. "Appendix A: Workshop Agendas." Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event: Workshop Report. Washington, DC: The National Academies Press, 2009.
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Assessing Medical Preparedness to Respond to a Terrorist Nuclear Event: Workshop Report
Appendix A Workshop Agendas
ASSESSING MEDICAL PREPAREDNESS TO RESPOND TO ATERRORIST NUCLEAR EVENT: WORKSHOP 1
Committee on Medical Preparedness for a Terrorist Nuclear Event
PUBLIC AGENDA
Day 1
Thursday, June 26, 2008
Lecture Room
National Academy of Sciences
2101 Constitution Avenue, N.W.
Washington, DC
Workshop Objectives:
The purpose of the workshop is to assess the current level of medical preparedness for a nuclear detonation of up to 10 kilotons (kts) in Tier 1 Urban Area Security Initiative (UASI) cities (New York/New Jersey; National Capitol Region; Houston; Chicago; Los Angeles; and San Francisco/Bay Area). The specific objectives of the workshop are to
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Appendix A
Workshop Agendas
ASSESSING MEDICAL PREPAREDNESS TO RESPOND TO A TERRORIST NUCLEAR EVENT: WORKSHOP 1
Committee on Medical Preparedness for a Terrorist Nuclear Event
PUBLIC AGENDA
Day 1
Thursday, June 26, 2008
Lecture Room
National Academy of Sciences
2101 Constitution Avenue, N.W.
Washington, DC
Workshop Objectives:
The purpose of the workshop is to assess the current level of medical preparedness for a nuclear detonation of up to 10 kilotons (kts) in Tier 1 Urban Area Security Initiative (UASI) cities (New York/New Jersey; National Capitol Region; Houston; Chicago; Los Angeles; and San Francisco/Bay Area). The specific objectives of the workshop are to
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review and summarize the overall emergency response activities and available health care capacity (including shelter, evacuation, decontamination, and medical infrastructure interdependencies) to treat the affected population;
examine the capacity and identify gaps in the capability of the federal, state, and local authorities to deliver available medical countermeasures in a timely enough way to be effective;
review and summarize available treatments for pertinent radiation illnesses, including the efficacy of medical countermeasures; and
appraise the expected benefit of medical countermeasures, including those currently under development.
8:30 a.m.
Welcome, Introductions, and Overview of Workshop Purpose and Objectives
GEORGES C. BENJAMIN, Committee Chair
Executive Director
American Public Health Association
B. TILMAN JOLLY
Office of Health Affairs
Department of Homeland Security
SESSION 1
NUCLEAR ATTACK 101: HEALTH AND HEALTH SYSTEM IMPACTS OF AN IMPROVISED NUCLEAR DEVICE EXPLOSION
Session Objectives: Provide basic information on the scope of the emergency medical needs that would be created by the detonation of a 10-kt nuclear device in a major city, including primary and secondary blast and thermal effects and the effects of prompt nuclear radiation and radiation from fallout on inhabitants and emergency responders. The main focus will be on the acute injuries caused by the blast, thermal, and prompt radiation effects of the initial explosion and by acute radiation exposure from fallout during the first three days after the explosion (excluding other important but longer-term impacts, such as long-term radiation effects, environmental contamination, and displacement of residents from contaminated areas). The potential impacts of the explosion on local emergency response and health system capacities will also be described. At the end of the session, workshop participants will have a basic understanding of the medical situation faced
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by emergency responders during the first 3 days post-explosion, which in turn will be the basis for assessing current medical preparedness at the local, state, and federal levels.
9:00 a.m.
Session Overview and Objectives
DANIEL F. FLYNN, Session Moderator
Department of Radiation Oncology
Caritas Holy Family Hospital and Medical Center
Methuen, MA
9:05 a.m.
Health Effects of a 10-kt-Equivalent Nuclear Explosion on an Urban Population and Emergency Responders
BROOKE BUDDEMEIER
Radiation Safety Specialist
Radiological and Nuclear Countermeasures Division
Global Security Principal Directorate
Lawrence Livermore National Laboratory
9:35 a.m.
