>> On behalf of the Centers for
Disease Control and Prevention,
welcome to this presentation of
"Public Health Planning for
Radiological and
Nuclear Terrorism."
I'm Dr. Charles Miller, Chief of
the Radiation Studies Branch in
the National Center for
Environmental Health at the CDC.
We are pleased to offer this new
program because it will help
public health officials and
emergency planners better
prepare for a radiological or
nuclear incident.
Our branch's first public health
satellite broadcast,
on February 3, 2005, was
"The Role of Public Health in a
Nuclear or Radiological
Terrorist Incident."
It provided introductory
material about radiation
principles, potential incident
scenarios, and protective
action guides.
Then, on March 9, 2006, we made
our second satellite broadcast.
This program, called
"Preparing for Radiological
Monitoring and Decontamination,"
provided initial information
about preparing for radiological
monitoring of people following a
terrorism incident.
Audience feedback from these two
broadcasts asked for more
specific guidance about planning
or responses to radiological
terrorism incidents.
This new program was created in
response to those requests.
Using the information in this
program, state, local, and
tribal public health officials
and planners can adapt and
supplement existing disaster
response plans to better prepare
for and respond to radiological
and nuclear incidents.
I highly recommend that you view
the first two broadcasts,
"The Role of Public Health in a
Nuclear or Radiological
Terrorist Incident" and
"Preparing for Radiological
Monitoring and Decontamination,"
as background for this program.
Reviewing the introductory
information in the first two
programs will prepare you for
the more advanced information in
this new program.
The first two programs can be
found on our web site
at www.bt.cdc.gov/radiation.
This program will provide you
with information about --
local government's roles and
responsibilities for planning
and emergency response to a
radiological or nuclear event;
planning for effective
radiological monitoring of
people, including addressing
initial and long-term
monitoring concerns;
pharmaceutical countermeasures
that may be used following a
radiological or nuclear
mass casualty incident, and
developing a communications plan
tailored to an incident
involving potential mass
exposure to radiation.
Our speakers are: first,
Dr. James Smith, former
Associate Director of Radiation,
Division of Environmental
Hazards and Health Effects in
the National Center for
Environmental Health at the CDC;
second, Dr. Jeffrey Nemhauser,
Medical Officer in the
Radiation Studies Branch in the
National Center for
Environmental Health at the CDC;
and last, Dr. Marsha Vanderford,
Director of the
Emergency Communications Branch
in the National Center for
Health Marketing at the CDC.
We sincerely hope that the
additional information in this
latest program will help you
adapt your planning processes to
accommodate the unique aspects
of responding to radiological
and nuclear terrorism.
Your feedback on this program is
most welcome.
You may send your comments or
questions to me at rsb@cdc.gov.
Please continue to check
our website at
www.bt.cdc.gov/radiation
for new information.
We greatly appreciate your
interest in CDC's program for
responding to radiation and
nuclear emergencies.
>> An emergency is an unforeseen
situation that is an imminent
and substantial threat to public
health or safety and that calls
for immediate action.
When we speak of radiological or
nuclear emergencies, we mean
unplanned incidents requiring an
urgent response, that involve at
least the potential for
significant exposures
to radiation.
All emergencies are local.
If a radiological or nuclear
emergency occurs, local public
health officials will need to
determine if they require the
assistance of the state or
tribal public health
organizations.
In turn, these agencies must
decide whether the assistance
of federal public health
response organizations
is required.
In a previous satellite
broadcast in this series, we
provided detailed information on
federal and state government
roles in planning for
and responding to
radiation incidents.
Given the key role played by
local authorities in any
emergency, we emphasize, in this
presentation, the roles and
responsibilities of the local
public health officials.
Without doubt, many agencies
other than public health will
be involved in any such
emergency, but the overarching
goal of all emergency response
activities is to keep people
safe and to protect
their health.
As a reminder --
you may view and download the
federal government's
National Response Plan from
the Department of
Homeland Security's website at
www.dhs.gov.
This plan includes not only the
basic plan, but also the
emergency support functions,
incident annexes,
and appendices.
It also identifies and explains
the concept of operations,
roles and responsibilities,
implementation guidance,
authorities,
and provides references.
The Plan's incident annexes
describe roles and
responsibilities for
specific contingencies,
such as terrorism,
radiological response,
and catastrophic incidents.
The Department of
Homeland Security coordinates
the federal response to
incidents of
national significance, such as
terrorist incidents involving
radioactive materials.
The Department of Health and
Human Services, or HHS,
coordinates public health
aspects of the federal response
to any incident of national
significance involving nuclear
or radiological material.
Again, while all emergencies are
local, if you decide you need
help, remember that CDC
assistance is available.
Health and Human Services has
tasked the CDC to coordinate
with state health agencies in
issues related to:
health surveillance,
public health information,
disease vector control,
worker health and safety,
as well as public health and
medical consultation, technical
assistance, and support.
CDC can also assist in the
management of long-term public
monitoring and support of the
affected population.
If requested,
this assistance includes
collecting and processing blood
samples and body fluids and
advising on medical assessment
and triage of victims.
