V. LESSONS LEARNED AND RECOMMENDATIONS
DU appears destined to play a major role on future battlefields. The Services need to ensure that all personnel who could be deployed into theaters where DU may be used are aware of its potential environmental and occupational hazards. This would include non-combat medical and support personnel who could find themselves treating DU casualties or repairing DU-contaminated vehicles.
A. Improvements in Training and Awareness
In recognition of the unease with which many people view all things radiological, training and education must address DUs radiological and toxicological properties, as well as ways to minimize any possible risk. All military members should be required to attend annual training courses on DU, preferably incorporated into existing annual Nuclear Biological and Chemical (NBC) initial or refresher training courses. Since DU ammunition is now available to other nations, contamination from DU could be widespread on future battlefields. Therefore, the knowledge, expertise, and equipment to prevent or mitigate exposures must be equally widespread.
In addition to education and training, Service guidance must reflect an elementary recognition of DU as a hazardous material and battlefield contaminant. Regulations, checklists, operating instructions, field standard operating procedures, medical emergency and surgical treatment standards, and other guidance must reflect sound, accurate, and current guidance regarding procedures to be followed in a DU environment in keeping with the principle that exposures should be prevented or minimized whenever possible.
The test and evaluation programs that paved the way for the fielding of DU munitions and armor acknowledged the potential for creating battlefield DU contamination. The Department of Defense (DoD) recognized the need to protect troops who might have to operate in such environments. Unfortunately, most of the guidance issued before and during the war was oriented toward peacetime accidents on US military installations, rather than addressing the very different demands of wartime and contingency operations. A number of memorandums and advisories (described in Tab O) containing simple, field expedient precautions and advice were sent to the theater, but often failed to reach units and troops who had to respond to accidents and events involving DU contamination.
The DoD has acknowledged that pre-war DU awareness training was inadequate. Abrams crewmen received a brief block of training on the peacetime, regulatory requirements for handling DU munitions. More extensive training was provided to Nuclear-Biological-Chemical (NBC) response personnel assigned to most units, as well as EOD, RADCON, and safety personnel. In general, this information was not shared outside these units or agencies. The lack of DU awareness was identified as a deficiency, as evidenced by a May 24, 1991, memorandum from the Armament Munitions and Chemical Command (AMCCOM) to the Training and Doctrine Command (TRADOC) recommending that DU safety training be given to all armor and infantry soldiers and officers who required it.
On September 9, 1997, the Special Assistant for Gulf War Illnesses wrote a memorandum to the Chief of Naval Operations, Chief of Staff of the Air Force, and Commandant of the US Marine Corps directing them to "ensure that all Service personnel who may come in contact with DU, especially on the battlefield, are thoroughly trained in how to handle it." The US Armys Training and Doctrine Command published Training Support Packages (TSPs) for respective training schools in September 1997. It is too early to evaluate the effectiveness of this training.
On January 7, 1998, John J. Hamre, Deputy Secretary of Defense sent a follow-up memorandum to the Service Secretaries requesting that they provide him with an outline of the Services depleted uranium training program. This program required identification of personnel categories to receive the training, a schedule for full implementation, and plans for periodic retraining. The Services responded in March 1998, outlining their respective plans along with implementation schedules. Although the Services are expanding their DU training efforts, their actions to date have only marginally improved their ability to contend with DU hazards. Full implementation of the various training programs will be underway during the summer of 1998. The Office of the Special Assistant will continue to monitor the status of the Services DU training efforts.
B. Developing Medically and Operationally Appropriate Guidance
During and after the Gulf War, the primary source of guidance concerning DU accidents was US Army Technical Bulletin (TB) 9-1300-278, "Guidelines for Safe Response to Handling, Storage, and Transportation Accidents Involving Army Tank Munitions or Armor Which Contain Depleted Uranium." This TB was developed for peacetime accidents and not intended for direct application to combat scenarios. It needs to be rewritten to reflect the realities that will be encountered in operational or battlefield situations. TB 9-1300-278 currently emphasizes the use of MOPP 4 personal protective equipment when operating in a DU-contaminated environment. In reality, MOPP 4 is inappropriate given the actual hazard, creates significant heat stress problems and degrades personal performance and operational efficiency.
