Potential Radiation Exposure in Military Operations: Protecting the Soldier Before, During, and After (1999)

Earlier chapters have emphasized the commander's duty to protect subordinate soldiers, including justification and optimization of radiation exposures. The purpose of this chapter is to provide a practical methodology by which commanders, while trying to achieve a military objective, can make decisions in the field when radiological risks are or may be present. This duty requires that the commander consider the entire context of the situation and then balance the anticipated benefit and risk. This is often difficult or impossible to achieve because of the limited quantifiable information available. Although the commander should also have a general idea of the benefit of the operation and the ongoing balancing of national security interest with risks to individuals, it is the quantification of the short-and long-term costs of the operation that this chapter addresses.

The commander is the immediate, at-the-scene, decisionmaker. The decisions a commander makes, however, are based on an amalgam of information, training, and perspective that the government (through the Executive Branch via the military, the Congress, and the courts) continually develops. The sole responsibility does not rest with the commander. Rather, the commander is the last link in that process for a given operational decision. The Department of Defense must prepare the commander for that task, in terms of training and support. That support, which has traditionally involved military intelligence information, casualty estimates, and the necessary equipment and supplies for a given mission, now should also include short- and long-term health risk estimates.

The risk or cost evaluation often begins with information from intelligence-gathering activities. The detail and validity of such intelligence can vary signifi-

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.

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

assessing most long-term risks, and the long-term effects of some agents may not even be known. Nonetheless, the committee finds that it is the commander's responsibility to consider long-term health consequences, in addition to acute injuries, in operational decisionmaking. In fact, hard data are often not available concerning even traditional information elements that the commander is expected to use in decisions. That task of making difficult decisions is the precise job of the commander. The commander accepts that responsibility with the expectation that DoD will give him or her the tools to carry it out.

After the military mission has been justified (i.e., greater benefit than cost is anticipated), the commander should optimize the plan to minimize the potential effects of any risk that is involved. The task is to complete the mission in a way that maximizes the benefit/risk ratio. Commanders may share the public perception of radiation risk, which is based largely on inaccurate or incomplete information, and may therefore attempt to avoid radiation at all costs. This is inappropriate. One goal of a radiation protection and safety training program for all personnel is to provide individuals with information and the opportunity to explore misperceptions that could contribute to such an inappropriate decision.

In addition to the implementation of radiation protection and safety training programs, military missions can be optimized in other ways. Examples of such optimization activities include providing additional protection or shielding; having more people involved in the process so that the mission can be accomplished more rapidly, thereby reducing the duration of each individual's exposure and lowering the dose received by each individual; and providing task-specific training related to the planned mission.

Commanders and other personnel make a multitude of decisions during the planning and execution of military operations. Often, despite careful planning, situations change, particularly during execution phases, requiring that additional decisions be made. In the same manner that commanders are kept advised of critical information regarding other aspects of the situation (e.g., weather forecasts or troop movements), so should they be kept informed of radiation matters. The committee does not intend for these guidelines either to overburden the commander and his or her staff or to dictate specific actions. Rather, its purpose is to highlight the facts that (1) ensuring the welfare of soldiers includes consideration of the possible long-term health effects of radiation and (2) communicating specific information to affected individuals (as well as to others who need it to achieve success in their particular part of the mission) is important.

From the top down, initial guidance regarding operations in environments where any potential exposure to radiation exists should include information about possible long-term health effects. This information and knowledge of adequate protective measures, including the role of personal responsibility in preventing or minimizing exposure, should provide an incentive to follow established procedures and report on deviations from normal expectations. Communications regarding radiation should be maintained as openly as communications in other leader-to-subordinate and soldier-to-soldier relationships. Commanders should tell soldiers everything they need to know both to get the job done and to protect themselves against the short- and long-term effects of radiation. Radiation risks are therefore a part of all risks inherent in military service. Although soldiers do not need training at the intensity or frequency required for workers operating in an active radiation environment, training should be used to make soldiers aware of the fundamental aspects of radiation risk and protection.

Communications about radiation should be distributed through the routine channels used by commanders and staff to transmit other data, guidance, and instructions up, down, and laterally throughout the command. When a risk of radiation exposure is present, the commander must provide specific information, such as exposure guidance, limitations, and restrictions, to all who can use it both to ensure the success of the mission and to ensure that appropriate follow-up actions are taken after completion of the operation. Some of the information is well suited for dissemination by standard procedures, such as through operations orders. Some might even become a part of the routine situation or spot reports that go up and down the chain of command.

In addition to internal communications within military organizations, civil and public affairs staff can significantly contribute to the successful completion of missions by disseminating information to the public. Depending on the magnitude of the radiation threat, the source of the radiation threat information, and awareness by others, commanders and staffs may need to provide guidance to military personnel and local civilian authorities regarding information flow among the military, the local populace, and community leaders. Although maintaining security and preventing panic or unreasonable demands on military units should be of concern, military personnel should provide adequate cautionary information to the public when appropriate. Members of the military and civilian nuclear communities recognize the importance of both of these aspects of operations and incorporate them in contingency plans for accidents and incidents. Military commanders, similarly, must include consideration of security and public reaction in the planning and execution of all operations involving expected radiation exposure.

Communications during follow-up actions are just as important as those before and during the operation. Closed-loop communications should be the norm when dealing with soldiers or any others regarding their health. If, despite all known precautions, soldiers have been placed in harm's way by performing

duties directed by the government, the government should accept responsibility for follow-up communications and medical care. Senior leaders, military and civilian, should insist on open, candid, and honest communications with those affected. If a soldier has received a radiation dose higher than preestablished levels, the government should notify the soldier of this and provide the soldier with information about the extent of possible short- and long-term adverse health effects consistent with the exposure experienced. This should be done in a manner similar to that in which soldiers are evaluated and advised of other potentially toxic exposures. Appropriate agencies, such as the U.S. Departments of Defense and Veterans Affairs, should establish procedures for providing any follow-up monitoring or medical support that may be required. Those agencies should be proactive in notifying affected individuals of follow-up procedures. An entity that oversees the monitoring, notification, and treatment responsibilities across all agencies may be necessary to authorize the use of resources across agency lines.