The utilization of risk assessments in tactical command decisions

The Science of the Total Environment 288 (2002) 119–129

The utilization of risk assessments in tactical command decisions夞 Warren W. Jederberga, Kenneth R. Stillb,*, G. Bruce Briggsc a OPNAV N343C, Navy Pentagon, Washington, DC, USA Naval Health Research Center Detachment (Toxicology) — NHRCyTD Bldg 433, 2612 5th St.,Wright-Patterson AFB, OH 45433-7903, USA c Geo-Centers Inc., Bldg 433, 2612 5th St., Wright-Patterson AFB, OH 45433-7903, USA

b

Received 1 June 2001; accepted 31 October 2001

Abstract Traditional risk assessments (as delineated by regulatory agencies) use health outcome endpoints of interest to society as a whole, and are based on broad assumptions about the demographics of the potentially exposed populations and the routes of exposure. Immediacy of impact is not normally a major consideration. In tactical situations, the commander must balance considerations of short-term health effects against mission accomplishment. Often the commander will decide to accept a risk that would not be considered under other circumstances. The traditional tools of human-health and environmental risk assessment may be used, but the risk levels and projected consequences must be adapted to the tactical scenario (i.e. the performance decrement associated with a short-term exposure tactical operation vs. the long-term health out-come for an exposed population under ‘normal conditions’). Risk assessors and health professionals must learn to articulate risk in terms that the tactical commander can place in his operational risk management (ORM) process. The process may require that the commander weigh non-health related mission critical considerations against health outcome issues. This presentation is intended to begin a dialogue that will lead to a harmonization of the use of risk assessment tools and their application in ORM as seen by tactical commanders, and a clarification of the strengths and limits of their utility in such applications. 䊚 2002 Elsevier Science B.V. All rights reserved. Keywords: Chemical biological radiological nuclear explosive (CBRNE); Environmental risk assessment (ERA); Human health risk assessment (HHRA); Operational risk management (ORM); Risk assessment; Risk communications; Toxic industrial material (TIM); Toxic industrial chemical (TIC); Weapons of mass destruction (WMD)

1. Introduction With the increased involvement of US military forces in military operations other than war (MOOTW) and the increased probability of 夞 Disclaimer: The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or the Naval Service at large, nor of any other government agencies. *Corresponding author.

engagements of small groups in urban environments, there is an increase in the likelihood of exposure of those forces to toxic industrial chemicals (TICs) and toxic industrial materials (TIMs). Also, the threat from non-conventional weapons used by terrorists has significantly increased. There is an increased awareness of, and concern for the medical consequences of long-term and short-term exposures to the potential milieu of environmental contaminants (Sonntag et al., 1997;

0048-9697/02/$ - see front matter 䊚 2002 Elsevier Science B.V. All rights reserved. PII: S 0 0 4 8 - 9 6 9 7 Ž 0 1 . 0 1 1 1 8 - 4

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NRC, 2000b). The national research council made the following statement: ‘Those involved in future conflicts must anticipate the need to integrate into planning at all stages, high quality research on the health consequences of combat and the deployments to hostile environments’. (ACEHR, 1997). It is therefore increasingly important that the risks associated with military service be clearly delineated and appropriate information given to the front-line managers for decision making. While most medical consequence data currently available have been based on traditional risk assessment paradigms, new ways of collecting and using the data are needed. The US military services have developed and promulgated an operational risk management (ORM) system to be used by leaders in the field (CNO, 1997). As stated by the Army Chief of Staff (NRC, 2000b). ‘Risk management is not an add-on feature to the decision making process but rather a fully integrated element of planning and executing operations... Risk management helps us preserve combat power and retain the flexibility for bold and decisive action. Proper risk management is a combat multiplier that we can ill afford to squander’. This system allows for the use of human health and environmental risk information, but requires that this information be balanced by concerns not found in traditional occupational or environmental setting. The field commander has immediacy for mission accomplishment that may put the importance of long-term health outcome in a lower priority. Those performing human health risk assessments (HHRA) and environmental risk assessments (ERA) must be attuned to potential or required use of their tools to generate data in the context of the field commander. Traditional endpoints (relative life-time risk of cancer, development of chronic illness, etc.) may need to be replaced by specific behavioral andyor performance decrements of importance to mission completion. Medical surveillance must be designed to accommodate the needs of the long-term health maintenance requirement and the short-term impact decision-making requirements (NRC, 2000a,b; DoD, 1997a,b).