This issue has been recognized by the Army, which has taken steps to remedy the situation. A meeting was conducted in April 1998 to discuss organizational roles and responsibilities relative to low level radioactive hazards in operational settings. An Integration Process Team (IPT) was formed to review low-level radiation as well as nuclear, biological, and chemical hazards, and associated environmental issues. At the soldier level, the Army has developed a new training task "Respond to Depleted Uranium /Low-Level Radioactive Materials (DULLRAM) Hazards." All soldiers must receive this training and demonstrate the appropriate knowledge of the hazard and how to respond to it before they are considered combat-ready. This training, due to commence in FY99, should produce a dramatic, sustained improvement in troop awareness of DU. This new training and its anticipated benefits are detailed in Tab O, Guidance for Protecting Troops.
C. Timely, Effective Dissemination of Information
In addition to instilling awareness of DU in troops, leaders, and units, advisories or warning messages issued by agencies such as AMCCOM must be disseminated in a timely, effective manner to the troops and units requiring that information. Specific reporting procedures and points of contact must also be established and institutionalized so that the information "disconnects" that occurred during the Gulf War are not repeated. Currently, agencies such as the Army Safety Office and the Army Medical Command have well-developed channels for issuing alerts and advisories that reach soldiers through the chain of command as well as unofficial channels like Armed Forces Radio. Many of these existing channels could be used to reinforce and expand servicemembers ability to operate safely in DU-contaminated environments.
D. Responsive Support to Tactical Ground Units
With few exceptions, most tactical ground units lack the requisite resources or training to effectively respond to large-scale incidents or events involving the uncontrolled release of DU. These units are, of necessity, structured, manned, equipped, and trained to execute a wartime mission. It is not reasonable or realistic to force these units to assume primary responsibility for health physics/industrial hygiene requirements, particularly at deployed locations. Instead, tactical commanders should be able to count on timely, effective support from dedicated radiation control (RADCON) teams and other specialists, as required.
The post-war ammunition explosion at Camp Doha, Kuwait is an instructive object lesson concerning the need for more rapid, responsive health physics/industrial hygiene support for deployed units. In the first week following a fire that damaged or destroyed 660 DU rounds and three M1A1 Heavy Armor tanks, the unit commander and his staff were forced to rely on the units integral NBC assets for advice and assistance in dealing with DU contamination. Unfortunately, these NBC assets were trained and equipped to respond to battlefield nuclear contamination, not accidents involving DU. Although they were familiar with DU and could carry out limited surveys and cleanup efforts, their effectiveness in this role was limited. Although RADCON teams were dispatched to Doha, they did not reach the base until a week after the firea week during which the unit leadership, with insufficient knowledge about DU or how to respond to DU contamination, sent troops into an area in which DU contamination was present without any personal protective equipment or DU awareness training. In addition, the RADCON teams deployed to Doha were not sent to support the unit or installation, per se, but rather to decontaminate and remove three contaminated M1A1 tanks and any exposed DU penetrators found in the immediate vicinity. The teams had little interface with the Commander and his staff, and left the installation when their mission was complete. Before, during, and after the RADCON teams arrival, hundreds of soldiers conducted clearing and cleanup operations in an area with localized DU contamination, without being told about the potential hazard from DU or simple, field-expedient ways to prevent or minimize potential exposures. In future deployments, the Commander, his staff, and unit personnel should be supported by a more robust and responsive in-theater health physics/industrial hygiene capability.
E. Clear and Unambiguous Division of Responsibility
Given the likelihood of future decontamination/recovery scenarios, executive agents need to be clearly identified and the scope of their duties sufficiently delineated to clearly establish responsibility and accountability for all aspects of the radiation control effort. Most fixed facilities such as Air Force bases have designated specialty teams, e.g., disaster preparedness and bioenvironmental engineering teams with well-defined roles of responsibilities. The responsibilities within operational units, as described above, are not as well defined.
