Lead exposure at firing ranges—a review

doi:10.1186/s12940-017-0246-0

Table 1

Blood Lead Levels Observed Following Shooting Firearms at Shooting ranges

			Blood Lead (μg/dL)
Activity	Firing		Mean (Median*)	SD	Range
Type	Range	Category				Location	n	Reference
Occupational
	Indoor
		Arsenal Firing Range Workers	37.2	11.7	22–59.6	Taiwan	10	Chau et al. (1995) [80]
		Arsenal Other Workers	13.3	5.6			98
		Firing Range and Gun Store Employees			19.9–40.7	California, USA	6	CDC (2014) [81]
		Firearms instructor & range cleaning and maintenance	88			New York, USA	1	Fisher-Fischbein et al. (1987) [82]
		Firearm Instructors Before Indoor Training: 4.3%			<20	New York, USA	1	Fischbein et al. (1979) [36]
		Firearm Instructors Before Indoor Training: 82.6%			20–39		19
		Firearm Instructors Before Indoor Training: 8.7%			40–59		2
		Firearm Instructors Before Indoor Training: 4.3%			>60		1
		Firearm Instructors After Indoor Training: 4.3%			<20		1
		Firearm Instructors After Indoor Training: 52.2%			20–39		12
		Firearm Instructors After Indoor Training: 34.8%			40–59		8
		Firearm Instructors After Indoor Training: 8.7%			>60		2
		Firearms Instructors and Officers: 42%			<40	New York, USA	19	Fischbein (1992) [83]
		Firearms Instructors and Officers: 34%			40–60		15
		Firearms Instructors and Officers: 24%			>60		11
		Firearm Instructors	125	15		USA	3	Landrigan et al. (1975) [84]
		Male Police Officers	5		1–18.2	Sweden	75	Löfstedt et al. (1999) [85]
		Female Police Officers	3.7				3
		Full Time Employee	77			Colorado, USA	1	Novotny et al. (1987) [86]
		Full Time Employee	59				1
		Full Time Employee	49				1
		Part Time Employee	41				1
		Shooting range supervisor	5.8	1.6	2.1–17.3	Republic of Korea	35	Park et al. (2016) [87]
		Professional shooter	11.6	1.9	3.0–34.3		24
		Shooting range manager	9.5	2.2	2.0–64.0		61
		All job types	8.6	2.1	2.0–64.0		120
		Firing Range Instructors	5.5	0.6	4.2–6.7	Sao Paulo, Brazil	20	Rocha et al. (2014) [35]
		Cadets - Before Training	3.3	0.15	3.0–3.6		21
		Cadets - After Training	18.2	1.5	16–21		21
		Instructor 1 Before Training	3.6				1
		Instructor 1 After Training	22.1				1
		Instructor 2 Before Training	7.7				1
		Instructor 2 After Training	18.3				1
		Instructors	19	7		Amman, Jordan	31	Abudhaise et al. (1996) [88]
		Trainees	22.9	4.6			54
		Controls	2.1	1.4			unknown
		Police Small Arms Instructors	43.5	6.2	33.1–49.7	England	7	Smith (1976) [89]
		US Coastguard Firearm Instructors - Pre BLL	2.4	1.6	0.9–5.6	Washington, USA	9	Torres (2014) [90]
		US Coastguard Firearm Instructors - Post BLL	2.3	1.2	0.9–4.6		9
		US Coastguard Firearm Instructors - Pre-Post BLL	2.4	1.4	0.9–5.1		9
		Police Trainees: Before Training - (1/29/87)	6.0 (6.4*)			Colorado, USA	17	Valway et al. (1989) [45]
		Police Trainees: Training - (3/3/87)	51.1 (51.6*)				17
		Police Trainees: Training - (3/31/87)	44.3 (43.1*)				17
		Police Trainees: Training - (5/3/87)	39.5 (40.0*)				17
		Israeli Defence Soldiers Baseline	10.3	2.3		Israel	29	Vivante et al. (2008) [37]
		Israeli Defence Soldiers Postexposure	18.8	3.6			29
		Indoor Range Instructors	8.5	7.6		Italy	unknown	Di Lorenzo et al. (2006) [91]
	Indoor/outdoor
		FBI Instructors 1989	14.6		9–21	Virginia, USA	7	CDC (1996) [65]