In this paper we will propose processes by which traditional risk assessment tools may be used and data developed in terms that are applicable and useful to field commanders in militarily relevant exposure scenarios. 2. Traditional risk assessments The approach and methodology for HHRAs and ERAs have been clearly articulated. As these processes have evolved, a wide variety of considerations have been addressed. These include uncertainty factors, modifying factors, hormesis, slope factors, low-level extrapolation, etc (NRC, 1994, 1983). Only recently have the issues of application to scenarios where default exposure assumption cannot be made, been addressed. Traditional risk assessment has been focused on the prevention of long-term adverse outcomes and the elimination or minimization of all risk to a level acceptable to the general public (10y6). Owing to the most probable exposure circumstances in current and future military operations, equal importance must be given to the unique ways in which risk data will be used and the criticality of performance decrement impact on mission performance. The ‘acceptable’ risk for these exposures may not be as conservative as a probability of 10y6. Table 1 contrasts differences between deployed personnel and type civilian occupational health assessments while Table 2 contrasts differences between environmental risk assessment parameters for deployed personnel and those for the general population. In evaluating potential environmental hazards throughout the world the military uses a tiered system (Still et al., 2000). The Tier I level of assessment strictly identifies industries by categories (e.g. industrial organic chemical manufacturing) and, when known, incorporates the specific chemicals or substances used in the physical hazard and toxicity ranking process. Tiers II and III of the risk assessment methodology are designed to describe the environmental fate of persistent pollutants, and explore the relationships with delayed health outcomes associated with such events. These evaluations are made available to

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Table 1 Differences between deployed personnel and typical civilian occupational health assessmentsa Assessment factors

Deployed personnel

Civilian occupational personnel

Exposure assessment Media

Multiple

Typically single

Types of contaminants

Smokeyobscurants Solvents ChemicalyBiological warfare agents Pesticides Weapons systems materials

Occupation-specific; effects, exposure limits usually known Exposure to militaryunique chemicals limited to specific manufacturing facilities

Identification of contaminants

Contaminants must first be identified and measured. Time is needed to determine local contamination Exposure levels and health effects data not readily available or in useful form

Hazardous chemicals already known; workers warned and protected Ambient air routinely monitored

Sources of contaminants

Many unknown and not characterized Usually a combination of point and non-point sources, fixed andyor mobile May be intentional or accidental May change during mission

Potential sources of contaminants in manufacturing environment are typically known Usually involve one single, stationary point source per incident Sources likely to change much

Contaminant concentrations

May be high because of level of treatmentycontrol or poor design, construction, operations and maintenance, or infrastructure breakdown

Probably lower ambient and workplace concentrations or contaminants under normal operating conditions

Area in which exposure occurs

Can change during mission, may be undefined

Usually defined and limited

Exposure profile

Extended periods

Typically 8 hyday 40 hyweek

Duration of exposure

Months to years

Occupational assessments based on 40 year exposure time

Routes of exposure

All routes possible for acute exposures to toxic contaminants

Typically one route (in regulated occupational exposures)

Exposed population

Typically young, healthy adults

Likely to include sensitive populations, infants, pregnant women, aged, immune deficient, etc.