Health System Impacts of a 10-kt-Equivalent Nuclear Explosion on an Urban Area
CHAM DALLAS
Director, Institute for Health Management and Mass Destruction Defense, University of Georgia
Chair, Department of Health Policy and Management, College of Public Health, University of Georgia
Department of Pharmaceutical & Biomedical Sciences, College of Pharmacy, University of Georgia
Department of Emergency Medicine, Medical College of Georgia
10:05 a.m.
Discussion led by
Daniel F. Flynn, Session Moderator
10:35 a.m.
BREAK
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SESSION 2
EMERGENCY MEDICAL CARE: STATE OF THE ART
Session Objective: Provide an overview of current approaches to medical response in the event of an improvised nuclear device (IND) explosion. The first presentation will cover the triage, decontamination, evacuation, and medical care of casualties from the immediate effects of a nuclear detonation (i.e., treatment of blast, thermal, and prompt radiation effects, including combined injuries). The second presentation will cover medical decision making and care of casualties from the delayed effects of a nuclear detonation (i.e., secondary triage and injuries from radioactive fallout).
10:45 a.m.
Session Overview and Objectives
DONNA F. BARBISCH, Session Moderator
President
Global Deterrence Alternatives, LLC
Washington, DC
10:50 a.m.
Urban Nuclear Detonation: Operational Conditions, Human Response and Casualty Management
JOHN MERCIER
Director of Military Medical Operations
Armed Forces Radiobiology Research Institute
11:20 a.m.
Medical Decision Making and Care of Casualties from Delayed Effects of a Nuclear Detonation
FRED A. METTLER, JR.
Professor Emeritus
Department of Radiology
New Mexico Federal Regional Medical Center
University of New Mexico
11:50 a.m.
Discussion led by
DONNA F. BARBISCH, Session Moderator
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12:20 p.m.
WORKING LUNCH IN THE LECTURE ROOM
Committee, speakers, participants, and staff will briefly recap the discussions from the morning sessions of the first day of the workshop.
SESSION 3
RADIATION COUNTERMEASURES
Session Objective: Provide an overview of current medical countermeasures for the acute effects of radiation exposure and of their efficacy as well as an assessment of the expected benefit of medical countermeasures currently under development.
1:30 p.m.
Session Overview and Objectives
RICHARD J. HATCHETT, Session Moderator
Associate Director of Radiation Countermeasures Research and Emergency Preparedness
National Institute of Allergy and Infectious Diseases
1:35 p.m.
Efficacy and Expected Benefit of Currently Available Radiation Countermeasures
ALBERT L. WILEY, JR.
Radiation Emergency Assistance Center/Training Site and World Health Organization Collaborating Center for Radiation Emergency Assistance
Oak Ridge Associated Universities
2:05 p.m.
Expected Benefit of Radiation Countermeasures Currently Under Development
NELSON J. CHAO
Professor of Medicine and Immunology
Chief, Division of Cellular Therapy
Duke University Medical Center
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2:35 p.m.
Distribution and Dispensing of Medical Countermeasures (i.e., How and When Will Countermeasures Get to Those Who Need Them?)
CARMEN T. MAHER
Policy Analyst
Office of Counterterrorism and Emerging Threats
Food and Drug Administration
STEVEN A. ADAMS
Deputy Director
Division of Strategic National Stockpile
Centers for Disease Control and Prevention
3:00 p.m.
Discussion led by
RICHARD J. HATCHETT, Session Moderator
3:30 p.m.
BREAK
SESSION 4
PROTECTIVE ACTIONS AND INTERVENTIONS: PART I
Session Objective: Provide an overview of current policies and programs to protect first responders and medical personnel from radiation exposure.
3:45 p.m.
Session Overview and Objectives
PAUL E. PEPE, Session Moderator
Professor of Medicine, Surgery, Pediatrics, and Public Health and Riggs Family Chair in Emergency Medicine
University of Texas Southwestern Medical Center at Dallas
3:50 p.m.
