source: Lippmann et al.
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For most, if not all of these analyses, there are likely to be broad variations in baseline levels, and the analyses can be quite expensive (Zhitkovich and Costa 1998~. Although analyses might be quite expensive, the collection and storage of the specimens is not, and a prudent precautionary sample collection procedure will permit sensitive determinations of the results of exposures that occurred during deployments.
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| Suscepti~.| Altered ~ Oinic~ Shrew I Defeca F~on ~ J J Jr J J Relationship between exposure and disease. (Source: Zhitkovich and TABLE 1 Examples of Biomarkers With Different Agent-Specificity 9 Specificity Biomarkers Exposure Low Intermediate High Sister chromatic exchanges and chromosomal abberations in peripheral lymphocytes Micronuclei in buccal cells p-oxo dG in urine or lymphocytic DNA N-acetyl-~-D-glucosaminidase in urine Mutagenesis at HPRT locus in lymphocytes or glycophoryn A in erythrocytes Urinary malonialdehyde Serum or urinary chromium Urinary nitrosoproline Immunoassay for PAM-DNA adducts 1-hydroxypyrene in urine Cholinergic muscarinic receptors or acetylcholinesterase activity Original substance in biologic specimens Substance-specific metabolite Chemical-specific DNA or protein adducts Biologic response characteristic of specific exposure Clastogens Clastogens Radiation and many chemicals Nephrotoxic agents Mutagens Agents causing lipid peroxidation Toxic and dietary forms of chromium Nitrosamines PAH compounds Organophosphorus insecticides For example, cadmium For example, S-phenylmercapturic acid for benzene For example, styrene-hemoglobin for styrene exposure 6-Aminolevulinic acid in urine (lead exposure)
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For some chemicals, excised abducts are then excreted in urine, and determinations of these abducts can provide a measure of biologically effective doses. Hair samples can provide a temporal history of peak exposures to toxic or trace metals and some organic species or DNA that are incorporated into the growing hair shaft.
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Collection of Samples of Environmental Media If pre-deployment samples or direct measurements of air, soil, water, and background radiation were collected, and their subsequent analyses indicated potentially serious toxicant exposures, then
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Geological Survey is engaged in the development of physiological and behavioral measures of acute chemical neurotoxicity in aquatic organisms as part of the deployment toxicology research program, and that the indicators that they have developed could be used to assess environmental contamination and associated risks at deployment sites. Use of Protective Measures The military has carefully developed specifications for the purchase, supply, distribution, and maintenance of personal protective devices, such as respirators, faceshields and goggles, and protective clothing, which are issued to deployed forces in anticipation of expected exposures.
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OPTIONS FOR POST-DEPLOYMENT EXPOSURE ASSESSMENTS The late deployment and early post-deployment period can be critically important for the collection ot samples and data that can help the military draw the most important lessons about toxicant exposures that might have taken place during the deployment. This period is usually a time when the military emergency or urgent situation justifying a deployment is past and there might be time and resources available during the phase-down for filling data and knowledge gaps that could not be addressed when there were more urgent priorities and when access to deployed personnel for the collection of biological samples and activity logs was infeasible.
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· Biological and environmental samples collected during and immediately following deployment needed to determine if serious toxicant exposures have taken place, based on evidence such as unusual illness patterns, alarms sounded by areawide chemical or biological agent sensors, and suspicious activities by hostile forces. · Biological samples collected during deployment and the early post-deployment period needed to investigate any unexplainable health problems that turn up among previously deployed forces, as happened with Gulf War Syndrome.
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Applications will include: · on-line access of deployment decision-makers to remote sensing and continuous monitoring data that they could consider in tactical planning; · data review by medical staff personnel to arrange for monitoring military personnel for possible effects of toxicant exposure; provide countermeasures during deployments; and set priorities for medical examinations and biomarker sample collections and analyses in the early post-deployment period; · on-line access and data review by industrial hygienists and environmental assessment specialists to arrange for additional sampling and monitoring, or analysis of archived samples, to resolve ambiguities or conflicts concerning levels of exposure or environmental contamination; and · review of medical and environmental data by epidemiologists in post-deployment investigations of possible causal factors for delayed-illness reports associated with service in a specific deployment. However, to accommodate all of these needs in a timely and efficient manner, it will be necessary to have a flexible system for sample and data management that can be adopted and applied uniformly by all of the military services.
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Engaging Industrial Hygiene Expertise for Cumulative Exposure Assessments There might need to be a component of the data resource devoted to the assessment of the cumulative exposure of each member of the deployed force to each of the toxicants encountered during the deployment that might account for excess illness observed among the cohort in the post-deployment period. Such assessments will involve the combination of measurement data, exposure models, and
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Thus, the creation of files on cumulative exposure assessment might be an iterative process that involves collaboration among hygienists, toxicologists, and epidemiologists. Engaging Toxicological Expertise for Interpreting Biomarker Data Currently, there are relatively few biomarkers that are specifically identified with toxic agents or stresses likely to be encountered during military deployments, and therefore few environmental or biological samples collected prior to, or during, a deployment are likely to be analyzed routinely.
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Personal Monitors With Electrical Signal Outputs Opportunities to use personal sensors and transducers to identify gaseous chemical exposures of deployed forces will be increasing in the near future as the inherent capabilities of miniature sensors, circuits, and telecommunications devices mature and are developed in the form of conveniently usable hardware. Recent symposia have highlighted applications of miniaturized electrochemical sensors and interferometers to make sensitive and specific concentration measurements that can be telemetered, along with spatial location coordinates, to central sites, such as military command posts and medical commands, for their surveillance and appropriate responses.
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For analyses that require more sensitive or sophisticated laboratory facilities or specialized analyses, the turn-around time will be longer, and there will be fewer opportunities for prompt feedback to deployed forces for additional timely sample collection or reduction of ongoing exposures. There will be, however, significant advantages in terms of documenting the full nature and extent of agents that were present at very low concentrations.
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As a result of this distinction, the risks are generally more likely to be less obvious to the forces on the ground and more likely to produce delayed health effects than promptly observable effects. When delayed effects are seen, they are likely to be nonspecific in origin or causation and the search for causality might require careful sifting through records relating troop activities to areas having environmental contamination and personal exposures and relating those exposures to nonexposed or less-exposed matched control populations.
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Research Needs This paper envisions a long-term iterative process of exposure and health-status monitoring to identify and characterize health risks to military personnel during noncombat deployments on sites where characteristics of chemical agent exposures are unknown or poorly known. Initially the technological means for pre-deployment environmental or on-line personal exposure assessments are expected to be limited to the detection and characterization of a limited number of chemical toxicants, and quantitative exposure assessments will be delayed by the time it takes for sample collection and laboratory analyses, and by the sensitivity and specificity of the analyses that can be performed.
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: physiological stress indicators Genetic engineering for sensitive populations Universal micro-environmental suits Validated methods for measuring relevant exposure and total dose data directly from biological samples taken by non-invasive techniques Replacement breathing systems Biologically-based exposure assessment systems Technological advances that measure low concentration of chemicals and biomarkers in biological specimens linked to internal dose concentrations at target .
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1996. Data elements for occupational exposure databases: Guidelines and recommendations for airborne hazards and noise.
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