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122 Table 1 (Continued) Assessment factors

Deployed personnel

Civilian occupational personnel

Exposure assessment Media

Multiple

Typically single

Acute effects producing performance decrements or casualties Any performance degradation effects impacting mission

Chronic effects associated with long term exposure to low concentrations

Chemical emissions data

Emissions data for OCONUS operations may be very limited or totally absent unless military collects it

Major point source emissions data records maintained and available Exposure levels monitored and regulated

Toxicity information

Not readily available in field

Electronically accessible from government agencies for common contaminants

Uncontrolled; unplanned; involuntary Troops located in closer proximity to contaminant sources May be no escape for troops

Controlled by facility design, operations, safety regulations, operator skills and training certification Evacuation plans prepared and posted Contaminant-specific protective clothing and equipment provided

External environment

May be hostile Limitations on logistical and medical support Personnel security may be an issue

Non-hostile environment Logistical and medical support usually available Personnel security not usually and issue

Early-warning systems

May not be available No early-warning systems in event of sudden or deliberate enemy actions

US facilities have early detectyearly warning systems, alarms and evacuation plans

Probability of disaster

High

Not as great because of safeguards in place in US

Hazard identificationyrisk characterization Health effects of greatest concern

Additional risk factors Probability of exposure

a

Adapted from Deployment Toxicology Research and Development Master Plan, Geo-Centers, Inc. September 1997.

the commander as one element in the decision making process (NRC, 2000a,b). 3. Risk management vs. risk assessment Field commanders are risk managers and the role that risks assessment information plays in

their risk management process is misunderstood. As stated in governing instruction, risk management does not imply or require risk elimination (OPNAVyMCO, 2000; CNO, 1997). The nature of military service requires an acknowledgement of acceptable risk above that of the general public.

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Table 2 Differences between deployed personnel and typical general population environmental health assessmenta Assessment factors

Deployed personnel

General population

Exposed to contaminants in multiple media in the field

Multiple media considered; typically one media selected for assessment

Types of contaminants

Some military unique Pesticides may be different from used in US Contaminants associated with older technologies

Military unique contaminants unlikely Pesticide usage controlled, regulated and workers protected Older facilitiesytechnologies being phased out in US

Identification of contaminants

Time needed to determine local environmental conditions Data and information useful to assessment either does not exist or is limited and less accurate May be unknownyundeterminable

Site history, products manufactured, and presence of contaminants usually known Technology for testing for present of contaminants in air, soil, groundwater and surface water available

Source(s) of contaminants

Many are probably unknown Usually a combination of point and non-point sources; fixed and mobile May change during mission

Most are probably known and characterized Point sources more likely to be of interest for water, soil and sediment; fixed sources more significant than mobile sources Sources not as likely to change

Contaminant concentrations

May be higher because of level of treatmentycontrol due to poor design, construction, operation and maintenance or infrastructure breakdown

Probably lower ambient and concentrations of contaminants under normal operating conditions Waste site assessments typically consider direct contact or close proximity

Area in which exposure occurs

Can change during mission, may be large or small

Usually defined and limited

Exposure profile

May be continuous

Exposure assessment considers time actually spent in contaminated area

Duration of exposure

Usually a period of few months up to a year

Lifetime exposures of interest for environmental

Routes of exposure

All routes possible for acute environmental

All routes considered in initial environmental

Exposure assessment Media

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124 Table 2 (Continued) Assessment factors

Deployed personnel

General population

exposure to toxic contaminants

assessments; typically one major route identified

Typically young, healthy adults

Must consider sensitive populations, infants, pregnant women, aged, immune deficient, etc.

Acute effects producing casualties Performance degradation affecting mission

Chronic effects associated with long term exposure to low concentration levels

Chemical emissions data

Emissions data for OCONUS operations may be very limited or totally absent

Major point source emissions data records maintained and available

Toxicity information

Not readily available in the field

Electronically accessible from government agencies for common contaminants

Human healthecological considerations

Human health dominates; ecological effects not as important unless a cause of human health problems or permanent and significant ecological damage Particularly true for conflict situations

Ecologically quality of increasing importance and priority

Probability of exposure

Uncontrolled; unplanned; involuntary Troops located in closer proximity to contaminant May be not escape for troops

Limited to proximity to contaminant source Location of hazardous waste sites of sources of industrial emissions typically known Residents may have choices—leave or stay

External environment

May be hostile Limitations on logistical and medical support Personnel security may be an issue

Non-hostile environment Logistical and medical support available Personnel security not usually an issue

Probability of disaster

High

Not as great because of safeguards in place in the US

Exposure assessment

Exposed population

Hazard identificationyrisk characterization Health effects of greatest concern

a

Adapted from Deployment Toxicology Research and Development Master Plan, Geo-Centers, Inc. September 1997.