		FBI Instructors 1990	13.7		6–27		7
		FBI Instructors 1991	7.6		<4–12		14
		FBI Range Techs 1989	16.2		10–24		5
		FBI Range Techs 1990	10.4		6–14		5
		FBI Range Techs 1991	13.6		8–28		5
		US Special Operations Forces - Year 2000	13.90			USA	255	Mancuso et al. (2008) [92]
		US Special Operations Forces - Year 2005	6.80				255
		Adult Target Shooters - Occupational - 21.6%			<25	New York, USA	26	Gelberg and DePersis (2009) [93]
		Adult Target Shooters - Occupational - 50.8%			25–39		61
		Adult Target Shooters - Occupational - 25%			40–59		30
		Adult Target Shooters - Occupational - 2.5%			60+		3
	Outdoor
		Range Instructors	6.7	5.3		Italy	unknown	Di Lorenzo et al. (2006) [91]
		Firing Range Instructors Before Training	41	10	28–66	California, USA	7	Goldberg et al. (1991) [38]
		Firing Range Instructors After Training	45	14	28–70		7
		Firing Range Instructors 6 Months After Training	31	5	28–38		7
		Soldiers Before Basic Training	<0.29			Israel	22	Greenberg et al. (2016) [94]
		Soldiers After Basic Training	1.17	1.73			22
		Soldiers After Advanced Training	3.92	1.99			22
		Body guards	8.10	2.70	3.0–14.4	Mexico	26	Madrid et al. (2016) [41]
		Instructors	7.60	1.40	6.6–8.6		2
		Shooting Range Caretakers	40.65	15.63	29.6–51.7		2
		Administrative	4.20	1.20	2.7–6.5		9
		Security	4.90	1.20	3.0–7.3		9
		Services	6.50	3.60	3.1–14.2		10
		Elite Group	6.40	2.60	4.2–11.4		6
		All Categories	7.60	6.80	2.7–51.7		64
		Howitzer Operators - Baseline	5.5		4.33–6.73	Oklahoma, USA	20	Smart et al. (1994) [40]
		Howitzer Operators - After 3rd Exercise	20.1		17.94–22.44		20
		Howitzer Operators - 8 Weeks After Exposure	11.9		9.92–14.02		12
		Shooting Instructor #1 Non-Jacketed bullets	24.02			Virginia, USA	1	Tripathi et al. (1991) [46]
		Shooting Instructor #1 Copper Jacketed Bullets	21.95				1
		Shooting Instructor #2 Non-Jacketed bullets	14.08				1
		Shooting Instructor #2 Copper Jacketed Bullets	13.04				1
		Outdoor Firing Range Police Cadets: Baseline - Day 0	6	1.1	5–8	Virginia, USA	7	Tripathi et al. (1989) [9]
		Outdoor Firing Range Police Cadets: Day 1	6	1.0	5–8		7
		Outdoor Firing Range Police Cadets: Day 2	11	2.1	7–14		7
		Outdoor Firing Range Police Cadets: Day 5	15	5.4	9–26		7
		Outdoor Firing Range Police Cadets: Day 69	9	2.8	6–14		7
Non-Occupational
	Indoor
		High School Shooting Coach	44			Alaska, USA	1	CDC (2005) [56]
		Firing Range A (School Range) - Students Aged 15–17 years	24.3		21.0–31.0		7
		Firing Range B (Commercial) - Students Aged 13–16 years	2.1				8
		Firing Range C (Volunteer Run) - Students Aged 15–19 years	18.5		5–37		24
		Firing Range D (School Range) - Students Aged 14–17 years	8.9		3.0–14.0		7
		Firing Range E (Volunteer Run) - Students Aged 7–17 years	7.6		2–13		20
		Shooter	9.2*		2.7–52.1	Germany	129	Demmeler et al. (2009) [44]
		Shooter: Q1 200 rounds/month	8.7*		2.8–31.4		27
		Shooter: Q2 200–399 rounds/month	9*		2.7–31.5		28
		Shooter: Q3 400–680 rounds/month	11.8*		2.9–37.5		29
		Shooter: Q4 > 680 rounds/month	13.8*		3.7–52.1		23
		Airguns	3.3*		1.8–12.7		20
		Airguns and .22 caliber	8.7*		1.4–17.2		15
		.22 lr bore & large caliber	10.7*		2.7–37.5		51
		Large caliber handgun	10*		2.8–32.6		32
