Strategies to Protect the Health of Deployed U.S. Forces Analytical Framework for Assessing Risks (2000) / Chapter Skim
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4 A Framework for Assessing Risk to Deployed Forces Ongoing Strategic Baseline Preparation and Planning
4 A Framework for Assessing Risk to Deployed Forces Ongoing Strategic Baseline Preparation and Planning
Pages 44-81
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From page 44... ...
It is divided into several components, providing places for various analyses, and organized to illustrate the role of each activity and how it contributes to an overall analysis of risks to deployed forces. The object is to foster a systematic approach to recognizing and cataloging potential hazards, founded on examination of the various activities and settings of deployment.
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From page 45... ...
ONGOING STRATEGIC BASELINE PREPARATION AND PLANNING Ongoing strategic baseline planning comprises all of the activities and analyses concerned with preparation, through analysis, systematic investigation, risk-aware design of procedures and materiel, and contingency planning for threatening eventualities before they occur. As such it includes all activities concerned with recognizing potential threats, anticipating the circumstances under which they might arise, and assessing and characterizing each kind of threat qualitatively and quantitatively.
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From page 47... ...
A FRAMEWORK FOR ASSESSING RISK TO DEPLOYED FORCES 47 ~o~st~-~ve ~'~o~v~m~e~n~t~A~c iol lo latlol Anal lips Al Alilclatlin ~g~ ~P~ost-~d~e~n~l~oUm~en~t~se~i~ce~Ex~no~su~re~reco~n~stru~ct ~Vete~n~s~ · Generate hypotheses and test with ~D~ma~Arc~h~ivj~na~ ~C~antu~re~d~u~rI~n~a~-d~e~l~oUm~e~nt~da a ~'~.~. ~l~m n~l~e~me~n~t~d~e ~l~oume~n~t-s~ ecu l~c~Eva~l~u~ate~ e~sso~n~s~Lear~ne~d~ ~ r~ ~ ~ A ~ ~ ~ ~ ~ ~ ~ follow-up systems · Deeper understanding of known threats ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ · Study pr~e~v~ous~y unanticipated Ongoing~Health Surveillance ~ ~ threats ~l~n~d~ivi~d~u~a~l~exam~n~atl~n~s~t~ed~to~d~e-~Feed~baGk~to~red~e~Olov~m~e~nt~n~l~a~n~-~ nl~ov~m~e~nt~h~l~st ~ r~ I ~ ~ ~ ~l~m~l~e~me~n~t~ ea~i~st~ri~es~w~i~th~tri~a~ae~fo~r~ ~'~~ ~d~ee 3~e~r~an~a~l~s~ ON60 NG SIRA~6 C _ DI~OCLI 1~ C PREPARATION SPECIFIC DEPLOYMENT ACTIVITI ES _ POST DE P LOOM ENT ACTIVITI ES Continued in Figures 2-4 Continued in Figure 5 ~ Continued in Figure 6 FIGURE 1.
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From page 48... ...
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From page 49... ...
49 z -o cn I o~ o .
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From page 53... ...
identify potential threats; (2) develop priorities for detailed analysis; (3)
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From page 54... ...
The object of this initial step is to recognize potential hazards for fuller consideration in the risk-analysis step. Exposure A second means of seeking potential hazards is to examine agents with notable exposure patterns.
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From page 55... ...
Inventories of Exposures Associated with Deployment Activities and Settings Under this approach, the main focus is on examining activities and settings for the exposures and the potential risks they entail. As such, it represents the greatest departure from the usual approach of beginning with agents and exposures and then examining the activities where potential hazards arise.
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From page 56... ...
These activities would include use of pesticides and insect repellents, standard vaccinations, waste disposal, exposure to exhaust fumes, and exposures associated with the operation and maintenance of military equipment. In short, they cover all of the potential hazardous exposures that deployed forces bring with them wherever they go on whatever mission.
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From page 57... ...