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Military field commanders therefore use traditional risk assessment data in a matrix of decision making that gives it significantly different weight than it is given in a civilian setting. Threats to deployed forces can be assessed with tools developed in the civilian risk assessment paradigm, but it must be recognized that the military context is different (Still et al., 2000). Risk assessors must work with the requirements of the field commander and develop the communications skill set that will allow for the optimal use of the tools of their trade by that commander. Military risk management instructions do not allow the commander to completely avoid risk. Risk management assists the commander to conserve lives and resources by avoiding unnecessary risk, making an informed decision to implement a course of action, identify feasible and effective control measures where specific standards do not exist, and provide reasonable alternatives for mission accomplishment. Clearly a broad area of concern is encompassed in the above ‘where specific standards do not exist’. This is an opportunity for the risk assessment (RA) and risk manager (RM) to develop processes from the ground up that will allow for full synergy of expertise and development of an agreed upon lexicon. Military risk management does not inhibit the commander’s and leader’s flexibility or initiative. While military risk management does not remove risk altogether, it also does not support a zero defects mindset. Rather, military risk management allows for a range of decision making vs. a GOy NO-GO decision. RM does not sanction or justify violation of law nor remove the necessity for standard drills, tactics, techniques, and procedures (CNO, 1997; OPNAVyMCO, 2000). A major tool to address some of the differences between classical RA and military RM is communications. It could be contended that part of the reason for the failure of extensive studies to resolve issues around ‘Gulf War Syndrome’ is the failure to acknowledge and address the ‘outrage’ of those who purport to be sufferers (Sandman, 1993; Covello et al., 1983; ACEHR, 1997; NRC, 2000b). However, those who focus on risk communication tools without understanding the underlying para-

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digms only add to the confusion by making inappropriate assumptions. The approach to military risk communication and risk assessment differs from traditional methods in that the communication is organized around the activities associated with military deployments (Briggs et al., submitted;NRC, 2000a,b, 1989). The goal is to communicate an understanding about the likelihood that those events could reduce readiness or interfere with the completion of the mission. Fig. 1 illustrates an approach that has been proposed for the assessment of toxic materials. As shown, the toxic hazards of greatest concern for the field commander are those that quickly and severely affect large numbers of the force. Exposures can result from intentional or unintentional releases or spills of the material. Even these hazards must be set in the context of potentially lethal consequences of combat actions. When addressing the issue of ‘performance deficits’, the research and operational communities must agree upon priorities and interpret risk data within agreed upon limits. For example, the consequences of miosis resultant from exposure to organophosphates are tactically very different for a pilot vs. a combat infantryman. While such considerations may place emphasis on research needs that are not quite as exotic as many researchers would wish, it would result in data that could significantly impact the potential adverse consequences of operations by deployed US military forces in both operations other than war and conflicts. These decisions must be based on quality data from well-planned laboratory animal studies that guide the judgments, which result in effective risk characterization and risk management (Still et al., 2000; NRC, 2000a,b). 4. Operational risk management (military) Each of the military services has described an operational risk management (ORM) process, which includes the following steps (OPNAVy MCO, 2000; CNO, 1997; DoA, 1998). Identify hazards — This step begins with an outline or chart of the major steps in the operation (operational analysis). Following this, a preliminary hazard analysis is conducted by listing all of

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Fig. 1. Dimensions of harm (adapted from Deployment Toxicology Research Development Master Plan, Geo-Centers, Inc. September 1997).

