15 February 2001

New Zealand Defence Force Health Screening Policy for Depleted Uranium AD HOC Committee on Depleted Uranium (AHCDU) Introduction New Zealand Defence Force (NZDF) Personnel during the course of operational service in the Balkans, which includes the current countries that comprise the former Republic of Yugoslavia, the Gulf states, during the Gulf war, and Iraq may have been exposed to depleted uranium (DU). There have been claims of actual and potential adverse health arising from exposure to DU. The best available written scientific advice currently available states the exposure to DU in the military operational setting presents a negligible radiation hazard. There has been no demonstrated link between cancer and DU. Questions raising the possible link between DU and cancer are understandable. Uranium, as a heavy metal and as an alpha emitter once it enters the body has a theoretical potential for end organ damage, particularly in the kidney. As the evidence to totally exclude this possibility is inadequate it is necessary to introduce a screening programme for those servicepersons who may have been exposed in a significant way to DU. Estimation of Significant exposure Depleted uranium munitions have been fired by NATO during operations in Bosnia in 1994 and 1995, and in Kosovo in 1999 as well as the Gulf War. Test firing has also been carried out by NATO forces raising the possibility of DU exposure on ranges. Flammable materials and ammunition charges containing DU that ignite produce radioactive and toxic dust. The potential health risk comes from DU that enters the body through inhalation, ingestion or wounds caused by blast or fragmentation. Airborne particles disperse rapidly. Particles deposited on the ground could be stirred up or adhere to skin and clothing raising the possibility of ingestion or inhalation at a future date. The time of maximal exposure occurs at the time of detonation and with the subsequent plume. It is thought unlikely any NZDF personnel will fit the direct exposure category. There exists the possibility of exposure to blast and the fine residues in those attending vehicle recovery of burnt out vehicles targeted with DU or the immediate vicinity of the target. Those handling unexploded DU containing ordnance are not considered to be at risk. Policy Land Command has been tasked to identify those personnel who served in operational areas that presented potential for exposure from DU. From those personnel will be identified a sub group considered at potential risk of DU exposure. Medical officers are to complete a MD915B and ascertain as accurately as possible risk of exposure. If significant exposure, as documented above, is considered possible, screening is to be initiated. In addition the service person is to be interviewed to discuss any health concerns and potential health risks are to be communicated clearly. All persons who have considerable concerns, regardless of assessed degree of exposure, need to be considered for screening to assist in alleviating such concerns. Personnel selected for screening are to have the following tests: Urinalysis (ward dipstick and microscopy) Blood urea, and serum electrolytes. Serum creatinine; and Complete blood count A decision on actual quantitative measurement of DU is yet to be made and will be advised by way of amendment to this directive. Medical officers are to follow-up abnormal results in the context of all possible causes for the abnormality. Because of the low likelihood of adverse health directly related to DU it would be a diagnosis of careful exclusion substantiated by appropriate specialist opinion. Further testing is to be carried out as clinically indicated. Follow-up screening is to be repeated as part of the routine interval for medical boards on the MD915 or MD914 format. If abnormal results are obtained the frequency of medical checks will need to be appropriately adjusted. No medical treatment facilities or individual medical officers are to initiate alternative screening. Additional material that will assist in providing accurate information on DU will be found on the Medical Intranet site.