Federal guidance is also
available from the EPA
as a Manual of Protective
Action Guides and Protective
Actions for Nuclear Incidents.
This is EPA document number 400.
The EPA's Radiation Protection
website offers recommendations
for protecting people and the
environment.
And the
Nuclear Regulatory Commission
offers radiation protection and
regulatory guidelines
at its website.
If so requested by state,
local, or tribal governments,
CDC can offer advice and can
assist in developing these
recommendations.
Nevertheless, in the event of a
nuclear or radiological
terrorist attack, you should be
prepared, within your
communities, to give immediate
protective action
recommendations.
The emergency response planning
for a radiological terrorist
incident should be as consistent
as possible with the planning
that already exists for other
disasters, such as fires,
floods, and HAZMAT incidents.
One of the first and most
important considerations local
governments will face for any
community is determining how
much planning is both necessary
and reasonable.
Most of the major response
roles, and certainly, the
responsibility for them, will
fall to local public health
professionals.
In these cases, it is paramount
that the decision-makers ensure
that no more risk is imposed on
responders and the public than
is absolutely necessary.
In that regard, keep in mind
that certain actions that have
been encouraged or permitted at
other disasters may not apply to
a radiation incident.
One example is the application
of time, distance, and shielding
principles, which were discussed
in depth in other presentations
in this series.
Local public health officials
can and should do as much as
possible in preparing for a
radiation incident.
Of course, to some degree, all
local communities have planned
for emergencies and disasters.
It is not our purpose here to
discuss emergency or disaster
planning in the broadest sense,
rather, we will review those
aspects of planning that pertain
specifically to a
radiation incident.
Most local agencies and
communities have not included
this type of scenario in
their plans.
With this in mind, here are some
specific planning pointers.
Determine public health roles
that include radiation
protection within the emergency
response structure and identify
who will fill those roles.
Identify all equipment,
supplies, communications,
and facilities needed to support
emergency response tasks.
Establish training requirements
for emergency responders that
include radiological principles
and practices.
Assure the existence of safe
shelters for food and
water supplies.
Evaluate what type of radiation
monitoring support and resources
are required wherever shelters
are to be established.
Establish plans for cold, warm,
and hot zones for all emergency
operations.
Determine a protocol for
requesting, when necessary,
deployment from the CDC's
Strategic National Stockpile.
A link to more information on
the stockpile can be found at
the website listed here.
Prepare a plan for coordinating
sampling and laboratory analyses
of biological and environmental
samples for radioactive
contamination.
Establish public, private, and
volunteer teams who, following a
disaster, will conduct a
needs-based assessment of the
affected population.
Identify and train those local
agencies designated to conduct
preliminary damage and
contamination assessment
surveys.
These surveys are designed to
recognize the extent of damage
and contamination to structures
and critical facilities.
Assure that procedures are
established to analyze, compile,
and report the results of these
assessments.
Finally, we would emphasize two
important points.
Identify who is responsible for
health and medical activities,
which include:
safety of water supplies,
proper sanitation,
protection of food supplies,
medical and mortuary services,
preventing or controlling
of epidemics,
and crisis counseling.
Know the name and contact
information for your state
radiation control program
director.
In both planning for and
responding to a radiation
incident, this person is vital.
Planning for the
Emergency Operations Center
is critical.
You must establish procedures
for activation of the EOC and
assure activation can be
accomplished quickly and
effectively.
Ensure the ability to request
needed resources --
for example,
equipment, personnel,
radiological expertise.
And also, track missions that
include weather conditions and
that target population
radiological monitoring.
Establish procedures for
possible EOC relocation.
This need may arise not only
because of damage from an
incident, but also because of
contamination, or the EOC's
original placement in the path
of a contaminated plume.
Provide an organizational chart
defining the day-to-day
operations, emergency
operations, each agency's roles
and responsibilities, and
coordination among state,
local, and tribal agencies.
Make certain that those agencies
with radiological
responsibilities are
properly included.
Communicate with agencies and
stakeholders from inside and
outside the public health
community.
Develop communication messages
specifically for
radiological scenarios.
Develop criteria for entry and
operations within the incident
site, and set exposure
standards and limits.
For example, when is it safe to
re-enter an area or facility.
The EPA provides recommendations
that may be adopted in the
immediate aftermath of
an incident.
These can be found in the EPA
400 Document referred to
earlier.
Determine who is responsible for
what actions in your area and
how to contact them.
Make certain that the list
includes those specifically
responsible for radiological or
nuclear emergencies.
Develop a list of resources
available within your community,
including radiation expertise.
Include websites, such as the
CDC Radiation Emergencies
website, and contact information
for groups, such as the local
fire departments, EPA regional
office, the HAZMAT teams.
And identify in advance local
professional radiation experts,
such as health and medical
physicists, radiation safety
officers, nuclear medicine
staff, and those staff at
facilities with radioactive
material licenses from the
Nuclear Regulatory Commission.
All have radiation detectors and
all have people familiar with
radiation and how to handle
radioactive materials.