the hazards associated with each step in the operational analysis along with possible causes for those hazards. Assess hazards — For each hazard identified, the associated degree of risk in terms of probability and severity is determined. Although not required, the use of a matrix may be helpful in assessing hazards. Make risk decisions — At the outset, risk control options are developed. singStart with the most serious risk and selection of controls that will reduce the risk to a minimum consistent with mission accomplishment. With selected controls in place, it must be decided if the benefit of the operation outweighs the risk. If risk outweighs benefit or if assistance is required to implement controls, communication with higher authority in the chain of command is necessary. Implement Controls — Engineering and administrative controls are to be implemented considered. These would include modification of

equipment, standard operating procedures, work rotations, personal protective equipment, etc., that are also standard controls for chemical and physical hazards encountered in occupational settings. Supervise — Conduct follow-up evaluations of the controls to ensure they remain in place and have the desired effect. Monitor for changes that may require further operational risk management, and take corrective action when necessary. As can be seen, the process may be done very quickly under field conditions or may be a long involved planning process for major actions. Under this system, risk is characterized by both the probability and severity of a potential loss that may result from hazards due to the presence of enemy forces or some other hazards (physical, chemical, biological) or conditions. The military mission must receive primacy and it may be necessary to accept more risk as accommodations to safety and long-term health outcomes have consequences on military effectiveness (Graham

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Fig. 2. Military operational risk management paradigm (Adapted from NRC Risk AssessmentyManagement Paradigm, Science and Judgement in Risk Assessment, NRC 1994).

et al., 1995; OPNAVyMCO, 2000; NRC, 2000b). An operational example is the requirement of the field commander to consider not only the benefit of using personal protective equipment (i.e. Mission Oriented Protective Posture) to prevent adverse health effects, but also the decrement in mission performance resulting from the use of such equipment. Fig. 2 illustrates the placement of the traditional risk assessment paradigm within the military operational risk management approach. While both processes use common methodology the context in which they are applied is quite different. As human health and environmental risk assessors understand this interplay, they will appreciate the kinds of data to be collected and the context in which those data will be used. Partnering

between the two communities is evolving. In several cases the tools used to define allowable exposure limits in an operational setting are being explored for chemical and physical stressors. Many organized efforts are and have been undertaken to address the issues of emergency exposure and low-level exposure guidelines (AIHA, 2000). Again, the same tools can be used, but must address the confounding exposures that are likely to be realized during military operations and in unique occupationalyenvironmental circumstances. 5. Bridging the gap Significant efforts are being made to further bridge the gap in communications between the

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traditional risk assessors and the field commanders. Efforts are being made to address unique issues such as chronic low-level exposures, emergency exposure levels, effects of multiple simultaneous exposures (high and low level), the interplay between physical and chemical stressors, others. Some strategies wsuch as radiation protection (NRC, 1990; ICRP, 1991; EPA, 1996) AEGLS (NRC, 2001), CEGLySPEGLyEEGL (NRC, 1986); USACPPM, 1999x; have already been developed while there are other non-standard exposure tools under development that could be readily adapted to the new dynamic. Within the military, working groups addressing operational risk issues are comprised of both technical and operational communities. US military forces are now responsible for the environmental impact of and the long-term health outcomes of operations (DoD, 1982, 1997a,b; NRC, 2000a,b). 6. Conclusion The currently used constructs for conducting human health and environmental risk assessments provide a paradigm and set of tools that can be applied to military situations. The data used in such constructs must reflect the priorities and complexities that are unique to the operational requirements of military forces to effectively allow field commanders to meet their mission and limit to the maximum extent possible, adverse health outcomes. Within the context of operational risk management, dialogue between risk assessors and operational personnel must be continuous and in depth to assure that both parties are fully aware of dynamicsydevelopments in the operational environment and the risk assessment approach. References ACEHR (U.S. Army Center for Environmental Health Research). 1997. Deployment Toxicology Research and Development. Frederick, MD September. AIHA (American Industrial Hygiene Association). In: Emergency Response Planning Guidelines and Workplace Environmental Exposure Level Guides Handbook, AIHA, Fairfax. VA, 2000.