Radiation Protection Standards
SARA D. DECAIR
Health Physicist
Center for Radiological Emergency Preparedness, Prevention, and Response
Environmental Protection Agency
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JOHN MACKINNEY
Deputy Director
Nuclear/Radiological/Chemical Threats and Science and Technology Policy, Office of Policy Development
Department of Homeland Security
JILL A. LIPOTI
Director
Division of Environmental Safety and Health
New Jersey Department of Environmental Protection
ERIC G. DAXON
Health Physicist
Battelle Memorial Institute–San Antonio Operations
4:40 p.m.
Discussion led by
PAUL E. PEPE, Session Moderator
5:10 p.m.
ADJOURNMENT
ASSESSING MEDICAL PREPAREDNESS TO RESPOND TO A TERRORIST NUCLEAR EVENT: WORKSHOP 1
Committee on Medical Preparedness for a Terrorist Nuclear Event
PUBLIC AGENDA
Day 2
Friday, June 27, 2008
Auditorium
National Academy of Sciences
2101 Constitution Avenue, N.W.
Washington, DC
8:30 a.m.
Welcome, Introductions, and Overview of Workshop Purpose and Objectives
GEORGES C. BENJAMIN, Committee Chair
Executive Director
American Public Health Association
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SESSION 5
PROTECTIVE ACTIONS AND INTERVENTIONS: PART II
Session Objective: Provide overview of best population protection practices during an IND incident. Issues include risk communication, psychosocial factors, and readiness to implement interventions to reduce mental and physical impacts.
8:45 a.m.
Session Overview and Objectives
ROBERT J. URSANO, Session Moderator
Professor of Psychiatry and Neuroscience
Chairman, Department of Psychiatry
Uniformed Services University of the Health Sciences
8:50 a.m.
Behavioral and Risk Communication Issues, and Intervention Strategies, in Nuclear Detonation Incidents
STEVEN M. BECKER
Associate Professor of Public Health
Vice Chair, Department of Environmental Health Sciences
Director, Disaster and Emergency Communication Research Unit
Director, Community Resilience and Disaster Management Program
University of Alabama at Birmingham
H. KEITH FLORIG
Senior Research Engineer
Department of Engineering and Public Policy
Carnegie Mellon University
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ANN E. NORWOOD
Senior Associate
Center for Biosecurity
University of Pittsburgh Medical Center
DORI B. REISSMAN
Senior Medical Advisor
Office of the Director
National Institute for Occupational Safety and Health
10:20 a.m.
BREAK
10:30 a.m.
Behavioral and Risk Communication Issues, and Intervention Strategies, in Nuclear Detonation Incidents (continued)
11:00 a.m.
Discussion led by
ROBERT J. URSANO, Session Moderator
SESSION 6
SUMMARY
11:30 a.m.
Summary of workshop discussions
JEROME M. HAUER
The Hauer Group
12:00 p.m.
Wrap-up and final thoughts
GEORGES C. BENJAMIN, Committee Chair
12:30 p.m.
ADJOURNMENT OF OPEN SESSION
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ASSESSING MEDICAL PREPAREDNESS TO RESPOND TO A TERRORIST NUCLEAR EVENT: WORKSHOP 2
Committee on Medical Preparedness for a Terrorist Nuclear Event
AGENDA
Day 1
Thursday, August 7, 2008
Auditorium
National Academy of Sciences
2101 Constitution Avenue, N.W.
Washington, DC
Workshop Objectives:
The purpose of the workshop is to assess the current level of medical preparedness for a nuclear detonation of up to 10 kts in Tier 1 Urban Area Security Initiative cities (New York/New Jersey; National Capitol Region; Houston; Chicago; Los Angeles; and San Francisco/Bay Area). The specific objectives of the workshop are to
review and summarize the overall emergency response activities and available health care capacity (including shelter, evacuation, decontamination, and medical infrastructure interdependencies) to treat the affected population;
examine the capacity and identify gaps in the capability of the federal, state, and local authorities to deliver available medical countermeasures in a timely enough way to be effective;
review and summarize available treatments for pertinent radiation illnesses including the efficacy of medical countermeasures; and
appraise the expected benefit of medical countermeasures, including those currently under development.