Rapid medical response to
nuclear or radiological
terrorism is crucial.
Without special preparation at
the state, local, and tribal
levels, a large-scale attack
involving radiation could
overwhelm the local and perhaps
even the national public health
infrastructure.
Large numbers of patients,
including both the injured and
those concerned about potential
exposure would seek
medical attention.
They would have a corresponding
need for supplies, diagnostic
tests, hospital beds, as well as
information and reassurance.
In addition, if provider
facilities, equipment, and
personnel become significantly
contaminated, the medical
services delivery system might
become quickly disabled.
First responders, hospitals, and
the emergency medical system are
generally responsible for
ensuring that the contaminated,
the injured, and those concerned
about potential exposure are
treated in an efficient manner.
But given the widespread fear of
such an unknown agent such as
radiation, the potential is
enormous for alarm and for major
disruption of everyday life.
Preparedness for radiological
terrorism is an essential
component of the U.S. public
health and surveillance and
response system.
Hospitals and public health
agencies should prepare for
radiological terrorism's unique
features, such as --
mass casualties with blast
injuries combined with burns,
radioactive contamination,
and Acute Radiation Syndrome.
The key to a hospital's capacity
to serve the critically ill is
to recognize that a hospital is
part of a community.
It is important that hospitals
work with their communities --
in particular, that hospitals
work with local and state health
and radiation protection
departments on developing plans
for notifying and communicating.
As mandated by the
Nuclear Regulatory Commission
requirements, most states have
already established such plans
for communities with operating
nuclear power plants.
Even in those communities,
however, the various states need
to plan more broadly than for a
nuclear power plan
incident alone.
Other scenarios involving
radiation are possible,
including incidents discussed in
other parts of this series.
When developing community
response plans, remember that
local hospitals are an integral
part of the community-wide
system for emergency response.
CDC has prepared
Interim Guidelines for Hospital
Response to Mass Casualties
from a Radiation Incident.
This can be found at the CDC
Radiation Emergencies website,
listed here.
CDC's recommendations are based
on the following six
focus areas --
notification and communication,
triage,
patient management,
healthcare provider protection
and resources,
surveillance,
and community planning.
We would encourage you to access
these Guidelines as you prepare
for hospital and medical
response to a
radiation incident.
Also of note, pharmaceuticals
and other medical
countermeasures are a
major issue.
Dr. Jeffrey Nemhauser will
address this important topic as
a separate lecture in
this program.
Discussion of the transport and
treatment of contaminated
patients, of hospital education
and training, and a number of
other issues related to medical
response during and following a
radiation incident are covered
in additional programs available
at the CDC
Radiation Emergencies website.
One of the top priorities
following a radiation incident
is that of screening people for
exposure and contamination,
therefore we are dedicating a
separate presentation to that
topic alone in the series.
The National Council of
Radiation Protection and
Measurements has recommendations
for the general public on
ensuring safe sheltering.
Sheltering is an effective
countermeasure with little
negative impact on the
affected community.
In general, sheltering will
significantly reduce exposure to
external radiation and to
internal contamination.
When escaping through a
radioactive contaminated area,
a reduction of internal
contamination by up to a factor
of 10 may be afforded by
advising people to use ad hoc
respiratory protection.
For example, breathing through
handkerchiefs or towels.
Following passage of the plume,
internal contamination may be
minimized by providing prompt
notification so that people
might open windows and restart
ventilation systems to flush out
any radioactive material that
may have migrated into
the structures.
With regard to worker health and
safety, all workers should be
screened for contamination at
the end of their duty shift,
after decontamination or after
time in the hot zone.
Responders younger than 18 or
with declared pregnancy must
only be allowed to work within
the cold zone.
Health and safety officers for
each agency will be responsible
for maintaining records and
recording radiation doses of
their agency workers.
Some of the many types of
necessary records are shown in
Table 1.
The recovery and re-occupancy
phase in the aftermath of an
incident deals with the
restoration of a contaminated
area, including property and
possessions.
Here are some important
considerations.
In the wake of a major radiation
incident, the decision to
re-occupy premises should be
made on a case-by-case basis
only after a risk-benefit
analysis, taking public health
and welfare into consideration.
Over the course of the clean-up
and recovery, state, local, and
tribal public health agencies
will collaborate with
federal agencies --
such as Homeland Security, EPA,
and the FDA --
to apply protective action
guides for food and water.
If an incident of national
significance occurs,
a previously established federal
interagency effort will be
operating, namely the
Federal Advisory Team for
Environment, Food, and Health.
These agencies will develop
long-term recommendations for
decontamination, re-entry into
contaminated areas, and for
final recovery of the incident
site and the surrounding areas.
In collaboration with the state,
local, and tribal governments,
the federal agencies will also
conduct long-term surveillance
and epidemiological studies.
These studies would include
assisting in the establishment
of registries to monitor health
effects from the incident and
providing information to the
public and responders on what is
known about long-term health
effects associated with
radiation exposure.
Of significant importance is
that public health agencies
establish a registry of affected
