Page 87 - JSOM Spring 2018

Lead Exposure in the Special Operations Shooter

How to Prevent Cognitive Decline and Permanent Disability

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Jonathan W. Brandon, 18D *; Justin K. Solarczyk, 18D ;
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Timur S. Durrani, MD, MPH, MBA 3

ABSTRACT
Lead toxicity is an important environmental disease and its metal and was used for centuries in plumbing (from plumbum,
effects on the human body can be devastating. Unique expo- Latin for “lead”). Easy manipulation and corrosion resistance
sures to Special Operations Forces personnel may include use have contributed to lead’s continued use today in an array of
of firing ranges, use of automotive fuels, production of am- items, including batteries and bullets. Due to concerns of tox-
munition, and bodily retention of bullets. Toxicity may de- icity, leaded paints were banned in residential housing in the
grade physical and psychological fitness, and cause long-term United States in 1978 and the replacement of leaded pipes and
negative health outcomes. Specific effects on fine motor move- plumbing fixtures remains a pervasive concern in many areas
ments, reaction times, and global function could negatively af- of the United States. 1
fect shooting skills and decision-making. Biologic monitoring
and chelation treatment are poor solutions for protecting this Definition of Lead Poisoning
population. Through primary prevention, Special Operations Laboratory measurement of blood lead level (BLL) is an im-
Forces personnel can be protected, in any environment, from perfect tool for diagnostic and therapeutic medical manage-
the devastating effects of lead exposure. This article offers ment; however, it provides a useful tool for quantifying recent
tools to physicians, environmental service officers, and Spe- lead exposure. The National Institute for Occupational Safety
cial Operations Medics for primary prevention of lead poison- and Health (NIOSH) of the US Centers for Disease Control
ing in the conventional and the austere or forward deployed and Prevention (CDC) manages the Adult Blood Lead Epi-
environments. demiology and Surveillance (ABLES) program. This program
has monitored legally mandated reporting by laboratories of
Keywords: lead toxicity; lead poisoning; environmental health; elevated BLL among employed adults in 41 states. In 2015,
primary prevention CDC/NIOSH revised the reference lead level for adults to 5μg/
dL whole blood, down from 10μg/dL set in 2009, in response
to the latest research findings. Thus, lead poisoning is defined
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as a BLL of higher than 5μg/dL.
Introduction
Special Operations Forces (SOF) Servicemembers receive longer, Exposure
more intensive, and more consistent weapons training than do Lead exposure occurs primarily through inhalation of aerosol-
their conventional counterparts. This extended training is pro- ized particles or through oral ingestion. Current sources of
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vided to increase combat effectiveness under harsh conditions. exposure for US adults are predominantly occupational and
However, an unwanted effect of extended weapons training is recreational. However, the primary pediatric source of expo-
potentially increased exposure to lead. Recent decades have pro- sure is oral consumption of deteriorating paint particles. 4
duced new evidence of the deleterious effects of lead exposure at
levels currently deemed permissible by federal and Army regu- Most small-arms munitions in use today by military and law
lations. Lead toxicity can damage the neurologic, cardiovascu- enforcement are composed of lead bullets that are ejected from
lar, and reproductive systems. Inhibition of the nervous system, a nonlead metal shell. The expulsion of this bullet at high ve-
in particular, could render the most elite human resources less locity through an imperfect cylinder (barrel) results in shearing
effective and subject to greater disability. This article summa- and fragmentation of lead particles. Propulsion of these bullets
rizes contemporary evidence in lead toxicity and the currently is initiated by the detonation of a primer (blasting cap) that
accepted guideline for safe firearms training. We also present may contain lead styphnate (2,4,6-trinitrobenzene-1,3-diol
a suggested path toward primary prevention of lead toxicoses. [lead salt]) and lead peroxide. Detonation leads to expulsion
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of lead-laden fumes (Figure 1). These fumes can be inhaled
during the shooting session or during the range refitting and
Background
cleaning process. Aerosolized lead particles may settle on po-
Lead is an elemental metal that was mined as early as during rous or adsorbable material such as clothing, car seats, and
the Roman Empire for uses ranging from a food additive to carpets, and later inhaled or ingested. Figure 2 depicts lead
coinage. Lead is a very stable, flexible, and corrosion-resistant exposure at a firing range.
*Address correspondence to UCSF Box 1369, San Francisco, CA 94143-1369; or jonathan.brandon@ucsf.edu
1 Mr Brandon is a medical student at the University of California San Francisco. Mr Solarczyk is a premedical student at the University of Cali-
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fornia Berkeley. Dr Durrani is an assistant medical director for the San Francisco Division of California Poison Control System and a preventive
medicine physician assigned to 1st Special Forces Command.
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