8:30 a.m.
Welcome, Introductions, and Overview of Workshop Purpose and Objectives
GEORGES C. BENJAMIN, Committee Chair
Executive Director
American Public Health Association
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SESSION 1
CURRENT PREPAREDNESS FOR AN IMPROVISED NUCLEAR DEVICE, PART I: IMMEDIATE CASUALTIES
Session Objective: In response to the committee’s statement of task, this session will explore the current level of medical preparedness for detonation of an IND of up to 10 kts in yield in a Tier 1 Urban Area Security Initiative area. Panels of local, state, and federal emergency response and medical personnel will review overall emergency response preparedness and capacity of the health care system to treat the population injured by the blast, thermal, and prompt radiation from an IND detonation, including the capacity of emergency medical services (EMS) to triage, treat, and transport the injured to treatment facilities and the capacity of the health care system to provide appropriate medical care to the numbers, types, and severities of likely injuries. The panels will address four aspects of emergency response preparedness: (1) the capacity of the emergency medical response to reach the injured and perform field triage and treatment, (2) the capacity to transport injured to area health care facilities, (3) the capacity of area health care facilities to evaluate and treat the likely numbers and types of injuries, and (4) the capacity to evacuate those who are seriously injured to appropriate health care facilities nationally.
8:55 a.m.
Session Overview and Objectives
GEORGE J. ANNAS, Session Moderator
Edward Utley Professor and Chair
Department of Health Law, Bioethics and Human Rights
Boston University School of Public Health
9:00 a.m.
Panel 1. Preparedness for emergency response to the detonation of a 10-kt IND (i.e., What capability is there to reach, triage, and treat those injured by the detonation safely?)
JOHN F. BROWN, San Francisco (San Francisco EMS Agency)
BROOKE BUDDEMEIER, Lawrence Livermore National Laboratory
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MICHAEL FITTON, New York (Fire Department of New York)
KATHLEEN “CASS” KAUFMAN, Los Angeles (Los Angeles County Department of Public Health)
JOSEPH S. NEWTON, Chicago (Chicago Fire Department)
RICHARD P. ZULEY, Chicago (Chicago Department of Public Health)
10:00 a.m.
Panel 2. Preparedness to transport casualties to area treatment facilities (i.e., What capability is there to know which treatment facilities are open, and what is the capacity to get them there?)
RICHARD L. ALCORTA, National Capital Region (Maryland Institute for EMS Systems)
CRAIG DEATLEY, National Capital Region (Washington Hospital Center, Washington, DC)
BRYAN HANLEY, Los Angeles (Los Angeles County EMS Agency)
DOUGLAS HAVRON, Houston (Southeast Texas Trauma Regional Advisory Council)
CARL E. LINDGREN, National Capital Region (Arlington Fire Department, Virginia)
11:00 a.m.
BREAK
11:15 a.m.
Panel 3. Preparedness of the metropolitan area’s medical system to treat casualties from a 10-kt IND
JOSEPH A. BARBERA, Institute for Crisis, Disaster, and Risk Management, George Washington University
JOHN F. BROWN, San Francisco (San Francisco EMS Agency)
PATRICIA HAWES, National Capital Region (Suburban Hospital, Bethesda, Maryland)
NATHANIEL HUPERT, Weill Medical College of Cornell University
AMY HIDEKO KAJI, Los Angeles (Harbor-UCLA Medical Center)
KATHERINE URANECK, New York (New York City Department of Health and Mental Hygiene)
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12:15 p.m.
WORKING LUNCH TO CONTINUE PANEL DISCUSSIONS
1:00 p.m.
Panel 4. Preparedness to evacuate serious casualties from a 10-kt IND from area hospitals to appropriate treatment facilities statewide and nationally
JOSEPH A. BARBERA, George Washington University
DAN HANFLING, National Capital Region (Inova Health System, Falls Church, Virginia)
JEROME M. HAUER, The Hauer Group
AASHISH SHAH, Houston (Texas Department of State Health Services)
KATHERINE URANECK, New York (New York City Department of Health and Mental Hygiene)
2:00 p.m.