Briggs G.B., Still K.R., Wilson C.L. New Risk Communication Strategies to Protect Deployed U.S. Forces, Risk Analysis (Submitted). CNO (Chief of Naval Operations). OPNAV Instruction 3500.39. Operational Risk Management. Department of the Navy, Washington, DC. April 3, 1997. Covello VT, Flamm WG, Rodricks JV, Tardiff RG, editors. The Analysis of Actual Vs. Perceived Risks.Plenum Press, 1983. DoA (Department of the Army). FM 10-4 Risk Management Field Manual. Headquarters, Washington, DC, 1998. DoD Directive 6490.2 – Joint Medical Surveillance, 30 August 1997, 1997a. DoD Directive 6490.3 – Implementation and Application of Joint Medical Surveillance for Deployments, 7 August 1997, 1997b. DoDINST 6055.5M Occupational Health Surveillance Manual, 1982. EPA (Environmental Protection Agency). (EPA 402-R-96016). Radiation Exposure and Risk Assessment Manual (RERAM), Office of Air and Radiation, Washington, DC, June 1996. Graham JD, Wiener JB, editors. Risk vs. Risk: Tradeoff in Protecting Health and the Environment.Harvard University Press, 1995. (International Commission on Radiological Protection). Recommendations of the International Commission on Radiological Protection 1990. Ann ICRP, 1991. NRC (National Research Council). Criteria and Methods for Preparing Emergency Exposure Guidance Level (EEGL), Short-Term Public Emergency Guidance Level (SPEGL), and Continuous Exposure Guidance Level (CEGL) Documents, National Research Council, Washington DC: National Academy Press. 1986. NRC (National Research Council). Health Effects of Exposure to Low Levels of Ionizing Radiation: BEIR V. Committee on the Biological Effects of Ionizing Radiations, National Research Council, Washington DC, National Academy Press, 1990. NRC (National Research Council). Improving Risk Communication. National Academy Press. Washington, DC, 1989. NRC (National Research Council). Risk Assessment in the Federal Government: Managing the Process. National Academy Press. Washington, DC, 1983. NRC (National Research Council). Science and Judgment in Risk Assessment. National Academy Press. Washington, DC, 1994. NRC (National Research Council). Standing Operating Procedures for Developing Acute Exposure Guideline Levels for Hazardous Chemicals, National Research Council, Washington DC: National Academy Press. 2001. NRC (National Research Council). Strategies to Protect the Health of Deployed U.S. Forces: Analytical Framework for Assessing Risks and Workshop Proceedings. National Academy Press. Washington, DC, 2000a.

W.W. Jederberg et al. / The Science of the Total Environment 288 (2002) 119–129 NRC (National Research Council). Strategies to Protect the Health of Deployed U.S. Forces: Assessing Health Risks to Deployed U.S. Forces and Workshop Proceedings. National Academy Press. Washington, DC, 2000b. OPNAVINST 3500.39yMCO 3500.27 OPERATIONAL RISK MANAGEMENT. Washington, DC., 2000. Sandman, PM,: Responding to Community Outrage: Strategies for Effective Risk Communication. Am Ind Hyg Assoc 1993.

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Sonntag DM, Jederberg WW, Lemasters GK, Simpson S, Still KR. Military Occupational Toxicology. In: Greenburg M, Hamilton R, editors. Chapter 22. Occupational, Industrial, and Environmental Toxicology.CV Mosby, 1997:183 –193. Still KR, Briggs GB, Knechtges P, Alexander WK, Wilson CL. Risk Assessment in Navy Deployment Toxicology. Hum Ecol Risk Assess 2000;6(6):1125 –1136. USACPPM TG 230A – Short-Term Chemical Exposure Guidelines for Deployed Military Personnel and May, 1999for Deployed Military Personnel, May 1999.