		IPSC (International Practical Shooting Federation)	19.2*		3.2–52.1		11
		Adult Target Shooters - Both Occupational & Non-Occupational - 1.5%			<25	New York, USA	2	Gelberg and DePersis (2009) [93]
		Adult Target Shooters - Both Occupational & Non-Occupational - 71.3%			25–39		92
		Adult Target Shooters - Both Occupational & Non-Occupational - 20.9%			40–59		27
		Adult Target Shooters - Both Occupational & Non-Occupational - 6.2%			60+		8
		Small Bore Rifle Shooter - End of Indoor Season	54.65			New Zealand	52	George et al. (1993) [39]
		Small Bore Rifle Shooter - Preseason Following Year	33.13				37
		Shooting Range #2	10.5	7		South Africa	30	Mathee et al. (2017) [15]
		Shooting Range #3	16.1	9.8			17
		Shooting Range #4	19.2	16.3			14
		Child (Age 1 year) - “index case”	46			USA	1	Moore (1995) [95]
		Mother - (Age 25 years)	11				1
		Father - (Age 25 years)	15				1
		Sibling - (Age 4)	14				1
		Sibling - (Age 2)	19				1
		Cousin - (Age 6)	28				1
		Cousin - (Age 8)	31				1
		Aunt - (Age 37)	30				1
		Child (Age 1 year.) “index case”: 3 Months After Intervention	19				1
		Mother - (Age 25 years): 3 Months After Intervention	8				1
		Father - (Age 25 years): 3 Months After Intervention	Not Measured				1
		Sibling - (Age 4): 3 Months After Intervention	11				1
		Sibling - (Age 2): 3 Months After Intervention	12				1
		Cousin- (Age 6): 3 Months After Intervention	13				1
		Cousin - (Age 8): 3 Months After Intervention	13				1
		Aunt - (Age 37): 3 Months After Intervention	13				1
		Indoor Shooting Range Employee Spouse	6			Colorado, USA	1	Novotny et al. (1987) [86]
		Indoor Shooting Range Employee Spouse	11				1
		Indoor Shooting Range Employee Spouse	6				1
		Recreational Shooters	29*		24–45	Germany	7	Ochsmann et al. (2009) [6]
		Competitive Marksmen - Adolescents Aged 14–16 years	21.3		18–28	Massachusetts, USA	4	Shannon (1999) [57]
		Shooters before indoor shooting season	10.6*		3.2–17.6	Sweden	22	Svensson et al. (1992) [96]
		Shooters after indoor shooting season	13.8*		6.9–28.8		22
		Airgun Shooters before indoor shooting season	9.1*		4.7–17.9		21
		Airgun Shooters after indoor shooting season	8.4*		2.0–22.2		21
		Archers before shooting season	6.1*		2.7–9.2		13
		Archers after shooting season	5.6*		3.1–8.7		13
		Shooter: shot 600 rounds 3 times per week for past 4 months	43.5			United Kingdom	1	White (1996) [97]
	Indoor/Outdoor
		Shooter	45	6.3	35–47	Connecticut, USA	6	Cook et al. (2015) [98]
		Irregular Frequency Indoor and Outdoor Shooter	6.7			Australia	1	Gulson et al. (2002) [99]
		Archers who also shot guns	7.8	10.26		South Africa	15	Mathee et al. (2017) [15]
		Gun shooters only (excluding archers and employees)	12.13	10.18			62
		Gun shooters who also work at the shooting range	16.3	7.83			8
		All gun shooters (including archers and employees)	11.9	10.15			85
		Less than monthly	8.4	5.5			23
		> monthly, but less than weekly	11.8	8.7			35
		> weekly, but < 3 times per week	14.3	15.2			21
		>3 times per week	12.5	9.7			7
		Pistol Sport Shooters	10.76	8.28		Helsinki, Finland	20	Asa-Mäkitaipale et al. (2009) [42]
	Outdoor
		Archery Range	4.5	2.7		South Africa	14	Mathee et al. (2017) [15]
		Shooting Range #1	7	4.3			12
		Practised archery only	3.3	2.25			31