State of Preparedness for Immediate Casualties: An Open Discussion by Committee Members and Audience
3:00 p.m.
BREAK
SESSION 2
CURRENTLY AVAILABLE MEDICAL RESOURCES
Session Objective: Discuss federal and state medical preparedness for an IND event in a Tier 1 UASI area, the assets that will be available in such an event, and the plans to use those assets.
3:15 p.m.
Session Overview and Objectives
JUDITH A. MONROE, Session Moderator
State Health Commissioner
Indiana State Department of Health
President, Association of State and Territorial Health Officials
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3:20 p.m.
Department of Health and Human Services Response Assets and Plans in the Event of an IND Detonation
ANN R. KNEBEL
Office of the Assistant Secretary for Preparedness and Response
Department of Health and Human Services
3:35 p.m.
Department of Energy Response Assets and Plans in the Event of an IND Detonation
ALAN L. REMICK
Office of Emergency Response
National Nuclear Security Administration
Department of Energy
3:50 p.m.
National Guard Response Assets and Plans in the Event of an IND Detonation
COL. DANIEL BOCHICCHIO
U.S. Army War College
4:05 p.m.
State Preparedness for an IND Event
JAMES S. BLUMENSTOCK
Association of State and Territorial Health Officials
4:20 p.m.
Discussion led by
JUDITH A. MONROE, Session Moderator
5:20 p.m.
ADJOURNMENT
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ASSESSING MEDICAL PREPAREDNESS TO RESPOND TO A TERRORIST NUCLEAR EVENT: WORKSHOP 2
Committee on Medical Preparedness for a Terrorist Nuclear Event
AGENDA
Day 2
Friday, August 8, 2008
Auditorium
National Academy of Sciences
2101 Constitution Avenue, N.W.
Washington, DC
8:00 a.m.
Welcome, Introductions, and Overview of Workshop Purpose and Objectives
GEORGES C. BENJAMIN, Committee Chair
Executive Director
American Public Health Association
SESSION 3
CURRENT PREPAREDNESS FOR AN IMPROVISED NUCLEAR DEVICE, PART II: PREVENTING AND TREATING FALLOUT CASUALTIES
Session Objective: Discuss the preparedness of Tier 1 UASI areas to manage the effects of the radiation fallout from a 10-kt IND and to identify, mitigate, and manage long-term effects. Issues include effectiveness of risk communication, short- and long-term mental health, efficacy of nonmedical protective actions such as sheltering in place and evacuation, and plans and expectations for state and federal response resources to augment local resources. This session will conclude with an assessment of what remains to be done.
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8:30 a.m.
Session Overview and Objectives
COLLEEN CONWAY-WELCH, Session Moderator
Nancy and Hilliard Travis Professor of Nursing
Dean, Vanderbilt University School of Nursing
8:35 a.m.
Panel 5. Preparedness to mitigate, identify, and address fallout casualties and to manage long-term consequences
THOMAS N. AHRENS, Los Angeles and San Francisco (California Department of Public Health)
BROOKE BUDDEMEIER, Lawrence Livermore National Laboratory
KATHLEEN “CASS” KAUFMAN, Los Angeles (Los Angeles County Department of Public Health)
JEANINE PRUD’HOMME, New York (New York City Department of Health and Mental Hygiene)
IRWIN REDLENER, Columbia University
ADELA SALAME-ALFIE, New York (New York State Department of Health)
REUBEN K. VARGHESE, National Capital Region (Arlington Public Health, Virginia)
MICHAEL WELLING, National Capital Region (Virginia Department of Health)
10:30 a.m.
BREAK
10:45 a.m.
State of Preparedness for Fallout Casualties: An Open Discussion by Committee Members and Audience
SESSION 4
SUMMARY
11:30 a.m.
Wrap-up and final thoughts
GEORGES C. BENJAMIN, Committee Chair
Executive Director
American Public Health Association
12:00 p.m.
ADJOURN WORKSHOP