F. Collection and Reporting of Survey and Monitoring Results
Post-exposure assessments are difficult to quantify in the absence of specific data such as radiation readings. Much of the current anxiety surrounding DU might have been allayed if survey and monitoring efforts had been better documented, and medical testing (e.g. 24-hour or spot urines) accomplished as necessary. According to Army Regulation 40-5, "The necessity, frequency, and methodology for performing bioassay procedures will depend on the radionuclide(s), their chemical and physical form, and the amount of material potentially available for entry into the human body." Memories corroborated by anecdotal evidence are insufficient to provide conclusive answers to troops who may or may not have been exposed to DU. In the future, radiation control and related medical efforts must be documented in sufficient detail to determine who was exposed, and to what degree.
The AN/PDR-27, AN/PDR-77 and AN/VDR-2 RADIAC instruments were primarily designed for battlefield nuclear exposures and are less than ideal for detecting and measuring the weak emissions given off by DU. Although improved RADIAC equipment has been deployed with US forces in Bosnia, its availability is limited. Radiation detection equipment must be readily available in combat units to expedite the identification of DU-contaminated vehicles.
The Services need to review their current Personal Protective Equipment (PPE) to ensure that personnel are able to operate safely in a DU environment. Current MOPP-4 gear, while affording protection in most chemical, biological, or radiological environments, can cause a rapid degradation in personal performance, especially in desert conditions and is excessive for most situations involving DU. Since DU contamination appears to be more likely than chemical, biological, or nuclear weapons scenarios, the Services should assess their current requirements to determine if supplemental, lightweight respirators and similar DU-suitable protective equipment could be acquired to replace MOPP-4 in the DU remediation (but not NBC protection) role.
In response to the wartime NBC hazard, procedures have been developed to mark contaminated vehicles or to create chemical hazard areas. Similar procedures should be considered for marking DU-contaminated vehicles and areas.
Considerable research was conducted on the environmental and medical implications of DU munitions during their developmental cycles. However limited research was devoted to establishing the medical effects from embedded DU fragments. Postwar efforts to fill this gap have been initiated through AFRRIs research (described earlier in Section IV.D) and the Department of Veterans Affairs surveillance and follow-up program (the Baltimore DU Program described in Section IV.C). The objective of this follow-up program is to determine whether the current criteria for removal of metal fragments applies to embedded DU fragments. While results to date indicate no requirement to change existing criteria, continued follow-up is required.
Current and future military munitions and equipment development efforts must evaluate all potentially harmful materials (including tungsten and lead) in the full context of operational exposures. While there are ongoing efforts aimed at fratricide prevention, development efforts must recognize fratricide related exposure scenarios as well as the probability of the enemy possessing and using potentially harmful materials. It is clear that DU will be used by future adversaries.
Research is needed to develop better estimates of the amount of depleted uranium that may be internalized by personnel entering vehicles after fires involving depleted uranium, or entering vehicles struck by depleted uranium. This information is required to determine and/or validate peacetime standards of practice and to help in establishing standards of practice for all military operations involving these munitions. This research is the foundation upon which technical bulletins and regulations prescribing DU precautions, exposure reporting, and medical monitoring must be based.
Because bio-monitoring of troops immediately after potentially significant exposure to DU (i.e., friendly fire incidents, immediate rescue efforts and working inside DU contaminated vehicles) was not done during the Gulf War, there are no medical data from such exposures for scientific evaluation. While peacetime bio-monitoring programs are in place, standards and guidance for specific bio-monitoring during combat must be developed and implemented. This monitoring must be tailored to the operational setting, recognizing that data collection during combat would be more difficult than in the postwar cleanup phase.
In this report, the Office of the Special Assistant for Gulf War Illnesses has presented a history of depleted uranium development, its use during the Gulf War, and resulting exposures. The investigation examined DUs propertieschemical and radiologicaland what the potential health risks of those properties could mean to an exposed individual.
