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proximate to the range area. Eating and rest locations should References
be separated from shooting areas by physical distance, with 1. Centers for Disease Control and Prevention. Fourth National
decontamination as needed. Even simple measures, such as Report on Human Exposure to Environmental Chemicals.
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of Occupational Safety and Health. 2015, December 22. Adult
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Education /niosh/topics/ables/description.html Retrieved August 22, 2017
Lead poisoning is not an exciting training topic, especially for 3. National Research Council. Potential Health Risks to DOD
the SOF member who is focused on winning wars and coming Firing-Range Personnel From Recurrent Lead Exposure.

home alive to his or her family. It is the responsibility of the Washington, DC: National Academies Press; 2013.
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6. Madrid GA, et al. Blood lead determinants and the prevalence
of neuropsychiatric symptoms in firearm users in Mexico. Int
• Educate all team members about their unique exposure J Occup Med Environ Health. 2016;219–228.
risk. 7. Tripathi RK, Llewellyn GC. Deterioration of air quality in
• Conduct lead exposure awareness briefings. firing ranges: a review of airborne lead exposures. In GC
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copper-jacketed, or zinc-based nonlead alternatives. 3. New York: Springer US; 1990:445–457.
• Ensure ranges and shoot houses have mechanical venti- 8. Asa-Mäkitaipale S, et al. Memory functions in recreational
lation installed with an airflow goal of 50 feet per min- pistol sport shooters: does lead matter? Environ Health In-
ute past the shooter. sights. 2009;3–13.
• Implement proper use of PPE, such as gloves, while han- 9. NIOSH. Adult blood lead epidemiology and surveillance. 10
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.html. Accessed September 5, 2017.
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• Implement use of (N)-100 or HEPA filter masks for per- levels: United States, 2002–2013. Morb Mortal Wkly Rep. 2014;
sonnel expected to be at the range for 8 or more hours. April 25:347–351.
• Minimize lead particulate inhalation by wearing a mask 11. Papanek PJ, et al. Occupational lead exposure in Los Angeles
during cleanup operations. county: an occupational risk surveillance strategy. Am J Ind Med.
• Schedule comprehensive cleanings using wet mopping 1992. PMID 1536154
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esis, diagnosis, and management. Ann Surg. 1982;305–313.
• Establish standard operating procedures for decontami- 13. Sawe B. Countries that still use gasoline. 2017. http://www.world
nation after shooting and, if possible, implement use of atlas.com/articles/countries-that-still-use-leaded-gasoline.html
change rooms where range clothes can be segregated 14. Kosnett M. Lead. In K Olson (ed). Poisoning & Drug Overdose,
from other attire during the washing process. Sixth Edition. New York: McGraw-Hill Companies; 2012.
15. Centers for Disease Control and Prevention. Fourth National Re-
port on Human Exposure to Environmental Chemicals. Atlanta,
Conclusion GA: Department of Health and Human Services; 2009.
16. Goldman R, Hu H. Adult occupational lead poisoning. 22 Novem-
Lead poisoning is preventable. Without mitigation of lead ber 2016. https://www-uptodate-com.ucsf.idm.oclc.org/contents
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Deterioration in fine motor movements, reaction times, or 17. NHANES III mortality study. Enivorn Health Perspect. 2006;114:
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ment are poor solutions to the problem. Primary prevention is 19. Fischbein A, Hu H. Occupational and environmental exposure to
the answer. SOF leadership is already implementing strategies lead. In WN Rom, SB Markowitz (eds). Environmental and Occu-
that can be used to protect workers in many fields, provid- pational Medicine. Philadelphia: Lippincott Williams & Wil kins;
ing an example for other military and industrial work units. 2007:958.
The most important target audience of this review is the team 20. Valentine WN, et al. Lead poisoning: association with hemolytic
Medics, for they are the doctors in the field and the eyes on anemia, basophilic stippling, erythrocyte pyrimidine 5'-nucleo-
tidase deficiency, and intraerythrocytic accumulation of pyrimi-
the ground. dines. J Clin Invest. 1976;928.
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Disclosures ylation within retrotransposons. Environ Health Perspect. 2010;
The authors have no financial relationships relevant to this 790.
article to disclose. 22. Wu Y, et al. High lead exposure is associated with telomere length
shortening in Chinese battery manufacturing plant workers. Oc-
cup Environ Med. 2012;557–563.
Author Contributions 23. Ni Z, et al. Lead exposure raises superoxide and hydrogen per-
JB and TD conceived the review concept. JB wrote the body oxide in human endothelial and vascular smooth muscle cells.
Kidney Int. 2004;23–29.
of the text. JS wrote the physical exam and education compo- 24. Landrigan PJ. Lead. In L Rosenstock, M Cullen, C Brodkin, C
nents. TD conducted internal review. All authors approved the Redlich (eds). Textbook of Clinical Occupational and Environ-
final version of the manuscript. mental Medicine. Philadelphia: Saunders; 1994:745–754

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