The aim of this review step is to identify those situations that should be subject to deeper scrutiny and perhaps toxicological experimentation (see Yang 1999~. Develop Priorities for Detailed Analysis The inventory created in the step that identifies potential threats might be quite large, and a clear view of potential hazards might in many cases be hampered by lack of data.
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From page 58... ...
This step to develop priorities has similarities to the discipline of comparative risk analysis in that it seeks to compare a wide array of hazards and identify which ones have the greatest likelihood of occurring and the greatest potential impact, and therefore deserve priority attention. (It differs, however, in that one is developing priorities for potential hazards for further risk analysis rather than preparing risk estimates for regulatory attention.)
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From page 59... ...
This uncertainty comes not only from the contingency of outcomes on unknown future events, but also from our incomplete understanding of the applicable causes and effects. The present framework urges a very comprehensive approach to investigating potential threats to deployed forces; it advocates consideration of the whole spectrum of potential threats from diverse sources and it calls for attention to all potential health effects of agents, not just those causing the most notable effects or those calling attention to the agent as a hazard in the first place.
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From page 60... ...
There are three areas in which data might be lacking. First, existing information might raise possibilities of adverse outcomes following exposure, but the data might be insufficient to provide robust answers about the magnitude or even the true existence of the risk in the population of interest.
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From page 61... ...
the likelihood that the data, if obtained, will help settle the outstanding issues or result in a sufficient reduction in uncertainty that it was worth obtaining the data. Methods to employ these principles in determining the benefit of additional data on a risk question are codified in the established quantitative discipline of Value of Information Analysis (Clemen 1990; von Winterfeldt and Edwards 1986)
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From page 62... ...
This section notes some commonalities among risk-assessment methods for different kinds of threats and calls attention to some special aspects of assessing risks for the purposes of protection of deployed forces. These matters may affect both the analytic methods and outcomes of risk assessments.
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From page 63... ...
the probability that an individual that takes up some agent succumbs to its toxic effects. This view broadens the more typical exposure assessment procedures of exploring various modes of exposure and estimating variations in levels of uptake, by including the probabilities that the different exposure scenarios actually occur.
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From page 64... ...
For agents that come to be well mixed into local air and water, or for local environmental pollution, the usual approaches for environmental contaminants can be used, in which the rates of consumption of air, food, and water are used to estimate ongoing intake rates of the contaminants they contain. The exposure factors that are used (inhalation rates, water consumption, body weights, exposure durations)
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From page 65... ...
components of hazard identification, doseresponse analysis, and risk characterization. Hazard Identification Hazard identification is distinct from the earlier step of identification of potential threats in that the aim is to assess the weight of evidence as to an agent's toxicity in humans.
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From page 66... ...
Currently, these models are better developed for description of infection rates than they are for describing the probabilities of appearance of disease symptoms among those who are infected. The challenge for the risk assessment of deployed forces will be to account for the fact that many microbial risk questions will be about agents that have not been well studied.
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From page 67... ...
, doses repeated over several days to weeks, and doses repeated for a substantial portion of lifetime, respectively; separate assessments of dependence of response on dose level are made for each duration category. An application of this approach designed for the case of deployed forces risk assessment is presented by Rodricks (1999, abstracted in Appendix A)
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From page 68... ...
Each approach has its advantages, and it is worthwhile pursuing both lines of analysis for application to assessment of risks to deployed forces. Risk Characterization Using the information gleaned from the hazard identification and doseresponse analysis steps, quantitative estimates of risk can be generated to provide a general understanding of the type and magnitude of an adverse effect that could be caused under particular circumstances or scenarios.
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From page 69... ...
The risk management tasks outlined below constitute the use and application of knowledge about threats to health and safety, and it is important to keep these ends in mind when characterizing risks so that the information obtained is appropriate and useful. The final step of the ongoing strategic baseline preparation phase of the framework is the incorporation of the understanding of risks gener
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From page 70... ...