Each of the DU-exposure incidents reported to date was investigated and analyzed in detail. Investigative efforts were aimed at establishing the facts and circumstances surrounding each incident and determining who might have been exposed. This effort is still ongoing, but the investigation has determined the essential facts of the most serious (Level I and II) exposure incidents and scenarios, as well as identifying many of the participants.
The report acknowledges that many American soldiers were exposed to DU through wounds, inhalation, ingestion, or bare skin contact. It also identifies and addresses significant shortcomings in the way US troops were trained to operate in environments where DU contamination was present, and identifies lessons learned that can be applied to future operational deployments. Further, it outlines steps this Office has taken to ensure that DU training and awareness receives proper emphasis from all Service components.
This report notes past inconsistencies between peacetime guidance and wartime practices. It explains why much of the guidance in place at the time of the Gulf War was excessive or disproportionate to the actual exposure hazard. It makes the case that future guidance must be practical and applicable to battlefield operations where contact with DU, under uncontrolled conditions, can occur over a broad range of environments.
The report outlines the new, expanded medical follow-up program aimed at identifying, evaluating, and providing medical follow-up, if need be, to personnel likely to have incurred the highest DU exposures. Although the focus of the notification effort is on these participants, soldiers who had lesser exposures can also request an evaluation for DU exposure.
In tandem with efforts to identify exposed personnel, efforts were undertaken to assess the possible health risks and medical significance of various exposure groups. Experts in relevant fields were consulted and expert literature was reviewed. The US Army Center for Health Promotion and Preventive Medicine (CHPPM), is currently performing DU dose assessments in an effort to apply refined data (from computer modeling and live-fire test results) to the study of DUs health effects. The RAND Corporation is doing an independent review of medical and scientific literature on known medical and health effects. Although CHPPM and RAND efforts are ongoing, preliminary estimates of worst case exposures do not indicate a significant radiological hazard. The medical significance of the preliminary chemical (heavy metal) estimates in humans is more difficult to determine and may be clarified once the RAND effort is completed.
Since 1993, the Department of Veterans Affairs has been monitoring 33 vets who were seriously injured in friendly fire incidents involving depleted uranium. These veterans are being monitored at the Baltimore VA Medical Center. While these veterans have very definite medical afflictions resulting from their wartime injuries, they are not sick from the heavy metal or radiological toxicity of DU. About half of this group still have depleted uranium metal fragments in their bodies. Those with higher than normal levels of uranium in their urine since monitoring began in 1993 have embedded DU fragments. These veterans are being followed very carefully and a number of different medical tests are being done to determine if the depleted uranium fragments are causing any health problems. The veterans being followed who were in friendly fire incidents but who do not have retained depleted uranium fragments, generally speaking, have not shown higher than normal levels of uranium in their urine.
Previous research has demonstrated that the organ that is most susceptible to damage from high doses of uranium is the kidney. For the 33 veterans in the program, tests for kidney function have all been normal. In addition, the reproductive health of this group appears to be normal in that all babies fathered by these veterans between 1991 and 1997 had no observable birth defects.
For the broader veteran population, data derived from the DoDs Comprehensive Clinical Evaluation Program that has evaluated tens of thousands of Gulf War veterans might be more applicable. Thus far, very few Gulf War veterans have been diagnosed with types of kidney damage for which depleted uranium would be on the list of possible causative agents. The rates of these diagnoses in this self-selected population (participation in the CCEP is voluntary) are consistent with the rates of similar kidney problems found in the general US population. By definition, those veterans with undiagnosed illnesses have not had any evidence of kidney damage. Therefore, there is no evidence that Gulf War veterans are experiencing adverse health effects from DUs chemical toxicity.
The reports bottom-line conclusion, based on a comprehensive review of available data and a science-based methodology, is that exposures to DUs heavy metal (chemical) toxicity or low-level radiation are not a cause of the undiagnosed illnesses afflicting some Gulf War veterans.
This case is still being investigated. As additional information becomes available, it will be incorporated. If you have records, photographs, recollections, or find errors in the details reported, please contact the DoD Persian Gulf Task Force Hot Line at 1-800-472-6719.
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