This is the final report of the Committee on Battlefield Radiation Exposure Criteria, produced under the auspices of the Medical Follow-up Agency of the Institute of Medicine, National Academy of Sciences. In it, the committee addresses technical and ethical aspects of military radiation protection and safety policies applicable in instances of the potential exposure of military personnel to radiation doses that are less than those that cause acute effects but that are associated with a long-term risk of subsequent cancers. At the request of the Surgeon General of the U.S. Army, the project's sponsor, the committee focused its interim report (IOM, 1997) on the scientific merit of proposed North Atlantic Treaty Organization (NATO) guidelines for this category of military operations. This final report summarizes the general technical points of the interim report and expands the committee's discussion of the ethical considerations, education, training, and the decisionmaking process involved in initiating appropriate actions when military personnel may be at risk of exposure to radiation doses up to 700 millisievert (mSv). The committee also includes consideration of the evaluation of the long-term health effects of radiation.

Contents

• COMMITTEE ON BATTLEFIELD RADIATION EXPOSURE CRITERIA
• Reviewers
• Preface
• Acknowledgments
• Radiation Unit Conversion Chart
• Acronyms
• Summary
• 1. Introduction
  • Background
  • Report Layout
  • Ethics
• 2. Fundamentals of Radiation Safety and Protection
  • Radiation Physics
  • Radiation Units and Measurements
  • Sources of Radiation Exposure
  • Radiation Dose Reduction
  • Radiation Biology
  • Assessment of Radiogenic Tumor Risk
• 3. Standard Practices in Occupational Radiation Protection
  • Control Philosophy
  • Radiation Safety training for Occupational Exposures
  • Records and Recordkeeping
  • Reporting
• 4. Current Paradigms for Radiation Protection in the U.S. Army
  • Occupational Exposure
  • Non-Occupational Exposures up to 700 Millisievert
  • High-Level Exposures in Nuclear War
  • Summary of Existing Army Programs
• 5. Army Radiation Protection and Safety Programs in Light of Civilian Standard Practices and Recommendations for Improvement
  • Review of This Committee's Interim Report
  • Guidance on Radiation Protection
• 6. Decisionmaking by Commanders
  • Information
  • Justification
  • Optimization
  • Communication
• 7. Follow-Up of Persons with Known or Suspected Exposure to Ionizing Radiation
  • Medical Follow-up
  • Epidemiologic Follow-up
  • Psychological Effects and Their Management
• 8. Recommendations
  • Balancing Future and Present Harm
  • Philosophy of Radiation Protection
  • Communicating Risk
  • Radiation Dosimetry, Records, and Reporting
  • Follow-up
• References
• Appendix A The ACE Directive
• Appendix B Participants in Committee Meetings and Workshop
• Appendix C Biographical Summaries

Support for this project was provided by the U.S. Army Medical Research and Materiel Command under Contract No. DAMD17-96-C-6095. The views, opinions, and/or findings contained in this report are those of the authors and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.