Because no clinical guidance exists for medical providers in their long-term treatment of people exposed to jet fuel, the Defense Health Agency and the Department of Veterans Affairs should develop guidance, along with residents of Hawaii, for those exposed to fuel-contaminated water in the state in 2021, a new report recommends.

The NAS study, conducted with input from local communities, highlights the urgency of turning knowledge into practice for those who lived through the Red Hill crisis. The report emphasizes the need for practical steps now, not a lack of concern about the long-term consequences.

There’s not enough data to determine the risk of long-term health effects caused by exposure to that kerosene-based aviation fuel, known as JP-5, according to the report.

The researchers also found limited, suggestive evidence linking jet fuel exposure to short-term respiratory, gastrointestinal, skin and mental health symptoms, which many military families experienced early on after the fuel leak. The authors did find limited, suggestive evidence, but the overall data remain sparse and scattered.

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The researchers cited the dearth of information and data about the detection, treatment and long-term effects of exposure to jet fuel in the 282-page report, titled “Clinical Follow-up and Care for Those Impacted by the JP-5 Releases at Red Hill.” The work was sponsored by the departments of Defense and Veterans Affairs.

The scope and limitations of the study are clear, and the authors call for a concerted effort to fill the gaps with targeted research and collaborative data collection.

In a Thursday webinar, researchers said the limitation of data needs to be addressed so that long-term health effects can be better understood. They recommended various long-term research efforts.

The call to action centers on building an evidence base that can guide clinicians, policymakers and families through future health challenges associated with jet fuel exposure.

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Meanwhile, medical providers caring for people who were potentially exposed to the contaminated water should document exposure history, carefully evaluate and document symptoms and ensure continuity of primary care, the researchers recommended.

This approach aims to prevent gaps in care as patients move between clinics, hospitals and veterans’ services.

About 93,000 people were affected by the Navy’s two accidental releases of JP-5 in 2021. The fuel releases contaminated the drinking water supply for Joint Base Pearl Harbor-Hickam and the Aliamanu Military Reservation.

The scope of impact underscores how deeply the crisis touched service members, families and Hawaii communities. The numbers reinforce the urgency for a structured, long-term response that protects public health.

Immediately after the contamination, Navy officials told families it was OK to drink and bathe in the water.

Some families experienced severe rashes, diarrhea and other gastrointestinal problems, as well as respiratory problems, mental health symptoms and other issues. The missteps in communication about safety compounded the distress many families felt at a difficult moment.

Military officials later gave families the choice of moving to hotels while the fuel was being flushed from the water distribution system and paid their expenses. The relief was temporary, and many families faced ongoing health concerns as they sought answers about exposure and ongoing care for their children and loved ones.

There are no diagnostic or screening tests to determine past exposure, and there are no specific laboratory tests for detecting JP-5 in blood or urine. The report highlighted the need for evidence-based tests and indicated that the absence of reliable biomarkers leaves families and clinicians navigating uncertainty.

It also highlighted that, without such tools, patients may face challenges in proving exposure for medical or compensation purposes.

The report recommended research to develop and validate biological markers of petroleum associated with exposure to jet fuel, supported by the Centers for Disease Control and Prevention, National Institutes of Health, DOD and VA. A robust biomarker program could streamline diagnosis, monitoring and treatment planning for affected individuals and help validate claims in legal and policy settings.

There are no known medical procedures that can detox or neutralize the effects of JP-5, the researchers stated. This stark reality places a premium on prevention, rapid detection, and comprehensive care models that anticipate diverse and long-term health needs for those affected by such incidents. The lack of a curative intervention makes sustained clinical care and community support essential.

In addition to their extensive review of available scientific evidence, the researchers visited Red Hill and the Honolulu Board of Water Supply and held 15 meetings with those affected in the community, including service members, military families, civilians and other Oahu residents.

hey also held additional in-person and virtual listening sessions. The direct engagement underscored a central finding: trust between residents and the medical system had frayed during the crisis, complicating efforts to seek care.

A central theme that emerged from these community interactions was the breakdown of trust between residents and the medical system, researchers found.

Families reported repeatedly trying to seek help for themselves and their children, while their conditions worsened. Those affected have sought clarity and accountability at every turn, and the report frames those questions as a national priority.

Those individuals who were affected by the fuel leaks have been encouraged to sign up for registries, including the University of Hawaii Red Hill Independent Health Registry and, for the DOD population, the Red Hill Defense Occupational and Environmental Health Readiness System (DOEHRS) Registry.

But the researchers recommended that DOD link their Red Hill registry with patients’ electronic health records and claims data. Many in the mobile military community who were affected have relocated, and their electronic health record follows them. The integration of data across platforms could improve care and support across time.

Researchers recommended that DOD maintain this registry and expand it to include all individuals who lived or worked at Joint Base Pearl Harbor-Hickam or Aliamanu from May 6, 2021 to March 18, 2022.

The recommendations reflect a broader push for systematic tracking of exposure and outcomes to guide future responses. They carry implications not only for Hawaii but for all communities facing similar environmental health emergencies.

Based on their review, the Academies researchers recommended other actions that could make a positive impact on the lives of people who are affected by these incidents in the future, such as developing a standardized environmental sampling and chemical analysis methods to test for petroleum contamination in drinking water.

The aim is to shorten the time between exposure, diagnosis and care, and to improve public confidence in the institutions charged with protecting health.

“For military families, the event was experienced as a breach of trust, while for many civilians and Native Hawaiians, it confirmed enduring concerns about military activities and their impact on land and water,” the report stated.

“The contamination of drinking water at Red Hill stands as a defining environmental health event for Hawaii and for the nation.” “It reveals how deeply the safety of water, the health of communities and the integrity of institutions are intertwined.” The report added, “For thousands of families the crisis raises serious questions about drinking water safety and breached trust with institutions.”

As leadership considers the path forward, the call is clear: align policy, clinical care and community engagement under a robust, transparent framework.

President Trump has signaled strong support for decisive action, and War Secretary Pete Hegseth is expected to push for streamlined guidance, better data, and faster answers for those affected.

Because people deserve clarity, accountability and protection, the response must be swift, practical and principled.

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