Incorporation involves the parts of risk management that can be conducted in the realm of generalized planning and preparation, by forging procedures, capabilities, and standards that will achieve reductions in threats to troops and establish appropriate decision-making practices that can be put to use in the eventuality of actual deployments. It uses the insights into risks posed by various activities and eventualities to plan how to conduct future operations with minimal unnecessary risk and to protect the health and safety of deployed forces to the maximum extent feasible.
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From page 71... ...
Although it is unwise to rely on standards alone as a means of controlling risks to military personnel, setting exposure standards is important in establishing a benchmark for protection of health against expected risks. It provides a straightforward means of defining health-protection goals, monitoring activities to assure that those goals are achieved, and allowing for a quick, relatively nontechnical evaluation of the risk potential of situations that have not received detailed analysis.
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From page 72... ...
Other standards that provide for different levels of tolerance of some toxic effects for various lengths of exposure could be imagined and could prove useful in particular settings. A caveat raised before is worth repeating here: standards tend to be set on the most obvious end points, but one must beware of overlooking subtle effects from low-level exposures that might accumulate with repeated episodes of exposure or might manifest themselves long after exposure, even though the exposure causes no detectable immediate harm and might be classified as "safe" with respect to the end point on which short-term limits are based.
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From page 73... ...
The key activities in this phase are to implement plans made in anticipation of deployment (ongoing strategic baseline preparations) , update them with information specific to the deployment situation at hand, note the advent of threatening exposures when they actually occur, and activate the appropriate parts of the response plans accordingly.
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From page 74... ...
During the course of deployment, the key issue is detection of potential exposures and recognition of when situations and contexts occur for which useful prior analysis has been conducted. In the ongoing strategic baseline planning, hypothetical scenarios and schemes for the unfolding of possible threats, the consequences of each threat realized, and the likelihood that hazardous situations would be encountered.
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From page 75... ...
Vigilancefor Unsuspected Exposures Detectors register the presence of those agents they are designed to detect, and prior analyses of threats address the situations that were anticipated, but necessarily exclude possible unexpected exposures. Detecting these in the short run is a challenge, because detection methods would have to be general enough to register whatever agents appear, yet not so
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From page 76... ...
It would appear wise to consider a moderate demand for such activity, but to act to ensure that that modest task is indeed carried out in a context of enormous pressure and demands for successful completion of the military mission. Medical surveillance and record keeping are discussed more fully in a companion report (IOM 1999~.
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From page 77... ...
In another sense, however, it is not specific, in that it should be part of a program of following each person through his or her military career and beyond, maintaining job and exposure histories to track all of the factors that are thought likely to be relevant to health protection and the discovery of hazards. Each person will have been involved in a range of activities, and each person's health experience should be examined in the light of that whole history, integrated over specific episodes, including specific deployments.
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From page 78... ...
Responsibilities and policy for medical surveillance are given in the 1997 Deployment Medical Surveillance Directive 6490.2. Issues surrounding systematic approaches to post-deployment health surveillance, including the question of how to capture key information to feed back to characterization of incompletely understood health risks, are further discussed in NSTC (1998)
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From page 79... ...
In such an analysis, the risk question is more about the probabilities of exposures of different numbers of people than about the health risk to a person given a certain exposure. Moreover, the whole spectrum of kinds of plant failure needs to be considered together, because adverse outcomes can arise in a number of ways.
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From page 80... ...
Several parallel examinations based on known hazards, notable exposures, and exposures associated with activities and settings directly should be conducted, and from the combined results of these examinations, an inventory should be created of the agents and exposures and the relative needs for more detailed risk analysis. After identifying potential hazards to deployed troops, the next step is to develop priorities for which hazards have the greatest likelihood of being encountered and pose the greatest threats to the military mission and to troop health.
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From page 81... ...
The second major phase of activities occurs when a specific deployment is anticipated. At that stage, the generalized contingency plans developed on an ongoing basis can be refined and made more specific, based on the known location, the type of mission, and current conditions.
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